The assessment of patient status in palliative medicine is essential for determining treatments and for clinical outcomes. The objective of assessment tools is to raise the quality of care for individual patients and their families. There are a number of tools available to assess pain, non-pain symptoms and quality of life. The tools are either uni-dimensional or multi-dimensional measures. Unfortunately, however, no single tool is recommended to be a superior to others in symptoms or quality of life assessment. Therefore, to select an appropriate assessment tool, one should consider the time frame and unique characteristics of tools depending on purpose and setting. The combination of prognostic index is highly recommended in prognostication, and web-based prognostic tools are available. Recently, a new objective prognostic score has been constructed through multicenter study in Korea. It does not include clinicalestimates of survival, but includes new objective prognostic factors, therefore, anyone can easily use it. For beginners in palliative medicine, relatively easy-to-use tools would be convenient. We recommend Eastern Cooperative Oncology Group performance status to assess functional status, numeric rating scale for pain assessment and the Korean version of brief pain inventory for initial pain assessment. Asking directly with numeric rating scale or the Korean version of MD Anderson Symptom Inventory would be desirable to assess various symptoms together. We think that European Organization Research and Treatment Quality of Life Questionnaire Core 15 for Palliative Care is good to assess the quality of life, while Objective Prognostic Score is convenient as prognostic index for beginners.
Brief Psychiatric Rating Scale ; Humans ; Korea ; Pain Measurement ; Palliative Care ; Quality of Life ; Surveys and Questionnaires

No abstract available.

This study was performed to examine the combined effects of L-carnitine and isoflavone supplementation on weight reduction and body fat distribution in overweight women. Overweight/obese women (body mass index > 23 kg/m2) who were not diagnosed any type of diseases were included in this study and sixty subjects (41.1 +/- 1.5 years, 25.9 +/- 0.3 kg/m2) were randomly assigned to a placebo (n = 30) or a supplement group (n = 30, L-carnitine 300 mg + isoflavone 40 mg/day). We measured anthropometric parameters, abdominal fat distribution by computerizd tomography and blood components before and after the 12 week intervention period. After the 12 weeks of supplementation, subjects in L-carnitine and isoflavone supplement group showed a significant reduction of body weight (p < 0.001), body fat % (p < 0.05), and waist to hip ratio (p < 0.01) whereas placebo group did not show any changes. In a CT-scanned results, total fat area at L4 level was significantly reduced by 8.1% (p < 0.01) with the reduction of visceral fat area (-11.1%, p < 0.001) and subcutaneous fat area (-7.0%, p < 0.05) in the supplement group. The supplementation of L-carnitine and isoflavone showed the significant improvement of HDL-C (p < 0.01) and apoB (p < 0.05) concentrations, however, change values in those markers were not significant compared with those of the placebo group. In addition, a significant increase of adiponectin level (p < 0.001) was observed in the supplement group after the intervention. The result of present study demonstrated that supplementation of 300 mg L-carnitine and 40 mg isoflavone per day for 12 weeks can give beneficial effects on weight reduction and visceral fat accumulation. These potential antiobesity supplement can produce more favorable effects when combined with lifestyle modification.
Abdominal Fat ; Adiponectin ; Adipose Tissue ; Apolipoproteins B ; Body Fat Distribution ; Body Weight ; Carnitine* ; Female ; Humans ; Intra-Abdominal Fat* ; Life Style ; Obesity ; Overweight* ; Subcutaneous Fat ; Waist-Hip Ratio ; Weight Loss*

