BACKGROUND: The mental problems of the elderly are at issue as a serious social phenomenon. The purpose of this study is to identify risk factors affecting the mood disorders of the elderly. METHODS: The subjects were 1,779,236 aged ≥65 and participated in health screening. Dependent variable was mood disorders. Independent variables were consisted of community level (regional deprivation index and healthcare resources) and individual level (sex, age, insurance type, disability, smoking, alcohol, physical activity, body mass index, and healthcare utilization). Multilevel logistic regression was performed. RESULTS: At the individual level, women, employed insured, severely disabled people, heavy alcohol drinkers, high-intensity physical activity, body mass index, and patients who had chronic disease and severe disease were significantly associated with mood disorders. As the age has increased, it has let increase of mood disorders. At the community level, as the regional deprivation index has increased by 1, mood disorders has been increased by 1.005 times. The intra-class coefficient was 7.04%. CONCLUSION: We found individual and community level factors are associated with mood disorders. Systematic approach is essential to reduce mood disorders.
Aged* ; Body Mass Index ; Chronic Disease ; Delivery of Health Care ; Female ; Health Services for the Aged ; Humans ; Insurance ; Linear Energy Transfer ; Logistic Models ; Mass Screening ; Mood Disorders* ; Motor Activity ; Multilevel Analysis ; Regional Health Planning ; Risk Factors ; Smoke ; Smoking

BACKGROUND/AIMS: Microsatellite instability (MSI) is defined as a change of any length due to either insertion or deletion of repeating units, in a microsatellite within a tumor when compared to normal tissue. MSI is closely related with genetic instability, particularly in hereditary nonpolyposis colorectal cancer. MSI is found in 10-50% of all gastric cancers, suggesting that MSI may play an important role in carcinogenesis. The aim of this study was to investigate the relationship between microsatellite instability and clinicopathologic features in early gastric cancers (EGCs) treated by endoscopic submucosal dissection (ESD). METHODS: We analyzed clinicopathological features of 95 specimens of EGCs including MSI, histologic type, mucin phenotype, p53, VEGF, location of cancer, depth of invasion, incidence of synchronous and metachronous cancer, age, and gender derived from 94 patients, treated by ESD during recent 19 months were analyzed in this study. RESULTS: According to microsatellite stability, MSI was observed in 13 (13.7%) cases of 95 specimens. The incidence of MSI was increased in patients with cancer at lower part of stomach and female gender. There was no significant relation between MSI and clinicopathologic features including histologic type, mucin phenotype, p53, VEGF, and depth of invasion. CONCLUSIONS: Our results demonstrate that there is no relationship between MSI and clinicopathologic features except tumor location and gender in ECGs treated by ESD. However, further studies are needed to evaluate the significance of MSI in EGCs.
Adult ; Aged ; Aged, 80 and over ; DNA Mutational Analysis ; Data Interpretation, Statistical ; Endoscopy, Gastrointestinal ; Female ; Humans ; Male ; *Microsatellite Instability ; Middle Aged ; Mucins/analysis ; Neoplasm Staging ; Predictive Value of Tests ; Stomach Neoplasms/*diagnosis/genetics/surgery ; Tumor Suppressor Protein p53/analysis ; Vascular Endothelial Growth Factor A/analysis

We present the multidetector CT findings with a pathologic correlation for the case of a solitary fibrous tumor located in the trachea. The MDCT revealed a well-circumscribed intraluminal mass arising from the trachea, with strong nodular enhancement in the periphery of the mass. The enhancement pattern of the mass corresponded histopathologically to a focal hypocellular area in the center and prominent blood vessels along the periphery of the mass. We also present volume-rendered and virtual bronchoscopic images of this rare submucosal tracheal tumor.
Female ; Humans ; Middle Aged ; Solitary Fibrous Tumors/*pathology/*radiography ; *Tomography, X-Ray Computed ; Tracheal Neoplasms/*pathology/*radiography

