No abstract available.
Aged* ; Humans

No abstract available.
Aneurysm, False* ; Carotid Artery, Internal* ; Epistaxis*

PURPOSE: This study was tried to evaluate the potential benefits of concurrent chemoradiation therapy (low dose daily cisplatin combined with split course radiation therapy) compared with conventional radiation therapy alone in stage III non-small cell lung cancer. The end points of analyses were response rate, overall survival, survival without locoregional failure, survival without distant metastasis, prognostic factors affecting survival and treatment related toxicities. MATERIAL AND METHODS: Between April 1992 and March 1994, 32 patients who had stage III non-small cell lung cancer were treated with concurrent chemoradiation therapy. Radiation therapy for 2 weeks (300cGy given 10 times up to 3000cGy) followed by a 3 weeks rest period and then radiation therapy for 2 more weeks (250cGy given 10 times up to 2500cGy) was combined with 6mg/M2 of cisplatin. Follow-up period ranged from 13 months to 48 months with median of 24 months. Historical control group consisted of 32 patients who had stage III non-small cell lung cancer were received conventionally fractionated (daily 170-200cGy) radiation therapy alone. Total radiation dose ranged from 5580cGy to 7000cGy with median of 5940 cGy. Follow-up period ranged from 36 months to 105 months with median of 62 months. RESULTS: Complete reponse rate was higher in chemoradiation therapy (CRT) group than radiation therapy (RT) group (18.8% vs. 6.3%). CRT group showed lower in-field failure rate compared with RT group (25% vs. 47%). The overall survival rate had no significant differences in between CRT group and RT group (17.5% vs. 9.4% at 2 years). The survival without locoregional failure (16.5% vs. 5.3% at 2 years) and survival without distant metastasis (17% vs. 4.6% at 2 years) also had no significant differences. In subgroup analyses for patients with good performance status (Karnofsky performance scale 80), CRT group showed significantly higher overall survival rate compared with RT group (62.5% vs. 15.6% at 2 years). The prognostic factors affecting survival rate were performance status and pathologic subtype (squamous cell cancer vs. nonsquamous cell cancer) in CRT group. In RT alone group, performance status and stage (IIIa vs IIIb) were identified as a prognostic factors. RTOG/EORTC grade 2-3 nausea and vomiting (22% vs. 6%) and bone marrow toxicities (25% vs. 15.6%) were significantly higher in CRT group compared with RT alone group. The incidence of RTOG/EORTC grade 3-4 pulmonary toxicity had no significant differences in between CRT group and RT group (16% vs. 6%). The incidence of WHO grade 3-4 pulmonary fibrosis also had no significant differences in both group (38% vs. 25%). In analyses for relationship of field size and pulmonary toxicity, the patients who treated with field size beyond 200cm2 had significantly higher rates of pulmonary toxicities. CONCLUSION: The CRT group showed significantly higher local control rate than RT group. There were no significant differences of survival rate in between two groups. The subgroup of patients who had good performance status showed higher overall survival rate in CRT group than RT group. In spite of higher incidence of acute toxicities with concurrent chemoradiation therapy, the survival gain in subgroup of patients with good performance status were encouraging. CRT group showed higher rate of early death within 1 year, higher 2 year survival rate compared with RT group. Therefore, to evaluate the accurate effect on survival of concurrent chemoradiation therapy, systematic follow-up for long term survivors are needed.
Bone Marrow ; Carcinoma, Non-Small-Cell Lung* ; Cisplatin ; Follow-Up Studies ; Humans ; Incidence ; Nausea ; Neoplasm Metastasis ; Pulmonary Fibrosis ; Survival Rate ; Survivors ; Vomiting

