OBJECTIVES: Continuous positive airway pressure (CPAP) is effective in the treatment of obstructive sleep apnea syndrome (OSAS), but the major limitation of CPAP may be poor compliance. The aims of the study were to investigate the compliance and side effects of CPAP, and to evaluate the efficacy of CPAP in patients with OSAS. METHODS: This study enrolled 106 patients with OSAS who took the CPAP treatment. The severity of daytime sleepiness was measured using Epworth Sleepiness Scale (ESS), and sleep quality and depressive symptoms were assessed by Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI), respectively. RESULTS: During 29 months of the study period, 41.5% of patients were using CPAP and 38.7% of patients stopped using it. Compared to non-compliant patients, compliant patients had a higher PSQI score and obstructive apnea index. Among non-compliant patients, 51.2% of them stopped using CPAP within 1months. 85.7% of non-compliant patients were discomforted by the CPAP, but much more nasopharyngeal symptoms were reported in the compliant group. ESS (p<0.01), PSQI (p<0.01) and BMI (p<0.01) were reduced significantly after CPAP treatment but not BDI (p=0.86). CONCLUSIONS: We concluded that CPAP can reduce the daytime sleepiness, nocturnal sleep disturbance, and body mass index. To increase the compliance of CPAP, we suggested that some education and support is needed at the early stage of the CPAP treatment.
Apnea ; Body Mass Index ; Compliance* ; Continuous Positive Airway Pressure ; Depression ; Education ; Humans ; Sleep Apnea, Obstructive*

Subretinal fluid drainage produces the indentation of the sclera by facilitating firm adhesion between the retina and either retinal pigment epithelium or Bruch's membrane and has the advantage that show the state of fundus and degree of indentation of sclera accurately during the operation. Becaulse it has complications such as choroidal bleeding, retinal incarceration, iatrogenic retinal break, choroidal detachment and loss of vitreous, it should be done carefully. The authors analyzed the clinical data of 128 cases(137 eyes) of retinal detachment surgery with subretinal fluid drainage at the Department of Ophthalmology, Pusan Paik Hospital, College of medicine, Inje University from May, 1988 to April, 1990. And the results were as follows: 1. The most common operative method of rhegmatogenous retinal detachment were explant buckling and encirclement with subretinal fluid drainage, and the success rate of first operation was 86.13% and the overall success rate of rhegmatogemous retinal detachment was 91.2% in 137 eyes of operation. 2. In 116 cases(92.8%) who were done subretinal fluid drainage, absorption of residual subretinal fluid took in a day. 3. The most common cause of surgical failure was proliferative vitreoretinopathy. 4. The most common complication was choroidal hemorrhage and it was developed 14 eyes(10.2%) mong 137 eyes. 5. The preoperative duration of symptom and extent of detachment were influenced to the surgical success rate and they had statistical significance(p<0.05). 6. The power of refraction was changed to myopia and ERG b-wave amplitude were increased and 89 eyes out of 137 eyes(69.6%) showed an improvement of vision at the three months after retinal detachment surgery.

No abstract available.
Breast Neoplasms* ; Breast* ; Drug Therapy* ; Methotrexate*

No abstract available.
Lung Neoplasms* ; Lung*

The purpose of this study was to evaluate the characteristics of craniofacial skeleton on orthognathic surgical cases with skeletal Class III malocclusion. For this study, 74 students at the dental college of Chosun University volunteered as a normal occlusion group. They had well-balanced faces and good occlusions with acceptable Class I molar relationship. They had not received orthodontic treatment and had no signs or symptoms of temporomandibular joint dysfunction. 45 malocclusion patients enrolled for orthognathic surgical treatment with skeletal Class III malocclusion at the Department of Orthodontics, College of Dentistry, Chosun University. On the basis of this study, the results of this study were as follows: 1. Skeletal Class III malocclusion was largely due to the overgrowth of mandible in man and the undergrowth of maxilla in woman. 2. The mandible was antero-inferiorly overgrown by large MP-HP angle and large gonial angle in orthognathic surgical cases with skeletal Class Iii malocclusion. And also, upper incisors were severely labioversioned, but on the other hand lower incisors were linguoversioned. 3. In female, lower-third facial height was characteristically shortened in comparison with middle-third facial height and also, lower facial throat angle was sgrall in male.
Dentistry ; Female ; Hand ; Humans ; Incisor ; Male ; Malocclusion* ; Mandible ; Maxilla ; Molar ; Orthodontics ; Orthognathic Surgery ; Pharynx ; Skeleton* ; Temporomandibular Joint

