Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in infants. Life-threatening RSV infection is often reported in young children and immunocompromised hosts. Since there is no report on ribavirin therapy for RSV pneumonia in pediatric cancer patients in Korea, we report one case of RSV pneumonia that developed in an infant with acute lymphoblastic leukemia (ALL). Despite administration of oral ribavirin and intravenous immunoglobulin, the patient's respiratory distress worsened and admission to an intensive care unit was necessary. Chest x-ray showed multifocal consolidation, pneumothorax, and pneumomediastinum. Treatment with aerosolized ribavirin led to significant clinical improvement. The role of aerosolized ribavirin is still controversial, but it might have a therapeutic potential for severe RSV pneumonia in children with leukemia.
Child ; Humans ; Immunocompromised Host ; Immunoglobulins ; Infant ; Intensive Care Units ; Korea ; Leukemia ; Mediastinal Emphysema ; Pneumonia ; Pneumothorax ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Ribavirin ; Thorax

The long-term studies of total knee arthroplasty (TKA) have confirmed reliable relief of pain and maintenance of function. However there have been few generalized studies of factors influencing the results of TKA. We evaluated retrospectively 187 TKAs (137 patients) which had been performed between January 1987 and May 1995. The follow-up period was from one year to eight years (mean, 3 years and 8 months). There were 133 knees of osteoarthritis (OA), 43 knees of rheumatoid arthritis (RA) and 11 knees of other causes including septic knee sequelae. We considered the preoperative factors as age, sex, side (right or left), body weight, height, primary disease, flexion contracture (FC), further flexion (FF), range of motion (ROM) of joint, deformity of varus and valgus and pain score, muscle strength score, instability score, total knee score according to the knee rating scale of the Hospital for Special Surgery (HSS). We considered the clinical results as FC, FF, ROM, pain, muscle strength, instability, total knee score according to the knee rating scale of the HSS and the radiological results as Roentgenographic Evaluation and Scoring System of American Knee Society and radiolucent line more than 2mm in width. We evaluated the clinical and radiological results of TKAs followed up more than I year and analyzed the results based on above factors. The results were as follows: 1. The preoperative factors influencing final FC were not the primary disease and FC, but the FF and ROM. The preoperative factors influencing final FF and ROM were the primary disease, the FF and ROM. 2. The pain, muscle power, instability scores were improved but there was no significant factor influencing them. The HSS knee scores were higher in OA group than RA group postoperatively. 3. There was no preoperative factor influencing the complication, revision, the radiological results. The preoperative factors influencing the results of TKA were the FF, ROM and the primary disease.
Arthritis, Rheumatoid ; Arthroplasty* ; Body Weight ; Congenital Abnormalities ; Contracture ; Follow-Up Studies ; Joints ; Knee* ; Muscle Strength ; Myalgia ; Osteoarthritis ; Range of Motion, Articular ; Retrospective Studies

Nineteen revision total knee arthroplasties (TKAs) performed from March 1991 to March 1995 were evaluated to determine the clinical and roentgenographic results and the problems in revision TKA. The mean age was 63 years (range, 23-85 years) and the mean follow-up time was 19 months (range, 12 months-4.4 years). The primary revisions were done in eighteen knees and a re-revision, in one. Four revision TKAs were performed for failed unicompartmental arthroplasty and fifteen, for failed TKA. The mean interval from initial to revision TKA was 4.1 years (range, 3.3 years-5 years) in failed unicompartmental arthroplasty and 5.7 years (range, 4 months-14 years) in failed TKA. The initial diagnosis was degenerative arthritis in 16 knees, tuberculous arthritis in two and rheumatoid arthritis in one. The main cause of revision for both of the failed unicompartmental arthroplasties and failed TKAs was aseptic loosening. The HSS knee score improved from 43+/-14 to 82+/-7 in the failed unicompartmental arthroplasties and from 46+/-16 to 79+/-14 in the failed TKAs. The clinical success rate of revision TKA was 78%. The coronal tibiofemoral angle improved from valgus 0.2degrees to valgus 5.1degrees. At final follow-up, radiolucent line greater than 2mm in width was found around femoral component in one knee. In our series, four complications were occurred. One knee was fused due to mas-sive bone loss and ipsilateral femur shaft fracture. Deep wound infections were developed in two knees and loss of fixation after tibial tuberosity osteotomy in one. In conclusion, significant improvements of clinical and radiological results were achieved in revision TKA but the success rate was relatively low and the complication rate was relatively high compared with primary TKA. So, especially appropriate skillful surgical techniques and postoperative cares were required to overcome the soft tissue problem and infection which was encountered in revision TKA.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty* ; Diagnosis ; Femur ; Follow-Up Studies ; Knee* ; Osteoarthritis ; Osteotomy ; Wound Infection

