OBJECTIVES: REM sleep behavior disorder (RBD) has received little attention in epidemiologic studies. This study aimed to determine the prevalence of probable REM sleep behavior disorder (pRBD) in the elderly population and its clinical features. METHODS: A random sample of 1,588 was selected from a roster of 14,050 elderly population living in Osan city. The subjects were asked to fill out the REM sleep behavior disorder screening questionnaire (RBDSQ). Subjects whose score were 5 or higher on RBDSQ underwent a diagnostic phase of person-to-person assessment by experts in RBD. RESULTS: Among 1,588 subjects, 886 elderly subjects participated in the screening phase and 123 subjects were assessed in the diagnostic phase. Eleven subjects were diagnosed as having pRBD, so prevalence was 1.5% (95% CI=0.70-2.30%). The frequency of depression and cognitive decline was significantly increased in patients with pRBD compared to subjects without pRBD, and there was no difference in sleep disturbances between two groups. CONCLUSIONS: Probable REM sleep behavior disorder is not rare in the elderly but frequently under-recognized. More attention should be paid to evaluation and treatment of RBD.
Aged ; Depression ; Epidemiologic Studies ; Humans ; Mass Screening ; Prevalence ; Surveys and Questionnaires ; REM Sleep Behavior Disorder ; Sleep, REM

Authors report a case of syndrome of inappropriate antidiuretic hormone(SIADH) associated with sertraline. A 77 years-old male patient showed decreased serum & urine osmolality with symptoms of nausea and anorexia after the ingestion of sertraline, 50 mg for four days, which led to the diagnosis of SIADH. The symptoms of nausea and anorexia improved as serum osmolality improved in several days after discontinuation of sertraline. It is recommended to check serum Na level routinely at the initial treatment when patients on SRRI aggrevate in symptom, have a past history of hyponatremia, or are old.
Aged ; Anorexia ; Diagnosis ; Eating ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Male ; Nausea ; Osmolar Concentration ; Sertraline*

Mutation of the p53 tumor-suppressor gene in exons 4 through 9 was examined in 34 cases of primary advanced gastric cancer using PCR-SSCP (polymerase chain reaction-single strand conformation polymorphism) and the results were compared with p53 protein expression as determined by immunohistochemistry (IHC) using a monoclonal antibody(DO-1). p53 protein detected by IHC was observed in 14 cases (41.2%) and genotypic mutation detected by PCR-SSCP in exons 4-9 was observed in 13 cases (38.2%) One case showed an aberrant band on PCR-SSCP both in Exon 7 and Exon 8/9. p53 alteration detected by either IHC or PCR-SSCP was observed in 19 cases (55.9%), but only 8 cases (23.5%) showed both p53 mutation and protein expression. We also tried to obtain the correlation between relative intensity of the shifted bands on PCR-SSCP and percentage of positive cells by IHC, but a significant correlation was not seen between relative intensity of shifted bands on PCR-SSCP and positve cell ratio. A discrepancy between p53 protein expression and p53 mutation is observed in primary gastric carcinomas. The reason for this discrepancy are not apparent. However, examination of gastric carcinomas for mutations in other exons may identify a better correlation with protein overexpression. The results obtained in this study suggest that the negative reaction for p53 immunohistochemistry may not necessarily mean no genetic alteration of the p53 locus.
Exons ; Immunohistochemistry* ; Stomach Neoplasms

Near total laryngectomy (NTL) is a procedure that creates a biological shunt between the airway and the neopharynx. Compared to total laryngectomy, NTL shunt performed in a suitable patient gives the ability to phonate at will. However, NTL has a potential for leak due to the invagination of the shunt into the neopharynx. Injection laryngoplasty is a mini-invasive technique that aims to manage aspiration caused by iatrogenic surgical complications. The procedure consists of moving a patient’s vocal cord toward the midline by injecting augmentation material. Authors report a case of a 74-year-old female, who was previously diagnosed to supraglottic cancer and have gone through NTL 12 years ago. 11 years after surgery, she reported aspiration through the neopharynx. Injection laryngoplasty was performed to relieve the leakage and she underwent the procedure two times using Hyaluronic acid. After injection laryngoplasty, leakage moderately decreased and the patient reported alleviation of her symptoms.

