Sleep disturbance is a one of common complaints among patients with panic disorder. However, clinicians and researchers did not give much attention to the sleep symptoms of panic disorder yet. Several previous studies suggested that the sleep disturbance in panic disorder is mediated by nocturnal panic attack. In terms of the pathophysiology of panic disorder, nocturnal panic attack seems to be closely associated with the sleep problems in panic disorder. In this article, the authors reviewed various previous studies about sleep of panic disorder and intended to give importance of evaluating sleep disturbances and nocturnal panic attack in panic disorder for both clinical and research purpose.
Humans ; Panic ; Panic Disorder

The stomach is the most frequent site of gastrointestinal stromal tumor (GIST). The common clinical manifestation of GIST are melena and hematochezia caused by gastointestinal bleeding. However, hemoperitoneum due to GIST rupture is a very rare condition. We describe a 33-year-old man with gastric GIST causing hemoperitoneum. A preoperative CT scan demonstrated large amount of fluid collection and extraluminal mass lesion in gastric antral area. He underwent an emergent laparotomy. The antral mass was polypoid shaped and showed ruptured focus. We performed a distal gastrectomy. The tumor was revealed as GIST with intermediate malignant risk by pathologic examination. The patient had an uneventful postoperative course and remains well.
Adult ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors/complications/*diagnosis/surgery ; Hemoperitoneum/*diagnosis/etiology ; Humans ; Male ; Tomography, X-Ray Computed

No abstract available.
Catheterization* ; Catheters* ; Hemothorax* ; Subclavian Vein*

BACKGROUND: Recently, many studies have focused on human epidermal growth factor receptor 2 (HER2) status in gastric cancer due to HER2-targeted therapy using trastuzumab. We investigated HER2 overexpression and amplification and their concordance rate in Korean gastric adenocarcinomas. METHODS: Tissue microarrays were constructed with 232 gastric adenocarcinoma samples. We performed immunohistochemistry (IHC), silver-enhanced in situ hybridization (SISH) and fluorescence in situ hybridization (FISH) for HER2. RESULTS: IHC was negative in 94.8% (218/232), equivocal in 1.7% (4/232) and positive in 3.5% (8/232) of cases. HER2 protein expression was heterogeneous in 75% (9/12) of IHC 2+/3+ cancers. Gene amplification was observed in 6.5% (15/230) by SISH and the same 15 cases were also FISH-positive. We observed HER2 amplification in 1.4%, 27.3%, 25%, and 100% of IHC 0, 1+, 2+, and 3+ gastric adenocarcinomas, respectively. The concordance rate between IHC and SISH results was 95.7%. CONCLUSIONS: HER2 overexpression and amplification were less frequent in gastric adenocarcinomas than breast carcinomas. Compared to breast carcinoma, (1) there may be IHC-negative but gene amplification-positive cases for HER2 and (2) frequent intratumoral heterogeneity of IHC for HER2 in gastric adenocarcinomas.
Adenocarcinoma ; Antibodies, Monoclonal, Humanized ; Breast ; Fluorescence ; Gene Amplification ; Humans ; Immunohistochemistry ; In Situ Hybridization ; In Situ Hybridization, Fluorescence ; Population Characteristics ; Receptor, Epidermal Growth Factor ; Receptor, erbB-2 ; Silver ; Stomach Neoplasms ; Trastuzumab

BACKGROUND: Cerebrospinal fluid (CSF) examination can be used to verify the presence of primary malignancies as well as cases of central nervous system (CNS) metastasis. Because of its importance, there have been several studies concerning the sensitivity of CSF cytology. To determine the practical use and reproducibility of diagnoses based on CSF cytology, we evaluated this test by analyzing cytology results from consecutive CSF samples. METHODS: Between July 2010 and June 2013, 385 CSF cytology samples from 42 patients were collected. The samples were gathered using a ventricular catheter and reservoir. CSF cytology of all patients was examined more than two times with immunocytochemistry for cytokeratin. RESULTS: Primary neoplastic sites and histologic types of patients' metastatic cancer were diverse. The overall sensitivity for detecting malignancy was 41.3%. Even within short-term intervals, diagnoses frequently changed. CONCLUSIONS: Our results were inconsistent, with low sensitivity, when compared to the results of previous studies. However, CSF evaluation can still provide valuable diagnostic and prognostic information because adjuvant treatments are now routinely performed in patients with CNS metastasis. Negative CSF cytology results should not be ignored, and continuous CSF follow-up is essential for following the clinical course of patients with metastatic cancer involving the CNS.
Catheters ; Central Nervous System ; Cerebrospinal Fluid* ; Diagnosis ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Neoplasm Metastasis