Results of 170 total knee arthroplasties(TKAs) performed from 1986 to 1995, followed up for at least one year, were reviewed. Lateral retinacular release was performed in 76 knees(45%) and not performed in 94 knees(55%). We compared the results of TKAs combined with lateral retinacular release with those without lateral retinacular release. The clinical results of TKAs were evaluated by the Knee Scoring System of Hospital for Special Surgery(HSS). The average follow-up period was 34 months. The clinical results assessed by HSS score, pain score and range of motion improved postoperatively in both groups, but there was no significant difference between the two groups. There were 8(4.7%) with patellar subluxations in 170 TKAs, one(1.3%) in the group with lateral retinacular release and 7(7.5%) in the group without lateral retinacular release(t-test; p<0.05). Analysis of lateral tilt of patella on roentgenographs also showed a significant difference between the two groups. 7 knees(9.2%) with lateral tilt were observed in the group with lateral retinacular release and 22 knees(23.4%) with lateral tilt in the group without lateral retinacular release(t-test; p<0.05). There was no osteonecrosis or fracture of patella in either group. In summary, lateral retinacular release might improve the patellar tracking and lower the incidence of patellar subluxation and lateral tilt of patella. Lateral retinacular release alone did not seem to cause patellar osteonecrosis and subsequent patellar fracture which were detectable in plain roentgenographs. So, we suggest that lateral retinacular release can be performed without great risk of potential patellar complications in TKAs requiring lateral retinacular release for proper patellar tracking.
Arthroplasty* ; Follow-Up Studies ; Incidence ; Knee* ; Osteonecrosis ; Patella ; Range of Motion, Articular

To examine the effectiveness and safety of erythropoietin on the anemia of end-stage chronic renal failure, we administered recombinant human erythropoietin(rHuEPO), Eporon(R), to 66 patients with anemia and chronic renal failure who were undergoing hemodialysis or peritoneal dialysis. All received Eporon(R) intravenously, two or three times per week at 150unit/kg, and then the dose of Eporon(R) was adjusted to 75-300unit/kg/week according to the hemoglobin response. The results of this study judged 19(39.6%) of 48 patients as being in a "markedly improved" condition while 23(47.9%) of 48 patients were judged as being in an "improved" condition. At results, the response rate of this study was 87.5%(42/48 patients). This was the same as the target response rate, 90%(p= 0.564). Serious adverse events occured in 6 cases during the study, but all proved to be unrelated to Eporon(R). These events included itching 1(1.5%), urticaria 1(1.5%) and headache 1(1.5%). No patients discontinued to participate in the study except one patient who withdrew from the study voluntarily. The symptoms of all adverse events eventually decreased and disappeared during the clinical study. No factors in the clinical laboratory tests changed significantly (p<0.05) except for the decrease of TSR and ferritin, a consequence of using iron hemoglobin synthesis caused by Eporon(R) administration. The significant increase in blood pressure, which could not be proved to be related to Eporon(R), disappeared during the study. Anti-Epo antibody was not detected in any samples. These results demonstrate that Eporon(R) is effective in many patients with the anemia of end-stage chronic renal failure.
Anemia* ; Blood Pressure ; Erythropoietin ; Ferritins ; Headache ; Humans* ; Iron ; Kidney Failure, Chronic* ; Peritoneal Dialysis ; Pruritus ; Renal Dialysis ; Urticaria

