PURPOSE: This study was conducted to obtain anatomical data useful for transacetabular screw fixation in total hip arthroplasty. MATERIAL AND METHODS: Using 67 hemipelvises of Korean adults cadaver, the variations of external iliac vessels and obturator neurovascular bundle were observed. Forty-nine pelvises were used for the study of vulnerable structures to transacetabular screw inserted through 8 points and 25 pelvises for measuring the thickness of articular cartilage, cortical bone and cancellous bone at each screw penetration site. RESULT: The lengths of S-pin inserted at the inferior, posterior and posteroinferior portion of the acetabulum were more than 20mm. The length of entire bone and thickness of cortical bone measured at the mid point of the posterosuperior portion were longest. The external iliac vessels showed variations in their spatial relationship. At anterosuperior portion, the bone and muscle layer were very thin. The cortical bone of articular side became thicker from center to periphery. The thickness of cortical bone in the pelvic cavity showed different values at different sites. CONCLUSION: The authors suggest that the structural varieties can be injured when inserting the fixation screw of acetabular cup, and the thickness of cortical and cancellous bone may be useful in total hip replacement.
Acetabulum* ; Adult ; Arthroplasty, Replacement, Hip* ; Cadaver ; Cartilage, Articular ; Humans ; Pelvis

BACKGROUND: The purposes of this study were to evaluate the effect of myocardial protection with our cold blood cardioplegic solution and to observe the relationship between ultrastructural study and other evaluation methods and its effectiveness. MATERIAL AND METHOD: We evaluated the changes of myocardial ultrastructure using semiquantitative scoring system, CK-MB fraction, SGOT and LDH1/LDH2, and EKG in 18 patients undergoing valvular heart surgery and coronary artery bypass grafting (CABG). Right atrial auricular biopsies were taken before the cardiopulmonary bypass (CPB) and shortly after the end of CPB. Myocardium-related serum enzymes & EKG were checked for 3 days of postoperative period and their postoperative peak enzyme value and observed new Q wave & ST segment elevation in EKG were choosen. RESULT: There were 8 males and 10 females, and their mean age was 55.6+/-13. Eight patients underwent valvular heart surgery and ten coronary artery bypass grafting. The mean CPB time was 119+/-29minutes and the mean aortic cross-clamp (ACC) time was 75.4+/-24 minutes. Before the start of CPB, the mean mitochondrial score was 1.28+/-0.53 and after the end of CPB, it significantly increased to 2.35+/-0.79. There was no evidence of perioperative myocardial infarction in terms of myocardiumrelated serum enzyme value and Q wave and ST change in EKG. There was no significant relationship between pre-CPB and post-CPB mitochondrial score and the mean time of CPB and ACC, and the mean value of postoperative peak CK-MB, SGOT and LDH1/LDH2, but there was relatively positive correlation of CPB time with peak LDH1/LDH2. CONCLUSION: Despite the apparent satisfactory results in myocardium-related serum enzymes & EKG, with this study using the cold blood cardioplegic solution, there were many changes in myocardial ultrastructures, and more studies are needed to obtain further information.
Aspartate Aminotransferases ; Biopsy ; Cardioplegic Solutions ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Electrocardiography ; Female ; Heart Arrest, Induced* ; Humans ; Male ; Mitochondria ; Myocardial Infarction ; Myocardium* ; Postoperative Period ; Thoracic Surgery*

PURPOSE: Refractory small-cell lung cancer (SCLC) has a poor prognosis, and current salvage chemotherapy for refractory SCLC, such as CAV (cyclophosphamide, adriamycin, vincristine) or topotecan, has an unsatisfactory outcome, with a response rate and overall survival of less than 10% and 6 months, respectively. This phase II study evaluated the role of topotecan combined with etoposide in SCLC patients that have progressed, or relapsed, within 3 months following completion of the initial chemotherapy. MATERIALS AND METHODS: Twenty-seven patients were entered into this study. Eligible patients had an ECOG performance status of less than, or equal to, 2, at least one bidimensionally measurable lesion and adequate end organ function. IV topotecan, 1.0 mg/m2/d for 5 consecutive days, and etoposide, 100 mg/m2/d through days 1 to 3, were administered every 3 weeks until disease progression or undue toxicity. RESULTS: The major toxicity was myelosuppression. Grade 3/4 anemia, granulocytopenia, and thrombocy-topenia occurred in 14.2, 34.8, and 27.3% of cycles, respectively. There was no treatment-related death, and other non-hematologic toxicities were generally mild. Four patients achieved partial responses, with a response rate RR of 14.8%. The progression-free survival PFS ranged from 1 to 7 months, with a median of 2.0 months (95% confidence interval 1.22~2.78 months). Twenty-five patients died, with a median overall survival of 5.5 months (ranging from 1 to 21 months, 95% CI 4.32~6.68 months), and the 6-month survival rate was 32.1% (95% confidence interval 14.4~49.8%). CONCLUSION: The combination of topotecan and etoposide chemotherapy showed a modest response rate, but failed to prolong survival of refractory SCLC patients compared to topotecan monotherapy.
Agranulocytosis ; Anemia ; Carcinoma, Small Cell ; Disease Progression ; Disease-Free Survival ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Etoposide* ; Humans ; Lung Neoplasms* ; Lung* ; Prognosis ; Survival Rate ; Topotecan*

