The intra-articular osteochondroma arising from soft tissue is very rare and has been reported less than a dozen cases in the English literature. This tumor is the result of extrasynovial metaplasia of the fibrous capsule or of the adjacent connective tissue of a joint. The authors experienced a case of giant intra-articular osteochondroma of the right knee in a 37 year-old man which arised from the medial meniscus. Histology as well as gross findings were consistent with osteochondroma. Excision of the mass with attached meniscus relieved symptoms. No recurrence, or malignant change was identified up to 1 year after excision.
Connective Tissue ; Joints ; Knee ; Menisci, Tibial ; Metaplasia ; Osteochondroma ; Recurrence

No abstract available.
Induction Chemotherapy*

OBJECTIVE: Most of the studies that have described surgical procedures for moyamoya disease(MMD) have had the aim to improve the blood flow mainly in the middle cerebral artery(MCA) territory. The purpose of this study is to clarify the good indications for a multiple burrhole operation to treat MMD. METHODS: With the patient under local anesthesia, burrhole trephination with a diameter of 1.5 to 2cm at 3 to 5cm lateral to the midline was performed in a total of 18 hemispheres during 12 procedures. The burrholes were opened in the frontal lobe at 19 sites in 10 patients and in the parietal lobe at 22 sites in 12 patients. Revascularization through multiple burrholes and arachnoid openings was performed in 12 patients who suffered from MMD. RESULTS: As seen on the follow up angiograms, good revascularization was achieved in 27 of 41 burrholes, and mainly from the middle meningeal artery and then from the superficial temporal artery. The moyamoya vessels were decreased in four patients. The neovascularization covered 68.4% of the frontal lobe and 63.5% of the parietal lobe. Compared with the preoperative 99mTc-HMPAO-SPECT, 6 patients showed improvement of cerebral blood flow on the postoperative 99mTc-HMPAO-SPECT. Transient ischemic attack disappeared in three of the four patients who presented with this symptom, and the preoperative symptoms improved in both of the patients who presented with headache and cerebral infarction. CONCLUSIONS: A multiple burrhole operation is a simple technique. The results of our series suggest that the revascularization obtained for adult MMD patients who underwent a multiple burrhole operation is similar to that obtained with other indirect surgeries, but long term follow up studies are needed.
Adult ; Anesthesia, Local ; Arachnoid ; Cerebral Infarction ; Follow-Up Studies ; Frontal Lobe ; Headache ; Humans ; Ischemic Attack, Transient ; Meningeal Arteries ; Moyamoya Disease ; Parietal Lobe ; Temporal Arteries

BACKGROUND: Aging is a significant issue worldwide, and Korea is one of the most rapidly aging countries. Along with the demographic transition, the age structure of intensive care unit (ICU) patients changes as well. METHODS: The aim of this study was to analyze the change in age distribution of the ICU patients over the last 10 years and its effect on clinical outcomes. Single-center, retrospective analysis of all patients aged ≥18 years admitted to either the medical or surgical ICU at St. Paul's Hospital, The Catholic University of Korea, between January 2005 and December 2014 was conducted. For clinical outcome, in-hospital mortality, duration of ICU stay, and hospital stay were analyzed. Cost analysis was performed to show the economic burden of each age strata. RESULTS: A total of 10,366 ICU patients were admitted to the chosen ICUs during the study period. The proportion of elderly patients aged ≥65 years increased from 47.9% in 2005 to 63.7% in 2014, and the proportion of the very elderly patients aged ≥80 years increased from 12.8% to 20.7%. However, this increased proportion of elderly patients did not lead to increased in-hospital mortality. The percent of ICU treatment days attributable to elderly patients increased from 51.1% in year 2005 to 64.0% in 2014. The elderly ICU patients were associated with higher in-hospital mortality compared to younger age groups. CONCLUSIONS: The proportion of elderly patients admitted to ICUs increased over the last decade. However, overall in-hospital mortality has not increased during the same period.
Age Distribution ; Aged* ; Aging ; Costs and Cost Analysis ; Critical Care* ; Hospital Mortality ; Humans ; Intensive Care Units* ; Korea* ; Length of Stay ; Mortality ; Population Dynamics ; Retrospective Studies*

No abstract available.
Family Practice* ; Hospitals, Community* ; Humans

No abstract available.
Intensive Care Units ; Sepsis ; Critical Illness ; Chronic Disease ; Hospital Mortality

PURPOSE: To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. MATERIALS AND METHODS: Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using 192Ir between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. RESULTS: The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT +/- external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (< or =grade 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. CONCLUSION: HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.
Brachytherapy* ; Humans ; Mouth Neoplasms ; Mouth* ; Radiotherapy ; Recurrence ; Retrospective Studies

