Limb salvage operations for osteosarcoma of the extremity usually consist of wide excision and skeletal reconstruction. Most osteosarcoma patients are anemic prior to the surgery as majority of them undergo preoperative neo-adjuvant chemotherapy; thus, it is necessary to treat anemia before and after the surgery since limb salvage operation tends to accompany significant blood loss. Despite the fact that blood transfusion has bad influence on prognosis, complication, and postoperative outcome of cancer patients, it is still considered as a standard management to fix anemia for limb salvage operations. We would like to present a case report in which the authors succeeded in performing limb salvage operations on patients with distal femur osteosarcoma without transfusion.
Anemia ; Blood Transfusion* ; Drug Therapy ; Extremities ; Femur* ; Humans ; Limb Salvage* ; Osteosarcoma* ; Prognosis

BACKGROUND: The increasing implementation of organ transplantation requires an unequivocal diagnosis of brain death for moral and legal reasons. Among instrumental investigations, angiographic demonstration of absent intracranial blood flow is considered to be the most reliable test in diagnosing brain death. This test should be easily accessible since most brain dead patients are vitally unstable and have various life-supporting equipments besides their beds. To investigate the usefulness of an intracranial CT angiography (CTA) for the diagnosis of brain death, we performed CTA in comatose patients who were either clinically brain dead or not. METHODS: Fourteen comatose patients (11 male and 3 female, aged from 17 to 63 years) with various brain insults were included in this study. Eleven patients were clinically brain dead. Among the remaining three patients, one showed subtle withdrawal movements in one extremity to noxious stimuli with absent brainstem reflexes, and the other two showed multifocal myoclonic seizures. CT scanning was performed with a table speed of 2 mm/sec, twenty seconds after beginning an injection of contrast media. The data were reformatted by maximum intensity projection (MIP) and shaded surface display (SSD) after the reconstruction of a 1 mm interval. A portable electroencephalography (EEG) was also taken serially in clinically brain dead patients except one. RESULTS: Intracranial arterial blood flow was preserved in those who showed either a seizure, abnormal posture or intact brainstem reflexes. On the other hand, intracranial arteries were not visualized in all brain dead patients with electrocerebral silence (ECS) on their EEG with the exception of one patient whose EEG was difficult to determine a ECS due to excessive mechanical artifacts. However, in the clinically brain dead patients, the intracranial arterial flow was preserved in those who suffered from widespread brainstem and cerebellar infarction or whose EEG demonstrated periodic lateralizing epileptiform discharges or a burst suppression pattern. CONCLUSIONS: Intracranial CTA seems to be a safe and noninvasive procedure for the determination of brain death that produces fast, reliable, and easy-to-interpret results. It can be used as an alternative method to the EEG when the EEG is not possible or difficult to interpret due to artifacts.
Angiography* ; Arteries ; Artifacts ; Brain Death* ; Brain Stem ; Brain* ; Coma ; Contrast Media ; Diagnosis ; Electroencephalography ; Extremities ; Female ; Hand ; Humans ; Infarction ; Male ; Organ Transplantation ; Posture ; Reflex ; Seizures ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Transplants

BACKGROUND: Cyclosporin A (CsA), a potent immunosuppressant, has been reported to be effective in the treatment of severe atopic dermatitis (AD). OBJECTIVE: The aim of this study was to evaluate the efficacy and side-effects of CsA in Korean patients with severe AD. MATERIALS AND METHODS: 16 patients with recalcitrant AD took CsA for at least 6 weeks. Among them, 11 patients were followed up for more than 16 weeks. Initial dose was 5mg/kg/day (maximum 300 mg/day) and the dose was reduced according to their therapeutic responses. SCORAD (Scoring AD) was used to evaluate clinical efficacy of CsA. During the 1st month of therapy, the therapeutic efficacy and side-effects were evaluated every 2weeks and after 1 month, every month. We checked blood pressure and laboratory abnormalities including liver function test, blood urea nitrogen (BUN), creatinine (Cr) and urinalysis at each visit in addition to observing clinical adverse effects. RESULTS: Significant reduction of SCORAD was noted in 15 patients after 6 weeks of CsA therapy. Only one patient stopped CsA therapy because of the elevation of blood pressure. Three patients showed albuminuria, which disappeared after CsA dose reduction. CONCLUSION: CsA can be used effectively and safely in severe Korean AD patients. Albuminuria seems to be a peculiar side-effect in Korean patients.
Albuminuria ; Blood Pressure ; Blood Urea Nitrogen ; Creatinine ; Cyclosporine* ; Dermatitis, Atopic* ; Humans ; Liver Function Tests ; Urinalysis

