PURPOSE: The stati of estrogen (ER) and progesterone receptors (PR) have been established as useful prognostic and predictive factors in the clinical management of women with breast cancer. This study was designed to correlate the presence of hormonal receptors with the established clinicopathological parameters, including age, tumor size, nodal status, stage, p53 and c-erbB-2 stati and to assess the prognostic significance of the hormonal receptors stati. METHODS: A retrospective study was conducted of all the breast cancer patients with known ER and PR stati between 1983 and 2002 at the Dongsan Medical center. The clinical features and pathological and immunohistochemistry reports were reviewed, and the ER and PR stati compared with the clinicopathological factors using independent sample T-tests, cross-tabulation, chi-square tests, and a one way ANNOVA. A survival analysis was performed using Kaplan-Meier method and log rank tests. RESULTS: Of 893 patients, 443 (49.6%) and 435 (48.5%) were ER-positive and PR-positive, respectively. The ratios of the patients with ER+PR+, ER+PR-, ER-PR+ and ER-ER- were 37.1, 12.5, 11.6 and 38.7%, respectively. The ER status was not related to the age, tumor size, nodal status, stage and c-erbB-2 status. The ER-negative patients had significantly more frequent overexpression p53 gene than the ER-positive patients (P=0.000). The PR status was not related to the age, nodal status, stage and c-erbB-2 status, but the average tumor size was larger in the PR-negative than the PR-positive patients (P=0.02). The PR-negative patients also had significantly more frequent overexpression p53 gene than the PR-positive patients (P= 0.000). The ER-positive or PR-positive patients had a better prognosis than the ER-negative and PR-negative patients (P=0.000). CONCLUSION: The hormonal receptors stati were not definitely related to the clinicopathological factors including the age, tumor size, lymph node status, stage, c-erbB-2 status, with the exception of p53 overexpression. A positive hormonal receptor status was a good prognostic factor.
Breast Neoplasms* ; Equidae* ; Estrogens ; Female ; Genes, p53 ; Humans ; Immunohistochemistry ; Lymph Nodes ; Prognosis ; Receptors, Progesterone ; Retrospective Studies

PURPOSE: As traffic accidents and invasive vascular procedures are increasing these days so are vascular trauma, either blunt or penetrating. So we investigated the changes of clinical status of vascular trauma for the last 10 years. METHOD: We retrospectively reviewed the medical records of 121 patients who had admitted and operated at Korea University Hospital due to traumatic arterial injuries from 1990 to 1999. We divided those patients by period into two groups; Era 1 (1990~1994) and Era 2 (1995~1999). The former group included 51 patients, the latter 70. Age distribution, causes of injury, location, degrees of injury, amputation rate, mortality rate, and operation methods between these two groups were compared. RESULT: The most common cause of arterial injury was blunt trauma by traffic accident in Era 1, injury by broken glasses in Era 2. Iatrogenic injury cases increased (from 3.9% in Era 1 to 10% in Era 2), and so did industrial injuries. Two groups also show similar distribution of degrees and location of injuries. Amputation rate in cases of vascular trauma of lower extremities correlates with combined fracture in both group (P<0.05). Amputation rate was 35.5% in Era 1, and 23.5% in Era 2. The mortality rate was 15.7% in Era 1 and 12.9% in Era 2 (p>0.05). Each group presented statistically significant correlation between location of injury and mortality (P<0.05). Abdominal injury was related to high mortality rate (63.2%). CONCLUSION: The latter period (Era 2) showed increased iatrogenic injury rate compared to the former. Amputation rate increased when combined with fracture in both groups, but mortality rate didn't significantly change between these two groups.
Abdominal Injuries ; Accidents, Traffic ; Age Distribution ; Amputation ; Eyeglasses ; Glass ; Humans ; Korea ; Lower Extremity ; Medical Records ; Mortality ; Retrospective Studies

Human orthotopic liver transplantation was first attempted in 1963. Living related liver transplantation has been introduced by Raia in 1988. In children, biliary atresia is the leading indication of living related liver transplantation. We performed 2 cases living related liver transplantation on May, 1996. The donors were 32 and 30 year old father, recipients were his 3 year old son and 4 year old daughter. The causes of liver failure were drug induced fulminant hepatitis and recurrent cholangitis due to biliary atresia. The first case was incompatible of ABO blood typing, donor AB(Rh+) and recipient B(Rh+). The ABO incompatible donor was performed preoperatively plasmapheresis. After left lateral segmentectomy of donor and total hepatectomy of recipient, donor liver was orthotopically transplanted. The average operation time of donor and recipient were 8 hours and 12.5 hours. The amount of transfusion in donor and recipient were average 2 pints and 2.5 pints. The perioperative immunosuppression was maintained with prednisone, azathioprine and cyclosporin, but 1st case was changed from cyclosporin to OKT3 on postoperative 9th day. The postoperative complications of recipient were pulmonary edema, bacterial and fungal infection. The donors were discharged on postoperative 8th and 9th day. The first case patient was discharged postoperative 42th day due to respiratory complication. The 2nd recipient was discharged postoperative 22th day. We suggested that living related liver transplantation is good modality for resolving the graft shrtage in pediatric liver transplantation.
Adult ; Azathioprine ; Biliary Atresia ; Blood Grouping and Crossmatching ; Child ; Child, Preschool ; Cholangitis ; Cyclosporine ; Fathers ; Hepatectomy ; Hepatitis ; Humans ; Immunosuppression ; Liver Failure ; Liver Transplantation* ; Liver* ; Mastectomy, Segmental ; Muromonab-CD3 ; Nuclear Family ; Plasmapheresis ; Postoperative Complications ; Prednisone ; Pulmonary Edema ; Tissue Donors ; Transplants

