PURPOSE: The combination of conservative surgery and radiotherapy is currently accepted as the preferred treatment for most patents with clinical stage I or II breast cancer. However, there is large amount of controversy concerning the optimal means of selecting patients and the details of the treatment technique. Breast cancer patients are being treated both in university hospitals and in community hospitals. Generally, the radiation therapy is not available in many community hospitals. Radiation therapy, which generally follows either a mastectomy or conservative surgery, is an important procedure. Therefore, the type of hospital facilities may influence which surgical procedures are selected. The authors conducted this study to analyse the current patterns of care for early invasive breast cancer in a hospital without a radiation therapy unit, even though the patient could receive such treatment from another affiliated hospital. METHODS: 131 cases of stage I and II breast cancer patients were reviewed between 1987 and 1997, and the types of treatments including surgery, radiation therapy and systemic therapy, were analysed retrospectively. RESULTS: The surgical procedures used were mainly a modified radical mastectomy (124/131, 94.7%), followed by breast conservation surgery (4/131, 3.1%), a total mastectomy (2/131, 1.5%) and a radical mastectomy (1/131, 0.8%). Radiation therapy was applied to 19 stage II patients (N=105), but not to any of the stage I patients (N=26). Systemic adju-vant therapy was done with chemotherapy (39/131, 29.8%), hormone therapy (17/131, 13.0%) and a combination of both modalities (67/131, 51.1%), with an exception of 8 cases. CONCLUSION:Breast c0onservation therapy for breast cancer patients was underutilized. The selection of the therapeutic method may be influenced by the facilities of the particular hospital. For proper treatment of early stage breast cancer, a surgeon must keep in close contact with bothe a radiologist and a radiotherapist, even in other affiliated hospitals.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Hospitals, Community ; Hospitals, University ; Humans ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Simple ; Radiotherapy ; Retrospective Studies

PURPOSE: The combination of conservative surgery and radiotherapy is currently accepted as the preferred treatment for most patents with clinical stage I or II breast cancer. However, there is large amount of controversy concerning the optimal means of selecting patients and the details of the treatment technique. Breast cancer patients are being treated both in university hospitals and in community hospitals. Generally, the radiation therapy is not available in many community hospitals. Radiation therapy, which generally follows either a mastectomy or conservative surgery, is an important procedure. Therefore, the type of hospital facilities may influence which surgical procedures are selected. The authors conducted this study to analyse the current patterns of care for early invasive breast cancer in a hospital without a radiation therapy unit, even though the patient could receive such treatment from another affiliated hospital. METHODS: 131 cases of stage I and II breast cancer patients were reviewed between 1987 and 1997, and the types of treatments including surgery, radiation therapy and systemic therapy, were analysed retrospectively. RESULTS: The surgical procedures used were mainly a modified radical mastectomy (124/131, 94.7%), followed by breast conservation surgery (4/131, 3.1%), a total mastectomy (2/131, 1.5%) and a radical mastectomy (1/131, 0.8%). Radiation therapy was applied to 19 stage II patients (N=105), but not to any of the stage I patients (N=26). Systemic adjuvant therapy was done with chemotherapy (39/131, 29.8%), hormone therapy (17/131, 13.0%) and a combination of both modalities (67/131, 51.1%), with an exception of 8 cases. CONCLUSION: Breast conservation therapy for breast cancer patients was underutilized. The selection of the therapeutic method may be influenced by the facilities of the particular hospital. For proper treatment of early stage breast cancer, a surgeon must keep in close contact with bothe a radiologist and a radiotherapist, even in other affiliated hospitals.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Hospitals, Community ; Hospitals, University ; Humans ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Simple ; Radiotherapy ; Retrospective Studies

Plasma cell Granuloma (PCG) is a form of idiopathic inflammatory pseudotumor (IPT). It is a rare entity character-ized by a nonneoplastic proliferation of inflammatory cells dominated by a polyclonal expansion of the plasma cells. This lesion has been discovered in many parts of the body including the central nervous system. We now report two cases of plasma cell granuloma involving the brain. The first case was a 42-year-old man who presented a right hemi-paresis. He had a lesion in the convexity of the left parietal region. The second case was a 58-year-old woman who was expressed confusion and a frontal-temporal headache. She had a lesion in the convexity of the left temporal region and mastoid bone. The diagnosis of PCG was confirmed by pathological and immunohistochemical studies revealing pre-dominant plasma cells in the affected tissues.
Adult ; Brain ; Central Nervous System ; Diagnosis ; Female ; Granuloma, Plasma Cell* ; Headache ; Humans ; Mastoid ; Middle Aged ; Plasma Cells* ; Plasma* ; Rabeprazole

