OBJECTIVES: This study investigated the effects of chronic medical diseases on depressive symptoms in individuals at high risk for depression living in rural areas, over a 1-year period.METHODS: A community-based longitudinal study was conducted; 67 participants aged 18–79 years residing in rural areas were included. In the first survey, all participants completed a self-report questionnaire battery. An interview was also conducted to obtain data on demographic variables and current or past chronic medical diseases. In the first survey, participants with the Center for Epidemiologic Studies Depression scale(CES-D) scores of 16 or higher were categorized as being at high risk for depression; the same assessments were carried out 1 year later in a follow-up survey. Multiple regression analysis was performed to determine the association of chronic medical diseases with 1-year follow-up depressive symptoms in the high-risk group.RESULTS: In model 1, which controlled for sociodemographic variables, the number of chronic medical diseases (p =0.026), baseline severity of depressive symptoms(p =0.002), and presence of diabetes(p =0.039) were significantly associated with the follow-up CES-D scores. In model 2, which further adjusted for Alcohol Use Disorder Identification Test and Beck Anxiety Inventory scores, the number of chronic medical diseases(p =0.036), baseline severity of depressive symptoms(p =0.017), and prevalence of diabetes(p =0.037) were also significantly associated with the follow-up CES-D scores.CONCLUSION: This study suggests that the number of chronic medical diseases, prevalence of diabetes, and severity of depressive symptoms are significantly associated with 1-year follow-up depressive symptoms in individuals at high risk for depression.
Anxiety ; Depression ; Diabetes Mellitus ; Epidemiologic Studies ; Follow-Up Studies ; Longitudinal Studies ; Prevalence ; Rural Population

Craniofacial cleft is a rare disease, and has multiple variations with a wide spectrum of severity. Among several classification systems of craniofacial clefts, the Tessier classification is the most widely used because of its simplicity and treatment-oriented approach. We report the case of a Tessier number 3 cleft with wide soft tissue and skeletal defect that resulted in direct communication among the orbital, maxillary sinus, nasal, and oral cavities. We performed soft tissue reconstruction using the straight-line advanced release technique that was devised for unilateral cleft lip repair. The extension of the lateral mucosal and medial mucosal flaps, the turn over flap from the outward turning lower eyelid, and wide dissection around the orbicularis oris muscle enabled successful soft tissue reconstruction without complications. Through this case, we have proved that the straight-line advanced release technique can be applied to severe craniofacial cleft repair as well as unilateral cleft lip repair.
Classification ; Cleft Lip ; Cleft Palate ; Congenital Abnormalities ; Craniofacial Abnormalities ; Eyelids ; Maxillary Sinus ; Orbit ; Rare Diseases ; Reconstructive Surgical Procedures

The ideal scalp reconstruction involves closure of the defect with similar hair-bearing local tissue in a single step. Various reconstructions can be used including primary closure, secondary healing, skin grafts, local flaps, and microvascular tissue transfer. A 53-year-old female patient suffered glioblastoma, which had recurred for the second time. The neurosurgeons performed radial debridement and an additional resection of the tumor, followed by reconstruction using a serratus anterior muscle flap with a split-thickness skin graft. Unfortunately, the flap became completely useless and a bilateral rotation flap was used to cover the defect. Two month later, seroma with infection was found due to recurrence of the tumor. Additional surgery was performed using multiple perforator based island flap. The patient was discharged two weeks after surgery without any complications, but two months later, the patient died. Radical surgical resection of tumor is the most important curative option, followed by functional and aesthetic reconstruction. We describe a patient with a highly malignant tumor that required multiple resections and subsequent reconstruction. Repeated recurrences of the tumor led to the failure of reconstruction and our strategy inevitably changed, from reconstruction to palliative treatment involving fast and stable wound closure for the patient's comfort.
Debridement ; Female ; Free Tissue Flaps* ; Glioblastoma ; Humans ; Middle Aged ; Neurosurgeons ; Palliative Care ; Perforator Flap ; Reconstructive Surgical Procedures ; Recurrence ; Scalp* ; Seroma ; Skin ; Surgical Flaps ; Transplants ; Wounds and Injuries

