OBJECTIVES: The purpose of this survey was to compare Korean menopausal women's perceptions of hormone replacement therapy before and after publication of the Women's Health Initiative (WHI) study. METHODS: This study was conducted through a survey of 713 postmenopausal women, who attended lectures on health to commemorate Korean Menopause Awareness Month, during 2009 in Seoul and the provinces (Incheon, Daejeon, Daegu, Gwangju and Busan). RESULTS: Respondents' knowledge concerning the cause of menopause have been increased to 86.7% in 2009, compared to 56.6% in 2002. Women who required hormone therapy increased to 57.6% in 2009, compared to 56.6% in 2002. As a source of information about hormone therapy, media was about 34.0% in 2009, different from the previous study that doctor's advice was 60.7%. Among the women who stopped hormone therapy, the most common reason was fear of cancer (31.8%), which increased compared to 9.3% in 2002. Women who received regular screening for breast cancer increased to 82.3% in 2009, compared to 35.0% in 2002. Women who checked bone mineral density (BMD) increased to 71.8% in 2009, compared to 40.2% in 2002. CONCLUSION: Menopausal women in Korea have increased their awareness of menopause. They responded that hormone therapy was helpful to manage menopausal symptoms, even after WHI study. They obtained menopause-related information through various sources, and the role of mass media has been greatly increased. But they were concerned about the increased risk for cancer, especially breast cancer.
Bone Density ; Breast Neoplasms ; Female ; Hormone Replacement Therapy ; Humans ; Korea ; Lectures ; Mass Media ; Mass Screening ; Menopause ; Publications ; Republic of Korea ; Women's Health

OBJECTIVE: After a rigorous management of increased intracranial pressure by decompressive craniectomy (DC), cranioplasty (CP) is usually carried out for functional and cosmetic purposes. However, the optimal timing of CP remains controversial. Our study aims to analyze the relationship between the optimal timing of CP and the post-operative complications. METHODS: From January 2013 to December 2015, ninety patients who underwent CP in a single institution were analyzed. We set the independent variables as follows: 1) patient characteristics; 2) the time interval between the DC and CP; 3) operation time; 4) anesthesia time; and 5) pre-operative computed tomography (CT) findings such as a degree of sunken brain by ratio of A (the median length from scalp to midline) to B (the length from midline to inner table of skull at this level). The dependent variables of this study are the event of post-operative complications. RESULTS: The overall complication rate was 33.3%. There was no statistical significance in the time interval between the DC and CP in the groups with and without complications of CP (p=0.632). However, there was a significant statistical difference in the degree of sunken brain by ratio (A/B) between the two groups (p<0.001). CONCLUSION: From this study, we conclude that it is better to determine the optimal timing of CP by the pre-operative CT finding than by the time interval between the DC and CP. Hereby, we suggest a potentially useful determinant of optimal timing of CP.
Anesthesia ; Brain* ; Decompressive Craniectomy ; Humans ; Intracranial Pressure ; Scalp ; Skull

The medical records of inpatients with diagnoses of either ICD-9 193(malignant neoplasm of the thyroid gland) or 226(benign neoplasm of the thyroid gland) in the claims sent in by medical care institutions throughout the country, to the Korea Medical Insurance Corporation (KMIC) during the period from January 1, 1986 to December 31, 1987 were abstracted. These records were abstracted in order to identify and confirm new cases of thyroid cancer among the beneficiaries of the KMIC. Using these data, the incidence rate of thyroid cancer among Koreans was estimated as of July 1, 1986 through June 30, 1987. The crude rates were estimated to be 0.76(95% Cl: 0.63-0.87) and 3.87(95% Cl: 3.60-4.14) per 100,000 in males and females, respectively, and the cumulative rates for the age spans 0-64 and 0-74 in males were 0.06% and 1.10%, respectively. In females, those were equally 0.35%. The age-adjusted rate for the world population was 0.93 per 100,000 in males, which is one of the lowest levels in the world. However, the adjusted rate in females was 3.96 per 100,000, which is an average level and very similar to that of the Chinese in Singapore and Shanghai. A similar tendency was shown in the case of the truncated rates for the age group of 35-64, which was 1.91 per 100,000 in males and 8.82 per 100,000 in females.
Adolescent ; Adult ; Age Factors ; Aged ; Epidemiologic Factors ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Sex Factors ; Thyroid Neoplasms/*epidemiology/pathology

Giant serpentine aneurysms are uncommon types of aneurysmal disease and have angiographically authentic features. We report a case of a 44-year-old male with headache and seizure. He presented a giant serpentine aneurysm arising from the middle cerebral artery (MCA). It was a large intracranial aneurysm thrombosed as a mass-like lesion while it maintained its outflow drainage into the distal MCA branches. The balloon occlusion test (BOT) was performed to test the tolerance of temporary collateral circulation. Following routine cerebral angiography, we performed an endovascular embolization on the proximal artery of MCA. He was discharged from the hospital with alert mental status and mild Gerstmann syndrome. The short-term follow-up imaging studies showed the decreased mass effect, and the patient presented an improved Gerstmann syndrome. After a careful evaluation of BOT, an endovascular embolization can be one of the powerful therapeutic instruments for giant serpentine aneurysm.
Adult ; Aneurysm* ; Arteries ; Balloon Occlusion ; Cerebral Angiography ; Collateral Circulation ; Drainage ; Follow-Up Studies ; Gerstmann Syndrome ; Headache ; Humans ; Intracranial Aneurysm ; Male ; Middle Cerebral Artery* ; Seizures

