Hemodialysis(HD)-associated hypotension is a frequent complication, but it is difficult to manage. Until now, several maneuvers have been tried to prevent the HD-associated hypotension. Of these, the sodium content of dialysate was regarded as an important factor for maintaining blood pressure during HD. In this study, we evaluated the effect of hypertonic dialysate on blood pressure, interdialytic weight gain and the incidence of thirst. The study was done for 6 weeks successively with 3 different groups. Each patient was dialysed with 3 different dialysates for 2 weeks: Group I(Conventional HD: sodium concentration: 137 mEq/L), Group II(Hypertonic HD: 147 mEq/L) and Group III (Sequential HD: from 147 to 140 mEq/L). Hemodynamic parameters(blood pressure, pulse rate and ultrafiltration rate), biochemical parameters(hematocrits, blood urea nitrogen, creatinine, osmolality, sodium, potassium, chloride, fasting blood sugar) and complications (interdialytic weight gain &thirsty sensation) were compared among 3 groups. The results were as follows: 1. Decline of systolic blood pressure and diastolic blood pressure at the time of a 3 hour check during hemodialysis was lower in the Group II than Group I and III (p=0.002; p=0.012). and decline of diastolic blood pressure at the time of a 4 hour check during hemodialysis was lower in the Group II and III than Group I(p=0.04). 2. ncidence of hypotensive episodes during dialysis was significantly lower in Group II than group I (p=0.0287). 3. The ultrafiltration in Group III at the time of 1 hour, 2 hour and 3 hour check during hemodialysis was higher than that in Group I and II at the time of 1 hour, 2 hour and 3 hour check during emodialysis respectively (p=0.0001; p=0.0001; p=0.0004). 4. Interdialytic weight gain was higher in Group II(3.1+/-0.8) than GroupI(2.8+/-0.8) and III (2.9+/-0.9) (p=0.0422). 5. Hematologic and biochemical results were not significantly different among 3 Groups. 6. Frequency of thirst was different in Group I, II and III, 0.05+/-0.12, 0.41+/-0.24 and 0.22+/-0.29 respectively (p=0.0259). The results suggest that hypertonic HD was effective in preventing HD-associated hypotension but interdialytic weight gain and thirst sensations were increased as compared with a conventional method. In this situation, sequential HD seems to be an alternative method to minimizes the side effect of hypertonic HD.
Blood Pressure* ; Blood Urea Nitrogen ; Creatinine ; Dialysis ; Dialysis Solutions ; Fasting ; Hemodynamics* ; Humans ; Hypotension ; Incidence* ; Osmolar Concentration ; Potassium ; Renal Dialysis* ; Sensation ; Sodium ; Thirst* ; Ultrafiltration* ; Weight Gain*

No abstract available.
Membranes* ; Pregnancy* ; Rupture*

Background/Aims: This study aimed to develop a rehabilitation program for musculoskeletal pain experienced by gastrointestinal endoscopists and to investigate its usefulness. Methods: This was a multicenter cohort study. During the first 2 weeks, a questionnaire regarding daily workload and musculoskeletal symptoms was administered. Then, a rehabilitation program including equipment/posture correction and stretching was conducted during the remaining 6 weeks. Follow-up daily workload and musculoskeletal symptom surveys were distributed during the last 2 weeks. The program satisfaction survey was performed at the 6th and 8th weeks. Results: Among 118 participants (69 men), 94% (n=111) complained of musculoskeletal pain at baseline. Various hospital activities at baseline were associated with multisite musculoskeletal pain, whereas only a few workloads were correlated with musculoskeletal pain after the rehabilitation program. Follow-up musculoskeletal pain was negatively correlated with equipment/ posture program performance; arm/elbow pain was negatively correlated with elbow (R=–0.307) and wrist (R=–0.205) posture; leg/foot pain was negatively correlated with monitor position, shoulder, elbow, wrist, leg, and foot posture. Higher performance in the scope position (86.8% in the improvement vs 71.3% in the aggravation group, p=0.054) and table height (94.1% vs 79.1%, p=0.054) were associated with pain improvement. An increased number of colonoscopy procedures (6.27 in the aggravation vs 0.02 in the improvement group, p=0.017) was associated with pain aggravation. Most participants reported being average (32%) or satisfied (67%) with the program at the end of the study. Conclusions Our rehabilitation program is easily applicable, satisfactory, and helpful for improving the musculoskeletal pain experienced by gastrointestinal endoscopists.

