BACKGROUND: DNA content analysis of human solid tumor is now widely performed by flow cytometric study. One of the most interesting and potentially observation in this field is that proliferative activity(S-Phase fraction of cell cycle) may profoundly affect the prognosis. METHOD: S-Phase fraction(SPF) have been measured by flow cytometric method using tumor cells isolated from paraffin embedded tissue. To evaluate the prognostic significance, SPF of small lung cancer cell was assessed in 42 patients who died after receiving anticancer chemotherapy. RESULTS: 1) Mean survival time of patients with small cell lung cancer was 190(± 156) days, Survival time were shortened, when TNM stage and PS scale were advanced. 2) Mean value of SPF of patients with small cell lung cancer was 27.4(±8.5)%. SPF had nothing to do with advance of TNM stage and PS scale. 3) In each identical TNM stage, there were not statistic significance between SPF and survival times. 4) There was a tendency like that higher SPF, better chemotherapeutic CONCLUSION: We could not find statistic significance between SPF and survival times, but SPF was a good predictive factor for chemotherapeutic response.
DNA ; Drug Therapy ; Humans ; Lung Neoplasms* ; Lung* ; Paraffin ; Prognosis ; Small Cell Lung Carcinoma ; Survival Rate

PURPOSE: This research sought to identify the utility value of chest computed tomography (CT) when it comes to the diagnosis of lung metastasis in cases of colorectal cancer. METHODS: From September 2004 to January 2008, 266 patients who were treated for colorectal cancer at Department of Surgery, Hanyang University College of Medicine, were divided into two groups: one that underwent preoperative and postoperative periodical chest CT (periodical inspection group, PIG; May 2006 to January 2008, 135 patients) and one that did not undergo periodical chest CT (non-periodical inspection group, NPIG; September 2004 to April 2006, 131 patients) for comparison. RESULTS: The overall lung metastasis diagnosis rates did not manifest any significant difference. The times to diagnose lung metastasis patients were 6.3 months and 15.7 months for the PIG and the NPIG, respectively (P = 0.022). The size of the metastatic lung nodule was smaller in the PIG than in the NPIG (< 1 cm in 9/9 patients vs. < 1 cm in 6/9 patients in the PIG and the NPIG, respectively; P = 0.02). A solitary lung metastasis was more frequently found in the PIG (5/9 patients) than in the NPIG (1/11 patients) (P = 0.024). During the follow-up period, 100% (2/2 patients) and 60% (3/5 patients) of the patients in the PIG and the NPIG, respectively, with stage III cancer underwent a lung metastasectomy (P = 0.002). CONCLUSION: Chest CT enables early diagnosis with a smaller size and a lower number of lung metastases in patients with colorectal cancer. Moreover, pulmonary the rate of the pulmonary resection for selected patients may be improved. However, the contribution of chest CT to increasing the survival rate must be investigated in a prospective randomized study.
Colorectal Neoplasms ; Early Diagnosis ; Follow-Up Studies ; Humans ; Lung ; Metastasectomy ; Neoplasm Metastasis ; Prospective Studies ; Survival Rate ; Thorax

In the management of advanced maxillary sinus cancer, sometimes it requires an extensive ablation and orbital exenteration that results in large and full defects of the cheek and orbital regions. Reconstruction of large orbital-maxillary defects can be accomplished in one stage by microsurgical free transfer of rectus abdominis myocutaneous flap. The muscle component is suitable to fill the orbital and maxillary cavities, and the skin components are used for cheek, palate and lateral nasal cavity wall reconstruction as a three-dimentional folded free flap. Major problems with this flap are the bulkiness, the possibility of abdominal hernia and muscle weakness following the removal of the rectus abdominis muscle. Free deep inferior epigastric artery skin flap without rectus abdominis muscle is available in the reconstruction of large orbital-maxillary defect without the problems of the rectus abdominis myocutaneous free flap. We experienced one case of rectus abdominis myocutaneous free flap, and one other case of inferior rectus abdominis free flap for the reconstruction of huge surgical defects due to radical maxillectomy with orbital excenteration. Both of the patients were satisfied and there have been no severe complication associated with these technique.
Cheek ; Epigastric Arteries ; Free Tissue Flaps* ; Hernia, Abdominal ; Humans ; Maxillary Sinus Neoplasms* ; Maxillary Sinus* ; Muscle Weakness ; Myocutaneous Flap ; Nasal Cavity ; Orbit ; Palate ; Rectus Abdominis* ; Skin

