OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on pressure ulcers which is a major, functionally-limiting medical problem impairing quality of life for many people each year. METHOD: Seven patients who had stage 3 pressure ulcers were enrolled for the study. Each patient was treated with 6 sessions of low-energy (0.10~0.15 mJ/mm2, 1,000 impulses) ESWT. The length, width, depth and soft tissue biopsy of pressure ulcers were evaluated every 2 weeks for 6 weeks. RESULTS: The length, width and depth decreased significantly after 2 weeks of ESWT application. Healthy granulation tissue was formed. Soft tissue biopsy revealed increased the number and size of capillaries and decreased inflammatory cells in treated case. CONCLUSION: ESWT promoted wound healing and revealed favorable histological changes in pressure ulcers. We suggest that ESWT can be used for the safety and effective management of pressure ulcer.
Biopsy ; Capillaries ; Granulation Tissue ; Humans ; Pressure Ulcer ; Quality of Life ; Shock ; Wound Healing

Spinal epidermoid cyst is less than 1% of the entire spinal cord tumor and a rare tumor. It is a slowly proliferating benign tumor and can be a result of either congenital or acquired factors. In particular, reports of acute paraplegia due to spinal epidermoid cyst rupture are very rare. Since authors experienced paraplegia resulting from congenital spinal epidermoid cyst rupture during an asthma attack, it is reported with a review of literature.
Asthma ; Epidermal Cyst ; Paraplegia ; Rupture ; Spinal Cord Neoplasms

Pneumorrhachis, caused by intraspinal air, is an exceptional but important radiographic finding that is accompanied by different etiologies. Pneumorrhachis, by itself, is usually asymptomatic and gets reabsorbed spontaneously. Therefore, the patients with pneumorrhachis are mostly managed conservatively. We encountered a unique case of atypical traumatic pneumorrhachis accompanied by paraparesis.
Humans ; Paraparesis* ; Pneumorrhachis*

We concentrated ourselves to evaluate the prognostic significance of the p53 gene mutations, its protein expression and MIB-1 index as a proliferative marker in canine mammary tumors. In the present study, a total of 20 cases were examined, among which there were 5 malignant mixed tumors, 4 mammary gland adenocarcinomas, 1 papillary adenocarcinoma, 8 benign mixed tumors and 2 mammary gland adenomas. Positive immunostaining for p53 with PAb240 antibody was found in 2 benign (20%) and 3 malignant (30%) tumors. However, PAb421 antibody did not give positive result at all. In Western blot analysis, the p53 expression in benign and malignant tumors was detected in 4 and 3 cases, respectively. p53 mutations were found in 6 cases out of the cases with detected p53 protein expression. The MIB-1 index in benign and malignant tumors were 17.6+/-20.8% and 29.0+/-27.2%, respectively and there was no significant difference between tumor types. There was a significant correlation between p53 mutations and p53 overexpression (correlation coefficient = 0.5, p < 0.05). In Kaplan-Meier survival analysis, the p53 index was associated with significantly shortened survival time (p < 0.01). In multivariate analysis, p53 overexpression was only an independent factor for indicator of worse prognosis in canine mammary tumors (p = 0.01). These results demonstrated that p53 gene mutations and protein overexpression using the PAb240 anti-p53 antibody were useful predictors of increased malignant potential and poor prognosis in canine mammary tumors.
Animals ; Antibodies, Antinuclear/metabolism ; Antibodies, Monoclonal/metabolism ; Blotting, Western/veterinary ; Dog Diseases/genetics/*metabolism ; Dogs ; Female ; Genes, p53/*genetics ; Immunohistochemistry/veterinary ; Ki-67 Antigen/metabolism ; Mammary Neoplasms, Animal/genetics/*metabolism ; *Mutation ; Predictive Value of Tests ; Proportional Hazards Models ; Tumor Suppressor Protein p53/*biosynthesis/genetics

