BACKGROUND: For reconstruction of the mild to moderate medial orbital wall fractures, various surgical approaches have been used. Prior existing W-shaped incision was a direct local approach through a 3 cm incision on the superior medial orbital area with a titanium mesh implant. In this study, the authors modified W-shaped incision and reconstructed the defect with silastic sheet to improve the result and the postoperative scar. METHODS: This study included 20 patients who had mild to moderate size of medial wall defect and therefore relatively suitable for reconstruction with silastic sheets from July, 2009 to December, 2011. A modified W-shaped skin incision approximately 1.2 to 1.5 cm in length was made along the superior medial orbital rim from approximately 1 cm medial to the medial canthus to the lower border of the medial eyebrow. The angles of the limbs of the W ranged from 150 to 160 degrees. RESULTS: By using soft flexible silastic sheet, the authors reduced the incision from 3 to 1.5 cm, and by widening the angle of the W limbs, scars were more effectively hided in the relaxed skin tension line. Scar assessment was done with modified patient and observer scar assessment scale and mean score from patients was 2.08 and mean score from observers was 2.12. CONCLUSION: Although this method will not be suitable for every case, it can be a consistent method to obtain the surgical goal in treatment of mild to moderate blowout fractures of the medial orbital wall.
Cicatrix ; Dimethylpolysiloxanes ; Extremities ; Eyebrows ; Humans ; Orbit ; Orbital Fractures ; Silicones ; Skin ; Titanium

Arotinolol, a new alpha and beta receptor antagonist, was administered in 27 essential hypertensive patients for 8 weeks in order to evaluate the antihypertensive effect and side effects. The dose were 10mg to 15mg given twice a day. The results are as follows : 1) Before medication, systolic and diastolic blood pressure in sitting, supine and erect position were 173.1+/-3.2/105.8+/-1.8, 171.1+/-3.6/86.7+/-2.0 and 169.3+/-2.6/97.2+/-2.1mmHg. 2) After 8 weeks treatment moderated to marked antihypertensive effect was observed in 74.0%(in systolic blood pressure) and 81.4%(in diastolic blood pressure) respectively in sitting position. 3) There was a significant reduction of pulse rate from 73.0+/-2.5 beats per minute on the beginning of the treatment to 63.4+/-5.2 beats per minute after 8 weeks of medication. 4) There was no significant change in hematocrit, WBC, serum lipid, GOT, GPT, BUN and creatinine. But fasting blood sugar was reduced from 95.3mg% to 81.5mg% with treatment. 5) The side effects of arotinolol were gastrointestinal symptoms(15%), fatigue(11%), dizziness(7%) and insomnia(3%). But these side effects were not severe enough to discontinue medication. In summary, arotinolol seemed to be an effective antihypertensive drug in treating mild to moderate hypertension without significant side effects.
Blood Glucose ; Blood Pressure ; Creatinine ; Fasting ; Heart Rate ; Hematocrit ; Humans ; Hypertension

PURPOSE: Cancer invasion is induced by several proteolytic enzyme systems associated with the destruction of basement membrane and extracellular matrix. Urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) have been reported as prognostic factors in breast cancer patients and plasminogen activation is regulated by various factor such as uPAR and growth factor. So we examined the tissue levels of urokinase-type plasminogen activator receptor (uPAR) in breast cancer patients. MATERIALS AND METHODS: Tissue uPAR levels were measured by ELISA assay in 268 breast cancer patients. RESULTS: The median and mean values of tissue uPAR level in breast cancer were 3.5 ng/mg and 4.8+-3.6 ng/mg cytosol protein, respectively. Tissue uPAR level was the highest in T1 stage, but there was no statistical significance between T stage (p >0.05). In nodal stage, there was also no difference in the value of uPAR according to progression. And the value of uPAR expression was not associated with estrogen and progesteron receptor status, number of involved node and percent of node involvement. In TNM stage, tissue uPAR levels were higher in patients with stage I-II than in patients with stage III-IV (p=0.027). In univariate analysis, nodal factor (p=0.0023) and TNM stage (p=0.0004) were significantly associated with overall survival. But, multivariate analysis showed that TNM stage was the only significant prognostic factor (p=0.0002). CONCLUSION: These results suggest that uPAR is mainly associated with initial tumor invasion and other factors might be involved in later stages of cancer progression.
Basement Membrane ; Breast Neoplasms* ; Breast* ; Cytosol ; Enzyme-Linked Immunosorbent Assay ; Estrogens ; Extracellular Matrix ; Humans ; Multivariate Analysis ; Plasminogen Activators* ; Plasminogen* ; Urokinase-Type Plasminogen Activator*

