OBJECTIVE: In view of the facts that education about diseases and realization of the need for drugs can improve compliance of the patients, we assessed the knowledge about drugs and medication compliance in psychiatric outpatients. In addition, we investigated factors that influence patients' compliance to develop a model of medication compliance. METHODS: One-hundred twelve male and eighty female psychiatric outpatient were asked about drug information using questionnaires. We developed a model that predicts medication compliance using chi square tests and multiple regression analysis. RESULTS: More than a hart of the patients knew at least one of the names and the effects of the drugs they had taken, but many of them didn't know the side effects of drugs. About eighty percent of the patients showed good compliance. Knowledge of side effects, belief in the benefits of drugs, and level of education could predict medication compliance reliably. CONCLUSIONS: Because education level could not be managed by physician, we could enhance compliance through education about drug side effects and benefits of medications.
Compliance ; Education ; Female ; Humans ; Male ; Medication Adherence* ; Outpatients* ; Surveys and Questionnaires

OBJECTIVE: A number of soluble factors,which play important role in the pathophysiology of rheumatoid synovitis are also known to be involved in osteoclast differentiation and activation through RANKL (Receptor activator of NF-kB ligand). To investigate the importance of RANKL in the pathogenesis of bone erosion in rheumatoid arthritis (RA) patients, we analyzed the expression of RANKL and Osteoprotegerin (OPG) and examined the formation of osteoclasts in rheumatoid synovial fibroblasts under the influence of various osteotropic factors. METHODS: Primary culture synoviocytes or fibroblast-like synoviocytes isolated from synovial tissues of 8 RA patients were cultured and treated with IL-1beta (2 ng/ml), TNF-alpha (2 ng/ml), INF-gamma(1000 micro/ml), IL-15 (10 ng/ml), IL-12 (10 ng/ml), dexamethasone (10(-9) M), PMA (10 ng/ml) or 1,25 (OH)2D3 (10(-9) M) for 18 hours. Expression RANKL or OPG mRNA was measured by semiquantitative RT-PCR within linear amplification condition. TRAP (+) MNC (tartrate resistant acid phosphatase-positive multinucleated cell) formation was induced from primary culture synoviocytes or in coculture system of synovial fibroblasts with PBMCs in the presence of M-CSF and 1,25 (OH)2D3. RESULTS: 1. The intensity of base-line expression was different from patient to patient. Primary culture synoviocytes and synovial fibroblasts express RANKL and OPG mRNA with decreasing intensity when they are passaged. 2. Expresssion of RANKL mRNA was significantly increased by 1,25 (OH)2D3 and IL-1beta (158.8+/-21% and 197.2+/-17% of controls, p<0.05 and p<0.005, respectively), while decreased significantly by dexamethasone (25.6+/-4.6% of controls, p<0.005). Expression of RANKL mRNA was significantly increased by IL-1beta and decreased by dexamethasone, in a dose- and time-dependant manner. 3. TRAP (+) MNCs are formed from primary culture synoviocytes or in coculture system of synovial fibroblasts and PBMC in the presence of M-CSF and 1,25 (OH)2D3. Dexamethasone clearly inhibited TRAP (+) MNCs formation from synovial cells. CONCLUSION: The regulatory mechanism for the expression of RANKL or OPG in rheumatoid synoviocytes might be different from that in bone marrow cells. Modulating the expression of these molecules could have potential therapeutic implication targeting bone destruction in RA.
Arthritis, Rheumatoid ; Bone Marrow Cells ; Coculture Techniques ; Dexamethasone ; Fibroblasts* ; Humans ; Interleukin-12 ; Interleukin-15 ; Macrophage Colony-Stimulating Factor ; NF-kappa B* ; Osteoclasts* ; Osteoprotegerin ; RNA, Messenger ; Synovitis ; Tumor Necrosis Factor-alpha

