For quality assurance purposes, the authors correlated aspiration cytology and subsequent tissue findings and examined the reasons for discrepancies. In three months from Jan. to Mar. 1996, 1,383 aspirations were performed, of which 285 (20.6%) had subsequent tissue diagnoses within two months. The aspiration sites were thyroid (483), lymph node (LN) (290), breast (250), soft tissue (154), liver (89), lung (49), salivary gland (26), pancreas (22), gallbladder (3), bone (3), joint (2), adrenal gland (2), scrotum (2), mediastinum (2), omentum (2), oral cavity (1), chest wall (1), and intraabdominal (1) and pelvic cavities (1). A total of 68 discrepancies were identified, and biopsies and smears from these cases were reviewed monthly. In 27 cases (40%), the discrepancy was attributed to sampling error. In five cases (9%), aspiration gave superior results with better sampling and preservation than biopsy. Thirty six cases (53% of discrepant cases) were errors in cytologic diagnosis. We categorized these discrepancies into "A", "B", and "C" ("A": minor disagreement with no affect on patient care, "B": minimal affect on patient care, "C": major affect on patient care), which were 9 (13%), 14 (21%) and 13 (19%) cases, respectively. In thirteen cases of category "C", there were eleven false negative and two false positive diagnoses. Eleven false negative cases included thyroid (3), lymph node (2), breast (2), bone (1), salivary gland (1), lung (1), and liver (1). Three cases of thyroid were papillary carcinomas diagnosed as nodular hyperplasia (1), occasional pleomorphic cells (1), and cystic change (1). Two breast cases of invasive ductal carcinomas were diagnosed as ductal hyperplasia. A malignant lymphoma was diagnosed as reactive hyperplasia and a metastatic carcinoma of LN was diagnosed as tuberculosis. Other cases were malignant tumors of bone, salivary gland, lung, and liver those were misinterpreted as benign lesion or normal. Of two false positive cases, one was nodular hyperplasia of thyroid diagnosed as papillary carcinoma and the other was normal islet cell of pancreas diagnosed as islet cell tumor. A continuous monitoring of laboratory performance is an essential component of the quality control and assurance, and the review of discrepant cases provides useful information for improvement of diagnosis.
Adenoma, Islet Cell ; Adrenal Glands ; Aspirations (Psychology) ; Biopsy ; Breast ; Carcinoma, Ductal ; Carcinoma, Papillary ; Diagnosis ; Gallbladder ; Humans ; Hyperplasia ; Islets of Langerhans ; Joints ; Liver ; Lung ; Lymph Nodes ; Lymphoma ; Mediastinum ; Mouth ; Omentum ; Pancreas ; Patient Care ; Quality Control ; Salivary Glands ; Scrotum ; Selection Bias ; Thoracic Wall ; Thyroid Gland ; Tuberculosis

Of all the aeromedical treats to flying safety, G-induced loss of consciousness (G-LOC) must be one of the most important. The present study is undertaken to acquire the physiological normative data (including lifestyle and physical fitness) of KAF pilots and to investigate the factors that will be related with G-LOC. From 15 May through 27 Nov 2000, 464 KAF pilots underwent high G training and flight performance tests at the Aeromedical Research and Training Center are checked CBC, total cholesterol, PFT, physical fitness battery tests-muscular strength, muscular endurance, power, and flexibility. High G training and 2 kinds (before and after the G-training) of questionnaire were tried. Pilot's attitude for health promotion was relatively passive and the proportions as of high and borderline risk for atherosclerosis in total cholesterol level were 4.98% and 22.1%, respectively. 17.6% of the pilots had G-LOC and three quarters of them fell into G-LOC within the first 5 seconds. Variables showing significant correlation (p<0.05) with G-LOC were as follows; height, age, total flying time, and high G-training times. Trunk extension had positive correlation and curls ups had negative correlation, but the reasons are needed more following study. Also, the judgments of pilots and a supervisor in skillfulness of L1 maneuver were significant with G-LOC.
Atherosclerosis ; Cholesterol ; Diptera ; Health Promotion ; Judgment ; Life Style ; Physical Fitness ; Pliability ; Risk Factors* ; Unconsciousness ; Surveys and Questionnaires

The authors analysed 2,653 cases of transthoracic fine needle aspiration cytology of the lung to evaluate the diagnostic accuracy and its limitation. A comparison was made between the original cytologic and the final histologic diagnoses on 1,149 cases from 1,074 patients. A diagnosis of malignancy was established in 38.3% benign in 48.1%, atypical lesion in 2.3%, and inadequate one in 11.9% of the cases. Statistical data on cytologic diagnoses were as follows; specificity 98.9%: sensitivity of procedure, 76.8%: sensitivity of diagnosis, 95.5%: false positive 5 cases: false negative 18 cases: predictive value for malignancy, 98.8%: predictive value for benign lesion, 79.5%: overall diagnostic efficiency, 87.5%: typing accuracy in malignant tumor, 80%.
Biopsy, Fine-Needle ; Diagnosis ; Diarrhea* ; Hemolytic-Uremic Syndrome* ; Humans ; Lung ; Sensitivity and Specificity

