PURPOSE: Oxidative stress is the well known causative factor for retinal damage. This study investigated the effects of glutathione on reactive oxygen species(ROS) induced injury in human retinal pigment epithelial(HRPE) cells. OBJECTS AND METHODS: HRPE cells (ATCC:CRL-2302) were cultured with DMEM media and exposed to oxidative stress (paraquat, hydrogen peroxide) and/or glutathione modulator[(buthionine sulfoximine (BSO), glutathione (GSH), 2-oxo 4-thiazolidine carboxylic acid (OTC)] for 2 days. The cell viability was determined by measuring the amount of reduced 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT). RESULTS: The rate of MTT reduction of HRPE cells decreased by either paraquat or hydrogen peroxide treatment. BSO as a inhibitor of glutathione biosynthesis potentiated paraquat- or hydrogen peroxideinduced HRPE cells injury. On the other hand GSH or OTC reduced the rate of decrement of MTT reduction in HRPE cells by paraquat and hydrogen peroxide. CONCLUSIONS: Glutathione seemed to play some role in prevention of ROS-induced HRPE cells injury and OTC may be used as an agents for prevention of free radical induced HRPE cell injury.
Cell Survival ; Epithelial Cells* ; Glutathione* ; Hand ; Humans* ; Hydrogen ; Hydrogen Peroxide ; Oxidative Stress ; Oxygen* ; Paraquat ; Retinaldehyde*

OBJECTIVE: To compare the short-term effects and advantages of transforaminal epidural steroid injection (TFESI) performed using the conventional (CL) and posterolateral (PL) approaches. METHOD: Fifty patients with lumbar radicular pain from lumbar spinal stenosis and herniated lumbar disc were enrolled. Subjects were randomly assigned to one of two groups (CL or PL group). All procedures were performed using a C-arm (KMC 950, KOMED, Kwangju, Kyunggi, Korea). We compared the frequency of complications during the procedure and the effects of the pain block between the two groups at 2, 4, and 12 weeks after the procedure. RESULTS: There were no significant differences in the demographic data, initial VNS (Visual numeric scale), or ODI (Oswestry disability index) between the CL group (n=26) and the PL group (n=24). There was no statistically significant difference in the outcome measures (VNS and ODI) between the groups at 2, 4, or 12 weeks. Symptoms of nerve root irritation occurred in 1 case of the CL group and in 7 cases of the PL group (p<0.05). Pricking of spinal nerve during the procedure and transient weakness after the procedure occurred in 6 cases and 3 cases, respectively in the CL group, but did not occur in the PL group. CONCLUSION: Our findings suggest that the posterolateral approach represents an alternative TFESI method in cases with difficult needle tip positioning in the anterior epidural space, and could lower the risk of target nerve root irritation and nerve penetration.
Epidural Space ; Humans ; Needles ; Outcome Assessment (Health Care) ; Spinal Nerves ; Spinal Stenosis

The purpose of this study was to investigate the arthro-sonographic appearance of the chronic anterior talofibular ligament (ATFL) injury. Twenty-nine patient, who were identified to have partial or complete ATFL tears by conventional ultrasonography were included. Intraarticular injection of 5 mL of fluid (2.5 cc lidocaine+2.5 saline) was performed under ultrasound-guidance, which was followed by arthrosonography. Among 23 patients with partial tear which was detected by the conventional ultrasonography, 11 patients were identified to have complete tear by the arthrosonography. Among 6 patients with complete tear was detected by conventional ultrasonography, all of them identified to have complete tear by the arthrosonography. Arthrosonography is helpful in evaluation the configuration of ATFL complete tear and detecting complete tear by making them appear larger and apparent after instillation of fluid.
Humans ; Injections, Intra-Articular ; Ligaments

A 36-year-old female amateur cyclist developed mononeuropathy of the deep branch of the ulnar nerve due to nerve compression adjacent to the ulnar tunnel (type II Guyon’s canal syndrome) caused by prolonged bicycle riding.The patient’s signs and symptoms persisted even after refraining from cycling for 4 weeks; thus, she underwent decompression of the deep branch of the ulnar nerve in the palm and wrist. Three months postoperation, she recovered nearly full power and function of her left hand.