BACKGROUND/AIMS: The emergence of lamivudine-resistant mutant hepatitis B virus (HBV), with aminoacid substitution in the YMDD motif of DNA polymerase, has been reported in the long-term lamivudine use group. However there is no report about the emergence of mutant viruses during the short-term lamivudine therapy. The objective of this study was to investigate the emergence of YMDD mutant HBV during short-term lamivudine therapy. METHODS: We evaluated twenty-eight chronic hepatitis B patients who were HBeAg and HBV DNA positive and treated with lamivudine 100mg p.o. daily for 12 weeks. First, we investigated the emergence of YMDD mutants by nested polymerase chain reaction (PCR) method developed by Chayama et al in 19 patients who lost HBV DNA during lamivudine therapy but showed HBV DNA re-emergence 2 weeks after the end of therapy. Second, DNA subcloning and sequencing of HBV DNA polymerase including YMDD motif was undertaken in one patient's serial blood samples at 0, 8, 12 weeks to confirm the results of nested PCR. RESULTS: YMDD motif mutation was detected in 17(90%) out of 19 patients at the end of therapy and the type of mutations were YIDD only. At the end of therapy, mutant was predominant in 5 patients, both mutant and wild type were similar in proportion in 3 patients, and wild type was predominant in 9 patients. When we carried out nested PCR serially with samples of 0, 2, 4, 8, 12, 14 weeks after initiation of therapy in 5 patients who were mutant predominant at 12 weeks, YIDD mutant began to be detected from 2 weeks in 4 patients and from 4 weeks in one patient. However, rapid turnover from mutant to wild type happened after the end of therapy, so only wild type was detected in 3 patients and wild type became predominant in 2 patients at 2 weeks after the end of therapy. All the sequencing results of serial blood samples in one patient were consistent with nested PCR data. CONCLUSIONS: The presence of YMDD motif HBV polymerase mutant may be possible before administration of lamivudine in Korean chronic hepatitis B patients. Nested PCR assay would be an useful method to detect YMDD mutant.
DNA ; Hepatitis B e Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Lamivudine* ; Polymerase Chain Reaction

A new method of urinary diversion via Skinner`s modification of Koch continent ileal reservoir was tried. With this method continence with storage of urine under low pressure is well maintained so that no external applicances are necessary. Ileorenal reflux is also prevented with this nipple forming technique. From May l986 to September l986, 4 patients underwent urinary diversion that included creation of a modified Koch pouch by Skinner. Previous urinary diversion was by ureterocutaneous diversion in 1 patient. A total of 3 patients underwent radical cystectomies for bladder cancer In 1 patient, simultaneous urethrectomy was done because of carcinoma in situ in the urethra. There were no operative mortalities. All patients are continent and without reflux to the upper urinary tract. The volume capacity of pouch is more than 400ml. The pouch is emptied by self-catheterization every 4 to 6 hours during the day and once at night. Postoperative follow-up presently is short and it is impossible to check late complications. Although preliminary, this clinical trial suggests that the quality of life for patients can be improved markedly by the modified Koch continent ileal reservoir.
Carcinoma in Situ ; Colonic Pouches* ; Cystectomy ; Follow-Up Studies ; Humans ; Mortality ; Nipples ; Quality of Life ; Urethra ; Urinary Bladder Neoplasms ; Urinary Diversion ; Urinary Tract

