Background/Aims: Papillary gastric cancer (GC) is classified as differentiated adenocarcinoma, together with well-differentiated (WD) and moderately differentiated (MD) adenocarcinoma. This study evaluated the risk of lymph node metastasis (LNM) in submucosal (SM) invasive papillary GC compared with other differentiated early GC types. Methods: This retrospective study involved three tertiary hospitals and enrolled 1,798 lesions with differentiated SM invasive GC treated with curative gastrectomy between March 2001 and December 2012. All pathology slides were reviewed, and clinicopathologic findings associated with LNM, including tumor size, location, gross type, ulceration, depth and width of SM invasion, and lymphovascular invasion (LVI), were analyzed. Results: The proportion of SM papillary GC was 2.8% (n=51). SM papillary GC was associated with larger tumor size and deeper and wider SM invasion than other differentiated GC types.LNM was significantly higher in the papillary type than in the MD and WD types. LNM was found in 27.5% of SM papillary GC patients (WD: 9.0%, MD: 21.2%). LVI was the only significant risk factor for LNM in SM papillary GC. The depth or width of SM invasion was not associated with LNM in papillary GC. Lower third location or elevated gross appearance was significantly associated with LVI. Conclusions SM papillary GC had the highest LNM rate, with features different from those of other differentiated SM invasive GCs. The treatment strategy for SM papillary GC should be carefully approached, especially for lesions located in the lower third or of the elevated gross type.

OBJECTIVES: The purpose of this study was to assess the associations between oral health, activity of daily living, and cognitive impairment among elderly people who live at home in a rural area. METHODS: A total of 183 participants older than 70 years of age were recruited from a public health center in a rural Korean city. Trained examiners conducted questionnaire surveys and at-home oral exams to assess oral health, geriatric function, and cognitive impairment. Oral health was assessed by counting remaining teeth and examining salivary flow. Geriatric function and cognitive impairment were assessed using the Mini-Nutritional Assessment (MNA), the Mini-Mental State Examination for Dementia Screening (MMSE-DS), and an activity of daily living (ADL) questionnaire. RESULTS: Mean age (SD) of the participants was 83.77 (5.99) years and 68.9% of them were women. The participants who had a lower number of remaining teeth were significantly older, had severe cognitive impairment, and poor ADL and MNA results. The participants with severe cognitive impairment were significantly older and had fewer remaining teeth and low salivary flow. Simple linear regression analysis showed an association between remaining teeth and cognitive impairment with a P-value of 0.000, which disappeared after adjusting for sex and age or sex, age, denture use, and salivary flow, respectively. CONCLUSIONS: Possible associations between remaining teeth and salivary flow, activity of daily living, and cognitive impairment were discovered among some elderly people living in a rural area.
Activities of Daily Living ; Aged* ; Dementia ; Dentures ; Female ; Humans ; Linear Models ; Mass Screening ; Oral Health ; Pilot Projects* ; Public Health ; Tooth*

BACKGROUND: Pyrazinamide (PZA) is an effective antitubercular drug that becomes toxic to Mycobacterium tuberculosis when converted to pyrazinoic acid by pyrazinamidase (PZase), encoded by mycobacterial pncA. A strong association was noted between the loss of PZase activity and PZA resistance. The causative organisms in extrapulmonary tuberculosis are rarely cultured and isolated. To detect pncA mutations in specimens from extrapulmonary tuberculosis as confirmative diagnosis of mycobacterial infection and alternative susceptibility test to PZA. METHODS: Specimens were collected from clinically proven extrapulmonary tuberculosis. pncA was sequenced and compared with wild-type pncA. RESULTS: pncA from 30 specimens from 23 donors were successfully amplified (56.6% in specimens, 59% in donors). Six mutations in pncA were detected (20.0% in amplified specimens, 26.1% in specimen donors) at nucleotide positions of 169, 248 and 419. The mutation at position 169 results in substitution of aspartic acid for histidine, a possible allelic variation of M. bovis that have intrinsic PZA resistance. The mutation at position 248 changes proline into arginine and that at position 419, arginine into histidine. CONCLUSION: DNA-based diagnosis using pncA may be simultaneously useful for the early diagnosis of mycobacterial infection and the rapid susceptibility to PZA in extrapulmonary tuberculosis. A potential implication of pncA allelic variation at 169 might be suggested as a rapid diagnostic test for M. bovis infection or Bacille Calmette-Guerin (BCG) reactivation.
Amidohydrolases ; Antitubercular Agents ; Arginine ; Aspartic Acid ; Diagnostic Tests, Routine ; Early Diagnosis ; Histidine ; Humans ; Mycobacterium bovis ; Mycobacterium tuberculosis ; Proline ; Pyrazinamide ; Tissue Donors ; Tuberculosis

