PURPOSE: We performed an immunohistochemical study with pre-treatment biopsy specimens to evaluate the prognostic significance of four biomolecular markers which can be used as a predictive assay for radiotherapy (RT) treatment of nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: From January 1998 through December 2006, 68 patients were histologically diagnosed as non-metastatic NPC and treated by RT. Only 38 patients had the paraffin block for the immunohistochemical study. Thirty-one patients had undifferentiated carcinoma and 7 patients had squamous cell carcinoma. Thirty-two patients (84%) had advanced stage NPC (2002 AJCC Stage III~IV). Immunohistochemical staining was performed for Met, COX-2, nm23-H1, and epidermal growth factor receptor (EGFR) expression using routine methods. RESULTS: The median follow-up time was 30 months (range, 11 to 83 months) for all patients, and 39 months (range, 19 to 83 months) for surviving patients. The 5-year overall survival (OS) rate of the patients with high Met extent (> or =50%) was significantly lower than that of the patients with low Met extent (48% vs. 84%, p=0.02). In addition, Met extent was also a significant prognostic factor in multivariate analysis (p=0.01). No correlation was observed between Met extent and T stage, N stage, stage group, gender, age, and the response to chemotherapy or RT. Met extent showed moderate correlation with COX-2 expression (Pearson coefficient 0.496, p<0.01), but COX-2 expression did not affect OS. Neither nm23-H1 or EGFR expression was a prognostic factor for OS in this study. CONCLUSION: High Met extent (> or =50%) might be an independent prognostic factor that predicts poor OS in NPC treated with RT.
Biopsy ; Carcinoma ; Carcinoma, Squamous Cell ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Nasopharyngeal Neoplasms ; Paraffin ; Receptor, Epidermal Growth Factor

VAHS is characterized by viral-like prodromal symptoms, high fever' malaise, hepatosp lenomegaly, pancytopenia. The dignosis is based on a bone marrow biopsy specimen that demonstrates histiocytic hyperplasia with prominent hemophagocytosis of red blood cells, platelets, and nucleated hematopoietic cells Recently, the use of immunosuppressants tends to increase due to increase of autoimmune disease and organ transplantation patients. A large portion of leukemia and organ transplant patients developed VAHS as a secondary viral infection after anticancer drug and immunosuppressants therapy was administered In the field of ophthalmology, VAHS can occur by administration of immunosuppressants in corneal transplantation and autoimmune uveitis patients. Recently we experienced a case of fatal VAHS in a young uveitis patient who had been treated with immunosuppressants. We report this specfic case with literature review bec,lUse of the need for careful observation of general findings occurring during treatment of immunosuppressants such as corticosteroid.
Autoimmune Diseases ; Biopsy ; Bone Marrow ; Corneal Transplantation ; Erythrocytes ; Humans ; Hyperplasia ; Immunosuppressive Agents ; Leukemia ; Ophthalmology ; Organ Transplantation ; Pancytopenia ; Prodromal Symptoms ; Transplants ; Uveitis*

PURPOSE: This study was performed to evaluate the changes in tear film and ocular surface after dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction. METHODS: Forty subjects who showed successful results at three months after endoscopic DCR were investigated. The changes in tear breakup time (BUT), basal secretion test (BST), corneal sensitivity test (CST), tear clearance rate (TCR) and keratoepitheliopathy (KEP) were evaluated. RESULTS: The mean age was 57.4+/-13.2 years (29~77 years). Preoperative BST and BUT in eyes which underwent DCR were 13.21+/-3.79 mm and 8.20+/-2.30 seconds, respectively. Three months after the operation, the respective values were 9.13+/-3.77 mm (p=0.01) and 6.27+/-2.20 seconds (p=0.03). Preoperative CST, TCR and KEP in eyes which underwent DCR were 57.89+/-4.18 mm, 3.26+/-0.91 and 0.12+/-0.53, respectively. Three months after the operation, the respective values were 57.75+/-3.55 mm (p=0.32), 3.04+/-0.87 (p=0.08) and 0.13+/-0.54 (p=0.08). No changes were observed between the preoperative and postoperative tear parameters in fellow eyes. CONCLUSIONS: The changes in tear film parameters including BST and BUT should be considered in patients who receive endoscopic DCR.
Dacryocystorhinostomy ; Eye ; Humans ; Nasolacrimal Duct ; Tears