BACKGROUND AND OBJECTIVES: The p53 protein is a 53 kD phosphoprotein. It is also one of the early recognition markers of malignancy and can be used to predict the aggressive behaviors of tumor. The human papilloma virus (HPV) is a species-specific, epitheliotrophic, double-stranded DNA virus. The purpose of this study was to evaluate the expression rate of p53, and to investigate whether a correlation exists between the rate of recurrence and the severity of lesion. We also investigated whether p53 expression rate and HPV affect recurrence and carcinogenesis of inverted papilloma. MATERIALS AND METHODS: Twenty-two cases of the inverted papilloma and 6 cases of squamous cell carcinoma arising in the inverted papilloma were used for the study. We used immunohistochemical staining for p53 and performed the molecular study of HPV DNA with in situ hybridization (ISH) on the paraffin embedded materials. RESULTS: 1) The overall expression rate of p53 was 39% (11/28). A significant correlation was observed between p53 protein accumulation and the severity of the lesion (p=0.0015). 2) Seven of 11 patients who tested positive for p53 showed recurrence, whereas two of the 12 patients who tested negative for p53 showed recurrence. There was a correlation between the rates of p53 expression and recurrence (p=0.029). 3) The HPV was detected in four cases (13%) of inverted papilloma. There was no statistical significance between HPV and the rate of recurrence(p=0.147). CONCLUSION: The results demonstate that p53 mutations and HPV may play a role in the oncogenesis of inverted papilloma.
Carcinogenesis ; Carcinoma, Squamous Cell ; DNA ; Humans ; In Situ Hybridization ; Papilloma ; Papilloma, Inverted* ; Paraffin ; Recurrence

BACKGROUND: In the past, the diagnosis of ductal carcinoma in situ (DCIS) was rare, but today the incidence of DCIS has become much more frequent, particularly in patients who underwent mammographic screening. The management of patients with DCIS has become a major clinical dilemma. It has become increasingly difficult to justify the routine use of mastectomy for patients with DCIS, because its natural history is uncertain and breast-conserving therapy (BCT) is currently used for the treatment of many patients with invasive breast cancer. METHODS: To investigate the incidence, clinicopathologic features and the outcome of treatment of DCIS and microinvasive carcinoma (MIC), the medical records and pathology slides of 91 patients with DCIS and MIC who had been treated at KCCH between 1983 and 1996 were reviewed retrospectively. Median follow-up period was 69.4 (4-158) months. RESULT: The results were as follewd; 1) The inciednce was 2.72% (91/3,343) and had been increasing (2.1% in 1980s and 3.3% 1990s). 2) The mean age was 44.2 years and peak age group was fifth decade. 3) The most common clinical features was a palpable mass (69%), followed by nipple discharge, MMG abnormality and Paget's disease in decreasing order of frequency. 4) According to the pathologic classification of Schwartz, comedo type was the most common (32%), followed by cribriform (23%), papillay (20%), mixed (11%), solid (9%) and micropapillary type (5%), 5) There were 58 cases (69%) of pure DCIS and 16 cases (17.5%) of MIC. In 17 case (18.5%) the presence of microinvasion was equivocal or could not be assessed. 6) There were no significant differences between DCIS and MIC in terms of mean age (44.5 years vs 43.8 years), mean tumor size (2.15 cm vs 2.25 cm), the frequency of comedo type (29% vs 36%), lymph node metastasis (0% vs 6%) and multicentricity (3.3% vs 3.0%). However, the palpable mass was more common in MIC than DCIS (82% vs 62%, p<0.05). 7) 75 patients (82%) were treated with mastectomy and 16 patients were treated with breast conserving surgery. 8) Bedsides 2 cases of systemic recurrence among MIC, there was no case of recurrence or disease-associated death during the period of follow-up. CONCLUSIONS: The incidence of DCIS and MIC showed increasing tendency primarily due to the increasing use of screening mammography. Even though the rates of BCT has been increasing, MRM was still the most common procedure for the treatment of DCIS and MIC. The outcome of treatment, in terms of recurrence or survival, was very excellent and almost the same for both groups of pure DCIS and MIC. More long-term follow-up and multicenter study seems to be neccessary to identify the differences in clinical features and outcome between pure DCIS and MIC in Korea.
Breast Neoplasms ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Mammography ; Mass Screening ; Mastectomy ; Mastectomy, Segmental ; Medical Records ; Natural History ; Neoplasm Metastasis ; Nipples ; Pathology ; Recurrence ; Retrospective Studies