BACKGROUND: Memory impairment results from various neurologic disorders. Among them, the memory loss associated with stroke is called amnesic stroke. Involved regions in the amnesic stroke are medial temporal lobe, thalamus, basal forebrain, retrosplenial region, and subcortical regions. Unilateral amnesic stroke is posterior cerebral artery territory including thalamus. Isolated infarction of hippocampal region has been rarely reported because hippocampus has dual blood supply from anterior choroidal cerebral artery and posterior cerebral artery. CASE REPORT: A 61-year old male with a history of diabetes for 6 years and hypertension for 13 years, was admitted with acute memory loss occurring 6 days before admission. He could not remember the exact date, place and recent events but could remember remote events about his personal and familial affairs. Brain MRI revealed an infarction in left hippocampal region and cerebral angiography showed multiple focal stenosis and luminal irregularity on left anterior choroidal, middle cerebral, basilar and both posterior cerebral arteries. COMMENTS: We report unilateral amnesic stroke only confined to left hippocampal region with literature review.
Amnesia ; Brain ; Cerebral Angiography ; Cerebral Arteries ; Choroid ; Constriction, Pathologic ; Hippocampus ; Humans ; Hypertension ; Infarction* ; Magnetic Resonance Imaging ; Male ; Memory Disorders* ; Memory* ; Middle Aged ; Nervous System Diseases ; Phenobarbital ; Posterior Cerebral Artery ; Prosencephalon ; Stroke ; Temporal Lobe ; Thalamus

This study describes the relation of physician's income and price of medical service and social welfare through microeconomic view, reviews the literature of influencing factor on physician's income, and it describes general distribution of physician's income, and analyzes influencing factor of physician's income. A total of 844 persons responded to the mail survey, through stratified sampling by 23 branches of medical society in Korean RBRVS study. The design of the study is cross sectional study, and the unit of analysis is a physician. To examine the change of average income per month, multiple regression was used to test the change according to physician's characteristics, demographic characteristics, scale of clinic(or hospital), average intensity of ordinary work, and specialty. The major findings of this study are as follows; 1. As for self-employed physicians, the difference of average income per month among specialties was 4,850,000won, but the difference was 6,020,000won under the control of control variables, and average income per month was significantly higher for physicians who had sick-beds than physicians who had no sick-beds. 2. The number of average out-patients per month and number of nurses and nursing aides significantly positively associated, but the number of physician significantly negatively associated with average income per month. In conclusion, the number of out-patient and number of nurses and nursing aides is the major influencing factor, and the difference of average income per month among specialties existed in self-employed physicians. So this study suggests basic hypothesis that the price of medical service and supply of physician by specialties are not pertinent. Being a cross-sectional study, this study can not suggest causal explanations. In the future, further study is needed for causal explanations.
Cross-Sectional Studies ; Humans ; Nursing ; Outpatients ; Postal Service ; Social Welfare ; Societies, Medical

Recently, cases with typical clinical manifestations of infectious mononucleosis are increasing in Korea. So, to evaluate the recent epidemiology of EBV infection in Korea, we performed EBV serologic antibody tests for IgG antibody to EBV-viral capsid antigen (VCA) and antibody to EBV-associated nuclear antigen (EBNA) among the 108 healthy Korean infants and children whose ages were from newborn to 15 years old. And the results were as follows; 1) The positive rates of anti-VCA IgG 100% in newborn, 90% in 2 to 6 months, 20% in 7 to 12 months, 60% in 1 to 2 years, 77.3% in 3 to 4 years, 88.5% in 5 to 6 years, 90% in 7 to 9 years, and 100% in 10 to 15 years of age, respectively. 2) The anti-VCA IgG titers ranged from 1:20 to 1:1280. 3) The positive rates of anti-EBNA were 100% in newborn, 60% in 2 6 months, 10% in 7 to 12 months, 60% in 1 to 2 years, 68.2% in 3 to 4 years, 84.5% in 5 to 6 years, 70% in 7 to 9 years, and 100% in 10 to 15 years of age, respectively. 4) The anti-EBNA titers ranged from 1:2 to 1:128. According to these data, the age of primary infection of EBV has increased compared to the previous data in Korean children.
Adolescent ; Capsid ; Child* ; Epidemiology ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Infant ; Infant, Newborn ; Infectious Mononucleosis ; Korea ; Prevalence*

