PURPOSE: To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS). MATERIALS AND METHODS: Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy. RESULTS: The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%). CONCLUSION: Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.
Academic Medical Centers ; Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Korea ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Treatment Outcome

BACKGROUND: Inguinal herniorrhaphy remains one of the most common general surgical operations. Mesh repair is advocated by several specialized hernia centers. The purpose of this study was to compare results of mesh and Shouldice repair for inguinal herniae. METHODS: A clinical review was made of 73 cases of inguinal herniae treated during the 3 years from January 1993 to December 1996 at the Department of Surgery, Dae Rim Saint Mary's Hospital, and at the Department of Surgery, Eum Sung Saint Mary's Hospital. We treated 38 patients with mesh repair and 35 patients with a Shouldice procedure. Among 73 cases, 72 cases were males and only one case was a female. All except 8 cases had indirect types of hernias. RESULTS: Mesh repair required less time (80 minutes) and was an easier operative technique than the Shouldice procedure (95 minutes), but postoperative pain was similar between the two procedures. Postoperative pain was relieved after one week in 60% of the patients and after four weeks in 88% of the patients. The complications following the operations were similar between the two procedures: voiding difficulties developed in two cases, wound infection in one case, and a hematoma in two cases. There were no recurrences during the 6 month to 3 year follow up. CONCLUSIONS: Inguinal herniorrhaphy using a mesh repair technique provides is simple, rapid, less painful, and effective.
Female ; Follow-Up Studies ; Hematoma ; Hernia ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Male ; Pain, Postoperative ; Recurrence ; Saints ; Wound Infection

A clinical analysis was made of 18 cases of traumatic diaphragmatic rupture which had been treated during the 8 years from January 1989 to December 1997 at the Department of Surgery & Chest Surgery, Dae Rim Saint Mary's Hospital. The results are as follows: 1) The most common ages were 3rd and 4th decades (61.1%).There were 14 males and 4 females (M : F = 3.5 : 1) 2) The traumatic diaphragmatic ruptures were due to blunt trauma in 13 (72.2%) patients (left 10, right 3) and penetrating trauma in 5 (27.8%) patients (left 5). 3) The common symptoms were dyspnea (77.8%), abdominal pain (66.7%), and chest pain (55.6%). 4) 12 of the 18 patients were diagnosed before operation. Six patients were diagnosed during operation. 5) 15 of the 18 patients were operated on within 24 hours (83.3%). 6) The most common associated intraabdominal injured organ was spleen (44.4%). The most common herniated organ was colon (27.8%). 7) Most of the injuries ranged in size from 6 to 10 cm in the blunt trauma patients (53.8%) and less than 5 cm in penetrating trauma patients (100%). 8) The operations were done using a laparotomy alone in 11 patients, a thoracotomy in 5 patients, and a thoracoabdominal incision in 2 patients. 9) Postoperative complications were developed in 8 patients (44.4%). 10) The perioperative mortality was 11.1%, and the causes of deaths were hypovolemic shock and septic shock. In conculusion, traumatic diaphragmatic rupture without severe associated organ injury could reveal a good outcome, if early diagnosis and proper treatment was performed.
Abdominal Pain ; Cause of Death ; Chest Pain ; Colon ; Dyspnea ; Early Diagnosis ; Female ; Humans ; Laparotomy ; Male ; Mortality ; Postoperative Complications ; Rupture* ; Saints ; Shock ; Shock, Septic ; Spleen ; Thoracotomy ; Thorax

Authors performed extrapedicular screws fixation in thoracic spines. Because patient had very narrow thoracic pedicles, classical transpedicular screws fixation could not be accomplished. In case of narrow thoracic pedicles, extrapedicular screws fixation would be a good alternative technique. We describe here a method for thoracic extrapedicular screws fixation.
Humans ; Spine

