BACKGROUND: Extracorporeal shock wave therapy (ESWT) is one of the treatment options used for patients with myofascial pain syndrome (MPS), although its effectiveness is controversial. The purpose of this study was to evaluate the effectiveness of ESWT in the treatment of MPS in terms of pain relief and functional improvements. METHODS: We assessed 93 patients with MPS who underwent ESWT from March 2009 to July 2014. After exclusion of 25 patients with shoulder diseases, 68 patients were enrolled in the study. The mean follow-up period was 7.5 months (± 4.2 weeks), and the average duration of symptoms was 5 months (range, 2-16 months). ESWT was applied to intramuscular taut bands and referred pain areas once a week for 3 weeks. Visual analog scale (VAS) pain scores and American Shoulder and Elbow Surgeons (ASES) scores were obtained at an initial assessment and at the 6-week, 3-month, and 6-month follow-up assessments. RESULTS: VAS pain scores and ASES scores improved significantly after 3 sessions of ESWT (p<0.05). Both scores were improved, although not significantly, after 6 weeks (p>0.05). CONCLUSIONS: ESWT is an effective treatment option for patients with MPS.
Elbow ; Follow-Up Studies ; Humans ; Myofascial Pain Syndromes* ; Pain, Referred ; Shock* ; Shoulder ; Visual Analog Scale

BACKGROUND: Although there is a controversy on the optimal timing for active infective endocarditis(IE), recently good results of early surgical intervention have been published. Herein, we analyzed the results of surgery for active IE according to the duration of preoperative antibiotic treatment. MATERIAL AND METHOD: Retrospectively, we analyzed 51 patients who underwent operation for active IE at the department of thoracic and cardiovascular surgery of Samsung medical center from Mar. 1995 to Oct. 2001. Male to female ratio was 39:12, mean age of the patients was 44.5+/-17.8 years(range : 13~74). Infected valves were mitral valve in 17(33.3%), aortic valve in 15(29.4%), mitral and aortic valve in 12(23.5), and tricuspid valve in 5(9.8%) cases. Among them, prosthetic valve endocarditis was present in 10(19.6%) cases. Infecting organism was Staphylococcus in 19 (37.3%), Streptococcus in 17(33.3%), Enterococcus in 3(5.9%), fungus in 3(5.9%), and other bacteria in 5(9.8%) cases. Organism was not isolated in 6(11.8%) cases, and two organisms were isolated in 4(7.8%) cases. Dividing these patients into two groups according to the duration of preoperative antibiotic treatment(A: less than 7 days, B: more than 8 days), we compared the surgical results between the two groups. RESULT: There were 16 cases in group A and 35 in group B. Annular reconstruction was performed in 10(62.5%) cases in group A and 10(28.6%) cases in group B, which has statistically significance(p<0.05). There was one early death in group B. Forty nine patients(96.1%) except two were followed up with mean follow-up duration of 28.7+/-23.6 months. Endocarditis was recurred in one in group A, and two in group B. Three late deaths occurred in group B. Recurrence rate and survival were not statistically different between the two groups. CONCLUSION: Early surgery for active IE showed good results as the result of that which was performed after prolonged antibiotic treatment; therefore, we believe that early surgery for active IE could effectively eradicate the infection.
Aortic Valve ; Bacteria ; Endocarditis* ; Enterococcus ; Female ; Follow-Up Studies ; Fungi ; Humans ; Male ; Mitral Valve ; Recurrence ; Retrospective Studies ; Staphylococcus ; Streptococcus ; Tricuspid Valve

We reviewed 86 thymic epithelial tumors and reclassified them according to the Kirchner and Muller- Hermelink classification. They were subtyped as medullary, mixed, predominantly cortical (organoid), cortical, well differentiated thymic carcinoma, and poorly differentiated thymic carcinoma. The frequency of each subtype was determined and histologic findings were related to stage and myasthenia gravis. Immunohistochemical stains for bcl-2 protein as a marker for medullary thymocytes and MIC-2 protein as a marker for cortical thymocytes were performed in each case. The stages and association of myasthenia gravis was significantly different in each subtypes. The results of this study demonstrate that this histogenetic classification is clinically applicable. The bcl-2 protein was specifically demonstrated in lymphocytes within areas of medullary differentiation and MIC-2 protein in cortical differentiation. The expression of bcl-2 and MIC-2 proteins lend histogenetic support for this new classification of thymoma. Bcl-2 protein is strongly expressed in tumor epithelial cells of every case of poorly differentiated thymic carcinoma whereas the other types of thymic epithelial tumors do not show epithelial expression of this protein. The strong expression of bcl-2 protein in tumor epithelium may be considered as a predictor of aggressive behavior in thymic epithelial tumors.
Classification ; Coloring Agents ; Epithelial Cells ; Epithelium ; Lymphocytes ; Myasthenia Gravis ; Staphylococcal Protein A ; Thymocytes ; Thymoma*

