OBJECTIVES: Over the last 30 years, despite the increasing sophistication in medical care, the mortality of acute renal failure(ARF) has remained virtually unchanged at 40-50%, but the reasons remain unknown. This study intend to identify prognostic risk factors influencing survival and predict the mortality in ARF patients. METHODS: We retrospectively analyzed 152 patients with ARF who required renal replacement therapy, or whose serum creatinine level above 5 mg/dl, from Jan. 1988 to May. 1995. Multiple factors which may influence mortality were evaluated by univariate and multivariate analysis. RESULTS: 1) Of the 152 patients, 97 were male and 55 were female. The mean age was 47 years and the overall mortality was 36.8%. 2) Based on the univariate analysis, age>60 years, cause of ARF, APACHE II score, number of failing organs, peak serum creatinine level, PaO2, coma, hypotension, ARDS, GI bleeding, ventilatory support, need for antiarrhythmics, DIC, cardiovascular failure, pulmonary failure, neurological failure, and gastrointestinal failure were all significant factors discriminating between survivors and nonsurvivors(p<0.05) 3) By multivariate analysis, hypotension, coma, ventilatory support, and age over 60 years were significant independent predictors influencing survival in ARF patients and logistic equation and logit score were as follows : z=-2.04+1.32(age over 60)+2.18(hypotension)+2.88 (ventilatory support) + 3.28(coma) P=ez/(1+ ez) 4) In ROC(receiver-operating characteristic)curve, when the cutoff point was 0.2, maximum sensitivity was 75% and maximum specificity was 82%. CONCLUSION: In ARF, prognostic risk factors for mortality were age over 60 years, hypotension, assisted ventilation and coma. The logit score by multiple analysis is a reliable predictor of mortality in ARF patients, however the further studies are required to confirm these results.
Acute Kidney Injury* ; APACHE ; Coma ; Creatinine ; Dacarbazine ; Female ; Hemorrhage ; Humans ; Hypotension ; Male ; Mortality* ; Multivariate Analysis ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors* ; Sensitivity and Specificity ; Survivors ; Ventilation

The aim of this study was to analyze the effect of age at beginning of treatment on the results of anisometropic amblyopia in twenty-two consecutive children. The children who had strabismus or any other ocular disease affecting visual acuity was excluded. Two age groups were defined, according to the age at which treatment was started : 7 years or less(group I. N=10), 8 years or more(group II. N=12). Mean age of group I was 5.3 years old(4.1-7.9), while group II was 10.2 years old(8.0-13.2). Six patients were treated with occlusion therapy, 11 patients with atropine penalization, 1 patient with occlusion therapy and atropine penalization alternatively and 4 patients with spectacle correction only. All children had cycloplegic refraction before treatment and at each visit the corrected visual acuity was assessed. The difference in refractive errors between two eyes before treatment was 2.58D(1-9D) in group I and 2.75D in group II. The mean initial corrected visual acuity of amblyopic eyes was 0.43 in group I and 0.46 in group II. There was no significant difference in initial visual acuity between the two groups. The range of follow up times was from 5 to 60 months, with an average of 18 months. There was no significant difference in final visual outcome of amblyopic eye between the two groups. For patients aged 7 years or less, 80%(8/10) of patients achieved a final visual acuity of 0.8 or better and 90%(9/10) achieved the same final visual acuity as in the sound eye. For patients aged 8 years or more, 83%(11/12) of patients achieved a final visual acuity of 0.8 or better and 83%(10/12) achieved the same final visual acuity as in the sound eye. The initial visual acuity, the methods of therapy did not affect the final visual outcome. In pure anisometropic amblyopia, the patients older than 8 years of age have been treated as effectively as the patients 7 years or less.
Age Factors ; Amblyopia* ; Anisometropia ; Atropine ; Child ; Follow-Up Studies ; Humans ; Refractive Errors ; Strabismus ; Treatment Outcome ; Visual Acuity

We studied 52 eyes of 41 patients who received excimer laser in situ keratomileusis with VisX 20/20 and were followed up for at least 6 months. Tweenty three patients were male and mean age was 30.7 years old (21-49 years old). Mean preoperative spherical equivalent was -11.69+/-4.02D and mean postoperative spherical equivalent was -0.49+/-1.32D at I month, -0.73+/-l.17D at 3 months and -1.11+/-l.21D at 6 months. Mean uncorrected visual acuity preoperatively was 0.06 and postoperatively was 0.62 at I month, 0.64 at 3 months, 0. 62 at 6 months. Mean corrected visual acuity preoperatively was 0.77 and postoperatively was 0.76 at I month, 0.78 at 3 months and 0.81 at 6 months. Seven eyes (13%) gained 2 lines or more of spectacle corrected visual acuity and I eye lost 2 lines of spectacle corrected visual acuity. There was no significant contrast sensitivity change between preoperation and postoperation. No eye had intraoperative complications. Postoperative complications included 9 eyes (17%) of interface foreign bodies, 7 eyes (13%) of cap microwrinkling and 15 eyes(29%) of night glare. No eye had postoperaive corneal opacity.
Contrast Sensitivity ; Corneal Opacity ; Foreign Bodies ; Glare ; Humans ; Intraoperative Complications ; Keratomileusis, Laser In Situ* ; Lasers, Excimer ; Male ; Myopia* ; Postoperative Complications ; Visual Acuity

To evaluate the accuracy of the nomogram for LASIK, we retrospectively studied 109 eyes of 81 patients who received LASIK and were followed up for at least 6 months, divided into 3 groups according to the nomogram: the group I include 19 eyed which performed stromal ablation with 85~95% do photorefractive keratectomy(PRK) nomogram, the group II included 60 eyes with 100% of PRK nomogram and the group III included 30 eyes with 105included 30 dyes with 105~110% of PRK nomogram. The Chiron utomated corneal shaper and the Visx 20/20 excimer laser were used in all eyes. Multizone multipass technique was used in all eyes. The mean preoperative spherical equivalent was -12.42D in group I, -11.43D in group II and -11.29D in group III. The mean postoperative spherical equivalent in group I was -0.89D at 1 month, -1.0D at 3 months, -1.64D at 6 months, in group II was -0.31D at 1 month, -0.62D at 3 months, -1.07D at 6 months and in group III was -0.22D at 1 month, -0.46D at 3 months, -0.84D at 6 months. Eleven eyes(58%) were within 1.00D if intended correction at 6 months in group I while 35 eyes(59%) in group II and 20 eyes(67%) in group III were within 1.00D of intended correction at 6 months. Our findings suggest that slight overcorrection is recommanded in LASIK and further study on LASIK nomogram may be required.
Coloring Agents ; Humans ; Keratomileusis, Laser In Situ* ; Lasers, Excimer ; Nomograms* ; Retrospective Studies

To determine the safety and efficacy of using subconjunctival 5- fluorouracil(5-FU) injection on high risk eyes for filtration failure who had undergone trabeculectomy with intraoperative mitomycin C(MMC), we conducted a retrospective analysis of 17 eyes of 17 consecutive patients. Intraoperative MMC exposure (0.4mg/ml) was followed by supplemental postoperative 5-FU injection as necessary to titrate bleb vascularity and intraocular pressure (IOP). Exposure time to MMC was 2 to 5 minutes based on multiple preoperative and intraoperative risk factors. Postoperative 5-FU was administered by subconjunctival injection(5mg) adjacent to or into the bleb in a weekly interval(mean 4 injections, range 2-5 injections). Mean follow-up time was 8.6 months. Overall mean preoperative IOP was 27.1+/-7.2mmHg compared with mean postoperative IOP of 12.3+/-7.4mmHg. Fifteen eyes(88%) achieved a final IOP < OR =21mmHg without medicatio and 11 eyes(64%) achieved a final IOP< OR =12mmHg. Complications developed after 5-FU injections included corneal epithelial defect in 2 eyes (12%), hypotony (IOP< OR =5, at least 2 visits) in 2 eyes(12%), and bleb leakage in 1 eye(6%). No patient had a hypotony induced maculopathy, hyphema or choroidal effusion. Our data suggest that postoperative 5-FU may be safely used adjunctively following MMC trabeculectomy in carefully selected patients, and may improve the overall success rate with high risk trabeculectomy.
Blister ; Choroid ; Filtration ; Fluorouracil* ; Follow-Up Studies ; Humans ; Hyphema ; Intraocular Pressure ; Mitomycin* ; Retrospective Studies ; Risk Factors ; Trabeculectomy*

