Refractory status asthmaticus represents the most severe clinical presentations of asthma, and it is typically associated with the presence of hypoxemia, hypercapnia, lactic acidosis, dynamic hyperventilation and altered state of consciousness. Several case reports have demonstrated extracorporeal membrane oxygenation (ECMO) as an alternative treatment method for patients with status asthmaticus that failed to respond to maximal conventional therapy. We experienced a case of pregnant woman with severe asthma attack not relieved by conventional treatment, in whom early administration of ECMO resulted in a good outcome. A 23-year-old woman at, 11 weeks of pregnancy, was admitted with acute asthma attack. Despite maximal rescue therapies with mechanical ventilation, her condition gradually deteriorated. Venovenous ECMO was initiated 4 hours from intubation and gas exchange with lung mechanics was rapidly recovered within hours. She was extubated 45 hours after initiation of ECMO and had successful weaning from ECMO 2 days after extubation. The patient had no complication and gave birth to a healthy baby at 37 weeks of gestation. This is the first case report in Korea on the successful use of ECMO in a pregnant woman with severe respiratory insufficiency due to status asthmaticus, who failed to respond to mechanical ventilation and maximum pharmacological treatment. Early ECMO application is a useful treatment option for patients with refractory status asthmaticus refractory to conventional therapy.

PURPOSE: To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: Data were collected and analyzed for 2412 NMIBC patients from 15 centers who were initially diagnosed after transurethral resection of bladder tumor (TURBT) from January 2006 to December 2010. Using univariable and multivariable Cox proportional hazards models, the prognostic value of each variable was evaluated for the time to first recurrence and progression. RESULTS: With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence-free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy. CONCLUSION: A preoperative PUC result may adversely affect RFS and PFS, particularly in high-risk NMIBC patients. Of particular note, intravesical BCG induction therapy should be administered as an adjunct to TURBT in order to improve RFS and PFS in patients with T1HG cancer.
Aged ; Carcinoma in Situ/*mortality/*pathology/therapy ; Disease Progression ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*mortality/*pathology ; Prognosis ; Proportional Hazards Models ; Republic of Korea ; Retrospective Studies ; Risk ; Urinary Bladder Neoplasms/*mortality/*pathology/therapy

BACKGROUND/AIMS: Hyperglycemia is associated with decreased 2-18[F]fluoro-2-deoxy-D-glucose (FDG) uptake by tumors assessed by positron emission tomography (PET). In this retrospective study we investigated a comparison of standardized uptake values (SUVs) in patients with primary colorectal cancers who either had diabetes mellitus (DM) or were otherwise healthy. METHODS: The medical records of 397 patients who were diagnosed with colorectal cancer and underwent PET-CT between January 2006 and December 2012 were analyzed. Eighty patients with DM and 317 patients without DM were included. Clinical characteristics were reviewed and maximal standardized uptake values (SUVmax) were calculated in the primary colorectal lesions. RESULTS: There was no significant difference between tumor SUVmax in DM patients (10.60+/-5.78) and those without DM (10.92+/-5.44). In addition, no significant difference was detected between tumor SUVmax in DM patients with glycated hemoglobin (HbA1c) levels <8% (10.34+/-5.17) and those with HbA1c levels > or =8% (10.61+/-7.27). The maximum size of the primary colorectal tumor was associated with SUVmax in a linear regression analysis. CONCLUSION: The results of this study showed that DM did not influence FDG uptake values in colorectal cancer patients regardless of glucose levels.
Colorectal Neoplasms* ; Diabetes Mellitus* ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Hyperglycemia ; Linear Models ; Medical Records ; Positron-Emission Tomography* ; Retrospective Studies

This study aims to conduct the comparative analysis of the radiation dose according to before and after the calibration of the ionization chamber used for measuring radiation dose in the MDCT, as well as of CTDIW according to temperature and pressure correction factors in the CT room. A comparative analysis was conducted based on the measured MDCT (GE light speed plus 4 slice, USA) data using head and body CT dosimetric phantom, and Model 2026C electrometer (RADICAL 2026C, USA) calibrated on March 21, 2007. As a result, the CTDIW value which reflected calibration factors, as well as correction factors of temperature and pressure, was found to be the range of 0.479~3.162 mGy in effective radiation dose than the uncorrected values. Also, under the routine abdomen routine CT image acquisition conditions used in reference hospitals, patient effective dose was measured to indicate the difference of the maximum of 0.7 mSv between before and after the application of such factors. These results imply that the calibration of the ion chamber, and the correction of temperature and pressure of the CT room are crucial in measuring and calculating patient effective dose. Thus, to measure patient radiation dose accurately, the detailed information should be made available regarding not only the temperature and pressure of the CT room, but also the humidity and recombination factor, characteristics of X-ray beam quality, exposure conditions, scan region, and so forth.
Abdomen ; Calibration ; Head ; Humans ; Humidity ; Light ; Recombination, Genetic

