PURPOSE: This study was done to examine the incidence of oral mucositis in hematopoietic stem cell transplantation patients and to identify factors influencing oral mucositis and patient outcomes according to severity. METHODS: In this retrospective study, data were collected from electronic medical records of 222 patients who had received hematopoietic stem cell transplantation. Oral mucositis was evaluated using WHO's assessment scale. Data were analyzed using Chi-square test, Fisher exact test, Spearman's correlation, Ordinal logistic regression, ANOVA and Kruskal-Wallis test. RESULTS: A total of 69.8% of the patients evaluated developed oral mucositis (grade II and over). As a results of ordinal regression, factors influencing oral mucositis severity were found to be diagnosis, type of transplantation, oxygen inhalation and the number of antiemetics administration before transplantation. The severity of oral mucositis was found to increase the days of hospitalization, days of TPN administration, days of using antibiotics and the number and dosage of analgesics. CONCLUSION: The results would help predict severity of oral mucositis in hematopoietic stem cell transplantation patients and suggest that provision of appropriate nursing assessment and oral care would improve patient outcomes.
Adolescent ; Adult ; Analgesics/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Body Mass Index ; Female ; *Hematopoietic Stem Cell Transplantation ; Hospitalization ; Humans ; Incidence ; Length of Stay ; Leukemia/therapy ; Logistic Models ; Male ; Middle Aged ; Oxygen Inhalation Therapy ; Parenteral Nutrition, Total ; Radiation Dosage ; Retrospective Studies ; Severity of Illness Index ; Stomatitis/*epidemiology/pathology/prevention & control ; Young Adult

OBJECTIVES: Seoul-Activities of Daily Living(S-ADL) was developed to assess elderly person's basic activities of daily living. This study aims to develop standardized ADL assessment scale and confirm the reliability and validity of the S-ADL. METHODS: It was participated in 336 controls and 145 patients diagnosed Alzheimer's disease. RESULTS: In controls, it was statistically significant to age, but not sex, education, region and presence of spouse. Also, reliability and validity were statistically significant. Principal axis factoring analysis revealed three factors that accounted for 66.67% of the total variance(1.self-care/hygiene, 2.ambulation, 3.toileting). According to each CDR stage, there were significant difference, except for CDR 0.5 and CDR 1 suggesting early dementia. Particularly, it was remarkable for functional impairment in CDR 2 and CDR 3 suggesting moderate to severe dementia. The order of the loss of function was (1) self-care/hygiene, (2) toileting, and (3) ambulation. CONCLUSIONS: Our study showed that the S-ADL could be a very reliable and valid tool for the assessment of functional disabilities of Korean dementia patients. Particularly, S-ADL would be useful in assessing daily function of moderate to severe AD.
Activities of Daily Living ; Aged ; Alzheimer Disease ; Axis, Cervical Vertebra ; Dementia ; Education ; Humans ; Reproducibility of Results* ; Spouses ; Walking

This study was designed to identify the efficiency of serum troponin-T (s-TnT) level as a diagnostic indicator for the perioperative myocardial damage with open heart surgery (OHS) and to compare with the conventional myocardial enzyme tests such as isoenzyme fraction of creatine kinase (% CK-MB) and isoenzyme ratio of lactate dehydrogenase (LDH1/LDH2 ratio). The study was performed on 30 adult patients who underwent OHS from Jan. 1996 to June 1996 at Inje University Pusan Paik Hospital, and they were divided into two groups accorfding to aortic clamping time (ACT) duration : group I (ACT<60 minutes, n=15); group II (ACT>60 minutes, n=15). S-TnT, % CK-MB, and LDH1/LDH2 ratio were measured in serial blood samples from all subjected patients. The results were obtained as follows. 1. In both groups, s-TnT concentrations increased gradually during OHS and elevated significantly at CPB-10 (p<0.001). The peak level was noticed at POD 1 in group I (1.10 +/-0.19 ng/ml), whereas, at CPB-off in group II (1.88+/-0.42 ng/ml). The elevated levels remained until POD 7 in both groups. 2. %CK-MB was risen significantly with the initiation of operations (p<0.001) and the peak levels were noticed at CPB-off in both groups (7.14+/-0.86% in group I, 10.69+/-1.27% in group II). Thereafter, these levels returned to normal values at POD 3. 3. There were no significant changes in the values of LDH1/LDH2 ratio during and after OHS compared with the control levels (p>0.05). 4. The serial changes of s-TnT were relatively well correlated with those of changes of % CK-MB (r=0.64, p<0.05). 5. The serial s-TnT levels were significantly higher in group II than group I from B-ACR to POD 1 (p<0.05), suggesting that duration of aortic clamping time was a major factor concerned with perioperative myocardial injury. In conclusion, measurement of s-TnT is a very useful indicator in assessing the myocardial cell damage and therefore it is expected that serial checking and evaluation of the s-TnT is very available for identification of the perioperative myocardial damage and for postoperative cares in patients with OHS.
Adult ; Busan ; Constriction ; Creatine Kinase ; Heart* ; Humans ; L-Lactate Dehydrogenase ; Reference Values ; Thoracic Surgery* ; Troponin T*

