OBJECTIVE: Our purpose was to compare the pregnancy outcomes of nulliparous women aged 40 years and older with those of nulliparous women under 35 years of age. METHODS: From January 1989 to December 1998 total 57,563 deliveries were seen in Gachon Gil Medical Center. Among them we experienced 59 cases of nulliparas at 40 years and older. These women were compared with 188 young nulliparas under 35 years of age as the control group. The statistical analysis was performed using Chi-square tests, and statistical significance was defined as p<0.05. RESULTS: The incidence rate of elderly nulliparas aged 40 years and older was increased from 0.04% in 1989 to 0.30% in 1998. The age distribution was from 40 years to 45 years. The gravidity of eldery nulliparas was 2.2 in comparison with 1.6 in control group. The incidence of uterine myoma, gestational DM, IUGR and oligohydramnios was significantly high rate in elderly nulliparas. There was significantly high rate of cesarean section in elderly nulliparas(88.1%) in comparison with control group(40.4%). The reasons of cesarean section were her demand(39.0%), CPD(15.3%) and breech presentation(13.6%) in decreasing order. The preterm delivery rate was 10.2% in elderly nulliparas in comparison with 4.3% in the control group. Placenta accreta and uterine atony were significantly high in elderly nulliparas and mean estimated blood loss was also high. There was no difference in 5-minute Apgar score between both group, but there were more cases of neonatal intensive care unit admission in neonates of elderly nulliparas(6.8% vs 0%). CONCLUSION: The incidence of elderly nulliparas is continuously increasing. The elderly nulliparas and their babies are at greater risk than young women. Therefore all elderly nulliparas aged 40 years and older can be regarded as high risk patients and they must be managed with careful attention.
Age Distribution ; Aged ; Apgar Score ; Cesarean Section ; Female ; Fetal Growth Retardation ; Gravidity ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Leiomyoma ; Oligohydramnios ; Placenta Accreta ; Pregnancy ; Pregnancy Outcome ; Uterine Inertia

PURPOSE: The Mesima-Ex is a kind of biologic response modifier, which is extracted from a mushroom called Phellinus linteus. Mesima-Ex consists of various chemical compounds which include protein bound polysaccharide, mucoprotein, triterpenoid, and quinones. Mesima-Ex exerts its antitumor effects by augmenting host immune response without any toxic side effects. In vitro study, Mesima-Ex seems to potentiates antibody dependent cell mediated cytotoxicity (ADCC) and cell mediated cytotoxicity (CMI) against tumor cells. We initiated this study to verify antitumor effects of Mesima-Ex as an antineoplastic agent. MATERIALS AND METHOD: Gastric cancer patients who underwent curative resection with normal hepatic and renal function were eligible. They were divided into two groups by random number table. One group (N=30: Mesima-Ex group) received postoperative adjuvant chemotherapy with 5-FU (500 mg/m2 weekly), adriamycin (40 mg/m2 every 3 weeks) and Mesima-Ex (6 cap daily per Os). Another group (N=37: control group) received 5-FU and adriamycin only without Mesima-Ex. NK (natural killer cell) activity, ADCC (antibody dependent cell mediated cytotoxicity), CD4 , and CD8 cells were measured and an analysis of disease free survival rate of the two study groups was performed. RESULTS: Sixty seven patients were enrolled in this study. Their median age was 55 years old. NK activity (basal activity: 25%) was enhanced significantly at the 2nd, and 4th months in the Mesima-Ex group (28.9%, 43.4%, p<0.05). ADCC was also enhanced from 37% to 42.1% at the 2nd month in the Mesima-Ex group (p<0.05). The control group did not show any significant change in NK activity or ADCC. The CD4 cell ratio was increased from 37% to 42.1% at the 2nd months in the Mesima-Ex group but not in the control group (p<0.05). There was no significant change in CD8 subsets (p>0.05). There were no toxic side effects more than grade III from Mesima-Ex administration. The two year disease free survival rate was higher in the Mesima-Ex group than that of the control group (77% vs 58%, p<0.05). CONCLUSION: Mesima-Ex can be used safely as an immunomodulator with standard chemotherapeutic agents for purpose of adjuvant chemotherapy. Mesima-Ex was effective in augmenting host immune response in vitro. The Mesima-Ex group showed a higher two year disease free survival rate than that of the control group.
Agaricales ; Antibody-Dependent Cell Cytotoxicity ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Doxorubicin ; Fluorouracil ; Humans ; Middle Aged ; Quinones ; Stomach Neoplasms*

