We treated 617 patients who were diagnosed as rotator cuff disease at the Department of Orthopaedic Surgery, Asan Medical Center in Korea between March, 1995 and December, 1996. We evaluated 175 cases who were followed up over five months and were treated according to our home treatment protocol. Average follow-up period was eleven months(range, five to eighteen months). We educated every patient who were not suspected of having full thickness tear of the rotator cuff based on clinical and MRI findings. According to patients condition, we treated them with both stretching and strengthening exercise or strengthening exercise only. This physician-directed home treatment was occasionally supported by the use of NSAID in case severe pain. Patients did stretching and strengthening exercise in 93(53%)cases, and strengthening exercise initially in 82(47%)cases. One hundred and forty five(83%) cases had satisfactory results. Home treatment of the rotator cuff disease is effective, convenient and not dangerous. We recommend this physiciandirected home treatment for primary management of almost all the patient with rotator cuff disease except full thickness tear of the rotator cuff tendon.
Chungcheongnam-do ; Clinical Protocols ; Follow-Up Studies ; Humans ; Korea ; Magnetic Resonance Imaging ; Rotator Cuff* ; Tendons

PURPOSE: Surgery is the treatment of choice for resectabel non-small cell lung cancer. For patients who are medically unable to tolerate a surgical resection or who refuse surgery, radiation therapy is an acceptable alternative. A retrospective analysis of patients with stage I non-small cell lung cancer treated with curative radiation therapy was performed to determine the results of curative radiation therapy and paterns of failure, and to identify factors that may influence survival. MATERIALS AND METHODS: From 1986 through 1993, 39 patients with T2N0M0 non-small cell lung cancer were treated with curative radiation therapy at department of radiation oncology, Kyungpook national university hospital All patients were not candidates for surgical resection because of either patient refusal (16 patients), poor pulmonary function (12 patients), old age (7 patients), poor performance (2 patients) or coexisting medical disease (2 patients). Median age of patients was 67 years. Histologic cell type was squamous cell carcinoma in 1. All patients were treated with megavoltage irradiation and radiation dose raged from 5000cGy to 6150 cGy with a median dose of 600cGy. The median follow-up was 17 months with a range of 4 to 82 months. Survival was measured from the date therapy initiated. RESULTS: The overall survival rate for entire patients was 40.6% at 2 years and 27.7% at 3years, with a median survival time of 21 months he disease-free survival at 2 and 3 years was 51.7% and 25.8%, respectively. Of evaluable 20 Patients with complete response, 15 Patients were considered to have failed. Of these, 13 patients showed local failure and 2 patients failed distantly. Response to treatment (p=0.0001), tumor size (p=0.0019) and age p=0.0247) were favorably associated with overall survival. Only age was predictive for disease-free survival (p=0.0452). CONCLUSION: Radiation therapy is an effective treatment for small (less than 3 cm) tumors, and should be offered as an alternative to surgery in elderly or infirm patients. Since local failure is the prominent patterns of relapse, potential methods to improve local control with radiation therapy are discussed.
Aged ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Disulfiram ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Radiation Oncology ; Rage ; Recurrence ; Retrospective Studies ; Survival Rate

OBJECTIVE: The purpose of this study was to assess the validity of CAGE (cut down, annoyed, guilty feeling, eye-opener) for older adults in community METHODS: Randomly selected alcohol drinking 182 older adults over 65 years of age in Incheon-Chungu participated in this study. We assessed alcohol use disorder by Korean Composite International Diagnostic Interview (K-CIDI) and interviewed by CAGE. The CAGE questionnaire is a brief alcohol screening questionnaire that can be interviewer or self-administered. Sensitivity, specificity, positive predictive value and receiver operating characteristics (ROC) curve for CAGE scores of 1-4 for older adults over 65 years of age was calculated. RESULTS: The mean age of 182 people was 71.3 (+/-5.2) years old and the number of male and female was 142 (78.0%) and 40 (22.0%) respectively. In 239 alcohol drinking older adults, 182 (76.2%) people answered in CAGE and CIDI. Among 182 people, 58 was Alcohol Use Disorder (AUD) and 124 was non-AUD. There was no age and educational differences between 182 people (case group) and 57 people (exclusion group). The sensitivity and specificity for a cut-off score of two was 72.5% and 85.5% respectively. The calculation of area under curve (AUC) by Receiver Operating Characteristics (ROC) was 0.806. CONCLUSION: The CAGE can easily discriminate older adults with alcohol use disorder from those without such a history. We suggest a score of '2' as the optimal cut-off score of CAGE.
Adult* ; Alcohol Drinking ; Area Under Curve ; Female ; Humans ; Male ; Mass Screening ; Surveys and Questionnaires ; ROC Curve ; Sensitivity and Specificity