Mandible fractures are common in maxillofacial trauma, and condyle fracture accounts for about 25% to 35% of all mandibular fractures. Malocclusion, deviation of the mandible, temporomandibular joint dysfunction and ankylosis may result in sequelae of condylar fractures. Over the years, there has been a continuous dispute over conservative versus open surgical treatment of mandibular condylar fractures. Surgeons who prefer closed treatment cite the reduced morbidity, while surgeons who prefer surgical treatment cite minimal sequelae. From 2000 to 2003, the authors performed open reduction on 10 patients with mandible condyle fractures. Immediate relief from malocclusion and correction of mandibular midline shifting were seen in all the patients. Late temporomandibular dysfunction, ankyloses were not seen. In patients who present symptoms preoperatively, benefits of open surgery can be determined to far outweigh the morbidity in the experienced hands.
Ankylosis ; Dissent and Disputes ; Hand ; Humans ; Malocclusion ; Mandible ; Mandibular Condyle* ; Mandibular Fractures ; Temporomandibular Joint

Sialadenosis is a unique form of non-inflammatory, non-neoplastic bilateral salivary gland disorder characterized by recurrent painless swelling which usually occurs in parotid glands. Alcoholism is one of the main causes of sialadenosis along with diabetes, bulimia, and other idiopathic causes. The prognosis is verified according to the degree of liver function. We present a case of a 46 year-old man who had alcoholic fatty liver disease diagnosed as alcoholic sialadenosis based on clinical points of recurrent bilateral parotid swelling after heavy alcohol drinking, computed tomography, and fine-needle aspiration biopsy. After stopping alcohol drinking and treated with conservative treatment, he got improved without specific sequela.
Adult ; *Alcohol Drinking ; Fatty Liver, Alcoholic/*diagnosis/etiology/radiography ; Humans ; Male ; Parotid Gland/*radiography/secretion ; Positron-Emission Tomography ; Sialadenitis/*diagnosis/etiology ; Tomography, X-Ray Computed

For patients refusing surgical treatment for deep early gastric cancer, hybrid natural orifice transluminal endoscopic surgery with sentinel lymph node navigation is a potential treatment option, particularly when the anatomic location of the cancer has low probability of lymph node metastasis. We report a case of deep early gastric cancer of the fundus beyond the endoscopic submucosal dissection indication that was treated by hybrid natural orifice transluminal endoscopic surgery with sentinel lymph node navigation. In a conventional approach, a total gastrectomy would have been needed; however, the patient refused surgical intervention. In this case, since the patient showed no positivity of the sentinel lymph node on intraoperative navigation, laparoscopic basin lymph node dissection was not performed. Hybrid natural orifice transluminal endoscopic surgery might be considered for specific regions such as the safety zone where lymph node metastases are less likely to occur.
Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Lymphatic Metastasis ; Natural Orifice Endoscopic Surgery* ; Neoplasm Metastasis ; Stomach Neoplasms*

OBJECTIVE: This study is performed to evaluate the role of gamma knife radiosurgery(GKS) for treatment of patients with large number of metastatic brain lesions. METHODS: The authors retrospectively reviewed the clinical outcome of 99 patients who underwent 124 GKS procedures for a total of 564 metastatic lesions. Sixty-three patients presented with 1 to 3 lesions (group A) and 36 patients presented with 4 or more lesions (group B) at initial GKS. The authors assessed survival according to a variety of possible prognostic factors. RESULTS: Median survival from the GKS for all cases was 28 weeks. The recursive partitioning analysis (RPA) class (p<0.0001) and the total tumor volume (p=0.0174) were significant factors influencing survival. The number of lesions, whole brain radiotherapy, primary tumor site, age, and sex were not significant. Median survival of group A (28 weeks) was not different from that of group B (28 weeks) (p=0.4027). Median survival was 66, 28, and 13 weeks for RPA class I, II, and III respectively in group A and 44, 36, and 11 weeks in group B. CONCLUSION: It is suggested that GKS provides a survival gain even in patients with a large number (4 or more) of metastatic lesions. Concerning the survival and the selection of patients for radiosurgery, RPA class and the total tumor volume should be considered as more important factors than the number of lesions. Multiplicity of the lesions alone should not be a factor for contraindication of radiosurgery.
Brain* ; Humans ; Neoplasm Metastasis* ; Radiosurgery* ; Radiotherapy ; Retrospective Studies ; Tumor Burden

BACKGROUND AND OBJECTIVES: Recent studies have reported that vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF)-1alpha are up-regulated in BRAF(V600E)-positive papillary thyroid carcinoma (PTC). We investigated whether papillary thyroid microcarcinomas (PTMCs) also exhibited increased expression of VEGF and HIF-1alpha. In addition, we analyzed the relationship between BRAF(V600E) mutation and clinicopathological parameters, as well as HIF-1alpha expression in PTMC. MATERIALS AND METHODS: We retrospectively selected 225 patients with PTMC. Immunohistochemical staining for HIF-1alpha and VEGF was performed using paraffinembedded PTMC tissue microarrays. BRAF(V600E) mutation status was analyzed by dideoxy sequencing. RESULTS: PTMCs larger than 0.5 cm tend to be related to aggressive clinicopathological features such as thyroid capsular invasion (p=0.023) and bilaterality (p=0.047). Immunoreactivity to HIF-1alpha (20.7%) and VEGF (30.2%) was more prominent in PTMCs as compared to normal follicular cells. However, HIF-1alpha and VEGF expression was not correlated with clinicopathological features. BRAF(V600E) mutation was found in 70.7% (159/225) of the PTMC cases. PTMCs harboring the BRAF(V600E) mutation exhibited larger tumor sizes as compared to PTMCs without the BRAF(V600E) mutation (p=0.038). However, BRAF(V600E) mutation status did not correlate with the expression of HIF-1alpha (p=0.623) or VEGF (p=0.990). CONCLUSION: HIF-1alpha and VEGF were more frequently detected in PTMCs as compared to normal thyroid tissues. However, BRAF(V600E) mutation status was not correlated with the expression of HIF-1alpha or VEGF in PTMCs.
Carcinoma ; Carcinoma, Papillary ; Humans ; Hypoxia-Inducible Factor 1 ; Proto-Oncogene Proteins B-raf ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Vascular Endothelial Growth Factor A

BACKGROUND: Periampullary diverticulum has been commonly discovered during endoscopic retrograde cholangiopancreatography(ERCP) in patients with various pancreaticobiliary diseases such as cholelithiasis and its clinical significance has been noted. Recently, periampullary diverticulum is known to be associated with choledocholithiasis, various pancreatobiliary diseases and intestinal symptoms. Our aims of study was to investigate characteristics of periampullary diverticulum and to determinate the positive relationship between periampullary diverticulum and choledocholithiasis, and to determinate whether periampullary diverticulum influences on the cannulation rate and complication performing ERCP and endoscopic sphincterotomy(EST). METHODS: We reviewed 162 of 594 cases, which had periampullary diverticulums on ERCP during the past 6 years, and investigated size, location and number of periampullary diverticulums with special reference to the location of cholelithiasis. We also compared success rate and complication rate of ERCP and EST in cases with or without periamullary diverticulum. RESULTS: The incidence of periampullary diverticulum was 27.3%(male 48.1%, female 51.9%). and increased after 50 years old. In anatomical characteriastics of periampullary diverticulum, most of the diverticulum was single(90.1%). Size was usually smaller than 1cm(48.8%) and was seperated from ampulla of Vater, type III(59.2%). Choledocholithiasis was more frequently found in patients with periampullary diverticulum(58.9%) than in patients without diverticulum(43.1), especially in type II(attatching type). Failure rate of ERCP was 14.8% with periampullary diverticulum and was 14.6% without it. Bleeding, one of serious complications of EST, was noted in 4 patients with periampullary diverticulum, and one patient was operated to control the bleeding. CONCLUSIONS: Periampullary diverticulum might be related with choledocholithiasis, but usually does not interfere with procedure of ERCP.
Ampulla of Vater ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Cholelithiasis ; Diverticulum* ; Female ; Hemorrhage ; Humans ; Incidence ; Middle Aged

PURPOSE: There have been limited reports on breast reconstruction after excision of phyllodes tumor. This paper reports four patients who had immediate reconstruction of the breast following excision of phyllodes tumor. METHODS: We retrospectively reviewed the medical records of 14 patients from March 2000 to March 2008. Clinical data were analyzed including age, presenting symptoms and signs, type of surgery and metastasis. RESULTS: The mean age was 38.6 years. The mean follow-up period was 40.6 months. Reconstruction was performed with latissimus dorsi musculocutaneous flap in 3 patients and transverse rectus abdominis musculocutaneous flap in 1 patient. Other cases were covered with skin graft or primary repair. 2 local recurrent cases were noted. CONCLUSION: The breast affected by phyllodes tumor must undergo complete excision. Followed by mastectomy, immediate reconstruction of breast improved cosmetic results, and allowed a wider surgical excision margin of tumor.
Breast ; Cosmetics ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mastectomy ; Medical Records ; Phyllodes Tumor ; Rectus Abdominis ; Retrospective Studies ; Skin ; Transplants