Subacute sclerosing panencephalitis (SSPE) is a slowly progressing, chronic persistent fatal central nervous system disease, involving gray and white matter, especially white matter caused by measles virus that affecting children and young adult. 45 to 68% of affected individuals had measles before the age of 2. Current knowledge of the pathogenesis of SSPE involves mutation of the measles virus, resulting in lack of production of the M(Matrix)-protein. No therapeutic maneuvour gas been proven conclusively to be of value. But recently intraventricular alpha-interferon (a-IFN) injection combined with oral inosiplex increase the length of survival and may bring remission or stabilization in SSPE. We report a case of SSPE which was diagnosed by history, clinical manifestation, typical EEG findings, high titer of measles antibodies in cerebrospinal fluid and serum by hemagglutinin inhibition method. We tried intraventricular a-IFN injection via Ommaya reservoir and oral inosiplex.
Antibodies ; Central Nervous System ; Cerebrospinal Fluid ; Child ; Electroencephalography ; Hemagglutinins ; Humans ; Inosine Pranobex ; Interferon-alpha* ; Measles ; Measles virus ; Subacute Sclerosing Panencephalitis* ; Young Adult

1) The sexual abuse victim group showed significantly higher neurotic traits of Free floating anxiety (p<0. 05), Phobic(p<0.01), Obsession(p<0.01), Somatic(p<0.05), Depression(p<0.01) than the control group. 2) The Neurotic traits of Somatic(p<0.01), Depression(p<0.01), Hysteric(p<0.01) were higher in the multiple-abused than the single-abused. 3) When the duration of being abused was concerned, subjects with more than 1 year duration had significantly higher neurotic traits of Obsession(p<0.05), Somatic(p<0.05), Depression(p<0.05) than subjects with less than 1 year duration. 4) The neurotic traits of Phobic, Somatic, Depression were significantly higher in the subjects with higher intensity of sexual abuse than with lower intensity. 5) Among 68 victims, 31 girls(45%) were assaulted by strangers, 10(14%) were by relatives, 7(10.3%) were by siblings, 6(8.8%) were by neihbors. Among them, 34 girls(50%) bad counselling or psychotherapy and the people to whom they had sought for help were friends(23 girls ; 68%), parents (7 girls ; 11.7%) and mental health professonals (2 girls ; 5.9%).
Anxiety ; Daegu* ; Depression ; Female* ; Humans ; Mental Health ; Parents ; Psychotherapy ; Sex Offenses* ; Siblings

BACKGROUND: As the prevalence of obesity has increased, the management of obesity has become important as well. The assessment of abdominal obesity is necessary, because it is an independent risk factor of cardiovascular disease. Although WHO Western Pacific Region recommends measurement of waist circumference as well as BMI, there is no data that supports screening and management of obesity in a Health Promotion Center (HPC). Therefore, surveys concerning such issues were done among HPCs in Seoul, Incheon and Kyonggi. METHODS: From April to May 2002, we investigated 115 general hospitals in Seoul, Incheon, Kyonggi and recruited 94 subjects. We obtained the data from a doctor or a nurse who worked in a HPC by telephone survey. RESULTS: The number of respondents was 100 among 115 and in 94 subjects we obtained detailed information. For criteria of obesity, the proportion of hospitals that used the BMI was 35.1%, and those that use the ideal body weight was 50.0%. For criteria of overweight, the BMI was used in 19.1%, and the ideal body weight in 44.7%. Those who did not use any method was 27.7%. Those using the criteria of abdominal obesity was 35.1%, but only 14.9% used waist circumference and 16.9% used bioelectrical impedance analysis. Diet control and exercise was recommended in 57.4% and 61.4%, respectively. Drug therapy was used in 38.2%. CONCLUSION: Although WHO Western Pacific Region recommends a new criteria of obesity, many HPCs do not follow them. Especially, the degree of recognition for abdominal obesity was low. Effort to assess and manage obesity adequately is necessary.
Cardiovascular Diseases ; Surveys and Questionnaires ; Diet ; Drug Therapy ; Electric Impedance ; Gyeonggi-do ; Health Promotion* ; Hospitals, General ; Ideal Body Weight ; Incheon ; Mass Screening* ; Obesity* ; Obesity, Abdominal ; Overweight ; Prevalence ; Risk Factors ; Seoul ; Telephone ; Waist Circumference

