OBJECTIVE: The purpose of this study is to review the cases of spinal plasma cell tumors treated in our department with regard to presenting symptoms and signs, diagnostic investigations, extent of surgical interventions, complications, survival time and influence on the quality of life. METHODS: In a retrospective study, twelve spinal plasma cell tumor patients who underwent surgery were evaluated between Oct. 1991 and Dec. 2000. Clinical staging system was evaluated by Durie-Salmon Staging System. RESULTS: There were multiple myeloma in nine and solitary plasmacytoma in three patients, six men and six women and aged 38 to 69 years(mean 56.8 years). The locations of the lesions were two cervical, two cervico-thoracic, three thoracic, one thoraco-lumbar, three lumbar and one sacral. The most common initial presenting symptom and sign were local pain and motor weakness. Radiographs showed pathologic compression fracture in six and the MRI finding were cortical infolding, focal to diffuse patterns of low-signal on T1WI, high signal intensity on T2WI, and variable of enhancement on Gadolinium enhanced T1W1. Sixteen operations were performed. and the adjuvant theraphy included radiotheraphy, chemotheraphy(combined oral melphalan and predinisone), and autologous PBST(peripheral blood stem cell transplantation). The follow-up period was three to sixty months(mean 27.0 months). The mean Karnofsky scale score was changed from 54.5 to 73.3 after follow up. One patient died of pulmonary metastasis and sepsis. CONCLUSION: Our experience suggests that treatment of spinal plasma cell tumor may be rewarding.
Female ; Follow-Up Studies ; Fractures, Compression ; Gadolinium ; Humans ; Karnofsky Performance Status ; Magnetic Resonance Imaging ; Male ; Melphalan ; Multiple Myeloma ; Neoplasm Metastasis ; Plasma Cells* ; Plasma* ; Plasmacytoma* ; Quality of Life ; Retrospective Studies ; Reward ; Sepsis ; Stem Cells

PURPOSE: Femorofemoral crossover bypass (FCB) is a good procedure for patients with unilateral iliac artery disease. There are many articles about the results of FCB, but most of them were limited to 5 years follow-up. The purpose of our study was to analysis the results of FCB with a 10-year follow-up period. MATERIALS AND METHODS: Between January 1995 and December 2010, 133 patients were operated in Samsung Medical Center (median follow-up: 58.8 months). We retrospectively analysed patient characteristics, the preoperative treatment, the operative procedure, and material used. RESULTS: The indications for FCB were claudication in 110 and critical limb ischemia in 23 patients. Three patients were died due to myocardiac infarction, intracranial hemorrhage, and acute respiratory failure within 30 days after surgery. The one-year primary and secondary patency rates were 89% and 97%, the 5-year primary and secondary patency rates were 70% and 85%, and the 10-year primary and secondary patency rates were 31% and 67%. The 5-year and 10-year limb salvage rates were 97% and 95%, respectively. CONCLUSION: Our long term analysis suggests that FCB might be a valuable alternative treatment modality in patients with unilateral iliac artery disease.
Extremities ; Follow-Up Studies ; Humans ; Iliac Artery ; Infarction ; Intracranial Hemorrhages ; Ischemia ; Limb Salvage ; Respiratory Insufficiency ; Retrospective Studies ; Surgical Procedures, Operative ; Transplants* ; Vascular Patency

Dieulafoy's lesion is an uncommon cause of gastrointestinal (GI) bleeding, but can be associated with massive, life-threatening GI bleeding. This lesion is an isolated protruding vessel of the submucosal artery associated with a small mucosal defect and normal surrounding mucosa. Although this lesion can occur throughout the GI tract (esophagus, stomach, duodenum, colon, rectum, etc), it has been rarely reported elsewhere than the stomach. Especially, there have been no reports of Dieulafoy lesion coexistent with early gastric cancer in Korea. We report the successful application of endoscopic hemoclipping for the treatment of a very rare Dieulafoy lesion coexistent with early gastric cancer.
Arteries ; Colon ; Duodenum ; Gastrointestinal Tract ; Glycosaminoglycans ; Hemorrhage ; Korea ; Mucous Membrane ; Rectum ; Stomach ; Stomach Neoplasms

BACKGROUND: The purpose of this study is to evaluate the patients' general perception about the analgesics and the effects of the preoperative education about analgesics and patient-controlled analgesia (PCA). METHODS: One hundred patients scheduled for elective gastrectomy were randomly allocated into two groups. In control group (n = 50), patients were given conventional preanesthetic visit with questionnaire survey on PCA one day before operation. In study group (n = 50), patients were sufficiently explained about postoperative analgesia and PCA by anesthesiologist and given precise explanation sheet about PCA. Total amounts of drug used in PCA as well as rescue analgesics, the pain scores, and side effects were compared. RESULTS: 62.2% of patients had much information from various sources that analgesics effects positively in the recovery phase, but actually 73.7% of patients considered that analgesics do not seem to have any influence on the recovery after operation. There was no difference between the amounts of total PCA used, rescue analgesics, and the pain scores. However, the educated patients complained less dizziness at postoperative days (POD) one. Also, the number of patients excluded from study due to the PCA discontinuation secondary to related side effects was less in educated patients (P = 0.025). CONCLUSIONS: Preoperative education about analgesics and PCA failed to demonstrate significant decrease in the amount of analgesics and of pain scores. However, it lowered the incidence of PCA discontinuation due to side effects.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics* ; Dizziness ; Education* ; Gastrectomy ; Humans ; Incidence ; Passive Cutaneous Anaphylaxis ; Postoperative Care