PURPOSE: Haglund's disease represents a painful heel caused by mechanically induced inflammation of the retrocalcaneal bursa and insertional Achilles tendinosis may coexist. Traditional open surgery can cause complications such as skin breakdown, painful scar and altered sensation around the heel. Endoscopic treatment offers the advantages that are related to minimally invasive procedure and we evaluate the clinical results and operative techniques of endoscopic decompression of retrocalcaneal space for Haglund's disease. MATERIALS AND METHODS: Our retrospective study included seven heels in six consecutive patients for which nonoperative treatment had failed and endoscopic decompression was performed. The mean age was forty-one years (range, 28 to 53 years). All of the patients had typical complaints of inflammation of the retrocalcaneal bursa and Fowler-Philip angle of more than 75degrees and positive parallel pitch lines were present on the lateral calcaneal radiograph. The endoscopic procedure consists of the resection of inflamed retrocalcaneal bursa and enough bone to prevent impingement of the bursa between the calcaneus and Achilles tendon. All patients were evaluated with radiologic angle, visual analogue scale (VAS) for pain and Ogilvie-Harris functional score. The mean follow-up was 18 months (range, 15 to 21 months). RESULTS: The mean operation time was 61 minutes (range, 50 to 85 minutes). VAS for pain and Fowler-Philip angle were decreased from preoperative 8.7 and 82degrees to postoperative 2.3 and 57degrees, respectively. One patient with ankylosing spondylitis had a fair result, 2 patients had good results and the remaining 3 patients had excellent results according to Ogilvie-Harris functional score. There were no surgical complications such as infection, Achilles tendon avulsion or abnormal heel sensation. CONCLUSION: The endoscopic decompression for Haglund's disease was demonstrated to have several advantages including low morbidity, allowance of functional rehabilitation, short recovery time and quick sports resumption. However a comparative study is needed to determine the value of endoscopic decompression and particular caution should be exerted for the enthesiopathy.
Achilles Tendon ; Calcaneus ; Cicatrix ; Decompression ; Follow-Up Studies ; Heel ; Humans ; Inflammation ; Retrospective Studies ; Sensation ; Skin ; Spondylitis, Ankylosing ; Sports ; Tendinopathy

The purpose of this study was to measure and evaluate radiation dose for MDCT parameters. Patient dose for various combination of MDCT parameters were experimentally measured, using MDCT (GE light speed plus 4 slice, USA), model 2026C electrometer (RADICAL 2026C, USA), standard Polymethylmethacrylate (PMMA) head and body CT dosimetry phantoms. In clinical situations, for a typical abdominal scan performed with MDCT at 120 kVp, 180 mAs, 20 mm collimation, and a pitch of 0.75, CTDIw, CTDIvol were measured as 20.2 mGy, 26.9 mGy, respectively. When scan length is assumed as 271.3 mm, DLP and measured effective dose of the abdominal would be calculated as 729.1 mGy cm, 10.9 mSv, respectively.
Head ; Humans ; Polymethyl Methacrylate

PURPOSE: To evaluate the effectiveness and safety of fentanyl-TTS in the management of radiotherapy induced acute pain and cancer pain treated with radiotherapy. MATERIALS AND METHODS: Our study was open labelled prospective phase IV multi-center study. the study population included patients with more 4 numeric rating scale(NRS) score pain although managed with other analgesics or more than 6 NRS score pain without analgesics. Patients divided into two groups; patients with radiotherapy induced pain (Group A) and patients with cancer pain treated with radiotherapy (Group B). All patients received 25 ug/hr of fentanyl transdermal patch. Primary end point was pain relief; second end points were change in patient quality of life, a degree of satisfaction for patients and clinician, side effects. RESULTS: Between March 2005 and June 2005, 312 patients from 26 participating institutes were registered, but 249 patients completed this study. Total number of patients in each group was 185 in Group A, 64 in Group B. Mean age was 60 years and male to female ratio was 76:24. Severe pain NRS score at 2 weeks after the application of fentanyl was decreased from 7.03 to 4.01, p=0.003. There was a significant improvement in insomnia, social functioning, and quality of life. A degree of satisfaction for patients and clinician was very high. The most common reasons of patients' satisfactions was good pain control. Ninety six patients reported side effect. Nausea was the most common side effect. There was no serious side effect. CONCLUSION: Fentanyl-TTS was effective in both relieving pain with good tolerability and improving the quality of life for patients with radiotherapy induced acute pain and cancer pain treated with radiotherapy. The satisfaction of the patients and doctors was good. There was no major side effect.
Academies and Institutes ; Acute Pain ; Analgesics ; Female ; Fentanyl* ; Humans ; Male ; Nausea ; Prospective Studies ; Quality of Life ; Radiotherapy* ; Sleep Initiation and Maintenance Disorders ; Transdermal Patch*

