In this study we evaluated the risk factors that affect the survival rate of penetrating keratoplasty(PKP). Retrospectively we reviewed medical records of 275 cases which had taken PKP for 9 years between 1989 and 1997 in AMC. Mean age of patients was 39. 9 years and mean follow up period was 32.6 months. Only PKP was performed in 182 eyes(66%)and combined procedure with cataract extraction, silicon oil removal or glaucoma surgery in 93 eyes(34%). PKP was combined with cataract extraction and IOL insertion in 56 eyes. We analyzed the survival rate with Kaplan-Meier survival function. The survival rate was 94%for 3 months, 87%for 6 months, 78%for 1 year, 69%for 2 years, 62%for 5 years. According to the success rate based on etiology, keratoconus was highly successful in 82.6%and the survival rate of regraft or bullous keratopathy was significantly lower than that of keratoconus(p<0.01). Major cause of graft failure was rejection(68%)and rejection was occurred within 12 months following PKP in 65.2%. Rejection was reversed in 40.7%with medical treatment. So the factor that significantly affected the survival of graft was causative disease and this study suggested that the effort to prevent rejection was most important in graft survival.
Cataract Extraction ; Corneal Transplantation* ; Follow-Up Studies ; Glaucoma ; Graft Survival ; Humans ; Keratoconus ; Keratoplasty, Penetrating ; Medical Records ; Retrospective Studies ; Risk Factors ; Silicone Oils ; Survival Rate ; Transplants

Using a high bandwidth cellular communication network is appropriate to implement a high-quality mobile emergency telemedicine system. In Korea, the commercial service of CDMA2000 1X-EVDO has been providing since 2002. In this paper, we designed the system that transfers the biological signal and the video information of a patient simultaneously based on this CDMA2000 1X-EVDO network environment. In CDMA2000 1X-EVDO, the maximum speed of its reverse link can be observed within 153.6Kbps. Before the system design, several field tests had been performed using commercial CDMA2000 1X-EVDO reverse link with the UDP data segments. The test had been taken under several velocity and tunnel areas of Seoul. With the test result we implemented an efficient emergency telemedicine system fitted to the features of CDMA2000 1X-EVDO reverse link using UDP packets. Additional header information is added to the UDP packet data. With the header information the emergency system can transmits the ECG signal prior to the video data and controls the transmission error. The designed system has the ability to transmit both the biological signals and MPEG4 video of 640x480 spatial resolution at the same time. We set up the ambulance with this system and test it on the road.
Ambulances ; Electrocardiography ; Emergencies* ; Humans ; Korea ; Seoul ; Telemedicine* ; Uridine Diphosphate

PURPOSE: To compare outcomes of robotic adrenalectomy with conventional laparoscopic adrenalectomy. MATERIALS AND METHODS: This retrospective study included 63 patients who underwent robotic or laparoscopic adrenalectomy between March 2005 and April 2016, with all operations performed using a transperitoneal approach. Outcomes were compared in the 29 patients who underwent robotic adrenalectomy and the 34 who underwent conventional laparoscopic adrenalectomy. RESULTS: Mean age (53.1±12.2 years vs. 51.4±15.1 years, p=0.631) and body mass index (25.9±3.8 kg/m2 vs. 25.2±3.5 kg/m2, p=0.461) were similar in the robotic and laparoscopic groups. A significant percentage of patients in the robotic group had undergone prior abdominal surgery (38% vs. 12%, p=0.015). Mean tumor sizes (3.0±1.5 cm vs. 3.7±2.7 cm, p=0.134) and the percentage of incidentalomas (75.9% vs. 73.5%, p=0.354) were similar in the robotic and laparoscopic groups. There were no statistical significance between-group differences in tumor size, operative time, estimated blood loss, perioperative hemoglobin change, length of hospital stay, and complication rates. Pathologic diagnosis showed that pheochromocytoma (21% vs. 3%) and metastatic tumor (24% vs. 6%) were more frequent in the robotic than in the laparoscopic group (p=0.019). Subgroup analysis of patients with low tumor volume (≤6.8 cm3) showed that operation time was significantly shorter in the robotic than in the laparoscopic group (p=0.045). CONCLUSIONS: Robotic adrenalectomy is feasible, with outcomes comparable to those of laparoscopic adrenalectomy.
Adrenal Glands ; Adrenalectomy* ; Body Mass Index ; Diagnosis ; Humans ; Length of Stay ; Operative Time ; Pheochromocytoma ; Retrospective Studies ; Tumor Burden

