PURPOSE: The purpose of this study was to compare functional status and the level of health care needs in elderly Koreans in health care institutions. METHODS: Data were collected from 2,521 elderly patients admitted in 50 health care institutions (hospitals, oriental hospitals, geriatric hospitals, and health care facilities) selected through proportional stratified sampling in 2008. We used a long-term care (LTC) assessment tool developed by the government, which consists of 52 items with 5 subscales. RESULTS: Statistically significant differences were detected in functional status and the level of health care needs among the subjects in different health care institutions. Of the sample population in geriatric hospitals, 48.9% were eligible for LTC Category 1, 20.9% for Category 2, and 17.2% for Category 3, and 13.1% of the subjects were not eligible for any of the categories. Of the sample population in health care facilities, 29.9% were eligible for LTC Category 1, 20.5% for Category 2, and 21.8% for Category 3, and 27.0% of the subjects were not eligible for any of the categories. CONCLUSION: The findings of this study indicate the necessity of the development of an evaluation system that helps determine whether a subject is eligible for LTC.
Aged* ; Delivery of Health Care* ; Health Status* ; Humans ; Institutionalization ; Long-Term Care

No abstract available.
Osteoclasts*

OBJECTIVES: The study was to compare the shaping ability of Reciproc (VDW) and WaveOne (Dentsply Maillefer) instruments compared with ProTaper, Profile and hand instrument during the preparation of simulated root canals. MATERIALS AND METHODS: Five groups (n = 5) were established. Reciproc, WaveOne, ProTaper, Profile and K file (K-flexo file) were used to prepare the resin simulated canals. A series of preoperative and postoperative images were taken by a microscope and superimposed in 2 different layers. The amount of resin removed from both the inner and the outer sides of the canal was measured to the level of 10 mm from the apical tip, with a 1 mm increment. RESULTS: The mean of resin removal from the inner canal wall was not different from the outer canal wall for Reciproc and WaveOne groups at apical third (1 - 3 mm level). There was no difference in the change of working length and maintenance of canal curvature. NiTi instruments are superior to stainless-steel K file in their shaping ability. CONCLUSIONS: Within the limitation of this present study, Reciproc and WaveOne instruments maintained the original canal curvature in curved canals better than ProTaper and Profile, which tend to transport towards the outer canal wall of the curve in the apical part of the canal.
Hand

PURPOSE: The trefoil factor family 1 (TFF1) has a protective effect against gastric mucosal damage induced by nonsteroidal anti-inflammatory drugs or ethanol. In addition, a TFF1 knockout mouse model has exhibited circumferential adenomas with high-grade dysplasia, of which 30% progressed into frankly invasive carcinomas. We tried to determine whether the expression pattern of the TFF1 could be involved in the development of sporadic gastric carcinomas. MATENRIALS AND METHODS: We examined TFF1 expression in a series of 43 sporadic gastric carcinomas and 18 gastric adenomas by immunohistochemistry. RESULTS: Strong positive TFF1 staining was identified primarily in the normal gastric mucosa, mainly in the cytoplasm of the superficial and foveolar epithelium. We found TFF1 expression in 55.8% (24 out of 43) of the gastric carcinomas and in 16.7% (3 out of 18) of the gastric adenomas. Statistically, TFF1 immunoreactivity was significantly higher in diffuse-type (82.4%) than in intestinal-type (38.5%) carcinomas (p=0.0058, Fisher's exact test). CONCLUSION: Our findings provide sufficient evidence that the expression of TFF1 in gastric cancer may simply disclose gastric-type differentiation of neoplastic cells and provide further support for the existence of at least two pathways of malignant transformation of the gastric mucosa: one via intestinal metaplasia and adenomatous dysplasia, leading to glandular carcinomas with intestinal-type differentiation, and the other via hyperplastic changes or de novo changes, leading to diffuse carcinomas and to a subset of glandular carcinomas displaying gastric-type differentiation.
Adenoma* ; Animals ; Cytoplasm ; Epithelium ; Ethanol ; Gastric Mucosa ; Humans ; Immunohistochemistry ; Lotus* ; Metaplasia ; Mice ; Mice, Knockout ; Stomach Neoplasms