Cytomegalovirus (CMV) infection is more frequent in immunocompromised patients those with acquired immunodeficiency syndrome (AIDS), malignant disease, steroid therapy. However, CMV can infect a healthy person who has normal immunity. Most cases of CMV infections are due to reactivation of latent virus. We report a case of cytomegalovirus colitis in a 73 years old woman who has congestive heart failure with normal immunity. Sigmidoscopy reveals cobble stone like mucosa and deep ulceration. CMV infection produces a cytomegalic cell containing a intranuclear inclusion, which is surrounded by clear halo in Hematoxylin-Eosin stain. Immunohistochemical stain for CMV reveals focal positive in cytoplasm and in nuclei of large cells. We diagnosed CMV colitis with histopathologic finding and immunohistochemistry through sigmoidoscopic mucosal biopsy.
Acquired Immunodeficiency Syndrome ; Aged ; Biopsy ; Colitis* ; Cytomegalovirus* ; Cytoplasm ; Female ; Heart Failure ; Humans ; Immunocompromised Host ; Immunohistochemistry ; Intranuclear Inclusion Bodies ; Mucous Membrane ; Ulcer

OBJECTIVE: To evaluate the diagnostic accuracy of a new ultrasound (US) classification system for differentiating between benign and malignant solid thyroid nodules. MATERIALS AND METHODS: In this study, we enrolled 191 consecutive patients who received real-time US and subsequent US diagnoses for solid thyroid nodules, and underwent US-guided fine-needle aspiration. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories by real-time US: "malignant," "suspicious for malignancy," "borderline," "probably benign," and "benign". We evaluated the diagnostic accuracy of thyroid US and the cut-off US criteria by comparing the US diagnoses of thyroid nodules with cytopathologic results. RESULTS: Of the 191 solid nodules, 103 were subjected to thyroid surgery. US categories for these 191 nodules were malignant (n = 52), suspicious for malignancy (n = 16), borderline (n = 23), probably benign (n = 18), and benign (n = 82). A receiver-operating characteristic curve analysis revealed that the US diagnosis for solid thyroid nodules using the 5-category US classification system was very good. The sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86%, 95%, 91%, 92%, and 92%, respectively, when benign, probably benign, and borderline categories were collectively classified as benign (negative). CONCLUSION: The diagnostic accuracy of thyroid US for solid thyroid nodules is high when the above-mentioned US classification system is applied.
Biopsy, Fine-Needle ; Cytodiagnosis ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Sensitivity and Specificity ; Thyroid Neoplasms/classification/congenital/pathology/*ultrasonography ; Thyroid Nodule/classification/pathology/*ultrasonography ; Ultrasonography, Interventional

Stent thrombosis is generally a fatal complication after percutaneous coronary intervention. Despite the incidence of stent thrombosis has reduced with improved techniques and drugs, stent thrombosis persists at a rate of 0.5-2% in elective cases, and up to 6% in patients with acute coronary syndromes. It almost always causes acute myocardial infarction or sudden cardiac death. While very late stent thrombosis, occurring beyond 1 year, is not uncommon with the use of drug-eluting stents, it is distinctly unusual with the use of bare-metal stents. We report a case of very late thrombosis of a bare-metal stent occurring 880 days after coronary stent implantation.
Acute Coronary Syndrome ; Coronary Thrombosis ; Death, Sudden, Cardiac ; Drug-Eluting Stents ; Humans ; Incidence ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stents* ; Thrombosis*