PURPOSE: The technique of partial liver transplantation from a living donor was developed to expand the donor pool. However such small grafts may not only be functionally inadequate for the recipient, but will also sustain injury characterized by cholestasis and histological features of ischemia after implantation. Damage to partial liver grafts after reperfusion is frequently observed but the mechanism of injury remains unclear. Injury to partial liver grafts may be related to changes in portal blood flow. In this study, we investigated the histologic changes of the reperfusion of livers after revascularization through the portal vein or hepatic artery following heterotopic partial liver transplantation in rats. METHODS: Inbred Lewis partial liver were transplanted to inbred Brown Norway rats heterotopically in three groups. The first group of transplants, Group I (Portal vein group, n=3) was reperfused firstly through the portal vein. The second group, Group II (Hepatic artery group, n=3) was firstly reperfused through the hepatic artery. The third group, Group III (Control, n=1) was sham-operated. After reperfusion, the liver grafts were procured and fixed in formalin. The reperfusion livers were studied using immunohistochemical staining and in-situ RT PCR. RESULTS: In the H&E staining of the reperfusion livers there were no differences between groups I and II. Using immunohistochemical staining of TNF,R, FAS L, caspase 8 and in-situ RT PCR (NOS mRNA, TNF,R mRNA, FAS mRNA), the hepatic artery first reperfusion liver showed more damage than the portal vein first reperfusion liver. TUNEL staing showed severe apoptosis in hepatic artery reperfusion liver. CONCLUSION: The expression of the apoptosis molecular markers was more prominent in the reperfused liver performed with initial revascularization using the hepatic artery, rather than portal vein. These findings may be due to fact that the high oxygen blood in the hepatic artery is stressful to the reperfusion liver. The routinely used portal vein first revascularization technique decrease reperfusion injury to the graft when compared to hepatic artery first revascularization.
Animals ; Apoptosis ; Arteries ; Caspase 8 ; Cholestasis ; Formaldehyde ; Hepatic Artery* ; Humans ; In Situ Nick-End Labeling ; Ischemia ; Liver Transplantation* ; Liver* ; Living Donors ; Norway ; Oxygen ; Polymerase Chain Reaction ; Portal Vein* ; Rats* ; Reperfusion Injury ; Reperfusion* ; RNA, Messenger ; Tissue Donors ; Transplants ; Veins

Problems of birth defects and low birth weight are important issues of public health because most infant mortality are caused by these two. To discover the etiology of birth defects and low birth weight, it is necessary to establish epidemiological birth defects monitoring system in Korea. With the rapid growing of internet usage in korea, the computer network has become the popular means of communicating and sharing of information. Our aim was to develop web-based reporting and database management system in Incheon to establish birth defects monitoring system to evaluate the incidence rate and patterns of birth defects in Korea. Public health center and private hospitals and clinics participated in this monitoring system. Web based reporting system have been built and operated during 2 years (first year: December 1st, 1998-November. 31, 1999; second year: January 1st, 2000 - December 31th, 2000). Trained nurses actively collected the records obtained from delivery units in the participating hospitals. During first and second year, the incidence rate of birth defect per thousand person was 10.0 and 8.0 respectively. In conclusion, we could build web-based monitoring system for birth defects successfully in Yonsu gu, Incheon. It could be a model of national standard for population-based monitoring system for birth defects in Korea.
Congenital Abnormalities* ; Database Management Systems ; Hospitals, Private ; Humans ; Incheon* ; Incidence ; Infant ; Infant Mortality ; Infant, Low Birth Weight ; Infant, Newborn ; Internet ; Korea ; Parturition* ; Public Health