BACKGROUND: There has been a lack of study on the structural changes of serum albumin in patients with minimal change disease (MCD). To determine whether glycation and/or conformational transitions of albumin are involved in the pathogenesis of albuminuria, nine patients with MCD were enrolled in a prospective follow-up study for comparison of these parameters in serum albumin during the remission and relapse of nephrotic syndrome. METHODS: Circular dichroism measurements were made with purified albumin. Ellipticities at each wavelength were transformed to mean residue ellipticity. Monosaccharide composition was analyzed by high-pH anion-exchange chromatography with pulsed amperometric detection. RESULTS: There was no difference in the proportions of alpha-helix, beta-conformation, and beta-turn of albumin between the sera of control patients and those with nephrotic syndrome. However, the proportion of the random configuration was slightly higher in the plasma albumin of patients in relapse than in those in remission. The proportion of the random configuration was lower in the albumin of the serum than in the urine of patients with nephrotic syndrome, but there was no difference in the proportions of alpha-helix, beta-conformation, and beta-turn of albumin between their plasma and urine. CONCLUSION: Our results suggest that conformational changes in albumin are involved in albuminuria in patients with MCD.
Adult ; Albuminuria/urine ; Case-Control Studies ; Female ; Follow-Up Studies ; Glycosylation ; Humans ; Male ; Middle Aged ; Nephrosis, Lipoid/*blood/urine ; Nephrotic Syndrome/blood/urine ; Prospective Studies ; Research Support, Non-U.S. Gov't ; Serum Albumin/*chemistry

PURPOSE: The aim of this study was to evaluate the safety and feasibility of D2 lymphadenectomy in elderly patients with gastric cancerby comparing the surgical outcomes and postoperative courses between an elderly group and a control group undergoing the same procedure. MATERIALS AND METHODS: Clinical information was reviewed for 1251 patients with gastric cancer who underwent gastrectomy between May 2004 and May 2007. Patients were classified into the following two groups: an elderly group (older than the average life span in Korea) and a control group (younger than the elderly group). Clinicopathologic features and postoperative courses after D2 lymphadenectomy were reviewed and compared between the two groups. RESULTS: There were a total of 120 (9%) elderly group patients among all those reviewed, and 86 (72.2%) of them underwent D2 lymphadenectomy. There was 27.5% postoperative morbidity in the elderly group, which was significantly different from thecontrol group (12.8%, p=0.003). However, on multivariate analysis, ASA score and combined resection were independent predictive factors of postoperative complications, while age was not predictive. CONCLUSION: Older age is not a predictive factor of postoperative complications in itself, and D2 lymphadenectomy can be safely performed in elderly patients with gastric cancer, provided they have good ASA scores and do not undergo accompanying combined resection.
Aged ; Gastrectomy ; Humans ; Lymph Node Excision ; Multivariate Analysis ; Postoperative Complications ; Stomach Neoplasms

BACKGROUND/AIMS: Transient elastography is a new noninvasive tool for measuring liver stiffness that accurately predicts significant fibrosis and cirrhosis. However, several studies have indicated that liver stiffness can be significantly influenced by major changes in aminotransferase in patients with chronic viral hepatitis. The aim of this study was to determine the factors influencing liver stiffness in patients with chronic liver disease. METHODS: We studied 158 patients with chronic liver disease who underwent transient elastography and liver biopsy sampling. Histologic findings on fibrosis and necroinflammatory activity in the biopsy specimens were evaluated according to the Korean Society of Pathologists Scoring System. Routine biochemical tests were performed according to standard methods. RESULTS: Liver stiffness was strongly correlated with liver fibrosis stage (Spearman coefficient=0.636, P<0.001), lobular activity (Spearman coefficient=0.359, P<0.001), and portoperiportal activity grade (Spearman coefficient=0.448, P<0.001). Liver stiffness was significantly associated with serum levels of total bilirubin (P=0.025), direct bilirubin (P=0.049), gamma-glutamyl transpeptidase (P=0.014), platelet count (P=0.004), albumin (P<0.001), and international normalized ratio (P<0.001). Multivariate analysis showed that fibrosis stage (B 3.50, P=0.009) and lobular activity grade (B 3.25, P=0.047) were independently associated with liver stiffness. CONCLUSIONS: Liver stiffness as measured by transient elastography is associated with the grade of necroinflammatory activity and the stage of fibrosis, irrespective of serum ALT levels.
Adult ; Aged ; Bilirubin/blood ; Biopsy ; Chronic Disease ; Elasticity ; *Elasticity Imaging Techniques ; Female ; Hepatitis B, Chronic/*complications ; Hepatitis C, Chronic/*complications ; Humans ; International Normalized Ratio ; Liver Cirrhosis/etiology/pathology/*ultrasonography ; Male ; Middle Aged ; Platelet Count ; Risk Factors ; Severity of Illness Index ; gamma-Glutamyltransferase/blood

