A new fibrinogen system, consisting of highly concentrated fibrinogen and thrombin, is going to be applied in many clinical fields. Especially in injuries of the cartilagenous joint surface as chondral or osteochondral fractures, replantation of the fragments must be considered mandarory in order to preserve joint congruence and to prevent further destruction of the articular cartilage. The authors have an encouraging results by using this fibrin adhesive system (F.A.S.) in the experimental works.
Cartilage, Articular ; Fibrin Tissue Adhesive ; Fibrinogen ; Joints ; Replantation ; Thrombin

No abstract available.
Cytarabine* ; Cytosine* ; Humans ; Idarubicin* ; Induction Chemotherapy* ; Leukemia, Myeloid, Acute*

PURPOSE: To validate the surgical principles by analyzing the cause of a correction loss after pedicle subtraction osteotomy in patients with a sagittal imbalance in the radiological aspects, retrospectively. MATERIALS AND METHODS: Forty cases were analyzed radiographycally according to the presence (Group A) or absence (Group B) of the lower mobile segment and anterior column support performed (Group A2) or not (Group A1), respectively. RESULTS: The overall correction loss of the total fused part appeared to increase in group A (p=0.025) and the degree of lordosis of the osteotomy site showed an almost zero correction loss in group A and B. No statistic difference of the correction loss of the upper segment of the osteotomy site between the two groups was found (p=0.138). The correction loss of the lower segment of osteotomy site increased statistically more in goup A (p=0.014). The correction loss in group A occurred more in the lower segment than in the upper segment and the correction loss of the lower segment in group A1 appeared to have a better correlation than group A2 (p=0.012). CONCLUSION: Correction loss occurs at the intervertebral disc of the mobile segment. It is considered desirable to have anterior column support to all lower segment of the osteotomy site, because the correction loss increases more in the lower segment than in the upper segment.
Animals ; Humans ; Intervertebral Disc ; Lordosis ; Osteotomy* ; Retrospective Studies

BACKGROUND: This study was undertaken to investigate the frequency, causes, and outcome of second malignancies(SM) following treatment of childhood cancer in Korea. METHODS: The Korean Society of Pediatric Hematology-Oncology(KSPHO) reviewed the records of patients who developed SM during the period of 1981-1997 through nationwide search. RESULTS: Twenty four cases were collected, among which 7 AML, 5 osteosarcoma and 5 ALL were observed. Fifteen of them were boys, and 9 girls (1.7:1). Familial cancer was registered in 5 cases among direct relatives. No interrelationship between first and SM was observed except in 2 retinoblastoma patients who developed osteosarcoma. The SM developed in a period of 8 to 144 months (mean:55 months) after the initiation of treatment for the first malignancy. Sixteen cases had radiotherapy for the first malignancy, and in 6 of them the SM developed in the irradiated area. Fifteen patients were treated with alkylating agents, 12 received anthracyclines and 7 received etoposide. They survived 1 to 110 months (mean:15 months) after development of the SM. Sixteen patients are dead, 3 currently free of disease, and 5 alive with disease. CONCLUSION: AML, osteosarcoma and ALL were most prevalent SM in Korean children. The mean latent period was 55 months, and showed poor mean survival period of 15 months. Radiotherapy seems to be a significant risk factor for the development of SM, but more cases are needed to assess the actual risk of certain chemotherapeutic agent. For this purpose, KSPHO continues to collect the cases of SM and to follow up the registered patients.
Alkylating Agents ; Anthracyclines ; Child ; Drug Therapy ; Etoposide ; Female ; Follow-Up Studies ; Humans ; Korea ; Neoplasms, Second Primary* ; Osteosarcoma ; Radiotherapy ; Retinoblastoma ; Risk Factors

