From January, 1984 to January, 1985 twelve patients with unstable fracture and fracture-dislocation of the thoraco . lumbar spine with neurologic deficits were treated with Harrington Instrument. Fixation by Harrington Instrumentation appeared to provide stabilization, reduction and return of neural function. Author performed Harrington Instrumentation with experience of 12 cases of unstable thoraco . lumbar spine fructure and fracture-dislocation with neurologic deficits. Results were as follows : 1) Spinal fracture and fracture-dislocation were most common in thoraco . lumbar Junction. 2) Harrington Instrumentation was very effective for keeping the spine stability in unstable fracture. 3) Six cases (50%) had a complete neurologic deficit and six cases (50%) had a incomplete neurologic deficit, two cases of the six patients with complete neurologic deficits recovered slightly but two cases with incomplete neurological deficit gained complete recovery. 4) During the postoperative period, early ambulation was possible and average admission period were 71 days. 5) Correction of spinal deformity. A. Average value of kyphotic angle (12.5 degrees). B. Average value of Iw(Index of weding) (1.32). C. Displacement was completely corrected in eight patients (100%).
Congenital Abnormalities ; Early Ambulation ; Humans ; Neurologic Manifestations ; Postoperative Period ; Spinal Fractures ; Spine*

Mucoepidermoid carcinoma was initially recognized as occurring only in the salivary gland and only later was it appreciated that it occurred in the bronchus and trachea as well. Mucoepidermoid carcinoma of bronchial gland origin is extremely rare, and little is known about their natural history. This carcinoma is derived from the minor salivary gland of the proximal tracheobronchial tree and it is divided into low-grade and high-grade by gross, histologic, and ultrastructural criteria. Also Its clinical and biologic behaviors are closely related with histologic grade of carcinoma. We have experienced a rare case of bronchial mucoepidermoid carcinoma associated with adenocarinoma which obstructed the left main bronchus and was successfully removed by the pneumonectomy.
Adenocarcinoma ; Bronchi ; Carcinoma, Mucoepidermoid* ; Lung ; Natural History ; Pneumonectomy ; Salivary Glands ; Salivary Glands, Minor ; Trachea ; Trees

BACKGROUND: Wolff-Parkinson-White syndrome(WPW syndrome) is well known and somtimes causes life-threatening arrhythmias.To date,the clinical and electrophysiologic charicteristics of patients with WPW syndrome in Korea has not been available,though results of catheter ablation treatment for atrioventricular reentrant tachycardia(AVRT) including WPW syndrome were reported. METHOD: Clinical and electrocardiographic(ECG) characteristics and results of electrophysiologic study of consecutive 400 patients with WPW syndrome who underwent electrophsiologic study between December 1986 and September 1995 were analyzed. RESULTS: Mean age of the patients was 35 years and male patients were more common(262male patients,65.5%).Mean duration and frequency of palpitation episodes were 8.1 years and 4.2 times per month,respectively.Thirty six patients(9.0%) experienced syncopal episodes and the half of them were associated with atrial fibrillation.Two cases of aborted sudden cardiac death were associated with atrial fibrillation.Twenty four cases of congenital heart diseases and 13 cases of acquired heart diseases were found.The most commonly associated cardiac disease was Ebstein's anomaly(8 cases,2,0%).Clinically,368 patients(92,0%) had ECG-documented tachycardias and 46 patients had two or more types of tachycardia.Orthodromic AVRT was the most common tachcardia (227 patients including 44 cases with coexisting atrial fibrillation).Atrial fibrillation was documented in 115 patients(31.1%) and antidromic AVRT in 23 patients(6.2%).Patients with antidromic AVRT were more likely to have multiple accessory pathways compared to those with orthodromic AVRT (30.4% versus 4.3%).On electrophysiologic study,the most commonly inducible tachcardia was also orthodromic AVRT (334/389 cases,89.8%).Antidromic AVRT was induced in 23 cases(6.0%).Atrial fibrillation was present in 104 patients(27.2%),especially in those with clinically documented atrial fibrillation(71.3% vs 12.3%).In 17 patients without inducible tachycardias,ventriculoatrial conduction was absent or had long effective refractory period.Finally,396 patients(99.0%) had clinically documented or inducible tachycardias.Eight patients with Ebstein's anomaly had right-sided accessory pathway(87.5%)exept one case.Twenty four patients had secondary accessory pathway.The most common site of accessory pathway including secondary accessory pathway was left free wall(204 cases,48.1%).Other accessory pathways were found at right free wall(123 cases,29.0%),posteroseptal(54 cases,17.5%)and anteroseptal site(15 cases,3.5%)in order. CONCLUSIONS: The clinical and electrophysiologic characteristics of patients in this series were similar with those of previous reports of other countries.Because certain types of tachyarrhythmia were associated with characteristic electrophysiologic findings such as the relationships between antidromic AVRT and presence of secondary accessory pathways or clinical atrial fibrillation and higher occurrence rate of atrial fibrillation during electrophysiologic study,it is important to document clinical tachyarrhythmias with ECG.And electrophysiologic study can have important clinical implications in diagnosis and especially in curative treatment.
Atrial Fibrillation ; Catheter Ablation ; Death, Sudden, Cardiac ; Diagnosis ; Ebstein Anomaly ; Heart Diseases ; Humans ; Korea ; Male ; Syncope ; Tachycardia ; Wolff-Parkinson-White Syndrome*