Castleman's disease is a rare non-neoplastic lymphoproliferative disorder of unknown etiology. It is divided into three histologic subtypes; hyaline-vascular(HV), plasma cell(PC) type and mixed type (HV-PC). It has two clinical expressions. The localized form, which presents as a slow growing mass, has a relatively benign clinical course. The multicentric form is multilocated and holds significant morbidity. The mainstay of treatment of the localized form is surgical resection. The multicentric form requires medical treatment comprising prednisolone and other immunosuppressor drugs. The disease in children seems to have a more favorable course than in adults. We report a 13-year- old boy with Castleman's disease of multicentric form who was successfully treated with prednisolone and intravenous immunoglobulin.
Adult ; Child* ; Giant Lymph Node Hyperplasia* ; Humans ; Immunoglobulins ; Lymphoproliferative Disorders ; Male ; Plasma ; Prednisolone*

We report 4 cases of malignant thymoma which were composed of 2 cases of invasive thymoma and 2 cases of thymic carcinoma. The cytologic findings of invasive thymoma were similar to those of benign thymoma. The distinctive cytologic features of thymic carcinoma were necrotic background, irregular clusters and individually scattered arrangement of anaplastic epithelial cells, and some scattered mature small lymphocytes. These findings may be found in the Hodgkin's lymphoma, seminoma, and metastatic squamous cell carcinoma, undifferentiated carcinoma, and large cell carcinoma of the lung. But, the feature of irregular clustering of anaplastic epithelial cell having scanty cytoplasm was different from Hodgkin's lymphoma and seminoma. Clinical and radiologic findings as well as cytologic finding were helpful in differential diagnosis of thymic carcinoma from metastatic carcinoma.
Breast ; Carcinoma ; Carcinoma, Large Cell ; Carcinoma, Squamous Cell ; Child* ; Cytoplasm ; Diagnosis, Differential ; Epithelial Cells ; Hodgkin Disease ; Humans ; Infant* ; Lung ; Lymphocytes ; Seminoma ; Thymoma ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND: Means to measure death anxiety, death depression and sense of symbolic immortality with approved validity and reliability does not yet exist in Korea. METHODS: Existing English questionnaires such as Templer Death Anxiety Scale (TDAS), Death Depression Scale (DDS), Sense of Symbolic Immortaligy Scale (SSIS) were translated into Korean by 5 translators, and then reviewed by 3 non-participants of translation for collegial summary and this summary was counter-translated again by another 2 non-participants. Another 3 non-participants of translation and counter-translation were chosen to examine the two sentences of each item. Then reexamination was done by retranslating and counter-translating the parts with errors. Aftr pretest on ordinary people. the completed questionnaires were given to medical students, residents and nurses of a university hospital. Pastors and missionaries were selected as comparison group. RESULTS: Kuder-Richardson or Cronbach-alpha that represent internal consistency of TDAS, DDS and SSIs was 0.69, 0.84 and 0.78. The three sentences that lowered internal consistency of SSIS was deleted. BDI and DDS showed a positive correlation (0.32, P=0.02), suggesting proved construct validity. Correlation coefficient that proves construct validity of TDAS and DDS was 0.54 (P<0.01), of SSIS and TDAS -0.23(P=0.04), of SSIS and DDS -0.29(P=0.01). The TDAS and DDS(P<0.01), DDS and BDI(P=0.02) have shown a positive correlation were shown. There was significant difference in the score of SSIS(P<0.01). The same results in cases where the 3 sentences was deleted. CONCLUSION: Korean versions of TDAS, DDS and SSIS were reliable and valid.
Anxiety* ; Attitude to Death ; Depression* ; Humans ; Korea ; Missions and Missionaries ; Reproducibility of Results* ; Students, Medical ; Surveys and Questionnaires

Reports on the cytologic or histopathologic findings of inflammatory pseudotumors are relatively infrequent and most of them have dealt with those involving the lung, liver, genitourinary tract, alimentary tract, spleen, mediastinum, retroperitoneum, etc. Moreover there have not been any cytologic studies of those involving lymph nodes. We present fine needle aspiration cytologic features of inflammatory pseudotumor occurring in a lymph node in a 64 year-old man. The aspirate consisted of proliferating spindle cells and admixed histiocytes, fibroblasts, lymphocytes, and plasma cells. Histiocytes were present either singly or in loosely cohesive small clusters. A few multinucleated giant cells were present as well. However, tuberculosis could be excluded by the absence of typical granuloma, caseation necrosis, or characteristic mixed spindle and inflammatory cell components. Other benign and malignant lymphadenopathies could also be differentiated based on cytologic findings.
Biopsy, Fine-Needle* ; Cellular Structures ; Fibroblasts ; Giant Cells ; Granuloma ; Granuloma, Plasma Cell* ; Histiocytes ; Humans ; Liver ; Lung ; Lymph Nodes* ; Lymphocytes ; Mediastinum ; Middle Aged ; Necrosis ; Plasma Cells ; Spleen ; Tuberculosis