BACKGROUND AND OBJECTIVES: HMG-CoA reductase inhibitors have been used for a decade to lower LDL cholesterol levels and to improve cardiovascular diseases and clinical outcomes. This study was designed to evaluate the clinical efficacy and safety profiles of atorvastatin, a new HMG-CoA reductase inhibitor, in patients with elevated LDL-cholesterolemia. MATERIAL AND METHODS: Eighty three patients who had high 12-hour fasting serum LDL-cholesterol level (> or =145 mg/dl and < or = 250 mg/dl) and serum TG level less than 400 mg/dl were enrolled. After completing an 4 week dietary phase, 50 patients who still had LDL-C > or =145 mg/dl and TG < or =400 mg/dl were assigned to receive atorvastatin 10 mg once daily for 4 weeks. After 4 weeks, the dose was continued for 4 weeks in each individual if serum LDL-cholesterol was maintained below 130 mg/dL. For each individual whose serum LDL-cholesterol was above 130 mg/dL, the dose was doubled (20 mg/day) and administered for 4 weeks. Serum AST, ALT and CPK were also measured in addition to blood chemistry tests for lipid profiles at 4 and 8 weeks for safety assessment. RESULTS: 1) The total study population who completed the whole protocol was composed of 46 patients (23 male, 23 female, mean age 54 years). 2) At 4 weeks, the reduction by mean percent change from the baseline in LDL-cholesterol was -44.8% (from 182.3+/-3.4 mg/dl to 99.7+/-2.9 mg/dl). The fixed goal of LDL-cholesterol less than 130 mg/dl was achieved by 95.8%. 3) At 4 weeks, the mean percent change from the baseline in TC, TG, HDL-C, LDL/HDL-C and ApoB were -32.3%, -17.4%, +9.6%, -48.5% and -36.6%, respectively. 4) At 8 weeks, the mean percent change from the baseline in LDL-cholesterol was -43.0% (from 182.3+/-3.4 mg/dl to 103+/-2.4 mg/dl). The fixed goal of LDL-cholesterol less than 130 mg/dl was achieved by 91.3% of the whole patients. 5) At 8 weeks, the mean percent change from the baseline in TC, TG, HDL-C, LDL/HDL-C and ApoB were -31.3%, -22.6%, +13.7%, -48.8% and -35.9%, respectively. 6) No serious side effects were observed during the whole period. CONCLUSION: Atorvastatin is highly effective and safe in modulating lipid profiles favorably (lower LDL-Cholesterol, lower TG, elevate HDL-Cholesterol), in patients with serum lipid abnormality.
Apolipoproteins B ; Cardiovascular Diseases ; Chemistry ; Cholesterol, LDL ; Fasting ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia ; Male ; Oxidoreductases ; Atorvastatin Calcium

BACKGROUND: Unlike 99mTc-Sestamibi, microbubbles used during myocardial contrast echocardiography (MCE) exist only in the vascular space. Therefore, there may be a difference in the pattern of myocardial perfusion between MCE and 99mTc-Sestamibi Single-Photon Emission Computed Tomography (SPECT) in acute myocardial infarction (AMI). OBJECTIVES: The purpose of this study was to assess myocardial perfusion using MCE with intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin microbubbles (IV MCE), and to compare it with SPECT and MCE with intracoronary injection of sonicated Hexabrix (IC MCE). METHODS: Seventeen patients with AMI (male 13, age 59.5+/-8.8 years, anterior MI 10) underwent IV MCE at 8.1+/-3.7 days after onset. SPECT and IC MCE were also performed at 1.2+/-1.0 days and 2.0+/-1.5 days from IV MCE respectively. Any revascularization procedures were not performed between three studies. Perfusion defect by three methods was scored semiquantitatively as 1 : normal perfusion, 0.5 : moderate defect, and 0 : severe defect at 16 segments of the left ventricle. RESULTS: 1) Perfusion defect in infarction territory was detected in 15 patients with SPECT, 12 patients with IV MCE and 11 patients with IC MCE. 2) Concordance of perfusion score at each segment was 93% between IV MCE and IC MCE, 65% between IV MCE and SPECT, and 64% between IC MCE and SPECT. 3) With IV MCE, perfusion defect was observed in all 32 segments which were considered as having defect (score 0 and 0.5) by IC MCE. However, defect by IV MCE was found only in 31 out of 108 segments considered as having defect by SPECT. CONCLUSION: In the assessment of myocardial perfusion in pts with AMI, IV MCE and IC MCE showed similar results. However, there was some discrepancy in the extent of perfusion defect between MCE studies and SPECT.
Echocardiography ; Glucose ; Heart Ventricles ; Humans ; Infarction ; Infusions, Intravenous ; Ioxaglic Acid ; Microbubbles ; Myocardial Infarction* ; Perfusion* ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