The Onyx liquid embolic system is a relatively safe and commonly used treatment for vascular malformations, such as arteriovenous fistulas and arteriovenous malformations. However, studies on possible complications after Onyx embolization in patients with vascular malformations are limited, and the occurrence of cranial nerve palsy is occasionally reported. Here we report the progress of two different types of cranial nerve palsy that can occur after embolization. In both cases, Onyx embolization was performed to treat vascular malformations and ipsilateral oculomotor and facial nerve palsies were observed. Both patients were treated with steroids and exhibited symptom improvement after several months. The most common types of neuropathy that can occur after Onyx embolization are facial nerve palsy and trigeminal neuralgia. Although the mechanisms underlying these neuropathies are not clear, they may involve traction injuries sustained while extracting the microcatheter, mass effects resulting from thrombi and edema, or Onyx reflux into the vasa nervorum. In most cases, the neuropathy spontaneously resolves several months following the procedure.
Arteriovenous Fistula ; Arteriovenous Malformations ; Cranial Nerve Diseases* ; Cranial Nerves* ; Edema ; Facial Nerve ; Humans ; Paralysis ; Steroids ; Traction ; Trigeminal Neuralgia ; Vasa Nervorum ; Vascular Malformations*

OBJECTIVE: Carotid artery stenting is helpful in patients with carotid artery stenosis and is a common method of treatment. However, data on the neurological consequences that might arise from, especially Asian patients after CAS is not enough. The purpose of this study was to investigate the outcome and prognostic factors affecting CAS patients.METHODS: From January 2013 to June 2018 it was enrolled 97 patients who underwent CAS with severe carotid artery stenosis in a single institution. We retrospectively reviewed neurologic complications such as restenosis, ipsilateral or contralateral stroke, and hyperperfusion during the 6-month follow-up period.RESULTS: There were no complication occured during the procedure in all 97 patients. Neurologic complications occurred in 30 patients (30.9%) after the procedure, and ipsilateral stroke 6 (6.2%), contralateral stroke 9 (9.4%), restenosis 2 (2.1%) and hyperperfusion 13 respectively. One of them had died (1.0%), of which the rest were discharged after symptoms improve. On univariate analysis, DM and pre-op NIHSS score was associated with the risk of CAS complication, exclusively. On the binary logistic regression for risk factors, DM (OR 0.144, 95% CI [0.029–0.718]), history of radiotheraphy (OR 36.103, 95% CI [1.009–1291.789]) and preoperative NIHSS (OR 1.266, 95% CI [1.059–1.513]) showed independent risk factors associated with post procedural neurological complications, statistically.CONCLUSION: Carotid artery stenting is a relatively safe and reliable long-term outcome for patients with carotid artery stenosis. However, careful observation should be taken after procedure immediately for any possible complications.
Asian Continental Ancestry Group ; Carotid Arteries ; Carotid Stenosis ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Logistic Models ; Methods ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Stents ; Stroke

OBJECTIVE: Subdural effusion, also known as subdural hygroma (SDG), is a secondary complication that can occur after decompressive craniectomy (DC). However, the pathogenesis of SDG is not fully understood. It is unclear whether SDG occurrence is related to preoperative patient status or surgical technique. The purpose of this study is to identify risk factors for SDG after DC. METHODS: Fifty-nine patients who underwent DC from January 2016 to December 2016 at the same institution were analyzed. We retrospectively reviewed the clinical and radiological features of the patients. We divided the patients into two groups based on the occurrence of SDG after DC. The risk factors for SDG were analyzed. RESULTS: The overall SDG rate after DC was 39% (23 patients). A statistically significant association was observed between preoperative diagnosis, e.g., subdural hemorrhage (SDH; odds ratio [OR], 4.99; 95% confidence interval [CI], 1.36–18.34) or subarachnoid hemorrhage (SAH; OR, 4.18; 95% CI, 1.07–16.32), and the occurrence of SDG after DC. Traumatic brain injury (OR, 4.91; 95% CI, 1.35–17.91) and preoperative cortical opening (OR, 4.77; 95% CI, 1.39–16.32) were important risk factors for SDG. Several surgical techniques did not show a statistically significant association with SDG. The occurrence of SDG after DC was related to the length of hospital stay (p=0.012), but not to prognosis. CONCLUSION: After DC, SDG is not related to patients' prognosis but to the length of hospital stay. Therefore, it is necessary to study the occurrence of postoperative SDG by confirming the presence of preoperative SDH, SAH, and cortical opening.
Brain Injuries ; Decompressive Craniectomy* ; Diagnosis ; Hematoma, Subdural ; Humans ; Length of Stay ; Odds Ratio ; Prognosis ; Retrospective Studies ; Risk Factors* ; Subarachnoid Hemorrhage ; Subdural Effusion*