Maspin is a recently described gene with tumor suppressor activity. The gene product is a 42 kD protein with homology to the serpin family of protease inhibitors and may play a role as an inhibitor of tumor cell invasion. The prior observation that invasive breast cancers and their metastases showed decreased maspin protein expression by immunostaining supports this speculation. However, the role of maspin in breast cancer progression has not been studied in detail. We, therefore, studied maspin protein expression in a series of hyperplasia, atypical ductal hyperplasia, intraductal carcinoma and invasive carcinomas. Immunohistochemical staining (IHC) for maspin was performed on paraffin sections of 136 breast specimens using a commercially available monoclonal antibody. Among the 106 cases studied were 36 moderate/florid ductal hyperplasia, 11 atypical ductal hyperplasia (ADH), 29 intraductal carcinoma (IDC) (4 low grade, 13 intermediate grade, 12 high grade) and 30 invasive ductal carcinomas. Thirty cases of normal breast were also studied as control group. IHC stains were scored using a semiquantitative scoring system. The mean IHC scores for maspin for normal, moderate/florid hyperplasia, atypical ductal hyperplasia, intraductal carcinoma, and invasive carcinoma were 5.51 1.30, 7.36 0.72, 3.82 1.60, 4.48 2.69, 3.97 3.30, respectively. These scores for each category were statistically significant (p<0.05), except between ADH and IDC. Maspin protein expression was increased in most cases of moderate/florid hyperplasia, while maspin expression was more heterogeneous in ADH and IDC. In high grade IDC, maspin protein expression was stronger than low and intermediate grade IDC, and this suggests the possibility of a compensatory cellular response against the forces driving further tumor progression. Two thirds of invasive ductal carcinomas expressed maspin protein weakly and focally. All metastatic carcinomas of lymph nodes were negative for maspin. It is possible that high grade IDC with strong maspin expression may represent a subset less likely to progress to invasive cancer. This speculation merits investigation in clinical outcome studies.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Coloring Agents ; Humans ; Hyperplasia* ; Lymph Nodes ; Neoplasm Metastasis ; Outcome Assessment (Health Care) ; Paraffin ; Protease Inhibitors

PURPOSE: The purpose.of this study was to characterize the enhancing patterns of hepatocellular carcinoma (HCC) on two-phase dynamic incremental liver scan with spiral CT. MATERIALS AND METHODS: Two-phase dynamic incremental liver scan using spiral CT was performed on 230 lesions in 107 patients with HCC. CT scanning was performed with a table speed of 13mm/sec and a section thickness of 10 mm;120 mL of contrast medium was injected intravenously with a automatic injector at the rate of 3mL/sec. CT scans were started 35 sec(early phase) and 3 min(delayed phase) after beginning injection of contrast medium. The tumors were divided into 2 groups according to size(< or = 3cm and > 3cm), the contrast enhancement patterns of HCCs and capsules in the early and delayed phases were analyzed in each group. RESULTS: Most of HCCs appeared as high-attenuating lesions in the early phase(75% in tumors smaller than 3cm and 61% in tumors larger than 3cm), and as low-attenuating lesions in the delayed phase(68% in tumors smaller than 3cm and 90% in tumors larger than 3cm). Forty-eight percent of HCCs smaller than 3cm and 58% of HCCs larger than 3cm were high-attenuating in the early phase and low-attenuating in the delayed phase. Thirty-two percent of capsules were low- or iso-attenuating in the early phase and high-attenuating in the delayed phase. Capsules were demonstrated in 22% in HCCs smaller than 3cm and 67% in HCCs larger than 3 cm(p <. 01). CONCLUSION: Two-phase dynamic scan with spiral CT is useful in the diagnosis of HCC because of a precise display of hemodynamic characteristics of HCCs.
Capsules ; Carcinoma, Hepatocellular* ; Diagnosis ; Hemodynamics ; Humans ; Liver ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed

Graves disease occur in association with myasthenia gravis is rare. We report a case of Graves disease and myasthenia gravis treated by bilateral subtotal thyroidectomy and total thymectomy simultaneously. A 37 year old woman was admitted with anterior neck mass and ptosis. Various examinations were compatible with combined Graves disease and myasthenia gravis. The bilateral subtotal thyroidectomy and total thymectomy were done simultaneously. The pathologic diagnosis was Graves disease and thymic hyperplasia. The patients postoperative course was uneventful. The thyroid function of patient became euthyroid and the clinical symptoms related with myastenia gravis resolved during follow up period.
Adult ; Diagnosis ; Female ; Follow-Up Studies ; Graves Disease* ; Humans ; Myasthenia Gravis* ; Neck ; Thymectomy* ; Thymus Hyperplasia ; Thyroid Gland ; Thyroidectomy*