PURPOSE: We analyzed the oncological outcome and prognostic factor of the chondrosarcoma arising from benign bone tumor due to malignant transformation. MATERIALS AND METHODS: From April 1986 to April 2009, 18 cases were considered eligible. We analyzed retrospectively the patient's characteristics and prognostic factors that affect to the local recurrence and distant metastasis. RESULTS: As classified by primary benign bone tumor, 4 cases were solitary osteochondroma, 11 cases were multiple osteochondromatosis and 3 cases were multiple enchondromatosis. The mean follow-up period was 85 months. The 5-year disease free survival rate of 18 patients was 85.9%. Their overall MSTS score was 25.2 (84%). There were local recurrence in 3 cases and no distant metastasis. We found that tumor location and surgical margin affected to the prognosis significantly. CONCLUSION: In secondary chondrosarcoma patients, the prognosis was good relatively and tumor location and surgical margin are important prognosis factor.
Chondrosarcoma ; Disease-Free Survival ; Enchondromatosis ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Osteochondroma ; Osteochondromatosis ; Prognosis ; Recurrence ; Retrospective Studies

PURPOSE: Respite care is not a discrete intervention, but encompasses a range of services. This research was conducted to clarify the phenomenon of respite care for family caregivers of elders with dementia from a nursing perspective. METHODS: The Hybrid Model of concept development was applied to clarify the concept of respite care for family caregivers of elders with dementia. The study was conducted in the following three steps, theoretical phase, fieldwork phase, and final analytic phase. RESULTS: The definition of respite care for family caregivers of elders with dementia was delineated through integration of data analyses in theoretical and fieldwork phase, and has three dimensions; tailored supports for caregivers, tailored supports based on physical and cognitive function of elders with dementia and community interventions related to family care function. CONCLUSION: Through this study, the concept of respite care for family caregivers of elders with dementia is clarified and reformulated as nursing practice phenomena in the Korean context, which indicates ways to develop caring practice forms for a family living with an elder with dementia in a community setting.
Caregivers ; Chimera ; Dementia ; Humans ; Respite Care ; Statistics as Topic

PURPOSE: Purposes of this study were to develop a community-based respite program for family caregivers and to test the effects of the program. METHODS: Focus group interviews were performed to extract meaning of respite care for family caregivers (13 participants) and a survey was done to identify respite needs of family caregivers (157 participants). The community-based respite program for family caregivers was developed based on results of the focus group interview and survey. The program was used with 41 participants (19 experimental and 22 control). Independent t-test and Mann-Whitney U-test were used to test differences between control and experimental groups for respite needs, burden of caregivers, subjective wellbeing, social support, fatigue and functional status of elders with dementia. RESULTS: There were statistical differences in caregiver burden, subjective wellbeing, and social support after the program, but, none for respite needs, fatigue and functional status of elders with dementia. CONCLUSION: The results indicate that a respite program can be useful to decrease burden of caregivers and increase subjective wellbeing and perceived social support of family caregivers in community settings. Further intervention research is needed to increase the functional status of elders with dementia and decrease fatigue in caregivers.
Caregivers ; Dementia ; Fatigue ; Focus Groups ; Humans ; Respite Care

For the evaluation of the correlation between the ETCO2 and the PaCO2 in post-extubated spontaneously breathing patients, we tested 30 patients in recovery room with Salter Divided Nasal Cannula, which have permanent bamer in the face piece and a dual tubing set that allows end tidal sampling from one nare and oxygen delivery to the other. When the wave form of capnogram looked regular and normal, the value of ETCO2 was recorded and the arterial blood was taken from the radial artery to analize blood gas immediately. The results were as following; 1. The mean value of PaCO2 was 42.0+/-4.8 mmHg. 2. The mean value of P(ET)CO2 was 39.3+/-5.1 mmHg. 3. The value of P(ET)CO2 acquired with Salter Divided Nasal Cannula hase close positive correlation with the values of the PaCO2. (PaCO2=0.75 x P(ET)CO2+/-12.64, r=0.79, p<0.001)
Catheters* ; Humans ; Oxygen ; Radial Artery ; Recovery Room ; Respiration*