BACKGROUND: Pemetrexed, a multi-targeted antifolate has been used as a second line treatment against non-small cell lung cancer (NSCLC). We aimed to clarify the efficacy and survival according to line of treatment, histologic type, and expression of thymidylate synthase (TS). METHODS: Ninety-eight patients were treated with pemetrexed as a second line treatment (n=43) or as an additional course of treatment (n=55). TS expression was studied with immunohistochemistry and graded as 0 to 3 based on the extent of expression. RESULTS: The response rate (RR) in 98 subjects was 10.2% and the disease control rate (DCR=PR+SD) was 30.6%. RR and DCR were 12.7% and 32.7% in non-squamous cell carcinoma (NSQC) compared to 7.0% and 27.9% in squamous cell carcinoma (SQC) (p>.05). No significant differences in RR and DCR were observed between a second line group (4.7%, 20.9%) and a further line group (14.5%, 38.2%). A similar trend was observed in the 88 response evaluable subjects. TS was expressed in 28.6% (grade 1), 24.5% (grade 2) and 7.1% (grade 3), respectively, and it was not expressed in 39.8% of subjects. TS expression rate was significantly higher in the SQC (72.1%) compared to NSQC (50.9%, p=0.033). However, the efficacy of pemetrexed was not significantly different by the extent of TS expression. CONCLUSION: Pemetrexed showed efficacy, not only in a second-line setting, but also in further lines of treatment for NSCLC. The efficacy of pemetrexed tended to be higher in patients with NSQC compared to SQC. TS expression rate was significantly higher in SQC compared to NSQC.
Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Glutamates ; Guanine ; Humans ; Immunohistochemistry ; Thymidylate Synthase ; Pemetrexed

PURPOSE: The purpose of this study is to evaluate the usefulness of MR imaging in the staging of brain abscesses and to determine the correlations between pathologic and MR findings. MATERIALS AND METHODS: Experimental brain abscesses were induced by direct inoculation of 1ml suspension of l06/ml Streptococcus pneumoniae into the brain parenchyma of ten New Zealand white rabbits. The evolution of abscess formation was divided into four stages, based on pathological criteria: early cerebritis (days 1 to 5), late cerebritis (days 6 to 10), early capsular (days 11 to 15), and late capsular (day 16 and later). The brain abscess of each animal was examined by MR imaging and light microscopy at 3, 8, 13, and 28 days; T1-weighted, T2-weighted and Gd-enhanced images were obtained. The MR images and pathologic findings of 13 pathologically confirmed clinical cases were compared to MR images of the experimental model. RESULTS: In the experimental model, signal intensity of the abscess content was at all stages hypointense on T1-weighted and hyperintense on T2-weighted images. In all ten cases, Gd-enhanced images showed an ill-defined contrast-enhanced lesion at the early cerebritis stage, and in four of seven cases, irregular ring enhancement at the late cerebritis stage. Pathologic specimens at this latter stage revealed prominent vascular proliferation and infiltration of chronic inflammatory cells. Signal intensity of the abscess wall during the capsular stage showed isointense relative brain parenchyma on T1-weighted images and this was hypointense on T2-weighted images. Gd-enhanced images demonstrated smooth ring enhancement of the abscess wall. At the early capsular stage, pathologic specimens revealed a discrete necrotic center surrounded by infiltration of reticulin and some collagen; at the late capsular stage, these specimens showed marked infiltration of collagen. In clinical cases, the signal intensity of abscess content was at all stages hypointenseon T1-weighted and hyperintense on T2-weighted images. Gd-enhanced images demonstrated ill-defined subtle contrast enhancement at the early cerebritis stage and irregular ring enhancement at the late cerebritis stage. In all cases, signal intensity of the abscess wall during the capsular stage was hypointense on T2-weighted images; at this stage, the abscess wall was showed a pattern of smooth ring enhancement. In clinical cases, hypointensity of the abscess wall, as seen on T2-weighted images, and the enhancement pattern of this wall were identical to these findings in the experimental model. CONCLUSION: In an experimental model, correlation between sequential MR findings can be used to predict the stage of a brain abscess; in clinical cases essential indicators are hypointensity and enhancement pattern of the abscess wall, as seen on T2-weighted images. In cases of brain abscess, MRI is a useful diagnostic modality, and in such cases, also helps determine the most suitable treatment.
Abscess ; Animals ; Brain Abscess* ; Brain* ; Collagen ; Magnetic Resonance Imaging* ; Microscopy ; Models, Theoretical* ; Rabbits ; Reticulin ; Streptococcus pneumoniae

The incidence of uterine myoma with cystic degeneration is 4% and symptomatic uterine myoma requires surgical management. We experienced a case of intraligamentary leiomyoma with huge cystic degeneration with its total weight 2526gm in 48 years old woman and brief review of the case and its literatures are presented.
Female ; Humans ; Incidence ; Leiomyoma* ; Middle Aged

Paclitaxel has been widely used for treating many solid tumors. Although colonic toxicity is an unusual complication of paclitaxel-based chemotherapy, the reported toxicities include pseudomembranous colitis, neutropenic enterocolitis and on rare occasions ischemic colitis. Genexol-PM(R), which is a recently developed cremophor-free, polymeric micelle-formulated paclitaxel, has shown a more potent antitumor effect because it can increase the usual dose of paclitaxel due to that Genexol-PM(R) does not include the toxic cremophor compound. We report here on a case of a 57-year-old man with advanced non-small cell lung cancer and who developed ischemic colitis after chemotherapy with Genexol-PM(R) and cisplatin. He complained of hematochezia with abdominal pain on the left lower quadrant. Colonoscopy revealed diffuse mucosal hemorrhage and edema from the sigmoid colon to the splenic flexure. After bowel rest, he recovered from his symptoms and the follow-up colonoscopic findings showed that the mucosa was healing. Since then, he was treated with pemetrexed monotherapy instead of a paclitaxel compound and platinum.
Abdominal Pain ; Carcinoma, Non-Small-Cell Lung ; Cisplatin ; Colitis, Ischemic ; Colon ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy ; Edema ; Enterocolitis, Neutropenic ; Enterocolitis, Pseudomembranous ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Glutamates ; Guanine ; Hemorrhage ; Humans ; Middle Aged ; Mucous Membrane ; Paclitaxel ; Platinum ; Polyethylene Glycols ; Polymers ; Pemetrexed

Severe hypoglycemia induces neuroglycopenic symptoms, including mental alteration, as glucose is the exclusive fuel for the central nervous system. However, some reports have shown that non-glucose fuels, like lactates and ketones, could be utilized by the brain during severe hypoglycemia. Herein, a case of extreme hypoglycemia in a 44-year old woman, subsequently diagnosed as congestive heart failure accompanied by ischemic hepatitis and lactic acidosis, is presented. In two episodes of extreme hypoglycemia, she was fully alert without obvious neurological deficits. In this unusual case, an increased supply of lactate might have maintained the cerebral function and prevented cerebral injury during the hypoglycemia that was induced as a result of starvation and hepatic and cardiac dysfunctions
Acidosis, Lactic* ; Adult ; Brain ; Central Nervous System ; Female ; Glucose ; Heart Failure ; Hepatitis ; Humans ; Hypoglycemia* ; Ketones ; Lactates ; Lactic Acid ; Masks* ; Starvation

Severe hypoglycemia induces neuroglycopenic symptoms, including mental alteration, as glucose is the exclusive fuel for the central nervous system. However, some reports have shown that non-glucose fuels, like lactates and ketones, could be utilized by the brain during severe hypoglycemia. Herein, a case of extreme hypoglycemia in a 44-year old woman, subsequently diagnosed as congestive heart failure accompanied by ischemic hepatitis and lactic acidosis, is presented. In two episodes of extreme hypoglycemia, she was fully alert without obvious neurological deficits. In this unusual case, an increased supply of lactate might have maintained the cerebral function and prevented cerebral injury during the hypoglycemia that was induced as a result of starvation and hepatic and cardiac dysfunctions
Acidosis, Lactic* ; Adult ; Brain ; Central Nervous System ; Female ; Glucose ; Heart Failure ; Hepatitis ; Humans ; Hypoglycemia* ; Ketones ; Lactates ; Lactic Acid ; Masks* ; Starvation

BACKGROUND: Radioiodine treatment is effective for the removal of remnant thyroid tissues after thyroidectomy in patients with differentiated thyroid carcinoma. To induce the elevation of serum TSH level which facilitates the uptake of radioiodine into remnants, a 4 to 6 week interval between thyroidectomy and radioiodine administration has been established. During the period of preparation, most patients have experienced overt symptoms of hypothyroidism which have led to the development of alternative strategies. Some reports have suggested that the interval could be reduced to about 3 weeks with less symptoms. We reevaluated the adequate time needed for the elevation of serum TSH level above 30microU/mL after thyroidectomy. METHODS: Forty five patients who had undergone total thyroidectomy for differentiated thyroid carcinoma were investigated. Serum TSH and free T4 levels were measured one or more times within 3 weeks after operation(total 97 blood samples). Eighty nine blood samples were obtained within 15 days. RESULTS: In 41 patients (91.1%) serum TSH levels increased to 30 microU/mL until 15 days after operation. Until postoperative 21 days, serum TSH levels in all the other patients reached 30microU/mL. In linear equation, the daily increment of serum TSH levels was 2.62microU/mL for the first 8 days after operation and 5.34micorU/mL for the next 7 days. The half-life of serum free T4 levels showed marked individual variations. CONCLUSION: Measurement of serum TSH level at about 15 days after total thyroidectomy for differentiated thyroid carcinoma may be useful in determining the time of radioiodine administration.
Half-Life ; Humans ; Hypothyroidism ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin