The purpose of this study was to examine the relationship between emotional labor and burnout, and whether the levels of self-efficacy and type A personality characteristics increase the risk of burnout in a sample of Korean female dental hygienists. Participants were 807 female dental hygienists with experience in performing customer service for one year or more in dental clinics, dental hospitals, or general hospitals in Korea. Data were collected using a structured self-administered questionnaire. A hierarchical multiple linear regression analysis was used to examine the effects of emotional labor on burnout, and to elucidate the additive effects of self-efficacy and type A personality on burnout. The results showed that “overload and conflict in customer service,”“emotional disharmony and hurt,” and “lack of a supportive and protective system in the organization” were positively associated with burnout. With reference to the relationship between personality traits and burnout, we found that personal traits such as self-efficacy and type A personality were significantly related to burnout, which confirmed the additive effects of self-efficacy and type A personality on burnout. These results indicate that engaging in excessive and prolonged emotional work in customer service roles is more likely to increase burnout. Additionally, an insufficient organizational supportive and protective system toward the negative consequences of emotional labor was found to accelerate burnout. The present findings also revealed that personality traits such as self-efficacy and type A personality are also important in understanding the relationship between emotional labor and burnout.
Dental Clinics ; Dental Hygienists* ; Female ; Hospitals, General ; Humans ; Korea ; Linear Models ; Type A Personality*

Degenerative pannus arising from the atlanto-axial articulation is a rare entity, which is associated with chronic atlanto-axial instability in degenerative arthropathies. Due to cervical instability and the mass effect on the spinal cord, it can produce severe neck pain and compressive myelopathy. We report a case of cervical myelopathy resulting from non-rheumatoid atlanto-axial subluxation. The posterior stabilization provided excellent neurological improvement and pannus regression. Early recognition of this condition is important as the clinical condition will deteriorate without surgical interventions.
Neck Pain ; Osteoarthritis ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases

PURPOSE: We analyzed the histopathologic findings of the patients with ultrasongraphic Breast Imaging Reporting and Data System (BI-RADS) Category 4a breast lesions to determine which patient can be excluded from any invasive, diagnostic procedure in the future. METHODS: Of the 180 cases of BI-RADS Category 4a breast lesions that were diagnosed with ultrasonography during a 6 month-period, 132 cases were pathologically confirmed and these were analyzed retrospectively. Four benign cases that did not undergo any further procedure after fine needle biopsy and 6 malignant cases (4.5%) were excluded from this study. RESULTS: Of the 122 cases, 77 cases (63.1%) showed homogeneous benign finding, and 45 cases (36.9%) showed heterogeneous finding that was made up of two or more different pathologic lesions. Fibroadenoma (55.8%) was the most frequent pathologic finding in the cases with homogeneous finding, followed by fibrocystic change (14.3%), and fibrosis (7.8%). The cases with heterogeneous finding presented fibrocystic change (55.5%), microcalcification (48.8%), ductal hyperplasia (42.2%), and fibroadenoma (31.1%) in the order of frequency. CONCLUSION: Lesion with heterogeneous histopathologic nature was the most frequent finding defined as category 4a in breast ultrasonography, followed by fibrodenoma, fibrocystic change, microcalcification, and ductal hyperplasia. Refining more specific ultrasonographic findings of these lesions would guarantee that radiologists exclude more benign lesions from category 4a.
Biopsy, Fine-Needle ; Breast ; Fibroadenoma ; Fibrosis ; Humans ; Hyperplasia ; Information Systems ; Retrospective Studies ; Ultrasonography, Mammary

PURPOSE: Breast Cancer is an inter-tumoral and intra-tumoral heterogeneous disease. It remains unclear whether this heterogeneity results from different target cells or from different subsets of genetic abnormalities, otherwise from both. We postulated that in addition to genetic cloning, a variety of cells that exist during the defined developmental stages of the human mammary gland could give rise to the heterogeneity of breast cancer. To verify this postulation, we have analyzed pure ductal carcinoma in situ (DCIS) for the expression of the biomarkers that represent the mammary stem cell, the early progenitor cells, and the glandular and myoepithelial cells of the mammary gland. METHODS: We investigated the relationship between the immnuohistochemical expression of the mammary development-associated biomarkers {cytokeratin-18 (CK18), cytokeratin-6 (CK6), alpha-smooth muscle actin (SMA), Wnt-1, Notch 3} and some other factors {the menopausal status, the estrogen receptor (ER) status, the progesterone receptor (PR) status, c-erbB-2, and the number of tumor foci} in 26 cases of DCIS. RESULTS: All 26 cases included in this study showed the positive expressions of CK18 and SMA. The expression of all the markers was not correlated with the menopausal status. The positive expression of CK6 had a statistically significant relationship with a negative estrogen receptor (p=0.014), positive c-erbB-2 (p=0.048), high nuclear grade (p=0.001), and single focus of DCIS (p=0.017). The expression of Wnt-1 and Notch 3 did not have significant correlation with any factors. However, the positive expression of Wnt-1 showed a tendency of a negative ER (p=0.061) and the positive expression of Notch 3 also showed a tendency of a negative ER (p=0.086) and a high nuclear grade (p=0.086). CONCLUSION: The CK6 positive tumor is thought to originate from the more primitive cells compared to the CK6 negative tumor. Unifocality of the CK positive tumor might result from the arrest of differentiation of the original cell after disease affection. DCISs could be categorized into the CK6 positive and negative groups.
Actins ; Biomarkers ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Clone Cells ; Cloning, Organism ; Estrogens ; Keratin-6 ; Mammary Glands, Human* ; Population Characteristics ; Receptors, Progesterone ; Stem Cells*

INTRODUCTION: Cathepsin D (CD) is a lysosomal protease that can be used as an important prognostic cytosolic factor for breast cancer. Its over-expression in breast cancer cells and in the host stromal cells in the tumor has been proposed as being a poor prognostic indicator. However, its prognostic value is still being debated. Therefore, CD expression needs to be examined in more relevant subsets of tissue in order to refine its prognostic significance and the clinical applications. METHODS: Regardless of the lymph node status, 110 T1 invasive ductal carcinomas of the breast were immunohistochemically evaluated for the CD expression using rabbit anti-cathepsin D monoclonal antibody. This study separately assessed the expression of CD in the invasive component (IDC), in the in situ component (DCIS), and in the juxtatumoral stromal cells (JTSC). The CD expression level in these three kinds of tissues were correlated with the nuclear grade, ER, PR, c-erb-B2, p53, the N stage, the T stage, and the 5 year metastasis-free survival. RESULTS: Positive CD expression in the JTSC was associated with the T stage (p = 0.001) and the N stage (p = 0.029), whereas positive CD expression in the DCIS and IDC was not. In addition, strong CD expression in the JTSC correlated with the nuclear grade of the invasive component (p = 0.024). In all three components, no statistically significant correlation was found between the biomarker (ER, PR, cerb-B2, p53) and the CD expression. On univariate analysis, positive expression in the JTSC was correlated with a poor 5 year- metastasis free survival (p = 0.007), but the positive expression in the IDC and DCIS was not. CONCLUSION: CD expression of the JTSC could represent the N stage, the T stage, and the nuclear grade of T1 IDC. Whether or not it would have an independent influence on the prognosis of T1 IDC, CD expression in the JTSC is probably an indicator of the tumor virulence. CD expression in the JTSC will provide an important clue for the development of new CD targeted therapies, and it will serve as an important criterion for selecting the appropriate candidates for these future targeted therapies.
Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating ; Cathepsin D* ; Cathepsins* ; Cytosol ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Stromal Cells* ; Virulence

PURPOSE: In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. MATERIALS AND METHODS: Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. RESULTS: Radical mastectomy was performed in 64.8% of total patients and 26% of patients received breast- conserving surgery (BCS). The proportions of patients receiving BCT were 47.5% in stage 0, 54.4% in stage I, and 20.3% in stage II. Some of the patients (6.6% of stage I, 10.1% of stage II and 66.7% of stage III) not received radiotherapy after BCS. Only 45% of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. CONCLUSION: Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted.
Breast Neoplasms* ; Breast* ; Education ; Geography ; Humans ; Incidence ; Korea* ; Mastectomy, Radical ; Mastectomy, Segmental ; Radiotherapy

PURPOSE: The purpose of this study was to determine the accuracy of ultrasound guided vacuum-assisted Mammotome biopsy (UVAMB) for breast lesions. METHODS: Percutaneous biopsies of 564 breast lesions, in 489 patients, using UVAMB were performed between October 2000 and May 2002. The pathological findings of the UVAMB were compared with excisional biopsies, sonographic follow-ups and clinical follow-up findings. We evaluated the complication on immediate post-biopsy and 1 week later using ultrasound. RESULTS: Of the 564 lesions, 108 (19.1%) were diagnosed as malignant by UVAMB, and of 456 benign lesions, 63 were excised. On excision two of the benign lesions were found to be carcinomas. The false negative rate of the UVAMB was 2.7%, and 99 (17.5%) of the 564 biopsies were revealed as hematomas by ultrasound 1 week later. However, almost all of complications were well controlled by conservative management. CONCLUSION: Ultrasound guided vacuum-assisted Mammotome biopsies reduced the possibility of false-negatives and underestimated the disease. The complications of UVAMB were not serious, was proved to be a good biopsy method for small, non-palpable breast lesions.
Biopsy* ; Breast* ; Follow-Up Studies ; Hematoma ; Humans ; Ultrasonography*

