No abstract available.
Keratinocytes*

Objective: Cerebral white matter changes (WMCs) and silent brain infarcts (SBIs) are common radiological findings in neurologically asymptomatic elderly people. Their presence is associated with an increased risk of stroke or dementia. Homocysteine (Hcy) can cause atherosclerosis and may thus act as a useful marker of stroke prior to symptom onset. This study aimed to evaluate the utility of Hcy as a surrogate marker for early intervention for stroke in community-dwelling healthy elderly persons with cerebrovascular lesions such as WMCs and SBIs. Methods: We assessed the relationship between the Hcy level and presence of WMCs/SBIs on brain computed tomography (CT) in 554 elderly individuals aged ≥65 years with no history of stroke or dementia. Results: The mean age of the participants was 74.43±7.32 years. Of the 554 patients, 106 (19.1%) had WMCs and/or SBI findings on brain CT. The mean Hcy level was higher in participants with WMCs/SBIs (P=0.001). The WMCs/SBIs group had a significantly greater number of participants with high Hcy levels than the non-WMCs/SBIs group (P<0.001). High Hcy levels (≥12.3 μmol/L) was significantly associated with WMCs and SBIs even after adjusting for age, Korean Mini Mental Status Examination score, education level, and vascular risk factors such as hypertension, diabetes, hyperlipidemia and smoking status. Conclusion: The result of our study suggests that regular monitoring of homocysteine level as a modifiable risk factor may be helpful for predicting the association of cerebrovascular lesions such as WMCs and SBIs for the prevention of future ischemic stroke and cognitive impairment.

No abstract available.
Pancreas*

BACKGROUND/AIMS: The endoscopic mucosal resection has now been adopted for a useful modality in both curative therapy and accurate diagnosis of early gastric cancer. A retrospective study was done to evaluate the indication and the limitation of endoscopic mucosal resection of early gastric cancer. METHODS: We studied 20 cases of early gastric cancer treated by endoscopic mucosal resection in Chungnam National University Hospital from November, 1995 to July, 1997. RESULTS: 1) The size affected the curability: 83. 3% of lesions less than 2 cm and 50. 0% of those larger than 2 cm were resected completely. 2) The depth of cancer invasion affected the curability: 87. 5% of lesion confined to mucosa were resected completely, while all of submucosal cancers were resected incompletely. 3) Among fourteen cases resected completely, three cases of lesions larger than 2 cm were residual cancer and two of those less than 2 cm were recurred locally. CONCLUSIONS: To be a curative therapy by endoscopic mucosal resection of early gastric cancer, we think that careful selection of the lesion, that is lesion less than 2cm and confined to mucosa, is necessary
Chungcheongnam-do ; Diagnosis ; Mucous Membrane ; Neoplasm, Residual ; Retrospective Studies ; Stomach Neoplasms*

BACKGROUND: The coagulation and fibrinolytic activities increase in the setting of acute myocardial infarction (AMI) and has been shown to increase further after the administration of thrombolytic agents. The reocclusion rate was slightly higher in patients with recombinant tissue type plasminogen activator (rt-PA) than urokinase (UK). However, there are few studies on serial changes in coagulation and fibrinolytic activities during the thrombolytic therapy. METHODS: Twenty five AMI patients who visited Yongdong Severance Hospital from August 1996 to August 1997 were recruited. They were randomized two groups either double bolus UK or accelerated rt-PA. Plasma levels of fibrinogen, thrombin-antithrombin III complex (TAT), plasmin-alpha2 plasmin inhibitor complex (PIC), activities of protein C and protein S were checked before and 3, 12, 24hrs and 7days after the thrombolytic therapy. RESULTS: Plasma level of fibrinogen was decreased 3 and 12hrs after the initiation of thrombolytic therapy in both groups (p<0.05) however, the fibrinogen level in UK treated group (59.9+/-33.5 mg/dl) was decreased than rt-PA treated group (198.2+/-64.3 mg/dl) at 3hrs after thrombolytic therapy (p<0.05). Activities of protein C and protein S were increased at 3hrs after thrombolytic therapy in both groups and no difference was noticed between UK and rt-PA group. Concentrations of TAT and PIC were increased in both groups even before the thrombolytic therapy was initiated. The increment of TAT level was larger in rt-PA group (21.7+/-16.1, 8.9+/-5.4 ng/mL) compared with UK group (15.0+/-17.9, 4.6+/-1.9 ng/mL) at 3 and 12 hrs after thrombolytic therapy (p<0.05). PIC level was significantly increased at 3 and 12 hrs after the treatment in both groups and no difference was noted between UK and rt-PA group. CONCLUSION: Both coagulation and fibrinolytic activities, activated already before thrombolytic therapy, were further aug-mented after thrombolytic therapy in AMI patients. The increment of fibrinolytic activity showed no significant difference between UK and rt-PA treated group. However the coagulation activity in rt-PA treated group was increased more than UK treated group.
Antifibrinolytic Agents ; Fibrinogen ; Fibrinolytic Agents ; Humans ; Myocardial Infarction* ; Plasma ; Protein C ; Protein S ; Thrombolytic Therapy ; Tissue Plasminogen Activator* ; Urokinase-Type Plasminogen Activator*