Cerebral amyloid angiopathy(CAA) is characterized by the deposition of amyloid beta-protein in the walls of small to medium-sized arteries of the leptomeninges and cerebral cortex. While often asymptomatic, CAA can develop into intracerebral hemorrhage facilitated by arterial hypertension. We report the case of a 52-year-old man with CAA and arterial hypertension who developed recurrent cerebral hemorrhages on three different occasions and in multiple non-overlapping loci over a period of nine years. Based on our findings, we recommend brain biopsies for all patients undergoing evacuation of multiple recurrence or atypical pattern intracerebral hemorrhages.
Amyloid ; Amyloid beta-Peptides ; Arteries ; Biopsy ; Brain ; Cerebral Amyloid Angiopathy* ; Cerebral Cortex ; Cerebral Hemorrhage* ; Humans ; Hypertension* ; Middle Aged ; Recurrence

BACKGROUND: The Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) is one of the most widely used questionnaires for assessing functional ability of the patients with upper extremity diseases. Carpal tunnel syndrome (CTS) is the most common neuropathic disease in the upper extremities. The aim of this study was to verify the validity, reliability, and responsiveness of Korean version of QuickDASH questionnaire (K-QuickDASH) in the patients with CTS. METHODS: In total, 83 subjects who underwent open carpal tunnel release (CTR) operation were selected. They fulfilled Korean version of Disabilities of the Arm, Shoulder and Hand questionnaire (K-DASH) and K-QuickDASH at two different time points: before and six months after the surgery. Both criterion-related and construct validities were evaluated using Pearson's correlation coefficient and factor analysis. Internal consistency was estimated using Cronbach's alpha, and test-retest reliability was assessed to verify the reliability of K-QuickDASH using intraclass correlation coefficient (ICC). The standardized response mean and the effect size were analyzed to confirm the responsiveness of the K-QuickDASH in CTS patients. RESULTS: Significant positive correlation was found between K-QuickDASH and K-DASH. All the questionnaire items were categorized into three factors. Acceptable internal consistency was confirmed in three categories of K-QuickDASH. A high test-retest reliability and responsiveness of K-QuickDASH were detected. CONCLUSION: K-QuickDASH in Korean patients with CTS was confirmed to have high degree of validity and reliability, and responsiveness after CTR. Therefore, the K-QuickDASH would be a good evaluation tool for evaluating clinical symptoms and determination of treatment outcomes in the patients with CTS.
Arm* ; Carpal Tunnel Syndrome* ; Hand* ; Humans ; Reproducibility of Results ; Shoulder* ; Upper Extremity

PURPOSE: We measured and compared the uPA, plasminogen activator inhibitor-1 (PAI-1) and uPA receptor (uPAR) levels in breast cancer tissues and blood of the patients to evaluate their clinical relevance for biotherapy. MATERIALS AND METHODS: uPA, PAI-1 (Monozyme, Netherland), uPAR (American Diagnostics, USA) levels were measured by ELISA assay in 192 breast cancer tissues, in 18 normal breast tissues and in 163 blood from breast cancer patients. RESULTS: There was a tendency of uPA increment from ductal carcinoma in situ while increment of PAI-1 and uPAR occurred from Ti. With the progression of cancer, uPA, PAI-1, uPAR tended to decrease; however, the uPA/uPAR, uPA/PAI-1 ratios remained unchanged. There was a correlation of uPA expression between normal and cancer tissues ( r(2)= 0.49). Correlation of uPA and PAI-1 was found in normal tissue and stage I cancer tissue while correlation of uPAR and PAI-1 was found with cancer progression. Between cancer tissue and blood significant correlations were found in uPA, PAI-1, uPAR levels. CONCLUSION: uPA, PAI-1, uPAR levels in cancer tissue elevated from the early stage maintaining correlative expressions with cancer progression. A positive correlation between cancer tissue and blood level suggested the applicability of the levels of uPA, PAI-1 or uPAR for detecting patients for biotherapy.
Biological Therapy* ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Enzyme-Linked Immunosorbent Assay ; Humans ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Urokinase-Type Plasminogen Activator*

