No abstract available.
Angelica*

Core decompression is still widely used in avascular necrosis of the femoral head but the results are unpredictable and the indications are not settled yet. The reparative process of the decompressed femoral head is poorly understood. Seven cases in 5 patients were undertaken THRA following failed decompression and these were studied for the radiological and pathological changes of the core tracts. The lesions of failed cases were involved more than 1/3 of femoral head on MRI and all cases were stage II A or B. The extent of the necrotic area in MRI was enlarged with crack, sclerosis and sometimes gas collection. Depression of the subchondral plates were also observed. Capillary ingrowth or neovascularization was not found at all and there were only fibrosis, inflammatory response and foreign body reactions.
Capillaries ; Decompression* ; Depression ; Fibrosis ; Foreign Bodies ; Head* ; Humans ; Magnetic Resonance Imaging ; Necrosis* ; Sclerosis

Radiologic findings of the 29 cases of radiation pneumonitis and fibrosis diagnosed by chest radiography atSeoul National University Hospital were evaluated and compared with clinical symptoms according to the passage oftime after radiation therapy. The resuls were as follows; 1. The first radiographic signs of radiation pneumonitisand fibrosis were observed 7.6 weeks and 19.3 weeks after radiation therapy respectively. Especially in 8 cases ofsmall cell ca., they were found 5.6 weeks and 10.4 weeks, appearing slinghtly earlier than those of 12 cases ofsquamous cell ca. of lung. 2. The appearing time and severity of the radiographic changes of radiation pneumonitisand fibrosis had no specific relationship with field size, tumor dose or time-dose-fractionation factors of thetreatment. 3. The most constant and characteristic radiological finding of radiation pneumonitis was the sharp andstraight margin of the lesion, which was not that of normal anatomical structures of the lung. Other findings werediffuse haziness, indistinct normal pulmonary markings, alveolar and nodular densities, air-bronchograms andindistinctness of heart border. In radiation fibrosis stage, the lesion characteristic and constant finding. Otherfindings were indistinctness of heart border, diaphragmatic tenting and compensatory emphysema.
Emphysema ; Fibrosis ; Heart ; Lung ; Radiation Pneumonitis ; Radiography ; Thorax

PURPOSE: To compare the tissue reactions of various water-soluble and oil-based contrast agents on the endometrium, salpingeat mucosa, and peritoneum. MATERIALS AND METHODS: Thirty-three rabbits were used for evaluating the histologic reactions of uterine endometrium, salpinx, and peritoneum. Hysterosalpingography(HSG) was underwent in these rabbits by using Lipiodol, Hexabrix, Rayvist, Ultravist-300, Ultravist-370, and normal saline. Pathotogic results were obtained in each of the six groups from the uterine endometrium, salpingeal mucosa, and peritoneum without knowledge of the contrast agent used and time interval from HSG. RESULTS: Mild inflammations were observed in the endometrium, salpingeal mucosa, and peritoneum during the first week of HSG in all rabbits in which water-soluble contrast agents were used. Although there was no significant difference in the degree of inflammation among the groups using various contrast agents, the group with oil-based contrast agent(Lipiodoi) showed delayed absorption of contrast agent in the peritoneum, frequent intravasation, fat granuloma, peritoneal adhesion, or uterine infarction. CONCLUSION: Our results suggest that water-soluble contrast agents can be used safely for HSG, but the use of oil-based contrast agent is questionable in safety and should be avoided in patients with tubal obstruction, salpingitis, or endometritis.
Absorption ; Contrast Media* ; Endometritis ; Endometrium* ; Ethiodized Oil ; Fallopian Tube Diseases ; Fallopian Tubes ; Female ; Granuloma ; Humans ; Infarction ; Inflammation ; Ioxaglic Acid ; Mucous Membrane* ; Peritoneum* ; Rabbits ; Salpingitis

Spontaneous testicular hemorrhagic necrosis is a rare disease usually associated with testicular torsion. Partially involved and suspicious testis tumor cases are also defined from orchiectomy specimens. Herein, a spontaneous hemorrhagic necrosis, without any testicular torsion, but with involvement of the whole testicle and epididymis, is reported. A 21 year old patient, who presented with a painless left testicular enlargement of several days duration was believed, based on physical examination, ultrasonography and elevation of serum LDH, to have a testicular tumor. Diagnosis was made only after radical orchiectomy and histopathological examination.
Diagnosis ; Epididymis ; Hemorrhage ; Humans ; Male ; Necrosis* ; Orchiectomy ; Physical Examination ; Rare Diseases ; Spermatic Cord Torsion ; Testis* ; Ultrasonography ; Young Adult

OBJECTIVE: To evaluate the effect of neuromuscular electrical stimulation (NMES) therapy on swallowing dysfunction in patients with chronic (more than 6 months) dysphagia caused by stroke. METHOD: A total of 16 patients with stroke-caused swallowing disorders based on a videofluoroscopic swallowing study (VFSS) were treated with NMES for two weeks. NMES was applied to the skin over the anterior neck muscles for one hour a day. Swallowing function was evaluated by the functional dysphagia scale using the VFSS, clinical dysphagia scale and the American Speech-Language Hearing Association National Outcomes Measurements System Swallowing Scale (ASHA NOMS scale) before and after electrical stimulation. Follow up VFSS was performed one month after intervention. RESULTS: After completing ten treatment sessions, aspiration, reflex coughing and the total score in the clinical dysphagia scale were significantly decreased (p<0.05). There was also a significant improvement in the ASHA NOMS scale (p<0.05). Regarding the functional dysphagia scale, the residue in the valleculae and piriformis sinus, and total scores were significantly decreased (p<0.05). Specifically, the scores of the pharyngeal phase were mainly decreased as compared to that of the oral phase. In addition, these effects were maintained one month after the intervention as measured with functional dysphagia scale. CONCLUSION: After ten sessions of NMES, we found improvement in dysphagia parameters in chronic dysphagia patients. Specifically, residue in the valleculae and piriformis sinus, and a parameter of the pharyngeal phase were significantly improved.
Cough ; Deglutition ; Deglutition Disorders* ; Electric Stimulation Therapy* ; Electric Stimulation* ; Follow-Up Studies ; Hearing ; Humans ; Neck Muscles ; Reflex ; Skin ; Stroke*

