BACKGROUND: The purpose of this study is to evaluate the disease-free survival (DFS) and overall survival (OS) of patients with stage IIB osteosarcoma at a single institution for 20 years and to compare the results according to the chemotherapy protocols. METHODS: From Jan 1988 to Nov 2008, 167 patients with osteosarcoma were treated at our hospital and among them, 117 patients (67 males and 50 females) with stage IIB osteosarcoma were evaluable. Their mean age was 22.6 years (range, 8 months to 71 years). Seventy-eight cases underwent the modified T10 (M-T10) protocol (group 1), 23 cases underwent the T20 protocol (group 2) and 16 cases underwent the T12 protocol (group 3). The DFS and OS were calculated and compared according to the chemotherapy protocols. RESULTS: At a mean follow-up of 78.9 months, 63 patients were continuously disease-free (63/117), 6 patients were alive after having metastatic lesions, 7 patients died of other cause and 41 patients died of their disease. The 5- and 10-year OS rates were 60.2% and 44.8%, respectively and the 5- and 10-year DFS rates were 53.5% and 41.4%, respectively. There was no significant difference of the OS and DFS between the chemotherapy protocols (p = 0.692, p = 0.113). CONCLUSIONS: At present, we achieved success rates close to the internationally accepted DFS and OS. We were able to achieve the higher survival rates using the M-T10 protocol over the 20 years. However, there was no significant difference of results between the chemotherapy protocols. We think the M-T10 protocol will achieve more favorable results in the near future.
Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*therapeutic use ; Bleomycin/administration & dosage ; Bone Neoplasms/*drug therapy/*mortality/surgery ; Chemotherapy, Adjuvant ; Child ; Child, Preschool ; Cyclophosphamide/administration & dosage ; Dactinomycin/administration & dosage ; Disease-Free Survival ; Doxorubicin/administration & dosage ; Female ; Follow-Up Studies ; Humans ; Infant ; Kaplan-Meier Estimate ; Leucovorin/administration & dosage ; Male ; Methotrexate/administration & dosage ; Middle Aged ; Neoadjuvant Therapy ; Osteosarcoma/*drug therapy/*mortality/surgery ; Survival Rate ; Vincristine/administration & dosage ; Young Adult

PURPOSE: We evaluated the complications of allograft reconstruction after a bone tumor resection, and reviewed literatures to overcome such complications. MATERIALS AND METHODS: We retrospectively reviewed clinical records and radiographs of fifteen patients in whom reconstruction with allograft after bone tumor resection. RESULTS: Eight patients were men and seven were women with a mean age of 27.1 years (1-56 years) and a mean follow-up period of 89.5 months (33-165 months). All postoperative complications related to the allograft were recorded. Twenty patients (80.0%) obtained a radiologic bony union at a mean of 8.35 months (4-12 months). The mean Musculoskeletal Tumor Society score was 73.5% (46.6-93.0%). Nine patients (60.0%) experienced one event and 3 (20.0%) patients experienced multiple events during the follow-up period. Recorded events were infection (3), fracture (2), nonunion (2), limb length discrepancy (2) and varus deformity (2). The mean event free survival period was 60.8 months (6-144 months). The mean allograft survival period was 80.2 months and the 5 year survival rate of the allografts was 83.0%. CONCLUSION: In order to overcome complications, the combination of an allograft and vascularized fibular graft is highly recommended. In the near future, the tissue engineering technique, the application of the stem cell and PRP, could reduce the complication of allograft such as resorption and nonunion.
Congenital Abnormalities ; Disease-Free Survival ; Extremities ; Female ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications ; Retrospective Studies ; Stem Cells ; Survival Rate ; Tissue Engineering ; Transplantation, Homologous ; Transplants

Membranous croup is a rare disease that is characterized by diffuse inflammation of the larynx, trachea, and bronchi with adherent or semiadherent mucopurulent membranes in the subglottic trachea and larynx. All cases have occurred in children and there has been no case of adults. The clinical signs, symptoms, progress and prognosis of membranous croup are more severe than those of ordinary croup. The detached membrane in membranous croup may cause a high degree of air way obstruction and give similar characteristics of laryngeal diphtheria, thus it is important to differentiate it from diphtheria by identifying the pathogen. Herein we report with a review of literature a rare case of adult membranous croup caused by methicillin-resistant staphylococcus aureus mimicking laryngeal diphtheria.