PURPOSE: This study compares the feasibility and safety of Totally Laparoscopic Total Gastrectomy (TLTG) with Open Total Gastrectomy (OTG) for Remnant Gastric Cancer (RGC) in patients who had previously undergone gastrectomy. METHODS: We retrospectively collected and analyzed the data of 139 consecutive patients who underwent OTG along with 21 patients who underwent TLTG for RGC between January 2008 and December 2016. One-to-two Propensity Score Matching (PSM) was performed to compare the age, gender, body mass index, American Society of Anesthesiologists score, clinical tumor stage, previous gastric disease, previous gastrectomy type, previous reconstruction type, history of previous upper abdominal surgery except gastrectomy, and combined major operations. A total of sixty patients (21 who underwent TLTG and 39 who underwent OTG) were matched, and surgical outcomes and survival rates were compared. RESULTS: The TLTG patients were found to recover bowel movements sooner than the OTG group (OTG 3.74±0.88 vs TLTG 3.19±0.81 days, p=0.02). Post-operative surgical outcomes, including pathological features, clinical courses, complications and survival rates did not differ between the two groups (p>0.05). CONCLUSION: Although TLTG was not found to have any definitive clinical advantage over OTG except for more rapid recovery of bowel movement, TLTG should be considered as safe and feasible surgical procedure as OTG for the treatment of RGC.
Body Mass Index ; Gastrectomy ; Humans ; Laparoscopy ; Propensity Score ; Retrospective Studies ; Stomach Diseases ; Stomach Neoplasms ; Survival Rate

PURPOSE: Gastric cancer is the most common malignancy in Korea. Although treatment such as surgery, chemotherapy, and immunotherapy has greatly improved, the mortality rate of gastic cancer is still high, A new therapeutic trial is necessary to improve the cure rate of gastric cancer. Therefore we investigated the pre-clinical significance of HSV-tk gene therapy using retroviral vector for gastric cancer cell lines. MATERIALS AND METHODS: LNC/HSV-tk retroviral vector and PA317/LNC/HSV-tk producer cell line were constructed. HSV-tk gene transduction and expression were detected by PCR. An in vitro ganciclovir(GCV) sensitivity test was performed by MTT assay. To evaluate in vivo GCV sensitivity, GCV was intraperitoneally injected after tumor formation in the nude mice. Bystander effect was observed in vitro MTT assay using YCC- S-2 cell line and in vivo using N87 and YCC-S-2 cell lines. RESULTS: The in vitro GCV sensitivity test showed that the growth inhibition was 30~32% with 0.5 uM GCV and 52~77% with 500 uM GCV in the HSV-tk transduced cell line in comparison with 0- 5% with 0.5 and 500 uM GCV in the parent cell line. The in vivo GCV administration showed that the tumors induced by HSV-tk transduced N87 cell line and YCC-S-2 cell line decreased completely, while the tumors with the parent cell lines continued to grow in nude mice. We observed no tumor cells in tissue specimen of the tumor induced by the N87/HSV-tk cell line after. GCV administration. In vitro and in vivo bystander effects were observed in HSV-tk/GCV system due to the resultant cell death exceeding the proportion of HSV-tk transduced cells in the mixtures of HSV-tk transduced and parent cells. CONCLUSION: HSV-tk transduced gastric cancer cell lines showed sensitivity to GCV and a bystander effect was observed. These results suggested that HSV-tk/GCV system should be evaluated in the clinical settings.
Animals ; Bystander Effect ; Cell Death ; Cell Line* ; Drug Therapy ; Ganciclovir* ; Genetic Therapy ; Herpes Simplex* ; Humans ; Immunotherapy ; Korea ; Mice ; Mice, Nude ; Mortality ; Parents ; Polymerase Chain Reaction ; Stomach Neoplasms* ; Thymidine Kinase* ; Thymidine* ; Zidovudine

