BACKGROUND/AIMS: This study was performed to evaluate the relationship between family history of gastrointestinal (GI) cancers and incidence of any GI cancer in the Korean population. METHODS: Between January 2015 and July 2016, 711 GI cancer patients and 849 controls in 16 hospitals in Korea were enrolled. Personal medical histories, life styles, and family history of GI cancers were collected via questionnaire. RESULTS: There was a significant difference in the incidence of family history of GI cancer between GI cancer patients and controls (p=0.002). Patients with family history of GI cancer tended to be diagnosed as GI cancer at younger age than those without family history (p=0.016). The family members of GI cancer patients who were diagnosed before 50 years of age were more frequently diagnosed as GI cancer before the age of 50 years (p=0.017). After adjusting for major confounding factors, age (adjusted odds ratio [AOR] 1.065, 95% confidence interval [CI]; 1.053–1.076), male gender (AOR 2.270, 95% CI; 1.618–3.184), smoking (AOR 1.570, 95% CI; 1.130–2.182), and sibling's history of GI cancer (AOR 1.973, 95% CI; 1.246–3.126) remained independently associated with GI cancers. CONCLUSIONS: GI cancer patients tended to have a first relative with a history of concordant GI cancer. Personal factors (old age and male) and lifestyle (smoking) contribute to the development of GI cancer, independently. Individuals with high risk for GI cancers may be advised to undergo screening at an earlier age.
Age Factors ; Gastrointestinal Neoplasms* ; Humans ; Incidence ; Korea ; Life Style ; Male ; Mass Screening ; Medical History Taking ; Odds Ratio ; Risk Factors ; Smoke ; Smoking

Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of motion preservation technologies like total disc arthroplasty. The true nature and scope of ASP remains poorly understood. The etiology of ASP is most likely multifactorial. Various factors including altered biomechanical stresses, surgical disruption of soft tissue and the natural history of cervical disc disease contribute to the development of ASP. General factors associated with disc degeneration including gender, age, smoking and sports may play a role in the development of ASP. Postoperative sagittal alignment and type of surgery are also considered potential causes of ASP. Therefore, a spine surgeon must be particularly careful to avoid unnecessary disruption of the musculoligamentous structures, reduced risk of direct injury to the disc during dissection and maintain a safe margin between the plate edge and adjacent vertebrae during anterior cervical fusion.
Humans ; Intervertebral Disc Degeneration ; Natural History ; Pathology* ; Reoperation ; Risk Factors ; Smoke ; Smoking ; Spinal Fusion ; Spine ; Sports ; Standard of Care ; Total Disc Replacement ; Viperidae

OBJECTIVE: This study was aimed to evaluate the age at natural menopause and related factors among women in a population based study in 2015 in Isfahan, Islamic Republic of Iran. METHODS: In this cross-sectional study 960 menopausal women were selected by cluster sampling. Demographic, socioeconomic, lifestyle behavior and reproductive history aspects were collected using a structured questionnaire. Woman and her husband's educational level and occupation with family income were the variables to construct socioeconomic status using principal component analysis. RESULTS: Mean and median of natural menopause age were 48.66 and 48 years, respectively. Women body mass index (BMI) more than 30 kg/m2 had significantly higher menopausal age than women with lower BMI (P value = 0.022). The mean of menopausal age was not statistically significant in regard to marital status, physical activity, smoking status, menarche age, age at first pregnancy and history of abortion. Menopause age with pregnancy numbers and age at last pregnancy had a significant positive association. Women with better socioeconomic status had significantly higher natural menopause age. Multiple linear regression shows significant relationship between lower age at menopause with higher age at marriage, higher number of pregnancy and lower socioeconomic status. CONCLUSION: Age at menopause in our studied sample is similar to previous estimates reported for other Iranian populations. Age at marriage, higher number of pregnancy and lower socioeconomic status were the significant factors in relations to age at menopause.
Age Factors ; Body Mass Index ; Cross-Sectional Studies ; Female ; Humans ; Iran* ; Islam ; Life Style ; Linear Models ; Marital Status ; Marriage ; Menarche ; Menopause* ; Motor Activity ; Occupations ; Pregnancy ; Principal Component Analysis ; Reproductive History ; Smoke ; Smoking ; Social Class ; Socioeconomic Factors