Nuclear DNA content of 32 cases of prostate adenocarcinoma diagnosed 1986-1991 was determined by flow cytometry, with the use of paraffin-embedded archival tissue. The present study was done to define the relationship between clinical stage, histopathological grade, and DNA ploidy. Aneuploidy was found in 10(31.3%) cases including 7 cases of near-tetraploidy. Among diploid tumors, 36.4% were localized disease(stage A and B), 13.6% were characterized by invasion outside the prostate(stage C), and 50.0% showed distant metastasis(stage D). Among aneuploid tumors, 10.0% were stage B, 50.0% stage C, and 40.0% stage D. The degree of glandular differentiation was characterized by the Gleason score and the percentage of sampled tissue involved by carcinoma was graded by Dhom's method. Apparent correlation was found between Gleason grade and Dhom grade(P<0.05). All 13 tumors with a Gleason grade I(score of 2 to 5) were diploid. Four of 9 tumors with a Gleason grade II(score of 6 to 7) were aneuploid(near-tetraploidy 33.3%, aneuploidy 11.1%) and 60.0%, of tumors with a Gleason grade III(score of 8 to 10) were aneuploid(near-tetraploidy 40.0%, aneuploidy 20%). The percentage of aneuploid cases increased with advanced clinical stage, but the relationship between aneuploidy versus clinical stage was not significant. However, it can be concluded that DNA ploidy correlates well with Gleason grade(p<0.05), which may have predictive prognostic value for prostate adeno-carcinomas.
Adenocarcinoma

OBJECTIVES: The myelodysplastic syndromes (MDS) are a group of acquired clonal hematopoietic disorders characterized by peripheral cytopenias and a hypercellular or normocellular dysplastic bone marrow. The mechanisms responsible for development of MDS are not known. We performed this study to evaluate the hematopoietic abnormalities and apoptosis in MDS. METHODS: Long-term bone marrow culture (LTBMC) was performed for colony assays, cobblestone area assay, stromal morphologic changes from 7 patients with MDS and 7 normal controls. In situ nick end labeling (ISNEL) method was performed for detection of apoptosis from LTBMC in 7 patients with MDS and 7 normal controls. ISNEL method also performed in bone marrow cell bloc samples in 36 patients with MI3S. RESULTS: Viability of nonadherent cells from LTBMC of patients with MDS was not decreased compared with normal controls at 1 week, but significantly decreased at 2 and 3 weeks compared with normal controls (P<0.0001). Formation of the cobblestone areas from patients with MDS was slightly decreased compared with normal controls at 1st week, but significantly decreased at 2nd and 3rd weeks compared with normal controls (P<0.0001). Slightly decreased compared with normal controls at 1 week, but significantly decreased at 2 and 3 weeks compared with normal controls (P<0.0001). Stromal layers produced in LTBMC of normal controls and 1 patient with MDS were detected at 1 week and were formed confluent stroma from 3 weeks, but another patients with MDS who did not form a confluent stroma. Patients with MDS had significantly lower colony forming unit granulocyte-macrophage (CFU-GM) compared with normal controls at 1 (P<0.01) and 2 weeks (P<0.001) of LTBMC. Two weeks of LTBMC resulted more profound inhibition of CFU-GM formation than 1 week (P<0.0001). Apoptotic cell death was absent in adherent and non adherent cells from normal controls at 1 and 2 weeks, but massive apoptotic cell death was found in adherent and non adherent cells from patients with MDS at 1 and 2 weeks and the degree of apoptosis was profound at 2 weeks compared with 1 week. Among the 36 patients, fifteen patients demonstrated varying degrees of apoptosis positive cells, 4 having low, 8 intermediates, and 3 high scores. Remaining 21 patients showed absent apoptosis or only occasional positive cells. CONCLUSION: Hematopoietic abnormalities such as a failure of differentiation are caused by the stromal defects and the biologic basis of the apparent paradox of peripheral cytopenias in the face of hypercellular (or normocellular) marrow is related by intramedullary apoptotic cell death of the stromal and hematopoietic cells.
Apoptosis* ; Bone Marrow Cells ; Bone Marrow* ; Cell Death ; Granulocyte-Macrophage Progenitor Cells ; Humans ; In Situ Nick-End Labeling* ; Myelodysplastic Syndromes* ; Stem Cells

No abstract available.
Anemia, Iron-Deficiency* ; Erythropoietin* ; Iron* ; Tumor Necrosis Factor-alpha*

PURPOSE: Urinary tract infection (UTI) in children is the most common disease during the infantile period, therefore early diagnosis and treatment are important. Pyuria is a useful clinical parameter for the initial diagnosis of a UTI. In this study we aimed to compare the clinical, laboratory, and imaging findings in relation to the duration of pyuria in infants with UTIs. METHODS: Three hundred seventy-four infants <12 months of age who were admitted between January 1995 and December 2005 for the first episode of a febrile UTI were retrospectively reviewed. Patients were divided into two groups according to the duration of pyuria as follows: group 1, pyuria resolved <3 days after initial treatment; and group 2, pyuria lasted at least 3 days after initial treatment. RESULTS: There were no significant differences between the two groups in relation to gender, age, total duration of fever, and organisms in the urine. Group 2 had a significantly higher peripheral blood leukocyte count (14,360.86+/-5,526.16 cells/mm3 vs. 11,822.55+/-5,687.26 cells/mm3, P<0.001), erythrocyte sedimentation rate (32.81+/-19.34 mm/hr vs. 23.74+/-20.43 mm/hr, P<0.001), and C-reactive protein (6.84+/-5.68 mg/dL vs. 3.78+/-3.99 mg/dL, P<0.001) than group 1. There was a significantly higher incidence of hydronephrosis and a higher grade of vesicoureteral reflux (VUR) in group 2 compared to group 1. CONCLUSION: In infants with UTI, pyuria of longer duration is related to severe UTI and higher grade VUR, therefore aggressive radiologic studies may be necessary.
Blood Sedimentation ; C-Reactive Protein ; Child ; Early Diagnosis ; Fever ; Humans ; Hydronephrosis ; Incidence ; Infant ; Leukocyte Count ; Pyuria ; Retrospective Studies ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux

The trematode Paramphistomum cervi empolyed in this experiment was obtained from the reticulum of cattle slaughtered at the local abbatoir. The worms were selected and washed several times in normal sterilized saline solution. Each about ten of intact worms were incubated in 50 cc volume of special incubation flasks with incubation mixture consisting of 50 cc of Krebs-Ringer phosohate buffer (pH 7.4) to which were added universally labeled C(14)-glucose and non-radioactive carrier glucose concentration of 200 mg per cent. The worms were allowed to incubate for 3 hours in the incubator at 38 C. After incubation period, respiratory CO(2) samples from central wall of incubation flask were analysed for total CO(2) production rate and their specific activity of respiratory CO(2). Glycogen samples isolated from worms were analysed for the tissue concentration and their radioactivities in order to determine the turnover rate of glycogen pool. The glucose uptake rate was determined by analysing the difference of the glucose concentration in a medium before and after incubation period. Radioactivities of these series of experiments were counted by an endwindow Geiger-Muller counter as an infinitely thin samples. The quantitative analysis of C(14)-glucose utilized by Paramphistomum cervi was summerized as the following. The glucose uptake rate by Paramphistomum was a mean value of 2.32+/-0.27 micro-mole/hr/g of wet wt. and total CO(2) production rate by the worms averaged 10.85+/-0.41 micro-mole/hr/g of wet wt. The relative specific activities of respiratory CO(2) averaged 49.72+/-13.20 per cent. Thus, a mean of 49.72 per cent of total CO(2) production rate was originated from the glucose in the medium, therefore the rate of CO(2) production derived from medium glucose was mean of 5.24+/-2.16 micro-mole/hr/g of wet wt. Thus, the average value of 37.46+/-5.28 per cent of glucose utilized by the worms from the medium glucose was oxidized to respiratory CO(2). The tissue concentration of Paraphismum was a mean of 41.56+/-5.82 micro-mole/hr/g of wet wt or 4.16+/-0.72 per cent/g , and the turnover rate of glycogen pool yielded with a mean of 0.12+/-0.014 percent/hr or 0.06+/-0.04 mg/hr/g of wet wt. Therefore, a mean value of 16.75+/-4.84 per cent of glucose was incorporated to the glycogen. These data account for that at least 54.21 per cent of the utilized glucose by the worms participated in furnishing the oxidation into respiratory CO(2) and the synthetic process into glycogen. According to the above data of the experiment, it is suggested in the metabolic process of glucose by the Paramphistomum that the synthetic process into the glycogen is less active than the oxidative process into the resppiratory CO(2).
parasitology-helminth-trematoda ; Paramphistomum cervi ; autoradiography ; biochemistry ; glucose ; metabolism ; CO(2) ; glycogen

No abstract available.
Animals ; Killer Cells, Natural* ; Mice*

Medical record of 66 eyes which had undergone pars plana vitrectomy for the treatment of proliferative diabetic retinopathy were reviewed to study their clinical features, incidences and types of complications, visual outcome, and visual prognostic factors. The final visual outcome showed the improvement in 50[76%] eyes, no change in 13[20%]eyes, and the worsening in 3[4%] eyes. Preoperative prognostic factors favoring final visual acuity included the followings:1]insulin dependent diabetes mellitus which developed before 30 years of age, 2]absence of iris neovascularization, 3]absence of tractional macular detachment. Postoperative complications included vitreous hemorrhage in 34[52%]eyes, cataract in 12[19%]eyes, increased intraocular pressure in 6[10%]eyes, rhegmatogenous retinal detachment in 4[6%]eyes, choroidal effusion in 3[5%]eyes, corneal epithelial defect in 2[3%]eyes, neovascular glaucoma in 1[2%] eye. Postoperative complications associated with poor visual outcome were rhegmatogenous retinal detachment and neovascular glaucoma.Intraoperative complication of iatrogenic retinal tear did not seem to deteriorate the final visual acuity.
Cataract ; Choroid ; Diabetes Mellitus ; Diabetic Retinopathy* ; Glaucoma, Neovascular ; Incidence ; Intraocular Pressure ; Iris ; Medical Records ; Postoperative Complications ; Retinal Detachment ; Retinal Perforations ; Traction ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage