Magnetic resonance (MR) imaging was performed in 41 patients with compression fracture of the spine. MR images of 14 patients with acute spinal trauma (within recent 1 month), eight patients with chronic trauma (over 1 month), and 19 patients with malignant cause without history of trauma were analyzed, retrospectively. Low signal intencities on T1-weighted images and high signal intensities on T2-weighted images were noted in 86% (12/14) of patients with acute trauma, Iso-signal intensities on all pulse sequences were noted in 50%(4/8) of patients with chronic trauma. Low signal intensities on T1-weighted images and high signal intensities on T2-weighted images were noted in 100%(19/19) of patients with metastatic compression fracture. Contrast enhancement was observed in all the cases of acute trauma(4/4) and metastases(18/18), whereas only 20% (1/5) of chronic trauma showed enhancement. Fragmentation was seen in 35% (5/14) of patients with acute trauma, in 25%(2/8) with chronic trauma, and not seen in the patients with metastasis. In conclusion, acute traumatic compression fracture can not be differentiated from malignant cause by MR signal intensity or contrast enhancement, but chronic compression fracture can be distinguished from metasasis. Fragmentation may suggest traumatic compression fracture. So MRI could be a useful method in differentiating the benign compression fractures from the pathologic ones caused by malignancy.
Fractures, Compression* ; Humans ; Magnetic Resonance Imaging ; Methods ; Neoplasm Metastasis* ; Retrospective Studies ; Spine

If one can measure the actual angle of the bowing and rotation of a long bone three-dimensionally, it will be a great help in fracture reductions, operative treatments of the congenital snomalies, determination of the fusion angles in arthrodeses, and so on. We developed a computer program that gives us the actual bowing and rotation angle when we input the angles from the two X-ray films with known angle between them. We measured anteversion and neck-shaft angle of the femur, the amount of bowing and rotation in fracture model, and the fusion angles in arthrodeses. The angles calculated from the computer program were same as those from another X-ray that showed the actual angle taken by derotating the subject.
Arthrodesis ; Femur ; X-Ray Film

No abstract available.
Hepatitis B Surface Antigens* ; Kidney Failure, Chronic* ; Korea* ; Liver Diseases* ; Liver*

No abstract available.
Osteoporosis*

PURPOSE: Patients with recurrent breast cancer usually die of their disease, even after radical surgery and adjuvant therapies which could reduce the odds of dying. Many studies analyzed and compared patients who died of recurrent disease with those that died without recurrent disease. However, less attention has been paid to evaluating factors associated with the timing of recurrence. Thus, the objective of this study is to investigate the correlation between various factors and the timing of recurrence. METHODS: We retrospectively reviewed the data of 95 recurrent breast cancer patients who underwent curative surgery to determine the prognostic factors such as menopausal status, operation method, stage, nodal status, histologic grade, nuclear grade, extensive intraductal carcinoma component, hormone receptor, p53, c-erbB-2, Ki-67, and molecular subtype. We had attempted to compare the recurrent patients within 2 years after operation and adjuvant chemotherapies as the early recurrence with those over 2 years as the late recurrence. RESULTS: Histologic grade (p=0.005), nuclear grade (p<0.001), p53 (p=0.022), and Ki-67 (p<0.001) were significant different factors that influenced the systemic recurrence between early recurrence and late recurrence. In stage I/II, histologic grade (p=0.001), nuclear grade (p<0.001), and Ki-67 (p=0.005) were significant factors that influenced the systemic early recurrence. In stage III, nuclear grade (p=0.024), and Ki-67 (p=0.001) were significant factors that influenced the systemic early recurrence. But subtypes (p=0.189, p=0.132, p=0.593, p=0.083) are not associated with the timing of recur rence. CONCLUSION: In systemic recurrent breast cancer patients, the risk factors such as histologic grade, nuclear grade, p53 and Ki-67 are also associated with the timing of recurrence. We sug gest that these patients should be proper treated and be closely followed up.
Breast ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Recurrence ; Retrospective Studies ; Risk Factors