PURPOSE: To investigate the prevalence and risk factors of atherosclerotic disease of the extracranial carotid artery in healthy Korean population. METHODS: Eight hundred twenty-five patients without previous history of transient ischemic attack, amaurosis fugax, and/or any neurologic deficit who underwent carotid artery ultrasonography were evaluated retrospectively. The patients were divided into five groups according to the degree of carotid artery stenosis using real-time B-mode high resolution ultrasonography; Group A-normal carotid artery, Group B-below 30% of carotid artery stenosis, Group C-from 31% to 50% of carotid artery stenosis, Group D-from 51% to 70% of carotid artery stenosis, Group E-above 71% of carotid artery stenosis. Medical Records of all patients were investigated for following factors; sex, age, family history, smoking, hypertension, diabetes mellitus, total cholesterol, HDL- cholesterol, LDL-cholesterol, TG (triglyceride), HbA-1c (hemoglobin A-1c), and folate. RESULTS: 12.5% of asymptomatic patients have carotid stenosis due to atherosclerosis of extracranial carotid artery. The prevalence of extracranial carotid artery stenosis was as follows; Group B: 2.2%, Group C: 7.0%, Group D: 3.0%. The age, total cholesterol, LDL-cholesterol and HbA-1c were significantly higher in Group B, C, D than Group A (P=0.001, 0.016, 0.011, 0.001). The prevalence of diabetes and hypertension were significantly higher in Group B, C, D than Group A. Other factors, however, were not different among the groups. CONCLUSION: Asymptomatic carotid artherosclerosis is not uncommon in Korea. Carotid ultrasonography would be necessary for patients with hypertension, diabetes, and high serum cholesterol level.
Amaurosis Fugax ; Atherosclerosis ; Carotid Arteries ; Carotid Artery Diseases* ; Carotid Stenosis ; Cholesterol ; Diabetes Mellitus ; Endarterectomy ; Folic Acid ; Humans ; Hypertension ; Ischemic Attack, Transient ; Korea* ; Medical Records ; Neurologic Manifestations ; Prevalence* ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stroke ; Ultrasonography

PURPOSE: To evaluate the changes of venous hemodynamics after the treatment of the primary varicose vein of the lower limbs. METHODS: We retrospectively analyzed 493 lower limbs (221 right and 272 left, 157 male and 336 female) who underwent surgery for the primary varicose veins from September 1994 to May 1999. All patients were evaluated using air-plethysmography (APG) pre-and post-operatively. RESULTS: The prevalent age was 40 to 49-year-old and the male to female ratio was 1:2. Presumed etiological factors included occupations requiring long periods of standing in 94 cases, and pregnancy in 188 female cases. The average duration of illness was 12.9+/-8.2 years. 232 limbs were treated with a method of the greater saphenous vein high ligation (GSV HL) and above knee (AK) stripping with varicosectomy (VS), 38 limbs with GSV HL and total stripping and VS, 101 with short saphenous vein HL and VS, 100 with external banding valvuloplasty of GSV and VS, 5 with external banding valvuloplasty of GSV only, 10 with Linton's operation, 6 with GSV branch ligation and VS, and sclerotherapy in 9. The reduction rate of venous volume (VV) were 13.9+/-6.6 % in GSV stripping group and 20.4+/-18.2% in GSV valvuloplasty group. The reduction rate of venous filling index (VFI) were 53.6+/-31.0% in GSV stripping group and 58.9+/-33.7% in GSV valvuloplasty group. The increasing rate of ejection fraction (EF) were 26.9+/-41.1% in GSV stripping group and 21.1+/- 32.2% in GSV valvuloplasty group. The reduction rate of ambulatory venous pressure (AVP) were 4.4+/-128% in GSV stripping group and 22.7+/-73.3% in GSV valvuloplasty group. CONCLUSION: In patients with primary varicose vein of the lower limbs, APG could be a useful method for the documentation of hemodynamic improvement by showing decrease in VV, VFI, AVP and increase in EF.
Extremities ; Female ; Hemodynamics* ; Humans ; Knee ; Ligation ; Lower Extremity* ; Male ; Middle Aged ; Occupations ; Pregnancy ; Retrospective Studies ; Saphenous Vein ; Sclerotherapy ; Varicose Veins* ; Venous Pressure

