Foreign bodies, such as surgical sponges or drains, are sometimes retained after surgical procedures.1 Retention of a drain in the breast tissue postoperatively is an unusual complication. This report describes two cases of characteristic sonographic findings related to retained silastic drains following breast surgery.
*Ultrasonography, Mammary ; Silicones ; Postoperative Complications/*diagnosis/radiography/ultrasonography ; *Mammography ; Humans ; Foreign Bodies/*diagnosis/radiography/ultrasonography ; Female ; Drainage/*instrumentation ; Dimethylpolysiloxanes ; Adult

BACKGROUND: In order to treat obese individuals, control of caloric intake after determination of patient's energy expenditure and recommendation of exercise program with possible use of specific medication is advised. There are many limitations in measuring all individuals energy expenditure by calorimetry, thus estimation is made using many variables such as weight, height, age, and gender. But, commonly used equations to predict resting energy expenditure(REE) are thought to result in overestimation of energy expenditure for use with obese individuals. This study investigated difference between measured and predicted resting energy expenditure in obese individuals. METHODS: Subjects were 133 adults who were admitted either to Internal Medicine Department and ENT Department of Yeung Nam University Hospital and their resting energy expenditure was measured by indirect calorimetry. According to age, sex, smoking habits and body mass index, Measured REE by indirect calorimetry between groups was compared. Predicted REE estimated by 6 equations to measured REE was compared in the two groups by body mass index 27kg/m2 under 65 years old individuals. RESULTS: There was no significant difference of measured REE between groups according to smoking habits(p>0.05). In the older group(> or =65 years old), REE was lower compared to the younger groups(<65 years old)(p<0.05). In the obese group(body mass index>27kg/m2) measured REE was higher than the normal weight group(BMI<27kg/m2)(p<0.05). Among 108 individuals under 65 years old, other equation except for Fleish equation and Robertson and Reid equation were inaccurate when applied to the obese group. CONCLUSIONS: These commonly used prediction equations tend to overestimate the REE in obese individuals, and the best estimates for the obese seem to be derived from the Fleish and Robertson and Reid equations.
Adult ; Aged ; Body Mass Index ; Calorimetry ; Calorimetry, Indirect* ; Energy Intake ; Energy Metabolism* ; Humans ; Internal Medicine ; Obesity ; Smoke ; Smoking

PURPOSE: To evaluate the sonographic, mammographic and MRI features of pregnancy-associated breast cancer with the major focus on the sonographic benefit in a diagnosis of pregnancy associated breast cancer. MATERIALS AND METHODS: From 1998 to 2002, sonography was performed on a total 7 patients (age 23 to 38 years), who were pathologically diagnosed with breast cancer during pregnancy. Six of those patients underwent mammography. Five patients underwent a breast MRI, preoperatively. The radiological findings were evaluated retrospectively. Six patients underwent surgery and 1 patient underwent a core biopsy and chemotherapy. The histological, nuclear grading and pathological staging were evaluated. RESULTS: The sonographic findings showed a mass with irregular shapes (n=6), irregular margins (n=6), a non-parallel orientation (n=5), complex echo patterns (n=5). Associated findings could be observed in 3 patients, including Cooper's ligament thickening (n=2), edema (n=2), skin thickening (n=1) and axillary lymphadenopathy (n=3). The sonographic findings were positive and showed masses in 6 patients. All the patients had a dense breast in mammography. The mammographic findings included masses (n=4), masses with microcalcifications (n=2), masses with axillary lymphadenopathy (n=3), calcifications alone (n=1), an asymmetric density alone (n=1), extremely dense breasts with negative findings (n=2). A breast MRI showed an irregular shaped mass (n=4) with a rim-like enhancement (n=3), linear ductal enhancement without a mass (n= 1), and the time intensity cure revealed the typical pattern and level of enhancement in the carcinoma. CONCLUSION: Sonography is a valuable tool for diagnosing pregnancy-associated breast cancer. However, mammography should be performed if there is a suspicious lesion on sonography in order to confirm the pregnancy-associated breast cancer. Mammography has a lower sensitivity during pregnancy due to the physiologic changes in the breasts. However, calcifications and associated findings are helpful in confirming pregnancy-associated breast cancer. physicians should not consider a rapidly growing lump in the breast during pregnancy to be benign and should perform radiological examinations and imaging-guided biopsies.
Biopsy ; Breast Neoplasms* ; Breast* ; Diagnosis ; Drug Therapy ; Edema ; Humans ; Ligaments ; Lymphatic Diseases ; Magnetic Resonance Imaging ; Mammography ; Pregnancy ; Retrospective Studies ; Skin ; Ultrasonography