PURPOSE:Prolonged cold ischemia has been shown to be an important factor in the development of post-transplant renal dysfunction. The exact mechanisms have not been completely defined. The expression of ICAM-1 (CD-54) in rat kidneys stored at 0, 4, 12, 24 and 48 hours in University of Wisconsin (UW) solution was studied in an attempt to correlate ischemia time with increased immunogenicity of the graft. METHODS: Kidneys from male Lewis rats were perfused with UW solution, removed and bathed in UW solution at 4 degrees C for 4, 12, 24, and 48 hours respectively. For the evaluation of expression of ICAM-1, immunohistochemical staining, Western blotting and RT-PCR were performed. RESULTS: Immunohistochemical staining in normal non-ischemic kidneys revealed that glomerular capillaries expressed ICAM-1 but that tubular cells did not. The preserved kidneys were analyzed with immunohistochemistry, Western blotting and semi-quantitative RT-PCR and showed increased transcription and expression of ICAM-1 in the cortex of the kidney. This expression reached a maximum at 24 hours and declined at 48 hours. The ICAM-1 protein expression in the preserved kidney cortex was increased at 4 hours (1.68+/-0.60 fold of control kidneys, (p=0.06)), 12 hours (2.38+/-0.90 fold, (p=0.02)), 24 hours (3.70+/-1.29 fold, (p=0.01)), and 48 hours (2.00+/-0.54 fold, (p=0.01)). The mRNA expression (the ratio of ICAM-1/GAPDH) in preserved kidneys cortex relative to control kidneys was increased at 4 hours (1.19+/-0.14 fold of control kidneys), 12 hours (1.38+/-0.16 fold),24 hours (1.77+/-0.29 fold), and 48 hours (1.19+/-0.12 fold) (p<0.05 for all time points). CONCLUSION: We conclude that cold preservation of rat kidneys in UW solution induces increasing levels of ICAM-1 cell surface expression and gene transcription. This increase in adhesion molecule expression can be a contributing factor in the development of post-transplant renal dysfunction by increasing the immunogenicity of the graft.
Animals ; Baths ; Blotting, Western ; Capillaries ; Cold Ischemia ; Humans ; Immunohistochemistry ; Intercellular Adhesion Molecule-1* ; Ischemia ; Kidney Cortex ; Kidney Transplantation ; Kidney* ; Male ; Rats* ; RNA, Messenger ; Transplants ; Wisconsin

OBJECTIVE: Minimal data exist regarding non-operative management of suspected pseudarthrosis after pedicle subtraction osteotomy (PSO). This study reports radiographic and clinical outcomes of non-operative management for post-PSO pseudarthrosis at a minimum 5 years post-detection.METHODS: Nineteen consecutive patients with implant breakage indicating probable pseudarthrosis after PSO surgery (13 women/six men; mean age at surgery, 58 years) without severe pain and disability were treated with non-operative management (mean follow-up, 5.8 years; range, 5–10 years). Non-operative management included medication, intermittent brace wearing and avoidance of excessive back strain. Radiographic and clinical outcomes analysis was performed.RESULTS: Sagittal vertical axis (SVA), proximal junctional angle, thoracic kyphosis achieved by a PSO were maintained after detection of pseudarthrosis through ultimate follow-up. Lumbar lordosis and PSO angle decreased at final follow-up. There was no significant change in Oswestry Disability Index (ODI) scores and Scoliosis Research Society (SRS) total score, or subscales of pain, self-image, function, satisfaction and mental health between detection of pseudarthrosis and ultimate follow-up. SVA greater than 11 cm showed poorer ODI and SRS total score, as well as the pain, self-image, and function subscales (p<0.05).CONCLUSION: Non-operative management of implant failure of probable pseudarthrosis after PSO offers acceptable outcomes even at 5 years after detection of implant breakage, provided SVA is maintained. As SVA increased, outcome scores decreased in this patient population.
Animals ; Braces ; Follow-Up Studies ; Humans ; Joint Deformities, Acquired ; Kyphosis ; Lordosis ; Male ; Mental Health ; Osteotomy ; Pseudarthrosis ; Scoliosis ; Spine