BACKGROUND: In recent years, lung cancer has been one of most common cause of death in Korea. Despite many physician's high degree of pessimism about the gains made in treatments progressive improvement in the survival of lung cancer by treatment has occurred, particulary in the early stages of the disease. However, a lot of patients refuse treatment or give up in the fight against the disease. This study was done to evaluate factors ifluencing the compliance to therapy and to lead in the establishment of special programs to enhance compliance in patients with lung cancer. METHODS: The medical records of 903 patients, whose ECOG(Eastern Cooperative Oncology Group) performance status was 3 or less and whose medical record was relatively satisfactory, among 1141 patients diagnosed with lung cancer between January 1989 and December 1996 were reviewed retrospectively. Compliance was classified into three groups based on the degree of compliance with physicians practice guideline : (a) complaints ; (b) patients who initially complied but gave up of themselves midway during the course of treatment ; (c) noncompliants who refused the treatment. RESULTS: The overall compliance rats was 63.9%, which was progressively increased from 57.3-61.3% in 1989 and 1990 to 64.2-67.5% in 1995 and 1996. Age, education level and occupation of patients bore statistically significant relationship with the compliance but sell marital status and smoking history did not. The compliance was significantly higher in patients without symptoms than with, and was also significantly higher in patients with good performance status. The compliance was significantly high in patients with NSCLC(non-small cell lung cancer) compared to SCLC(small cell lung cancer), but after exclusion of stage l and ll, among NSCLC, which had higher compliance to surgery there was no significant difference of compliance by histology. The compliance was significantly lower in advanced stage. CONCLUSION: To enhance the compliance, special care including education programs about therapy including complicantion and prognosis are necessary, especially for educationally and economically disadvantaged patients.
Animals ; Cause of Death ; Compliance* ; Education ; Humans ; Korea ; Lung Neoplasms* ; Lung* ; Marital Status ; Medical Records ; Occupations ; Prognosis ; Rats ; Retrospective Studies ; Smoke ; Smoking ; Vulnerable Populations

BACKGROUND: Leptin has been found to be involved in the regulation of hematopoiesis processes and angiogenesis. Therefore, we investigated the effect of leptin in the proliferation and angiogenesis of peripheral blood (PB)-derived endothelial progenitor cells (EPCs). METHODS: Mononuclear cells were isolated from PB of healthy male volunteers and were cultured in endothelial cell growth medium-2 (EGM-2). After 6 days of culture, cells were treated with 50 ng/mL vascular endothelial growth factor (VEGF) and/or with various concentrations of leptin (10 ng/mL, 100 ng/mL, 1microgram/mL, and 10 microgram/mL) and were further cultured for one week. Proliferation of EPCs was examined by an assay measuring the uptake of 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbo cyanine-labeled acetylated LDL (Dil-ac-LDL) and tubule formation on a matrigel. The control group of cells was not treated with VEGF and/or leptin. RESULTS: The number of Dil-ac-LDL labeled-EPCs, tubule formation on matrigel and the number of cells present along tubules were significantly increased in the leptin-treated groups of cells as compared to the control group or VEGF treated group of cells (P<.05). The effect was synergistically increased in the group of cells co-treated with leptin and VEGF. The number of EPCs was increased in a leptin dose-dependent manner that was maximal at a concentration of 1microgram/mL leptin. CONCLUSION: This study shows that leptin increased in vitro proliferation and angiogenesis of EPCs derived from peripheral blood.
Endothelial Cells ; Hematopoiesis ; Humans ; Leptin* ; Male ; Stem Cells* ; Vascular Endothelial Growth Factor A ; Volunteers