BACKGROUND/AIMS: The natural history of severe erosive reflux disease in Korea remains uncertain. We aimed to evaluate endoscopic follow-up results in subjects with severe reflux esophagitis under routine clinical care. MATERIALS AND METHODS: A total 61,891 subjects underwent an upper endoscopic examination in the health check-up program from January 2007 to December 2013. We reviewed medical charts of patients who had been diagnosed with severe reflux esophagitis. The severity of reflux esophagitis was determined by the Los Angeles (LA) classification system. Patients underwent at least one follow up endoscopy after diagnosis of severe reflux esophagitis. We classified the patients into two groups; regressed in severity and remained unchanged, according to follow up endoscopic status. RESULTS: Based on endoscopic findings, 5,938 subjects (9.6%) were found to have reflux esopohagitis: 121 subjects (0.2%) in LA-C; 39 subjects (0.06%) in LA-D. Among 31 patients who had endoscopic follow-up, 23 patients (74.2%) showed regression from LA C/D to LA A/B or minimal change disease or normal. The mean follow up duration was 42.2 months in regression group and 53.2 months in no change group. All patients had been treated with proton pump inhibitors (PPIs) on a regular or on-demand basis. Age, sex, smoking, alcohol, exercise, hypertension, diabetes mellitus, dyslipidemia, sliding hiatal hernia, body mass index, waist circumference and duration of PPIs therapy did not significantly influence regression of severe reflux esophagitis. CONCLUSIONS: The majority of severe reflux esophagitis patients under routine clinical care showed improvement on endoscopic follow-up.
Body Mass Index ; Classification ; Diabetes Mellitus ; Diagnosis ; Dyslipidemias ; Endoscopy* ; Esophagitis ; Esophagitis, Peptic* ; Follow-Up Studies* ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Hypertension ; Korea* ; Natural History ; Nephrosis, Lipoid ; Proton Pump Inhibitors ; Smoke ; Smoking ; Waist Circumference

STUDY DESIGN: Retrospective case series. PURPOSE: To calculate the prevalence of L5-S1 intervertebral disc degeneration (IDD) by evaluating gynecological disease findings, obtained by pelvic magnetic resonance imaging (MRI), and reveal the risk factors for IDD by analyzing its relationship with age, sacral structure, body mass index (BMI), number of deliveries, and intrapelvic space-occupying lesions. OVERVIEW OF LITERATURE: Age, obesity, height, smoking history, occupation, and lumbosacral structure are reportedly the main factors of lumbar IDD. However, in women, the relationship of IDD with obstetric and gynecological history is unclear. METHODS: The presence of L5-S1 IDD was evaluated on sagittal T2-weighted pelvic MRI during gynecological evaluations in 660 Japanese women. We measured the sacral table angle (STA), sacral kyphosis angle (SKA), and intrapelvic space-occupying lesion size. Age, height, weight, BMI, number of deliveries, lumbosacral structure, size of space-occupying lesions, and presence of uterine leiomyoma based on medical records were compared between the IDD-positive and IDD-negative groups. RESULTS: Lumbosacral IDD was observed in 405 cases (61.4%), and its prevalence increased with age. Differences in age, height, weight, BMI, and number of deliveries between the IDD-positive and -negative groups were significant, but differences in STA, SKA, and presence of uterine leiomyoma and space-occupying lesion size were not. Logistic regression analysis indicated that age, BMI, and STA were risk factors for lumbosacral IDD. CONCLUSIONS: Age is the biggest risk factor for lumbosacral IDD in Japanese women, with BMI and STA also contributing to its development. However, SKA and obstetric and gynecological history were not significantly involved.
Asian Continental Ancestry Group* ; Body Mass Index ; Female ; Humans ; Intervertebral Disc Degeneration* ; Kyphosis ; Leiomyoma ; Logistic Models ; Magnetic Resonance Imaging* ; Medical Records ; Obesity ; Occupations ; Prevalence ; Reproductive History ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking

PURPOSE: An accurate determination of the natural history of a cerebral aneurysm has implications on management. Few risk factors other than female gender and cigarette smoking have been identified to be associated with cerebral aneurysm progression, particularly rapid progression. MATERIALS AND METHODS: This case series and literature review serves to illustrate a relationship between spontaneous carotid occlusion and rapid enlargement of cerebral aneurysms. RESULTS: In our case series, we demonstrated that increased hemodynamic stress on collateral vessels caused by a spontaneous carotid occlusion may contribute to unusually rapid aneurysm growth and/or rupture. CONCLUSION: Spontaneous carotid occlusive disease may be considered a risk factor for rapid cerebral aneurysm progression and/or rupture that may warrant more aggressive management options, including more frequent surveillance imaging in previously treated aneurysms.
Aneurysm ; Carotid Artery, Internal* ; Female ; Hemodynamics ; Humans ; Intracranial Aneurysm* ; Natural History ; Risk Factors ; Rupture ; Smoking

OBJECTIVE: Due to longer life spans, patients newly diagnosed with unruptured intracranial aneurysms (UIAs) are increasing in number. This study aimed to evaluate how management of UIAs in patients age 65 years and older affects the clinical outcomes and post-procedural morbidity rates in these patients. METHODS: We retrospectively reviewed 109 patients harboring 136 aneurysms across 12 years, between 1997 and 2009, at our institute. We obtained the following data from all patients : age, sex, location and size of the aneurysm(s), presence of symptoms, risk factors for stroke, treatment modality, and postoperative 1-year morbidity and mortality. We classified these patients into three groups : Group A (surgical clipping), Group B (coil embolization), and Group C (observation only). RESULTS: Among the 109 patients, 56 (51.4%) underwent clipping treatment, 25 (23%) patients were treated with coiling, and 28 observation only. The overall morbidity and mortality rates were 2.46% and 0%, respectively. The morbidity rate was 1.78% for clipping and 4% for coiling. Factors such as hypertension, diabetes mellitus, hypercholesterolemia, smoking, and family history of stroke were correlated with unfavorable outcomes. Two in the observation group refused follow-up and died of intracranial ruptured aneurysms. The observation group had a 7% mortality rate. CONCLUSION: Our results show acceptable favorable outcome of treatment-related morbidity comparing with the natural history of unruptured cerebral aneurysm. Surgical clipping did not lead to inferior outcomes in our study, although coil embolization is generally more popular for treating elderly patients. In the treatment of patients more than 65 years old, age is not the limiting factor.
Aged ; Aneurysm ; Aneurysm, Ruptured ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Hypercholesterolemia ; Hypertension ; Intracranial Aneurysm ; Natural History ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stroke ; Surgical Instruments

BACKGROUND: Breast cancer is the one of the commonly diagnosed female cancer in Korea. Numerous factors have been noted to be associated with risk of breast cancer: body mass index, menarche, menopause, family history, pregnancy and delivery, breastfeeding, alcohol use, smoking habits, diet, education and use of oral contraceptives. Little is known about hair minerals in breast cancer patient and about correlation between hair minerals and body mass index. METHODS: We compared hair mineral analysis data of 37 breast cancer subject with age and body mass index-matched normal control data (N = 144) by cross-sectional analysis. All breast cancer patients were newly diagnosed at one Breast Cancer Center in Ajou University and had their hair cut before anti-cancer chemotherapy, and the normal controls (without breast cancer) also had their hair cut for various reasons in out-patient clinics of the Department of Family Practice and Community Health. RESULTS: Breast cancer patients had low calcium, magnesium, and zinc, whereas they had high arsenic, sodium, and potassium compared with the normal controls. Only hair zinc level had significant negative correlation with body mass index (r = -0.705, P < 0.001) in breast cancer patients, not in normal controls. CONCLUSION: We observed the difference of hair mineral patterns in newly diagnosed breast cancer patients compared to normal controls and the correlation between these minerals and body mass index in breast cancer patient. Especially hair zinc concentration was significantly reduced and had significant negative correlation with body mass index in breast cancer patients.
Arsenic ; Body Mass Index ; Breast ; Breast Feeding ; Breast Neoplasms ; Calcium ; Contraceptives, Oral ; Cross-Sectional Studies ; Family Practice ; Female ; Food Habits ; Hair ; Humans ; Korea ; Magnesium ; Menarche ; Menopause ; Minerals ; Outpatients ; Potassium ; Reproductive History ; Smoke ; Smoking ; Sodium ; Zinc

