PURPOSE: The purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample. MATERIALS AND METHODS: A total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively. RESULTS: After the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period. CONCLUSION: Patients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.
Biopsy ; Chemoradiotherapy* ; Disease-Free Survival ; Follow-Up Studies ; Glioblastoma* ; Humans ; Korea* ; Methylation ; Radiotherapy ; Retrospective Studies* ; Survival Rate

PURPOSE: The incidence of glufosinate poisoning is gradually increasing, and it can be fatal if severe poisoning occurs. However, factors useful for predicting the post-discharge neurological prognosis of patients who have ingested glufosinate have yet to be identified. Our objective was to evaluate the utility of the acute physiology and chronic health evaluation (APACHE) II score measured in the emergency department for predicting the neurological prognosis. METHODS: From April 2012 to August 2014, we conducted a retrospective study of patients who had ingested glufosinate. The outcome of the patients at discharge was defined by the Cerebral Performance Category Score (CPC). The patients were divided into a good prognosis group (CPC 1, 2) and a poor prognosis group (CPC 3, 4, 5), after which the APACHE II scores were compared. The Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve from patients determined calibration and discrimination. RESULTS: A total of 76 patients were enrolled (good prognosis group: 67 vs poor prognosis group: 9). The cut-off value for the APACHE II score was 12 and the area under the curve value was 0.891. The Hosmer and Lemeshow C statistic χ2 was 7.414 (p=0.387), indicating good calibration for APACHE II. CONCLUSION: The APACHE II score is useful at predicting the neurological prognosis of patients who have ingested glufosinate.
APACHE* ; Calibration ; Discrimination (Psychology) ; Emergency Service, Hospital ; Herbicides ; Humans ; Incidence ; Poisoning ; Prognosis ; Retrospective Studies ; ROC Curve

BACKGROUND/AIMS: Transarterial chemoembolization (TACE) improves the survival of patients with unresectable hepatocellular carcinoma (HCC) and has been recommended as a first-line therapy for nonsurgical patients with large or multifocal HCC. The long-term outcome of HCC patients receiving TACE prior to hepatic resection is uncertain. METHODS: Between January 1997 and December 2007, 1,530 patients underwent hepatic resection for HCC at our center. Thirty-two patients received 1~12 sessions of TACE followed by surgical resection (TACE-surgery group). Their overall and recurrence-free survival rates were compared with those of 64 age- and sex-matched controls who underwent surgery only (surgery group). Overall and recurrence-free survival rates were analyzed. RESULTS: The 1-, 2-, and 5-year overall survival rates did not differ significantly between the TACE-surgery group and the surgery group (78%, 60%, and 26%, respectively, vs. 97%, 83%, and 45%, respectively; P=0.11); however, the 1-, 2-, and 5-year recurrence-free survival rates were significantly lower in the TACE-surgery group than in the surgery group (58%, 36%, and 7%, respectively, vs. 77%, 58%, and 32%, respectively; P=0.01). The distribution of recurrence sites in the TACE-surgery group were intrahepatic in 85.7% and extrahepatic in 14.3%, and did not differ from those in the surgery group (91.4% and 8.6%, respectively; P=0.66). CONCLUSIONS: HCC patients who underwent TACE before resection appear to have overall survival rates that are comparable to those without preoperative therapy, although recurrence rates appear to be higher in patients with TACE.
Adult ; Age Factors ; Aged ; Antibiotics, Antineoplastic/administration & dosage ; Carcinoma, Hepatocellular/mortality/surgery/*therapy ; Chemoembolization, Therapeutic ; Disease-Free Survival ; Doxorubicin/administration & dosage ; Female ; Hepatectomy ; Hepatitis B/complications ; Hepatitis C/complications ; Humans ; Liver Neoplasms/mortality/surgery/*therapy ; Male ; Middle Aged ; Neoplasm Staging ; Preoperative Care ; Severity of Illness Index ; Sex Factors ; Survival Rate