PURPOSE: The aim of our study was to evaluate the value of coronal reformatted images using multi-detector computed tomography (MDCT) imaging in non small cell lung cancer (NSCLC) for the determination of lymph node (LN) metastasis. MATERIALS AND METHODS: Chest CT scans using MDCT were performed in 43 patients with pathologically proven NSCLC. The images were reconstructed with a 3 mm thickness in the axial and coronal planes. The axial images were examined for LN metastasis with and without the coronal reformatted images by the consensus of two radiologists on two separate occasions. RESULTS: In total, 214 nodal groups were dissected, of which, 33 (15.4%) were pathologically proven as LN metastasis. The sensitivity of diagnosis was higher when assessing both the axial and coronal reformatted images compared to the axial images alone (51.5% vs. 33.3%), whereas the specificity and accuracy was lower when examining both the axial and coronal reformatted images (65.7% vs. 87.8% and 63.6% vs. 79.4%). Despite this, the additional coronal reformatted images provided additional anatomical information which was helpful in the assessment of accurate nodal stations and the decline of the pitfalls. CONCLUSION: The value of coronal reformatted images for the diagnosis of nodal metastasis in NSCLC may still be unclear; however, the coronal reformatted images may lend support to the axial images in being able to provide additional anatomical information.
Carcinoma, Non-Small-Cell Lung ; Consensus ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Radiographic Image Interpretation, Computer-Assisted ; Sensitivity and Specificity ; Small Cell Lung Carcinoma ; Thorax

Gastrointestinal bleeding from an unknown origin occurs in 2~10% of patients with a small bowel lesion. The recent developments in capsule endoscopy and double- balloon enteroscopy have helped improve the accuracy of a diagnosis of small bowel bleeding. Inflammatory myofibroblastic tumors are most often observed in the lungs of young adults but have rarely been reported in conjunction with a small bowel bleeding episode. We report a case of a bleeding inflammatory myofibroblastic tumor in the jejunum that had been diagnosed as non specific jejunal bleeding by capsule endoscopy and confirmed by double- balloon enteroscopy.
Capsule Endoscopy ; Double-Balloon Enteroscopy ; Hemorrhage ; Humans ; Jejunum ; Lung ; Myofibroblasts ; Young Adult

PURPOSE: Despite extracardiac conduit Fontan had many advantages, long-term results related to longevity of conduit, and anticoagulation were not proven. This study was to evaluate the long-term outcome of hospital survivors with extracardiac Fontan circulation. METHODS: Between 1996 and 2006, 200 patients underwent extracardiac conduit Fontan operation. Median age at the Fontan operation was 3.4 years (range:16 months-35.7 years). All patients (89.5 %) except 21 patients of one stage Fontan operation underwent bi-directional cavopulmonary shunt. Fenestration was required in 85 patients (42.5%). RESULTS: There has been 6 hospital mortalities (3.0%), and 7 late mortalities (3.6%) at a mean follow-up of 52.4+/-32.2 months (range; 18days-120 months). Overall 10-years survival was 92.4 2.1%. Multivariate analysis identified severe infection at early postoperative periods (hazard ratio =12.439, P=0.001), and high pulmonary arterial pressure at preoperative period (hazard ratio=3.445, P=0.038) as risk factors for mortality. Reoperation was performed in 24 patients (12.0%), and freedom from reoperation was 82.4+/-4.1% at 10 years. Arrhythmia occurred in 32 patients (16.0%) after Fontan operation, and freedom from arrhythmia was 85.14.4% at 10 years. Risk factors for arrhythmia were heterotaxy syndrome (P=0.001), Follow up duration (P=0.027) and the age at Fontan operation (P=0.001). Freedom from thromboembolism was 92.91.9% at 10 years. The conduit cross- sectional area decreased by 14%, and the extent of decrease of the conduit cross-sectional remained stable irrespective of the follow-up duration. 95.2% of patients had New York Heart Association class I. CONCLUSIONS: After 10 years of follow-up, the overall survival, and the functional status of survivors of the extracardiac Fontan procedure are satisfactory. Fenestration has a beneficial effect on the results of high-risk Fontan patients. The incidence of late deaths, reoperations, obstructions of the cavopulmonary pathway, arrhythmias and thromboembolisms is low.
Arrhythmias, Cardiac ; Arterial Pressure ; Follow-Up Studies ; Fontan Procedure* ; Freedom ; Heart ; Heart Bypass, Right ; Heterotaxy Syndrome ; Hospital Mortality ; Humans ; Incidence ; Korea* ; Longevity ; Mortality ; Multivariate Analysis ; Postoperative Period ; Preoperative Period ; Reoperation ; Risk Factors ; Survivors ; Thromboembolism

