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

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.

Extracorporeal shock wave lithotripsy (ESWL) has been established as the first line procedure of urinary stone treatment. To evaluate clinical efficacy and to identify the criteria of proper patient selection tempered by understanding of the limitations of the ESWL therapy available. We reviewed 2500 patients with urinary stone treated by ESWL using the Northgate SD-3 lithotriptor between June, 1989 and May, 1995. The results were obtained as follows: 1. The total average success rate of treatment was 92.6%. 2. The success rate according to stone locations were 88% in kidney (1074/1214 cases), 93.5% in ureter(1275/1323 cases) and 92.7% in bladder (38/41 cases). 3. The success rate according to stone size measured on the KUB film were 98.0% below 10mm, 91.0% in 11 - 20mm, 80.0% in 21 - 30mm and 68.7% over 31mm. 4. The average numbers of treatment were 2.3 sessions and the mean number of shock per treatment were 1940 +- 230. 5. Of the 2578 cases, 2178(84.5%) were treated by ESWL monotherapy. For auxiliary procedure, Double-J stents were placed in 64 cases and nephrostomy in 49 cases. Stone manipulation including push back, Dormia basket, Ureteroscopy were performed in 161 cases. We conclude that as a highly effective and minimally invasive treatment modality, ESWL has become to be the therapy of choice in 85.5% of urinary stones. When ESWL therapy is less effective for stone size larger than 3 cm(68.7%), staghorn calculi (65.5%) and presence of anatomical barriers, the additional endourologic procedures need to be indicated.
Calculi ; Humans ; Kidney ; Lithotripsy* ; Patient Selection ; Shock* ; Stents ; Ureteroscopy ; Urinary Bladder ; Urinary Calculi*

Extracorporeal shock wave lithotripsy (ESWL) has been established as the first line procedure of urinary stone treatment. To evaluate clinical efficacy and to identify the criteria of proper patient selection tempered by understanding of the limitations of the ESWL therapy available. We reviewed 2500 patients with urinary stone treated by ESWL using the Northgate SD-3 lithotriptor between June, 1989 and May, 1995. The results were obtained as follows: 1. The total average success rate of treatment was 92.6%. 2. The success rate according to stone locations were 88% in kidney (1074/1214 cases), 93.5% in ureter(1275/1323 cases) and 92.7% in bladder (38/41 cases). 3. The success rate according to stone size measured on the KUB film were 98.0% below 10mm, 91.0% in 11 - 20mm, 80.0% in 21 - 30mm and 68.7% over 31mm. 4. The average numbers of treatment were 2.3 sessions and the mean number of shock per treatment were 1940 +- 230. 5. Of the 2578 cases, 2178(84.5%) were treated by ESWL monotherapy. For auxiliary procedure, Double-J stents were placed in 64 cases and nephrostomy in 49 cases. Stone manipulation including push back, Dormia basket, Ureteroscopy were performed in 161 cases. We conclude that as a highly effective and minimally invasive treatment modality, ESWL has become to be the therapy of choice in 85.5% of urinary stones. When ESWL therapy is less effective for stone size larger than 3 cm(68.7%), staghorn calculi (65.5%) and presence of anatomical barriers, the additional endourologic procedures need to be indicated.
Calculi ; Humans ; Kidney ; Lithotripsy* ; Patient Selection ; Shock* ; Stents ; Ureteroscopy ; Urinary Bladder ; Urinary Calculi*

Vaginal clear cell adenocarcinoma is a very rare malignant disease and it has been known to be associated with in utero exposure to DES. We expreienced a case of clear cell adenocarcinoma of the cagina in 40 years ole woman, and present the case with a brief review of related literatures.
Adenocarcinoma, Clear Cell* ; Female ; Humans ; Vagina*

Vaginal clear cell adenocarcinoma is a very rare malignant disease and it has been known to be associated with in utero exposure to DES. We expreienced a case of clear cell adenocarcinoma of the cagina in 40 years ole woman, and present the case with a brief review of related literatures.
Adenocarcinoma, Clear Cell* ; Female ; Humans ; Vagina*

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

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

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