PURPOSE: This study was performed to evaluate the effect of dietary factors on the risk of breast cancer in Korean women. METHODS: New histologically proven breast cancer cases (n=108) were selected at Hanyang and Soonchunhyang University Hospitals in Seoul. Controls (n=121) were selected from patients in the Departments of Plastic Surgery, General Surgery and Opthalmology at the same hospitals by frequency matching of age and menopausal status. Informations on demographic, reproductive, and dietary factors were collected by an interviewer. Food intake was assessed by using food frequency questionnaires. The association of dietary factors with breast cancer risk was analyzed using total nutrient intake and food intake based on menopausal status. The statistical analysis was done by using unconditional logistic regression after adjusting for age and other confounding factors. RESULTS: The results were as follows: Breast cancer risk significantly decreased with consumption of the following nutrients: fiber in postmenopausal women, vit C in postmenopausal and total women, and vit E in premenopausal women. However, neither total energy nor fat intake was associated with development of breast cancer. Grape and pepper intake in premenopausal women and kimchi intake in total women were significantly associated with decreasing risk of breast cancer. Overall consumption of vegetables and fruits was associated with decreased breast cancer risk. CONCLUSION: Consumption of vegetables and fruits showed a protective effect in breast cancer risk, but neither the intake of fat nor the intake of protein was associated with breast cancer risk in this study. These findings suggest that the consumption of vegetables, and fruits is a protective factor. Further studies with larger numbers of subjects should be conducted to evaluate the association between breast cancer risk and dietary factors.
Breast Neoplasms* ; Breast* ; Case-Control Studies* ; Eating ; Female ; Fruit ; Hospitals, University ; Humans ; Logistic Models ; Surveys and Questionnaires ; Seoul ; Surgery, Plastic ; Vegetables ; Vitis

This study was conducted to assess the effect of nutrition counseling for postoperative female breast cancer patients (N = 38). In baseline survey, we investigated the nutrition parameters by measuring anthropometric and biochemical blood index and assessing nutrient intake using recall method. Individual nutrition counseling was performed 3 times with 2 - 3 weeks intervals. Patients were offered nutrition information related to breast cancer and desirable life style after cancer operation. The effects of counseling program were assessed 2 month later. Of biochemical parameters, serum total cholesterol level was significantly reduced after nutrition counseling program. Nutrient intakes of postoperative breast cancer patients were generally below the RDA level at the baseline survey. After nutrition counseling, mean daily intake of total energy, protein, calcium were significantly elevated. Of dietary habit, meal regularity and control of portion size were improved and fruits and vegetables intake were significantly increased after nutrition counseling. Control of fatty food intake and alcohol drinking were significantly improved after nutrition counseling program. Score of general nutrition knowledge and knowledge about breast cancer, were significantly increased after nutrition counseling from 2.1 to 3.2 and from 2.3 to 3.8, respectively. It can be postulated that the dietary habit and nutrients intake of postoperative breast cancer patients can be improved by individual nutrition counseling program. In further study, the systematic group nutrition counseling program is needed.
Alcohol Drinking ; Breast Neoplasms* ; Breast* ; Calcium ; Cholesterol ; Counseling* ; Diet* ; Eating ; Female ; Food Habits ; Fruit ; Humans ; Life Style ; Meals ; Nutritional Status* ; Portion Size ; Surveys and Questionnaires ; Vegetables

This study was conducted to investigate the relationship between alcohol consumption, physical activity and breast cancer risk in Korean women. Newly histologically identified cases (N = 108) were selected at Hanyang and Soonchunhyang University Hospitals in Seoul, from January 1998 to August 1999. Hospital-based controls (n = 121) were the patients who visited at the same hospital in the department of plastic surgery, general surgery and opthalmology. Subjects were asked informations on demographic, reproductive, and history of breast feeding as well as physical activity, exercise habit, alcohol consumption by individual interview. Odds ratio (OR) and 95% Confidence Intervals (CI) were calculated by using unconditional logistic regression after adjusted for confounding factors. Among postmenopausal women, the risk of breast cancer increased with increasing alcohol drinking: relative risk for the highest group (> or = 150 g per week) compared with the lowest group (never drinking) was 2.05 (CI=1.74-3.79). Association of exercise and high physical activity for breast cancer appeared to be limited to women with high physical index among postmenopausal women. We observed decreasing risk of breast cancer with increasing physical activity index among postmenopausal women (OR=0.49,95% CI=0.56-0.92). Results of this study support a protective effects of physical activity during adulthood for breast cancer.
Alcohol Drinking* ; Breast Feeding ; Breast Neoplasms* ; Breast* ; Case-Control Studies* ; Female ; Hospitals, University ; Humans ; Logistic Models ; Motor Activity* ; Odds Ratio ; Seoul ; Surgery, Plastic