PURPOSE: We analyzed the survival and failure patterns of cervix cancer patients treated with irradiation alone to evaluate our treatment method and to compare with the others. METHODS AND MATERIALS: Two hundred and twenty cervical cancer patients, Stage IB, IIA, and IIB who completed the planned treatment between May 1987 and December 1991 were analyzed retrospectively. The Stage IB patients were restaged to the Stage IB1 and IB2 by the recently revised FIGO classification. Patients were treated with a combination of external irradiation and the intracavitary brachytherapy. Determination of the tumor control was done at the time of 6 months postirradiation. The follow-up time was ranged from 3 to 115 months and the mean was 62 months and the follow-up rate was 93.6%(206/220). RESULTS: The overall 5-year survival rate of Stage IB1(N=50), IB2(N=15), IIA(N=58), and IIB(N=97) was 94%, 87%, 69%, and 56%, respectively. In the univariate analysis of prognostic factors,stage(0.00), initial Hg level (p=0.00), initial TA-4(tumor-associated) antigen level(p=0.02), initial CEA level(p=0.02), barrel-shaped tumor(p=0.02), whole cervical involvement (0.00), pelvic lymphadenopathy(LAP) in CT(p=0.04), and post-irradiation adjuvant chemotherapy(p=0.00) were statistically significant in survival analysis. In a while, multivariate analysis showed that the stage was the most powerful prognostic indicator and the post-irradiation chemotherapy factor also showed the statistical significance. The overall local control rate was 81% and by the stage, 100% in Stage IB1, 86.7% in Stage IB2, 84.5% in Stage IIA, and 68.1% in Stage IIB, respectively. The overall tumor recurrence rate was 15.5%(27/174) and by the stage, 8%(4/50) in Stage IB1, 0%(0/13) in Stage IB2, 22.4%(11/49) in Stage IIA, and 19.4%(12/62) in Stage IIB, respectively. CONCLUSIONS: We obtained the similar treatment results to the other's ones in early stage cervical cancer patients. But in Stage IIB, the local control rate was lower than that of the other institutes and also the survival was poorer. So it seems to be necessary to reevaluate the treatment method in advanced cervical cancer patients.
Academies and Institutes ; Brachytherapy ; Cervix Uteri* ; Classification ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms

PURPOSE: Central compartment reoperation for recurrent thyroid carcinoma is challenging to surgeons due to the scar tissues and adhesions and the distortion of the normal anatomic relationships. This study was carried out to investigate the central neck recurrence patterns and the surgical morbidity of reoperation for patients with papillary thyroid carcinoma. METHODS: The study population was comprised 68 papillary thyroid carcinoma patients (15 males and 53 females, median age: 50.8 years [range: 12~78 years]) who underwent reoperation for recurrent tumors in the central compartment of the neck between January 1999 and June 2007. All of the patients had undergone prior total thyroidectomy. RESULTS: Of the 68 patients, 21 recurrences occurred in the proper thyroid tissue of the thyroid bed, 43 in the central neck nodes and 4 in a combination of the central nodes and proper thyroid tissue. The common recurrent site from the proper thyroid tissue were at the berry ligaments and at the level of the upper one-third of the recurrent laryngeal nerves, while the common nodal recurrence sites were the lower-most portion of the paratracheal nodes and the right paraesophageal nodes (the lymph nodes posterior to the right recurrent laryngeal nerve). Eleven cases of transient hypocalcemia (17.5%, 11/63) and 3 cases of permanent hypocalcemia (4.3%, 3/63) were noted after reoperation. Recurrent laryngeal nerve injury occurred in 5 patients (8.1%, 5/62), but three of them were intentionally resected with the recurrent cancers. CONCLUSION: Reoperation for central neck recurrence of papillary thyroid carcinoma is associated with a higher complication rate. Meticulous surgical dissection of the central compartment based on the recurrent patterns is important to reduce injury to the recurrent laryngeal nerves and parathyroid glands.
Carcinoma ; Cicatrix ; Female ; Fruit ; Humans ; Hypocalcemia ; Intention ; Ligaments ; Lymph Nodes ; Male ; Neck ; Recurrence ; Recurrent Laryngeal Nerve ; Recurrent Laryngeal Nerve Injuries ; Reoperation ; Thyroid Gland ; Thyroid Neoplasms

PURPOSE: The clinical importance of papillary microcarcinoma (PTMC) is debatable. Because PTMC is being diagnosed with increasing frequency, it is important to describe the clinical and histological characteristics that confer aggressive behavior to this cancer. This study was carried out to evaluate the clinical and histological characteristics of PTMC and to determine an appropriate treatment strategy for such cases. METHODS: From Jan. 2000 to Dec. 2005, 1,255 patients with small papillary carcinoma, which measured less than 2.0 cm in its greater dimension, underwent total thyroidectomy at our institution. Among these patients, 633 (50.4%) had a thyorid carcinoma less than or equal to 1 cm in diameter (Group A). The clinicopathologic features and treatment outcome of these patients were evaluated and compared with the remaining 622 cases (49.6%) (Group B). RESULTS: For the patients with PTMC (Group A), there were 70 men and 563 women with a median age of 44 years (range; 12~86). During a mean follow-up of 32.5+/-18.2 months, 6 patients (0.9%) developed locoregional recurrences and 3 patients (0.5%) showed distant metastases. There was no disease-related mortality in both groups. The disease of group B was more likely to show extracapsular invasion (P < 0.001), invasion to adjacent structures (P < 0.001), and lateral neck node metastasis (P < 0.001) than that of group A. However, there were no significant differences in multifocality (P=0.189), bilaterality (P=0.203), the locoregional recurrence rate (P=0.065) and the distant meta-stasis rate (P=0.325) between the two groups. On multivariate analysis, locoregional recurrent disease was associated with central lymph node metastases (P=0.033) and lateral neck node metastases (P=0.022). CONCLUSION: Despite PTMC having less aggressive clinicopathologic parameters as compared with clinical cancer (>1 cm), some PTMCs show aggressive clinical behavior and locoregional recurrence. The treatment of PTMC should be individualized based on its tumor risk profiles and the clinical presentations. Moreover, performing close follow-up is essential, especially for those patients who present with cervicolateral lymph node metastases.
Carcinoma, Papillary ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Mortality ; Multivariate Analysis ; Neck ; Neoplasm Metastasis ; Recurrence ; Thyroid Gland* ; Thyroidectomy ; Treatment Outcome

PURPOSE: There is a long-standing debate about whether postoperative adhesive small bowel obstruction (SBO) is best managed operatively or nonoperatively. The aim of this study is to define predictive factors for surgical indication in the treatment of an adhesive SBO. METHODS: Medical records and laboratory data of 211 patients who had a SBO after a laparotomy from January 2000 to December 2008 were reviewed retrospectively. The patients were divided into two groups according to the modality of SBO treatment: operatively and nonoperatively. The laboratory data and clinical parameters were compared between the two groups and a statistical analysis was performed. RESULTS: A Mann-Whitney analysis revealed previous SBO history, amylase, erythrocyte sedimentation rate (ESR), creatine phosphokinase, drainage amount via a Levin tube to be significant factors associated with surgical management. A multivariate analysis showed drainage amount via a Levin tube of 500 mL/day or greater (P=0.007), amylase of 90 IU/L or greater (P=0.04), and ESR of 11 mm/hr or greater (P=0.03) to be independent predictive factors for surgery. CONCLUSION: Surgical management should be considered among adhesive SBO patients with elevated amylase (> or =90 IU/L) and ESR (> or =11 mm/hr) and with large drainage amount through the Levin tube (> or =500 mL/day).
Adhesives ; Amylases ; Blood Sedimentation ; Creatine Kinase ; Drainage ; Humans ; Laparotomy ; Medical Records ; Multivariate Analysis ; Retrospective Studies

PURPOSE: In response to a growing threat of violence in hospitals, we examined a specific educational effort to reduce emergency department (ED) violence in the shortterm. METHODS: Cross-sectional prospective surveys were conducted at Chosun University Hospital Emergency Center during a baseline period from May 26 to Jul. 9. 2003, and during a post-education period from Aug. 7 to Sep. 20. 2003. Questions addressed the degree of violence, the reason for the violence, demographic information about the perpetrator of the violence, the outbreak time of the violence and the response of emergency personnel. RESULTS: After an education program on violence, the rate of violent events in the ED was decreased by 23.5%. A notable change was that ED workers handled the violence more positively during the post-education period by isolating or restraining the aggressor. Almost all of the violence was caused by males, particularly those in their third or fourth decade. The violence occurred mostly on the night shift. Of the violence, 52.4% was caused by the patient while 34.8% was caused by the patient's guardian. The leading causes of violence were drunkenness and delays in laboratory tests and treatment. Verbal abuse and threats were the most concern forms of violence. CONCLUSION: Violent events are frequent in the ED. Education programs may reduce the number of events at least temporarily.
Alcoholic Intoxication ; Education* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Male ; Prospective Studies ; Violence*

OBJECTIVE: To compare the short-term effect and advantage of transforaminal epidural steroid injection (TFESI) performed using the Kambin's triangle and subpedicular approaches. METHOD: Forty-two patients with radicular pain from lumbar spinal stenosis were enrolled. Subjects were randomly assigned to one of two groups. All procedures were performed using C-arm KMC 950. The frequency of complications during the procedure and the effect of TFESI at 2 and 4 weeks after the procedure between the two groups were compared. Short-term outcomes were measured using a visual numeric scale (VNS) and a five-grade scale. Multiple logistic regression analyses were performed to evaluate the relationship between possible outcome predictors (Kambin's triangle or subpedicular approach, age, duration of symptoms and sex) and the therapeutic effect. RESULTS: VNS was improved 2 weeks after the injection and continued to improve until 4 weeks in both groups. There were no statistical differences in changes of VNS, effectiveness and contrast spread pattern between these two groups. No correlation was found between the other variables tested and therapeutic effect. Spinal nerve pricking occurred in five cases of the subpedicular and in none of the cases of the Kambin's triangle approach (p<0.05). CONCLUSION: The Kambin's triangle approach is as efficacious as the subpedicular approach for short-term effect and offers considerable advantages (i.e., less spinal nerve pricking during procedure). The Kambin's triangle approach maybe an alternative method for transforaminal epidural steroid injection in cases where needle tip positioning in the anterior epidural space is difficult.
Constriction, Pathologic ; Epidural Space ; Humans ; Imidazoles ; Injections, Epidural ; Logistic Models ; Needles ; Nitro Compounds ; Spinal Nerves ; Spinal Stenosis