OBJECTIVES: Nasal continuous positive airway pressure (nCPAP) is the treatment of choice and has been shown to reduce the frequency of nocturnal respiratory events, improve sleep architecture, and decrease daytime sleepiness in patients with obstructive sleep apnea syndrome (OSAS). However, little is known about the compliance of nCPAP treatment in Korea. Our objective was to look into the nCPAP compliance and examine the factors influencing it. METHODS: We reviewed the records of one hundred and twenty consecutive patients with OSAS referred for nocturnal polysomnography with nCPAP pressure titration during the period of January 1995 through April 1999 to the Seoul National University Hospital. We performed a telephone interview and obtained data from eighty-three patients. RESULTS: In sixty patients who had accepted nCPAP treatment, twenty-six patients (43.3%) were still using nCPAP device, while thirty-four patients (56.7%) stopped using it. Fifteen patients (25%) were using nCPAP device everyday. In thirty-four patients who discontinued nCPAP use, twenty-five patients (73.5%) did within the first three months, and thirty-one (91.2%) within the first year. Significant predictor of long-term nCPAP use was the presence of subjective daytime sleepiness before nCPAP application. CONCLUSIONS: Long-term compliance with nCPAP treatment appears to be associated with the presence of subjective daytime sleepiness before nCPAP application. Long-term compliance with nCPAP may be mostly predicted from the usage pattern within the first three months of use.
Compliance* ; Continuous Positive Airway Pressure* ; Humans ; Interviews as Topic ; Korea ; Polysomnography ; Seoul ; Sleep Apnea, Obstructive*

The present study was aimed at investigating the effect of cyclosporine A (CsA) on the renal renin-angiotensin systems. In rats chronically treated with CsA, the intrarenal expression of various genes of the renin-angiotensin system was assessed by Northern blot analysis. Along with the increases in plasma and renal renin activities, chronic CsA-treatment differentially affected the renal expression of renin-angiotensin system. The treatment with CsA for one week did not significantly alter the expression of either type 1 angiotensin II receptor (AT1A) or angiotensinogen gene, but increased the renin mRNA level. The three-week-treatment caused increases in the expression not only of renin but also of AT1A and angiotensinogen genes. Supplementation with L-arginine kept the expression of renin mRNA normal in the one-week-treated, but failed to prevent the alterations of the gene expression in the three-week-treated. Feedback control among components of the renin-angiotensin system also influences angiotesinogen. In the liver, the expression of angiotensinogen mRNA was decreased by the CsA-treatment for either one- or three-weeks. In conclusion, chronic CsA-treatment is associated with a differential expression of various genes for the renin-angiotensin system. L-Arginine may be effective in maintaining the normality of renin-angiotensin system only during early period after beginning the use of CsA.
Angiotensinogen ; Animals ; Arginine ; Blotting, Northern ; Cyclosporine* ; Gene Expression ; Liver ; Plasma ; Rats ; Receptors, Angiotensin ; Renin ; Renin-Angiotensin System* ; RNA, Messenger

No abstract available.
Child ; Coronary Vessels* ; Echocardiography ; Humans

OBJECTIVES: This study was designed to investigate the prevalence of depressive symptoms in patients with breast cancer and to identify demographic variables and clinical characteristics impact on depressive symptoms and health related quality of life in patients with breast cancer in a university hospital. METHODS: Fourty-one patients with breast cancer were selected, who had visited the department of General surgery of the Wonkwang University hospital with a diagnosis of breast cancer regularly during the period November, 2010-May, 2011. All of subjects were evaluated for the depression, anxiety and the health related quality of life with Beck Depression Inventory(BDI), anxiety subscale of Personality Assessment Inventory(PAI) and Short-Form 36 Health Survey-Korean version(SF-36-K). Patients were divided into depressive symptoms and non-depressive symptoms group according to the BDI score. We compared SF-36-K between two groups, and analized multiple regression with depression and health related quality of life as criterion variables and demographic and clinical characteristics. RESULTS: The prevalence of depression in patients with breast cancer in a University hospital was 36.4%. Compared to the non-depression, depressed patients with breast cancer appeared significantly lower mean scores on six subscales in SF-36-K : Physical function(p<.01), Role-physical(p<.001), General health(p<.05), Social function(p<.001), Role-emotional(p<.001) and Mental health(p<.001). But there was no significant difference between two groups in Vitality and Bodily pain. Anxiety, level of education and presence of enforcement of chemotherapy(63.6%) were significant explanation variables for depressive symptoms. And type of surgery and age (55.8%) were significant explanation variables for health related quality of life. CONCLUSIONS: The prevalence of depressive symptoms in patients with breast cancer in a University hospital was 36%. The depressive symptoms had not only negative impact on the health related quality of life but also important explanation variable for health related quality of life. These results suggest that depressive symptoms in patients with breast cancer should be evaluated and treated for improving patient's health related quality of life.
Anxiety ; Breast ; Breast Neoplasms ; Depression ; Humans ; Personality Assessment ; Prevalence ; Quality of Life