PURPOSE: This study aimed to investigate the effects of oral hygiene care by oral professionals on periodontal health in type 2 diabetes mellitus patients. MATERIALS AND METHODS: Diabetic participants were recruited at a university hospital and matched at a 1:1 ratio by age and gender, and randomly allocated into intervention (40 people) and control groups (35 people). Tooth brushing instruction, oral health education, and supra-gingival scaling were implemented in all patients at baseline. This program was repeatedly conducted in intervention patients every month for 6 months, and twice at baseline and the sixth month in the control. Oral health was measured by decayed, missing, and filled teeth (DMFT), plaque index, calculus index, bleeding index, patient hygiene performance (PHP) index, tooth mobility, Russel's periodontal index, and community periodontal index (CPI). Diabetes-related factors, oral and general health behaviors, and sociodemographic factors were interviewed as other confounding factors. An analysis of covariance (ANCOVA) was used with SPSS for Windows 14.0. RESULTS: At baseline, there were no significant differences between the two groups in average of periodontal health (calculus index, bleeding index, Russel's periodontal index, CPI, and tooth mobility), diabetes-related factors (fasting blood glucose, postprandial blood glucose, and HbA1c), and in distribution of sociodemographic factors and health behaviors. In intervention group, plaque index, dental calculus index, bleeding index, and PHP index were reduced fairly and steadily from the baseline. There were significant differences in plaque index, dental calculus index, bleeding index, PHP index, and Russel's periodontal index between the two groups at sixth month after adjusted for baseline status. CONCLUSION: Intensive oral hygiene care can persistently improve oral inflammation status and could slow periodontal deterioration.
Adult ; Aged ; Dental Plaque Index ; *Diabetes Mellitus, Type 2 ; Female ; Gingivitis/*prevention & control ; Humans ; Male ; Middle Aged ; Oral Hygiene/education/*methods ; Periodontal Diseases/*prevention & control

BACKGROUND: Acute myelogenous leukemia (AML) is frequently encountered in elderly patients whereas intensive chemotherapy yield lower rate of complete remission (CR) and survival than young patients. This study was aimed to review the clinical features and treatment outcomes of elderly patients (>or=60) with AML. METHODS: We respectively reviewed the clinical features, laboratory findings and outcomes of treatment from the medical records of 115 patients with the elderly AML (>or=60), admitted in Seoul National University Hospital, between Jan.1995 and Dec.2004. RESULTS: Their median age was 66 (60~86) years with male predominance (M:F=68:47). Complete response rate in patients with conventional chemotherapy was 66.7% (42 of 63 patients; 95% CI 50.2~78.4). Median overall survival (OS) was 5.2 months with clinical benefit in the conventional chemotherapy group, compared to supportive or palliative group (11.5 vs 0.9months; p<0.0001). In between two age groups, the sixties (n=69) showed higher CR rate (69.0 vs 61.9%; p=0.9) and longer median overall survival (7.0 vs 4.4months; p=0.8) than patients group of the seventies (n=38) but without statistical significance. CONCLUSIONS: Conventional induction chemotherapy improved survival rate than palliative or supportive treatment.
Aged* ; Drug Therapy ; Humans ; Induction Chemotherapy ; Leukemia, Myeloid, Acute* ; Male ; Medical Records ; Prognosis ; Retrospective Studies* ; Seoul ; Survival Rate

