We report a case of secretory carcinoma with axillary lymph node metastasis in a 21-year old woman. She was aware of a mass in her breast for 10 years and noticed a rapid growth of the preexisting mass during the last years. Histologically, the tumor was composed of micropapillary and microcystic or cribriform glandular structures which contained eosinophilic, mucinous, intraluminal secretions. The center had a dense hyalinized strama with a solid infiltrative growth of tumor cells with intracytoplasmic secretory vacuoles at the periphery. In addition, marked intraductal papillary epithelial proliferations were present at the superficial portions of the tumor near the nipple. Prognostic factors and their relationship to juvenile papillomatosis are discussed with a review of the literature.
Female ; Humans ; Neoplasm Metastasis ; Breast Neoplasms

OBJECTIVES: This study aimed to evaluate the mental health status of the children of psychiatric patients in order to plan for the resources that may be necessary to help these children achieve their full potential. METHODS: Forty-eight children (age 9–18) whose parents were registered in 5 community mental health centers located in Seoul were recruited. Tests assessing 3 psychological domains were conducted: 1) cognition: Korean version of Learning Disability Evaluation Scale, Comprehensive Attention Test, 2) parent reported emotion and behavior: Korean Child Behavior Checklist, Korean attention-deficit hyperactivity disorder Rating Scale, and 3) self-reported emotion and behavior: Korean Beck's Depression Inventory-II/Children's Depression Inventory-II, Korean Youth Self Report). We defined the children as having a high risk of developing mental health problems if their test scores were over the cut-off levels in 2 or more of the 3 domains assessed. RESULTS: Twelve (25%) children were classified as having a high risk of developing mental health issues. 20 (41.6%) children scored above the cut-off in only one of the domains. CONCLUSION: Our results suggest that the children of psychiatric patients might be vulnerable to mental illness and need early prevention or interven-tions for the sake of their mental health.
Adolescent ; Checklist ; Child Behavior ; Child* ; Cognition ; Community Mental Health Centers ; Depression ; Humans ; Learning Disorders ; Mass Screening* ; Mental Health* ; Parents* ; Seoul

No abstract available.
Female ; Humans ; Vaginosis, Bacterial*

Purpose: This study examined the effects of a physical stability exercise program on the functional movement and balance of middle school volleyball players to provide future management and training data to improve the performance of volleyball players. Methods: The subjects were 20 volleyball players from Y Middle School in Mokpo. The results of comparing and analyzing the effects of the physical stability exercise program on the functional movement and balance of middle school volleyball players for 10 weeks are as follows. Results: The number of participants who showed power and agility (p<0.01) was increased significantly, and the response time was shortened significantly (p<0.01). On the evaluation of functional movement, the total score showed a significant difference between the pre-test at 10.90±1.30 points and the post-test at 13.81±.60 (p<0.001). The subjects’ balance showed a significant difference from 84.11±7.53 to 97.65±8.47 (p<0.001), and the Right Composite Score showed a significant difference from 83.74±6.64 to 97.27±8.48 (p<0.001). Conclusion The application of a physical stability exercise program for 10 weeks is effective in improving the speed, agility, functional movement, and balance to volleyball players who are weakened and at risk of injury. This is believed to prevent or reduce injury.

Purpose: This study examined the effects of a physical stability exercise program on the functional movement and balance of middle school volleyball players to provide future management and training data to improve the performance of volleyball players. Methods: The subjects were 20 volleyball players from Y Middle School in Mokpo. The results of comparing and analyzing the effects of the physical stability exercise program on the functional movement and balance of middle school volleyball players for 10 weeks are as follows. Results: The number of participants who showed power and agility (p<0.01) was increased significantly, and the response time was shortened significantly (p<0.01). On the evaluation of functional movement, the total score showed a significant difference between the pre-test at 10.90±1.30 points and the post-test at 13.81±.60 (p<0.001). The subjects’ balance showed a significant difference from 84.11±7.53 to 97.65±8.47 (p<0.001), and the Right Composite Score showed a significant difference from 83.74±6.64 to 97.27±8.48 (p<0.001). Conclusion The application of a physical stability exercise program for 10 weeks is effective in improving the speed, agility, functional movement, and balance to volleyball players who are weakened and at risk of injury. This is believed to prevent or reduce injury.

PURPOSE: The purpose of this study is to evaluate the changing pattern of communication skills of medical students according to length and methods of training. METHODS: We evaluated a 1-week communications training course in 2003, a 1-year course in 2004, and a 1-semester course in 2005 during development of our curriculum. We have conducted the 10-minute CPX on abdominal pain annually since 2002 to assess the clinical performance of medical students who have completed the 3rd year clerkship. We selected CPX videos that were appropriate for assessment. One hundred sixty-four videos were available (1-week didactics: 42 cases, 1-week training: 28 cases, 1-semester training: 50 cases, 1-year training: 44 cases). We developed a 10-item global rating checklist to assess communication skills. A 5-point Likert scale was used to evaluate each item (4-very likely, 0-least likely). Two expert standardized patient (SP) raters evaluated the communication skills of students independently. We analyzed the outcomes based on the training length and methods. The reliability (G coefficient) was 0.825 with 2 SPs and 1 station. RESULTS: The communication skills of students improved with practice and longer training, especially with regard to opening the interview, expressing empathy, understanding the patient's perspective, and preparing for the physical examination. Rapport-building, organization of the interview, understandable explanation, nonverbal communication, active listening and consideration during the physical examination was unchanged between durations of training. The scores for empathetic expression, active listening and understanding the patient's perspective were low across all groups. CONCLUSION: We should concentrate our efforts to improve students' skills in empathetic expression, active listening and understanding the patient's perspective.
Abdominal Pain ; Checklist ; Curriculum ; Educational Measurement ; Empathy ; Humans ; Nonverbal Communication ; Physical Examination ; Reproducibility of Results ; Students, Medical