PURPOSE: Surgery for thyroid disease requires skin incisions that can result in postsurgical problems. Therefore, several approaches in thyroid surgery have been developed to avoid large scars on the anterior neck. Since the first report of endoscopic subtotal parathyroidectomy, various endoscopic approaches have been reported. However, to be able to perform these procedures using endoscopic instruments in a skillful manner, sufficient training time and effort is required. We assessed the feasibility and cosmetic benefit of the far lateral neck approach using natural skin fold thyroidectomy. METHODS: From July 2011 to February 2014, 123 patients underwent thyroidectomy via far lateral neck approach by one surgeon. An approximately 5 to 6 cm incision was created on the natural skin fold at the far lateral neck, so that the scar can be completely hidden by a V-shaped collar shirt. Thyroidectomy was performed using a Harmonic scalpel(R) and conventional tie technique. RESULTS: The mean operation time was 89.6+/-18.4 min for benign tumors and 79.1+/-30.1 min for malignant tumors. The number of retrieved lymph nodes (mean) was 5.4+/-3.5 in the central neck compartment dissection group, and 26.9+/-13.1 in the lateral neck lymph node dissection group. The 3, 6, and 12 month cosmetic satisfaction score (mean) after the operation was 7.47, 7.68, and 8.81. There were no hypertrophic scars or keloid on the neck. CONCLUSION: Far lateral approach using natural skin fold for thyroidectomy is safe and patients expressed high cosmetic satisfaction. In addition, the technique is suitable for inexperienced surgeons in endoscopic thyroidectomy. It can be a feasible alternative to conventional or endoscopic thyroidectomy.
Cicatrix ; Cicatrix, Hypertrophic ; Humans ; Keloid ; Lymph Node Excision ; Lymph Nodes ; Neck* ; Parathyroidectomy ; Skin* ; Thyroid Diseases ; Thyroid Gland ; Thyroidectomy*

A case of foreign body (a black rubber string of 60cm in length used for masturbation) in the bladder was presented in a 17 years old Korean boy and reported with review of literature.
Adolescent ; Foreign Bodies* ; Humans ; Male ; Rubber ; Urinary Bladder*

PURPOSE: Neoadjuvant chemotherapy (NAC) has become the standard treatment for locally advanced breast cancer. The postoperatively adjuvant systemic treatment is based on the status of the histological and biological markers of either the pre-NAC or the post-NAC. There have been several reports that have demonstrated the changes of the histological and biological markers after NAC. The aim of this study is to investigate the effects of NAC on the expression of the histological and biological markers of breast cancer. METHODS: We analyzed the paired pre- and post-NAC tumor specimens from 37 patients with stage IIIA, IIIB or IIIC breast cancer. All the patients received 2 to 6 cycles of anthracycline-containing NAC. Over 6 pieces of pre-NAC tumor specimens were taken by 14 G core needle from multiple sites of a tumor, and the post-NAC specimens were taken at the time of the operation. The histologic grade and immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), c-erbB2, p53, Ki67, CD31 and p-glycoprotein were analyzed in the paired pre- and post-NAC tumor specimens from 37 patients. RESULTS: Twenty five patients (67.6%) revealed significant changes of more than one marker. The markers that showed changes of more than two grades were as follows; histologic grade in 1, ER in 4, PR in 9, c-erbB2 in 4, p53 in 1, Ki67 in 4, CD31 in 9 and pglycoprotein in 5 patients. In 12 patients (32.4%), significant changes were found in the markers that can influence the decision-making for adjuvant treatment (i.e. ER, PR and c-erbB2). The ER/PR status changed from positive to negative in 4 patients and c-erbB2 was changed from positive to negative in 3 patients. Among those patients, the strategy of adjuvant treatment was adjusted according to the changes. CONCLUSION: The specimens for the histologic and biologic markers of a tumor should be taken before NAC because NAC can have an influence on the expression of the prognostic markers of locally advanced breast cancers, and this may subsequently influence predicting the prognosis and making the decision for adjuvant systemic treatment.
Biomarkers ; Breast ; Breast Neoplasms ; Estrogens ; Humans ; Needles ; P-Glycoprotein ; Prognosis ; Receptors, Progesterone