BACKGROUND: To compare the effectiveness of intraoperative three-dimensional (3D) image and conventional two-dimensional (2D) fluoroscopic images, which are used in the treatment of acute calcaneal fractures. METHODS: We retrospectively analyzed 40 patients who suffered calcaneal fracture and underwent surgery at Inje University Busan Paik Hospital. The patients were divided into two groups. Only 2D fluoroscopy was used to evaluate 20 patients of group 1. On the other hand, 3D fluoroscopy was performed on the remaining 20 patients of group 2; 3D fluoroscopy was performed on these patients after they were extensively evaluated by 2D fluoroscopy during surgery. We reviewed the radiographic and clinical outcomes of these patients, whose average follow-up period was 42.6 months. RESULTS: In group 2, 3D fluoroscopy detected four cases (20%) of articular incongruence and screw misplacement. All these complicated cases were corrected during surgery. At the final follow-up session, the mean American Orthopedic Foot and Ankle Society (AOFAS) hind foot score was 78.3 (range, 65 to 95) in group 1 and 82.3 (range, 68 to 95) in group 2. CONCLUSIONS: Intraoperative 3D imaging of calcaneal fractures is considered to be useful in evaluating the congruence of joints and the placement of implants.
Adult ; Calcaneus/*injuries/radiography/*surgery ; Female ; Fluoroscopy ; Fracture Fixation, Internal/*methods ; Fractures, Bone/radiography/*surgery ; Humans ; Imaging, Three-Dimensional/*methods ; Male ; Middle Aged ; Operative Time ; Young Adult

PURPOSE: Hemorrhagic metastatic brain tumors are not rare, but little is known about the surgical outcome following treatment. We conducted this study to determine the result of the surgical outcome of hemorrhagic metastatic brain tumors. MATERIALS AND METHODS: From July 2001 to December 2008, 21 patients underwent surgery for hemorrhagic metastatic brain tumors at our institution. 15 patients had lung cancer, 3 had hepatocellular carcinoma, and the rest had rectal cancer, renal cell carcinoma, and sarcoma. 20 patients had macroscopic hemorrhage in the tumors, and one patient had intracerebral hemorrhage surrounding the tumor. A retrospective clinical review was conducted focusing on the patterns of presenting symptoms and signs, as well as local recurrence following surgery. RESULTS: Among 21 hemorrhagic brain metastases, local recurrence developed in two patients. The 12 month progression free survival rate was 86.1%. Mean time to progression was 20.8 months and median survival time after surgery was 11.7 months. CONCLUSION: The results of our study showed that hemorrhagic metastatic brain tumors rarely recurred after surgery. Surgery should be considered as a good treatment option for hemorrhagic brain metastasis, especially in cases with increased intracranial pressure or severe neurologic deficits.
Brain ; Brain Neoplasms ; Carcinoma, Hepatocellular ; Carcinoma, Renal Cell ; Cerebral Hemorrhage ; Disease-Free Survival ; Hemorrhage ; Humans ; Intracranial Pressure ; Lung Neoplasms ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neurologic Manifestations ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Sarcoma

PURPOSE: In this study, we investigated the potential of injectable hydrogel scaffolds for the regeneration of nucleus pulposus. MATERIALS AND METHODS: We prepared injectable hydrogels [Chitosan-Pluronic (CP), CP/Osteogenic Protein-1 (CP/OP-1), CP/Gly-Arg-Gly-Asp-Ser (CP/GRGDS), CP/GRGDS/OP-1] for this study. One of the four potential materials was selected through the cell viability tests. For each material, primary cultured nucleus pulposus (NP) cells from New Zealand rabbits were seeded onto each material. For the investigation of the effects of mechanical stimulation, the commercially available bioreactor was used. 0.2 MPa of intermittent hydrostatic pressure was imposed for 3 days after 7th day of seeding with the pattern of 2 min and 15 min for stimulating and resting, respectively. The specimens were harvested at 1, 10, 14 day after seeding for analyses. RESULTS: The MTT assay for 5 days revealed that CP/OP-1 group showed significant increase. The other two groups (CP/GRGDS and CP/GRGDS/OP-1) showed that the proliferation rate increased until 3 days after culture, while it decreased on day 5. The mechanical stimuli induced higher amounts of DNA measured in CP/OP- 1 on day 5 after culture. However, no significant difference was observed between two groups. CONCLUSION: We came to the conclusions that the biochemical environment as well as mechanical stimulation may play an important role in regenerating nucleus pulposus matrix, especially in CP/OP-1 in this study. However, further study are recommended in relation to mechanical effects as well as biochemical conditions.
Bioreactors ; Cell Survival ; DNA ; Hydrogel ; Hydrogels ; Hydrostatic Pressure ; Intervertebral Disc ; Porphyrins ; Rabbits ; Regeneration ; Seeds