PURPOSE: Survivin is a member of the inhibitors of apoptosis family. It has recently comes into the limelight as a promising tumor marker, but many previous reports have shown controversial results regarding the significance and prognostic value of a survivin expression. In this study we determined the correlation between the survivin expression and the conventional prognostic markers and we also investigated the outcomes according to the localization of the survivin expression. METHODS: Tissue microarray (TMA) blocks were made with formalin-fixed paraffin-embedded tissues from 185 breast cancer patients and the immunohistochemical staining was done using an anti-survivin antibody. Among these, 157 patients were available for a survivin expression. The conventional clinicopathologic features and overall survival were correlated with the localization of the survivin expression. RESULTS: Survivin was expressed in 101 breast cancers (64.3%). A higher cytoplasmic survivin expression were noted in the older group (p=0.003), in the node-negative cancers (p=0.012), in the earlier tumor stages (p=0.012) and in the cancers that had not been treated with adjuvant chemotherapy (p=0.014). On the contrary, a higher nuclear survivin expression was inversely correlated with an estrogen expression (p=0.006) and a progesterone receptor (p=0.043) expression. In terms of survival, a cytoplasmic expression was associated with improved overall survival (p=0.01) but a nuclear survivin expression was correlated with unfavorable overall survival (p=0.002). A high cytoplasmic to nuclear ratio of survivin was associated with improved overall survival (p=0.001) conversely, increased nuclear to cytoplasmic survivin ratio was correlated with unfavorable overall survival (p<0.0001). Multivariate analysis revealed that nuclear survivin expression (p=0.001) and high nuclear to cytoplasmic survivin ratio (p=0.012) were independent predictor of overall survival. CONCLUSION: Survivin is frequently expressed in primary breast cancer. A cytoplasmic survivin expression is a good prognostic predictor for patients with axillary node negative early breast cancers and a nuclear survivin expression is a worse independent predictor of overall survival for patients with axillary node positive breast cancers.
Apoptosis ; Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Cytoplasm ; Estrogens ; Humans ; Multivariate Analysis ; Receptors, Progesterone

BACKGROUND: The Pap smear has brought about a dramatic improvement in the prevention of cervical cancer in women worldwide. In an effort to decrease the occasional false negatives in the Pap smear and further increase the screened population, ThinPrep Pap Test (TP), a fluid-based cytology collection method, has been developed. With preservation of claimed advantages of TP, we have developed a Pap test solution for manual preparatory process and compared our manually processed fluid-based Pap smear with TP to identify cytologic similarities and differences between the two methods. METHODS: Cervical swipes of 204 patients were prospectively collected in the 'Pap solution' and also in PreservCyt solution for TP. Diagnoses and smear characteristics were compared. RESULTS: The diagnoses of the paired smears agreed in 190 of the 204 cases (93.1%). The smear characteristics regarding overall cellularity and background cellularities were similar in the two methods and the stainability of the cells was virtually the same. CONCLUSIONS: The 'Pap solution' has similar performance characteristics as TP in many aspects. With its advantages of cost-effectiveness and easier preparatory process, the 'Pap solution' can match previously implemented thin layer preparation.
Female ; Humans ; Prospective Studies ; Uterine Cervical Neoplasms

PURPOSE: Cyclooxygenase-2 (Cox-2) is the rate-limiting enzyme in the conversion of arachidonic acid to prostaglandins and can be induced by various agents such as growth factors and tumor promoters. Cox-2 contributes to carcinogenesis and tumor growth. This study was performed to demonstrate the correlation between elevated expression of Cox-2 and pathologic factors in breast cancer. METHODS: Cox-2 expression was analyzed immunohistochemically in paraffin-embedded tumor samples from 40 patients with breast cancer. Cox-2 expression was defined as negative or positive. The correlation between Cox-2 expression and pathologic factors (tumor size, axillary lymph node metastasis, TNM stage and histologic grade) was analyzed. RESULTS: Cox-2 was highly expressed in proportion to tumor size, but the difference was not significant (P>0.05). High Cox-2 expression was observed in the presence of axillary lymph node metastasis and TNM stage III, but was not significant (P>0.05). The Cox-2 expression rate was significantly associated with high histologic grade (I: 42.9%, II: 50.0%, III: 80.0%) (P=0.046). CONCLUSION: Elevated levels of Cox-2 expression were associated with large tumor size, presence of axillary lymph node metastasis, high TNM stage and high histologic grade, and can therefore be a possible marker for poor prognosis. Due to the small number of cases, we couldn't confirm the statistical significance except in terms of histologic grade. Further prospective studies with a large number of cases are required.
Arachidonic Acid ; Breast Neoplasms* ; Carcinogenesis ; Carcinogens ; Cyclooxygenase 2* ; Humans ; Intercellular Signaling Peptides and Proteins ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Prostaglandins