PURPOSE: With the introduction of H. pylori eradication and proton pump inhibitor, the operative treatments for the acute or chronic complications of peptic ulcer, such as perforation, bleeding and stricture, have decreased. Also owing to the development of non-operative treatment such as interventional endoscopic treatment, the surgical approach to the acute complications, like perforation and bleeding, has diminished. The non-operative treatments for the stricture and obstruction of chronic peptic ulcer in part related to discontinuation of medication have not been satisfactory. We analyzed the clinical outcomes of the patients who underwent operative treatment for outlet obstruction with peptic ulcer. Materials of Methods: From January 1994 to December 2007, we reviewed 31 patients who had been operated on at the National Medical Center for peptic ulcer obstruction. We excluded the cases of adhesive obstructions that were caused by a former ulcer operation and also the cases of obstructions found during emergency operations for treating perforation and bleeding. We classified the surgical treatment group into the bypass operation group and the surgical resection group. We evaluated the effects of the operations by the Visick score. The recurrences were confirmed only by the endoscopic observation of peptic ulcer. RESULTS: The number of patients in the bypass operation group was 6 (19.4%) and that of resection group was 25 (80.6%). The mean age was 57.5 (25~81) years. The number of male patients was 29 (93.5%) and the number of females was 2 (6.5%). The mean symptom duration was 29.6 months. There were 19 smokers (61.3%), 6 NSAID users (19.4%) and 7 H. pylori positive patients (22.6%). Two patients underwent endoscopic balloon dilatation with no success. The locations of lesion were the stomach, the duodenum and both in 9, 20 and 2 cases, respectively. There were operative complications in 13 cases (41.9%), recurrent ulcers in 2 cases (6.5%), and reoperations in 4 cases. The mean Visick score was 1.8 (1~4). There were no statistically significant clinicopathologic differences between the bypass operation group and the resection group. The two groups had 1 case each of recurrence. Although the bypass group had a greater complication rate (83.3%) than the resection group (32%), this was not statistically meaningful (P=0.175). The mean Visick score was 3.0 in the bypass group and 1.6 in the resection group, so the resection group was better (P=0.001). CONCLUSION: For a case of chronic peptic ulcer with outlet obstruction, even though it has been reported that endoscopic balloon dilatation worked well, surgery is still regarded as an important treatment. If you consider the patients' satisfaction and the difficulty of diagnosing malignant ulcers, surgical resection should be recommended more often than a bypass operation.
Adhesives ; Constriction, Pathologic ; Dilatation ; Duodenum ; Emergencies ; Female ; Gastric Outlet Obstruction ; Hemorrhage ; Humans ; Male ; Peptic Ulcer ; Proton Pumps ; Recurrence ; Stomach ; Ulcer

We reviewed the clinical findings of infectious mononucleosis and performed Epstein-Barr virus (EBV) serologic antibody tests in infectious mononucleosis and healthy group. One groupwas 18 cases of children, diagnosed as infectious mononucleosis who had been admitted to the department of Pediatrics, Asan Medical Center for two years and eight months, from November, 1989 to June, 1992. Another group was 20 cases of healthy 5-year old children. @ES The results wereas follows: 1) The age distributions of 18 patients with infectious mononucleosis were as follows: nine patients were less than 5 year old and nine patients (50%)were older than 5 year old. 2) The hematologic findings revealed increased atypicallymphocytes in sixteen patients (88%), leukopenia in one patient (6%), thrombocytopenia in one patient (6%). In addition, we observed transient hepatitis in eight patients (44%) and jaundice in one patient (6%). 3) Hemophagocytic sydrome wasdeveloped in one patient who expired due to meningitis. 4) The heterophil antibody tests werepositive in two cases (11%) out of eighteen infectious mononucleosis patients. 5) EBV serologic antibody tests for IgM antibody to EBV-viral capsid antigen (VCA) in 18 patients were all positive, which implies primary infection. 6) EBV serologic antibody tests for IgG antibody to EBV-VCA and antibody to Epstein-Barr nuclear antigen (EBNA) in helathy 5-year old children were negative in 3 cases (15%) out of 20 cases each other, which suggests primary infection might occur afer five years of age. 7) Recently, more cases of clinically typical infectious mononucleosis are detected and the onset of EBV primary infection is becoming late in Korea, which is thought to be due to economic developments and improvements of environmental hygine. And we recommend EBV serologic antibody test for the confirmative diagnostic test of infectious mononucleosis.
Age Distribution ; Capsid ; Child* ; Child, Preschool ; Chungcheongnam-do ; Diagnostic Tests, Routine ; Hepatitis ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Infectious Mononucleosis* ; Jaundice ; Korea ; Leukopenia ; Meningitis ; Pediatrics ; Thrombocytopenia