OBJECTIVE: To evaluate the long-term fertility and reproductive outcomes after conservative surgery, to observe the recurrence pattern and to elucidate the significance of retroperitoneal lymph node evaluation in patients with malignant ovarian germ cell tumors. METHODS: We reviewed the medical records of fifty patients who had been diagnosed as malignant ovarian germ cell tumors from 1991 to 2001 at Asan Medical Center. RESULTS: During on the median follow-up of 54 months, six patients recurred and five patients died. Out of the six recurred patients, three patients (50%) were found to have retroperitoneal lymph nodes involved, especially in patients with dysgerminoma and one patient contralateral ovary involved after conservative surgery. Out of the forty patients who had received conservative surgery, twenty-two (55.0%) had stage Ia tumors and thirteen (32.5%) had stage II and III. Adjuvant chemotherapy was performed for thirty- one patients (77.5%) and comprehensive surgical staging including retroperitoneal lymph node evaluation was performed for six patients (15%). During chemotherapy, fifteen patients out of nineteen with normal menstrual cycles became amenorrheic but most of them (13/15) recovered their normal menstrual cycles and gave birth to five healthy babies. Out of the thirteen patients with advanced disease who had received conservative surgery, two patients died after recurrences and one died of disease progression. CONCLUSION: Conservative surgery is the treatment of choice in young women with early stage disease, but in case of advanced disease, it requires prudent decision-making. Considering conservative surgery, retroperitoneal lymph node evaluation is needed, especially in patients with dysgerminoma.
Chemotherapy, Adjuvant ; Chungcheongnam-do ; Disease Progression ; Drug Therapy ; Dysgerminoma ; Female ; Fertility ; Follow-Up Studies ; Germ Cells* ; Humans ; Lymph Nodes* ; Medical Records ; Menstrual Cycle ; Neoplasms, Germ Cell and Embryonal* ; Ovary ; Parturition ; Recurrence

BACKGROUND AND OBJECTIVES: Acute systemic inflammation is associated with an increased risk of acute cardiovascular events. Recently published data have suggested that chronic inflammation could be an independent risk factor for hypertension. Association between interleukin (IL)-6 or tumor necrosis factor (TNF)-alpha and hypertension is controversial. The purpose of this study is to investigate the association between blood pressure and cytokines such as TNF-alpha, IL-6 and adiponectin in hypertensive children. SUBJECTS AND METHODS: Eighty hypertensive children were included in this study. The obesity index, body mass index (BMI) and skin fold thickness of the subjects were measured, and the fat mass and distributions analyzed. Blood pressure was also measured, as were the serum aldosterone, renin, angiotensin converting enzyme (ACE), insulin and homocysteine levels. The serum TNF-alpha, IL-6 and adiponectin levels were also estimated. RESULTS: The serum renin, insulin, homocysteine and IL-6 levels were significantly increased in hypertensive compared to normal children. The serum TNF-alpha level had positive correlation with the insulin and negative correlations with adiponectin levels, respectively. The level of insulin had a significant negative correlation with that of adiponectin. CONCLUSION: The serum IL-6 level was significantly increased in hypertensive children. Further long-term follow-up studies will be required to reveal the role of cytokines in hypertensive children.
Adiponectin ; Aldosterone ; Blood Pressure ; Body Mass Index ; Child* ; Cytokines ; Homocysteine ; Humans ; Hypertension ; Inflammation ; Insulin ; Interleukin-6* ; Interleukins ; Obesity ; Peptidyl-Dipeptidase A ; Renin ; Risk Factors ; Skin ; Tumor Necrosis Factor-alpha*