The intramedullary nailing for humeral shaft fractures has become popular fixation method. It affords less invasive procedure, good stability and early rehabilitation. However many complications were reported such as nonunion, pain and motion limitation of shoulder. We managed 33 patients using interlocking intramedullary nail for the humeral shaft fractures, and nonunion occurred in 9 patients. We reviewed these 9 cases and analyzed the relationship between the nonunions and the fracture sites as well as fracture types. The results were as follows; 1. Nonunion occurred in 9 patients of 25 patients treated closed reduction, but did not occur in 8 patients treated open reduction. 2. The union was obtained in all 6 patients with proximal one third fracture. But nonunion occurred in 6 patients of 19 patients with middle one third fracture and in 3 patients of 8 patients with distal one third fracture. 3. Nonunion after interlocking nails for humeral shaft fractures did not occur in all 6 spiral fracture patients. Nonunion occurred in 5 patients of 8 comminuted fracture patients, in 3 patients of 6 transverse fracture patients and in 1 patient of 3 oblique fracture patients with below the middle one third of humerus. Our study showed that the high rate of nonunion occurred in the comminuted, transverse and oblique fracture below the middle one third of humerus. On the basis of these findings, we recommend that closer attention should be paid when choose the fixation method in these types of the humeral shaft fractures.
Fracture Fixation, Intramedullary ; Fractures, Comminuted ; Humans ; Humerus ; Rehabilitation ; Shoulder

BACKGROUND: Androgenic alopecia (AGA) is the most common type of hair loss. It is likely inherited genetically and is promoted by dihydrotestosterone. 5α-reductase has been proven a good target through finasteride use. However, the pathogenesis of AGA cannot be fully explained based only on dihydrotestosterone levels. OBJECTIVE: To identify similar hairloss inhibition activity of RE-ORGA with mode of action other than finasteride. METHODS: We prepared RE-ORGA from Korean herb mixtures. We performed MTT assays for cytotoxicity, Cell Counting Kit-8 assays for cell proliferation, and western blot to identify expression levels of 5α-reductase and Bax. RNA-sequencing was performed for the expression patterns of genes in dihydrotestosterone-activated pathways. Anti-inflammatory activity was also assessed by the expression levels of tumor necrosis factor-alpha (TNF-α) and interleukin 6. RESULTS: REORGA could promote the proliferation of human dermal papilla cells and showed low cytotoxicity. It also inhibited the expression of 5α-reductases and Bax in the cells. RNA-sequencing results verified that the mRNA expressions of SRD5A1, Bax, transforming growth factor-beta 1 (TGF-β1), and TGF-β1 induced transcript 1 (TGFβ1I1) were decreased, whereas expression of protein tyrosine kinase 2 beta (PTK2β) was more elevated. REORGA also showed anti-inflammatory activity through decreased mRNA levels of TNF-α. CONCLUSION: Transcriptionally, up-regulation of PTK2β and concomitant down-regulation of TGFβ1I1 imply that RE-ORGA can modulate androgen receptor sensitivity, decreasing the expression of 5α-reductase type II and Bax together with TGF-β1 transcripts; RE-ORGA also showed partial anti-inflammatory activity. Overall, RE-ORGA is expected to alleviate hair loss by regulating 5α-reductase activity and the receptor's androgen sensitivity.
Alopecia ; Blotting, Western ; Cell Count ; Cell Proliferation ; Cholestenone 5 alpha-Reductase ; Dihydrotestosterone ; Down-Regulation ; Finasteride ; Hair ; Humans ; Interleukin-6 ; Protein-Tyrosine Kinases ; Receptors, Androgen ; RNA, Messenger ; Tumor Necrosis Factor-alpha ; Up-Regulation