PURPOSE: As increased level of prostaglandin has been identified in the bony lesions of Langerhans cell histiocytosis (LCH), we speculated that indomethacin, a potent prostaglandin inhibitor, may be effective for patients with LCH. METHODS: Retrospective review of 8 children with LCH (male 7, female 1) treated with indomethacin at Seoul National University Children's Hospital from September 1999 to February 2001 was done. The dose of indomethacin ranged from 1.8 to 2.8 mg/kg/day in two divided doses. RESULTS: Four patients with single bony lesion had a complete response to treatment. Among them one patient was treated with indomethacin after fourth relapse. Two patients with multiple bony lesions seemed to have partial response to treatment with indomethacin initially but showed disease progression later. Two patients with extraosseous lesion did not respond, but skull lesions were resolved after treatment. No serious toxicities of indomethacin treatment were observed. CONCLUSION: Indomethacin seems to be a very convenient and useful therapy for LCH involving single bony lesion. The mechanism how the LCH imporves in response to indomethacin has to be elucidated. Whether it has a specific role in slowing disease progression or we are seeing merely a spontaneous remission has to be studied in large scale.
Child ; Disease Progression ; Female ; Histiocytosis, Langerhans-Cell* ; Humans ; Indomethacin* ; Prostaglandin Antagonists ; Recurrence ; Remission, Spontaneous ; Retrospective Studies ; Seoul ; Skull

It is known that radiation can induce various kind of mutations, cancers and congenital malformations. Day 9 rats embryos were cultured by whole embryo culture method and irradiated 0.1, 0.5, 2 and 5 Gy at day 10 to study the effect of radiation on the development of rat embryos. Haversting after 48 hours culture, the morphological changes and apoptosis were investigated. In addition, we assessed the expression patterns of p53, WAF1, Bcl -2, Bcl -x and Bax. Compared to the control group, no remarkable morphological changes were observed in the low dosage group (0.1 and 0.5 Gy). But at high dosage group (2 and 5 Gy), growth was retarded and the heart beats were weak. The crown rump length, the number of somites, and branchial arch were decreased and the rotation of embryo and development of otic pit and lens pit, and upper limb bud was delayed significantly. Especially in the 5 Gy group the most of external morphology were difficult to discriminate. In histological observations, high dosage group showed marked increase in the number of apoptotic bodies in the optic cup, trigeminal ganglion, pharyngeal arches, heart and small intestine. In western blot analysis, Bcl -x and Bax were not expressed in all groups. Expression level of Bcl -2 was constant regardless of the amount of radiation. Expression level of p53 and WAF1 increased significantly in accordance with the increasing amount of radiation. Especially, WAF1 was expressed 7.2, 6.3, 9.9 and 11.3 folds more than the control groups when embryos were exposed to 0.1, 0.5, 2 and 5 Gy, respectively. Considering WAF1 arrests cell cycle, we concluded that cell cycle was affected most sensitively to radiation injury. From these results, radiation showed growth retardation, decrease in protein synthesis, increase in apoptosis and expression of related genetic materials. These results may be used as a standard to test the effect of drugs for reducing and protecting agents against deterious effect of radiation in developing embryo and fetus.
Animals ; Apoptosis ; Blotting, Western ; Branchial Region ; Cell Cycle ; Crown-Rump Length ; Embryonic Structures* ; Fetus ; Heart ; Intestine, Small ; Radiation Injuries ; Rats ; Somites ; Trigeminal Ganglion ; Upper Extremity