BACKGROUND: It is well known that non-alcoholic fatty liver disease is associated with type 2 diabetes mellitus, obesity, and dyslipidemia. Non-alcoholic fatty liver disease is frequently found in non-diabetic, normal weight adults, but the meaning of it is not fully investigated. We tested the hypothesis that there is association between non-alcoholic fatty liver disease with insulin resistance in non-diabetic, normal weight adults. METHODS: We examined 60 Korean adults above the age of 30 years, participating in medical check-up at the Chung-Ang University Hospital, from Sep 2003 to Jan 2004. Heapatitis B and C serologies were negative, and not the history of alcohol abuse. A standard interview, physical exam and biochemical study were conducted, and an experienced operator carried out ultrasound liver studies. We assessed the clinical characteristics of subjects and HOMA (Homeostasis Model Assessment), QUICKI (Quantitative Insulin Sensitivity Check Index) as an index of insulin resistance. RESULTS: We classified subjects into 2 groups: the controls (n=42), and those with non-alcoholic fatty liver disease (n=18). The frequency in the men was higher than that in the women (70 vs 30 %, p<0.05). Body mass index, waist circumference, hip circumference, waist/hip ratio, triglyceride, HDL-cholesterol, alanine transferase, and uric acid was significantly different between two groups (p<0.05). Insulin resistance (HOMA-IR) was significantly higher in subjects with non-alcoholic fatty liver disease (p<0.05). CONCLUSION: Non-alcoholic fatty liver disease is associated with insulin resistance in non- diabetic, normal weight adults.
Adult* ; Alanine ; Alcoholism ; Body Mass Index ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Fatty Liver* ; Female ; Hip ; Humans ; Insulin Resistance* ; Insulin* ; Liver ; Male ; Obesity ; Transferases ; Triglycerides ; Ultrasonography ; Uric Acid ; Waist Circumference

BACKGROUND: Mutations leading to hyperactivation of the RAS pathway play a critical role in the pathogenesis of juvenile myelomonocytic leukemia (JMML). Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative therapy, and the role of anti-leukemic treatment prior to HSCT is still controversial. In this study, we analyzed the response of cytarabine monotherapy as a bridging therapy for HSCT in children recently diagnosed with JMML.METHODS: We retrospectively reviewed the medical records of patients with JMML at Seoul St. Mary's Hospital from December 2009 to April 2012.RESULTS: A total 7 patients with JMML were diagnosed and treated with chemotherapy and HSCT. At presentation, all patients showed hepatosplenomegaly and the median leukocyte count was 41.9x109/L (range, 34.3-85.0), median monocyte count was 5.6x109/L (range, 2.7-26.3) and median fetal hemoglobin (HbF) was 13.5% (range, 2.8-42.7). Karyotypic abnormalities in bone marrow cells were noted in 2 cases. Three patients had mutation of NRAS and 2 patients had mutation of NF1. One of the patients with NF1 mutations had characteristic clinical features and familial history of neurofibromatosis. All patients were treated with non-intensive sequential cytarabine chemotherapy (70 mg/m2/day, I.V., 4-12 days) before HSCT and achieved complete hematologic response. All patients underwent unrelated (N=2) or familial mismatched (N=5) HSCT, and all patients successfully engrafted. All patients, except one who relapsed, are alive with leukemia free, although the duration of follow-up is short.CONCLUSION: In our cohort of NRAS prevalent patients, non-intensive cytarabine monotherapy was effective as pre-transplant bridging treatment for JMML.
Bone Marrow Cells ; Child ; Cohort Studies ; Cytarabine ; Fetal Hemoglobin ; Follow-Up Studies ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Leukemia ; Leukemia, Myelomonocytic, Juvenile ; Leukocyte Count ; Medical Records ; Monocytes ; Neurofibromatoses ; Retrospective Studies

