PURPOSE: To evaluate the clinical aspects of severe endogenous endophthalmitis requiring evisceration,particularly underlying disease, causative microorganisms, and infection focus, and to assess the outcome of evisceration. METHODS: The records of 13 patients who were diagnosed with endogenous endophthalmitis requiring evisceration and treated at Yeungnam University Hospital from July 1994 to April 2007 were retrospectively reviewed. RESULTS: Of the 13 patients, all patients had diabetes mellitus, five had advanced liver disease, and one had aplastic anemia. Infection foci were pyelonephritis, pneumonia, and liver abscess. Five cases were confirmed with positive culture of lebsiella pneumoniae. Ten cases underwent evisceration with hydroxyapatite implantation, and three cases were treated conservatively because the patient was in poor systemic condition. Of the 10 patients who underwent evisceration, ocular implants were exposed in five cases. CONCLUSIONS: This study suggests that evisceration with primary orbital implant insertion for endogenous endophthalmitis involves the risk of implant exposure, but after secondary repair, all patients have stable clinical courses.
Anemia, Aplastic ; Diabetes Mellitus ; Durapatite ; Endophthalmitis ; Humans ; Liver Abscess ; Liver Diseases ; Orbital Implants ; Pneumonia ; Pyelonephritis ; Retrospective Studies

OBJECTIVES: There is continuing controversy about the benefits of decompressive craniectomy in massive cerebral edema following space occupying hemispheric cerebral infarction. The aims of this study are to determine the effectiveness and to confirm the life-saving nature of decompressive craniectomy with dural augmentation for massive cerebral infarction. PATIENTS AND METHODS: We present twelve patients with medically uncontrollable hemispheric cerebral infarction. All were treated with extensive craniectomy and duroplasty without resection of necrotic tissue. We evaluated various characteristics(size of hemispheric infarction, Glasgow Coma Scale, volume of low density and midline shift in CT) at three different periods(preoperative, immediate postoperative and 3-4weeks after operation) and evaluated effectiveness of hemicraniectomy for massive cerebral edema after large hemispheric infarction. RESULTS: All patients have survived from surgery. Nine patients with nondominant hemispheric infarction showed significant functional recovery with minimal assistance, and remaining two patients with dominant hemispheric infarction and one patient with nondominant hemispheric infarction have functionally dependent. The volume of low density and midline shift in CT were significantly reduced after decompressive craniectomy. CONCLUSIONS: Our results indicate that decompressive craniectomy with dural augmentation without resection of necrotic tissue for massive cerebral hemispheric infarction not only reduce the mortality and infarction size but also significantly improve the outcome, especially for nondominant hemispheric infarction.
Brain Edema ; Cerebral Infarction* ; Decompressive Craniectomy* ; Glasgow Coma Scale ; Humans ; Infarction ; Mortality

PURPOSE: This study evaluated the long term clinical and radiographic results and the survival rates of unicompartmental knee arthroplasty (UKA). In addition, the factors affecting the survival of the procedure were analyzed and the survival curve was compared according to the affecting factors. MATERIALS AND METHODS: Ninety-nine cases of UKA performed between December 1982 and January 1996 were involved: 10 cases with Modular II, 44 cases with Microloc, and 45 cases with Allegretto prostheses. The mean follow-up period was 16.5 years. Clinically, the hospital for special surgery (HSS) scoring system and the range of motion (ROM) were evaluated. Radiographically, the femorotibial angle (FTA) was measured. The survival rate was analyzed using the Kaplan–Meier method. Cox regression analysis was used to identify the factors affecting the survival according to age, sex, body mass index, preoperative diagnosis, and type of implant. The Kaplan–Meier survival curves were compared according to the factors affecting the survival of UKA. RESULTS: The overall average HSS score and ROM was 57.7 and 134.3° preoperatively, 92.7 and 138.4° at 1 year postoperatively, and 79.1 and 138.4° at the last follow-up (p<0.001, respectively). The overall average FTA was varus 0.8° preoperatively, valgus 4.1° at postoperative 2 weeks, and valgus 3.0° at the last follow-up. The overall 5-, 10-, 15- and 20-year survival rates were 91.8%, 82.9%, 71.0%, and 67.0%, respectively. The factors affecting the survival were the age and type of implant. The risk of the failure decreased with age (hazard ratio=0.933). The Microloc group was more hazardous than the other prostheses (hazard ratio=0.202, 0.430, respectively). The survival curve in the patients below 60 years of age was significantly lower than those of the patients over 60 years of age (p=0.003); the survival curve of the Microloc group was lower compared to the Modular II and Allegretto groups (p=0.025). CONCLUSION: The long-term clinical and radiographic results and survival of UKA using old fixed bearing prostheses were satisfactory. The selection of appropriate patient and prosthesis will be important for the long term survival of the UKA procedure.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Body Mass Index ; Diagnosis ; Follow-Up Studies ; Humans ; Knee ; Methods ; Prostheses and Implants ; Range of Motion, Articular ; Survival Analysis ; Survival Rate

OBJECTIVE: Dehydroepiandrosterone sulphate (DHEAS), the major steroidal product of the human adrenal, is abnormally low in patients with SLE. Moreover, a recent study confirms a positive effect of the precursor DHEA on the disease course in SLE, which supports an etiologically important role of the hormone on SLE. The aim of this study is to search for an interrelation between clinical manifestations, laboratory findings, and disease activities and DHEAS in patients with SLE. METHOD: DHEAS were measured by radioimmunoassay kit using 125I-labeled DHEA-SO4 antibody-coated tube in the serum of 48 patients with SLE and in 46 control subjects. Laboratory findings, clinical symptoms, signs and SLE disease activity index (SLEDAI) in SLE patients were evaluated at blood sampling time. RESULTS: DHEAS was lower in patients with SLE compared to controls (45.60+/-42.62 mug/dL vs 101.55+/-56.54 mug/dL, p<0.005). The serum DHEAS levels were significantly negative correlation with SLEDAI (r=-0.333, p<0.05). There were significantly negative correlations between daily steroid dose and DHEAS (r=-0.384, p=0.012), and the amount of steroid used during previous 2 months and DHEAS (r=-0.011, p=0.011). CONCLUSIONS: Patients with SLE have low levels of DHEAS and significant negative correlation between SLEDAI, steroid dose and DHEAS.
Dehydroepiandrosterone* ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Radioimmunoassay

BACKGROUND: The transplantation of organs between phylogenetically disparate or harmonious species has invariably failed due to the occurrence of hyperacute rejection or accerelated acute rejection. But concordant cardiac xenograft offer us an opportunity to study xenotransplantation in the absence of hyperacute rejection. Current therapeutics for the prolongation of survival of rodent concordant xenotransplantation are not ideal with many regimens having a high mortality rate. Cyclosporine A & Mycophenolate Mofetil are new immunosuppresive agent which has been shown to be effective at prolonging survival of allograft, as purine synthesis inhibitor. MATERIAL AND METHOD: We used white mongrel rats as recipient and mice as donor, divided 4 groups(n=6), control group(Group 1) has no medication or pretreatment, Group 2 has splenectomy as pretreatment 7~10 days before transplantation, Group 3 has Cyclosporine A treatment group, Group 4 has combined treatment of Cyclosporine A & Mycophenolate Mofetil(RS 61443). We compared survival time. RESULT: We can't find significant difference of survival time between each groups. CONCLUSION: We concluded that rejection of cardiac xenograft was different from rejection of allograft, and new immunossuppresive Agent(Mycophenolate Mofetil, Cyclosporine A) was not effective for prolongation of survival time after cardiac xenograft.
Allografts ; Animals ; Cyclosporine ; Heart* ; Heterografts* ; Humans ; Immunosuppression ; Mice* ; Models, Theoretical* ; Mortality ; Rats* ; Rodentia ; Splenectomy ; Tissue Donors ; Transplantation ; Transplantation, Heterologous

Oncogenic osteomalacia is a rare clinicopathological condition. The syndrome is characterized by hypophosphataemic osteomalacia with hyperphosphaturia, low plasma 1,25-dihydroxyvitamin D and normal plasma calcaemia and parathyroid hormone, associated with a tumor, generally of mesenchymal origin. Complete excision of the tumour results in cure of the whole syndrome. Recently we experienced 56-year-old woman with oncogenic osteomalacia caused by a chondromyxoid fibroma of the left foot. We report this case with the review of literatures.
Female ; Fibroma* ; Foot ; Humans ; Hypophosphatemia, Familial ; Middle Aged ; Osteomalacia* ; Parathyroid Hormone ; Plasma

BACKGROUND AND OBJECTIVES: Antibiotic prophylaxis of infective endocarditis is required before high-risk procedures in patient with high-risk heart diseases. Although guidelines for the prevention of infective endocarditis were proposed by the American Heart Association in 1997, compliance to these recommendations has not been evaluated in Korea. SUBJECTS AND METHODS: This was a retrospective, multicentered study in 8 Korean university hospitals. Patients with high-risk heart diseases, having undergone invasive dental procedures between Jan. 1, 2000 and Dec. 31, 2003, were enrolled. The medical and dental records of the patients were reviewed to evaluate whether the prophylaxis had been appropriate. RESULTS: Of the initial 4,912 patients, 184 that had been treated with invasive dental procedures (255 total episodes, mean 1.4/patient) were evaluated. The most common high-risk heart disease was a prosthetic heart valve (233 procedures), followed by a previous history of infective endocarditis (22 procedures), cyanotic heart diseases (5 procedures) and systemic pulmonic venous shunts (2 procedures). Antibiotic prophylaxis was performed in 231 procedures (90.8%). Amoxicillin was the most common antibiotic used for prophylaxis (88.6%); however, the adequate dosage (2 gm) was administered in only 56% of these cases. Therefore, the appropriate prophylaxis, according to the AHA recommendations, was performed in only 14.1% (36 procedures). The mean duration of prophylaxis and number of antibiotic doses were 2.40 days (2.40+/-2.44) and 7.97 doses (7.97+/-7.18), respectively. A previous history of infective endocarditis (p=0.03) and dental extraction (p<0.01) resulted in a longer duration of prophylaxis. CONCLUSION: Only 14.1% of the high risk group procedures were given appropriate antibiotic prophylaxis according to the AHA recommendations. These data suggest that protocol-based education of both doctors and patients is required for appropriate antimicrobial therapy during high-risk procedures for the prevention of infective endocarditis in patients with high-risk heart disease.
American Heart Association ; Amoxicillin ; Antibiotic Prophylaxis ; Compliance ; Dental Records ; Education ; Endocarditis* ; Heart Diseases ; Heart Valves ; Hospitals, University ; Humans ; Korea ; Retrospective Studies

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.