This study was performed to find out the influences of ethanol on the metabolism of trichloroethylene(TRI) in rats. TRI in corn oil at the dosage of 150, 300, 600 mg/kg was injected peritoneally once a day for two days to two groups. In one group ethanol(4 g/kg) was taken orally 30 minutes before TRI injection, and the other group ethanol was not. The results of experiments are as follows: 1. The contents of cytochrome P-450 and b5 had inverse relationship with in-jected TRI amounts in both groups. 2. The activity of NADPH P-450 reductase was decreased slowly in TRI injected group related with TRI amount, but decreased drastically in the group pretreated with ethanol. 3. The activity of NADH b5 reductase had relationship with injected TRI amount, but the statistical significance was found only in the groups of 300 and 600 mg/kg of TRI injected without relevance to ethanol when compared with the group that was not injected. 4. The activity of ADH was more decreased and ALDH activity was more increased in groups that TRI injected and ethanol was pretreated with ethanol groups than in group without any treatment. These results suggest that ethanol may inhibit epoxide formulation, the first step or TRI metabolism, and change from TCE-OH to TCA also.
Animals ; Corn Oil ; Cytochrome P-450 Enzyme System ; Ethanol* ; Liver* ; Metabolism ; NAD ; NADP ; Oxidoreductases ; Rats* ; Trichloroethylene*

BACKGROUND: Type 1 diabetes mellitus is frequently associated with other autoimmune diseases. The broad concept of polyendocrinopathies takes into consideration that patients affected by at least one endocrine disease may have another autoimmune disorder or express specific autoantibodies. Anti-glutamic acid decarboxylase autoantibodies, now recognized as one of the major serological markers for type 1 diabetes has been reported to be higher in type 1 diabetes patients with autoimmune thyroid diseases (ATD) than in those without ATD. The objective of the present study was to evaluate the prevalences of GAD65 antibodies applying a newly developed assay(anti-GAD65) in type 1 diabetes patients with and without ATD. METHODS: We developed a new anti-GAD65 assay after mammalian expression of a recombinant GAD65 antigen. Since the detection of anti-GAD65 is rather complicated and insensitive due to inherent antigenic difference of antibody recognition in conventional assays, we applied this new approach in measuring anti-GAD autoantibodies and compared the result with ICA and anti-GAD measurement using the purified porcine GAD (anti-GAD) in 109 cases of type 1 diabetes, 29 of whom had concomitant ATD (mean age at diagnosis: 7.9 yr, mean duration of type 1 diabetes: 4.5 yrs). RESULTS: The overall prevalence of anti-GAD65 antibodies was 65% (71 of 109) in patients with Korean type 1 diabetes. Prevalences and titers of anti-GAD65 had not changed much after controlling for the duration and the status of concomitant ATD. In contrast, the prevalence of anti-GAD was 56%(61 of 109), while that of ICA(+) WAS 36% in type 1 diabetes patients. We found significant, but not strong association of anti-GAD65 either with anti-GAD(r=0.4, p<0.01) or with ICA(r=0.6, p< 0.001). CONCLUSION: From this, we could assess that autoantibodies are present at comparable sensitivity and specificity in Korean type 1 diabetes patients. This anti-GAD65 assay, another immunologic marker for type 1 diabetes might also confer disease susceptibility among Koreans, but no increase in the prevalence or in the titer in patients with ATD may suggest that this marker is unlikely to give much benefit, for the detection of the overlapping disease of type 1 diabetes and ATD.
Antibodies ; Autoantibodies* ; Autoimmune Diseases ; Biomarkers ; Diabetes Mellitus, Type 1* ; Diagnosis ; Disease Susceptibility ; Endocrine System Diseases ; Humans ; Prevalence ; Sensitivity and Specificity ; Thyroid Diseases* ; Thyroid Gland*