OBJECTIVES: Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated the influence of injection speed of local anesthetic to subarachnoid space on maternal hypotension and level of sensory block. METHODS: Bupivacaine (0.5%) 9 mg with fentanyl 10 microg was injected to subarachnoid space either quickly (during 20 seconds, 0.1 mL/sec, n=20) or slowly (during 100 seconds, 0.02 mL/sec, n=20) in parturients scheduled for elective cesarean section. The onset and level of sensory block was checked and heart rate and blood pressure was checked by 2.5 minutes during 20 minutes. Hypotension (systolic blood pressure <100 mmHg or <70% of baseline) was treated with ephedrine. RESULTS: Hypotension occurred 70% of parturients with spinal anesthesia. Slow injection didn't influence on the onset and level of sensory block and didn't reduce the incidence of hypotension. But onset of hypotension was delayed. CONCLUSION: Slow injection (during 100 seconds, 0.02 mL/sec) of local anesthetic delayed onset of hypotension and required less amount of ephedrine. Slow injection of local anesthetic was one of the effective methods for the cardiovascular stability during cesarean section under spinal anesthesia.
Anesthesia ; Anesthesia, Spinal ; Blood Pressure ; Bupivacaine ; Cesarean Section ; Ephedrine ; Female ; Fentanyl ; Heart Rate ; Hypotension ; Incidence ; Injections, Spinal ; Pregnancy ; Subarachnoid Space

BACKGROUND: This study was performed to compare the clinical outcomes of intestinal Behcet's disease with a simple ulcer. METHODS: We analyzed the medical records of 52 patients that were suspected as having intestinal Behcet's disease. Of these patients, 27 patients (Group 1) met both the criteria of the International Study Group for Behcet's Disease and the Behcet's Disease Research Committee of Japan. Thirteen patients (Group 2) met only the latter criteria and the other patients (Group 3) did not meet any criteria. The efficacy of medical treatment was assessed by the presence of gastrointestinal symptoms and follow-up colonoscopic findings. RESULTS: The mean age for patients with a diagnosis of an intestinal lesion was 38.6+/-12.2 years. The sex ratio was 1.08:1 (M:F) and the mean follow-up duration was 35.2+/-39.5 months. A single, smaller than 5 mm, round and shallow ulcer with an erythematous margin that was located at the leocecal area showed most typical colonoscopic features for intestinal Behcet's disease. No significant differences were found in the clinical manifestations and colonoscopic findings among the three groups of patients. Nineteen (44%) patients achieved complere remission from a sumptomatic point of view and 10 (39%) patients were proved to be complete remission according to follow up colonoscopy after medical treatment. Eleven patients (21.2%) underwent surgery. The overall cumulative rates of a first surgery and re-surgery were 40.5% and 71.9% at 10 years. No statistical relationship was found in the response of medical treatment and the cumulative rate of surgery among the groups. CONCLUSIONS: The clinical course and outcomes of an intestinal simple ulcer are not different from that for intestinal Behcet's disease.
Colonoscopy ; Diagnosis ; Follow-Up Studies ; Humans ; Japan ; Medical Records ; Sex Ratio ; Ulcer*

PURPOSE: The purpose of our study was to evaluate the outcome of intensified induction therapy using the Vanderbilt regimen in patients with a poor prognosis non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: We retrospectively analyzed the results of two pilot studies, which enrolled the patients aged 60 years or less, with a previously untreated NHL of intermediate grade on the Working formulation, having 2 or 3 adverse prognostic factors on the age- adjusted International Prognostic Index. Patients received an intensified induction, with the regimen described by the Vanderbilt group. RESULTS: Thirty-five patients were analyzed. After induction, 29 patients (83%) achieved more than partial response (PR): 22 (63%) complete response (CR) and 7 (20%) PR. Three of the PRs were subsequently converted to CR following consolidation therapy. The overall CR rate, following the completion of treatment, was 71%. The 3-year overall survival (OS) rate of all patients was 53%. In the univariate analysis, age (50 years) was the only factor affecting the OS. The 3-year disease-free survival (DFS) rate of patients with CR was 68%. In the univariate analysis, age and bone marrow involvement were the factors affecting the DFS. Two patients died from the treatment-related toxicity of the induction therapy: one due to sepsis and the other due to congestive heart failure. CONCLUSION: Although the CR rate was relatively high, the OS or DFS of patients with a poor prognosis NHL, who had received the intensified induction using the Vanderbilt regimen, were no different from those that had received the conventional chemotherapy, as reported by the International Prognostic Index Project. However, the OS or DFS in the young patient groups were encouraging. To test the hypothesized benefits of our approach in the young patient groups, a larger cohort of patients aged 50 years or less should be studied.
Bone Marrow ; Cohort Studies ; Disease-Free Survival ; Drug Therapy ; Heart Failure ; Humans ; Lymphoma, Non-Hodgkin* ; Pilot Projects ; Prognosis ; Retrospective Studies ; Sepsis