PURPOSE: Although advances in technology have reduced the risk of ceramic implant fractures in total hip arthroplasty, these injuries do occur and their treatment remains challenging. There is a lack of studies reporting on the effectiveness of ceramic components in revision hip arthroplasty after ceramic bearing fracture. The aim of this study is to evaluate clinical and radiologic outcomes of revision surgery with ceramic-on-ceramic components after ceramic bearing fractures in young (i.e., under 60 years old) and active patients. MATERIALS AND METHODS: Eight patients who, from May 2004 to November 2011, underwent ceramic-on-ceramic revision surgery following a ceramic component fracture and had more than 6 years follow up were enrolled in this study. All eight patients were male with mean ages at first and revision surgeries of 39 years (range, 31–50 years) and 43.8 years (range, 33–60 years), respectively. There were 6 and 2 cases of ceramic liner and ceramic head fractures, respectively. The average time from the first operation to revision surgery was 54.3 months (range, 9–120 months), and the average follow up period was 9.7 years (range, 6–13.3 years). RESULTS: At the last follow up, all patients showed improvement in Harris hip score and pain relief and there were no cases of loosening or osteolysis. CONCLUSION: Revision total hip arthroplasty using ceramic-on-ceramic components after ceramic component fracture is a feasible and appropriate surgical option in young and active patients.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Ceramics ; Follow-Up Studies ; Head ; Hip ; Hip Prosthesis ; Humans ; Male ; Osteolysis

In this investigation, we made a study of the efficacy of luteolin (a flavonoid found in plants such as vegetables, herbs and fruits) on vascular contractibility and to elucidate the mechanism underlying the relaxation. Isometric contractions of denuded muscles were stored and combined with western blot analysis which was conducted to assess the phosphorylation of myosin phosphatase targeting subunit 1 (MYPT1) and phosphorylation-dependent inhibitory protein for myosin phosphatase (CPI-17) and to examine the effect of luteolin on the RhoA/ROCK/CPI-17 pathway. Luteolin significantly alleviated phorbol ester-, fluoride- and thromboxane mimetic-elicited contractions regardless of endothelial nitric oxide synthesis, implying its direct effect on smooth muscle. It also significantly alleviated the fluoride-elicited elevation in pCPI-17 and pMYPT1 levels and phorbol 12,13-dibutyrate-elicited in-crease in pERK1/2 level, suggesting depression of ROCK and PKC/MEK activity and ensuing phosphorylation of MYPT1, CPI-17 and ERK1/2. Taken together, these results suggest that luteolin-elicited relaxation includes myosin phosphatase reactivation and calcium desensitization, which seems to be arbitrated by CPI-17 dephosphorylation via ROCK/PKC inhibition.

PURPOSE: With the increased use of chemotherapy for non small cell lung cancer (NSCLC), a growing group of patients can now be considered for second-line chemotherapy. However, guidelines for the second line treatment remain to be developed. The objective of this study was to evaluate the efficacy and safety of the gemcitabine and vinorelbine combination therapy in patients with advanced NSCLC, pretreated with taxane and platinum based regimens. Gemcitabine has already demonstrated activity in this patient group, with the combination therapy having been reported to be well tolerated in previous phase I/II studies. MATERIALS AND METHODS: Forty two patients with advanced NSCLC (stages III/IV), having received prior taxane and platinum based chemotherapy, with an ECOG performance status (PS) 0~2, and unimpaired hematopoietic and organ function, were treated with vinorelbine, 20 mg/m2, followed by gemcitabine, 1, 000 mg/m2, both administered on days 1, 8 and 15, every 4 weeks. RESULTS: Out of the 42 patients enrolled, 41 were evaluable for their response, and all 42 for their toxicity. The patient's characteristics were as follows; median age=60 years (42~73), median PS=1 (range 0~2), a gender ratio 31: 11 males/females, with stages IIIA, IIIB and IV in 3, 14 and 25 cases. The objective responses included a partial response (PR) 8/41 (19.5%), a stable disease 15/41 (36.6%) and a progressive disease 18/41 (43.9%). The median time-to progression (TTP) and survival were 4 months, ranging from 2 to 14 months, and 8 months, ranging from 2 to 17+ months, respectively. Grade 3 neutropenia was seen in 19% of the patient, and there was no grade 4 neutropenia or episodes of febrile neutropenia. No grade 4 thrombocytopenia or other grade 3/4 non-hematological toxicities were observed. CONCLUSION: The combination of gemcitabine/vinorelbine is active and well tolerated in patients with advanced NSCLC having failed prior taxane/platinum therapy.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy* ; Febrile Neutropenia ; Humans ; Neutropenia ; Platinum ; Small Cell Lung Carcinoma ; Thrombocytopenia

OBJECTIVES: Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. METHODS: Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. RESULTS: Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p=0.021) after adjustment for residence, socioeconomic status, and morbidity. CONCLUSIONS: Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.
Adult ; Age Factors ; Aged ; Demography ; Fees, Medical ; Female ; Health Services Needs and Demand/*statistics & numerical data/utilization ; Humans ; Male ; Mental Disorders/psychology ; Mental Health/statistics & numerical data ; Middle Aged ; Motivation ; Sex Factors ; Socioeconomic Factors ; Suicide/economics/prevention & control/*statistics & numerical data ; Time Factors

PURPOSE: About 10 percent of patients with colorectal cancer develop pulmonary metastases, but selection of patients for resection of lung metastases is difficult problem. This study was performed to identify prognostic factors after resection of pulmonary metastases from colorectal cancer. METHODS: We reviewed retrospectively the clinical course of 64 patients who underwent surgical resection of primary colorectal cancer and metastatic lung disease at the Yonsei University College of Medicine between November 1994 and January 2005. We analyzed the prognostic factors with special reference of the clinicopathologic factors of primary tumors. Univariate and multivariate analyses of survival were used to identify significant prognostic factors. RESULTS: Overall five-year survival rate after resection of lung metastases was 38.4 %. The mean size of the largest metastatic nodules is 2.73 cm. The median interval between colorectal resection and lung resection (disease free interval) was 28.7 months. The disease free interval, number and size of the pulmonary metastases were not significant prognostic factor. The negative hilar lymph node metastasis, colon cancer rather than rectal cancer, normal serum CEA were significant prognostic factors in multivariate analysis. CONCLUSION: Pulmonary resection for metastases from colorectal cancer may help prolong survival in selected patients. In this study, we found that if patients had negative pulmonary hilar lymph node metastases, normal range of serum CEA, and colon cancer rather than rectal cancer, the prognosis preferable than others.
Colonic Neoplasms ; Colorectal Neoplasms* ; Humans ; Lung ; Lung Diseases ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis ; Rectal Neoplasms ; Reference Values ; Retrospective Studies ; Survival Rate

Wegener's granulomatosis (WG)is a multisystemic inflammatory disease characterized by necrotizing granulomatous inflammation and vasculitis of unknown etiology which classically affects the upper airway,lung,and kidney.Subglottic stenosis (SGS)is rare and occurs independently of other features of active WG. SGS can be a life-threatening manifestation of disease,and prompt diagnosis is essential.Since the presenting symptoms of SGS can be nonspecific,SGS should be considered in the differential diagnosis of any patient with WG who has increasing dyspnea,voice change,or cough.Although both surgical and medical treatments have been utilized,the optimal therapeutic approach to SGS in patients with WG has not been determined.So far,a case of WG with SGS has not been reported in Korea.Recently,we experienced a case of 59-year-old woman with SGS in WG.She responded to prednisolone and methotrexate therapy and did not require surgical intervention.So we report this case with a review of literatures.
Constriction, Pathologic* ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Inflammation ; Methotrexate ; Middle Aged ; Prednisolone ; Vasculitis ; Wegener Granulomatosis*

The most common anterior mediastinal tumors originate from the thymus. Among them, thymic carcinomas occur as an early local invasion and wide spread metastases. However, when squamous cell carcinoma in the thymus or mediastinum is identified, an occult primary lung cancer must be excluded because the histologic types resemble those found more typically in the lung. CD5 and cytokeratin immunohistochemical staining is useful in evaluating biopsy samples from those tumors. Spuamous cell carcinoma of an unknown primary origin in the mediastinum is a rare occurrence and there are only a handful of case reports. Here we describe a case with an anterior mediastinal mass of squamous cell carcinoma with unknown primary origin. A resection of the mediastinal mass without an association with the lung was performed. Immunohistochemical stainings were positive using cytokeratin 13, and negative using CD5 and cytokeratin 7. This was followed by chemotherapy for presured thymic carcinoma.
Biopsy ; Carcinoma, Squamous Cell* ; Drug Therapy ; Hand ; Keratin-13* ; Keratin-7* ; Keratins* ; Lung ; Lung Neoplasms ; Mediastinum ; Neoplasm Metastasis ; Thymoma ; Thymus Gland*