PURPOSE: Neutropenia is common in patients receiving myelotoxic chemotherapy. The aim of this study is to compare the efficacy, safety and adverse events between prophylactically administered Leukokine and Grasin. METHODS: An open-label, randomized, phase III study was designed to compare the effects of a subcutaneous injection of Leukokine (CJ Corp.) 100mug/m2 with Grasin (Jeil Pharm. Inc.) in patients receiving induction chemotherapy for acute leukemia. All patients received one dose of G-CSF every day during the study period. Total period of G-CSF injection was not over 14 days. The administration of G-CSF began on day 14 after beginning of chemotherapy under CCG strategy. In other chemotherapies, the injection of G-CSF started on day 1 from end of chemotherapy. Injection of G-CSF stopped after absolute neutrophil count recovery was achieved. RESULTS: The median numbers of times of administration were 9.6 (2~14) /cycle for Leukokine and 8.8 (2~14) /cycle for Grasin. The time to needed for neutrophil recovery more than 1, 000/mm3 was 6.6 4.9 day and 4.7 4.8 day of the Leukokine and Grasin, respectively (P=0.14). The mean duration of neutropenia less than 500/mm3 was 7.6 5.6 days for Leukokine and 6.1 6.0 days for Grasin (P=0.28). The results for the two groups were also not significantly different in adverse events, physical examination and laboratory findings. CONCLUSION: Leukokine was safe and well tolerated in these patients population. Injection of Leukokine provided neutrophil recovery with safety and efficacy similar to that provided by Grasin.
Drug Therapy ; Granulocyte Colony-Stimulating Factor ; Humans ; Induction Chemotherapy* ; Injections, Subcutaneous ; Leukemia* ; Neutropenia ; Neutrophils ; Physical Examination

PURPOSE: The needs of stem cell transplantation are increasing in Korea under the circumstance of medical insurance coverage since 1996. But allogeneic bone marrow transplants have the limitation in acquisition of matched donor because of small number of siblings in modern society. Although unrelated stem cell transplantations were made possible in Korea with the establishment of Korean Marrow Donor Program, less than one third of patients who need stem cell transplantation are seeking the matched donors through this program and it still takes too much time and efforts. In this clinical setting, cord blood offers an exciting alternative to traditional sources of stem cells. To implement the widespread clinical use of cord blood stem cells, it is necessary to establish the cord blood bank from which stem cell specimens are obtained. METHODS: To establish the cord blood bank in Korea, we started to develop the proper methods to obtain the cord bloods. Various ways of collecting the cord bloods, separation of red blood cells and storage methods were tried and the standard recommendations were made. RESULTS: Mean volume of collected umbilical cord blood was above 70mL by open or closed method in vaginal delivery and cesarean section. Among the RBC depletion methods by using 3% gelatin, Ficoll-Hypaque, or modified Ficoll-Hypaque method, 3% gelatin sedimentation showed the best result in viability and number of mononuclear cells(MNC), CD34+ cell, and day 14 CFU-GM. The recovery rate after freezing-thawing MNC was higher in the group of using 10% DMSO and programmed freezer starting from 4degrees C than in the group of using mixed with DMSO and hydroxyethyl starch and without programmed freezer. Nine patients underwent cord blood transplantation until December 1998. Among them, 6 patients showed the long-term successful engraftment. CONCLUSION: We have developed simple, efficient, and reproducible methods for collection, processing, and storage of cord blood to establish the cord blood bank. There are some administrative issues including the legal and financial problems that possibly will be resolved by the support of the government and the medical team.
Bone Marrow ; Cesarean Section ; Dimethyl Sulfoxide ; Erythrocytes ; Female ; Fetal Blood* ; Gelatin ; Granulocyte-Macrophage Progenitor Cells ; Humans ; Insurance Coverage ; Korea* ; Pregnancy ; Siblings ; Starch ; Stem Cell Transplantation ; Stem Cells* ; Tissue Donors