PURPOSE: To evaluate the clinical and radiologic results of percutaneous surgical treatment of the intra-articular fractures of the distal radius, we have compared the results of percutaneous pinning and the combination of percutaneous pinning with external fixation after closed reduction. MATERIALS AND METHODS: We analysed the results of 52 patients with intra-articular fracture who received the operative treatment with closed reduction in the period of June, 1995 to June, 2001 and also were in regular follow-up at least one year. We used the subjective analysis by Cole & Obletz and the objective analysis by Scheck. RESULTS: We have found the outcome that 83.3% of percutaneous pinning were graded above "Good" in type B and C1 and 82.2% of the combination treatment of percutaneous pinning with external fixation were graded above "Good" in type C2 and C3. CONCLUSION: The percutaneous pinning and external fixator after closed reduction in intra-articular fractures of the distal radius are considered useful to restore the articular congruity and make good clinical results.
External Fixators ; Follow-Up Studies ; Humans ; Intra-Articular Fractures* ; Radius*

PURPOSE: To evaluate the modified Ender nailing technique for the treatment of femoral intertrochanteric fractures in elderly patients. MATERIALS AND METHODS: 31 cases of femoral intertrochanteric fractures treated by modified Ender nailing from May 1997 to December 2004 were included in this study. We analyzed the method of the anesthesia, amount of intraoperative blood loss, operation time, number of used nail, postoperative ability of ambulation, postoperative complication, and the time for radiological union. RESULTS: 22 cases were operated under epidural anesthesia and 9 cases under general anesthesia. The average amount of intraoperative blood loss was 55 ml and average time for operation was 37 minutes. The average number of used nails were 3.1. The postoperative ambulatory ability was clinically recovered to the preoperative ambulatory ability in 23 cases, and decreased than before in 8 cases. Postoperative complications included knee joint pain or limitation of motion of the knee joint and distal migration of the nails. The average time for radiological bone union was 17.1 weeks postoperatively. CONCLUSION: The modified Ender nailing technique is the one of the proper method in elderly femoral intertrochanteric fractures with associated medical problems. This method reduce the operation time and the amount of intraoperative blood loss.
Aged ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Femur* ; Hip Fractures ; Humans ; Knee Joint ; Postoperative Complications ; Walking

Human papillomavirus type 16 (HPV-16) plays an etiological role in benign and malignant epithelial tumors. A critical event in HPV transformation of human cells is the inactivation of retinoblastoma protein (pRB) by the E7 protein. The metabolic half-life of pRB is decreased in cells that express high-risk HPV E7 proteins. The present study investigated the frequency of HPV-16 E7 variants in Korean women and compared the pRB degradation activity of E7 variant proteins. Of the 40 HPV-positive specimens from a total of 91 tissue specimens, 21 HPV-16 positive specimens were studied by sequencing analysis to determine the variation of E7 gene. The most frequent E7 variant was N29S (57%). The HPV-16 E7 variant was more prevalent in invasive cervical cancer tissue specimens than in those from low grade clinical stage. The degradation of pRB in HaCaT cells by HPV-16 E7 variant proteins was investigated by western blot analysis. There was no significant difference in pRB degradation activity between the HPV-16 E7 prototype protein and E7 variant proteins. The pRB degradation activity did not differ among HPV-16 E7 variants. These results suggest that the E7-induced degradation of pRB is important in cervical tumorigenesis; however, there was no relation between the pRB degradation activity and the variations in HPV-16 E7 protein among Korean women.
Blotting, Western ; Carcinogenesis ; Carcinoma ; Female ; Half-Life ; Human papillomavirus 16 ; Humans* ; Retinoblastoma Protein ; Retinoblastoma* ; Uterine Cervical Neoplasms