OBJECTIVES: Hearing loss disrupts the balance of auditory-somatosensory inputs in the cochlear nucleus (CN) of the brainstem, which has been suggested to be a mechanism of tinnitus. This disruption results from maladaptive auditory-somatosensory plasticity, which is a form of axonal sprouting. Axonal sprouting is promoted by transforming growth factor (TGF)-β signaling, which can be inhibited by losartan. We investigated whether losartan prevents maladaptive auditory-somatosensory plasticity after hearing loss. METHODS: The study consisted of two stages: determining the time course of auditory-somatosensory plasticity following hearing loss and preventing auditory-somatosensory plasticity using losartan. In the first stage, rats were randomly divided into two groups: a control group that underwent a sham operation and a deaf group that underwent cochlea ablation on the left side. CNs were harvested 1 and 2 weeks after surgery. In the second stage, rats were randomly divided into either a saline group that underwent cochlear ablation on the left side and received normal saline or a losartan group that underwent cochlear ablation on the left side and received losartan. CNs were harvested 2 weeks after surgery. Hearing was estimated with auditory brainstem responses (ABRs). Western blotting was performed for vesicular glutamate transporter 1 (VGLUT1), reflecting auditory input; vesicular glutamate transporter 2 (VGLUT2), reflecting somatosensory input; growth-associated protein 43 (GAP-43), reflecting axonal sprouting; and p-Smad2/3. RESULTS: Baseline ABR thresholds before surgery ranged from 20 to 35 dB sound pressure level. After cochlear ablation, ABR thresholds were higher than 80 dB. In the first experiment, VGLUT2/VGLUT1 ratios did not differ significantly between the control and deaf groups 1 week after surgery. At 2 weeks after surgery, the deaf group had a significantly higher VGLUT2/VGLUT1 ratio compared to the control group. In the second experiment, the losartan group had a significantly lower VGLUT2/VGLUT1 ratio along with significantly lower p-Smad3 and GAP-43 levels compared to the saline group. CONCLUSION: Losartan might prevent axonal sprouting after hearing loss by blocking TGF-β signaling thereby preventing maladaptive auditory-somatosensory plasticity.
Animals ; Axons ; Blotting, Western ; Brain Stem ; Cochlea ; Cochlear Nucleus ; Evoked Potentials, Auditory, Brain Stem ; GAP-43 Protein ; Hearing Loss ; Hearing ; Losartan ; Plastics ; Rats ; Tinnitus ; Transforming Growth Factors ; Vesicular Glutamate Transport Protein 1 ; Vesicular Glutamate Transport Protein 2

PURPOSE: We studied 250 men who are over 50 years of age to evaluate the feature of benign prostatic hyperplasia and its impact on quality of life in rural areas of the Korea. MATERIALS AND METHODS: Two hundred fifty men participated in this study. Urinalysis, urine culture, uroflowmetry, digital rectal examination and serum PSA were examined on all the participants. Transrectal ultrasonography(TRUS) were performed in 234 men. RESULTS: Of these 250 men, symptom prevalence was 78.71%. The age distributions of 50-59, 60-69, 70-79 and > or =80 years of age were 91, 111, 43 and 5 men respectively(mean 62.4). The mean prostatic volumes for 50-59, 60-69, 70-79 and > or =80 years of age group were 27.33cm3, 29.95cm3, 28.89cm3 and 33.55cm3. Of these, its volume difference was not statistically significant. Of 250 men, mildly symptomatic group(IPSS< or =7) was 22.5%, moderately symptomatic group(8< or =IPSS< or =19) 43%, and severely symptomatic group(IPSS> or =20) 34.5%. Severely symptomatic group showed higher mean age(p=0.0478), lower maximal flow rate(MFR)(p=0.024) and average flow rate(AFR)(p=0.003). Mildly symptomatic group showed smaller prostatic volume(p=0.013). Mean quality of life score for mildly, moderately, and severely symptomatic group were 2.09, 3.50, and 4.51 points, the score of which showed statistical difference(p<0.001). On comparison between the group of MFR<15ml/sec and the group of MFR> or =15ml/sec, statistical difference for the mean age (p<0.001), voided volume (p<0.001), QOL (p=0.02) and symptom score (p=0.002) was found. But no difference was found in prostatic volume(p=0.261). MFR, AFR and voided volume did not show significant correlation with prostatic volume. But serum PSA level was strongly correlated with prostatic volume. The AFR was a greatest determinant to symptom score in multiple regression analysis. CONCLUSIONS: The symptom prevalence in rural areas of the Korea is not any less than that of western society. This study shows that it too has a great impact on the quality of life in rural Korea. The prostatic volume itself had no significance on symptom score nor uroflowmetric parameters. The uroflowmetric parameter such as MFR is more important in evaluating symptomatic patients than prostatic volume itself.
Age Distribution ; Digital Rectal Examination ; Gangwon-do* ; Humans ; Korea ; Male ; Prevalence ; Prostatic Hyperplasia* ; Quality of Life* ; Ultrasonography ; Urinalysis