BACKGROUND/AIMS: Guidelines for current postoperative colonoscopic surveillance are not specified in colorectal cancer (CRC) patients with synchronous adenoma (SA). We performed this retrospective study to determine the postoperative colonoscopic surveillance interval for the CRC patients with SA. METHODS: One hundred and twenty-four CRC patients with SA (SA-group) and the same number of patients without SA (NSA-group) were selected from our database. Two groups were matched by the stage of CRC. Median colonoscopic surveillance period was 55 (12-99) months. The colonoscopic surveillance frequency and interval were similar between the two groups. RESULTS: Mean age was higher and male was more frequent in SA-group than NSA-group (p= 0.0001). The incidence of missed adenoma, advanced missed adenoma and metachronous adenoma (MA) were higher in SA-group (30.8% vs. 5.8% at 1st yr., p=0.0001; 4.4% vs. 0%, p=0.0001; 31.1% vs. 9.1% at 2nd yr., p=0.016) during the first consecutive two years of surveillance. The MA- and advanced-MA-free survival rate were lower in SA-group (24.6% vs. 6.6%, p=0.0001; 4.1% vs. 0%, p=0.02) during three years after surgery. Dysplasia of the SA (p=0.04; OR, 110.3; 95% CI, 1.13-10742.6) and presence of missed adenoma (p=0.036; OR, 43.6; 95% CI, 1.28-1490.1) were risk factors for the advanced MA on a multivariate analysis in SA-group. CONCLUSIONS: Postoperative colonoscopic surveillance at first year after surgery is warranted in CRC patients with SA.
Adenoma/diagnosis/*surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoma/diagnosis/*surgery ; Colonic Neoplasms/diagnosis/*surgery ; *Colonoscopy ; Colorectal Neoplasms/diagnosis/*surgery ; Disease-Free Survival ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary/diagnosis/*surgery

It has been reported that the maintenance of proper ligament balance around the knee joint and the proper location of tibio-femoral joint line position are very important factors for obtaining good knee joint function after the total knee replacement arthroplasty. but, yet the exact effect of the change of joint line on the result of total knee replacement arthroplasty has not been elucidated. The purpose of this study is to evaluate the effect of the change of joint line on the patellar position and the postoperative knee joint function as well as the effect of antero-posterior offset of tibial component on the clinical result. The authors performed the clinical and radiological analysis of 85 knees, in which total knee replacement arthroplasty was performed and followed over 1 year. Tibio-femoral joint line changed from -7mm to +6.8mm (average -0.07) and in this range, the change of joint line did not influence the clinical result and the patellar position. As tibio-femoral joint line migrated proximally, the patella migrated distally and as tibio-femoral joint line migrated distally, the patella migrated proximally. Postoperative pain decreased as the patella and patellar articular surface moved proximally. As the patellar bone height from tibial tuberosity decreased postoperatively. The range of motion decreased. Antero-ppsterior offset of tibial component distributed from -4.2mm to +4.5mm (average 0.62mm) and no effect on cllinical result in this range. In conclusion, it may be suggested that the change of joint line in total knee replacement arthroplasty must be changed as little as possible for the good postoperative range of motion and relief of pain.
Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Joints* ; Knee ; Knee Joint ; Ligaments ; Pain, Postoperative ; Patella ; Range of Motion, Articular