BACKGROUND: Although occupational asthma is defined as a reversible airway obstruction causally related to exposure in the working environment, many occupational asthmatics complain of asthmatic symptoms despite avoidance of the causative agent. Subjects and methods. Twenty-nine patients with occupational asthma who had been confirmed by specific bronchial challenge with reactive dye or isocyanates and had avoided the causative agent for at least 6 months were included in this study. A questionnaire about asthmatic symptoms and medication requirements, a lung functiontest, and a methacholine bronchial provocation test were performed. RESULTS: Asthmatic symptoms at follow-up were remitted in seven (41.2%) isocyanate-induced asthmatics, but none with reactive dye-induced asthma were remitted. At follow-up, the symptom-medication score and FEV1 were significantly improved in isocyanate-induced asthmatics than in those with reactive dye-induced asthma, but the geometric mean of PC20-methacholine was not different between the two groups. Among 17 isocyanate-induced asthmatics, a duration from symptom onset to avoidance was significantly shorter in the remission group than in the nonremission group, although the symptom-medication scores, FEV1 (% predictive value) and logPC20-methacholine at an initial diagnosis, and follow-up period defined as duration from avoidance to follow-up, showed no difference between the two groups. CONCLUSION: The outcome of occupational asthma may be determined by the causative agents and the duration from onset of asthmatic symptoms to avoidance.
Airway Obstruction ; Asthma ; Asthma, Occupational* ; Bronchial Provocation Tests ; Diagnosis ; Follow-Up Studies ; Humans ; Isocyanates ; Lung ; Methacholine Chloride ; Prognosis ; Surveys and Questionnaires

BACKGROUND: Exercise can aggravate asthmatic symptoms in many patients with bronchial asthma. It is caused by that inhaled air bypasses nasal cavity and goes directly to the lower airways through open mouth dring exercise. Although the pathogenetic mechanisms of exercise-induced asthma(EIA) have not been clarified yet, there is evidence that chemical mediators, released from the inflammatory cells triggered by airway cooling or drying, might be responsible for induction of bronchoconstriction. However, it has been controversial which chemical mediators or cells are involved in such process. Objectiye . The aim of this study was to evaluate the role of activated mast cells in the pathogenesis of EIA and find out whether or not sulfidopeptide leukotrienes (LTC4/d4/E4) are involved in the exercise-induced bronchoconstriction. MATERIAL AND METHOD: Eleven asthmatics with documented exercise-induced bronchoconstriction and 10 control subjects were studied. Before and 6 hours after free running for 6 minutes, forced expiratory volume in 1 second (FEV,) and the concentrations of N- methylhistamine, LTE4, and creatinine in unine collected for 6 hours after exercise were determined. RESULT: Urinary concentrations of N-methylhistamine(mean+SE, ng/mg creatinine) of EIA patients before and after exercise were 159+40 and 450+75, respectively. Those of control subjects were 208+ 54 and 275+ 62, respectively. Uninary N-methylhistamine levels of EIA group increased significantly after exercise, while those of control group did not change. Urinary concentrations of LTE,(mean+SE, pg/mg creatinine) of EIA patients before and after exercise were 15.6 k2.6 and 22.2+5.8, respectively. Those of control subjects were 10.4+ 4.0, 18.2 +7.0, respectively. The concentrations of LTE4 in the urine samples collected before exerise revealed no difference between EIA and control subjects (p=0.07). There was no change after exercise in both groups. Percent fall of FEV, was 29.1+8.0% (mean+SD) in EIA group and 3.4 + 4.0% in control group, respectively. There was no correlation between reduction of FEV, and change in urinary concentrations of N-methyl-histmine after exercise. CONCLUSTION: Chemical mediators of activated mast cells may be involved in exercise-induced bronchoconstriction, but there is little evidence for enhanced sulfidopeptide leukotriene generation as assessed by urinary LTE4.
Asthma ; Asthma, Exercise-Induced* ; Bronchoconstriction ; Creatinine ; Forced Expiratory Volume ; Humans ; Leukotriene E4 ; Leukotrienes ; Mast Cells ; Mouth ; Nasal Cavity ; Running