Intussusception is a relatively common disease in children, but it is a rare clinical entity in adults. More than 80% of all patients with intussusception are less than two years of age, but adults account for only 5 to 10 percent of all intussusception cases. The significance of this disease in the aspect of statistics is mentioned as "rule of fives", which means 5% of all intussusceptions occur in adults, and it accounts for up to 5% of all cases of bowel obstruction in adults. In children, classic symptoms include episodic abdominal pain, "current-jelly" stool and a sausage-shaped abdominal mass on examination. However, in adults, it is likely to appear with non-specific gastrointestinal trouble without classic symptoms. Therefore, it is very important to use early diagnositic tool. In contrast to childhood intussusception, which is idiopathic in 90% of cases, adult intussusception has a definable lesion in more than 90% of cases 3). Tumors, both benign and malignant, are the most frequent cause of intussusecption in adults. We experienced seven cases of adult intussusception at Inha hospital from Jan. 1994 to Dec. 1997. The patients of adult intussusception are classified as three cases of ileoileal type and four ileocecal type. There were no specific signs or symptoms with patient experienced. It included abdominal pain, diarrhea and palpable mass. Their diagnosis was made in six patients using abdominal CT scan. It is difficult to define a diagnosis preoperatively, because the symptom of adult intussusception are variable and insignificant among individuals. We had been taken the final diagnostic tool with the abdominal CT scan in six of seven patients, which revealed "target lesions" in all cases. So, it is useful in the diagnosis of adult intussusception. Bowels were resected for the treatment of adult intussusception. The extent of the resection was contained the lesion and the defunctioned segments. The operations were performed as four segmental resections of small bowel and three ileocecal resections. The pathological findings were disclosed as three tumors, three lymphadenopathies and a adhesion of bowel. We concluded that the abdominal CT scanning is a usefull diagnostic tool in the diagnosis of adult intussusception.
Abdominal Pain ; Adult* ; Child ; Diagnosis ; Diarrhea ; Humans ; Intussusception* ; Tomography, X-Ray Computed*

No abstract available.

PURPOSE: This study was conducted to evaluate the survival differences between curative stage IV and non-curative stage IV gastric cancers after gastrectomy. METHODS: Stage IV gastric cancer patients who received gastrectomy were selected from our surgical data-base from 1995 to 2004. These patients were separated into two groups according to the curability by surgery. We analyzed the survival differences between curative stage IV patients and non-curative stage IV patients. Survival analysis was performed by Kaplan-Meier survival analysis. RESULTS: During a 10-year period, gastrectomy was performed in 2,214 patients. 224 patients were diagnosed as stage IV. 144 patients were male and 80 patients were female. 97 patients received total gastrectomy. 127 patients received subtotal gastrectomy. 173 patients were diagnosed with curative stage IV and 51 patients were non-curative stage IV. Overall 3-year and 5-year survival rates of stage IV gastric cancer patients in this study were 31.5% and 18.4%. 3-YSR of curative and non-curative stage IV were 36.0% and 16.7% respectively (P-value=0.0204). 5-YSR of curative and non-curative stage IV was 21.9% and 4.2% (P-value=0.0169). CONCLUSION: Significant survival differences were found between curative and non-curative stage IV. Although direct tumor extension or distant metastasis exists, gastrectomy with combined resection was important to improve prognosis if it is possible to resect. When it comes to the matter of survival rate, the subclassification of stage IV gastric cancer should be considered for further management.
Female ; Gastrectomy ; Humans ; Male ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms ; Survival Rate

Inflammatory pseudotumor (IPT) is an uncommon clinical condition characterized by proliferation of spindle cells, inflammatory cells, and small vessels. IPT has been reported in various anatomical sites, including the orbit, lung, liver, spleen, and so on. IPT of the lymph node is very rare. We recently experienced a 65-year-old woman diagnosed with IPT of the lymph node in the splenic hilar, or distal supra-pancreatic area, mimicking gastric submucosal tumor. The tumor was removed without event using the laparoscopic method. This lesion in the splenic hilum is extremely rare and has not been cited in the current literature. We describe such a rare case of IPT with a review of the literature.
Aged ; Female ; Granuloma, Plasma Cell ; Humans ; Liver ; Lung ; Lymph Nodes ; Orbit ; Spleen

PURPOSE: Considerable variation exists in hospital admission rates for patients with community-acquired pneumonia (CAP). The objective of this study was to evaluate whether the pneumonia severity index (PSI) could be applied to patients with CAP as a method for triage in an emergency medical center. METHODS: A total number of 110 patients admitted with community-acquired pneumonia between January 1997 and September 2001. Their medical records were reviewed, with pneumonia severity index, and other risk factors, the time to resolution, and the results of treatment being evaluated. RESULTS: The pneumonia severity index accurately identified the patients with community-acquired pneumonia. Factors we evaluated were related to significant differences statistically, including such as PaCO2, WBC count, suffered lobe count, hypoxic index (PaO2/ F i O2), diabetes, hypertension, number of coexisting illness, period of admission and intravenous antibiotic therapy, and aggravated PaO2. If body temperature was less than 38.5 degrees C, it was considerable for outpatients clinics in Class I and II. CONCLUSION: The pneumonia severity index was a useful screening tool for patients with community-acquired pneumonia. Admission and an active therapeutic plan could be recommended for patients assigned to Class III. Inappropriate admissions were reduced to 27.3% by modified triage algorithm.
Body Temperature ; Emergencies ; Humans ; Hypertension ; Mass Screening ; Medical Records ; Outpatients ; Pneumonia* ; Risk Factors ; Triage*