BACKGROUND/AIMS: A gastrointestinal mesenchymal tumor contains a leiomyoma and gastrointestinal stromal tumor (GIST). The natural course can vary according to the histology and other characteristics. This study evaluated the natural course of a benign mesenchymal tumor in the upper gastrointestinal tract using endoscopic ultrasonography (EUS). METHODS: Submucosal mesenchymal tumors are considered benign according to the following criteria of EUS: 1) the tumor originates from the muscularis mucosa or muscularis propria; 2) is well demarcated, homogenous and hypoechoic; and 3) has a regular surface. In this study, the changes of size, internal echo pattern and marginal regularity were evaluated retrospectively in 26 lesions that all were < 3 cm and were followed up for more than 2 years. RESULTS: The average size of the tumors on EUS was 11.5 mm. The mean follow-up period was 47.4 months. The follow-up EUS revealed no change in echo features in any patient. In only one patient, the size of the tumor increased from 26 to 34 mm without a change in the internal echo or marginal regularity after 24 months. This patient underwent a laparoscopic gastric wedge resection. The pathologic diagnosis was a leiomyoma. CONCLUSIONS: Most small submucosal tumors that are compatible with the EUS criteria of a benign GIST/ leiomyoma do not change over a period of 24 months, and the EUS criteria are effective in diagnosing benign GISTs/leiomyomas. A benign GIST/leiomyoma at EUS might be followed up by EUS at an interval of 2 years.
Diagnosis ; Endosonography ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Humans ; Leiomyoma ; Mucous Membrane ; Retrospective Studies ; Upper Gastrointestinal Tract*

The importance of quality control for dramatically growing genetic tests continues to be emphasized with increasing clinical demands. Diagnostic genetics subcommitee of KSQACP performed two trials for cytogenetic study in 2002. Cytogenetic surveys were performed by 33 laboratories and answered correctly in most laboratories except some problems in nomenclature and analysis for mosaicism and cytogenetics of neoplasia. The molecular genetic test surveys include M. tuberculosis, HCV, HBV, leukemia/lymphoma, ABO genotyping, ApoE genotyping, spinocerebellar ataxia (SCA), spinal muscular atrophy (SMA), and mitochondrial encephalomyopathy, lactic acidosis, and stroke like episodes (MELAS). HBV, SCA, SMA, MELAS tests were the first challenge of the genetic survey. Molecular genetic survey showed excellent results in most participants, however, ABO genotyping tests should be improved by new methods in a few laboratories. External quality assessment program for diagnostic genetics could be helpful to give participants many chances of continuous education and of interesting case materials.
Acidosis, Lactic ; Apolipoproteins E ; Cytogenetics ; Education ; Genetics* ; Korea* ; MELAS Syndrome ; Mitochondrial Encephalomyopathies ; Molecular Biology ; Mosaicism ; Muscular Atrophy, Spinal ; Quality Control ; Spinocerebellar Ataxias ; Stroke ; Tuberculosis