PURPOSE: Sentinel lymph node (SLN) biopsy is thought to be a highly accurate method of assessing axillary nodal status in breast cancer. Furthermore, it can improve axillary staging by providing a more detailed examination of selected lymph nodes with a high probability of metastasis rather than the entire axillary nodes. The purpose of this study was to assess the incidence of SLN micrometastasis in node-negative breast cancer. METHODS: SLN biopsy was performed in 40 patients with clinically node-negative breast cancer using vital blue dye and/or radioisotope methods; the blue dye method was used in 21 cases, the isotope method in 14 cases, and a combination of both methods in 5 cases. All lymph nodes were evaluated by routine pathologic examination, and a more detailed examination was performed on sentinel nodes in node-negative cases; sentinel nodes were serially sectioned at an interval of 40micrometer depth followed by H&E and cytokeratin immunohistochemical (IHC) staining. RESULTS: Sentinel nodes were detected in 35 of 40 patients (87.5%). The mapping technique used in the remaining 5 cases was vital blue dye method only. Axillary node metastasis was found in 16 of 40 patients. Sentinel node biopsy accurately reflected the axillary node status in all cases; the sensitivity, specificity, and overall accuracy were 100, 100 and 100%, respectively. In 11 of 16 node-positive patients (68.8%), sentinel nodes were the only metastatic nodes. Occult micrometastases were found in SLN by serial section and IHC staining in 4 of 19 patients diagnosed as node- negative by routine pathological examination (21.1%). Occult micrometastasis of SLN was not correlated with primary tumor size, histologic grade or lymphovascular invasion with the exception of the S-phase fraction (P=0.023). CONCLUSION: SLN biopsy was a highly accurate method of assessing axillary node metastasis in breast cancer. Serial sectioning and IHC staining of SLN were sensitive methods in the detection of occult lymph node metastasis.
Biopsy ; Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Keratins ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Sensitivity and Specificity

PURPOSE: Sentinel lymph node (SLN) biopsy is thought to be a highly accurate method of assessing axillary nodal status in breast cancer. Furthermore, it can improve axillary staging by providing a more detailed examination of selected lymph nodes with a high probability of metastasis rather than the entire axillary nodes. The purpose of this study was to assess the incidence of SLN micrometastasis in node-negative breast cancer. METHODS: SLN biopsy was performed in 40 patients with clinically node-negative breast cancer using vital blue dye and/or radioisotope methods; the blue dye method was used in 21 cases, the isotope method in 14 cases, and a combination of both methods in 5 cases. All lymph nodes were evaluated by routine pathologic examination, and a more detailed examination was performed on sentinel nodes in node-negative cases; sentinel nodes were serially sectioned at an interval of 40micrometer depth followed by H&E and cytokeratin immunohistochemical (IHC) staining. RESULTS: Sentinel nodes were detected in 35 of 40 patients (87.5%). The mapping technique used in the remaining 5 cases was vital blue dye method only. Axillary node metastasis was found in 16 of 40 patients. Sentinel node biopsy accurately reflected the axillary node status in all cases; the sensitivity, specificity, and overall accuracy were 100, 100 and 100%, respectively. In 11 of 16 node-positive patients (68.8%), sentinel nodes were the only metastatic nodes. Occult micrometastases were found in SLN by serial section and IHC staining in 4 of 19 patients diagnosed as node- negative by routine pathological examination (21.1%). Occult micrometastasis of SLN was not correlated with primary tumor size, histologic grade or lymphovascular invasion with the exception of the S-phase fraction (P=0.023). CONCLUSION: SLN biopsy was a highly accurate method of assessing axillary node metastasis in breast cancer. Serial sectioning and IHC staining of SLN were sensitive methods in the detection of occult lymph node metastasis.
Biopsy ; Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Keratins ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Sensitivity and Specificity

PURPOSE: Misdiagnosis is frequent in femoral hernia as inguinal hernia. The aims of this study were to examine the diagnostic concordance and to define the factors having influence on the correct diagnosis of femoral hernia. METHODS: Thirty-two patients who underwent femoral hernia operations were analyzed retrospectively. RESULTS: The mean age of the study subjects was 65.8+/-15.5 (36~97) and the female to male ratio was 5.4:1. The mean body mass index (BMI) was 19.8 kg/m2 (14.6~26.9 kg/m2). Twelve patients (37.5%) showed pre- and post-operative diagnostic concordance and 20 patients (62.5%) did not. Among the 20 misdiagnosed cases, 16 cases were misdiagnosed as inguinal hernia, 2 cases as lipoma, and 1 case as lymphadenopathy. The factors related to the correct diagnosis of femoral hernias were associated with groin mass (96.9%, 31/32: 23 painless and 8 painful), size fluctuation of mass (cyclic wax and wane pattern) (84.4%, 27/32), long duration of mass (over 1 month) (75.0%, 24/32), femoral venous compression CT findings (63.6%, 14/22), and positive ultrasonographic findings (42.1%, 8/19). Emergency operation was done in 12 cases (37.5%). Incarceration was found in 23 cases (71.9%) and most of the incarcerated organs were omental fat (11 cases) and small bowel (10 cases). Bowel resection was done in 4 cases and 2 patients combined inguinal hernia. CONCLUSION: Through the careful taking of medical history and physical examination, physicians can achieve the correct diagnosis and can also decrease the frequency of emergency operations and their related complications.
Body Mass Index ; Diagnostic Errors ; Emergencies ; Female ; Groin ; Hernia, Femoral ; Hernia, Inguinal ; Humans ; Lipoma ; Lymphatic Diseases ; Male ; Physical Examination