BACKGROUND: To standardize the separation method of cord blood and establish the Korean Cord Blood Bank, we analysed the data regarding cord blood separation from 8 different hospitals which involved in cord blood banking project. METHODS: We analysed 306 samples which collected with heparinized syringes and separated within 24 hours by Ficoll-Hypaque density gradient separation method and RBC depletion method with 3% gelatin. We performed the mononuclear cell (MNC) count, viability, CD34+ cell count and CFU-GM count following separation of cord blood. We assessed the yield of hematopoietic stem cells by different separation methods in 9 hospitals and the variability among hospitals which performed cord blood separation by same method. RESULTS: 1) In 204 samples of cord blood separated with Ficoll-Hypaque, there were significant differences in MNC count, viability, CD34+ cell count and CFU-GM count among all engaged hospitals, but not in each individual hospital. 2) In 102 samples of cord blood separated with 3% gelatin, there were significant differences in viability, CFU-GM count and CD34+ cell count among all engaged hospitals, but not in MNC count. 3) The yield of MNCs, CD34+ cells and CFU-GM was higher in the cord blood separated with 3% gelatin than Ficoll-Hypaque. CONCLUSION: We suggest that RBC depletion method with 3% gelatin would be better than Ficoll-Hypaque method in order to increase the yield of hematopoietic stem cells and standardize the method of cord blood separation.
Cell Count ; Fetal Blood* ; Gelatin ; Granulocyte-Macrophage Progenitor Cells ; Hematopoietic Stem Cells ; Heparin ; Syringes

The efficacy of tandem high-dose chemotherapy and autologous stem cell rescue (HDCT/ASCR) was investigated in patients with high-risk neuroblastoma. Patients over 1 yr of age who were newly diagnosed with stage 4 neuroblastoma from January 2000 to December 2005 were enrolled in The Korean Society of Pediatric Hematology-Oncology registry. All patients who were assigned to receive HDCT/ASCR at diagnosis were retrospectively analyzed to investigate the efficacy of single or tandem HDCT/ASCR. Seventy and 71 patients were assigned to receive single or tandem HDCT/ASCR at diagnosis. Fifty-seven and 59 patients in the single or tandem HDCT group underwent single or tandem HDCT/ASCR as scheduled. Twenty-four and 38 patients in the single or tandem HDCT group remained event free with a median follow-up of 56 (24-88) months. When the survival rate was analyzed according to intent-to-treat at diagnosis, the probability of the 5-yr event-free survival+/-95% confidence intervals was higher in the tandem HDCT group than in the single HDCT group (51.2+/-12.4% vs. 31.3+/-11.5%, P=0.030). The results of the present study demonstrate that the tandem HDCT/ASCR strategy is significantly better than the single HDCT/ASCR strategy for improved survival in the treatment of high-risk neuroblastoma patients.
Adolescent ; Child ; Child, Preschool ; Combined Modality Therapy/mortality ; Drug Therapy/*mortality ; Female ; Humans ; Infant ; Korea/epidemiology ; Longitudinal Studies ; Male ; Neuroblastoma/*mortality/*therapy ; Prevalence ; Risk Assessment/methods ; Risk Factors ; Stem Cell Transplantation/*mortality ; Survival Analysis ; Survival Rate ; Treatment Outcome