OBJECTIVE: To evaluate the outcomes of laparoscopico-vaginal (modified) radical hysterectomy and to compare surgical parameters and recurrence rate of these with those of conventional abdominal radical hysterectomy. METHODS: From October 1997 to March 2002, we have performed 37 cases of LVMRH (laparoscopico- vaginal modified radical hysterectomy) +PLND (pelvic lymph node dissection) and 47 cases of LVRH (laparoscopico-vaginal radical hysterectomy) with paraaortic lymph node sampling +PLND. Inclusion criteria for laparoscopic group were patients with FIGO stage IA1 to IB1 which exocervical mass size was less than 2 cm clinically. As a control group, we selected 46 cases for the MRH group and 96 cases for the RH group. These groups had the same FIGO stage and the same tumor size less than 2 cm or tumor volume calculated by MRI being less than 4.2 cm3, while the age for each group were identically matched with the laparoscopic group. RESULTS: The mean duration of surgery, the number of lymph nodes and the rate of perioperative and postoperative complications were similar in both the laparoscopic and the conventional laparotomy group. The mean duration of hospital stay was significantly shorter in patients treated by laparoscopic surgery (LVMRH vs. MRH; 9 vs. 15, LVRH vs. RH; 13 vs. 21 days). No lymph node metastasis was reported in both LVMRH and MRH group. No recurrences but only one patient in MRH group were found in both groups during the median follow up of 34.5 and 43.5 months, respectively. The positive rates of pelvic lymph node metastasis in both RH groups were similarly 6.4%. Four (8.5%) of 47 LVRH patients and two (2.1%) of 96 RH patients had recurrences. However, in patients who had tumor volume being less than 4.2 cm3, recurrence rate was 2.5% (1/40) and 42.9% (3/7) in those with tumor volume larger than 4.2 cm3. There was one death in a patient with pulmonary metastasis who took LVRH in spite of vigorous chemotherapy. Three year progression free survival rates were 96.7% in LVRH group (tumor volume<4.2 cm3) and 97.9% in RH group (p=0.81). CONCLUSION: Laparoscopic surgery for treatment of early small volume cervical cancer, especially stage IA is safe and effective alternatives in terms of operative morbidity and mortality. However, patients with large volume disease (>4.2 cm3) who were treated by LVRH had higher recurrence rate compared to those by conventional RH. It is concluded that laparoscopic surgery for the treatment of cervical cancer would be better to be limited to patients with early disease who have the largest tumor diameter less than 2 cm or tumor volume less than 4.2 cm3 carefully measured by MRI.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Hysterectomy* ; Laparoscopy ; Laparotomy ; Length of Stay ; Lymph Nodes ; Magnetic Resonance Imaging ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence ; Tumor Burden ; Uterine Cervical Neoplasms*