Conventional tests for the identification of mycobacteria may frequently result in erroneous identification and underestimate the diversity within the genus Mycobacterium. However, this problem can be overcome by molecular approach like as 16S rRNA gene (rDNA) or RNA polymerase gene (rpoB) sequence analysis. In this study, a molecular approach analyzing partial sequence of 16S rDNA and rpoB gene was applied to mycobacteria other than M tuberculosis (MOTT) isolates that had not been definitely identified by conventional physical and biochemical tests. Among the eighteen isolates included in this study, twelve isolates could be identified to the species level and six were identified to the complex level. Compared with the results by 16S rDNA analysis, the rpoB analysis could di6erentiate some of the strains into the subspecies level.
DNA, Ribosomal* ; DNA-Directed RNA Polymerases ; Genes, rRNA ; Mycobacterium ; Sequence Analysis* ; Tuberculosis*

BACKGROUND: The histopathological classification of an invasive breast carcinoma in its earliest phases is fraught with pitfalls. We wanted to clarify the biology and the clinicopathological features of a microinvasive carcinoma, which are not fully understood, by comparing then with those of an in-situ cancer. Particular attention was paid to identifying the novel markers which might be representative of a microinvasive carcinoma. METHODS: From January 1986 to December 1996, a total of 72 microinvasive carcinomas, defined as in-situ carcinomas with invasion present in less than 10% of the histological section, were found. Their paraffin blocks were chosen for immunohistochemical staining against four molecules. RESULTS: Microinvasive carcinomas had a greater primary-tumor size (2.66+/-0.17 cm vs 2.21+/-0.19 cm, p=0.045) and a larger number of metastatic axillary nodes (0.21+/-0.25 vs 0.06+/-0.16, p=0.019) than DCIS (Ductal carcinoma in situ). In terms of nuclear grade (p=0.198) and comedo type (p=0.562), there were no statistical significances between microinvasive carcinomas and DCIS. Among three primary- tumor features (size, comedo component, and nuclear grade), a tumor size> or =2.5 cm had a marginal significance affecting the incidence of axillary-node metastasis in microinvasive carcinomas (p=0.081). Of the investigational prognostic factors determined by using immunohistochemical staining, p53 expression was observed more frequently in microinvasive tumors than in DCIS (p=0.031). CONCLUSION: A microinvasive carcinoma is thought to be transitional disease entity between the in-situ to the invasive forms. In spite of the marginal statistical significance of the result a microinvasive carcinoma larger than 2.5 cm could be an indication for axillary-node dissection. In addition, p53 mutation might play an important biological role in the progression from a noninvasive to an invasive form. Also the results provide further evidence that p53 mutation might have potential use as a molecular marker.
Biology ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Classification ; Incidence ; Neoplasm Metastasis ; Paraffin

PURPOSE: Histopathological classification of invasive breast carcinoma with its earliest phases is fraught with pitfalls. We were willing to clarify the biology and clinicopathological features of microinvasive carcinoma which is not fully understood in comparison with those of in situ cancer. Particular attention is paid to identifying the novel markers which can be representative of the microinvasive carcinoma. METHODS: From January 1986 to December 1996, a total of 72 microinvasive carcinomas, defined as in situ carcinomas with invasion present in less than 10% of the histological section, were found out. Their paraffin blocks were chosen for immunohistochemical staining against four molecules. RESULTS: Microinvasive carcinoma was greater in primary tumor size (2.66?0.17cm vs 2.21?0.19cm, P=0.045) and metastatic axillary nodes (0.21?0.25 vs 0.06?0.16, P=0.019) than DCIS. In terms of nuclear grade(P=0.198) and comedo type(P=0.562), there was no statistical significance between microinvasive carcinoma and DCIS. Among three primary tumor features(size, comedo component, and nuclear grade), the tumor size> or =2.5cm had marginal significance affecting the incidence of axillary node metastasis in microinvasive carcinoma(P=0.081). Of investigational prognostic factors, determined by immunohistochemical staining, p53 expression was observed more frequently in microinvasive disease entity from in situ to invasive from than DCIS(P=0.031). CONCLUSION: Microinvasive carcinoma is thought to be transitional disease entity from in situ to invasive form. The microinvasive carcinoma of 2.5cm could be indication for axillary node dissection. In addition, p53 mutation might play a important biological role in progression from noninvasive to invasive form and these results provide further evidence that p53 mutation could have potential use as a molecular marker.
Biology ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Classification ; Incidence ; Neoplasm Metastasis ; Paraffin