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is one of the most important armamentarium against various hematologic malignancies or some solid tumors. We investigated the number of patients who might need transplants and compared with that of actual transplants to conceptualize current status and circumstances of HSCTs in Korean children. METHODS: Questionnaires were sent to Korean Society of Hematopoietic Stem Cell Transplantation (KSHSCT) members who were taking care of children with malignancies or hematologic diseases. Almost all of the newly diagnosed patients between Jan, 1st and Dec, 31st, 2003 were enrolled in the study. RESULTS: Seven hundred forty eight children (male to female ratio = 1.4:1) were enrolled. The median age was 6.1 years old (8 days~28.8 years old). Malignant diseases consisted of 695 cases (92.9%), and among them almost half were hematologic malignancies. The participating members speculated that HSCTs should be indicated in 285 children (38.1%) which included 209 allogeneic, and 76 autologous transplants. In reality, however, allogeneic HSCTs were performed only in 140 children (67.0%) with the median interval of 5.9 month, and autologous transplants in 44 children (57.9%) with 8.3 month. In autologous setting, all the patients received peripheral blood stem cells (PBSCs), whereas bone marrow (61%), cord blood (34%), and PBSC (5%) were used in allogeneic HSCTs. Donor types were as follows: unrelated donor (37%), cord blood (34%), sibling donor (25%), and family (4%). The reasons for not performing HSCTs were unfavorable disease status or death, no availability of suitable donor, economical situation, and refusal by parental preferences. Under the strict insurance regulations, many transplants were not covered by insurance. More autologous transplants were performed without insurance coverage than allogeneic HSCTs (P=0.013). Those cases were advanced cases and HLA mismatch transplants for allogeneic setting, and relatively rare diseases still awaiting favorable results of transplants for autologous setting. CONCLUSION: HSCTs are essential part of treatment strategies for children with various diseases. Unfortunately, however, a third of patients who were in need of transplants did not receive HSCTs due to various reasons. It is necessary to expand unrelated donor pool or cord blood banks for the cases lacking HLA-identical sibling donors. Also medical insurances should cover HSCTs for rare diseases as well as for less favorable but novel situations where there are no suitable alternatives.
Autografts ; Bone Marrow ; Child* ; Disulfiram ; Female ; Fetal Blood ; Hematologic Diseases ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Insurance ; Insurance Coverage ; Parents ; Rare Diseases ; Siblings ; Social Control, Formal ; Stem Cells ; Tissue Donors ; Unrelated Donors ; Surveys and Questionnaires

PURPOSE: Childhood acute immune thrombocytopenic purpura (ITP) is a benign hematologic disease. Therapy does not affect the natural history of the illness. We evaluated the clinical and laboratory findings, treatment and prognosis of childhood acute ITP in Korea through a retrospective multicenter study. METHODS: We analyzed retrospectively the data of 1, 829 children with acute ITP through survey of 33 hospitals among 43 hospitals in Korea from Sep. 1992 to Aug. 2001. RESULTS: Male to female ratio was 1.3: 1 and the median age at the diagnosis of ITP was 2.9 (0.1 17) years. Median duration of follow up was 6 months. One hundred and forty nine cases of the total 1, 829 patients (8.1%) received no treatment. The initial median platelet count of the non-treated group was 42, 500/mm3. Among the 861 cases who were followed up over 6 months, 315 cases (36.6%) progressed into chronic ITP. Associated with this high rate of chronicity of childhood acute ITP patients in Korea, we must consider the fact that acute ITP patients with fast improvement in the first episode tend not to follow up. Considering that fact, the rate of chronicity becomes 17.2% of the 1, 829 acute ITP patients. The treated group used many kinds of treatment methods. Intravenous immunoglobulins (IVIG) with or without prednisolone (PD) (67.5%) were the most commonly used regimens. In the group treated with IVIG alone, the platelet count began to rise above 50, 000/mm3 at 2.6 days, 100, 000/mm3 at 3.7 days and 150, 000/mm3 at 4.9 days. Four hundred and twenty two cases of the 1, 686 (25.0%) cases followed up after first episode of ITP relapsed. The relapse rate was significantly higher in older patients and in girls than in younger patients and in boys (P< 0.05). The chronicity of ITP statistically increased with age (P< 0.05) and that was the only valuable factor. CONCLUSION: Despite the fact that childhood acute ITP is a pretty common disaese, there is no agreement on the best treatment method for this disease. The establishment of Korean treatment guideline of childhood acute ITP, based on an analysis of multicenters, seems to be needed.
Child ; Diagnosis ; Female ; Follow-Up Studies ; Hematologic Diseases ; Humans ; Immunoglobulins, Intravenous ; Korea* ; Male ; Natural History ; Platelet Count ; Prednisolone ; Prognosis ; Purpura, Thrombocytopenic, Idiopathic* ; Recurrence ; Retrospective Studies