BACKGROUND: The goal of percutaneous transluminal angioplasty(PTA) is recanalization of the arterial stenosis or occlusion. The low incidence of serious complications makes PTA an attractive form of treatment for selected patients, especially if the lesions are not severe enough to warrant surgery or the patient is at high operative risk. The purpose of this study was to assess the feasibility, safety, and efficacy of PTA as an alternative or primary therapy for whole body arterial occlusive disease. METHODS: PTA was performed in 397 patients(male 342, female 55 : mean age 58.9+/-12.4 yr) with arterial occlusive disease. The patients were followed after PTA for a mean period of 22+/-11months. The information on restenosis, recurrence of symptom, redo-PTA, bypass surgery and amputation was obtained by follow-up angiography, plethysmography and self-administered questionnaire. RESULTS: In the 313 patients who underwent PTA for low extremity vascular disease, the overall success rate was 80.6%. Technical success rate for the iliac lesions was 84.7%, for the femoropopliteal lesions 74.8%, and for the infrapopliteal lesions 78.6% respectively. These results showed that outcome for iliac lesions were significantly better than those for femoropopliteal lesions(p<0.001). The technical success rate for the low extremity vessels was greater in the stenting group than in the ballooning group(98.2% vs 68.9%, p<0.001). In 260 lesions followed after PTA for low extremity vascular disease, cumulative patency rate at 3 years was greater in the iliac artery group than in the femoropopliteal artery group (84.6% vs 50.8%, p<0.001). In femoropopliteal lesions, cumulative patency rate at 3 year was greater for intervention of stenotic lesions compared to occlusive lesions(60.3% vs 38.1%, p<0.05). Carotid artery stenting in 25 patients(35 lesions) was successful in all lesions. Angiography and/or duplex sonography which was performed at 5.5+/-2.6 months in 18 patients(24 lesions) followed after carotid stenting revealed no evidence of restenosis. Subclavian artery stenting in the 16 patients(17 lesions) was successful in 16 lesions(94%). Renal artery stenting in the 17 patients(18 lesions) was successful in all lesions. Angiography at 8.5+/-3.5 months in 6 patients(6 lesions) followed after renal stenting revealed no evidence of restenosis. PTA for total occlusion of abdominal aorta was successful in 11 lesions(84.6%) of the 13 lesions. Angiography at 13+/-12 months in 7 patients(7 lesions) followed after PTA for abdominal aorta revealed significant restenosis in 2 patients. Minor complications during the PTA for peripheral disease occurred in 25 patients of 397 patients. CONCLUSION: PTA for whole body arterial occlusive disease can be performed with an excellent technical success rate and minimal morbidity and mortality. PTA for carotid, subclavian, renal, iliac artery or abdominal aorta represents a true alternative to vascular surgery as a first-line treatment. Despite acceptable initial success rate, PTA for femoropopliteal or infrapopliteal artery warrants further validation because it has high incidence of clinical restenosis during the follow-up periods.
Amputation ; Angiography ; Angioplasty ; Aorta, Abdominal ; Arterial Occlusive Diseases* ; Arteries ; Carotid Arteries ; Constriction, Pathologic ; Extremities ; Female ; Follow-Up Studies ; Humans ; Iliac Artery ; Incidence ; Mortality ; Plethysmography ; Recurrence ; Renal Artery ; Stents ; Subclavian Artery ; Vascular Diseases ; Surveys and Questionnaires

BACKGROUND: Liver ischemia-reperfusion injury is one of the major problems in liver transplantation and radical liver surgery. Ischemia-reperfusion injury is known to be induced by oxygen free radicals and the cell damages used to result in cell necrosis. However, apoptosis, another type of cell death, may be also related to the ischemia-reperfusion injury and hepatic dysfunction after ischemia-reperfusion injury may also be associated with the apoptosis. We examined the correlation between ischemiareperfusion injury and apoptosis in rat liver by apoptosis morphological study. METHODS: Male Sprague-Dawley rats were used. For each rats, 60 minutes partial clamp was applied to the hepatic artery and portal vein. Then, 5 groups which had 4 rats each were divided on the base of reperfusion injury duration of 0, 1, 3, 6, 24 hour (total numbers of rat were 20). For each rat, the central lobe which was given ischemic injury (ischemic groups) and the lateral lobe which was not given ischemic injury (control groups) were sampled after 60 minutes ischemia time. Apoptosis was examined by the method of TdT-mediated dUTP-biotin nick end labeling (TUNEL) assay. Counter staining was H&E staining and under the light microscopy with x60 and x300 magnification, apoptotic cell were examined. RESULTS: The groups of apoptotic cells were observed in 24hr reperfusion group. In 24 hr groups, besides conglomeration of apoptotic cells destructed hepatocyte cytoplasms were also observed. In all of the non-ischemic control group, no apoptosis was observed. Although the early reperfusion groups had not so much apoptotic cells as 24 hour group, the number of apoptotic cells in 0, 1, 3, 6 was significantly increased compared with the control groups. CONCLUSION: Apoptosis activity may be increased during reperfusion period with the maximum in 24 hour. This meant that apoptosis in ischemia-reperfusion injury might be associated with the chronic damage to hepatocyte and it might be the one of the causes of fibrosis or cirrhosis mechanism.
Animals ; Apoptosis* ; Cell Death ; Cytoplasm ; Fibrosis ; Free Radicals ; Hepatic Artery ; Hepatocytes ; Humans ; Ischemia ; Liver Transplantation ; Liver* ; Male ; Microscopy ; Necrosis ; Oxygen ; Portal Vein ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury*