OBJECTIVE: The aim of this study was to evaluate the consistency between revised prognostic score derived from the Tokuhashi scoring system(TSS) and the actual patient survival period after surgical treatment at our institution. METHODS: From 1998 to 2005, surgically treated 44 patients with metastatic spine tumors were reviewed retrospectively at our institution. Among these 44 patients, 32 had died, 2 were alive at the time of the last follow-up evaluation, and 10 were lost to the follow-up. Only 32 patients who died after surgery have been investigated in this study. Preoperatively, patients were staged serveral standard diagnostic modalities, such as, plain radiographs, computed tomography, magnetic resonance imaging and etc. Each patient was evaluated using the TSS and placed in one of three groups depending upon this evaluation. RESULTS: The actual mean(+/-SD) survival period was 6.6 months(+/-1.14) for the first group (predicted survival periods in revised TSS, less than 6 months), 15.1 months(+/- 5.38) for the second group(predicted survival periods in revised TSS, 6 months or more) and 37.5 months(+/-8.70) for the third group(predictied survival period in revised TSS, 1 year or more). The survival periods for these groups were significantly different(p=0.0006). Applying the TSS for evaluation of prognosis of metastatic spinal tumors was found to be very reliable results with a statistically significance. Of six parameters measured in the TSS, Extraspinal bone metastases, metastases to the major internal organs, the primary tumor site contributed to predicting the survival periods. CONCLUSIONS: This study has revealed that the revised prognostic score resulting from the TSS predicts actual survival periods remarkably well. Hence, we thought that the revised TSS could be useful and reliable tool in prognosis of metastic spinal tumors.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Spine

OBJECT: The aim of this study is to analyze the statistical significance between the clinical result and subsidence and lordosis loss after anterior cervical discectomy and interbody fusion operation for degenerative cervical disc diseases. METHODS: From January 2004 to December 2006, retrospective study of 82 patients with symptomatic degenerative cervical disc disease who underwent anterior cervical discectomy and interbody fusion using the PEEK SolisTM cage and the carbon composite Osta-PekTM cage with autologous bone graft was done. Mean follow-up period was 13.2 months. Clinical results were assessed by bone fusion, subsidence, segmental lordosis loss and Odom's criteria. RESULTS: Of the 82 patients, single level fusion was accomplished in 67 patients and two-level fusion in 15 patients. Total accomplished fusion level was 97: C3/4 in 9 levels, C4/5 in 29 levels, C5/6 in 37 levels, C6/7 in 21 levels, C7/T1 in 1 level. 9 patients fit into complete resolved, 59 improved and 14 not changed, thus the success rate in clinical outcome was 82.9%. Bone fusion was successfully confirmed in the total of 82 patients. The height of disc space was decreased to 2.13+/-2.16mm: 2.64+/-1.81mm in the Osta-PekTM cage, 2.44+/-1.36mm in the PEEK SolisTM cage. The Osta-PekTM cage provided higher subsidence tendency than the PEEK SolisTM cage in our study. However, there was no statistical significance between the two cage groups. The subsidence and lordosis loss showed poor clinical outcome, but there was no statistical significance. CONCLUSIONS: There were no significant differences between the Osta-PekTM cage and PEEK SolisTM cage on clinical outco mes. Both cages showed low subsidences and lordosis loss with good fusion rate and clinical outcome.
Animals ; Carbon ; Diskectomy ; Follow-Up Studies ; Humans ; Ketones ; Lordosis ; Polyethylene Glycols ; Retrospective Studies ; Transplants

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and mortality worldwide. The aim of this study was to evaluate the risk factors associated with recurrent hospital admissions for exacerbation of COPD in Korea. METHODS: A retrospective study of 77 consecutive patients hospitalized for exacerbation of COPD at Pusan National University Hospital during the time period January 2005 to May 2008 was performed. The information was collected from the hospitalization period: clinical information, spirometric measures, and laboratory variables. In addition, socioeconomic characteristics, co-morbidity, anxiety, and depression were reviewed. Frequent readmission was defined as 2 or more hospitalizations in the year following discharge. RESULTS: During the 1-year period after discharge, 42 patients (54.6%) reported one hospital admission and 35 patients (45.4%) reported 2 or more hospital readmissions. Among the 35 frequent readmission patients, 4 had more than 10 readmissions. Univariate analysis showed that a body mass index (BMI) <18.5 kg/m2, duration >36 months, forced expiratory volume in 1 second (FEV1) <50% predicted, arterial CO2 partial pressure (PaCO2) >40 mm Hg, and arterial oxygen saturation (SaO2) <95% at discharge were associated significantly with frequent readmissions. The multivariate analysis revealed that BMI <18.5 kg/m2, PaCO2 >40 mm Hg at discharge were independently associated with frequent readmissions for exacerbation of COPD. CONCLUSION: Frequent readmissions for exacerbation of COPD were associated with low BMI and hypercapnia at discharge.
Anxiety ; Body Mass Index ; Cinnarizine ; Depression ; Forced Expiratory Volume ; Hospitalization ; Humans ; Hypercapnia ; Multivariate Analysis ; Oxygen ; Partial Pressure ; Patient Readmission ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors

BACKGROUND: We evaluated the clinical outcomes and prognostic factors of patients requiring prolonged mechanical ventilation (PMV), defined as ventilator care for > or =21 days, who were admitted to the medical intensive care unit (ICU) of a university hospital in Korea. METHODS: During the study period, a total of 2,644 patients were admitted to the medical ICU, and 136 patients (5.1%) were enrolled between 2005 and 2010. RESULTS: The mean age of the patients was 61.3+/-14.5 years, and 94 (69.1%) were male. The ICU and six-month cumulative mortality rates were 45.6 and 58.8%, respectively. There were 96 patients with tracheostomy placement after admission and their mean period from admission to the day of tracheostomy was 21.3+/-8.4 days. Sixty-three patients (46.3%) were successfully weaned from ventilator care. Of the ICU survivors (n=74), 34 patients (45.9%) were transferred to other hospitals (not university hospitals). Two variables (thrombocytopenia [hazard ratio (HR), 1.964; 95% confidence interval (CI), 1.225~3.148; p=0.005] and the requirement for vasopressors [HR, 1.822; 95% CI, 1.111~2.986; p=0.017] on day 21) were found to be independent factors of survival on based on the Cox proportional hazard model. CONCLUSION: We found that patients requiring PMV had high six-month cumulative mortality rates, and that two clinical variables (measured on day 21), thrombocytopenia and requirement for vasopressors, may be associated with prognostic indicators.
Humans ; Critical Care ; Intensive Care Units ; Korea ; Male ; Respiration, Artificial ; Survivors ; Thrombocytopenia ; Tracheostomy ; Ventilators, Mechanical

BACKGROUND: Synergistic antitumor effects of the combined chemoimmunotherapy based on dendritic cells have been reported recently. The aim of this study is to search new applicability of gefitinib into the combination treatment through the confirmation of gefitinib effects on the monocyte derived dendritic cells (moDCs); most potent antigen presenting cell (APC). METHODS: Immature and mature monocyte-derived dendritic cell (im, mMoDC)s were generated from peripheral blood monocyte (PBMC) in Opti-MEM culture medium supplemented with IL-4, GM-CSF and cocktail, consisting of TNF-alpha (10 ng/mL), IL-1beta (10 ng/mL), IL-6 (1,000 U/mL) and PGE2 (1 micro/mL). Various concentrations of gefitinib also added on day 6 to see the influence on immature and mature MoDCs. Immunophenotyping of DCs under the gefitinib was performed by using monoclonal antibodies (CD14, CD80, CD83, CD86, HLA-ABC, HLA-DR). Supernatant IL-12 production and apoptosis of DCs was evaluated. And MLR assay with [3H]-thymidine uptake assay was done. RESULTS: Expression of CD83, MHC I were decreased in mMoDCs and MHC I was decreased in imMoDCs under gefitinib. IL-12 production from mMoDCs was decreased under 10 microM of gefitinib sinificantly. Differences of T cell proliferation capacity were not observed in each concentration of geftinib. CONCLUSION: In spite of decreased expressions of some dendritic cell surface molecules and IL-12 production under 10 microM of gefitinib, significant negative influences of gefitinib in antigen presenting capacity and T cell stimulation were not observed.
Antibodies, Monoclonal ; Apoptosis ; Cell Proliferation ; Dendritic Cells ; Dinoprostone ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Immunophenotyping ; Interleukin-12 ; Interleukin-4 ; Interleukin-6 ; Monocytes ; Quinazolines ; Tumor Necrosis Factor-alpha

Churg-Strauss syndrome (CSS) is a disorder that is characterized by asthma, hypereosinophilia and systemic vasculitis affecting a number of organs. The manifestations of acute cholecystitis and diffuse alveolar hemorrhage are rarely reported in CSS. A 22-year-old woman with bronchial asthma visited our hospital complaining of right upper quadrant pain with a sudden onset. The abdominal computed tomography (CT) scan revealed gall bladder edema consistent with acute cholecystitis. On the initial evaluation, marked hypereosinophilia was observed in the peripheral blood smear. The nerve conduction velocity measurements and a skin biopsy performed to confirm the organ involvement of disease indicated typical mononeuritis multiplex and necrotizing vasculitis, respectively, which was complicated with CSS. On the 12th hospital day, ground glass opacity and consolidations were newly developed on both lung fields. The bronchoalveolar lavage (BAL) fluid showed increasing bloody return in sequential aliquots that were characteristic of a diffuse alveolar hemorrhage. We report a case of CSS with acute cholecystitis and diffuse alveolar hemorrhage.
Acalculous Cholecystitis ; Asthma ; Biopsy ; Bronchoalveolar Lavage ; Cholecystitis, Acute ; Churg-Strauss Syndrome ; Edema ; Female ; Glass ; Hemorrhage ; Humans ; Lung ; Mononeuropathies ; Neural Conduction ; Skin ; Systemic Vasculitis ; Urinary Bladder ; Vasculitis ; Young Adult