BACKGROUND/AIMS: Treatment using multiple daily insulin (MDI) should give diabetic patients many benefits. Nevertheless, few studies have examined the impact of an increased frequency of daily insulin injection on quality of life, anxiety levels, and depression in diabetic patients, and individual's continued compliance with MDI is unclear. This study examined these issues using standardized questionnaires. METHODS: This was a cross-sectional, randomized study. Ninety-nine insulin-treated type 2 diabetic patients (mean age 53.1+/-12 years, mean duration of diabetes 10.3+/-6.5 years) were divided a group (n=50) who injected insulin four times daily (mean age 49.6+/-12.3 years, mean duration of diabetes 6.5+/-6.4 years) and a group (n=49) who injected insulin once or twice daily (mean age 56.4+/-11.6 years, mean duration of diabetes 11.5+/-5.8 years). All patients independently completed the Korean Version of the World Health Organization Quality of Life Scale Abbreviated Version and standardized Hospital Anxiety and Depression Scale for Koreans. RESULTS: No significant differences were evident with respect to age, gender, and duration of diabetes between the two groups (p<0.05). No significant differences were evident in the results of the questionnaires between the two groups, except for the physical health domain (p<0.05). CONCLUSIONS:Multiple daily insulin injections had nearly no influence on quality of life, anxiety levels, or depression in type 2 diabetic patients. Therefore, treatment with MDI should be considered for patients who would benefit from this.
Anxiety ; Compliance ; Depression ; Diabetes Mellitus ; Humans ; Insulin ; Quality of Life ; World Health Organization ; Surveys and Questionnaires

BACKGROUND/AIMS: This study reviewes the clinicopathological features, prognosis, and differences in the expression of p53 and Ki-67 immunochemical staining in squamous cell and adenosquamous carcinoma of the stomach. METHODS: From January 1995 to June 2005, 2,282 cases of gastric carcinoma were resected surgically in our hospital and 191 additional cases were resected by endoscopic mucosal resection. Retrospective pathologic review and immunochemical staining of p53 and Ki-67 were performed. RESULTS: The study consists of eight cases (0.032%) of primary squamous cell carcinoma (one case) and adenosquamous carcinoma (seven cases) without early gastric cancer. Six cases (75.0%) were male and two cases were female. The mean age was 66 year-old. The clinical presentation and physical findings did not differ from those of adenocarcinoma. The mean tumor size was 5.2+/-1.7 cm. Macroscopically, five were Borrmann type 3 (62.5%) and three were type 2. At the initial diagnosis, six (75%) were stage IV based on TNM tumor staging. Six cases (75%) progressed despite the therapy while two cases responded to the treatment. The median survival time was 11.0 months (range 4.3+/-17.7). Overexpression of p53 was seen in five cases (62.5%) and their survival was poor when compared to the p53-negative group (p=0.04). The mean Ki-67 labeling index was 70.0+/-20.8%, and was not associated with p53 staining (p>0.05). CONCLUSIONS: Adenosquamous and squamous cell carcinoma of the stomach are very rare. They tend to be at advanced stages on initial diagnosis, and progress rapidly. They show p53 protein overexpression and high Ki-67 labeling index, which might be related to poor prognosis.
Adult ; Aged ; Carcinoma, Adenosquamous/chemistry/mortality/*pathology ; Carcinoma, Squamous Cell/chemistry/mortality/*pathology ; Female ; Humans ; Immunohistochemistry ; Ki-67 Antigen/*analysis ; Male ; Middle Aged ; Stomach Neoplasms/chemistry/mortality/*pathology ; Survival Rate ; Tumor Suppressor Protein p53/*analysis

BACKGROUND/AIMS: Gastritis cystica profunda (GCP) is a rare disease that is characterized by a hyperplastic and cystic dilatation of the pseudopyloric gland with submucosal invasion. GCP is regarded as a benign lesion. However, there is some controversy regarding its malignant potential. This study reviewed the clinical features and association with malignancy. METHODS: From January 2001 to June 2005, 1,010 cases of resected and 1,228 cases of an endoscopic mucosal resection or polypectomy were examined. RESULTS: Thirty-nine cases (1.7%) were confirmed pathologically and were not associated with prior gastric surgery mostly. The mean age was 60.0+/-11.4 years old and there were 29 male patients. The body was most commonly located on the longitudinal axis (57.1%). Eleven cases (28.2%) were not associated any other gastric lesion, the majority of which were the polypoid type (82.0%). However, two cases were found as a hypertrophic mucosal fold, and a submucosal tumor, respectively. Seventeen cases (43.6%) were associated with early gastric cancer. CONCLUSIONS: Despite its rarity, GCP should be considered when an endoscopically polypoid lesion or submucosal tumor (SMT) is found. Because of its association with early gastric cancer or adenoma, more study will be needed to examine the relationship between GCP and gastric carcinogen
Adenoma ; Axis, Cervical Vertebra ; Dilatation ; Gastritis* ; Humans ; Male ; Rare Diseases ; Stomach Neoplasms