Purpose: The purpose of our study was to assess the clinical and radiological results of isolated acetabular revision and the differences in the results between monoblock and modular femoral stems. Materials and Methods: Between October 1991 and June 2002, 39 patients (39 hips) underwent isolated acetabular revisions with use of uncemented cups and bone grafts. The mean period of follow-up was 5 years 3 months (range, 2 years 1 month to 9 years 8 months). The mean age of the patients at the time of the surgery was 51 years old (range, 26 to 75 years old). The monoblock femoral stems were used in 19 hips and the modular femoral stems were used in 20 hips. The monoblock stems were retained without exchange provided that there was no gross scratch on the femoral head and the femoral stem was confirmed to be stable and fixed intraoperatively. In the modular stems, the femoral heads were always exchanged with new ones. Results: The mean Harris hip score improved from 57 to 87 points. Radiologically, all the stems retained at surgery remained well osseointegrated without osteolysis. Re-revisions of the acetabular components were performed in 5 hips using monoblock stems due to periacetabular osteolysis caused by excessive wear of polyethylene and subsequent loosening of the cups in 3 hips and mechanically unstable acetabular cups without osteolysis in 2 hips. The mean wear rate of polyethylene coupled with the monoblock stem was 0.27 mm/year which was greater than the 0.11 mm/year in the cases with modular stems. Conclusion: To prevent failure of acetabular cups that may occur later by excessive wear of polyethylene, we recommend revision of the well-fixed monoblock femoral stems even though there is no gross scratch on the femoral heads of the monoblock stems.
Acetabulum* ; Follow-Up Studies ; Head ; Hip ; Humans ; Osteolysis ; Polyethylene ; Transplants

Several methods for the management of intractable pain for various conditions including malignant disorders, herpes zoster, and low back pain and/or sciatica in 80 patients were described and analyzed. Neurolytric blocks of celiac plexus were given to the patients suffering from intra-abdominal pain from malignant origin or chronic pancreatitis. Herpes zoster was treated mainly by chemical sympathectomy via paravertebral route and occassionaly corticosteroid was administered epidurally with the local anesthetic, bupivacaine. All the patients with low back pain and/or sciatica were given epidural corticosteroid one to three times. Other peripheral were blocks and regional corticosteroid therpy were given to the rest of the patients. Fair to excellent result was obtained in 71% of the patients but the response was poor in the remaining 28% of the patients. It seems that the earlier the patients were referred to the pain clinic, the better the results were.
Bupivacaine ; Celiac Plexus ; Herpes Zoster ; Humans ; Low Back Pain ; Pain Clinics ; Pain, Intractable ; Pancreatitis, Chronic ; Sciatica ; Sympathectomy, Chemical

Evaluation of inadevertent dural puncture occuring among 308 epidural blocks done for the relief of pain from various conditions was performed. Dural puncture was suspected in 5 out of 308 eqidural bloks(1.6%). Aspiration of CSF was negative 3 cases in which dural puncture was suspected only after developing spinal anesthesia. Of the 3 negative CSF aspirations, one case had a history of laminectomy. Adhesions of the adjacent tissues might result in the loss of flexibility and a decreases in potential epidural space which might cause dural tearing during injection and subarachoid injection of the local anesthetic followed by high spinal anesthesia. In another case, the needle tip was obstructed by tissue which led to negative aspiration of CSF and failure to feel loss of resistance. The second injection at the same site many cause subarachonold injection of the local anesthetic through the previously perforated dura mater and in turn, lead to spinal anesthesia. In the last case, there was no reason to suspect dural puncture since the loss of resistance plus air rebound were definite and aspiration of CSF was negative, but dural puncture was suspected after the patient developed spinal anesthesia.
Anesthesia, Spinal ; Aspirations (Psychology) ; Dura Mater ; Epidural Space ; Humans ; Laminectomy ; Needles ; Pliability ; Punctures*

