PURPOSE: Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) to antiepileptic drug (AED), are rare, but result in significant morbidity and mortality. We investigated the major culprit drugs, clinical characteristics, and clinical course and outcomes of AED-induced SCARs using a nationwide registry in Korea. METHODS: A total of 161 patients with AED-induced SCARs from 28 referral hospitals were analyzed. The causative AEDs, clinical characteristics, organ involvements, details of treatment, and outcomes were evaluated. We compared the clinical and laboratory parameters between SJS/TEN and DRESS according to the leading causative drugs. We further determined risk factors for prolonged hospitalization in AED-induced SCARs. RESULTS: Carbamazepine and lamotrigine were the most common culprit drugs causing SCARs. Valproic acid and levetiracetam also emerged as the major causative agents. The disease duration and hospital stay in carbamazepine-induced SJS/TEN were shorter than those in other AEDs (P< 0.05, respectively). In younger patients, lamotrigine caused higher incidences of DRESS than other drugs (P= 0.045). Carbamazepine, the most common culprit drug for SCARs, was associated with a favorable outcome related with prolonged hospitalization in SJS (odds ratio, 0.12; 95% confidence interval, 0.02-0.63, P= 0.12), and thrombocytopenia was found to be a risk factor for prolonged hospitalization in DRESS. CONCLUSION: This was the first large-scale epidemiological study of AED-induced SCARs in Korea. Valproic acid and levetiracetam were the significant emerging AEDs causing SCARs in addition to the well-known offending AEDs such as carbamazepine and lamotrigine. Carbamazepine was associated with reduced hospitalization, but thrombocytopenia was a risk factor for prolonged hospitalization. Our results suggest that the clinical characteristics and clinical courses of AED-induced SCARs might vary according to the individual AEDs.
Anticonvulsants ; Carbamazepine ; Cicatrix ; Drug Hypersensitivity Syndrome ; Epidemiologic Studies ; Hospitalization ; Humans ; Incidence ; Korea ; Length of Stay ; Mortality ; Referral and Consultation ; Risk Factors ; Stevens-Johnson Syndrome ; Thrombocytopenia ; Valproic Acid

BACKGROUND AND OBJECTIVES: This study compared two types of skin graft reconstruction for the defect of the radial forearm free flap. SUBJECTS AND METHOD: Ten cases of split-thickness skin graft (STSG) harvested from the thigh were analyzed. Also, ten cases of full-thickness skin graft (FTSG) harvest from the inguinal area applied with vacuum-assisted closure (VAC) system were analyzed. RESULTS: The defect size of the radial forearm was increased more in the STSG group than in the FTSG group (p<0.05). Skin grafts were recovered completely sooner in the FTSG group than in the STSG group although it was not statistically significant (p=0.082). Five complications (pruritus, hypertrophic scar) were found in the donor site in the STSG group (p<0.05). FTSG gave better scores according to the Vancouver Scar Scale in terms of pigmentation, pliability, and height (p<0.05). CONCLUSION FTSG harvested from the inguinal area with the application of VAC system has many advantages for the defect of the radial forearm free flap although it is usually used for smaller size defects than for STSGs.

BACKGROUND AND OBJECTIVES: This study compared two types of skin graft reconstruction for the defect of the radial forearm free flap. SUBJECTS AND METHOD: Ten cases of split-thickness skin graft (STSG) harvested from the thigh were analyzed. Also, ten cases of full-thickness skin graft (FTSG) harvest from the inguinal area applied with vacuum-assisted closure (VAC) system were analyzed. RESULTS: The defect size of the radial forearm was increased more in the STSG group than in the FTSG group (p<0.05). Skin grafts were recovered completely sooner in the FTSG group than in the STSG group although it was not statistically significant (p=0.082). Five complications (pruritus, hypertrophic scar) were found in the donor site in the STSG group (p<0.05). FTSG gave better scores according to the Vancouver Scar Scale in terms of pigmentation, pliability, and height (p<0.05). CONCLUSION: FTSG harvested from the inguinal area with the application of VAC system has many advantages for the defect of the radial forearm free flap although it is usually used for smaller size defects than for STSGs.
Cicatrix ; Forearm ; Free Tissue Flaps ; Humans ; Methods ; Negative-Pressure Wound Therapy ; Pigmentation ; Pliability ; Reconstructive Surgical Procedures ; Skin Transplantation ; Skin ; Thigh ; Tissue Donors ; Transplants