PURPOSE: By virtue of advances in scientific methods and technical systems, there has been a rapid growth in the number of end stage renal disease (ESRD) patients treated using continuous ambulatory peritoneal dialysis (CAPD) as their primary renal replacement therapy. However, there are various catheter related complications that are limiting factors in patient and catheter maintenance. This study was aimed at introducing of the techniques of CAPD catheter implantation designed for reducing the complication rate, as well as conducting an investigation of the incidence of CAPD catheter related complications and patient survival and catheter survival rates. METHODS: We performed 234 cases of CAPD catheter implantation using a conventional surgical method (n=162, between January 1993 and December 1997) or a modified surgical method (n=72, between January 1998 and December 1999), and retrospectively reviewed the patient's medical records to elucidate the incidence of early catheter related complications and the catheter removal rate in relation to the surgical methods. RESULTS: There were 21 cases (23.8%) of peritonitis in the modified group, which was less than that in the conventional group (79 cases, 48.8%) (P=0.036). There were 9 cases (12.5%) of exit site and tunnel infection in the modified group, which was less than that in the conventional group (36 cases, 22.2%) (P=0.019). We were able to reduce the peritonitis as well as exit site and tunnel infection by a long segment of tunneling and immobilization of the catheter to the skin. Nine cases of leakage (5.5%) have occurred in the conventional group and one case (1.3%) in the modified group; the difference was statistically significant (P=0.046). CONCLUSION: These results indicate that our modified surgical methods can reduce the rate of early catheter related complications.
Catheters* ; Humans ; Immobilization ; Incidence ; Kidney Failure, Chronic ; Medical Records ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Replacement Therapy ; Retrospective Studies ; Skin ; Survival Rate ; Virtues

PURPOSE: The purpose of this article is to analyze the results of combined agioplasity and femorofemoral bypass in patients with unilateral iliac arterial occlusive disease. METHOD: During the 11-year period from 1990 to 2000, 44 patients with iliac artery occlusion and a hemodynamically significant contralateral iliac artery stenosis were treated by using a combination of percutaneous transluminal angioplasity (PTA) and femorofemoral bypass (n=18) as well as aortobifemoral bypass (n=12) and iliofemoral bypass (n=14) at Korea university medical center. PTA was performed if the lesions in the donor iliac artery were less than 3 cm in length with no more than one well-localized lesion in either the common or external iliac artery, or both. Stent was deployed for suboptimal PTAs. The femorofemoral bypass was done within 3 to 5 days after PTA or stenting. RESULT: The mean age was 61.2 years. The Indications of femorofemoral bypass were hypertension, ischemic heart disease, chronic obstructive lung disease, old age (>75), cancer, and previous abdominal operation. The complication rate of the combination treatment was lower than that of the others. Primary patency rate at 1 and 3 years were 89%, 78% for aortobifemoral bypass, 83%, 66% for iliofemoral bypass, and 77%, 65% for femorofemoral bypass, respectively. CONCLUSION: The combination of PTA with or without stent deployment and femorofemoral bypass can be a useful option for treating iliac occlusion and contralateral iliac stenosis in patients with severe comorbid illness, advanced age, and intra-abdominal pathology. Angioplasity can allow more widespread use of femorofemoral bypass in these patients.
Academic Medical Centers ; Angioplasty* ; Arterial Occlusive Diseases* ; Constriction, Pathologic ; Humans ; Hypertension ; Iliac Artery ; Korea ; Myocardial Ischemia ; Pathology ; Pulmonary Disease, Chronic Obstructive ; Stents ; Tissue Donors

PURPOSE: The cold ischemia augments the inflammatory cell infiltration in the rat kidney allograft by increasing expression of ICAM-1. The ICAM-1 proteins and ICAM-1 mRNA were overexpressed and upregulated on the tubular epithelium and endothelium of renal allografts that were preserved in the cold preservation solution such as University of Wisconsin (UW) solution. The aims of this study was to examine whether perfusion of kidney with anti ICAM-1 antibody (1A29) prevent inflammations and injuries of graft even in long ischemic time. METHODS: Rat kidneys were perfused in situ with 60 mL of cold UW solution without or with anti-rat ICAM-1 antibody and nephrectomized. The kidneys were exposed to 48 hour cold (4 degrees C storage time) ischemia and examined for the counts of necrotic tubules and apoptotic cells on the high power fields by terminal deoxynucleotidyltransferase mediated nick-end labeling (TUNEL) assay. RESULTS: The number of necrotic tubules per high power field of the allograft treated by anti ICAM-1antibody (6.97+/-4.25) was significantly less than that of the other control allograft (12.71+/-6.42) (P<0.001). The number of apoptotic cells per high power field of antibody treated graft (4.27+/-4.11) was significantly less than that of the other control graft (8.43+/-5.56) (P<0.001). CONCLUSION: Rat anti ICAM-1 antibody (1A29) inhibits ICAM-1 mediated allograft tubular necrosis as well as apoptosis. These results are expected to contribute to prevent allograft rejection and delayed graft function when used for pretreatment of allografts with anti ICAM-1 antibody mixtures of the perfusion and preserving solution clinically.
Allografts ; Animals ; Apoptosis ; Cold Ischemia ; Delayed Graft Function ; DNA Nucleotidylexotransferase ; Endothelium ; Epithelium ; Inflammation ; Intercellular Adhesion Molecule-1* ; Ischemia ; Kidney* ; Necrosis ; Perfusion ; Rats* ; RNA, Messenger ; Transplantation ; Transplants ; Wisconsin*