In literatures, most of the studies of severe hyponatremia during or following its treatment has been concentrated with special references to the rate of correction and its neurologic outcomes. But, there is relatively few ones analyzing the diverse clinical manifestations of neurologic symptorns or complications during the course of treating severe hyponatremia. We experienced a catastrophic course related to hyponatremia in a 51 year woman with severe rheumatoid arthritis, who underwent knee joint replacement, and this case revealed the initial transient neurologic recovery for 3 days by the initial rapid correction of hyponatremia, then followed by delayed deterioration of osmotic demyelination syndrome leading to locked-in syndrome. Reported cases with similar clinical course (biphasic course) in the world lituratures were reviewed with special interests in the initial maximum rate of correction of hyponatremia and radiologic findings. This review suggests that clinicians treating the patients with severe symptomatic hyponatremia should be aware of the possibility of delayed neurologic sequelae despite the recovery of neurologic status as well as the degree of hyponatremia in the early treatment course of hyponatremia.
Arthritis, Rheumatoid ; Demyelinating Diseases* ; Female ; Humans ; Hyponatremia ; Knee Joint ; Quadriplegia

PURPOSE: To evaluate the classification of punctal stenosis based on the shape of the external punctum, clinical characteristics and histopathologic features. METHODS: Patients who experienced tearing and were diagnosed with punctal stenosis were evaluated in this study. Punctal stenosis was classified according to the shape of the lower external punctum, which included membranous type, slit type, horseshoe type, and pinpoint type. Tear meniscus height, 2% fluorescein dye disappearance test and lacrimal pathway irrigation were measured or performed. For treatment, a punctal snip operation and silicone tube placement were performed, and the peripunctal histopathological findings were evaluated. RESULTS: Punctal stenosis was classified into four types: membranous type (17 eyes, 21.5%), slit type (11 eyes, 13.9%), horseshoe type (25 eyes, 31.6%), and pinpoint type (26 eyes, 32.9%). The tear meniscus was significantly higher, and the 2% fluorescein dye disappeared significantly more slowly in the punctal stenosis group. However, correlation of the tear meniscus height and 2% fluorescein dye disappearance test with the punctum shape was not statistically significant. A history of previous chemotherapy was significantly associated with the occurrence of punctal stenosis, especially the membranous type (p < 0.05). Histopathologic evaluation of the punctum showed differences between the punctum types. Pinpoint puncta exhibited a high density of muscle fibers, while they were faintly visible in the membranous type. CONCLUSIONS: Acquired punctal stenosis has various shapes, and the major types of stenotic puncta exhibited unique histopathologic features. Punctal stenosis and its pathophysiology may be related to multiple factors, such as age and systemic 5-fluorouracil chemotherapy history.
Classification* ; Constriction, Pathologic* ; Drug Therapy ; Fluorescein ; Fluorouracil ; Humans ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases* ; Silicon ; Silicones ; Tears

PURPOSE: To evaluate the clinical significance of renal excretion of oral Gastrografin in gastric resectionpatients. MATERIAL AND METHOD: Seven days affter gastric resection, eight normal volunteers and 30 patientsunderwent abdominal and CT scanning before and 1-1.5 his after oral administiration of Gastrografin. Theattenuation coefficients of the bladder were measured and the maximal attenuation difference between pre-andpost-gastrografin administration was calculated. RESULTS: In the control group, there was no abnormal renalexcretion of oral Gastrografin, though in 83 % of patients(25 of 30), this was demonstrated as focal increase inthe density (> or = 20 HU) of the bladder and/or collecting system, or ureteral opacification. Mean maximal densitydifference was 84.4+/-82.9HU in the patient group (n=24), with renal excretion of enteral Gastrografin and,3.5+/-4.4 HU in the control group (n=7), with statistical significance (Student's t-test, p<0.01). No patientshowed either radiological or clinical evidence of direct leakage from the suture site. Patients who underwenttotal gastrectomy showed a higher maximal density difference than those in whom gastrectomy was subtotal. CONCLUSION: Unless direct leakage is visvalized on fluoroscopy or spot films, renal excretion of oralGastrografin should not be regarded as a sign of anastomotic leakage. Situations other than leakage, e. g.increased mucosal permeability or absorption, or increased bowel transit time in postoperative duration, should beconsidered as possible causes.
Absorption ; Administration, Oral* ; Anastomotic Leak ; Diatrizoate Meglumine* ; Fluoroscopy ; Gastrectomy ; Healthy Volunteers ; Humans ; Permeability ; Sutures ; Tomography, X-Ray Computed ; Ureter ; Urinary Bladder