BACKGROUNDS: Katz index of ADL and Barthel index of ADL have been used to evaluate the function of disabled elderly in Korea. But no ADL scale reflecting Korean's own language expression and culture has been developed and verified yet. METHODS: Descriptions of basic activities which needed others' help were collected from 190 Korean disabled elderly. The collected results were categorized into basic activities of daily living and instrumental activities of daily living, and then in each domain such as bathing, shopping, etc. Preliminary instrument items were selected by the judgement of the expert committee, considering the frequency of the responses and the importance of each item. A preliminary questionnaire was developed based on the selected items. The preliminary questionnaire was pretested twice, and corrected by the results. Finally a scholar on Korean literature verified the questionnaire on the grammar and context. RESULTS: A total of 408 basic activities of daily living and 242 instrumental activities of daily living were collected. The activities were categorized into 7 domains of ADL(dressing, washing face and hand, bathing, eating, transfer, toileting, continence) and 10 domains of IADL(decorating, housework, preparing meals, laundry, outgoing for a short distance, using transportation, shopping, handling money, using telephone, taking medicine) CONCLUSIONS: We developed a Korean Activities of Daily Living(K-ADL) scale and Korean Instrumental Activities of Daily Living(K-IADL) scale reflecting Korean elderly's own language expression and culture.
Activities of Daily Living ; Aged ; Baths ; Eating ; Hand ; Housekeeping ; Humans ; Korea ; Meals ; Surveys and Questionnaires ; Telephone ; Transportation

OBJECTIVE: The validity of olfactory bulbectomized rat as an animal depression model and the possibilities of the NMDA antagonist as an antidepressant would be evaluated by demonstrating structural alterations in their brain MRIs and histological findings of hippocampus. METHODS: Those 8-week old male Sprague-Dawley rats received either an olfactory bulbectomy or sham operation and volume changes at ventricles and caudate nucleus in their brain MRI were acquired at preoperation and postoperation. Those olfactory bulbectomized rats received either memantine, an uncompetitive NMDA antagonist, or normal saline, a placebo, and their brain structural changes in MRI were acquired. At preoperation, postoperation, and postmedication each one of the rats with sham-operation, with memantine, and with placebo was sacrificed to acquire histological impressions. RESULTS: 1) Comparison of the volume changes between preoperation and postoperation showed statistical significance; the volumes of the left and right lateral ventricles (p=0.007, p=0.008) and the third ventricle (p=0.003) increased significantly but the volumes of left and right caudate nucleus decreased (p=0.014, p=0.032), compared to that of the controls. 2) After 6-weeks of memantine administrations, the OB rats revealed more definite recovery in brain MRIs statistically than the controls: the volumes of left and right ventricles and left and right caudate nucleus (p=0.004, p=0.03 ; p=0.04, p=0.05). 3) The hippocampus histological findings of the olfactory bulbectomy showed frequently eosinophilic cytoplasm and hyperchromatic nucleus with shrinkage in CA3. After memantine intake, the hippocampus histological findings returned to nearly normal and showed mixtures of normal cell and abnormal neuron cell. CONCLUSION: The OB models would be valid as an animal model of depression and alterations in their brain MRI images after administrations of NMDA antagonist could be an indicator of antidepressant effects.
Animals ; Brain ; Caudate Nucleus ; Cytoplasm ; Depression* ; Eosinophils ; Heart Ventricles ; Hippocampus ; Humans ; Lateral Ventricles ; Magnetic Resonance Imaging* ; Male ; Memantine* ; Models, Animal ; N-Methylaspartate ; Neurons ; Rats* ; Rats, Sprague-Dawley ; Third Ventricle