We evaluated the biological scaffold properties of canine small intestinal submucosa (SIS) compared to a those of polypropylene mesh in growing rats with full-thickness abdominal defects. SIS is used to repair musculoskeletal tissue while promoting cell migration and supporting tissue regeneration. Polypropylene mesh is a non-resorbable synthetic material that can endure mechanical tension. Canine SIS was obtained from donor German shepherds, and its porous collagen fiber structure was identified using scanning electron microscopy (SEM). A 2.50-cm2 section of canine SIS (SIS group) or mesh (mesh group) was implanted in Sprague-Dawley rats. At 1, 2, 4, 12, and 24 weeks after surgery, the implants were histopathologically examined and tensile load was tested. One month after surgery, CD68+ macrophage numbers in the SIS group were increased, but the number of CD8+ T cells in this group declined more rapidly than that in rats treated with the mesh. In the SIS group, few adhesions and well-developed autologous abdominal muscle infiltration into the SIS collagen fibers were observed. No significant differences in the tensile load test results were found between the SIS and mesh groups at 24 weeks. Canine SIS may therefore be a suitable replacement for artificial biological scaffolds in small animals.
Abdominal Wall/*surgery ; Animals ; Biocompatible Materials/*therapeutic use ; Dogs ; Female ; Intestinal Mucosa/cytology/transplantation ; Intestine, Small/cytology/*transplantation ; Polypropylenes/*therapeutic use ; Rats ; Rats, Sprague-Dawley ; Tensile Strength ; Tissue Adhesions ; *Tissue Scaffolds ; Transplantation, Heterologous/*methods ; *Wound Healing

Here, we describe two dogs in which canine small intestinal submucosa (SIS) was implanted as a biomaterial scaffold during perineal herniorrhaphy. Both dogs had developed severe muscle weakness, unilaterally herniated rectal protrusions, and heart problems with potential anesthetic risks. Areas affected by the perineal hernia (PH) located between the internal obturator and external anal sphincter muscles were reconstructed with naive canine SIS sheets. In 12 months, post-operative complications such as wound infections, sciatic paralysis, rectal prolapse, or recurrence of the hernia were not observed. Symptoms of defecatory tenesmus also improved. Neither case showed any signs of rejection or specific immune responses as determined by complete and differential cell counts. Our findings demonstrate that canine SIS can be used as a biomaterial scaffold for PH repair in dogs.
Animals ; Biocompatible Materials ; Dog Diseases/*surgery ; Dogs ; Hernia, Abdominal/surgery/*veterinary ; Herniorrhaphy/veterinary ; Intestinal Mucosa/*transplantation ; Intestine, Small/*transplantation ; Male ; Perineum/surgery ; Postoperative Complications/veterinary ; Transplantation, Homologous/veterinary

Background and Objectives: Transsphenoidal (TS) surgery for removal of pituitary lesions has become popular with improvements in diagnostic and treatment modalities, as well as endonasal and endoscopic methods, resulting in reduced complications. Rhinosinusitis (RS) is considered a risk factor for postoperative intracranial infections. Previously, we showed that concurrent TS surgery and endoscopic sinus surgery (ESS) yielded a favorable outcome in cases with pituitary lesions and RS. However, there seems to be a lack of consensus in performing simultaneous TS and ESS for patients with a pituitary lesion and RS. We would like to validate the feasibility of performing two operations concurrently.Subjects and Method We reviewed the medical records of 13 patients who underwent simultaneous TS surgery and ESS between 2007 and 2016. One patient underwent concurrent TS surgery and ESS twice due to the regrowth of pituitary macroadenoma and recurrence of RS. Results: There were only four minor nasal complications during the postoperative period, which were controlled with conservative treatment. Only one patient exhibited postoperative cerebrospinal fluid leakage and no patients experienced intracranial complications. Conclusion This study shows that it might be better to treat patients with pituitary lesion and RS simultaneously. Also, further studies with large cases would be necessary to manage these patients without intracranial complications.