This study is a clinical review of two groups of patients. Group I was composed of 97 patients who were submitted to negative appendectomy under the impression of acute appendicitis and, group II was 45 patients who received conservative treatment with the same impression at the department of surgery, Dae Rim Saint Mary's Hospital, from January 1, 1994 to August 31, 1996.The purpose of this study is to identify possible factors for the decision of operation or conservative treatment in the patients with suspected appendicitis and so to decrease unnecessary operation. Clinical characteristics of the patients were compared between two groups by the method of comparison of means(X test). The following results were obtained; 1) The incidences of group I and group II among the patients in the state of suspicious appendicitis were 97 of 1,004 cases(9.7%) and 45 of 1,004 cases(4.5%) respectively. 2) The number of female patients was 1.5 times more than male in both groups(p<0.05). 3) In group I the number of patients under 30 years of age was more than that of patients above 30 years of age(p<0.05) and in group II the highest incidence was shown in the patients in forth decades. 4) Symptoms over 3 days were more frequent in group I(31%) and in group II those within 12 hours were prominent(42.2%). 5) Gastrointestinal symptoms of anorexia, nausea and vomiting were more frequent in group I than group II. 6) Body temperature over 37.5 degrees C appeared in 15% of patients in group I and 11% in group II, but this difference showed no statistical significance and there was no sex difference. 7) RLQ rebound tenderness was manifested in 60% of patients in group I and 37.7% in group II, this difference has statistical significance(p<0.05). Migration pain to RLQ appeared in 12% of patients in group I aand 17.7% in group II(p>0.05) 8) Leukocytosis above 10,000/mm3 appeared in 44% of patients in group I and 53.3% in group II(p>0.05). 9) In admission route, the patients via ER was 2 times more than those of OPD in group I and in group II that was 5 times more than this.
Anorexia ; Appendectomy* ; Appendicitis* ; Body Temperature ; Female ; Humans ; Incidence ; Leukocytosis ; Male ; Nausea ; Saints ; Sex Characteristics ; Vomiting

OBJECTIVE: Spontaneous intracerebral hemorrhage (sICH) is a leading cause of morbidity and mortality, especially in Asian countries. Nevertheless, few reports of sICH in young people have been published. This study investigates the clinical features of sICH in young people. METHODS: Between February 1999 and December 2007, we retrospectively reviewed the medical records of patients aged 45 years diagnosed with sICH at our institute. We analyzed the causes, locations, risk factors, and final outcomes of sICH in these patients. RESULTS: Twenty-one patients (14.5%) were younger than 25 years, while 27 patients (18.6%) were 25~34 years old. Ninety-seven patients (66.9%) were between the ages of 35~45. The most common cause of sICH was hypertension (57.9%). The most common location of sICH was in the lobar region (35.2%). Vascular anomaly was the main cause in both the <25 age group (76.2%) and the 25~34 age group (70.4%). The diagnostic rate of angiography was 75% for the under 25 age group and 80% in the 25~34 age group. CONCLUSIONS: Hypertension is the most common cause of sICH in people between 35 and 45, and vascular anomaly is the main cause in people under 35 years of age. Thus, angiography should be mandatory for people under 35 with sICH, and for people with lobar hemorrhage. For young people, early diagnosis of hypertension and strict blood pressure control is recommended.
Aged ; Angiography ; Asian Continental Ancestry Group ; Blood Pressure ; Cerebral Hemorrhage ; Early Diagnosis ; Hemorrhage ; Humans ; Hypertension ; Medical Records ; Retrospective Studies ; Risk Factors

BACKGROUND: In the milieu of the postischemic nerve system, oxygen plays an important, but different role on the ischemia/reperfusion injury. Oxygen is needed in newly restored oxidative phosphorylation to reenergize neurons depleted of ATP and membrane potential. Alternatively, oxygen may also be used as substrate for the destructive free radical-mediated processes that seem to be common final pathways in numerous mechanisms of ischemia/reperfusion injury. Several investigators have reported decreasing inspired oxygen concentration was neuroprotective. But, others have demonstrated hyperbaric oxygen was useful for reducing the ischemia/reperfusion injury. Our study aims first to evaluate the effects of difference in arterial oxygen tension on early phase of ischemia/reperfusion injury and to outline practical use of oxygen to reduce ischemic/reperfusion injury. METHODS: A rabbit spinal cord ischemia model of infrarenal aortic occlusion for 17 mins was employed. Rabbits were randomly assigned to three groups. The rabbits in control group (n = 3) did not undergo ischemic insult. The rabbits in group A (n = 5) and B (n = 5) underwent ischemic insult for 17 mins and then breathed oxygen (6 L/min) via facial mask or room air, respectively. We observed neurologic function for 2 days. The sections of the spinal cords were stained with hematoxylin and eosin, and the number of spinal motor neurons in ventral region was counted by light microscopy. RESULTS: All rabbits in control group did not have neurologic dysfunction whereas all rabbits in group A and B had neurologic dysfunction at same degree. Spinal motor neurons in ventral gray matter in group A and B decreased significantly compared with those in control group (P < 0.05). But, difference in number between group A and B was not significant. CONCLUSIONS: The result indicated that the level of arterial oxygen tension within the clinical range had little effect on early phase of ischemia/reperfusion injury.
Adenosine Triphosphate ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Masks ; Membrane Potentials ; Microscopy ; Motor Neurons ; Neurologic Manifestations ; Neurons ; Oxidative Phosphorylation ; Oxygen* ; Rabbits* ; Research Personnel ; Spinal Cord Ischemia ; Spinal Cord*