BACKGROUND/AIMS: The palliative prognostic index (PPI) was designed to predict life expectancy based on clinical symptoms. In this study, a PPI was constructed and used with other biological parameters to predict 3-week survival in patients with advanced cancer. METHODS: The study included 222 patients. The PPI was constructed with five variables (performance status, oral intake, edema, dyspnea at rest, and delirium). PPI scores were grouped as follows: 4 (group 1); > 4 and < or = 6 (group 2); and > 6 (group 3). At admission, seven biological variables (white blood cell count, lymphocyte, C-reactive protein [CRP], bilirubin, albumin, creatinine, and lactate dehydrogenase) were measured. RESULTS: The overall survival duration was 50 days in group 1, 22 days in group 2, and 14 days in groups 3. Using the PPI, a survival of < 3 weeks in group 3 was predicted with a sensitivity of 76.5% and a specificity of 65.4%. The important factors significantly affecting the 3-week survival rate were a PPI score > 6 and increases in serum bilirubin and CRP levels. Furthermore, the 3-week survival rate in patients with hepatopancreatobiliary cancer was more accurately predicted using a combination of the PPI, CRP, and serum bilirubin levels. CONCLUSIONS: Although a PPI has limitations, it can be quickly applied to determine survival duration in patients admitted to hospice and accurately predicts 3-week survival. Furthermore, bilirubin and CRP are useful factors for predicting 3-week survival in patients with gastrointestinal cancer, including hepatopancreatobiliary cancer.
Bilirubin ; Blood Cell Count ; C-Reactive Protein ; Creatinine ; Dyspnea ; Edema ; Gastrointestinal Neoplasms ; Hospice Care ; Hospices ; Humans ; Lactic Acid ; Life Expectancy ; Lymphocytes ; Prospective Studies ; Sensitivity and Specificity ; Survival Analysis ; Survival Rate ; Terminally Ill

The prognostic role of resting pulmonary hyperinflation as measured by residual volume (RV)/total lung capacity (TLC) in chronic obstructive pulmonary disease (COPD) remains poorly understood. Therefore, this study aimed to identify the factors related to resting pulmonary hyperinflation in COPD and to determine whether resting pulmonary hyperinflation is a prognostic factor in COPD. In total, 353 patients with COPD in the Korean Obstructive Lung Disease cohort recruited from 16 hospitals were enrolled. Resting pulmonary hyperinflation was defined as RV/TLC > or = 40%. Multivariate logistic regression analysis demonstrated that older age (P = 0.001), lower forced expiratory volume in 1 second (FEV1) (P < 0.001), higher St. George Respiratory Questionnaire (SGRQ) score (P = 0.019), and higher emphysema index (P = 0.010) were associated independently with resting hyperinflation. Multivariate Cox regression model that included age, gender, dyspnea scale, SGRQ, RV/TLC, and 6-min walking distance revealed that an older age (HR = 1.07, P = 0.027), a higher RV/TLC (HR = 1.04, P = 0.025), and a shorter 6-min walking distance (HR = 0.99, P < 0.001) were independent predictors of all-cause mortality. Our data showed that older age, higher emphysema index, higher SGRQ score, and lower FEV1 were associated independently with resting pulmonary hyperinflation in COPD. RV/TLC is an independent risk factor for all-cause mortality in COPD.
Aged ; Dyspnea/diagnosis/physiopathology ; Exercise Test ; Exercise Tolerance ; Female ; Forced Expiratory Flow Rates/physiology ; Forced Expiratory Volume ; Humans ; Lung/*physiopathology ; Male ; Middle Aged ; Prognosis ; Pulmonary Disease, Chronic Obstructive/*diagnosis/mortality/physiopathology ; Pulmonary Emphysema/*diagnosis/mortality/physiopathology ; Republic of Korea ; Residual Volume/*physiology ; Respiratory Function Tests ; Surveys and Questionnaires ; Total Lung Capacity/*physiology ; Vital Capacity ; Walking/physiology

Purpose: Germline mutations in DNA damage repair (DDR) genes such as BRCA2 have been associated with prostate cancer (PC) risk but has not been thoroughly evaluated for metastatic prostate cancer (mPC) in Asian men. This study attempts to evaluate frequency of DDR mutations in the largest cohort of Koreans. Materials and Methods: We recruited 340 patients with mPC unselected for family history of cancer and compared to 495 controls. Whole genome sequencing was applied to assess germline pathogenic/likely pathogenic variants (PV/LPVs) in 26 DDR genes and HOXB13, including 7 genes (ATM, BRCA1/2, CHEK2, BRIP1, PALB2, and NBN) associated with hereditary PC. Comparisons to published Caucasian and Japanese cohorts were performed. Results: Total of 28 PV/LPVs were identified in 30 (8.8%) patients; mutations were found in 13 genes, including BRCA2 (15 men [4.41%]), ATM (2 men [0.59%]), NBN (2 men [0.59%], and BRIP1 (2 men [0.59%]). Only one patient had HOXB13 mutation (0.29%). A lower rate of overall germline variant frequency was observed in Korean mPC compared to Caucasians (8.8% vs. 11.8%), but individual variants notably differed from Caucasian and geographically similar Japanese cohorts. PV/LPVs in DDR genes tended to increase gradually with higher Gleason scores (GS 7, 7.1%; GS 8, 7.5%; GS 9–10, 9.9%). Conclusions BRCA2 was the most frequently mutated gene common to different cohorts supporting its importance, but differences in variant distribution in Korean mPC underscore the need for ethnic-specific genetic models. Future ethnic-specific analyses are warranted to verify our findings.