We experienced a rare clinical manifestation of a digoxin induced catatonic stupor without other features of digoxin toxicity. This case suggests that the neurological manifestation of digoxin toxicity can occur without the usual side effects. Also, a serum digoxin level should be checked in any elderly patient presenting with abnormal cerebral func-tions, irrespective of whether or not the dose of digoxin has been changed. (J Korean Neurol Assoc 19(4):438~439, 2001)
Aged ; Digoxin ; Humans ; Neurologic Manifestations ; Stupor*

BACKGROUND: Broncholithiasis is uncommon but clinically important because it may cause a variety of nonspecific symptoms and signs prior to the onset of lithoptysis, and rarely massive hemoptysis. METHOD: A retrospective clinical study was done on 11 case of broncholithiasis diagnosed at Kyungpook National University Hospital from Jan. 1985 to Dec. 1993. The study investigated the clinical features, radiologic findings, bronchoscopic findings and management. RESULTS: 1) The common symptoms included cough, dyspnea, hemoptysis, fever and purulent sputum. Lithoptysis occurred in 3 patients. 2) The radiologic findings were variable and nonspecific. Hilar calcification and parenchymal calcification were the most common findings. 3) The bronchoscopy was performed in 10 patients and revealed broncholiths in 9 patients. 4) Chemical composition of broncholiths was analyzed in 2 patients. Calcium carbonate was main component. 5) In 6 out of 9 patients in whom broncholiths was revealed by bronchoscopy, broncholiths were successfully extracted through the flexible bronchoscope. 6) In 9 patients, broncholithiasis was related to tuberculosis and in 1 case, related to silicosis. CONCLUSION: Broncholithiasis shows a variable clinical spectrum. Tuberculosis is the most common cause of broncholithiasis. In the case of no accompanied complication, nonsurgical management such as bronchoscopic removal and conservative therapy is an effective measure.
Bronchoscopes ; Bronchoscopy ; Calcium Carbonate ; Cough ; Dyspnea ; Fever ; Gyeongsangbuk-do ; Hemoptysis ; Humans ; Retrospective Studies ; Silicosis ; Sputum ; Tuberculosis

OBJECTIVE: To analyze morphologic differences between only spondylolysis group and mild spondylolisthesis one in young-aged persons and to find useful parameters for radiological assessment of mild spondylolisthesis. METHOD: Twenty patients with only lumbar spondylolysis, 18 patients with mild lumbar spondylolisthesis and 19 normal subjects were recruited in this study. Their radiological findings were examined. The films of subjects were evaluated with respect to variables describing wedging of the spondylolytic vertebra, relative thickness and lengths of the transverse processes. The evaluation was made with attention to possible signs which could mean vertebral slipping. The lumbar index reflects the degree of wedge deformity of the spondylolytic vertebra. RESULTS: Lumbar index was significantly lower in spondylolisthesis group than only spondylolysis group. There was no significant difference in relative thickness of L5 transverse process between two groups. The incidence of a midline lumbar or sacral defect in the spondylolisthesis group was higher than other groups. CONCLUSION: Our results support the usefulness of lumbar index as a supplement parameter for radiological assessment of mild spondylolisthesis.
Congenital Abnormalities ; Humans ; Incidence ; Spine ; Spondylolisthesis* ; Spondylolysis

Carcinoid tumor of the middle ear cavity is a rare neoplasm of low malignant potential. It grows slowly and rarely metastasizes. We recently experienced a case of carcinoid tumor of the middle ear cavity occurring in a 51-year-old female who was presented with hearing loss and tinnitus of the right ear. A 1 cm sized pinkish soft mass was noted in the promontory of the middle ear. Histologically, the mass was composed of nests and cords of tumor cells with slightly pleomorphic nuclei and eosinophilic cytoplasm. The extracellular matrix was glassy pink, homogeneous and exhibited apple green birefringence under a polarized light microscope after Congo red staining. The tumor cells showed immunoreactivity for cytokeratin, chromogranin A, synaptophysin, neuron-specific enolase and calcitonin. Electron microscopic examination confirmed the presence of neurosecretory granules. The production of calcitonin and amyloid by the tumor cells suggests the possible relationship of this tumor to the thyroid C cells.
Amyloid* ; Birefringence ; Calcitonin* ; Carcinoid Tumor* ; Chromogranin A ; Congo Red ; Cytoplasm ; Ear ; Ear, Middle* ; Eosinophils ; Extracellular Matrix ; Female ; Hearing Loss ; Humans ; Keratins ; Middle Aged ; Phosphopyruvate Hydratase ; Plaque, Amyloid* ; Synaptophysin ; Thyroid Gland ; Tinnitus