Idiopathic hypereosinophilic syndrome (IHES) is a rare disorder defined by persistent blood eosinophilia, evidence of eosinophil-associated organ dysfunction and absence of secondary causes. Eosinophilic infiltration and its mediator release can cause damage to multiple organs. Although IHES can involve every organ system, bladder involvement is rarely evidenced. We recently reported a case of IHES with both bladder and gastrointestinal tract involvement. A 43-year-old woman visited Hallym University Sacred Heart Hospital complaining of urinary frequency, abdominal pain, and diarrhea for several months. Abdominal pelvic computed tomographic scan showed diffuse wall thickenings in her bladder and colon with small pelvic ascites. Laboratory investigation showed a marked peripheral eosinophilia and tissue biopsies confirmed eosinophilic infiltration in the bladder wall, esophagus, and duodenum. The patient was treated with prednisolone and her eosinophilia and symptoms have gradually improved.
Abdominal Pain* ; Adult ; Ascites ; Biopsy ; Colon ; Cystitis ; Diarrhea* ; Duodenum ; Enteritis ; Eosinophilia ; Eosinophilic Esophagitis ; Eosinophils ; Esophagus ; Female ; Gastrointestinal Tract ; Heart ; Humans ; Hypereosinophilic Syndrome* ; Prednisolone ; Urinary Bladder

PURPOSE: We evaluated the treatment efficacy including survival and recurrence, and factors associated with recurrence in osteosarcoma patients treated with preoperative chemotherapy, surgery, and adjuvant chemotherapy. MATERIALS AND METHODS: Forty nine patients with osteosarcoma were treated with preoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion for 3 cycles, followed by surgery. According to the pathologic response, if tumor was necrotized more than 90%, the same adjuvant chemotherapy was reintroduced for 3 cycles, and if the response was not enough, then the salvage regimen was introduced. Plain chest film and chest CT scan were taken monthly and every 3 months, respectively. When tumor recurred, the metastasectomy was performed whenever possible. RESULTS: Forty three patients were evaluable with amedian follow up of 53 months. Five-year disease-free and overallsurvival rate was 47.0% and 66.9%, respectively. The recurrence was observed in 22 patients (51.2%) with median time of 12.5 months. Baseline alkaline phosphatase (ALP) was the only significant factor for recurrence (p=0.03) and the patients with the possibility of metastasectomy recurrence showed higher post-relapse survival compared to other treatment modalities (26 momths vs 5~12 months). CONCLUSION: These results indicates that pre- and postoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion showed comparable treatment efficacy and acceptable toxicities.
Alkaline Phosphatase ; Chemotherapy, Adjuvant ; Cisplatin ; Doxorubicin ; Drug Therapy* ; Extremities* ; Follow-Up Studies ; Humans ; Metastasectomy ; Osteosarcoma* ; Recurrence ; Thorax ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND: Smoke inhalation injury is an important determinant of mortality in burn patients. The early detection of inhalation injury in burn patients is important because the incidence of respiratory failure after inhalation injury was known to be high, with hypoxemia, pneumonia, and prolonged ventilatory support being commonplace. Acute carbon monoxide poisoning was one feature of smoke inhalation. The purpose of our study were to investigate the clinical characteristics of burn patients whose initial arterial carboxyhemoglobin (COHb) level had been elevated, to assess the clinical impact of COHb for smoke inhalation injury. METHODS: Among 1,416 burn patients had been admitted at our institution from August 1, 2001 to July 31, 2002, 39 patients whose initial arterial COHb level have been more than 5% were included. We compared clinical scoring system for inhalation injury, percent total body surface area (%TBSA) burn, initial chest X-ray findings, APACHE II scores and SAPS II scores between survivors (n=27) and non-survivors (n=12) retrospectively. RESULTS: COHb level were 9.7(5.71% and 10.3(8.81% in survivors and in non-survivors (p>0.05). Mean %TBSA burn of survivors and non-survivors were 16.6+/-17.8% and 60.7+/-28.8% (p<0.001). We did not find any difference in clinical scoring system, initial chest X-ray findings in survivors and in non-survivors. But %TBSA burn, APACHE II and SAPS II scores were high in non-survivors than in survivors significantly. Important factors associated with death were %TBSA burn, APACHE II scores, SAPS II scores, and the most important factor in predicting mortality was %TBSA burn. CONCLUSION: Burn patients with elevated initial arterial COHb level showed poor prognosis, but further study may be performed to know that the effect of COHb on prognosis in burn patients accompanying smoke inhalation.
Anoxia ; APACHE ; Body Surface Area ; Burns* ; Carbon Monoxide Poisoning ; Carboxyhemoglobin* ; Humans ; Incidence ; Inhalation ; Mortality ; Pneumonia ; Prognosis* ; Respiratory Insufficiency ; Retrospective Studies ; Smoke ; Smoke Inhalation Injury ; Survivors ; Thorax