Immunosuppressive therapy can improve clinical, biochemical and histological features and considerably prolong survival in patients with autoimmune hepatitis. Although ethnicity may affect disease severity and presentation, the long-term outcome of immunosuppression in Korean populations is unknown. This study was aimed to assess the efficacy of immunosuppressive therapy and determine the prognosis of autoimmune hepatitis in Korean populations. We reviewed the medical records of 86 patients diagnosed as having autoimmune hepatitis at the Samsung Medical Center between 1994 and 2008. Seventy-two (83.7%) patients reached remission after a median treatment duration of 3.5 months (range 1 to 44 months). Attempts to withdraw medications were made in 24 cases after the median treatment duration of 36 months (median 6 to 125 months). Thirteen of 24 (54.1%) patients relapsed after treatment withdrawal. Of the 86 patients, 6 (7.2%) experienced disease progression and the overall 5-and 10-yr progression-free survival rates were 91.2% and 85.5%, respectively. In conclusion, immunosuppressive therapy for autoimmune hepatitis results in a favorable rate of remission and excellent progression-free survival, but the relapse rate after treatment withdrawal is high. This suggests that long-term immunosuppressive therapy may be particularly important for treatment of Korean patients.
Adolescent ; Adult ; Aged ; Azathioprine/therapeutic use ; Disease-Free Survival ; Drug Therapy, Combination ; Female ; Hepatitis, Autoimmune/*drug therapy/mortality/pathology ; Humans ; Immunosuppressive Agents/*therapeutic use ; Male ; Middle Aged ; Prednisolone/therapeutic use ; Prognosis ; Recurrence ; Republic of Korea ; Retrospective Studies ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: Nonalcoholic steatohepatitis can develop from nonalcoholic fatty liver and progress to severe liver disease such as cirrhosis. The mechanism determining the progression from fatty liver to steatohepatitis is unknown. Iron is suspected to enhance hepatic damage associated with nonalcoholic fatty liver disease (NAFLD). The aims of this study were to evaluate the relationship of serum iron indices and hepatic iron deposition with hepatic fibrosis or inflammation, and to assess whether the increased hepatic iron deposition is an independent predictor of progression to liver injury. METHODS: The biochemical and histopathological data of thirty-nine patients with NAFLD were analyzed. Liver biopsy findings were graded according to the method described by Brunt, et al. Hepatic iron concentration was available in 29 of 39 patients. RESULTS: The mean hepatic iron concentration and hepatic iron indices were 1,349+/-1,188 microgram/g dry weight and 0.9+/-0.7 microgram/g/age. Serum ferritin and body mass indices were associated with hepatic inflammation (p=0.001, p=0.006) and fibrosis (p=0.005, p=0.013). Hepatic iron concentration and hepatic iron index were not associated with hepatic inflammation and fibrosis. Multivariate analysis did not identify serum ferritin or body mass index as an independent predictor of liver injury. CONCLUSIONS: Hepatic iron deposition shows no association with the degree of hepatic inflammation or fibrosis. Hepatic iron is not an independent predictor of hepatic injury in patients with NAFLD.
Adolescent ; Adult ; Fatty Liver/complications/*metabolism ; Female ; Ferritins/blood ; Humans ; Inflammation ; Iron/blood/*metabolism ; Liver/*metabolism/pathology ; Liver Cirrhosis/*etiology/metabolism/pathology ; Male ; Middle Aged

Snapping syndrome has rarely been reported in the knee. A snapping knee mainly occurs in the case of a translation of the lateral meniscus or a lateral discoid meniscus. Other causes include biceps femoris tendon, semitendinosus iliotibial band, and popliteus tendon. We recently experienced a case of a snapping knee caused by the semitendinosus tendon passing over the medial tibial condyle as a result of trauma.
Knee* ; Menisci, Tibial ; Tendons*

PURPOSE: To analyze the risk factors and the treatment results of the distal chevron osteotomy for the hallux valgus in young adult. MATERIALS AND METHODS: Eleven cases of hallux valgus in 9 patients who underwent the distal chevron osteotomy between February 2000 and January 2004 were included for the study. For the clinical evaluation, we used hallux-metatarsophalangeal interphalangeal scale of American Orthopaedic Foot and Ankle Society (AOFAS). For radiological evaluation, we measured hallux valgus angle (HVA) and intermetatarsal angle (IMA). RESULTS: Five patients had family history of hallux valgus. Symptoms were aggravated by military drill and sports activity. The average AOFAS scale was 62.5 preoperatively, and 88.4 at final follow-up. The HVA and IMA were 34.9 degrees, and 15.8 degrees preoperatively, 16.3 degrees and 8.2 degrees at postoperative 6 weeks, and 19.9 degrees and 9.8 degrees at final follow-up. CONCLUSION: The symptoms of hallux valgus in young adults were aggravated by military drill and sports activity. Distal chevron osteotomy was useful for the treatment of the moderate to severe hallux valgus in young patients.
Ankle ; Follow-Up Studies ; Foot ; Hallux Valgus* ; Hallux* ; Humans ; Military Personnel ; Osteotomy* ; Risk Factors ; Sports ; Young Adult*

PURPOSE: To analyze the risk factors and the treatment results of the distal chevron osteotomy for the hallux valgus in young adult. MATERIALS AND METHODS: Eleven cases of hallux valgus in 9 patients who underwent the distal chevron osteotomy between February 2000 and January 2004 were included for the study. For the clinical evaluation, we used hallux-metatarsophalangeal interphalangeal scale of American Orthopaedic Foot and Ankle Society (AOFAS). For radiological evaluation, we measured hallux valgus angle (HVA) and intermetatarsal angle (IMA). RESULTS: Five patients had family history of hallux valgus. Symptoms were aggravated by military drill and sports activity. The average AOFAS scale was 62.5 preoperatively, and 88.4 at final follow-up. The HVA and IMA were 34.9 degrees, and 15.8 degrees preoperatively, 16.3 degrees and 8.2 degrees at postoperative 6 weeks, and 19.9 degrees and 9.8 degrees at final follow-up. CONCLUSION: The symptoms of hallux valgus in young adults were aggravated by military drill and sports activity. Distal chevron osteotomy was useful for the treatment of the moderate to severe hallux valgus in young patients.
Ankle ; Follow-Up Studies ; Foot ; Hallux Valgus* ; Hallux* ; Humans ; Military Personnel ; Osteotomy* ; Risk Factors ; Sports ; Young Adult*