The surgeries based on the outpstient department have increased recently. One of the indications of outpatient surgery is chemical peeling of the face that usually re- quires only deep sedation of short duration. The purpose of this study was to evaluate the effeets of ketamine and midszolam for out patient facial chemical peeling. Fifty-nine unpremedicated patients undergoing chemical peeling of the face were anesthetized with bolus intravenous injection of 1mg/kg of ketamine and 0.1 mg/kg of midazolam. Additional dose of ketamine(10-20mg) was given as needed. During operation, we observed systolic and diastolic blood pressure with noninvasive blood pressure monitor and peripheral oxygen saturation(SpO2) with pulse oximeter. All patients were allowed to breathe spontane- ously without ventilatory support during the operation. There was no case of airway ob- struction and SpO2 value was over 97% in most cases. The systolic and diastolic blood pressure and pulse rate were increased after the injection of ketamine and midazolam. And we observed the untoward effect of anesthetics such as the purposeless movement(6.8%), involuntary phonation(3.4%), skin rash(3.4%) and headache(1.7%). In postoperative analysis about the recall, bad dream, mood, and the degree of satisfaction of this type of anesthesia, the rate of patient's positive acceptance was high(86.4%) and the reeovery time was 58min. We conclude that combination of intravenous ketamine and midszolam can produce satisfactory anesthesia with few complications for outpatient chemical peeling surgery of the face.
Ambulatory Surgical Procedures ; Anesthesia* ; Anesthetics ; Blood Pressure ; Blood Pressure Monitors ; Deep Sedation ; Dreams ; Heart Rate ; Humans ; Injections, Intravenous ; Ketamine* ; Midazolam* ; Outpatients* ; Oxygen ; Skin

PURPOSE: We analyzed the oncologic outcome of the malignant transformed benign giant cell tumor of bone. MATERIALS AND METHODS: Between January 2000 and February 2012, 5 cases were referred with suspicious malignant transformation of benign giant cell tumor. No patients underwent radiation therapy. RESULTS: After referral, all patients received the wide excision of the tumor and its' pathologic diagnosis were osteosarcoma. As classified by the location of tumor lesion, 3 cases were located in the distal femur, 1 case was in the distal radius and 1 case was in the proximal femur. The average latent period between diagnosis of benign giant cell tumor and diagnosis of secondary malignant giant cell tumor was 49.2 months. (range, 24-126 months) The mean follow-up period was 21.6 months. There were subsequent local recurrence in 2 cases and 3 patients developed distant metastasis. All patients with lung metastasis were dead. CONCLUSION: Malignant transformation of benign giant cell tumor of bone can be occurred within 5 years. Therefore, when benign giant cell tumor suspicious malignant transformation, it is necessary to do more aggressive treatment.
Femur ; Follow-Up Studies ; Giant Cell Tumor of Bone ; Giant Cell Tumors ; Giant Cells ; Humans ; Lung ; Neoplasm Metastasis ; Osteosarcoma ; Radius ; Recurrence ; Referral and Consultation

BACKGROUND/AIMS: Thrombopoietin (TPO) is an important cytokine for megakaryocyte maturation and platelet production. Because the main site of its production is liver, the failing liver may have a role in thrombocytopenia in chronic liver disease. The aims of this study were to determine the serum TPO levels in cirrhotic patients with thrombocytopenia and clarify the relation between the serum TPO levels and liver function impairment. METHOD: Cirrhotic paitents with thrombocytopenia (LC, n=57, Child class A/B/C; 20/13/24), chronic hepatitis patients (CH, n=24), oncologic patients with thrombocytopenia induced by chemotherapy (HO, n=7), acute viral hepatitis patients (AVH, n=5) and healthy controls (HC, n=5) were enrolled. Serum TPO was measured by an ELISA method. RESULTS: Although the mean platelets counts of LC (69+/-32, x103/ul: mean+/-SD) were lower than those of HC (229+/-29, x103/ul), serum TPO levels in LC (108+/-63 pg/ml: mean+/-SD) were not significantly different from HC (122+/-24 pg/ml). In HO, serum TPO was significantly higher than LC (623+/-746 vs 108+/-63 pg/ml, p<0.05) inspite of comparable platelets counts. In LC, serum TPO level was not significantly different among Child class groups. It was not correlated with serum ALT, serum albumin levels, prothrombin time, serum bile acid, Child class, Child score and partial thromboplastin time, but weakly correlated with serum total bilirubin (p=0.038, r=0.288) and platelet counts (p=0.041, r=0.287). CONCLUSIONS: Although impaired hepatic production of TPO seems to be the main cause of low serum TPO levels in thrombocytopenic cirrhotic patients, there was no correlation between serum TPO level and the severity of liver dysfunction. The role of other factors such as megakaryocyte mass in bone marrow, portal hypertension and hypersplenism may be necessary to explain the putative mechanism between TPO and platelet numbers in liver cirrhosis with thrombocytopenia.
Bile ; Bilirubin ; Blood Platelets ; Bone Marrow ; Child ; Drug Therapy ; Enzyme-Linked Immunosorbent Assay ; Hepatitis ; Hepatitis, Chronic ; Humans ; Hypersplenism ; Hypertension, Portal ; Liver ; Liver Cirrhosis ; Liver Diseases ; Megakaryocytes ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Serum Albumin ; Thrombocytopenia* ; Thrombopoietin*

OBJECTIVE: To evaluate the learning curve of laparoscopic radical hysterectomy (LRH) for gynecologic oncologists who underwent residency- and fellowship-training on laparoscopic surgery without previous experience in performing abdominal radical hysterectomy (ARH). METHODS: We retrospectively reviewed 84 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB cervical cancer who underwent LRH (Piver type III) between April 2006 and March 2014. The patients were divided into two groups (surgeon A group, 42 patients; surgeon B group, 42 patients) according to the surgeon with or without ARH experience. Clinico-pathologic data were analyzed between the 2 groups. Operating times were analyzed using the cumulative sum technique. RESULTS: The operating time in surgeon A started at 5 to 10 standard deviations of mean operating time and afterward steeply decreased with operative experience (Pearson correlation coefficient=-0.508, P=0.001). Surgeon B, however, showed a gentle slope of learning curve within 2 standard deviations of mean operating time (Pearson correlation coefficient=-0.225, P=0.152). Approximately 18 cases for both surgeons were required to achieve surgical proficiency for LRH. Multivariate analysis showed that tumor size (>4 cm) was significantly associated with increased operating time (P=0.027; odds ratio, 4.667; 95% confidence interval, 1.187 to 18.352). CONCLUSION: After completing the residency- and fellowship-training course on gynecologic laparoscopy, gynecologic oncologists, even without ARH experience, might reach an acceptable level of surgical proficiency in LRH after approximately 20 cases and showed a gentle slope of learning curve, taking less effort to initially perform LRH.
Gynecology ; Humans ; Hysterectomy* ; Laparoscopy ; Learning Curve* ; Learning* ; Multivariate Analysis ; Odds Ratio ; Retrospective Studies ; Uterine Cervical Neoplasms

BACKGROUND: Sometimes hypoxemia occurs in the postoperative recovery room because of postoperative residual curarization (PORC). Some reports show that postoperative residual curarization is common. PORC occurs after the use of the long-acting muscle relaxants. It has been recommended to use intermediate-acting muscle relaxants and a TOF monitor to decrease PORC. The purpose of this study was to examine whether the use of the TOF monitor during propofol anesthesia affects the incidence of postoperative residual curarization. METHODS: 38 ASA I or II patients were divided randomly into two groups of 19 each. They received propofol-fentanyl-nitrous oxide for anesthesia. Pancuronium (80 100 microgram/kg) was used to facilitate tracheal intubation and additional doses were used to maintain surgical relaxation. The requirement for incremental doses of pancuronium and adequacy of recovery following reversal were assessed, either with (control group:n = 19) or without (experimental group:n = 19) TOF monitoring. Fifteen minutes after the arrival at the recovery room, neuromuscular function was assessed clinically and by using TOF. RESULTS: There were no statistical differences in body weight, age, or duration of operation between the two groups. There was no statistical difference in the total dose of pancuronium and total dose of pancuronium relative to body weight and duration of operation. There were statistical differences in TOF ratio in the recovery room (0.73 vs. 0.86). The incidence of PORC was 47% in the control group and 5% in the experimental group. CONCLUSIONS: Though the monitoring of TOF did not effect the dose of muscle relaxant, it may have reduced the incidence of PORC. However, the PORC had no clinical significance because the mean TOF ratio in the two groups was over 0.7 and there were no clinical signs of residual muscle weakness.
Anesthesia* ; Anoxia ; Body Weight ; Humans ; Incidence ; Intubation ; Muscle Weakness ; Pancuronium ; Propofol* ; Recovery Room ; Relaxation

OBJECTIVE: The purpose of this study is to validate the Gynecologic Oncology Group (GOG) criteria for adjuvant treatment in a different cohort of patients and to evaluate the simplified risk criteria predicting the prognosis and tailoring adjuvant treatment in patients with surgically staged endometrial cancer. METHODS: We performed a retrospective analysis of 261 consecutive patients with surgically staged endometrial cancer between January 2000 and February 2013. All patients had complete staging procedures and were surgically staged according to the 2009 International Federation of Gynecology and Obstetrics staging system. Clinical and pathologic data were obtained from medical records. We designed the simplified risk criteria for adjuvant treatment according to the risk factors associated with survival. The patients were divided into low and low-intermediate, high-intermediate, and high-risk groups according to the GOG criteria and simplified criteria and their survivals were compared. Receiver-operating characteristic curve analysis was used to evaluate the prognostic significance of both criteria. RESULTS: Median follow-up time was 48 months (range, 10 to 122 months). According to the GOG criteria, we identified 197 low and low-intermediate risk patients, 20 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. Using the simplified risk criteria, we identified 189 low and low-intermediate risk patients, 28 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. The performance of the simplified criteria (area under the curve [AUC]=0.829 and 0.916 for disease recurrences and deaths, respectively) was as good as the GOG criteria (AUC=0.836 and 0.921 for disease recurrences and deaths, respectively). CONCLUSION: The simplified criteria may be easily applicable and offer useful information for planning strategy of adjuvant treatment in patients with surgically staged endometrial cancer as the GOG criteria.
Adult ; Aged ; Aged, 80 and over ; Chemotherapy, Adjuvant ; Endometrial Neoplasms/pathology/surgery/*therapy ; Female ; Humans ; Middle Aged ; Neoplasm Staging ; Prognosis ; Radiotherapy, Adjuvant ; Retrospective Studies ; Risk Factors ; Survival Analysis