The aims of this study were to verify the hypoxia-reoxygenation injury of primary cultured Kupffer cells and the effect of propofol against the hypoxia-reoxygenation injury through quantitating lactate dehydrogenase (LDH) release and superoxide dismutase (SOD) activity.The sequential treatments with hypoxia and reoxygenation induced significant increasement of LDH release (P.0.01) and decresement of SOD activity(P.0.05) in primary cultured Kupffer cell. The level of LDH release and SOD activity after sequential treatments with hypoxia and reoxygenation were restored to the control level by the propofol treatment in the concentration of 0.5 and 5 microgram/mL. Propofol in concentration of 50 microgram/mL induced significant increasement of LDH release (P.0.01) on both normal culture and hypoxia-reoxygenation culture of the Kupffer cell. As hypoxia and reoxygenation procedures and propofol treatment were concurrently added to the cultured Kupffer cell, propofol treatment in the concentration of 50 microgram/mL decreased significantly the SOD activity (P.0.01). In conclusion, propofol in this hypoxia-reoxygenation model could provide a valuable clue for the study of liver transplantation and of propofol.
Anoxia ; Kupffer Cells ; L-Lactate Dehydrogenase ; Liver Transplantation ; Propofol* ; Superoxide Dismutase* ; Superoxides*

The etiology of breast cancer is not yet clear. Several epidemiologic studies have supported the concepts that endogenous female sex hormones, i.e., estrogen and progesterone, may play a central role in the development of breast cancer. Female reproductive factors such as menstruation, pregnancy, and breast feeding are well-known risk factors of breast cancer. There have been many suggestions that all these factors are midiated by female sex hormeones. However, only a few studies have evaluated the relationship between the reproductive factors and endogenous female sex hormones. This study was designed to evaluate the relationship between the reproductive factors and endogenous female sex hormones in Korean women. We analyzed the relationship between reproductive factors and female sex hormones in 153 premenopausal women 153 postmenopausal women who participated in a community health promotion program in Haman County, Korea. The questionnaires about reproductive factors were completed by personal interview. Serum level of total estradiol(E2), progesterone(:g), and sex hormone binding globulin(SHBG) were measured by radioimmunoassay. There was no significant correlation between age at menarche and E2 in both premenopausal and postmenopausal groups. In postmenopausal subjects, E2 level increased significantly with the age at menopause increasing(r=0.25, p=0.009), adjusting for the potential confounding effect of both age and body mass index. There was a positive correlation between E2 and the intervals between age at menarche and age at menopause(r=0.25, p=0.009). Moreover, the serum level of SHBG was significantly correlated with total months of breast feeding(r=0.19, p=0.048), as well as with age at first fullterm pregnancy(r=-0.24, p=0.01). However, Pg was correlated with none of reproductive factors in both groups. This study observed that female reproductive factors, e.g., age at menopause, breast feeding, age at first fullterm pregnancy, were correlated with serum female hormones, particularly E2 and SHBG. The results provide an evidence that the relationship between the reproductive factors and breast cancer risk may be mediated, at least in part, through serum female hormones, especially estradiol in Korean women.
Body Mass Index ; Breast ; Breast Feeding ; Breast Neoplasms ; Epidemiologic Studies ; Estradiol ; Estrogens* ; Female ; Gonadal Steroid Hormones ; Health Promotion ; Humans ; Korea* ; Menarche ; Menopause ; Menstruation ; Pregnancy ; Progesterone* ; Radioimmunoassay ; Risk Factors ; Sex Hormone-Binding Globulin* ; Surveys and Questionnaires

PURPOSE: PURPOSE of this study was to evaluate the clinical and radiological results and complications of total knee arthroplasty(TKA) using the systems including an asymmetric tibial tray and a deep trochlear-grooved femoral component. MATERIALS AND METHODS: Ninety-five total knee replacement arthroplasties(68 patients) with the implant system, which has the asymmetric tibial tray and a deep trochlear grooved femoral component were analyzed clinically and radiologically. Retrograde analysis with the Knee Society clinical rating system, roentgenographic evaluation and scoring system and the Hospital for Special Surgery(HSS) score were done. The patients were average 66 years old and the follow-up period was 23month(range, 12 month to 49 month). RESULTS: Knee score was improved from 43 points to 90 points. Function score was improved from 47 points to 85 points. HSS score was improved 57 points to 89 points. Tibio-femoral angle was improved from varus 4o to valgus 5o. In last clinic visit, there was no case which had progressive radiolucent line or above 4 points in radiolucent score except one septic loosening case. There was no case of patellofemoral complications, including patellofemoral instability, patellar fracture, patellar component failure, patellar component loosening, and patellar clunk syndrome. CONCLUSTION: The TKA in this series showed excellent clinical and radiological results and low inci- dence of patellar complication.
Aged ; Ambulatory Care ; Arthroplasty* ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Humans ; Knee*