BACKGROUND: Bronchial hbyperresponsiveness (BHR) is a key feature of asthma, and may precede the development of asthma. Genetically determined and acquired factors may contribute to development of BHR. OBJECTIVE: To evaluate expression of bronchial responsiveness to methacholine according to age, sex, smoking habit, and atopy in general population without bronchial asthma, a cross sectional study was performed. METHOD: A total of 1,190 general population who composed of 408 subjects with age less than 19 years (young age group), 621 subjects with age from 20 to 40 years (middle age group), and 161 subjects with age more than 41 years (old age group) were enrolled. Evaluations were made by a questionnaire, serum IgE level and skin prick test to common inhalant allergens, and methacholine bronchial provocation test (MBPT). Bronchial responsiveness were evaluated by positive rate of MBPT (PC,p-methacholine 4 25mg/ml), and slope of dose- response curve (slope, %fall of FEV, / log[last concentration of methacholine, mg/ml]). RESULT: Positive rate of MBPT was 11.0%, and slope (mean+SE) was 10.6+0.2 %/mg/ml. Postive rate of MBPT was more prevalent in the young age group than in middle and old age groups (19.6% vs. 6.6% vs. 6.2%, p<0.05), and slope was higher in young age group than in other groups (14.4+0.4 vs. 8.6+0.3 vs. 8.9+0.5 %/mg/ml, p<0.05). No significant differences in positive rate of MBPT and slope were noted according to sex in young and old age groups. However, in the middle age group, slope was higher in females than in males (9.5+0.4 vs. 7.9+ 0.3 %/mg/ml, p<0.05). No significant differences of slope was observed according to smoking habit in males of middle age group, but in males of old age group, the slope was higher in subjects with smoking habit than those without it (9.6+0.8 vs. 6.5+0.9 %/mg/ml, p<0.05). Significant relationship was observed between geometric value of serum IgE level and slope(r=0. 152, p=0.009). The postive rate of MBPT and slope were significantly higher in subjects with positive skin rea,ctivity to common inhalant allergens than those without it (14.3% vs. 8.6%, p ( 0.05; 11.8+0.4 vs. 9.8+0.3 %/mg/ml, p<0.05). The difference of bronchial responsiveness according to skin reactivity was observed in young and middle age groups, but not in old age group. CONCLUSION: Bronchial responsiveness to methacholine is significantly higher in children than in adults, in middle-aged females than in middle-aged males. Atopy and smoking may have a dif ferent role to determine the bronchial responsiveness depending upon age and sex.
Adult ; Allergens ; Asthma* ; Bronchial Provocation Tests ; Child ; Female ; Humans ; Immunoglobulin E ; Male ; Methacholine Chloride* ; Middle Aged ; Skin ; Smoke ; Smoking ; Surveys and Questionnaires

OBJECTIVE: The exact position of the lesion during the pallidotomy is critical to obtain the clinical improvement of parkinson's disease without damage to surrounding structure. Ventriculogrphy, CT(computed tomograpy) or MRI(magnetic resonance imaging) have been used to determine the initial coordinates of stereotactic target for pallidotomy. The goal of this study was to determine whether microelectrode recording significantly improves the neurophysiologic localization of the target obtained from MRI. METHODS: Twenty patients were studied. They underwent a unilateral pallidotomy. Leksell frame was applied and T1 axial images parallel to the AC-PC(anterior commissure-posterior commissure) plane using a 1.5 Tesla MRI with 3mm slice thickness were obtained. Anteroposterior coordinate of target was chosen at 2mm in front of the midcommissural point and lateral coordinate between 19 and 22mm from the midline. The vertical coordinate was calculated on coronal slice using a fast spin echo inversion recovery sequence(FSEIR) related to the position of the choroidal fissure and ranged over 4-5mm below the AC-PC plane. Confirmation of the anatomical target was done on axial slices using the same FSEIR sequence. Microrecording was done at the pallidum contralateral to the symptomatic side using an electrode with a tip diameter of 1nm diameter tip and 1.1-1.4 mOhm impedance at 1000Hz. Electrophysiologic localization of the target was also confirmed intraoperatively by macrostimulation. RESULTS: Microrecording techniques were reliable to define the transition from the base of the pallidum which was characterized by the disappearance of spike activity and by the change of the audible background activity. Signals from high amplitude neurons firing at 200-400Hz were recorded in the pallidal base. X, Y and Z coordinates of target obtained from the MRI were within 1mm from the X, Y, Z coordinates obtained with microrecording in 16 patients (80%), 15 patients(75%), 10 patients(50%) respectively. The difference of Y coordinate between on MRI and on microrecording was 4mm in only one patient. CONCLUSION: The MRI was accurate to localize the target within 1mm of the error from microrecording target in 70% of the patients. 4mm discrepancy was observed only once. We conclude that MRI alone can be used to determine the target for pallidotomy in most patients. However, microrecording technique can still be extremely valuable in patents with aberrant anatomy or unusual MRI coordinates. We also consider physiologic confirmation of the target using macrostimulation to be mandatory in all cases.
Choroid ; Electric Impedance ; Electrodes ; Fires ; Humans ; Magnetic Resonance Imaging* ; Microelectrodes ; Neurons ; Pallidotomy* ; Parkinson Disease*