The ideal scalp reconstruction involves closure of the defect with similar hair-bearing local tissue in a single step. Various reconstructions can be used including primary closure, secondary healing, skin grafts, local flaps, and microvascular tissue transfer. A 53-year-old female patient suffered glioblastoma, which had recurred for the second time. The neurosurgeons performed radial debridement and an additional resection of the tumor, followed by reconstruction using a serratus anterior muscle flap with a split-thickness skin graft. Unfortunately, the flap became completely useless and a bilateral rotation flap was used to cover the defect. Two month later, seroma with infection was found due to recurrence of the tumor. Additional surgery was performed using multiple perforator based island flap. The patient was discharged two weeks after surgery without any complications, but two months later, the patient died. Radical surgical resection of tumor is the most important curative option, followed by functional and aesthetic reconstruction. We describe a patient with a highly malignant tumor that required multiple resections and subsequent reconstruction. Repeated recurrences of the tumor led to the failure of reconstruction and our strategy inevitably changed, from reconstruction to palliative treatment involving fast and stable wound closure for the patient's comfort.
Debridement ; Female ; Free Tissue Flaps* ; Glioblastoma ; Humans ; Middle Aged ; Neurosurgeons ; Palliative Care ; Perforator Flap ; Reconstructive Surgical Procedures ; Recurrence ; Scalp* ; Seroma ; Skin ; Surgical Flaps ; Transplants ; Wounds and Injuries

BACKGROUND: Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy, although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke. METHODS: From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use. RESULTS: A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological deficit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological deficit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment. CONCLUSION: In very elderly patients, mild neurological deficit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy.
Aged ; Hospitals, University ; Humans ; National Institute of Neurological Disorders and Stroke ; Registries ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator

PURPOSE: The large disparity in outcomes of out-of-hospital cardiac arrest (OHCA) between communities makes it important determine pre-hospital factors associated with outcome of OHCA. The study evaluated pre-hospital care performed by 119 rescuers in OHCA and investigated pre-hospital factors that influenced return of spontaneous circulation (ROSC) and automated external defibrillator (AED) use. METHODS: We retrospectively analyzed 119 OHCA patients with presumed cardiac origin admitted to our emergency department transported by 119 rescuers from May 2007 to April 2010. Patients were divided according to achievement of ROSC and AED use prior to comparative analysis. RESULTS: Twenty six patients (21.8%) experienced ROSC and only five patients (4.2%) survived to discharge. In the study area, scene-to-hospital arrival time was significantly shorter in the ROSC group (15.0+/-5.8 minutes) than the non-ROSC group (19.4+/-9.1 minutes) (p=0.02) and electrocardiography (ECG) application was associated with non-AED use. CONCLUSION: Cooperation of emergency medical services and hospitals in the community to reduce hospital arrival time is needed to improve ROSC in OHCA patients. AED use on scene prior to ECG application will be encouraged and higher level training and continuous education of 119 rescuers for AED use will be needed to enhance AED application.
Achievement ; Defibrillators ; Electrocardiography ; Emergencies ; Emergency Medical Services ; Humans ; Out-of-Hospital Cardiac Arrest ; Retrospective Studies