BACKGROUND: There has been a growing realization that a variety of anticancer drugs can induce apoptotic cell death. In the present study, an attempt was made to investigate the responsiveness of gastric cancer cells to various anticancer drugs and to identify which apoptosis-related proteins could be correlated to chemosensitivity. METHODS: Nine human Korean gastric cancer cell lines (SNU-1, -5, -16, -484, -601, -620, -638, -668, and -719) were analyzed. The cytotoxicity of each cell line to camptothecin, cisplatin, mitomycin C, vincristine, 5-FU, epirubicin, and doxorubicin was determined by using a MTT (dimethylthiazole- diphenyltetrazolium-bromide) assay. Apoptosis-related proteins (p53, p21, Bcl-2, Bcl-x, and Bax) were detected using a Western blot assay. RESULTS: Of the nine gastric cancer cell lines, SNU-1 was resistant while SNU-5 was sensitive to anticancer drugs. Mutated p53 was detected in all the cell lines. The highest expression of Bcl-2 was observed in SNU-1 while less or no expression of Bcl-2 was observed in SNU-5, -484, and -601. Bcl-xL was less expressed in SNU-5 than in the other cell lines. CONCLUSIONS: Chemosensitivity in gastric cancer cell lines was correlated mainly with the level of Bcl-2 and partly with that of Bcl-xL. There was no correlation between the chemosensitivity and other apoptosis-related proteins, such as p21, p53, Bax, and Bcl-xS in the studied gastric cancer cell lines.
Blotting, Western ; Camptothecin ; Cell Death ; Cell Line* ; Cisplatin ; Doxorubicin ; Epirubicin ; Fluorouracil ; Humans ; Mitomycin ; Stomach Neoplasms* ; Vincristine

PURPOSE: The purpose of this study was to review the daily practice of inferior vena cava filters (IVCFs) in a tertiary referral center in Korea and to reveal the retrieval rate and the methods for improving it. MATERIALS AND METHODS: Through the electronic medical record system, a retrospective review was performed on 115 consecutive patients who underwent placement of retrievable IVCFs between February 2000 and January 2011 in Seoul National University Hospital. RESULTS: IVCF placement was done in 115 cases (113 patients). There were 68 men (59.1%), and the mean age was 58.5+/-15.5 years (range, 10-96 years). The affiliated departments were Vascular Surgery (57 cases, 49.6%), and Internal Medicine (20 cases, 17.4%). Advanced malignancy was the most commonly associated disease (n=30, 26%). The indications for IVCF placement were categorized; absolute indications in 36 cases (31.3%), relative indications in 78 cases (67.8%), and prophylactic use in 1 case (0.9%). The most common indications were thrombolysis/thrombectomy for iliocaval deep vein thrombosis (DVT) (n=55, 47.8). Of the 115 filters, 68 were retrieved (retrieval rate, 59%). The most common cause of non-retrieval was chronic high risk of venous thromboembolism in 24 patients (51%), followed by residual proximal DVT (n=7, 15%), and negligence by unknown reasons (n=6, 13%). CONCLUSION: To improve the retrieval rate, the number of follow-up losses to vascular specialists must be decreased, which can be achieved by establishment of a dedicated IVC filter clinic, implementation of a filter registry, and regular education for medical teams and patients along with their families.
Education ; Electronic Health Records ; Follow-Up Studies ; Humans ; Internal Medicine ; Korea ; Male ; Malpractice ; Pulmonary Embolism ; Retrospective Studies ; Seoul ; Specialization ; Tertiary Care Centers* ; Vena Cava Filters* ; Venous Thromboembolism ; Venous Thrombosis

OBJECTIVES: The aim of this prospective study is to investigate predictors estimating relapse in Korean alcohol-dependent patients using variables like alcohol history, drinking craving, treatment motivation and insight. METHODS: Alcohol dependent patients(N=48) who completed questionnaires about sociodemographic variables and drinking history, Timeline Follow-Back(TLFB), Obsessive-Compulsive Drinking Scale(OCSD), Alcohol Urge Questionnaire(AUQ), Pennsylvania Alcohol Craving Scale(PACS), University of Rhode Island Change Assessment(URICA), Hanil Alcohol Insight Scale(HAIS) were followed-up for 24weeks. Subjects who drank heavily(5 standard drinking or more/day) or were not followed up anymore were classified as the relapse group. We used logistic regression analysis with backward elimination of SPSS PC+11.5 to investigate relapse estimate predictors. RESULTS: Average drinking amount per drinking day for last 1 year and HAIS score were predictors of relapse in alcohol-dependent patients. CONCLUSIONS: Our findings suggest that therapist should give more attention to alcohol-dependent patients who had more drinks per drinking day for last 1 year and had lower insight level.
Alcoholism ; Drinking ; Follow-Up Studies* ; Humans ; Logistic Models ; Motivation ; Pennsylvania ; Prospective Studies ; Recurrence* ; Rhode Island