BACKGROUND AND OBJECTIVES: A new Doppler time index of myocardial performance (the Tei index) has been studied as a useful predictor of global cardiac function. It is defined as (a-b)/b, where a is the interval between the end and onset of the mitral inflow, and b is the ejection time of the left ventricular outflow. However, the Doppler time intervals are not measured on the same cardiac cycle. SUBJECTS AND METHODS: We compared the tissue Doppler imaging (TDI)-derived Tei index, which can be measured on the same cardiac cycle, with the conventional Tei index as measured by pulsed wave Doppler method, in healthy persons (n=44), in patients having diastolic dysfunction with an E/E' ratio >10 (DD, n=56), and in patients having systolic dysfunction with an ejection fraction<50% (SD, n=10). At the septal and lateral mitral annulus from the apical 4-chamber view, the time interval between the end and onset of the mitral annular velocities during diastole (a') minus the duration of the systolic wave (b') divided by b', which is (a'-b')/b', is defined as the TDI-tei index. RESULTS: The TDI-Tei index and the conventional Tei index were significantly higher in the SD group than in the DD group, and they were also higher in the DD group than in the healthy controls. The TDI-Tei index at the septal and lateral annulus correlated well with the Tei index (r=0.71, r=0.65, respectively, p<0.001) and this showed a good correlation with other echocardiographic parameters of diastolic function. CONCLUSION: We demonstrated that the TDI-Tei index correlates well with the conventional Tei index along with having the advantage of simultaneous recording of the systolic and diastolic velocities in adults.
Adult* ; Diastole ; Echocardiography ; Echocardiography, Doppler ; Humans ; Ventricular Function

PURPOSE: Asthma-related morbidity and mortality are increasing, and the financial burden imposed by this condition will substantially increase. Nevertheless, little information is available regarding the nature and magnitude of the burden due to asthma at the national level. This study was conducted to characterize the financial burden imposed by asthma in the Republic of Korea at the national level. METHODS: The overall prevalence of asthma and the costs of related medical services were determined using data from the National Health Insurance Corporation, which is responsible for the National Health Insurance scheme. Indirect costs, including expenditures on complementary and alternative medicines, and the economic impact of an impaired quality of life (intangible costs) were estimated by surveying 660 asthmatics, and these estimates were transformed to the national level using the prevalence of asthma. RESULTS: The prevalence of asthma and total costs related to the disease in 2004 were 4.19% and $2.04 billion, respectively. Direct costs and indirect costs contributed equally to total costs (46.9% and 53.1%, respectively). However, when intangible costs were included, total costs rose to $4.11 billion, which was equivalent to 0.44% of the national gross domestic product in 2004. CONCLUSIONS: The results provide evidence that asthma is a major health cost factor in the Republic of Korea and that intangible costs associated with asthma are significant cost drivers.
Asthma ; Gross Domestic Product ; Health Care Costs ; Health Expenditures ; National Health Programs ; Prevalence ; Quality of Life ; Republic of Korea

BACKGROUND: Acute renal failure is one of the leading causes of postoperative morbidity and mortality. The purpose of this study was to determine the risk factors that are associated with acute renal failure after colorectal surgery. MATERIALS AND METHODS: Five hundred seventy patients who operated colorectal surgery at the Yeungnam University Medical Center over three years from 2004 to 2006 were enrolled in this study. The effects of gender, age, ASA classification, concomitant disease, surgery type and duration, reoperation, urogenital manipulation, medication, hypotension, hypovolemia, transfusion, and postoperative ventilatory care on the occurrence of acute renal failure after colorectal surgery were studied. RESULTS: The major risk factors of acute renal failure after colorectal surgery were age of patients (P=0.003), ASA classification (P<0.001), concomitant disease (P<0.001), duration of the time surgery (P=0.034), reoperation (P=0.001), use of intraoperative diuretics (P=0.005), use of postoperative diuretics (P<0.001), intraoperative hypotension (P=0.018), intraoperative transfusion (P<0.001), postoperative transfusion (P<0.001), and postoperative ventilatory care (P=0.001). CONCLUSION: Multiple factors cause synergistic effects on the development of acute renal failure after colorectal surgery. Therefore, efforts to reduce the risk factors associated with acute renal failure are needed. In addition, intensive postoperative care should be provided to all patients.
Academic Medical Centers ; Acute Kidney Injury* ; Classification ; Colorectal Surgery* ; Diuretics ; Humans ; Hypotension ; Hypovolemia ; Mortality ; Postoperative Care ; Reoperation ; Risk Factors*