BACKGROUND: It is known that HLA molecule can restrict specific IgE responses, but few studies have documented the association between HLA and sensitization to house dust mite(HDM). OBJECTIVE: To evaluate whether a specific HLA type can be a risk or protective factor for the development of HDM sensitivity. METHOD: Total 146 subjects were genotyped for HLA-DRB1 using PCR-SSP technique and HDM sensitivity, determined by skin prick test using two mite allergens, D. pteronyssinus (Dp) and D. farinae (Df). Subjects were grouped according to Dp or Df sensitivity and linkage analysis between HDM sensitivity and HLA-DRB1 genotype was performed. RESULTS: The data revealed higher allele frequencies of DRB1*07 in Dp or Df sensitive groups compared to insensitive groups (11.6% vs. 2.6% in Dp, 11.5% vs. 3.3% in Df group, p<0.05), but the other allele frequencies showed no difference. CONCLUSION: There was a significant association between HLA-DRB1*07 genotype and HDM sensitization. These results indicate that antigen presentation by HLA class II molecule restricts the development of specific IgE response to HDM.
Allergens ; Antigen Presentation ; Dust* ; Gene Frequency ; Genotype* ; HLA-DRB1 Chains* ; Immunoglobulin E ; Mites ; Pyroglyphidae* ; Skin

BACKGROUND: Familial aggregation of the phenotypes can be caused by common environmental and genetic factors, but there has been no family study on familial aggregation of the bronchial asthma, and genetic role of atopy and bronchial responsiveness in the development of asthma in Korean families. OBJECTIVE: We did family study to evaluate the familial aggregation of bronchial asthma, and the genetic role of atopy and bronchial responsiveness in the development of asthma. MATERIALS AND METHODS: Questionnaire, serum total IgE level, skin prick test with 10 common aeroallergens, and bronchial responsiveness to methacholine were performed in 154 parents of atopic asthmatics, 72 parents of atopic control, and 65 parents of non-atopic control. RESULTS: Bronchial asthma was more prevalent in parents of atopic asthmatics(7.1% ) than in parents of non-atopic control(0% ). Geometric mean of serum total IgE level was not different among parents of atopic asthmatics, atopic control, and non-atopic control(2.03+0.06, 2.10 +0.07, and 1.89 +0.09 IU/ml). Positive rates of skin prick test to 10 common aeroallergens were more prevalent in parents of atopic asthmatics(43.0% ) and atopic control(43.0% ) than in parents of non-atopic control(27.8%). Prevalence of bronchial hyperresponsiveness to methacholine was more prevalent in parents of atopic asthmatics(17.0% ) than in parents of atopic control(7.2%) and non-atopic control(1.5%), and slope of dose-response curve was more increased in parents of atopic asthmatics(11.0+ 1.5) than in parents of atopic control and non-atopic control(4.8+ 0.7 and 3.0+ 0.5). CONCLUSION: Bronchial asthma runs in Korean families, and genetic role of atopy and bronchial responsiveness may be important in the development of asthma.
Asthma* ; Humans ; Immunoglobulin E ; Methacholine Chloride ; Parents ; Phenotype ; Prevalence ; Skin ; Surveys and Questionnaires

OBJECTIVES: Dopamine transporter concentrations have been known to decrease in Parkinson's disease(PD). The aim of the present study was to evaluate the correlation between SPECT measurements of [I-123]N-(3-iodopropene-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane(IPT) as an imaging agent for measuring changes in transporter concentrations with PD. PATIENTS AND METHODS:IPT labelled with 4.87+/-1.29mCi(180.19+/-47.73 MBq) of [I-123] was intravenously injected into 23 patients(age:58+/-12) with PD and three normal controls(NC)(age:37+/-7) as bolus. Brain SPECT were then performed at 1 hour and 2 hours after injection on a double headed camera. The statistical parameters were the contrast ratio of left basal ganglia(BG) and right basal ganglia to occipital cortex(OCC) per milli curies of injected radiotracer at 1 hour and 2 hours. The correlations were evaluated between these parameters and Hoehn-Yahr classification of the patients. RESULTS: The(BG-OCC)/OCC/mCi ratios at 1 hour and 2 hours for PD and NC were 0.14+/-0.07 and 0.27+/-0.07(1 hour) and 0.12+/-0.07 and 0.34+/-0.04(2 hour), respectively. The(BG-OCC)/OCC/mCi ratios of Parkinson's disease were decreased with higher grade of Hoehn-Yahr classification of the patients. The ratio between BG and OCC for PD were clearly separated from NC and may be useful outcome measures for clinical diagnosis. CONCLUSION: The findings suggest that IPT may be a very useful tracer for early diagnosis and treatment of PD and study of dopamine re-uptake site.
Basal Ganglia ; Brain ; Classification ; Diagnosis ; Dopamine Plasma Membrane Transport Proteins* ; Dopamine* ; Early Diagnosis ; Head ; Humans ; Outcome Assessment (Health Care) ; Parkinson Disease ; Tomography, Emission-Computed, Single-Photon*