OBJECTIVE: To evaluate the efficacy and side effects of cispaltin and carboplatin each in combination with paclitaxel in recurrent epithelial ovarian cancer who had not taken paclitaxel-based chemotherapy. MATERIALS AND METHODS: Between January 1994 and October 1999, in department of obstetrics and gynecology, Asan medical Center, 42 recurrent ovarian cancer patients who had initial platinum-based chemotherapy except paclitaxel were treated with paclitaxel-based chemotherapy. One group was 14 patients treated with paclitaxel-cisplatin and the other group was 28 patients treated with paclitaxel-carboplatin. Disease free interval before recurrence was 6 months at least. Patients received paclitaxel 135mg/m2 followed by either cisplatin 75mg/m2 or carboplatin 300mg/m2. The schedule was repeated every 3 weeks for at least 6 cycle. Response was evaluated by physical examination, serial serum CA 125 measurement, chest PA before each cycle, and abdomino-pelvic CT scan every 3 cycles. RESULTS: As paclitaxel-cisplaitin group, with a median follow-up of 34.5 months (range, 9-60 months), 1 patient had complete response, 6 patients had partial response, 3 patients had stable disease and 4 patients had persistent disease, overall response rate was 50%, mean survival duration was 40 months. As paclitaxel-carboplatin group, with a median follow-up of 25.5 months (7-36 months), 4 patients had complete response, 11 patients had partial response, 6 patients had stable disease, and 7 patients had persistent disease, overall response rate was 53.4%, mean survival of 24 months. As grade of side effects in each group, we evaluated leukopenia, anemia, thrombocytopenia, nausea, vomiting, fever, neurological abnormality, and renal abnormality. The rate of grade 3 to 4 leukopenia was 11% in paclitaxel-cisplatin arm and 17% paclitaxel-arboplatin, in arm. CONCLUSION: These results demonstrate that the combined chemotherapy of paclitaxel followed by cisplatin or carboplatin is highly effective and safe in recurrent epithelial ovarian cancer who had taken no previous paclitaxel-based chemotherapy.
Anemia ; Appointments and Schedules ; Arm ; Carboplatin ; Chungcheongnam-do ; Cisplatin ; Drug Therapy ; Drug Therapy, Combination* ; Fever ; Follow-Up Studies ; Gynecology ; Humans ; Leukopenia ; Nausea ; Obstetrics ; Ovarian Neoplasms* ; Paclitaxel ; Physical Examination ; Recurrence ; Thorax ; Thrombocytopenia ; Tomography, X-Ray Computed ; Vomiting

BACKGROUND AND OBJECTIVES: Obesity has reached epidemic proportions globally and affects people of all ages. Recent studies have shown that visceral adipose tissue measured by magnetic resonance imaging and/or computed tomography correlates positively with epicardial adipose tissue. Epicardial fat, which is correlated to several metabolic parameters, can be assessed by echocardiography. The aim of this study was to evaluate epicardial fat thickness and other metabolic parameters in obese adolescents and investigate the correlation between epicardial fat thickness and other metabolic parameters in obese adolescents. SUBJECTS AND METHODS: We selected 99 subjects, between ages 15-17 years of age, to be enrolled in this study. Sixty five obese adolescents with a body mass index (BMI) >95 percentile and 34 control subjects were included in this study. Echocardiographic measurements including epicardial fat thickness as well as anthropometric and blood pressure (BP) measurements were performed. The following parameters were estimated: blood glucose, total cholesterol, triglyceride, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, aspartate aminotransferase, alanine aminotransferase, free fatty acid, interleukin-6, tumor necrosis factor-alpha, leptin, adiponectin and high sensitive C reactive protein. RESULTS: The obese group showed a statistically significant correlation with echocardiographic epicardial fat thickness and, BMI, waist circumference, obesity index, fat percentage, systolic BP, insulin level, leptin and adiponectin. Multivariate linear regression analysis showed epicardial fat thickness as the most significant independent parameter to correlate with obese adolescents. CONCLUSION: These data suggest that epicardial fat thickness measured by echocardiography is a practical and accurate parameter for predicting visceral obesity.
Adiponectin ; Adipose Tissue ; Adolescent ; Alanine Transaminase ; Aspartate Aminotransferases ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol ; Echocardiography ; Humans ; Insulin ; Interleukin-6 ; Intra-Abdominal Fat ; Leptin ; Linear Models ; Magnetic Resonance Imaging ; Obesity ; Obesity, Abdominal ; Tumor Necrosis Factor-alpha ; Waist Circumference