PURPOSE: The objective of this study was to assess the supportive needs of breast cancer patients and determine the socio-demographic and clinicopathological predictors of those unmet needs. METHODS: Of 302 eligible breast cancer patients, attending Yonsei University Severance Hospital, 250 completed the surveys. The supportive care needs were assessed by administering a Supportive Care Needs Survey. RESULTS: Of the ten highest perceived needs items, 7 items were related to the health system and information domain and 2 to the psychological domain. The univariate analysis in each domain showed education (P=0.083) and chemotherapy (P=0.042) were significant predictors in the psychological domain; education (0=0.000), time since surgery (P=0.009), node metastasis (0.022), chemotherapy (P=0.001) and radiation therapy (P=0.003) in the physical and daily living domain; age (P=0, 009) and duration of marriage (P= 0.004) for sexuality; node metastasis (P=0.048), TNM stage (P=0.036), and recurrence (P=0.010) in the health system and information domain and religion (P=0.016) in the care and support domain. A multivariate analysis showed age (P=0.0253) and chemotherapy (P=0.0517) as significant independent predictors in the sexuality domain; education (P=0.0010), chemotherapy (P=0.0011), radiation therapy (P= 0.0133) and time since surgery (P=0.036) in the physical and daily living domain; recurrence (P=0.0324) in the health system and information; domain and education (P=0.0134) and chemotherapy (P=0.0207) in psychological domain. CONCLUSION: Breast cancer patients experience high levels of unmet supportive needs across each domain, but especially in the health systems and information domain. Also, the types of needs varied according to the patient subgroups. This study suggests considerable improvements be made in terms of supportive care of breast cancer patients.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Education ; Humans ; Marriage ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Sexuality

No abstract available.
Esophagus* ; Melanoma*

PURPOSE: This study was to examine the effects of 3 domains of continuing education (CE) for healthcare managers. METHODS: A group of 20 healthcare managers, attending 3 levels of CE, were the subjects. The data were collected by structured questionnaires before and after each education. The data were analyzed by Friedman test, Wilcoxon Signed Ranked Test, and Bonferroni correction. RESULTS: After completing CE, there was significant improvement on the scores of knowledge, attitude, and skills. CONCLUSION: This study suggests that CE for healthcare managers is an effective strategy to promote the competency of healthcare managers, who take care of the chronically ill patients.
Chronic Disease ; Delivery of Health Care ; Education, Continuing ; Humans ; Surveys and Questionnaires

Thrombomodulin (TM) is thrombin receptor present on the luminal surface of endothelial cells. Because the thrombin-TM complex acts as an anticoagulant, the functional variants or deficiency of TM may lead to increment of thrombotic tendency. In this study, we screened the genetic variants of the TM gene in patients with myocardial infarction (MI) and analyzed the genotype to elucidate the effects of genetic variations of TM gene on the development of the MI. We screened a promoter region and coding sequence of the TM gene using single strand conformation polymorphism-heteroduplex analysis and identified three common genetic variants: those were TM G-33A, TM Ala455Val, and TM C1922T. The genotype frequencies were investigated in the patients with MI (n=234) and control subjects (n=291) by the method of allele-specific oligomer hybridization. The frequencies of mutant genotypes (TM -33A, TM 455Val, and TM 1922T) were higher in patient group compared to the control subjects in males while there were no significant differences in females. In the multiple logistic regression analysis, TM 455Val and TM 1922T alleles were independent risk factors for MI (OR[95% CI: 1.799[1.125-2.878] p=0.014 and 5.624[1.019-31.025], p=0.048, respectively) in males. However, the genetic variations were not independent risk factors for MI in females. There were significant linkage disequilibriums among three genetic variants. These linkage disequilibriums explain the similar effects of three genetic variants on the development of MI. To investigate the effect of the TM G-33A mutation on TM promoter activity, the two TM promoter constructs (pTM-355 and pTM-125, bearing TM -33G or TM -33A) containing of firefly luciferase gene were transfected into HepG2, BAE, and CHO cells. The promoter activities were higher in the promoter constructs with TM -33G compared to the constructs with TM -33A in pTM-355. These results suggest the possibility of the positive predisposing effect of TM -33A allele on MI in males. The functional study for TM Ala455Val and TM C1922T should be followed to elucidate the genotype effects of these mutations on the development of MI. In this study, we identified three genetic variants of TM gene and showed the significant associations between genetic variants and MI in males. These results proposed that TM gene is an attractive candidate for genetic risk factor for MI in Koreans.
Alleles ; Animals ; CHO Cells ; Clinical Coding ; Cricetinae ; Endothelial Cells ; Female ; Fireflies ; Genetic Variation ; Genotype ; Humans ; Linkage Disequilibrium ; Logistic Models ; Luciferases ; Male ; Myocardial Infarction* ; Phenobarbital ; Promoter Regions, Genetic ; Receptors, Thrombin ; Risk Factors* ; Thrombomodulin