BACKGROUND: Extramammary Paget's disease (EMPD) is an intraepidermal adenocarcinoma which usually affects elderly individuals. Due to its multifocal nature and indistinct demarcation from normal skin, recurrences are common, even after invasive surgical treatment. Topical application of imiquimod, an immune response modifier, has been reported to be effective in the treatment of not only anogenital warts, but also cutaneous malignancies such as actinic keratoses and basal cell carcinoma. There are only a few case reports on the treatment of EMPD with topical imiquimod in the literature. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of topical imiquimod for the treatment of EMPD. METHODS: Seven elderly patients (6 male and 1 female), whose ages ranged from 60 to 81 years (average, 68.4 years), were diagnosed with anogenital EMPD, which were further confirmed by skin biopsy. None of the patients were found to have associated internal neoplasms. Considering the patients' ages and morbidity associated with invasive treatment options, they were instructed to topically apply 5% imiquimod cream on their skin lesions once to three times a week. Imiquimod was applied for an average of 29.5 weeks. The patients were followed up on a monthly or bimonthly basis for any adverse affects or changes to the lesions. Residual lesions were surgically excised in 2 patients after 5 and 8 months of imiquimod application. RESULTS: With long-term imiquimod application, all 7 subjects experienced transient irritation, erythema, focal erosion, or hypopigmentation of the application site. One patient experienced flu-like symptoms. Clinical cure was observed in all 7 patients during treatment, and/or early observation period. However, a pathologic cure was observed in 2 patients only. The lesions recurred in 3 patients during the follow-up period. CONCLUSION: Since imiquimod has strong advantages in the preservation of function and cosmetics, it could be an effective primary treatment option for primary limited cutaneous EMPD, especially in elderly patients.
Adenocarcinoma ; Aged ; Biopsy ; Carcinoma, Basal Cell ; Erythema ; Follow-Up Studies ; Humans ; Hypopigmentation ; Keratosis, Actinic ; Male ; Paget Disease, Extramammary* ; Recurrence ; Skin ; Warts

We evaluated the antihypertensive effect of amlodipine, a calcium channel bloker, in 35 cases of essential hypertention. After 12 weeks' administration(5~10mg q.d.), the following results were obtained : 1) The systoloic and diastolic blood pressure were decreased significantly(170.3+/-12.2mmHg vs 143.7+/-13.0mmHg p<0.01 and 104.7+/-5.9mmHg vs 87.8+/-6.5mmHg, p<0.01, respectively) but the heart rate was independant of amlodipine administration. 2) The systolic blood pressure was lowered by 20mmHg or more in 26(76.5%) of 34 patients and the diastolic pressure was lowered by 10mmHg or more in 26(76.5%) of 34 patients at 12 weeks after amlodipine administration. 3) The adverse effects of amlodipine were dizziness in 5, edema in 5, indigestion in 3, constipation in 2, headache, flushing, insomnia in 1 patient respectively and only one of them discontinued amlodipine administration due to severs facial flushing and skin eruption.
Amlodipine* ; Blood Pressure ; Calcium Channels ; Constipation ; Dizziness ; Dyspepsia ; Edema ; Flushing ; Headache ; Heart Rate ; Humans ; Skin ; Sleep Initiation and Maintenance Disorders

OBJECTIVE: To determine the effective and safe dose of Dysport(R) (one of the commercial botulinum toxins) for relieving the spasticity of calf muscle in cerebral palsy. METHOD: Twenty spastic cerebral palsy children (34 limbs) were randomly assigned to a high dose (HD; 16 Unit/kg/limb) injection group and low dose (LD; 8 Unit/kg/limb) injection group. Locomotor rating scale (LRS) and para meters of 3 dimensional gait analysis including ankle dorsiflexion angle at stance phase (MADA), maximal dynamic gastrocnemius (MDGL) and soleus length (MDSL) were assessed before, 4 weeks after, and 12 weeks after injection. RESULTS: Mean LRS, MADAs, MDGLs and MDSLs were significantly increased both 4 and 12 weeks after injection in HD group. In LD group, LRS, MADAs, MDGLs and MDSLs showed some improvement but they were statistically insignificant. The high dose had no adverse effect except the mild and transient weakness, which was tolerable to the cerebral palsy patients. CONCLUSION: The present study demonstrated the high dose injection of Dysport was more effective than the low dose injection to relieve the spasticity of calf muscle in cerebral palsy.
Ankle ; Botulinum Toxins* ; Cerebral Palsy* ; Child ; Gait ; Humans ; Muscle Spasticity*