BACKGROUND/AIMS: The distribut ion of HCV genotypes varies with geographical area, and genot ypes can affect t he nat ur al course of HCV infection, but adequate genot yping data were not accumulat ed in Korea. This study was des igned to det ermine the pattern of distribution of HCV genotypes in Korea and it's clinical implications. METHODS: 100 cons ecut ive anti- HCV( +), RT-PCR(+) cases were recruited. Genotype specific oligonucleotide primers were made according to the sequence variation of NS5 region of HCV genome. Heminested PCR with mixed primersets was per formed, and genotype specific PCR products of different size were verified. Sequencing of cloned PCR products was done in cases with representative genotypes. Clinical profiles of genotype 1b and 2a were compared. RESULTS: Genotyping was done in 78 among 100 cases. Genotype 1b (48/ 78, 57.7%) and 2a (25/ 78, 32.1%) were most prevalent , and 1a (1/ 78, 1.3%) and mixed form (7/ 78, 9.0%) were also found. Milder cases with persistent normal ALT levels were more frequently seen in genotype 2a ( 9/ 25, 36.0%) than in genot ype 1b (3/ 45, 6.7%) (p< 0.01). CONCLUSIONS: Genotype 1b and 2a were major ones in anti- HCV( +) Korean adults, and the tendency of milder clinical course of genotype 2a was suggested.
Adult ; Clone Cells ; DEET ; DNA Primers ; Genome ; Genotype ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Korea ; Polymerase Chain Reaction*

STUDY DESIGN: A case report. OBJECTIVES: In patients with fracture-dislocation of the lumbar spine with neurologic deficit and hemodynamic instability, minimally invasive surgery made/produced good clinical results. So the authors have reported the results with literature review. SUMMARY OF LITERATURE REVIEW: In patients with unstable lumbar spine fracture-dislocation, early surgical treatment has been preferred due to its many advantages of anatomical reduction, nerve decompression, recovery of nerve function, and early rehabilitation, etc. But for patients with unstable lumbar spine fracture-dislocation and who are hemodynamically unstable, the surgical treatment is generally delayed, so there are many cases that cannot fulfill the expectation of neurologic recovery. MATERIALS AND METHODS: In patients with unstable lumbar 2-3 spine fracture-dislocation and who are hemodynamically unstable, applying the concept of stage operation, postural reduction and minimal invasive percutaneous pedicle screw fixation were conducted as soon as possible. Then after recover of general condition, decompression and posterior fusion were conducted as a second stage operation. RESULTS: After the first stage operation, motor grade was improved from 3 to 4 below the L3 spine level in postoperative physical examination. The second stage operation was conducted two weeks later and neurologic symptom was more improved after the second stage operation. CONCLUSIONS: In patients with lumbar spine fracture-dislocation having hemodynamic instability and neurologic deficit, early minimally invasive fixation for reducing complications of open reduction and internal fixation may contribute to improving general conditions and recovery of neurologic deficits.
Decompression ; Hemodynamics* ; Humans ; Neurologic Manifestations* ; Physical Examination ; Rehabilitation ; Spine*

Spontaneous spinal epidural hematomas without any risk factors, such as spinal tap, trauma, pregnancy, bleeding diathesis, vascular malformations, hypertension, etc. are relatively rare clinical entities. In addition, the clinical suspicion is quite difficult because there are various clinical symptoms according to the size and location of hematoma. However, the speed of diagnosis and initiation of the appropriate treatment are important because the outcome for patients is usually determined by the location and degree of neurological deficits and the duration of dural compression. We report the diagnosis and treatment of spontaneous spinal epidural hematoma in this case with a review of the relevant literature.
Disease Susceptibility ; Hematoma ; Hematoma, Epidural, Spinal ; Hemorrhage ; Humans ; Hypertension ; Pregnancy ; Risk Factors ; Spinal Puncture ; Vascular Malformations