OBJECTIVES: In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. METHODS: This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. RESULTS: The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. CONCLUSIONS: Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future.
Delivery of Health Care ; Electronic Health Records ; Emergency Medical Services ; Health Records, Personal ; Hospital Information Systems ; Humans ; Information Systems ; Management Information Systems ; Quality of Health Care

Objective: This study aimed to investigate the perception of emergency medical service (EMS) providers and medical directors toward the field skill proficiency of EMS providers. We further examined differences in perception according to the certification and hospital career of individuals. Methods: This survey was conducted enrolling all active EMS providers in Busan, Ulsan, and Gyeongnam, as well as emergency physicians who participated in direct medical direction. Pre-developed questionnaires were sent as text messages to individual EMS providers and emergency physicians using an internet-based survey tool (Google Forms).Questionnaires were composed of 25 items in 7 categories: “airway management”, “ventilatory support”, “circulatory support”, “field assessment and management of trauma patients”, “field assessment and management of patients with chest pain”, “field assessment and management of patients with neurologic symptoms”, and “other items”. The response was based on a five-point Likert scale, where 0 score indicated no experience at all. Results: The questionnaire was distributed to 1,781 EMS providers and 52 medical directors; of these, 1,314 (73.7%) EMS providers and 34 (65.3%) medical directors completed the survey. EMS providers rated themselves as above average (3 points) for most of the questions. However, the majority responded that they had no experience or low proficiency in endotracheal intubation and prehospital delivery (median 2; interquartile range [IQR], 0-3). Conversely, medical directors assessed the EMS provider’s proficiency as above average in use of I-gel, recognition of hypoglycemia, field management of trauma patients, use of oropharyngeal and nasopharyngeal airway, use of laryngeal mask airway, and optimal oxygen supply (median, 4; IQR, 3-4), but responded with low scores for most other questions. Based on the EMS provider certification, nurses scored themselves more proficient than level-1 emergency medical technicians (EMTs) for intravenous access (P<0.001), whereas level-1 EMTs recognized themselves more proficient than nurses for endotracheal intubation (P<0.001), use of Magill forceps (P=0.004), and pediatric cardiopulmonary resuscitation (P<0.001). Conclusion This study recognized the discrepancies in the perception of EMS provider’s field skill proficiency, as perceived by EMS providers and medical directors, and between level-1 EMTs and nurses. We propose that regional EMS authorities need to make persistent efforts to narrow these perception gaps through effective educational programs for EMS providers and medical directors.

PURPOSE: Palivizumab prophylaxis has been used in the high risk groups of respiratory syncytial virus (RSV) infections, especially with the prematures, infants with chronic lung diseases or hemodynamically significant congenital heart disease. Substantial variations in timing of RSV outbreaks presents a challenge for the optimized use of palivizumab prophylaxis. This study investigates the epidemiologic characteristics of RSV associated lower respiratory tract infections (LRTI) in children, to help guide in the application of palivizumab prophylaxis in the Republic of Korea. METHODS: This was a retrospective observational study. We performed RSV culture or multiplex RT-PCR from children under 60 months of age admitted for LRTI at three hospitals in the capital area of Korea from May 2008 to April 2011. The study identified RSV infection and analyzed the RSV detection rates. RESULTS: RSV detection rate was 18.8% (1,721/9,178). The RSV season of 2008-2009 is from the second week of August to the fourth week of March and, that of 2009-2010 is from the first week of October to the third week of Apirl and that of 2010-2011 is from the third week of September to the third week of March. The RSV detection rate in preterms and low birth weight infants were significantly higher during the RSV season and non-RSV season. CONCLUSION: The RSV seasons were shown to have variations in onset, offset, and durations in each year. Physicains should determine the timing of the first and final doses of palivizumab on the basis of information about the RSV season in their own area. The real-time surveillance systems to analyze the variations of RSV seasons are necessary for the effective and economical preventions of RSV infections in high risk groups.
Antibodies, Monoclonal, Humanized ; Child ; Disease Outbreaks ; Heart Diseases ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Korea ; Lung Diseases ; Republic of Korea ; Respiratory Syncytial Viruses ; Respiratory System ; Respiratory Tract Infections ; Retrospective Studies ; Seasons ; Palivizumab

Endoscopic submucosal dissection (ESD) has been successfully performed in thrombocytopenic conditions such as in patients with liver cirrhosis but successful ESD for early gastric cancer (EGC) in hematologic diseases has rarely been reported. A 52-year-old male patient, who had previously been diagnosed with myelodysplastic syndrome 2 years ago, was admitted to our hospital for ESD of EGC. ESD was performed successfully in this patient after platelet concentrates transfusion on the day of ESD. ESD might be an option for the treatment of EGC in thrombocytopenia due to hematologic diseases when optimal supportive managements are applied.
Early Detection of Cancer ; Endosonography ; Gastric Mucosa/*surgery ; Gastroscopy ; Humans ; Male ; Middle Aged ; Myelodysplastic Syndromes/complications/*diagnosis/pathology ; Stomach Neoplasms/complications/*diagnosis/pathology ; Tomography, X-Ray Computed

BACKGROUND: Smoking and alcohol consumption are the main risk factors for squamous cell carcinoma of the upper aerodigestive tract (SCCUAT). However, human papillomavirus (HPV) has been etiologically linked with tonsillar squamous cell carcinoma (TSCC). Therefore, we investigated the etiologic role of HPV in the context of SCCUAT in Korea. METHODS: Archival paraffin block samples from 136 cases previously diagnosed as SCCUAT were randomly selected. A commercial HPV DNA chip was used for HPV genotyping. RESULTS: One hundred and seventeen cases were available after checking beta-globin (47 cases of tonsil and 70 of non-tonsil). A HPV-positive result (HPV 16 and 18) occurred in 13 cases of SCCUAT, and 12 cases were tonsil (25.5%, 12/47). Among the 12 HPV-positive patients with TSCC, nine were non-smokers and non-drinkers. Most HPV-negative patients with TSCC had a history of alcohol drinking and smoking (32/35, 91.4%). HPV infection status was not significantly associated with histological grade, clinical stage, or survival in patients with TSCC. CONCLUSIONS: HPV infection was significantly higher in patients with TSCC among those with SCCUAT. HPV may be independent risk factor in development of TSCC, such as smoking and alcohol drinking.
Alcohol Drinking ; beta-Globins ; Carcinoma, Squamous Cell ; Humans ; Korea ; Oligonucleotide Array Sequence Analysis ; Palatine Tonsil ; Paraffin ; Risk Factors ; Smoke ; Smoking

PURPOSE: To report our opinions of management about avascular necrosis following operative treatment of talar fracture and dislocation. MATERIALS AND METHODS: We followed up 5 patients who were diagnosed as talar avascular necrosis after operation of talar fracture and dislocation. Clinical and radiological analysis were performed. The mean age of patients was 36 years. There were 4 males and 1 females. The average follow up was 51 months. Hawkins scoring system was used as clinical evaluation. RESULTS: Regardless of radiological sclerotic finding, all patients showed satisfactory clinical result. Despite arthritic change in one patient, there were no further radiological and clinical deterioration to require salvage procedure. CONCLUSION: Most avascular necrosis after operative treatment of talar fracture and dislocation showed satisfactory result with conservative treatment. Thus, salvage operation such as talectomy or ankle fusion should be reserved in cases of intractable ankle pain and claudication.
Ankle ; Dislocations* ; Female ; Follow-Up Studies* ; Humans ; Male ; Necrosis*

PURPOSE: To report our opinions of management about avascular necrosis following operative treatment of talar fracture and dislocation. MATERIALS AND METHODS: We followed up 5 patients who were diagnosed as talar avascular necrosis after operation of talar fracture and dislocation. Clinical and radiological analysis were performed. The mean age of patients was 36 years. There were 4 males and 1 females. The average follow up was 51 months. Hawkins scoring system was used as clinical evaluation. RESULTS: Regardless of radiological sclerotic finding, all patients showed satisfactory clinical result. Despite arthritic change in one patient, there were no further radiological and clinical deterioration to require salvage procedure. CONCLUSION: Most avascular necrosis after operative treatment of talar fracture and dislocation showed satisfactory result with conservative treatment. Thus, salvage operation such as talectomy or ankle fusion should be reserved in cases of intractable ankle pain and claudication.
Ankle ; Dislocations* ; Female ; Follow-Up Studies* ; Humans ; Male ; Necrosis*