OBJECTIVE: This study is to analyze the direct effects of hyperprolactinemia, cause of anovulation and infertility, on ovarian function. METHODS: The prepubertal female Sprague-Dawley (SD) rats were obtained and ovulation was induced with PMSG and hCG s.c.. The rats were divided into four groups, which received the following treatments IP : saline 0.2 ml, 150 ug PRL, 300 ug PRL, 300 ug PRL plus 300 ug naloxone. The animals were killed and the oviducts were evaluated for the presence of ova. The ovary were then removed and evaluated under light microscopy. For changes of follicular t-PA and PGE2 concentration after PRL, immature female SD rats were stimulated as described above. At four hours after the hCG injection the rats were killed and the ovaried were removed. Each isolated ovaries were incubated in culture plate containing incubation medium or 300 ng PRL to be tested. And PRL plus gonadotropin in incubation medium was tested because of change of PGE2 concentration. After incubation period, t-PA and PGE2 were measured by EIA. Differences between groups were assessed by two-way ANOVA of variance followed Mann-Whitney U test or Kruskal-Wallis test for multiple comparisons. p<0.05 was considered statistically significant. RESULTS: As result, prolactin transiently suppresses ovulation, especially with its increased concentration not by altering the ovarian morphology. But ovulation inhibition was reversed by naloxone injection. The level of t-PA in control and prolactin-treated group increased steadily in response to human chorionic gonadotropin administration, yet lower in prolactin-treated group. But PGE2 concentration was increased in gonadotropin mixed groups but not affected in prolactin-treated group despite a significant blockade of ovulation. CONCLUSION: Thus, further studies on the effect of high level prolactin on ovulatory function would significantly contribute toward the patient with hyperprolactinemia for managing infertility and maintaining appropriate female reproductive function.
Animals ; Anovulation ; Chorionic Gonadotropin ; Dinoprostone* ; Female ; Gonadotropins ; Humans ; Hyperprolactinemia ; Infertility ; Microscopy ; Naloxone ; Ovary ; Oviducts ; Ovulation ; Ovulation Inhibition ; Ovum ; Prolactin* ; Rats* ; Rats, Sprague-Dawley

We experienced a case of diastasis of the symphysis pubis accompanying severe pubic pain and serious gait disturbance, which was developed at 34 weeks gestation before labor pain in 36-year-old primiparous woman, who has experienced previous cesarean section at her first pregnancy due to pelvic pain before onset of labor, so we report a case with a review of the literature.
Adult ; Cesarean Section ; Female ; Gait* ; Humans ; Labor Pain* ; Pelvic Pain ; Pregnancy

The purpose of this study was investigating serum lipid, apolipoprotein levels and their correlations in healthy adults of Gyeongnam area. The BMI (body mass index) was significantly higher (p < 0.001) in male (25.2 +/- 2.7 kg/m2) than female (23.8 +/- 1.5 kg/m2), however PBF (percent body fat) was significantly higher (p < 0.001) in female (29.6 +/- 4.3%) than male (22.7 +/- 5.0%). The WHR (waist to hip ratio) and blood pressure in the groups showed there was no significant differences. The levels of serum total cholesterol, LDL-cholesterol and apolipoprotein B were significantly higher (p < 0.01) in male (208.7 +/- 27.7 mg/dl, 129.0 +/- 26.9 mg/dl, 1.0 +/- 0.2 g/L) than female (193.6 +/- 29.1 mg/dl, 112.5 +/- 29.5 mg/dl, 0.9 +/- 0.2 g/L, but HDL-cholesterol level was significantly higher (p < 0.01) in female (54.9 +/- 6.6 mg/dl) than male (49.9 +/- 7.3 mg/dl). The LDL-C/HDL-C, Apo B/Apo A-I and AI (atherogenic index) were significantly higher (p < 0.001) in male (2.6 +/- 0.6, 0.8 +/- 0.2, 3.3 +/- 0.7) than female (2.1 +/- 0.5, 0.6 +/- 0.2, 2.6 +/- 0.5). The triglyceride level was positively correlated with apolipoprotein B concentration (p < 0.05) and negatively correlated with HDL-cholesterol concentration (p < 0.05), however no significant correlation was found with apolipoprotein A-I. According to these results, we conclude that male adults are expecting higher incidence of cardiovascular disease than female adults and we suggest the serum triglyceride should be kept normal level for the prevention of these diseases.
Adult* ; Apolipoprotein A-I ; Apolipoproteins* ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Female ; Hip ; Humans ; Incidence ; Male ; Triglycerides

We experienced 3 cases of early stage tubal cancer incidentally recognized during the operation and diagnosed pathologically after surgery of the tubo-ovarian abscess, the symptomatic adenomyosis, the myoma with adnexal cyst patients, so we report our cases with a review of the literature.
Abscess ; Adenomyosis ; Humans ; Myoma