BACKGROUND: The brachial-ankle pulse wave velocity (baPWV) is a useful parameter to assess arterial stiffness. However, it is difficult to evaluate arterial stiffness in hypertensive patients because the baPWV is affected by the blood pressure itself. This study was designed to estimate the relationship between the change of the blood pressure parameters and the baPWV (delta baPWV) when hypertensive patients were subjected to an acute reduction of blood pressure. METHODS: Thirty patients with essential hypertension and whose blood pressure was higher than 140/90 mmHg were enrolled. In all the patients, the blood pressure and baPWV were measured using an automatic waveform analyzer with the patients at a resting state. When the reduction of blood pressure was more than 10 mmHg after sublingual administration of nifedipine 10 mg, then the blood pressure and baPWV were measured again in the same manner and then they were compared with the baseline values. Spearman's correlation and multiple linear regression tests were performed to estimate the relationship between the change of the blood pressure parameters (delta SBP, delta DBP, delta MAP and delta PP) and the delta baPWV. RESULTS: The baPWV was significantly decreased shortly after the administration of nifedipine (1903.6+/-305.2 cm/sec vs. 1716+/-252.0 cm/sec, respectively, p<0.01). The delta baPWV was correlated with the delta SBP (r=0.550, p<0.01), delta DBP (r=0.386, p<0.05), delta MAP (r=0.441, p<0.05), and delta PP (r=0.442. p<0.05). On the multiple regression analysis, the delta SBP was the only significant variable for predicting the delta baPWV, and the linear equation was delta baPWV=8.7 x SBP-48. CONCLUSIONS: The baPWV is affected by the systolic blood pressure level to a large degree and careful attention must be paid to the blood pressure level when evaluating arterial stiffness with using the baPWV.
Administration, Sublingual ; Aged ; Blood Flow Velocity ; Blood Pressure/*drug effects/physiology ; Brachial Artery/*physiopathology ; Female ; Humans ; Hypertension/diagnosis/*physiopathology ; Male ; Middle Aged ; Nifedipine/administration & dosage ; Pulse ; Systole/physiology ; Vasodilator Agents/administration & dosage

BACKGROUND: Analysis of mutations in the epidermal growth factor receptor gene (EGFR) is important for predicting response to EGFR tyrosine kinase inhibitors. The overall rate of EGFR mutations in Korean patients is variable. To obtain comprehensive data on the status of EGFR mutations in Korean patients with lung cancer, the Cardiopulmonary Pathology Study Group of the Korean Society of Pathologists initiated a nationwide survey. METHODS: We obtained 1,753 reports on EGFR mutations in patients with lung cancer from 15 hospitals between January and December 2009. We compared EGFR mutations with patient age, sex, history of smoking, histologic diagnosis, specimen type, procurement site, tumor cell dissection, and laboratory status. RESULTS: The overall EGFR mutation rate was 34.3% in patients with non-small cell lung cancer (NSCLC) and 43.3% in patients with adenocarcinoma. EGFR mutation rate was significantly higher in women, never smokers, patients with adenocarcinoma, and patients who had undergone excisional biopsy. EGFR mutation rates did not differ with respect to patient age or procurement site among patients with NSCLC. CONCLUSIONS: EGFR mutation rates and statuses were similar to those in published data from other East Asian countries.
Adenocarcinoma ; Asian Continental Ancestry Group ; Biopsy ; Carcinoma, Non-Small-Cell Lung* ; Diagnosis ; Epidermal Growth Factor* ; Female ; Humans ; Lung Neoplasms ; Mutation Rate ; Pathology ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor* ; Smoke ; Smoking