Gallbladder agenesis is a rare condition of hepatobiliary congenital anomaly. It is caused by failure of development of the caudal division of the primitive hepatic diverticulum or failure of vacuolization after the solid phase of embryonic development. It is divided into 2 groups: (1) those whose conditions are discovered clinically because of persistent symptoms and proven by abdominal exploration with operative cholangiography; and (2) those who are asymptomatic during life and whose conditions are discovered only at necropsy. If symptoms are present, they are unlikely to be related to gallbladder disease. It is impossible, at present, to make a preoperative diagnosis of gallbladder agenesis. Operative cholangiography is absolutely necessary to rule out an intrahepatic gall bladder. Confirmation at surgery and autopsy requires thorough dissection of the biliary tract and liver bed. Therefore, we presented this case with a brief review of the related literature.
Autopsy ; Biliary Tract ; Cholangiography ; Diagnosis ; Diverticulum ; Embryonic Development ; Female ; Gallbladder Diseases ; Gallbladder* ; Liver ; Pregnancy ; Urinary Bladder

OBJECTIVE: To determine the effect of shunt devices on the surgical outcome in the idiopathic normal pressure hydrocephalus(NPH), the authors present a retrospective analysis of 39 elderly patients who underwent shunt operations between November 1994 and May 2000, retrospectively. METHODS: The patients enrolled in this study did not have the history of intracranial hemorrhage, head injury, infection, cerebral infarction and brain tumor. The mean age was 69.9(range:52-89) years. Thirteen patients who received operations with simple pressure-control shunt valves(Group I), 22 patients with siphon-control shunt valves(Group II), and four patients with flow-regulating shunt valves (Group III). Final outcome with the clinical improvement and shunt associated complications were evaluated at the last follow-up and the mean follow-up period was 14.7 months. RESULTS: Signs or symptoms of shunt dysfunction were found in eight of 39 patients(20.5%) in the subsequent course. In group I, five out of 13 patients had suffered from symptomatic subdural hematomas and one from overdrainage symptoms(46.2%);in group II, two out of 22 from underdrainage(9%);in group III, one out of four from symptomatic subdural hematomas(25%). Five patients required operative shunt revisions and five underwent burr-hole trephinations for subdural hematomas. Clinical improvements were observed in 10(79.6%), 19(86.4%), and 3(75%) patients in group I, II, and III respectively. Surgical outcomes were better for patients with siphon-control shunt valves than there with the other shunt valves in terms of shunt associated complications and functional improvements(p=0.05). CONCLUSION: The shunt operation with siphon-control shunt valves might be good for the elderly patients with idiopathic NPH.
Aged ; Brain Neoplasms ; Cerebral Infarction ; Craniocerebral Trauma ; Follow-Up Studies ; Hematoma, Subdural ; Humans ; Hydrocephalus, Normal Pressure* ; Intracranial Hemorrhages ; Retrospective Studies ; Ventriculoperitoneal Shunt

BACKGROUND: Hypoglycemia is the most common therapeutic complication of diabetes mellitus and especially in elderly diabetic patients with diminished cardiac and cerebral circulation can cause serious tissue damage. Though many studies have attempted to evaluate hypoglycemia in IDDM or adult diabetic patients, few studies in the elderly. We have compared clinical characteristics of severe hypoglycemia in elderly diabetes with adult diabetes. METHODS: This study include 56 severe hypoglycemic patients who have admitted to emergency department of National Medical Center from march 1, 1992 to december 31, 1997. they are divided two group (adult group; 21, elderly group; 35) and authors investigate the cause, the symptom, the time of severe hypoglycemia, degree of education, treatment method in each group. RESULTS: 1) DM education was not well done in severe hypoglycemic patients. 2) The frequency of severe hypoglycemia in the elderly was more than adult (adult: 21 (38%), elderly 35 (62%)). 3) In both population, the most common symptom of severe hypoglycemia was neuroglycopenic symptom, especially in the elderly (adult: 57%, elderly: 77%). 4) Decreased food intake (49%) in the elderly and overdose of insulin (38%) in the adult were the most common cause of severe hypoglycemia. 5) Severe hypoglycemia occurred more often between midnight and 6 AM in the adult, between noon and 6 PM in the elderly. 6) The treatment of diabetes mellitus is insulin (71%) and oral hypoglycemic agent (29%) in the adult, oral hypoglycemic agent (51%) and insulin (49%) in the elderly. CONCLUSION: For prevention of severe hypoglycemia, we should emphasize the importance of DM education and especially elderly diabetic patients should be educated about the symptoms of hypoglycemia, the self-management of hypoglycemia, the need for a regular carbohydrate intake and more easy and effective diet program is require in elderly diabetes.
Adult ; Aged* ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diet ; Eating ; Education ; Emergency Service, Hospital ; Humans ; Hypoglycemia* ; Insulin ; Self Care