PURPOSE: We evaluated the prognostic significance of T3 subtypes and the role of adjuvant radiotherapy in patients with resected the American Joint Committee on Cancer stage IIB T3N0M0 non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: T3N0 NSCLC patients who underwent resection from January 1990 to October 2009 (n = 102) were enrolled and categorized into 6 subgroups according to the extent of invasion: parietal pleura chest wall invasion, mediastinal pleural invasion, diaphragm invasion, separated tumor nodules in the same lobe, endobronchial tumor <2 cm distal to the carina, and tumor-associated collapse. RESULTS: The median overall survival (OS) and disease-free survival (DFS) were 55.3 months and 51.2 months, respectively. In postoperative T3N0M0 patients, the tumor size was a significant prognostic factor for survival (OS, p = 0.035 and DFS, p = 0.035, respectively). Patients with endobronchial tumors within 2 cm of the carina also showed better OS and DFS than those in the other T3 subtypes (p = 0.018 and p = 0.016, respectively). However, adjuvant radiotherapy did not cause any improvement in survival (OS, p = 0.518 and DFS, p = 0.463, respectively). Only patients with mediastinal pleural invasion (n = 25) demonstrated improved OS and DFS after adjuvant radiotherapy (n = 18) (p = 0.012 and p = 0.040, respectively). CONCLUSION: The T3N0 NSCLC subtype that showed the most favorable prognosis is the one with endobronchial tumors within 2 cm of the carina. Adjuvant radiotherapy is not effective in improving survival outcome in resected T3N0 NSCLC.
Carcinoma, Non-Small-Cell Lung* ; Diaphragm ; Disease-Free Survival ; Humans ; Joints ; Pleura ; Prognosis ; Radiotherapy, Adjuvant* ; Thoracic Wall

PURPOSE: To investigate the care patterns for radiation therapy and to determine inter-hospital differences for patients with laryngeal carcinoma in Korea. MATERIALS AND METHODS: A total of 237 cases of laryngeal carcinoma (glottis, 144; supraglottis, 93) assembled from 23 hospitals, who underwent irradiation in the year of 1998 and 1999, were retrospectively analyzed to investigate inter-hospital differences with respect to radiotherapy treatment. We grouped the 23 hospitals based on the number of new patients annually irradiated in 1998; and designated them as group A (> or =900 patients), group B (> or =400 patients and <900 patients), and group C (<400 patients). RESULTS: The median age of the 237 patients was 62 years (range, 25 to 88 years), of which 216 were male and 21 were female. The clinical stages were distributed as follows: for glottis cancer, I; 61.8%, II; 21.5%, III; 4.2%, IVa; 11.1%, IVb; 1.4%, and in supraglottic cancer, I; 4.3%, II; 19.4%, III; 28.0%, IVa; 43.0%, IVb; 5.4%, respectively. Some differences were observed among the 3 groups with respect to the dose calculation method, radiation energy, field arrangement, and use of an immobilization device. No significant difference among 3 hospital groups was observed with respect to treatment modality, irradiation volume, and median total dose delivered to the primary site. CONCLUSION: This study revealed that radiotherapy process and patterns of care are relatively uniform in laryngeal cancer patients in Korean hospitals, and we hope this nationwide data can be used as a basis for the standardization of radiotherapy for the treatment of laryngeal cancer.
Female ; Glottis ; Humans ; Immobilization ; Korea ; Laryngeal Neoplasms ; Male ; Retrospective Studies

PURPOSE: The purpose of this study is to analyze the most discriminative MR findings for making the differential diagnosis of tuberculous and pyogenic spondylitis. MATERIALS AND METHODS: Sixty MR scans of 18 pyogenic spondylitis patients and 42 tuberculous spondylitis patients were retrospectively reviewed. The statistical analysis was performed using stepwise discriminant analysis and Student's T-test. RESULTS: The patients with tuberculous spondylitis had a significantly higher incidence of MRI findings as follows (p <0.05): smooth margin of a paraspinal mass/abscess in 67% [28/42] of the tuberculous spondylitis patients vs 6% [1/18] in the pyogenic spondylitis patients, mild endplate erosion in 52% [22/42] vs 38% [7/18], respectively, the presence of paraspinal mass/abscess in 100% [42/42] vs 6% [1/18], respectively, central dark signal intensity of the abscess in 86% [36/42] vs 39% [7/18]), respectively, subligamentous spread in 81% [34/42] vs 50% [9/18]), respectively, severe vertebral collapse in 20% [8/42] vs 11% [2/18]), respectively, and posterior extension in 62% [26/42] vs 33% [6/18]), respectively. Among of them, the significant discriminative MR findings were the margin of a paraspinal mass, the grade of endplate erosion and the presence or absence of a paraspinal mass in that order. CONCLUSION: In the differentiation of tuberculous and pyogenic spondylitis, the margin of the paraspinal mass, the grade of endplate erosion and the presence or absence of a paraspinal mass are the most three discriminating MR findings in that order.
Abscess ; Diagnosis, Differential ; Humans ; Incidence ; Magnetic Resonance Imaging ; Retrospective Studies ; Spondylitis*

Mini implants had been used provisionally for the healing period of implants in the beginning. But it becomes used for the on-going purpose, because it is simple to use, economic and especially suitable for the overdenture. But there is few studies about the stability of mini implants, that is most important factor for the on-going purpose, and particularly the implant parameters affecting the initial stability. The purpose of this study was to evaluate the stress and the strain distribution pattern of immediate- loaded screw type orthodontic mini-implant and the parameters affecting the initial stability of immediate-loaded mini-implant. Two dimensional finite element models were made and contact non-linear finite element analysis was performed. The magnitude and distribution of Von Mises stresses were evaluated. The obtained results were as follows: 1. The stress was concentrated on the thread tip of an implant in the cortical bone. 2. The direction of load is the most important factor for the stress distribution in cortical bone. 3. The diameter of an implant is the most important factor for the stress distribution in the trabecular bone. In conclusion, if the horizontal load vector is successfully controlled, mini-implants, which diameter is under 3mm, can be used for the on-going purpose.
Denture, Overlay ; Finite Element Analysis

OBJECTIVE: To develop a Korean version of Modified Barthel Index (K-MBI) for subjects with stroke and to test the reliability and validity of K-MBI. METHOD: Six senior physiatrists translated the 5th version of MBI into K-MBI and we administered K-MBI to 30 subjects with stroke. Fifteen different examiners working at the 5 different university hospitals evaluated video-recorded examination cases independently to test the reliability and validity of K-MBI. We analyzed intra- and inter-rater reliabilities of the K-MBI by the Kendall's coefficient of concordance and Spearman's correlation coefficients, respectively. Cronbach's alpha coefficient was used for assessing internal consistency of the K-MBI and Spearman's correlation between the K-MBI and Brunnstr?m stage was employed to evaluate the validity of the K-MBI. RESULTS: The intra-rater reliabilities of physiatrists, resident physicians of rehabilitation medicine and occupational therapists were 0.93~1.00, 0.87~0.99, and 0.97~1.00 (p< 0.01), respectively. The inter-rater reliabilities were 0.93~0.98 (p<0.01) and Cronbach's alpha was 0.84 (p<0.01) as the internal consistency reliability of K-MBI. For construct validation study, each item of K-MBI had significant correlation with total score of K-MBI (r=0.54~0.78, p< 0.01). CONCLUSION: The K-MBI is a reliable and valid instrument for measuring functional status of subjects with stroke.
Hospitals, University ; Rehabilitation ; Reproducibility of Results ; Stroke*

OBJECTIVE: The purpose of this study was to evaluate the reliability of patient pain drawings using a 3-dimensional (3D) virtual human body system. METHOD: Pain drawings were collected from thirty-four patients with various types of musculoskeletal pain. On the first clinic visit, patients were instructed to draw in their pain areas on a diagram depicting the body (P1). The examining physiatrist, blinded to the patients drawing, also drew in the pain areas on a separate diagram based on thorough history taking (D). After 2 to 9 days without treatment, patients repeated their pain drawings (P2). A second physiatrist input each of the pain drawings into thePain Chart System (PCS), for comparison of pain distribution sites and areas among the three drawings. The weighted-sum of comparison algorithms was calculated for similarity determinations between drawings. RESULTS: The similarity values between P1 and P2, and P1 and D were 0.63+/-0.18 (mean+/-S.D.) and 0.62+/-0.18 (mean+/-S.D.), respectively, reflecting a high reliability of pain drawings. CONCLUSION: High test-retest and inter-individual reliability of successive pain drawings suggest that pain drawings may be a useful tool to describe the painful sites.
Ambulatory Care ; Human Body* ; Humans ; Humans* ; Musculoskeletal Pain

Complement-mediated neutrophil activation has been hypothesized to be an important mechanism of reperfusion injury. It has been proposed that C1 esterase inhibitor (C1 INH) may prevent the complement-dependent activation of polymorphonuclear leukocytes (PMNs) that occurs within postischemic myocardium. Therefore, The effect of C1 INH was examined in neutrophil dependent isolated perfused rat heart model of ischemia (I) (20 min) and reperfusion (R) (45 min). Administration of C1 INH (5 mg/Kg) to I/R hearts in the presence of PMNs (100 X 106) and homologous plasma improved coronary flow and preserved cardiac contractile function (p<0.001) in comparison to those I/R hearts receiving only vehicle. In addition, C1 INH significantly (p<0.001) reduced PMN accumulation in the ischemic myocardium as evidenced by an attenuation in myeloperoxidase activity. These findings demonstrate the C1 INH is a potent and effective cardioprotective agent inhibits leukocyte-endothelial interaction and preserves cardiac contractile function and coronary perfusion following myocardial ischemia and reperfusion.
Animals ; Complement C1 Inhibitor Protein* ; Complement C1s* ; Heart* ; Ischemia* ; Myocardial Ischemia ; Myocardium ; Neutrophil Activation ; Neutrophils ; Perfusion ; Peroxidase ; Plasma ; Rats* ; Reperfusion Injury ; Reperfusion*