BACKGROUND: Microcirculatory derangement in sepsis plays a crucial role in the impairment of tissue oxygenation that can lead to multi-organ failure and death. The change of RBC rheology in sepsis has been known to be important factors in microcirculatory derangement. Several studies have demonstrated that RBCs have decreased deformability in sepsis. We investigated the relationship between multi-organ failure and spherical index of RBC estimated by flow cytometer in critically ill patients with or without sepsis compared with the relationship in healthy volunteers. METHODS: Fourteen non-septic critically ill patients, 18 septic patients and 10 healthy volunteers were evaluated. We obtained peripheral venous blood from each patient and analyzed the change of RBC shape using flow cytometer (Becton Dickinson FACSCalibur) within 90 minute. The change of RBC shape was accessed with spherical index (M2/M1). A decrease in M2/M1 was correlated with the sphericity of the RBC and considered to have a lower capacity to alter their shape when placed in microcirculation. Multi-organ failure was accessed with sequential organ failure assessment (SOFA) score. RESULTS: The M2/M1 ratio of healthy volunteers, non-septic patients and septic patients were 2.25+/-0.08, 2.16+/-0.39 and 2.05+/-0.53, respectively. But, there was no significant difference between each group (p>0.05). And, there was no significant correlation between M2/M1 ratio of septic and non- septic patients and SOFA score (p>0.05, r2= -0.13). CONCLUSIONS: In our study, the spherical index of RBC was not associated with multi-organ failure in sepsis. But, further studies may be needed to evaluate the role of RBC rheology in sepsis.
Critical Illness ; Healthy Volunteers ; Humans ; Microcirculation ; Oxygen ; Rheology ; Sepsis*

BACKGROUND: Despite early aggressive treatment, post myocardial infarction(MI) ventricular septal defect(VSD) revealed high surgical mortality. We reviewed the 10-year experiences of surgically treated post-MI VSD in Yonsei University. MATERIAL AND METHOD: From Jan. 1991 to May 2001, 17 patients underwent surgical repair of post-MI VSD. Ages ranged between 47 and 77 years (mean age=63.2+/-9.1). There were 10 males and 7 females. VSD was located at anterior in 16 patients and at posterior in one. IABP was inserted preoperatively in 12 patients due to cardiogenic shock. Mean interval from MI to occurrence of VSD was 5.6 days. Among patients undergoing early surgical correction(n=13), mean interval from occurrence of VSD to operation was 2.5 days. In 11 patients, concomitant CABG was performed during repair of VSD. RESULT: Four patients died within 30 days after the operation (30 day mortality=23.5%). Among 12 patients with preoperative cardiogenic shock, 4 patients died within 30 days (30-day mortality=33.3%). During mean follow up period of 52 months, one patient died of unknown cause and 10-year survival of discharged patients was 66.7%. All follow-up patients were in NYHA functional class I or II when their last OPD visit. CONCLUSION: In the treatment of post-MI VSD, aggressive medical treatment with early surgical correction seems to be very important in terms early and long-term survival of patients.
Female ; Follow-Up Studies ; Heart Septal Defects ; Humans ; Male ; Mortality ; Myocardial Infarction ; Shock, Cardiogenic

Intrauterine midgut volvulus is an extremely rare and potentially life-threatening disease, requiring prompt surgical intervention after birth. Non-specific prenatal signs of fetal midgut volvulus cause late diagnosis and treatment, resulting very poor outcome. We report a case of preterm newborn with intrauterine midgut volvulus due to malrotation, who survived after immediate postnatal surgical intervention.
Delayed Diagnosis ; Humans ; Infant, Newborn ; Infant, Premature* ; Intestinal Volvulus* ; Parturition

PURPOSE: Since 2005, the Ministry of Health & Welfare has provided financial support to promote palliative care for terminal cancer patients. We analyzed how palliative care facilities used the funding between 2006 and 2010. METHODS: Frequency analysis was conducted by the item of expenditure based on fiscal reports of the palliative care facilities. Linear regression analysis was performed to examine a trend over time. Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare expenditure items, the number of provision of financial support and type of palliative care units. RESULTS: About a half of the fund was spent to pay care givers salary, improve facilities and purchase equipment regardless of the year, the number of financial support provided or facility type. By year, the operation cost for palliative care program and the education cost for health care workers have significantly increased in linear regression analysis (P<0.01). However, the amount of financial support for the low income group has decreased over years (P=0.024). This trend was affected by evaluation criteria and weight. CONCLUSION: The government aid for palliative care units has been used to improve facilities and equipment. Moreover, desirable changes were noted such as a higher portion of expenses for program operation and care giver training to enhance the quality of care. However, the evaluation criteria need to be adjusted to prevent any further decrease in the support provided to the low income group.
Caregivers ; Delivery of Health Care ; Financial Management ; Financial Support ; Financing, Government ; Health Expenditures ; Humans ; Korea ; Linear Models ; Palliative Care ; Practice Guidelines as Topic ; Salaries and Fringe Benefits