BACKGROUND: There are many arguments that Helicobacter pylori is a protective factor or a risk factor for GERD. Some authors reported a high incidence of reflux esophagitis in patients who had received Helicobacter pylori eradication therapy. We studied the prevalence of pathologic gastroesophageal reflux in Helicobacter pylori positive peptic ulcer patients and the effects of Helicobacter pylori eradication therapy on development of pathologic gastroesophageal reflux. METHODS: A total of 44 patients with endoscopically documented peptic ulcer disease and Helicobacter pylori infection underwent 24-hour esophageal pH monitoring and received a week of triple therapy. After three months of cessation of triple therapy, patients underwent 24-hour esophageal pH monitoring again. 24-hour esophageal pH monitoring of 44 patients were compared before and after the triple therapy. Helicobacter pylori status was evaluated by Giemsa stain, rapid urease test and urea breath test at each examination. RESULTS: The patients were classified into cured and ongoing Helicobacter pylori infection group. In cured patients group, there was no significant difference in the prevalence of pathologic gastroesophageal reflux before and after Helicobacter pylori eradication (p=0.8). In 44 patients, 30 patients had pathologic gastroesophageal reflux before eradication. In these patients, 27 patients cured Helicobacter pylori infection and 3 patients were ongoing Helicobacter pylori infection. Among 27 patients who cured Helicobacter pylori infection, 5 patients recovered from pathologic gastroesophageal reflux after eradication. In patients without pathologic gastroesophageal reflux before eradication, the prevalence of pathologic gastroesophageal reflux was not associated with Helicobacter pylori eradication (p=1). CONCLUSION: We find that the prevalence of pathologic gastroesophageal reflux in patients with peptic ulcer is high before Helicobacter pylori eradication. We suggest that Helicobacter pylori eradication in patients with peptic ulcer disease is not associated with development of pathologic gastroesophageal reflux.
Azure Stains ; Breath Tests ; Esophageal pH Monitoring ; Esophagitis, Peptic ; Gastroesophageal Reflux ; Helicobacter pylori* ; Helicobacter* ; Humans ; Hydrogen-Ion Concentration* ; Incidence ; Peptic Ulcer* ; Prevalence ; Risk Factors ; Urea ; Urease

OBJECTIVE: To assess several variables that are known as the risk factor of preeclampsia. METHODS: We have studied with 279 pregnant women who were diagnosed with preeclampsia and went through delivery in Chungnam University from January, 1998 to December, 2002. For control group, we chose 364 non-hypertensive pregnant women who went through delivery from January, 2002 to December, 2002 through random process. Through reviewing each patient's chart, we collected data regarding age, parity, past medical history, past obstetric history, family history, presence of gestational diabetes, height, body weight, before and at the time of delivery, delivery mode and neonatal outcomes. Statistical analysis was performed using x2-test, Student t-test. A value of p below 0.05 was considered to show statistical significance. RESULTS: During the study period, 298 women had preeclampsia so that the incidence of preeclampsia was 6.0%. Age and past medical history were not related to preeclampsia. The primiparous women in this study are likely to show a higher incidence of preclampsia (OR 1.35, 95% CI 1.16-1.5, p=0.017). In addition, women whose BMI are ranged from 25.0 kg/m2 to 30.0 kg/m2 (p=0.027), and ranged from 30.0 kg/m2 to 40.0 kg/m2 (p=0.027) had a higher incidence of preeclampsia. By using a multiple logistic regression analysis about the BMI changes, we found out that there was a higher rate of preeclmapsia among pregnant women with over 7.11 kg/m2 BMI increasement compared with BMZ before pregnancy (OR=2.97, 95% CI 2.22-3.99, p<0.05). Finally, women who had previous preeclmapsia were in a higher reoccurrence. According to the study, those who have hypertensive family history and twin gestation showed significantly higher risk in the incidence of preeclampsia as 1.92 fold (95% CI 1.38-2.66 and 2.61 fold (95% CI 1.29-5.29) retrospectively. CONCLUSION: Women with primiparity, BMI>or=25.0 kg/m2, previous preeclampsia, family history of chronic hypertension, twin gestation showed an increased risk of preeclampsia.
Body Height ; Case-Control Studies* ; Chungcheongnam-do ; Diabetes, Gestational ; Female ; Humans ; Hypertension ; Incidence ; Logistic Models ; Parity ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women ; Retrospective Studies ; Risk Factors*