OBJECTIVE: Study was designed preliminarily to observe the accordance of caregivers strain and depression with other factors such as sex of the patient, caregiver, lesion side, Mini Mental Status Examination (MMSE) score and Beck's Depression Index (BDI). METHOD: We composed a questionnaire with BDI, and the Sense of Competence Questionnaire (SCQ) in order to evaluate the amount of stress and depression of caregivers. Evaluation of the patient was done by interviewing them along with reviewing their medical records and obtaining scores such as the MMSE, Functional Inependence Index (FIM) and the Geriatric Depression Scale (GDS). RESULTS: BDI of the caregivers showed a negative correlation with the patients' age. Lesion side nor age, nor the prevalence of hemiplegia of patients did not show statistical relevance with the strain that the caregiver felt. The first subscale of SCQ showed a positive correlation with the caregiving time that the caregiver gave. In accordance to the sex of the caregiver, females showed to spend more time with the patient, showed to be more unsatisfied with the patient but showed a tendency of lesser SCQ score. CONCLUSION: Depression, strain and burden that the caregivers went through showed to have slight correlation with the patient and caregiver factors.
Caregivers* ; Depression* ; Female ; Hemiplegia ; Humans ; Medical Records ; Mental Competency ; Prevalence ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to evaluate the efficacy of annual breast screening, which includes a mammography and a clinical physical examination. METHODS: From April 1995 to March 2000, we performed 51,170 annual clinical examinations and mammographies on 26,354 women, who wanted to undergo breast screening, at the breast center. Ninety-five breast cancers were detected during screening, and of these, only 76 breast cancers were operated on. The result were compared with 650 symptomatic breast cancers from the outpatient department (OPD). RESULTS: Of the 51,170 cases screened, the recall rate for further examination was 9.9% (n=5,066), and the biopsy rate was 2.1% (n=1,096). Ninety-five breast cancers were detected; a detection rate of 0.19%. Fourteen breast cancers were detected after more than 2 screening rounds. On the analysis of the medical audit data based on the screening mammographies, the positive predictive value, confirmed when a biopsy from a surgical consultation was recommended (PPV), was 8.6%. Further, 41 cases involving tumors found at stage 0 or I (54%). There were 25 cases of axillary lymph node metastasis (32.9%). These results were compatible with the ideal rates for medical audits, except for PPV and axillary lymph node metastases. The pathologic stages of the screened group were: 0, 22.4%; I, 31.6%; II, 40.8%; III, 5.2%, whereas those of the OPD group were 0, 3.4%; I, 27.4%; II, 52.8%; III, 15.5%, and IV, 0.8%. Early breast cancers were detected more frequently through screening than by the OPD (P<0.05). Breast conservation surgery was carried out on 32.9% (25 cases) from the screened group, but only 12.8% (83 cases) from the OPD group (P<0.05). CONCLUSION: Our breast cancer screening was properly performed. Further, these findings indicate that breast cancer screening using a clinical examination and a mammography is very effective in the early detection of breast cancer.
Biopsy ; Breast Neoplasms* ; Breast* ; Female ; Humans ; Lymph Nodes ; Mammography ; Mass Screening* ; Medical Audit ; Neoplasm Metastasis ; Outpatients ; Physical Examination

PURPOSE: The purpose of this study was to determine the potential role of three-dimensional conformal radiotherapy (3D-CRT) in the treatment of primary unresectable hepatocellular carcinoma. The preliminary results on the efficacy and the toxicity of 3D-CRT are reported. MATERIALS AND METHODS: Seventeen patients were enrolled in this study, which was conducted prospectively from January 1995 to June 1997. The exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child-Pugh classification C, tumors occupying more than two thirds of the entire liver, and a performance status of more than 3 on the ECOG scale. Two patients were treated with radiotherapy only while the remaining 15 were treated with combined transcatheter arterial chemoembolization. Radiotherapy was given to the field including the tumor plus a 1.5 cm margin using a 3D-CRT technique. The radiation dose ranged from 36~60 Gy (median; 59.4 Gy). Tumor response was based on a radiological examination such as the CT scan, MR imaging, and hepatic artery angiography at 4~8 weeks following the completion of treatment. The acute and subacute toxicities were monitored. RESULTS: An objective response was observed in 11 out of 17 patients, giving a response rate of 64.7%. The actuarial survival rate at 2 years was 21.2% from the start of radiotherapy (median survival; 19 months). Six patients developed a distant metastasis consisting of a lung metastasis in 5 patients and bone metastasis in one. The complications related to 3D-CRT were gastro-duodenitis (>or= grade 2) in 2 patients. There were no treatment related deaths and radiation induced hepatitis. CONCLUSION: The preliminary results show that 3D-CRT is a reliable and effective treatment modality for primary unresectable hepatocellular carcinoma compared to other conventional modalities. Further studies to evaluate the definitive role of the 3D-CRT technique in the treatment of primary unresectable hepatocellular carcinoma are needed.
Angiography ; Carcinoma, Hepatocellular* ; Classification ; Hepatic Artery ; Hepatitis ; Humans ; Liver ; Liver Cirrhosis ; Lung ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Prospective Studies ; Radiotherapy ; Radiotherapy, Conformal* ; Survival Rate ; Tomography, X-Ray Computed