Although avascular necrosis of the hallucal sesamoid has not been frequently addressed in the literature, it should be considered in the differential diagnosis of persistent forefoot pain. We experienced 3 cases of avascular necrosis of the hallucal sesamoid with sclerosis of the sesamoid bone on radiograghs and computed tomograghy images. T1 and T2-weighted MRI images in 2 patients showed low signal intensity in the sesamoid bone, which suggested osteonecrosis and confirmed by histology. We report 3 cases of avascular necrosis of sesamoid with a review of the literature.
Diagnosis, Differential ; Humans ; Necrosis ; Osteonecrosis ; Sclerosis ; Sesamoid Bones

Transplanting fetal kidney cells (FKCs) can regenerate kidney. This requires in vitro expansion in cell number to acquire enough cells for transplantation. However, FKCs may change their cellular characteristics during expansion and, thus, may not regenerate kidney tissue upon transplantation. We investigated how cell culture period affects cellular characteristics and in vivo regenerative potential of FKCs. As the passage number increased, cell growth rate and colony forming ability decreased while senescence and apoptosis increased. To examine in vivo regenerative potential, FKCs cultured through different numbers of passages were implanted into the parenchyma of kidneys of immunodeficient mice using fibrin gel for 4 wk. Histological analyses showed passage-dependent kidney tissue regeneration, and the regeneration was better when cells from lower number of passages were implanted. This result shows that in vitro culture of FKCs significantly affects the cell characteristics and in vivo tissue regenerative potential.
Animals ; Apoptosis/physiology ; Cell Aging/physiology ; Cell Culture Techniques ; Cell Proliferation ; Cells, Cultured ; Colony-Forming Units Assay ; Female ; Fetal Tissue Transplantation/methods/physiology ; Fetus/cytology/*physiology ; Kidney/embryology/*physiology ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Rats ; Rats, Sprague-Dawley ; Regeneration/*physiology

Fractures of the acromial process or the coracoid process of scapula are rare, and this is usually the result of direct trauma to the shoulder. This type of fracture is often neglected, but it can be detected by performing careful evaluation. We report here on an unusual case involving a fracture of the coracoid process along with concomitant acromial fracture.
Scapula ; Shoulder

To increase the biocompatibility and durability of glutaraldehyde (GA)-fixed valves, a biological coating with viable endothelial cells (ECs) has been proposed. However, stable EC layers have not been formed successfully on GA-fixed valves due to their inability to repopulate. In this study, to improve cellular adhesion and proliferation, the GA-fixed prostheses were detoxified by treatment with citric acid to remove free aldehyde groups. Canine bone marrow mononuclear cells (MNCs) were differentiated into EC-like cells and myofibroblast-like cells in vitro. Detoxified prostheses were seeded and recellularized with differentiated bone marrow-derived cells (BMCs) for seven days. Untreated GA-fixed prostheses were used as controls. Cell attachment, proliferation, metabolic activity, and viability were investigated and cell-seeded leaflets were histologically analyzed. On detoxified GA-fixed prostheses, BMC seeding resulted in uninhibited cell proliferation after seven days. In contrast, on untreated GA-fixed prostheses, cell attachment was poor and no viable cells were observed. Positive staining for smooth muscle a-actin, CD31, and proliferating cell nuclear antigen was observed on the luminal side of the detoxified valve leaflets, indicating differentiation and proliferation of the seeded BMCs. These results demonstrate that the treatment of GA-fixed valves with citric acid established a surface more suitable for cellular attachment and proliferation. Engineering heart valves by seeding detoxified GA-fixed biological valve prostheses with BMCs may increase biocompatibility and durability of the prostheses. This method could be utilized as a new approach for the restoration of heart valve structure and function in the treatment of end-stage heart valve disease.
Tissue Fixation ; Tissue Engineering/*methods ; Swine ; Proliferating Cell Nuclear Antigen/analysis ; Muscle, Smooth/chemistry ; Microscopy, Electron, Scanning ; Immunohistochemistry ; Heart Valves/cytology/*physiology ; Heart Valve Prosthesis ; Glutaral/*chemistry ; Endothelial Cells/cytology/physiology ; Dogs ; Cell Survival/physiology ; Cell Proliferation ; Cell Differentiation/physiology ; Cell Culture Techniques/*methods ; Cell Adhesion/physiology ; Bone Marrow Cells/chemistry/*physiology/ultrastructure ; Antigens, CD31/analysis ; Animals ; Actins/analysis