BACKGROUND: Recently, cardiopulmonary exercise testing (CPX) has become a popular diagnostic method for differentiating the main cause of exertional dyspnea or exercise limitation. We evaluated the difference in the CPX results according to interpretative algorithms and the methods of exercise in Korea. METHOD: Sixty-six patients with chronic lung disease and 48 adults with dyspneic symptoms, but with no abnormalities in a spirometry performed symptom limited CPX, were included in this study. The results were interpreted using both Wasserman's(WA) and Eschenbacher's algorithm (EA), and a comparison between both algorithms was made. Thirty-three healthy medical students performed the CPX with a cycle ergometer and treadmill. The results were interpreted with EA and the concurrenec in interpretations was evaluated according to the methods of exercise. RESULTS: 1. In patients with chronic lung disease, the overall concordance rate between the two algorithms was 63.6%. The concordance rates were 69.8% in patients with obstructive, 25.0% in those with restrictive, and 66.7% in those with mixed pulmonary insufficiency. In patients with dyspneic symptoms but normal findings in resting spirometry, the concordance rate was 60.4%. 2. In healthy medical students, in results interpreted with EA, the concordance rate between the cycle ergometer and treadmill exercise was 25.0%. CONCLUSION: Both interpretative algorithms and methods of exercise may affect the CPX results. In using CPX as a diagnostic test for the causes of dyspnea in the Korean population, the interpretative algorithms and method of exercise need to be standardized, and a predictive VO2max equation needs to be established.
Adult ; Diagnostic Tests, Routine ; Dyspnea ; Exercise Test* ; Humans ; Korea ; Lung Diseases ; Methods* ; Spirometry ; Students, Medical

PURPOSE: To evaluate the predictive factors of radiation pneumonitis (RP) and associated changes in pulmonary function after definitive concurrent chemoradiotherapy (CCRT) in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Medical records of 60 patients with NSCLC who received definitive CCRT were retrospectively reviewed. Dose volumetric (DV) parameters, clinical factors, and pulmonary function test (PFT) data were analyzed. RP was graded according to the CTCAE ver. 4.0. Percentage of lung volume that received a dose of threshold (Vdose) and mean lung dose (MLD) were analyzed for potential DV predictors. PFT changes were calculated as the difference between pre-RT and post-RT values at 3, 6, and 12 months after RT. RESULTS: Twenty-two patients (37%) developed grade > or =2 RP. Among clinical factors, tumor location in lower lobe was associated with RP. Among the DV parameters, only MLD >15 Gy was associated with grade > or =2 RP. There were statistically significant decreases in PFT at all points compared with pre-RT values in grade > or =2 RP group. MLD was associated with forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) changes at 6 and 12 months. V10 was associated with FVC changes at 12 months. V20 and V30 were associated with FEV1 changes at 6 months and FVC changes at 12 months. CONCLUSION: After definitive CCRT in patients with NSCLC, MLD >15 Gy and lower lobe tumor location were predictors of grade > or =2 RP. Pulmonary functions were decreased after CCRT and the magnitude of changes was associated with DV parameters.
Carcinoma, Non-Small-Cell Lung ; Chemoradiotherapy ; Forced Expiratory Volume ; Humans ; Lung ; Medical Records ; Radiation Pneumonitis ; Respiratory Function Tests ; Retrospective Studies ; Vital Capacity

No abstract available.

Background : It has been suggested that thrombospondin (TSP) is a p53-dependent negative regulator of tumor angiogenesis. TSP expression and localization in hepatocellular carcinomas (HCCs) and its association with overexpression of p53 protein were investigated. Methods : TSP-1 and -2 expressions were examined in 40 HCC specimens by immunohistochemical staining and in 4 HCC cell lines by Western blotting. In addition, p53 protein expression and microvessel density (MVD) were correlated with the TSP expression. Results : Strong immu- nopositivity for TSP-1 was observed in fibroblasts, vascular endothelial cells, and some vas- cular smooth muscle cells of the stroma in 18 cases (45%), and in tumor cells in 3 cases (7.5%) of 40 cases of HCC. Immunoreactivity for TSP-2 was observed in only the sinusoidal lining cells of the tumor in 15 cases (46%), and in tumor cells in 2 cases (6%) of 32 cases of HCC. TSP-1 expression was inversely correlated with MVD (p=0.028), but TSP-2 expression did not show any correlation with MVD. Although p53 was overexpressed in 17 cases, there was no significant correlation between TSP and p53 expressions. None of the HCC cell lines expressed TSP-1 or -2. Conclusions : These findings indicate that TSP-1 is mainly derived from nonparenchymal cells, and may decrease tumor angiogenesis in HCC.
Angiogenesis Inhibitors ; Blotting, Western ; Carcinoma, Hepatocellular* ; Cell Line ; Endothelial Cells ; Fibroblasts ; Microvessels ; Myocytes, Smooth Muscle ; Thrombospondin 1 ; Thrombospondins