BACKGROUND: Androgenic alopecia (AGA) is the most common type of hair loss. It is likely inherited genetically and is promoted by dihydrotestosterone. 5α-reductase has been proven a good target through finasteride use. However, the pathogenesis of AGA cannot be fully explained based only on dihydrotestosterone levels. OBJECTIVE: To identify similar hairloss inhibition activity of RE-ORGA with mode of action other than finasteride. METHODS: We prepared RE-ORGA from Korean herb mixtures. We performed MTT assays for cytotoxicity, Cell Counting Kit-8 assays for cell proliferation, and western blot to identify expression levels of 5α-reductase and Bax. RNA-sequencing was performed for the expression patterns of genes in dihydrotestosterone-activated pathways. Anti-inflammatory activity was also assessed by the expression levels of tumor necrosis factor-alpha (TNF-α) and interleukin 6. RESULTS: REORGA could promote the proliferation of human dermal papilla cells and showed low cytotoxicity. It also inhibited the expression of 5α-reductases and Bax in the cells. RNA-sequencing results verified that the mRNA expressions of SRD5A1, Bax, transforming growth factor-beta 1 (TGF-β1), and TGF-β1 induced transcript 1 (TGFβ1I1) were decreased, whereas expression of protein tyrosine kinase 2 beta (PTK2β) was more elevated. REORGA also showed anti-inflammatory activity through decreased mRNA levels of TNF-α. CONCLUSION: Transcriptionally, up-regulation of PTK2β and concomitant down-regulation of TGFβ1I1 imply that RE-ORGA can modulate androgen receptor sensitivity, decreasing the expression of 5α-reductase type II and Bax together with TGF-β1 transcripts; RE-ORGA also showed partial anti-inflammatory activity. Overall, RE-ORGA is expected to alleviate hair loss by regulating 5α-reductase activity and the receptor's androgen sensitivity.
Alopecia ; Blotting, Western ; Cell Count ; Cell Proliferation ; Cholestenone 5 alpha-Reductase ; Dihydrotestosterone ; Down-Regulation ; Finasteride ; Hair ; Humans ; Interleukin-6 ; Protein-Tyrosine Kinases ; Receptors, Androgen ; RNA, Messenger ; Tumor Necrosis Factor-alpha ; Up-Regulation

OBJECTIVE: To evaluate the usefulness of 10% dextrose swallowing test (DST) to detect aspiration for patient with tracheostomy in comparison with modified blue dye test (MBDT). METHOD: Fifteen brain injured patients with tracheostomy were tested by DST and MBDT. The newly developed DST consists of 3 steps. In the first step, 5 cc 10% dextrose solution is fed 3 times by spoon. In the second step, tracheal secretion is sampled by suction catheter just before swallowing, and 30 seconds, 90 seconds after swallowing. In the third step, tracheal secretion is smeared to glucose oxidase test strip to detect aspiration with color change from pink to purple. MBDT with 0.01 % methylene blue solution was also performed in the same order. The tracheal secretion was smeared to the white paper to see the color change to blue. Videofluoroscopic swallowing study (VFSS) was performed for 9 out of 15 patients. RESULTS: Fourteen out of 15 patients showed the same outcome in DST and MBDT (kappa=0.815). Seven out of 9 patients showed the same outcome in DST and VFSS (kappa=0.571). Eight out of 9 patients showed the same outcome in MBDT and VFSS (kappa=0.780). CONCLUSION: The DST is a reliable method to detect aspiration for patient with tracheostomy.
Brain ; Catheters ; Deglutition* ; Glucose Oxidase ; Glucose* ; Humans ; Methylene Blue ; Suction ; Tracheostomy*

OBJECTIVE: To develop and evaluate newly designed orthosis to control contracture of the shoulder and the forearm in the spastic upper limb. METHOD: Subjects were 6 hemiplegic patients and 1 tetraplegic patient who showed the features of spasticity. Volar wrist hand orthosis was modified to attach a plastic stick which can be easily separated. The orthosis was applied in supinated position for 8 weeks. The shoulder and elbow range of motion was measured every 2 weeks for 8 weeks. RESULTS: The subjects with spasticity showed significant improvement in the shoulder abduction (p<0.05), adduction (p<0.05) and external rotation (p<0.05) after applying modified volar wrist hand orthosis for 8 weeks. The forearm supination was well maintained for 8 weeks. CONCLUSION: The newly designed orthosis showed significant effects in the improvement of the shoulder abduction, adduction and external rotation and the forearm supination of spastic upper limbs.
Contracture* ; Elbow ; Forearm* ; Hand ; Humans ; Muscle Spasticity* ; Orthotic Devices* ; Plastics ; Range of Motion, Articular ; Shoulder* ; Supination ; Upper Extremity ; Wrist