Autoimmune hemolytic anemia due to antibody formation against the A or B antigen in renal transplant recipients has been reported on rare occasions. We experienced a case of autoimmune hemolytic anemia which developed 11 days after renal transplantation during CsA and prednisolone administration as immunosuppressive agents. The patient was a 46 year old male, blood group was Rh(+) A, who had received a kidney from his Rh(+) O, HLA haploty'pe identical elder brother. He was transfused with three units of Rh(+) A RBCs preoperatively and his hemoglobin level was 9.2g/dl 1 day after transplantation. After 11 to 12 days posttransplantation, the hemoglobin level dropped to 3.8g/dl. A peripheral blood smear showed marked spherocytosis and polychromatophilia. The reticulocyte count was increased to 4.2%, and total bilirubin was increased to 2.91mg/dl. The LDH was raised to 561 IU/L and the plasma Hb level was 6.Smg/dl. Blood bank tests confirmed that the autoantibody cause hemolytic anemia was anti-A. If transplant recipients of blood groups A, B, or AB, who recieve organs from blood group 0 donors, have hemolytic anemia and ABO discrepancy, the possibility of AIHA due to anti-A or anti-B should be considered.
Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune* ; Antibody Formation ; Bilirubin ; Blood Banks ; Blood Group Antigens ; Humans ; Immunosuppressive Agents ; Kidney ; Kidney Transplantation ; Male ; Middle Aged ; Plasma ; Prednisolone ; Reticulocyte Count ; Siblings ; Tissue Donors* ; Transplantation*

OBJECTIVES: The quality of life of medical students was investigated and compared with that of general college students to identify what kind of problems medical students are suffering from. METHOD: Korean version of WHOQOL-BREF was administered to 317 medical students and 150 general college students of Yonsei University in 1999. Collected data were analyzed with t-test and multiple regression analysis RESULTS: There was no significant difference in the total scores of WHOQOL-BREF between medical students and general college students. However, the scores of facets of sleep and rest, sexual activity, and participation and opportunities for recreation/leisure were significantly lower in medical students than in general college students, while the scores of facets of dependency on medication and treatment, financial resources, opportunities for acquiring new information and skills, and transport were significantly higher in medical students than in general college students. The score of social relationships domain was significantly lower in medical students than in general college students, while, the score of environmental domain was significantly higher in medical students than in general college students. Physical, environmental and social relationships domains contributed more to the quality of life of medical students than psychological domain while psychological and environmental domains contributed more to the quality of life of general college students than physical and social relationships domains. CONCLUSION: The result suggests that it is necessary to improve the quality of life of medical students in social relationships domain and in the facets of sleep and rest, sexual activity, participation and opportunities for recreation/leisure.
Humans ; Quality of Life* ; Sexual Behavior ; Students, Medical*

Advances in fiberoptic endoscopy have improved diagnostic capabilities and management in piatients with gastrointestinal polyps. The gastrointestinal polyp is a premalignant lesion in varying degrees, according to size, pathology, and location. Endoscopic polypectomy has long been considered as a safe and effective method for removal of polyps. Sixty endoscopic gastrointestinal polypectomies were done in 53 patients who visited Hanyang University Hospital from 1984 to l990, and the clinical characteristics including histopathalogy were evaluated. (continue...)
Endoscopy ; Humans ; Pathology ; Polyps

PURPOSE: There has been debate on the use of peritoneal irrigation and drainage following gastric cancer surgery. This study was conducted to evaluate the usefulness of routine peritoneal irrigation and drainage following gastric cancer surgery, especially with regard to the perioperative leukocyte count. METHODS: Of 298 patients, 153 were enrolled in the test group (without peritoneal irrigation & drainage), between October 2001 and August 2002, and 145 in the control group (with peritoneal irrigation and drainage), between January 2001 and September 2001. The demographics, range of dissection, pathological staging, operation times, anesthesia times, fever, perioperative leukocyte counts and operative complications were retrospectively analyzed in these consecutive patients. RESULTS: It was found that there was no difference in the demographics, range of dissection, pathological staging and operative complications between the two groups. However, the operation times, anesthesia times, and mean length of hospitalization in the test group were significantly shorter than those in the control group. No significance differences were found between the two groups with regard to the perioperative leukocyte counts. CONCLUSION: The routine usage of peritoneal irrigation and drainage was found to be neither safe nor effective in gastric cancer surgery patients.
Anesthesia ; Demography ; Drainage* ; Fever ; Hospitalization ; Humans ; Leukocyte Count* ; Leukocytes* ; Peritoneal Lavage* ; Retrospective Studies ; Stomach Neoplasms*