BACKGROUND: Although there were studies about ethnic differences in aortic valve thickness and calcification that they may play a role in aortic valvular stenosis (AVS) progression, few studies about the progression rate of AVS in Asian population have been reported. The purpose of this study was to evaluate the progression rate of AVS in Korean patients. METHODS: We retrospectively analyzed 325 patients (181 men, age: 67 +/- 13 years) with AVS who had 2 or more echocardiograms at least 6 months apart from 2003 to 2008. The patients with other significant valvular diseases or history of cardiac surgery were excluded. The progression rate of AVS was expressed in terms of increase in maximum aortic jet velocity per year (meter/second/year). RESULTS: Baseline AVS was mild in 207 (64%), moderate in 81 (25%), and severe in 37 (11%). There were no significant differences among the three groups in terms of age, gender, hypertension, smoking, and hypercholesterolemia. The mean progression rate was 0.12 +/- 0.23 m/s/yr and more rapid in severe AVS (0.28 +/- 0.36 m/s/yr) when compared to moderate (0.14 +/- 0.26 m/s/yr) and mild AVS (0.09 +/- 0.18 m/s/yr) (p < 0.001). The progression rate in bicuspid AVS was significantly higher than other AVS (0.23 +/- 0.35 vs. 0.11 +/- 0.20 m/s/yr, p = 0.002). By multivariate analysis, initial maximum aortic jet velocity (Beta = 0.175, p = 0.003), bicuspid aortic valve (Beta = 0.127, p = 0.029), and E velocity (Beta = -0.134, p = 0.018) were significantly associated with AVS progression. CONCLUSION: The progression rate of AVS in Korean patients is slower than that reported in Western population. Therefore, ethnic difference should be considered for the follow-up of the patients with AVS.
Aortic Valve ; Aortic Valve Stenosis ; Asian Continental Ancestry Group ; Bicuspid ; Constriction, Pathologic ; Disease Progression ; Follow-Up Studies ; Heart Valve Diseases ; Humans ; Hypercholesterolemia ; Hypertension ; Male ; Multivariate Analysis ; Natural History ; Retrospective Studies ; Smoke ; Smoking ; Thoracic Surgery

Cerebral aneurysms are common lesions. In most populations, the incidence of subarachnoid hemorrhage (SAH) is 10 per 100,000 personyears. The case fatality rate of SAH is about 50 percent in population-based studies, with a trend toward gradual improvement. Associated conditions include autosomal dominant polycystic kidney disease, fibromuscular dysplasia, Marfan's syndrome, Ehlers-Danlos syndrome, and arteriovenous malformations of the brain. The risk factors for the rupture of cerebral aneurysms include increasing size, specific site, smoking, and hypertension. Cerebral aneurysms can be divided into two different categories: saccular (atherosclerotic) and dissecting (nonatherosclerotic). The most common histologic finding in saccular aneurysms is a decrease in the tunica media, the middle muscular layer of the artery, causing structural defects. These defects combined with hemodynamic factors, lead to aneurysmal outpouchings at arterial branch points in the subarachnoid space at the base of the brain. Dissecting aneurysms are characterized by widespread disruption of the internal elastic lamina that leads to mural thrombus formation and causes ischemic or hemorrhagic symptoms. Ultimately, therapeutic strategies should be based on the epidemiology, natural history, and pathogenesis of the cerebral aneurysms.
Aneurysm ; Aneurysm, Dissecting ; Arteries ; Arteriovenous Malformations ; Brain ; Ehlers-Danlos Syndrome ; Fibromuscular Dysplasia ; Hemodynamics ; Hypertension ; Incidence ; Intracranial Aneurysm ; Marfan Syndrome ; Natural History ; Polycystic Kidney, Autosomal Dominant ; Risk Factors ; Rupture ; Smoke ; Smoking ; Subarachnoid Hemorrhage ; Subarachnoid Space ; Thrombosis ; Tunica Media