PURPOSE:In Korea, the school urine screening program is a useful tool for screening urine abnormalities. It is particularly useful in early detection of membranoproliferative glomerulonephritis(MPGN) I, which frequently progresses to chronic renal failure. In this study, we studied the medical history, laboratory findings, and histologic findings of MPGN I to gain helpful information on early detection and treatment. METHODS:The subjects were 19 children, who were diagnosed with MPGN I from kidney biopsies that were performed in ten nationwide university hospitals because of abnormal urine findings from school urine screening programs conducted from July 1999 to April 2004. We divided the patients into 2 groups, a nephrotic range proteinuria group(n=8) and a non- nephrotic proteinuria group(n=11), and retrospectively analyzed the clinical features, laboratory findings, histologic findings, treatment, and clinical course. RESULTS:The mean age at the first abnormal urinalysis was 10.6+/-2.2 years in the nephrotic proteinuria group and 9.6+/-3.2 years in the non-nephrotic proteinuria group. The mean age at the time of kidney biopsy was 11.3+/-2.3 years in the nephrotic range proteinuria group and 10.4+/-3.2 years in the non-nephrotic proteinuria group respectively. There was no significant difference in the mean age and sex between the two groups. In the nephrotic proteinuria group, 6 children had a low plasma C3 level and in the non-nephrotic proteinuria group, 8 children had a low plasma C3 level, but there was no significant difference between the 2 groups. There was no significant difference in the laboratory test results(including WBC count, RBC count, platelet count and other serologic tests) between the 2 groups except for 24 hour urine protein secretion. There was no difference between the 2 groups with regard to the acute and chronic changes in the glomerulus on light microscopic findings, IgG, IgA, Ig M, C1q, C3, C4, fibrogen deposition on immunofluoroscence findings, and mesangial deposits, subendothelial deposits, and subepithelial deposits on electron microscopic findings. The children were treated with corticosteroids, ACE(angiotensin-converting enzyme) inhibitors, dipyridamole and other immunosuppressive agents. During the course of treatment, there were no children whose clinical condition worsened. Among 19 children, 3 children went into remission (2 in the nephrotic proteinuria group, 1 in the non-nephrotic proteinuria group) and 9 children went into a partial remission(4 in the nephrotic proteinuria group, 5 in the non-nephrotic proteinuria group) on urinalysis. There was no significant difference in the treatment results between the two groups. CONCLUSION:The 73.7% of children who were incidentally diagnosed with MPGN I by the school urine screening program had reduced C3. 42.1% of the children had nephrotic range proteinuria. There were no significant differences in clinical features, laboratory test results, light microscopic, immunofluorescence microscopic, and electron microscopic findings between the nephrotic proteinuria group and the non-nephrotic proteinuria group except for the 24 hour urine protein secretion. Therefore, for early detection of MPGN I during the school urine screening program, we strongly recommend a kidney biopsy if children have abnormal urine findings such as persistent proteinuria and persistent hematuria, or if the serum C3 is reduced.
Adrenal Cortex Hormones ; Biopsy ; Child ; Dipyridamole ; Fluorescent Antibody Technique ; Glomerulonephritis, Membranoproliferative* ; Hematuria ; Hospitals, University ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Immunosuppressive Agents ; Kidney ; Kidney Failure, Chronic ; Korea ; Mass Screening* ; Plasma ; Platelet Count ; Prognosis ; Proteinuria ; Retrospective Studies ; Urinalysis