BACKGROUND AND OBJECTIVES: Large volume reduction after hemodialysis in patients with chronic renal failure alters the preload. We investigated the cardiac function by total ejection isovolume (TEI) index- a new simple, readily reproducible Doppler echocardiographic index combining systolic and diastolic function- before and after dialysis. MATERIALS AND METHOD: Thirty-one patients on maintenance hemodialysis including 6 diabetes and 13 hypertensives without known organic heart disease and with normal systolic function were enrolled. They were divided into two groups according to ultrafiltration volume at the study dialysis session, group 1 (2.5kg or less) and group 2 (more than 2.5 kg). They are 46+/-12 years old on average. We examined two-dimensional, M-mode, pulsed wave and tissue Doppler before and after dialysis immediately. TEI index was calculated by dividing the sum of the isovolumic relaxation time (IVRT) and isovolumic contraction time (ICT) by the ejection time. RESULTS: After dialysis, significant decrease of body weight was noted, but baseline heart rate, blood pressure, Left ventricular (LV) ejection fraction and LV mass index were not changed significantly. LV end-diastolic volume was decreased significantly after dialysis in all group, and end-systolic volume was decreased significantly in total and group 2. Peak early E velocity and ratio of E to the peak late (A) velocity (E/A) from mitral inflow signal were decreased significantly after dialysis in all group and deceleration time of early filling phase was prolonged in total and group 1, but A and IVRT did not change significantly. Of the septal mitral annulus motion, Ean velocity and Ean/Aan ratio was decreased, but no significant change was noted in the lateral annulus. The TEI index did not chage significantly after dialysis in all group. CONCLUSION: A new simple echocardiographic TEI index can be used to measure the global myocardial function in patients with chronic renal failure before and after dialysis, relatively independent of preload change.
Blood Pressure ; Body Weight ; Deceleration ; Dialysis ; Echocardiography ; Heart Diseases ; Heart Rate ; Humans ; Kidney Failure, Chronic ; Relaxation ; Renal Dialysis* ; Ultrafiltration

PURPOSE: In children, dysphagia is a common cause of recurrent pneumonia and malnutrition and can be fatal. However, till now no studies were performed concerning the clinical investigation of dysphagia in Korea. METHODS: In this study we evaluated the clinical manifestations of dysphagia in children with an age range between 1 month and 12 years by reviewing the clinical records, and we classified the dysphagia by videofluoroesophagography. RESULTS: The etiologies of dysphagia demonstrated as follows; developmental delay in 7 patients, treacheoesophageal fistula in 2 patients, and ischemic encephalopathy, encephalitis, brain tumor, subepiglottic stenosis, bronchiolitis, and Williams syndrome in 1 patient, respectively. The presenting symptoms of dysphagia revealed as follows; choking in 7(46%) patients, nasal regurgitation in 2(13.3%) patients, hypersensitive gag reflex in 2(13.3%) patients and drooling, foreign body sensation, and feeding refusal in 1 patient, respectively. The complications of dysphagia were malnutrition in 12(80%) patients, which was followed by aspiration pneumonia in 8(53.3%) patients. On videofluoroesophagography, 5 patients showed oral phase dysphagia, Seven and two patients showed pharyngeal and esophageal phase dysphagia, respectively. Two patients presented normal deglutition on videofluoroesophagography. Total of 8 patients required gastrostomy because of recurrent aspiration and poor weight gain. In 7 patients, however, dysphagia improved with rehabilitation therapy only. CONCLUSION: Our data demonstrated that the complications of dysphagia in childhood were not uncommon, and suggested that diagnostic workup including videofluoroesophagography were helpful in classifying the feeding difficulties of these children. Gastrostomy and rehabilitation offered effective therapeutic possibilities.
Airway Obstruction ; Brain Ischemia ; Brain Neoplasms ; Bronchiolitis ; Child* ; Constriction, Pathologic ; Deglutition ; Deglutition Disorders* ; Disulfiram ; Encephalitis ; Fistula ; Foreign Bodies ; Gastrostomy ; Humans ; Korea ; Malnutrition ; Pneumonia ; Pneumonia, Aspiration ; Reflex ; Rehabilitation ; Sensation ; Sialorrhea ; Weight Gain ; Williams Syndrome