BACKGROUND: Antimicrobial resistance is considered as the primary reason for eradication failure of Helicobacter pylori. Resistance to clarithromycin is mostly due to the point mutation in H. pylori 23S rRNA gene. The aims of this study were to determine the primary resistance rate to clarithromycin and metronidazole and to examine the mechanism of clarithromycin resistance in H. pylori isolates. METHODS: Seventy-nine strains were isolated from 73 patients within about five years. The susceptibility of H. pylori isolates to clarithromycin and metronidazole were tested by E-test and broth dilution test. To detect point mutations in the 23S rRNA gene, PCR-RFLP (restriction fragment length polymorphism) was performed. Mutations in clarithromycin-resistant strains also were analyzed by direct sequencing. RESULTS: The resistance rate to clarithromycin (>1 mg/L) and metronidazole (>8 mg/L) were 5.1% and 54.4%, respectively. Annual metronidazole-resistant rates were 43.7% (7/16) in 1996-1997, 61.1% (11/18) in 1998, 55.6% (5/9) in 1999, and 55.6% (20/36) in 2000. Annual clarithromycin- resistant rates were 6.3% (1/16) in 1996-1997, 0% (0/18) in 1998, 11.1% (1/9) in 1999, and 5.6% (2/36) in 2000. Two of 4 clarithromycin-resistant isolates contained the A2144G mutation. One isolate contained A2143G mutation. One isolate possibly contained T2183C mutation. Different strains, isolated separately from antrum and body in 6 patients, showed same susceptibility to clarithromycin. However, different strains in two patients showed different susceptibility to metronidazole. CONCLUSION: No significant increase of resistantce rate to both clarithromycin and metronidazole were found within recent five years. Resistance of H. pylori to clarithromycin was caused by A2144G and A2143G mutation mainly and by T2183C mutation possibly.
Clarithromycin* ; Genes, rRNA ; Helicobacter pylori* ; Helicobacter* ; Humans ; Metronidazole ; Point Mutation

PURPOSE: To investigate the prevalence and risk factors in stenosis of the extracranial carotid artery in a healthy Korean population. METHODS: Seventeen thousand two hundred and eighty one patients, without previous history of transient ischemic attacks, amaurosis of fugax and/or any neurologic deficit, who underwent carotid artery ultrasonography, were evaluated retrospectively. The patients were divided into six groups according to the degree of carotid artery stenosis, using real time B-mode high resolution ultrasonography; Group A-normal, Group B-from 1 to 15% carotid artery stenosis, Group C-from 16 to 49% carotid artery stenosis, Group D-from 50 to 79% carotid artery stenosis, Group E-from 80 to 90% carotid artery stenosis and Group F-carotid artery occlusion (100%). Medical the records of all patients were investigated for the following factors; age, gender, diabetes mellitus, hypertension, smoking, over weight, total cholesterol, HDL- cholesterol, LDL-cholesterol, TG (triglyceride), and HbA-1c (hemoglobinA-1c). RESULTS: There were 950 (5.5%) cases in Group A, 82 (0.5%) in Group B, 710 (4.1%) in Group C, 138 (0.8%) in Group D, 2 (0.01%) in Group E, 18 (0.1%) in Group F. The age, total cholesterol, LDL-cholesterol, and HbA-1c were higher in Groups B, C, D, E and F than in Group A, with statistical significance. Other factors, however, were no different among the groups. CONCLUSION: Asymptomatic carotid stenosis is not uncom mon in Korea. To prevent a stroke caused by carotid stenosis, carotid ultrasonography would be necessary in patients at high risk of atherosclerosis, such as hypertension, diabetes and a high serum cholesterol level.
Arteries ; Atherosclerosis ; Blindness ; Carotid Arteries ; Carotid Stenosis* ; Cholesterol ; Constriction, Pathologic ; Diabetes Mellitus ; Humans ; Hypertension ; Ischemic Attack, Transient ; Korea ; Neurologic Manifestations ; Prevalence* ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking ; Stroke ; Ultrasonography