Diagnosis ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Mouth ; Mucocele ; Mucous Membrane ; Ranula ; Salivary Ducts ; Sublingual Gland

BACKGROUND/AIMS: Pandemic influenza A (H1N1) virus infection presents with variable severity. However, little is known about clinical predictors of disease severity. We studied the clinical predictors of severe pandemic H1N1 pneumonia and their correlation with radiological findings. METHODS: We reviewed medical and radiological records of adults with pandemic H1N1 pneumonia. After classification of patients into severe and non-severe groups, the following data were evaluated: demographic data, pneumonia severity index (PSI), CURB65, risk factors, time to first dose of antiviral medication, routine laboratory data, clinical outcome, and radiological characteristics. RESULTS: Of 37 patients with pandemic H1N1 pneumonia, 12 and 25 were assigned to the severe and non-severe groups, respectively. PSI score, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dyhydrogenase (LDH) levels were higher in the severe group than in the non-severe group (p = 0.035, 0.0003, 0.0023, and 0.0002, respectively). AST, ALT, and LDH levels were positively correlated with the radiological findings (p < 0.0001, 0.0003, and < 0.0001, respectively) and with the number of involved lobes (p = 0.663, 0.0134, and 0.0019, respectively). The most common finding on high resolution computed tomography (HRCT) scans was ground-glass attenuation with consolidation (n = 22, 60%), which had a predominantly patchy distribution (n = 31). CONCLUSIONS: We demonstrated a positive correlation between clinical findings, such as serum AST, ALT, and LDH levels, and radiological findings. A combination of clinical and HRCT indicators would be useful in predicting the clinical outcome of pandemic H1N1 pneumonia.
Adolescent ; Adult ; Aged ; Alanine Transaminase/blood ; Antiviral Agents/therapeutic use ; Aspartate Aminotransferases/blood ; Biological Markers/blood ; Chi-Square Distribution ; Clinical Enzyme Tests ; Female ; Humans ; Influenza A Virus, H1N1 Subtype/*pathogenicity ; Influenza, Human/*diagnosis/mortality/radiography/therapy/virology ; L-Lactate Dehydrogenase/blood ; Lung/*radiography/virology ; Male ; Middle Aged ; *Pandemics ; Pneumonia, Viral/*diagnosis/mortality/radiography/therapy/virology ; Predictive Value of Tests ; Prognosis ; Republic of Korea/epidemiology ; Respiration, Artificial ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; *Tomography, X-Ray Computed ; Young Adult

BACKGROUND: Maspin (mammary serine protease inhibitor) is a member of the serpin superfamily. A few studies have examined the role of maspin in tumor suppression of non-small cell lung cancer (NSCLC); however, its role in the development and progression of NSCLC still remains controversial. We evaluated the immunohistochemical expression of maspin in order to elucidate its clinical significance in NSCLC. METHODS: We analyzed 145 patients with pathologically confirmed NSCLC, including 66 cases of squamous cell carcinomas (SCCs) and 79 cases of adenocarcinomas (ADCs). We performed a immuno-histochemical stain with maspin and PCNA (proliferating cell nuclear antigen) using tissue microarray blocks. RESULTS: There were 108 men and 37 women in the study population. The mean age of patients in the study was 63.7 years (range, 40.0~82.0; median, 65.0). The proportion of maspin expression was significantly higher in SCCs (52/66, 78.8%; p<0.01) than in ADCs (17/79, 21.5%; p<0.01). Maspin expression was not associated with PCNA (p=0.828), lymph node involvement (p=0.483), or tumor stage (p=0.216), but showed correlation with well-to-moderate tumor differentiation (p=0.012). There was no observed correlation between maspin expression and survival with NSCLC (p=0.218). CONCLUSION: The present study suggests that maspin expression was significantly higher in SCCs than in ADCs and was associated with low histological grade. However, maspin expression was not an independent factor to predict a prognosis in NSCLC.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Female ; Humans ; Lymph Nodes ; Male ; Prognosis ; Proliferating Cell Nuclear Antigen ; Serine Proteases ; Serpins

Here we report the first fatality caused by H1N1 influenza virus infection with acute respiratory distress syndrome in Korea. A 55-year-old man presented at our emergency department with dyspnea, fever, diffuse myalgia and malaise. Bilateral lung air-space consolidation was detected on his initial chest radiograph combined with severe hypoxemia. He was supported by mechanical ventilation and treated with antibiotics. A nasopharyngeal aspirate was positive for influenza A rapid antigen and oseltamivir was started on day 3 of admission. The nasal swab sample was positive for influenza H1N1 virus by real-time reverse-transcriptase polymerase chain reaction. Despite aggressive treatment, he had refractory hypoxemia and uncontrolled septic shock. On day 5 of admission he went into cardiac arrest and expired.
Anoxia ; Anti-Bacterial Agents ; Dyspnea ; Emergencies ; Fever ; Heart Arrest ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Korea ; Lung ; Middle Aged ; Orthomyxoviridae ; Oseltamivir ; Pneumonia, Viral ; Polymerase Chain Reaction ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Shock, Septic ; Thorax