We report a case of tubulointerstitial nephritis and uveitis (TINU) syndrome in an old age female. A 66-year-old woman presented with nonspecific systemic symptoms and severe renal dysfunction. Renal biopsy showed acute interstitial nephritis and ophthalmologic examination revealed bilateral panuveitis. Evaluations for connective tissue diseases and infectious diseases were negative. She was treated with total eight sessions of hemodialysis, oral steroids and topical steroids. Renal function had improved significantly and remained stable at follow-up, although it did not fully recovered yet. TINU syndrome should be considered in cases of unexplained tubulointerstitial nephritis, especially in the presence of ocular symptom.
Acute Kidney Injury ; Aged ; Biopsy ; Communicable Diseases ; Connective Tissue Diseases ; Female ; Follow-Up Studies ; Humans ; Nephritis, Interstitial ; Panuveitis ; Renal Dialysis ; Steroids ; Uveitis

We purified phytoestrogens from Pueraria root (Pueraria mirifica from Thailand and Pueraria lobata from Korea), which is used as a rejuvenating folk medicine in Thailand and China. Dried, powdered plant material was extracted with 100% ethanol and further separated by concentration, filtration, and thin layer silica gel chromatography. Using the fractions obtained during separation, we first investigated their cytotoxicity in several cancer cell lines from various tissues. The ethanol-extracted components (PE1, PE4) had significant antiproliferative effects on breast cancer cell lines, including MCF-7, ZR-75-1, MDA-MB-231, SK-BR-3, and Hs578T. Second, we compared these results with the cytotoxic effects of known flavonoids, sterols, and coumarins from Pueraria root. The known compounds were not as effective, and occurred in a different polarity region on HPLC. Third, further separation resulted in the isolation of eight different components (Sub PE-A to -H). One of these, PE-D, affected the growth of some breast cancer cell lines (MCF-7, MDA-MB-231) in a dose- and time-dependent manner, as well as the growth of ovarian (2774) and cervical cancer cells (HeLa). Finally, a transfection assay showed that this component had an estrogenic effect similar to 17beta-estradiol, which activates both estrogen receptor a (ER alpha) and ER beta. The NMR analysis determined that spinasterol (stigmasta-7, 22-dien-3beta-ol) is an active cytotoxic component of Pueraria root.
Antineoplastic Agents/isolation & purification/*pharmacology ; Chromatography, High Pressure Liquid ; Estrogen Receptor alpha/agonists ; Estrogen Receptor beta/agonists ; Female ; Humans ; Plant Preparations/therapeutic use ; Plant Roots/*chemistry ; Pueraria/*chemistry ; Research Support, Non-U.S. Gov't ; Stigmasterol/*analogs & derivatives/isolation & purification/pharmacology ; Transfection ; Tumor Cells, Cultured

OBJECTIVE: To compare the clinical efficacy between nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen in knee osteoarthritis according to ultrasonographic findings. METHODS: We administered 12 mg of NSAIDs (lornoxicam) plus misoprostol 300microgram or 1,950 mg of acetaminophen in 40 randomly selected patients who fulfilled the ACR criteria for knee osteoarthritis. The effectiveness of these drugs on osteoarthritis was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. In addition, we performed ultrasonography of the knee joints and assessed length of capsular distension, length of medial and lateral osteophyte, amount of joint effusion, and the presence of synovial proliferation. RESULTS: There were significant correlations between WOMAC score and length of capsular distension and length of medial/lateral osteophyte. At 6 weeks, both lornoxicam and acetaminophen-treated patients had significant lower levels of WOMAC score compared to the entry into the trial (p<0.01 and p<0.05, respectively). As compared the clinical efficacy between the two groups, the lornoxicam-treated patients showed a greater decrease in WOMAC score than patients treated with acetaminophen (p=0.026). When we further divided the patients into the subgroups according to the sonographic severity, the patients with severe capsular distension (> or =0.7 cm) or severe medial osteophyte (length of osteophytes > or =0.4 cm) showed better responses to lornoxicam than to acetaminophen in terms of the reduction of WOMAC score (p=0.008 for severe capsular distension, p=0.03 for severe medial osteophyte). However, in the subgroup with mild forms of capsular distension (<0.7 cm) or medial osteophytes (<0.4 cm), no difference was found in the reduction of WOMAC score 6 weeks after treatment with lornoxicam versus acetaminophen. CONCLUSIONS: Patients with osteoarthritis of the knee had significantly greater improvements in pain score over 6 weeks with lornoxicam than with acetaminophen, particularly in patients with severe forms of capsular distension and medial osteophyte on joint ultrasonography. Ultrasonography could be an useful tool to determine the usage of NSAIDs versus acetaminophen in knee osteoarthritis patients.
Acetaminophen* ; Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Joints ; Knee Joint ; Knee* ; Misoprostol ; Ontario ; Osteoarthritis ; Osteoarthritis, Knee* ; Osteophyte ; Ultrasonography