Anterior temporal lobectomy is the most popular surgical method for mesiobasal temporal lobe epilepsy. The key point in anterior temporal lobectomy is to resect lateral neocortex as little as possible, and mesiobasal structures as much as possible without surgical complication. We analyzed surgical anatomy on MRI scans of 20 persons to evaluate the relationships of anatomical structures related with surgical steps in anterior temporal lobectomy. On the oblique axial scan, the distance from temporal pole to anterior margin of hippocampus was 29.8+/-1.5mm. The length of hippocampus to the level of posterior margin of cerebral peduncle was 25.6+/-2.4mm. On the oblique coronal image through hippocampal head, the distance between the surface of superior temporal sulcus and lateral margin of temporal horn roof was 32.5+/-2.2mm. The angle between middle fossa base line and the line connecting superior temporal sulcus and lateral margin of temporal horn roof was 33.6+/-5.2 degree. The distance between lateral temporal surface and brain stem, and that between lateral temporal surface and collateral sulcus was 49.9+/-1.9mm and 40.6+/-3.3mm, respectively. The distance between collateral sulcus and lateral margin of temporal horn roof was 14.2+/-1.8mm, and the angle between middle fossa base line and the line connecting lateral margin of temporal horn roof and collateral sulcus was 60.4+/-7.4 degree. On the sagittal image, the angle between superior temporal sulcus and hippocampal axis was 18.8+/-1.1 degree. In conclusion, surgical complication of anterior temporal lobectomy can be reduced by careful consideration of anatomical relationships between anatomical structures encountered in each surgical steps in anterior temporal lobectomy.
Animals ; Anterior Temporal Lobectomy ; Axis, Cervical Vertebra ; Brain Stem ; Epilepsy, Temporal Lobe* ; Head ; Hippocampus ; Horns ; Humans ; Magnetic Resonance Imaging* ; Neocortex ; Tegmentum Mesencephali ; Temporal Lobe*

Botryomycosis is a rare, chronic and suppurative di- sease that is often mistaken clinically and histologically for a fungal infection, because the histologic feature shows a cluster of bacteria found within an eosinophilic matrix or capsule, giving the appearance of granules mimicking the sulfur granules of actinomycosis. Staphy- lococcus aureus is the most common organism cultured from lesions of botryomycosis, but other bacteria have also been isolated and implicated, including Psudomonas aeruginosa, E. coli, Proteus spp., Bacillus spp.. In some case, multiple pathogenic bacteria were found on cul ture. This disease has two patterns of organ involve ment. The more common type is cutaneous type, which involves the skin, subcutaneous soft tissue, muscle and bone. The other is visceral type which involves the lungs, liver, tongue, orbit, bowel, brain, kidney or pros tate. We report a case of brain and pulmonary botry omycosis in a 60 year-old man, who have early lung cancer. Botryomycosis was diagnosed by brain mass removal, PCNA and bronchoscopy, and lung cancer was detected incidentally by bronchoscope. The patient was treated with the Penicillin G after operation of brain mass, and right pneumonectomy was done.
Actinomycosis ; Bacillus ; Bacteria ; Brain ; Bronchoscopes ; Bronchoscopy ; Eosinophils ; Humans ; Kidney ; Liver ; Lung Neoplasms* ; Lung* ; Middle Aged ; Oceans and Seas ; Orbit ; Penicillin G ; Pneumonectomy ; Proliferating Cell Nuclear Antigen ; Proteus ; Skin ; Sulfur ; Tongue