BACKGROUND: The value of metabolic syndrome (MetS) evaluation in predicting cardiovascular disease is recently criticized. We investigated, in hypertensive patients without diabetes mellitus, the influence of MetS on the target organ damage. METHODS: Data from the fourth Korean National Health and Nutrition Examination Survey performed in 2008 were analyzed. Metabolic syndrome is defined by the 2001 National Cholesterol Education Program-Third Adult Treatment Panel guideline. The category of hypertension is defined following the seventh report of the Joint National Commitee-7 guideline. RESULTS: The prevalence of target organ damage (TOD), defined as history of myocardial infarction/angina/stroke/chronic renal disease as well as the presence of macroalbuminuria, was increased according to blood pressure; 8.5% in the population of normal blood pressure, 12.5% in those of prehypertensive range, and 20.5% in hypertensive population. Hypertensive population associated with MetS showed greater prevalence of TOD than those without MetS even excluding diabetic population. The presence of MetS in hypertensive population showed 2.2 fold increased risk for TOD. Any single parameter of MetS diagnostic criteria as well as obesity did not show the comparable range of risk prediction as MetS. CONCLUSIONS: These results indicate a strong relationship of Mets with TOD in hypertensive population. Evaluating the metabolic components in hypertensive population is necessary in establishing management strategies for overall risk.
Adult ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Diabetes Mellitus ; Humans ; Hypertension ; Joints ; Nutrition Surveys ; Obesity ; Prevalence

BACKGROUND: Tuberculosis is still one of the most seriously threatening infections in Korea, because of multidrug resistant tuberculosis. Results of antituberculosis drug susceptibility test can provide clinicians very important informations for selection of proper regimens for treatment. METHODS: In this study the results of antituberculosis drug susceptibility test of 298 cases at Kyunghee Medical Center from 2000 to 2003 were retrospectively analysed to evaluate the trend of antituberculosis drug susceptibility. The procedure of drug susceptibility test was based on the absolute concentration method using Lowenstein-Jensen solid media. RESULTS: The resistance rate of Mycobacterium tuberculosis to one or more drugs was increased from 29.3% in 2000 to 48.2% in 2003, and the rates of multiple resistance to two or more drugs increased from 13.3% in 2000 to 20.5% in 2003. The increase in resistance rate to individual drug during study period were 20.0% to 24.1% in isoniazid, 9.3% to 19.3% in rifampicin, 5.3% to 15.7% in ethambutol, 4.0% to 10.8% in para-aminosalicylic acid, 2.7% to 6.0% in kanamycin, 1.3% to 7.2% in ethionamide, 1.3% to 6.0% in capreomycin, 1.3% to 7.2% in prothionamide, 0.0% to 12.1% in ofloxacin, 6.7%to 3.6% in streptomycin, 6.7% to 7.2% in cycloserine, 10.7% to 8.4% in pyrazinamide, respectively. CONCLUSIONS: The resistance rate of M. tuberculosis has been increased with years and multidrug resistant M. tuberculosis was commonly encountered in the specimens from the patients visited Kyunghee Medical center.
Aminosalicylic Acid ; Capreomycin ; Cycloserine ; Ethambutol ; Ethionamide ; Humans ; Isoniazid ; Kanamycin ; Korea ; Mycobacterium tuberculosis ; Ofloxacin ; Prothionamide ; Pyrazinamide ; Retrospective Studies ; Rifampin ; Streptomycin ; Tuberculosis

As the usage of biologics for rheumatic diseases increases, such as rheumatoid arthritis and ankylosing spondylitis, various cutaneous adverse events are also being increasingly reported. We experienced a case of development of vitiligo during a TNF-alpha antagonist therapy in a 22-year-old woman with rheumatoid arthritis. The patient was presented with vitiligo lesions on the dorsum of both hands after 1 month of treatment with etanercept. Vitiligo improved with topical tacrolimus ointment and excimer laser treatment without the discontinuation of etanercept. No clearly defined mechanism for vitiligo induced by TNF-alpha antagonist exits. However, considering that vitiligo is an autoimmune disorder, the development of this skin lesion in association with the TNF-alpha antagonist could be explained by a paradoxical induction of the autoimmune process.
Arthritis, Rheumatoid ; Biological Agents ; Female ; Hand ; Humans ; Immunoglobulin G ; Lasers, Excimer ; Receptors, Tumor Necrosis Factor ; Rheumatic Diseases ; Skin ; Spondylitis, Ankylosing ; Tacrolimus ; Tumor Necrosis Factor-alpha ; Vitiligo ; Young Adult ; Etanercept