Background/Aims: Prokinetics such as mosapride citrate CR (conventional-release; Gasmotin) are commonly used in functional dyspepsia (FD). This study aims to evaluate the efficacy and safety of once-a-day mosapride citrate SR (DWJ1252), a sustained-release formulation of mosapride citrate, compared with mosapride citrate CR 3 times a day, in patients with FD. Methods: In this multicenter, randomized, double-blind, active-controlled, non-inferiority study, 119 patients with FD (by the Rome III criteria, 60 for mosapride citrate SR and 59 for mosapride citrate CR) were randomly allocated to mosapride citrate SR once daily or mosapride citrate CR thrice daily for 4 weeks in 16 medical institutions. Primary end point was the change in gastrointestinal symptom (GIS) score from baseline, assessed by GIS questionnaires on 5-point Likert scale after 4-week treatment. Secondary end points and safety profiles were also analyzed. Results: The study included 51 and 49 subjects in the mosapride citrate SR and mosapride citrate CR groups, respectively. GIS scores at week 4 were significantly reduced in both groups (mean ± SD: − 10.04 ± 4.45 and − 10.86 ± 5.53 in the mosapride citrate SR and mosapride citrate CR groups, respectively; P < 0.001), and the GIS changes from baseline did not differ between the 2 groups (difference, 0.82 point; 95% CI, − 1.17, 2.81; P = 0.643). Changes in GIS at weeks 2 and 4 and quality of life at week 4, and the improvement rates of global assessments at weeks 2 and 4, did not differ between the groups. Adverse events were similar in the 2 groups, and there were no serious adverse events. Conclusion In patients with FD, mosapride citrate SR once daily is as effective as mosapride citrate CR thrice daily, with a similar safety profile.

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing disease with genetic and environmental background. Many factors may act as triggers and affect the course of the disease. However, little is known about the factors affecting the disease severities in Korean childhood AD. OBJECTIVE: The aim was to document the distinct characteristics of childhood AD in Korea and to determine which manifestations are prone to be present in the settings of different severity of the disease. METHOD: The clinical manifestations, past medical and family history, and inducing or aggravating factors were studied in patients, who participated in the open lectures for childhood AD patients in three provinces of Korea. The severity of the disease was evaluated using the Eczema Area and Severity Index (EASI) and the factors affecting the severity of the disease were determined. Skin prick tests with four allergens, Dermatophagoides pteronyssinus, milk, peanut and egg, were also carried out. RESULTS: Of the 93 patients, 38.7% had the disease onset between the age of three and six, while 17.2% had it between the age of seven and fifteen. Sixty-five percent of the patients had family members with a history of atopic diseases, such as AD, asthma, allergic rhinitis and allergic conjunctivitis. In order of frequency, the patients either had a history of or presently accompanying infantile eczema, allergic rhinitis, asthma or allergic conjunctivitis. Among the patients, 27% took herbal medication. The most frequently involved site was the flexural area. The most common aggravating factors were sweating in hot environment, wool fabric and stress. When AD patients were categorized into mild, moderate and severe groups by EASI, the older onset age, the longer duration, facial distribution, history of taking herbal medication, cholinergic condition, wool fabric and stress were found to be significant factors influencing the severity of the disease. Skin prick test with the four major allergens revealed the highest prevalence in Dermatophagoides pteronyssinus. CONCLUSION: The age of onset of AD was higher than that has been reported. Many suffered from infantile dermatitis and had other accompanying atopic diseases. Aggravating factors should be avoided to minimize the risk of disease aggravation. Based on the fact that late onset age, duration, facial distribution, history of taking herbal medication, cholinergic condition, wool and stress were the statistically significant factors, we may predict the severity or the course of the disease.
Age of Onset ; Allergens ; Antigens, Dermatophagoides ; Asthma ; Conjunctivitis, Allergic ; Dermatitis ; Dermatitis, Atopic* ; Dermatophagoides pteronyssinus ; Eczema ; Humans ; Korea* ; Lectures ; Milk ; Ovum ; Prevalence ; Rhinitis ; Skin ; Sweat ; Sweating ; Wool