OBJECTIVE: To compare the treatment thresholds for osteoporosis medication based on bone mineral density (BMD) results and fracture risk assessment tool (FRAX) risks in patients with a distal radius fracture. METHODS: The data of 116 consecutive women aged 50~89 years (mean 64.5 years) with a distal radius fracture were collated to identify clinical risk factors, which were inserted into the FRAX algorithm to calculate 10-year fracture risks. Proportions of patients indicated for osteoporosis medication based on BMD alone and based on FRAX risks were determined. Sensitivity estimation was done with FRAX plus BMD as a gold standard measurement for osteoporosis treatment. RESULTS: Of the 116 patients, 38% needed osteoporosis medication based on BMD alone, and 41% were indicated for treatment based on FRAX plus BMD. These proportions were not significantly different (P = 0.481). However, 56% of patients were indicated for treatment based on FRAX excluding BMD, which was significantly larger than the proportion determined by BMD alone (P = 0.001) or FRAX plus BMD (P = 0.003). Sensitivity, specificity, positive predictive value, negative predictive value for BMD alone were 75%, 93%, 90%, 82% and those for FRAX without BMD were 83%, 70%, 69%, 84%. CONCLUSION: No difference was found in the proportion of patients that need osteoporosis medication based on BMD results alone and FRAX plus BMD risks, suggesting BMD measurement can be sufficient to detect candidates for osteoporosis medication in patients with a distal radius fracture. FRAX excluding BMD may include too many patients that do not need osteoporosis treatment.
Aged ; Bone Density ; Female ; Humans ; Osteoporosis ; Radius ; Radius Fractures ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity

PURPOSE: For tumor growth, invasion and metastasis, a cascade of linked sequential biological events is essential; overproduction of growth factors, activation of proteolytic enzymes, induction of tumor angiogenesis, and enhanced tumor cell motility and attachment. We tried to test whether the biological therapy against the biological targets can modulate the specific biological characteristics, and furthermore increased anti-tumor effects can be induced when the biological therapy and cytotoxic chemotherapy were combined. MATERIALS AND METHODS: YCC-1, 2, 3, 7, and AGS human gastric cancer cell lines were used in these studies. Pentosan polysulfate (PPS) as a heparin-binding growth factor (HBGF) inhibitor, Tranexamic acid as a plasmin inhibitor, Adriamycin as a chemotherapeutic agent, were selected. The methods were Northern blot analysis for the detection of Midkine (MK) expression, soft agar assay for autocrine tumorigenicity. The expression of uPA, PAI-1 was determined by ELISA, while the MMPs activities were evaluated by zymography. The effects of each drug on tumorigenicity and tumor cell proliferation were evaluated by soft agar assay and cell proliferation assay, respectively. RESULTS: YCC-3, 7, AGS cell lines expressed MK mRNA, whereas YCC-1, 2 did not. YCC-2 cell line showed increased expression of uPA and MMP activities. Only MK expressing YCC-3 and 7 cell lines showed the tumorigenicity. PPS suppressed the colony forming activities as much as Adriamycin did (PPS; 8~24%, Adriamycin; 12~40%), but it showed only cytostatic effects in cell proliferation assay (PPS; 60~103%, Adriamycin; 22~97%). When PPS was combined with Adriamycin on the Adriamycin resistant, MK expressing YCC-7 cell line, the growth inhibition rate increased up to 84%, while that of PPS or Adriamycin single treatment was 40%, 22%, respectively (p=0.001). CONCLUSION: The modulation of specific biological targets can induce the anti-tumor effects. This suggests the possible clinical application of biological therapy in gastric cancer.
Agar ; Antifibrinolytic Agents ; Biological Therapy ; Blotting, Northern ; Cell Line* ; Cell Movement ; Cell Proliferation ; Doxorubicin ; Drug Therapy ; Enzyme-Linked Immunosorbent Assay ; Humans* ; Intercellular Signaling Peptides and Proteins ; Matrix Metalloproteinases ; Neoplasm Metastasis ; Pentosan Sulfuric Polyester ; Peptide Hydrolases ; Plasminogen Activator Inhibitor 1 ; Population Characteristics ; RNA, Messenger ; Robenidine ; Stomach Neoplasms* ; Tranexamic Acid