No abstract available.
Cervix Uteri* ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Follicular Fluid* ; Humans* ; Spermatozoa* ; Spouses*

PURPOSE: This study was designed to review the results of 2nd and 3rd kidney transplantation at our center. METHODS: Total 1,500 patients who had undergone kidney transplantation from 1968 to Aug 2005 at the Catholic Medical Center were retrospectively analyzed. The graft and patient survival were determined using Kaplan-Meier actuarial survival curves, compared with those of first transplant and assessed for significance using the log rank test. RESULTS: The patient of 2nd transplantation was 77 cases (male 55, female 22, mean age: 48.9+/-2.4 years) and 3rd transplantation was 5 patients (male 4, female 1, mean age 46.8+/-6.0 years). The 82 kidneys included from living donors in 67 patients and from cadaveric donors in 15 patients. The most common cause of renal failure of retransplanted kidney was chronic GN (2nd: 62 cases (80.5%), 3rd: 5 cases (100%)). The immunosuppressive regimen was mainly based on cyclosporine (2nd: 61 cases (79.2%), 3rd: 3 cases (60%)). The mean duration of the second transplantation from the first was 89.0 months and the third transplantation from the second was 32.7 months. There were 16 cases of death patients and the main cause of death was infection and cardiovascular events. The graft survival of 2nd & 3rd transplantation in 1 year were over 80%. CONCLUSION: Renal retransplantation is safe, effective, and the treatment of choice in patients with failed previous kidney transplantation for patient's quality of life and not associated with increased mortality retransplantation. The results of graft survival for retransplantation seem to be excellent for primary transplantation under cyclosporine or tacrolimus-based immunosuppression. The use of the potent and appropriate immunosuppression and surgical technique for retransplantation could help to improve better results.
Cadaver ; Cause of Death ; Cyclosporine ; Female ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation* ; Kidney* ; Living Donors ; Mortality ; Organ Transplantation* ; Quality of Life ; Renal Insufficiency ; Retrospective Studies ; Tissue Donors ; Transplants*

OBJECTIVE: The results of the excision of both outer and inner membranes with fenestration to the basal and parasellar cisterns for symptomatic primary middle cranial fossa arachnoid cysts are presented. METHODS: Twenty-three symptomatic cases of middle cranial fossa arachnoid cyst treated by excision with fenestration from 1993 to 2001 at our hospital were analyzed retrospectively. RESULTS: There was no significant morbidity and mortality after surgery and no recurrence of cyst during the follow-up period(mean 40.8 months). We observed reduction of the cyst with expansion of the surrounding brain and clinical improvement in most of the patients. All cases of type III by Galassi classification, 83% of type II cases and half of type I cases were belonged to the excellent group(reduction of the cyst size over 50% during follow-up period). Seventeen cases(74%) were belonged to the excellent group and 6 cases(26%) were the good group(reduction of the cyst size under 50% during follow-up period). CONCLUSION: The results of this study suggest that the excision and fenestration procedure may be considered as the primary shunt-independent procedure in patients with symptomatic middle cranial fossa arachnoid cyst.
Arachnoid Cysts ; Arachnoid* ; Brain ; Classification ; Cranial Fossa, Middle* ; Follow-Up Studies ; Humans ; Membranes ; Mortality ; Recurrence ; Retrospective Studies