OBJECTIVE: Our purpose was to investigate the relation between types of early diastolic notch and placental location and to evaluate the differences in perinatal outcomes. METHODS: We evaluated the Doppler waveform of the uterine artery in 149 pregnant women having an early diastolic notch after 26 weeks gestation, however we were unable to follow the obstetric outcomes in 20 women. Placental location was determined by transverse view of ultrasonography and classified as central and lateral placenta. The unilateral diastolic notches were divided into 3 groups depending on the placental location (ipsilateral: same side of the placenta, contralateral: opposite side of the placenta, and median: central placenta) RESULTS: In the bilateral notch group, the S/D ratio of the contralateral uterine artery was higher than the ipsilateral one(n=60, mean=3.22 Vs 2.80, p=0.0067). Of the 89 unilateral notches observed, the S/D ratio of the uterine artery in patients having early diastolic notch was higher compared to those without early diastolic notch.(t-test, mean=2.74,1.92, p=0.0001) Patients with bilateral notches were associated with poor perinatal outcomes significantly more than the patients with unilateral notches(p=0.003). Among the unilateral groups (ipsilateral: n=10, median: n=21, contralateral: n=58), there was no significant difference in perinatal outcomes. CONCLUSION: The early diastolic notch can be observed on both or either sides of the uterine artery independent on placental location. More bilateral notches were associated with poor pregnancy outcomes than unilateral notches. The pregnancy outcomes tended to be similar in unilateral notch irrespective of placental location, but showed worse outcomes than the control group. Careful analysis of the uterine artery in nonplacental side is necessary because of the frequent appearance of early diastolic notch and higher vascular resistance.
Female ; Humans ; Placenta ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Rheology* ; Ultrasonography ; Uterine Artery* ; Vascular Resistance

PURPOSE: To cmpare the clinical results of complex tibial plateau fractures treated by hybrid external fixation and dual plate fixation. MATERIALS AND METHODS: We studied forty patients with Schatzker type V and VI fractures respectively and selected twenty seven patients who were followed at least one year between January 2000 and December 2005. We evaluated the clinical results in which fourteen fractures with hybrid external fixation were compared with thirteen fractures with dual plate fixation. The clinical results were evaluated according to Knee Society Clinical Rating System and the statistical analysis was performed by Student t-test. RESULTS: There were no significant differences in terms of bone union time (average union time: dual plate fixation 13.8 weeks, hybrid external fixation 14.2 weeks). The quality of osseous reduction was superior in the fractures with dual plate fixation than those with hybrid external fixation. There were significant differences in functional score (average functional score: dual plate fixation 73, hybrid external fixation 62), but not in average knee score. CONCLUSION: The hybrid external fixation can be a useful modality for treatment of complex proximal tibial plateau fractures. But the good quality of the fracture reduction by dual plate fixation may be a indicator for favorable prognosis for satisfactory knee function.
Chimera ; External Fixators ; Humans ; Knee ; Prognosis

No abstract available.
Pancreaticoduodenectomy* ; Risk Factors*

The use of a cultured autologous keratinocyte sheet has become a recognized method for the coverage of extensive bums during recent years. The disadvantages of these sheet grafts are a long time-lag until keratinocyte sheets are available, the fragility and difficulty in handling of grafts, an unpredictable take rate and extremely high costs. In this study we investigated the transplantation of cultured keratinocytes as single cells suspended in autologous fibrin glue. In a rat model with standardized full thickness wounds, this new transplantation technique was evaluated and compared directly to the conventional keratinocyte sheet grafting technique. After transplantation, wounds were evaluated for the degree of epithelial coverage, and then microscopic structures were evaluated under light and electron microscopy. The results were as follows: 1) The fibrinogen solution prepared from autologous blood had 12 times more fibrinogen compared to the original blood. 2) After transplantation of cultured keratinocyt-es in fibrin glue, the degree of epithelial coverage was 79% at 2 weeks, which was comparable to 17% for cultured keratinocyte sheet graft 3) Typical basement membrane structures were consistently found at 2 weeks after transplantation of keratinocytes in fibrin glue. 4) Rete ridges were found at 4 weeks after transplantation of keratinocytes in fibrin glue. In conclusion, the transplantation technique of keratinocytes in fibrin glue is available earlier than sheet grafts, it transfers actively proliferating cells and it simplifies the grafting procedure. As well, this technique leads to an earlier epithelial covering and an earlier restoration of the dermo-epidermal junction than sheet grafting.
Basement Membrane ; Fibrin Tissue Adhesive* ; Fibrin* ; Fibrinogen ; Keratinocytes* ; Microscopy, Electron ; Models, Animal ; Transplants ; Wounds and Injuries

Vitamin A and its metabolite, retinoic acid, have been recommended for the treatment of psoriasis, ichthyosis, acne vulgaris and Darier's disease which resulted from abaormal regulatory function of keratinocytes. In recent years retinoic acid analogs (retinoids) have been synthesized and shown to be more potent and less toxic than retinoic acid. Since these drugs are therapeutically effective for skin diseases, only with longterm adminiatration of large doses, their toxicities must be seriously considered. The liver is the main site for both storage and excretion of vitamin A and ita derivatives, which may produce injury to the liver and other organs as a result of excess of lysosomal enzyme control. Fatty vacuoles, infiltration of inflammatory cells, focal necrosis, increase in lysosomal enzymes, distension of the RER, decrease in the ribosomes, swelling of the mitochondria, and proliferation of the SER within the hepatocytes have been observed in livers of vitamin A- as well as retinoic acid-treated rats. Its excess may also cause mucous metaplasia of secretory cells of the pancreas. (countinued...)
Acne Vulgaris ; Amphotericin B* ; Animals ; Darier Disease ; Hepatocytes ; Ichthyosis ; Keratinocytes ; Liver ; Metaplasia ; Mitochondria ; Necrosis ; Pancreas ; Psoriasis ; Rats ; Ribosomes ; Skin Diseases ; Tretinoin ; Vacuoles ; Vitamin A ; Vitamins

No abstract available.