BACKGROUND: The purpose of this study was to evaluate the clinical features and treatment outcome of patients with primary non- Hodgkin's lymphoma (NHL) of bone. METHODS: A survey of 1,050 NHL patients who had been diagnosed at Korea Cancer Center Hospital between 1989 and 2001 identified 32 patients with NHL involving bone. Of these 32 patients, 22 patients were diagnosed as primary NHL of bone. The clinical data were available in 17 of the patients, and analyzed retrospectively. RESULTS: The male to female ratio was 3.3:1 and the median age was 31 years (range, 16- 52 years). The most common presenting symptom was bone pain of involved site (76.5%) and the most commonly involved site was tibia. Stages at diagnosis were as follows: stage I in 6 patients; stage II in 2 patients; stage III in 2 patients; stage IV in 7 patients. According to the REAL classification, the most common histologic subtype was diffuse large B cell lymphoma. Of evaluable 16 patients, 5 patients had B symptoms. The risk groups accord-ing to International Prognostic Index (IPI) were as follows: low risk in 9 patients, low-intermediate risk in 4 patients, high-intermediate risk in 1 patient, high risk in 2 patients, not evaluable in 1 patient. The first-line treatment modalities were as follows: combined radiation and chemotherapy in 8 patients (1 for palliative aim, 7 for curative aim); chemotherapy only in 4 patients; radiation only in 2 patients; surgery and chemotherapy in 1 patient. Objective response rate to treatment was 93.3% (95% confidence interval; 80.9~100%) and five-year survival rate was 57% (95% confidence interval; 30.5~83.4%). CONCLUSION: Most patients complained bone pain at involved site. The histologic subtype was diverse, but the most common subtype was diffuse large B cell lymphoma. The prognosis is similar to other non- Hodgkin's lymphomas.
Classification ; Diagnosis ; Drug Therapy ; Female ; Hodgkin Disease ; Humans ; Korea ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin* ; Male ; Prognosis ; Retrospective Studies ; Survival Rate ; Tibia ; Treatment Outcome

BACKGROUND/AIMS: Mallory-Weiss syndrome refers to a laceration or lacerations in the region of the gastroesophageal junction due to vomiting, retching, or coughing induced by several causes, and preceding hematemesis. In the last several years, endoscopic therapies have dramatically changed the need for emergency surgery in patients with upper gastrointestinal bleeding. There is only little information however, regarding the indication criteria and the efficacy of endoscopic therapies in severe upper gastrointestinal bleeding, due to Mallory-Weiss syndrome. This study was designed to assess the usefulness and the indications of endoscopic O-ring band ligation. METHODS: Thirty patients with Mallory- Weiss syndrome who were experiencing a related hemorrhage were studied. Among these, 5 patients with active bleeding or a visible vessel revealed during an endoscopic examination were treated with O-ring band ligation. Patients with blood clots or linear tears received only conservative treatment.
Cough ; Emergencies ; Esophagogastric Junction ; Hematemesis ; Hemorrhage ; Humans ; Lacerations ; Ligation* ; Mallory-Weiss Syndrome ; Vomiting