BACKGROUND: Recent development of endoscopic devices and surgical techniques enabled the video-assisted thoracoscopic sympathetic surgery to be reliable, safe and minimally invasive for the treatment of hyperhidrosis. People with axillary hyperhidrosis, however, were not as satisfied as those with palmar or craniofacial hyperhidrosis due to more frequent and severe compensatory sweating and lack of effect on concomitant osmidrosis. MATERIAL AND METHOD: From March 1997 through April 1999, 45 cases of axillary hyperhidrosis underwent T3,4 sympathectomy(21 patients), T2,4 sympathicotomy(20 patients) or T4 sympathectomy(4 patients). We evaluated and analyzed the early effect of symptomatic relief, compensatory hyperhidrosis and the level of long term satisfaction. The sex ratio was 28 males: 17 females with an average age of 28 years, ranging from 13 to 46 years. Two patients had concomitant osmidrosis and one patient who underwent T3,4 sympathectomy experienced profuse compensatory sweating on face and scalp for which he underwent a reoperation of T2 sympathicotomy 93 days later. All the procedures were performed under general anesthesia in semifowler's position with 30 elevation of the upper body. A 2mm needle thoracoscope was used except in 2 cases with moderate to severe pleural adhesions where a 5mm thoracoscope was used. RESULT: Average operation time was 46.2+/-11 minutes for T3,4 sympathectomy; 32.5+/-23 minutes for T2,4 sympathicotomy; and 53.8+/-18 minutes for T4 sympathectomy. Every patient who underwent T3,4 sympathectomy and T2,4 sympathicotomy showed satisfaction 17 cases(81%) and 12 cases(60%) had absolutely no sweating after T3,4 sympathectomy and T2,4 sympathicotomy, respectively and the remaining 4 cases(19%) and 8 cases(40%) experienced 'decreased amount of sweating with slightly moist armpits'. Compensatory hyperhidrosis was present in 67% and 60% of the cases after T3,4 sympathectomy and T2,4 sympathicotomy, but only 10% and 5 %, were severe enough to be embarrassing or disabling. The level of satisfaction was high in both groups, with 86% after T3,4 sympathectomy and 89% after T2,4 sympathicotomy. CONCLUSION: Both T3,4 sympathectomy and T2,4 sympathicotomy were effective means of treating axillary hyperhidrosis. T3,4 sympathectomy had superior symptomatic relief although T2,4 sympathicotomy was favored because of shorter operation time, easier surgical technique and milder compensatory sweating. Long term satisfaction level, however, was similar in both groups.
Anesthesia, General ; Female ; Humans ; Hyperhidrosis* ; Male ; Needles ; Reoperation ; Scalp ; Sex Ratio ; Sweat ; Sweating ; Sympathectomy ; Thoracoscopes

BACKGROUND AND OBJECTIVES: Cardiovascular complications are the leading cause of morbidity and mortality in childhood cancer survivors. Hematopoietic stem cell transplantation (HSCT) is a curable therapy for pediatric cancer. However, changes in cardiac function in children after HSCT are not well known. We assessed left ventricular (LV) function in children after HSCT using speckle tracking echocardiography (STE). SUBJECTS AND METHODS: Forty consecutive patients with median age of 11.9 years (range, 1.5-16 years) who received HSCT for acute leukemia and had comprehensive echocardiography before and after (median 9.2 month) HSCT were included in this study. The LV function parameters including conventional tissue Doppler imaging (TDI) and STE data were collected from pre- and post-HSCT echocardiography. These data were compared to those of 39 age-matched normal controls. RESULTS: Compared to normal controls, post HSCT patients had similar (p=0.06) LV ejection fraction. However, the following three LV function parameters were significantly decreased in post HSCT patients: rate-corrected velocity of circumferential fiber shortening (p=0.04), mitral inflow E velocity (p<0.001), and mitral septal annular E' velocity (p=0.03). The following four STE parameters were also significantly decreased in post HSCT patients: LV global circumferential systolic strain (p<0.01), strain rate (SR, p=0.01), circumferential diastolic SR (p<0.01), and longitudinal diastolic SR (p<0.001). There was no significant change in TDI or STE parameters after HSCT compared to pre-HSCT. Patients with anthracycline cumulative dose >400 mg/m2 showed significantly (p<0.05) lower circumferential systolic strain and circumferential diastolic SR. CONCLUSION: Subclinical cardiac dysfunction is evident in children after HSCT. It might be associated with pre-HSCT anthracycline exposure with little effect of conditioning regimens. Serial monitoring of cardiac function is mandatory for all children following HSCT.
Case-Control Studies* ; Child* ; Echocardiography* ; Hematopoietic Stem Cell Transplantation* ; Humans ; Leukemia* ; Mortality ; Stem Cell Transplantation ; Survivors ; Ventricular Dysfunction, Left*

BACKGROUND AND OBJECTIVES: Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE. SUBJECTS AND METHODS: The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD. RESULTS: The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only. CONCLUSION: TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE.
Axis, Cervical Vertebra ; Biomarkers ; Dilatation ; Echocardiography ; Electrocardiography ; Heart ; Hominidae ; Humans ; Hypokinesia ; Medical Records ; Natriuretic Peptide, Brain ; Prognosis ; Pulmonary Embolism ; Retrospective Studies ; Sensitivity and Specificity ; Ventricular Dysfunction, Right