As neonates are brought to the emergency department (ED) for various complaints, it is challenging for emergency physicians to clinically determine the urgency of the visit. We sought to explore clinical characteristics associated with urgent visits to the ED. We conducted a retrospective study by reviewing medical records of neonatal visits to a tertiary pediatric regional emergency center for 5 years. Cases of patients who were discharged after checking only chest or abdominal X-ray or discharged without workup, were classified as non-urgent visits. Cases where more examinations were performed, or when the patient was hospitalized, were classified as urgent visits. Various clinical features and process in the ED were compared between the groups. Of the 1,008 cases enrolled in this study, 856 (84.9%) were urgent and 152 (15.1%) were non-urgent visits. After adjustment by multiple logistic regression analysis, non-urgent visits were associated with self-referrals rather than physician-referrals (odds ratio [OR], 5.96), visits in the evening rather than at night or daytime (OR, 2.51), patient visits from home rather than from medical facilities (OR, 2.19; 95). Fever and jaundice were the most common complaints (25.7% and 24.5%, respectively), and their OR of non-urgent visit was relatively low (adjusted OR 0.03 and 0.03, respectively). However, other common complaints, such as vomiting and cough (7.4% and 7.1%, respectively), were more likely to be non-urgent visits (adjusted OR 2.96 and 9.83, respectively). For suspected non-urgent visits, emergency physicians need to try to reduce unnecessary workup and shorten length of stay in ED.
Cough ; Emergencies* ; Emergency Service, Hospital* ; Fever ; Humans ; Infant, Newborn ; Jaundice ; Length of Stay ; Logistic Models ; Medical Records ; Retrospective Studies ; Thorax ; Vomiting

PURPOSE: The pro-inflammatory cytokine, tumor necrosis factor-alpha (TNF-alpha), is a central mediator of the immune response involved in a wide range of immuno-inflammatory and infectious diseases. There is increasing evidence that TNF-alpha may promote the development and spread of the cancer. Polymorphisms in the TNF-alpha promoter have been related to TNF-alpha production. Therefore, we investigated the potential association of TNF-alpha genotypes with gastric cancer in the Korean population. METHODS: The study included 66 patients with gastric adenoma, 75 patients with gastric carcinoma, and 551 healthy controls. The -308 and -238 polymorphisms in the TNF-alpha promoter were analyzed by PCR- restriction fragment length polymorphism (RFLP). Distributions of TNF-alpha promoter polymorphisms were compared between groups by chi2 test. P values smaller than 0.05 were considered to be significant. RESULTS: The proportion of individuals carrying the TNF-alpha -308A allele was higher in the carcinoma group compared to controls and adenomas, but the differences were not significant (P=0.124). However, the TNF-alpha -308A allele was significantly associated with advanced gastric carcinoma (P=0.026), serosa invasion (P=0.004), neural invasion (P= 0.021), and lymph node metastasis (P=0.005). On the other hand, the TNF-alpha -238G/A polymorphism was not associated with the development of gastric adenoma and carcinoma and the severity of gastric carcinoma. CONCLUSION: These results suggest that the TNF-alpha -308A allele is associated with the severity of gastric carcinoma in terms of invasion and metastasis in the Korean population. Therefore, TNF-alpha promoter polymorphism could be used as a predictive marker of the severity of gastric carcinoma.
Adenoma ; Alleles ; Communicable Diseases ; Genotype ; Hand ; Humans ; Lymph Nodes ; Necrosis* ; Neoplasm Metastasis ; Polymorphism, Restriction Fragment Length ; Serous Membrane ; Stomach Neoplasms ; Tumor Necrosis Factor-alpha

Primary papillary serous carcinoma of the peritoneum(PPSCP) is vere rare. It has been suggested that PPSCP derives from embryonal coelomic epithelium with m llerian ducts potential. PPSCP can develop from a single or multicentric focus. The clinical and histologic disease entities are similar to those of primary papillary serous carcinoma of the ovary, but PPSCP involves the ovarian surface only minimally(microscopic disease) or spares the ovaries entirely. We have experienced a case of primary papillary serous carcinoma of the peritoneum and report this case with brief review of the concerned literature.
Epithelium ; Female ; Ovary ; Peritoneum*

OBJECTIVE: To evaluate the epidemiologic change of patients with spinal cord injury who were admitted to a Rehabilitation Hospital, Yonsei University College of Medicine, during 1987-1996 and 2004-2008. METHODS: Medical records of 629 patients with spinal cord injury admitted to the Rehabilitation Hospital, Yonsei University College of Medicine, from 2004 to 2008 were collected and reviewed retrospectively. RESULTS: The male-to-female ratio decreased to 2.86:1, the mean age at injury increased, nontraumatic etiology increased, traffic accident remained to be the most common in traumatic spinal cord injury, and falling increased significantly. Tumor was the most common etiology in nontraumatic spinal cord injury, tetraplegia and incomplete injuries occurred more than paraplegia and complete injuries, indwelling catheter was the most common voiding method, and the duration of hospitalization decreased. CONCLUSION: Many trends changed in epidemiology of spinal cord injury.
Accidents, Traffic ; Catheters, Indwelling ; Hospitalization ; Humans ; Medical Records ; Paraplegia ; Quadriplegia ; Spinal Cord ; Spinal Cord Injuries