BACKGROUND: The coagulation and fibrinolytic activities increase in the setting of acute myocardial infarction (AMI) and has been shown to increase further after the administration of thrombolytic agents. The reocclusion rate was slightly higher in patients with recombinant tissue type plasminogen activator (rt-PA) than urokinase (UK). However, there are few studies on serial changes in coagulation and fibrinolytic activities during the thrombolytic therapy. METHODS: Twenty five AMI patients who visited Yongdong Severance Hospital from August 1996 to August 1997 were recruited. They were randomized two groups either double bolus UK or accelerated rt-PA. Plasma levels of fibrinogen, thrombin-antithrombin III complex (TAT), plasmin-alpha2 plasmin inhibitor complex (PIC), activities of protein C and protein S were checked before and 3, 12, 24hrs and 7days after the thrombolytic therapy. RESULTS: Plasma level of fibrinogen was decreased 3 and 12hrs after the initiation of thrombolytic therapy in both groups (p<0.05) however, the fibrinogen level in UK treated group (59.9+/-33.5 mg/dl) was decreased than rt-PA treated group (198.2+/-64.3 mg/dl) at 3hrs after thrombolytic therapy (p<0.05). Activities of protein C and protein S were increased at 3hrs after thrombolytic therapy in both groups and no difference was noticed between UK and rt-PA group. Concentrations of TAT and PIC were increased in both groups even before the thrombolytic therapy was initiated. The increment of TAT level was larger in rt-PA group (21.7+/-16.1, 8.9+/-5.4 ng/mL) compared with UK group (15.0+/-17.9, 4.6+/-1.9 ng/mL) at 3 and 12 hrs after thrombolytic therapy (p<0.05). PIC level was significantly increased at 3 and 12 hrs after the treatment in both groups and no difference was noted between UK and rt-PA group. CONCLUSION: Both coagulation and fibrinolytic activities, activated already before thrombolytic therapy, were further aug-mented after thrombolytic therapy in AMI patients. The increment of fibrinolytic activity showed no significant difference between UK and rt-PA treated group. However the coagulation activity in rt-PA treated group was increased more than UK treated group.
Antifibrinolytic Agents ; Fibrinogen ; Fibrinolytic Agents ; Humans ; Myocardial Infarction* ; Plasma ; Protein C ; Protein S ; Thrombolytic Therapy ; Tissue Plasminogen Activator* ; Urokinase-Type Plasminogen Activator*

No abstract available.
Skin Neoplasms* ; Skin*

OBJECTIVE: The justification of informed consent requires that a patient be provided with the information necessary for deciding treatment and able to use such information based on reasonable thinking. The clinical decision to consider anyone who has mental disorder as incompetence without objective assessment does not only encroach human rights of the persons with mental illness, but seriously prevent them from being recovered. Hence the objective assessment of competency is needed in mental health. Our study aimed to develop the Korean Tool of Competency to Consent to Psychiatric Hospitalization and to analyze the reliability and validity of this tool. METHODS: Totally 98 patients with mental illness who were hospitalized in mental hospital, participated in this study. For the subjects a questionnaire composing of 22 questions of understanding, appreciation, reasoning and expression of a choice was used. To investigate validity of this tool, MMSE-K, insight test, estimated IQ, BPRS were conducted. Its reliability and usefulness were examined with Cronbach's alpha, ICC and ROC analysis respectively and criterion related validation performed. RESULTS: As results, this tool shows that agreement between raters is relatively high and the confirmatory factor analysis for constructive validation shows that the tool is valid. Also, for criterion related validation, estimated IQ, insight and MMSE are significantly correlated to understanding, appreciation and reasoning. However competence to express a choice did not show any significant correlation with criterion variables, nor showed BPRS any significant correlation with sub-competences. CONCLUSION: Our study developed the Korean Tool of Competency to Consent to Psychiatric Admission Treatment in the Mentally Ill, verified the reliability and validity of the tool and analyzed the optimum cutoff to distinguish between competence and incompetence in sub-competences. Korean Assessment Tool of Competency to Consent to Psychiatric Hospitalization (KATOC), analyzed the reliability and validity of this tool and presented the cutoff points by subarea. As a result, the reliability and validity of satisfactory levels were verified, the ROC analysis was implemented based on the clinical assessment and the cutoff points were found in understanding, appreciation, expression of a choice and reasoning. Such findings showed that the tool developed by researchers could be very favorably used in Korea.
Hospitalization ; Hospitals, Psychiatric ; Human Rights ; Humans ; Informed Consent ; Korea ; Mental Competency ; Mental Disorders ; Mental Health ; Mentally Ill Persons ; Surveys and Questionnaires ; Reproducibility of Results ; ROC Curve ; Thinking

No abstract available.
Escherichia coli* ; Escherichia* ; Humans*

Lupus panniculitis is a rare disease that may present with similar clinical manifestations to an infection, such as cellulitis or abscess. This paper reports a case of a 25-year-old woman with systemic lupus erythematosus who underwent surgical intervention initially with the suspicion of an abscess but who was eventually diagnosed with lupus panniculitis. Despite the low incidence of lower leg involvement of panniculitis, clinicians should be aware of the possibility of an etiology other than infection when encountering patients with inflammatory diseases. Moreover, a skin biopsy and magnetic resonance imaging with a diffusion-weight image may be helpful.