PURPOSE: To evaluate the risk of vertebral compression fracture (VCF) after conventional radiotherapy (RT) for colorectal cancer (CRC) with spine metastasis and to identify risk factors for VCF in metastatic and non-metastatic irradiated spines. MATERIALS AND METHODS: We retrospectively reviewed 68 spinal segments in 16 patients who received conventional RT between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of an existing fracture. The target volume included all metastatic spinal segments and one additional non-metastatic vertebra adjacent to the tumor-involved spines. RESULTS: The median follow-up was 7.8 months. Among all 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0% respectively, compared with 5.2% and 4.7% for segments without prior irradiation or pre-existing compression fracture, respectively (both p < 0.05). The 1-year fracture-free probability was 87.8% (95% CI, 78.2-97.4). On multivariate analysis, prior irradiation (HR, 7.30; 95% CI, 1.31-40.86) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52) were independent risk factors for VCF. CONCLUSION: The incidence of VCF following conventional RT to the spine is not particularly high, regardless of metastatic tumor involvement. Spines that received irradiation and/or have pre-existing compression fracture before RT have an increased risk of VCF and require close observation.
Colorectal Neoplasms* ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Incidence ; Multivariate Analysis ; Neoplasm Metastasis ; Radiotherapy ; Retrospective Studies ; Risk Factors ; Spinal Fractures ; Spinal Neoplasms ; Spine*

Of several possible configurations of pin fixation of a displaced supracondylar fracture of the humerus in children, the medial and lateral crossed pinning technique has been known to provide the greatest resistance to gross rotational displacement. A new technique with ipsilateral two lateral crossed pins was devised so as to avoid the ulnar nerve injury with good stability for fracture site. During the period from 1992 to 1994, 18 children with displaced supracondylar fracture of the humerus were treated by closed reduction and ipsilateral two lateral crossed pinning. Eighty nine percents of the final results were satisfactory. There were no ulnar nerve injuries and fixation loss in all cases from the treatment. This is a safe, simple and reliable technique for providing the good stability of fracture site as well as avoiding the ulnar nerve injury.
Child ; Humans ; Humerus ; Ulnar Nerve ; Ulnar Neuropathies ; United Nations

PURPOSE: To evaluate the clinical outcomes of patients who underwent radiation therapy with or without targeted molecular therapy for the treatment of spinal metastasis from renal cell carcinoma (RCC). MATERIALS AND METHODS: A total of 28 spinal metastatic lesions from RCC patients treated with radiotherapy between June 2009 and June 2015 were retrospectively reviewed. Thirteen lesions were treated concurrently with targeted molecular therapy (concurrent group) and 15 lesions were not (nonconcurrent group). Local control was defined as lack of radiographically evident local progression and neurological deterioration. RESULTS: At a median follow-up of 11 months (range, 2 to 58 months), the 1-year local progression-free rate (LPFR) was 67.0%. The patients with concurrent targeted molecular therapy showed significantly higher LPFR than those without (p = 0.019). After multivariate analysis, use of concurrent targeted molecular therapy showed a tendency towards improved LPFR (hazard ratio, 0.13; 95% confidence interval, 0.01 to 1.16). There was no difference in the incidence of systemic progression between concurrent and nonconcurrent groups. No grade ≥2 toxicities were observed during or after radiotherapy. CONCLUSION: Our study suggests the possibility that concurrent use of targeted molecular therapy during radiotherapy may improve LPFR. Further study with a large population is required to confirm these results.
Carcinoma, Renal Cell* ; Follow-Up Studies ; Humans ; Incidence ; Molecular Targeted Therapy* ; Multivariate Analysis ; Neoplasm Metastasis* ; Radiotherapy ; Retrospective Studies ; Treatment Outcome*

OBJECTIVE: The authors demonstrate neuroprotective effects of antioxidant in reperfusion injury using ischemic rat model and evaluate the clinical eligibility of this agent to ischemic cerebrovascular diseases. METHODS: Rat model was made according to Longa method. Thirty-six Sprague-Dawley rats were used and were equally divided into three groups;A) treated subcutaneously with D,L-6,8-Thioctic acid 30 minutes before occlusion, B) within one hour after occlusion, and C) with vehicle only. Neurologic examination was performed immediately and 24 hours after reperfusion. Twenty-four hours after reperfusion, brains were extracted and stained with 2% 2,3,5-Triphenyltetrazolim chloride in 2mm-thickness section. Then, fixed sections were digitalized and used for infarct area calculation. RESULTS: There was no significant statistical difference in recorded hemodynamic and physiologic parameters between three groups. The neurologic status taken immediately following reperfusion were A) 2.67+/-0.492, B) 2.75+/-0.452, and C) 2.83+/-0.389, and were improved to A) 1.67+/-0.898, B) 1.92+/-0.900, and C) 2.08+/-0.793 just before sacrificing. However, there was no statistically significant difference between three groups. Mean volume of cerebral infarction was A) 9.5+/-1.67%, B) 10.4+/-1.58%, and C) 11.3+/-1.12% with no significant difference. Any specific correlation between the neurologic status and the mean infarction volume was not observed. CONCLUSION: Any single agent does not seem to reduce the infarction volume holistically, therefore, the incoming therapeutic target should be the development of versatile neuroprotective agents or the selection of preexisting synergistic compounds without compromising patients' safety.
Animals ; Brain ; Cerebral Infarction* ; Hemodynamics ; Infarction ; Models, Animal* ; Neurologic Examination ; Neuroprotective Agents ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury

PURPOSE: To investigate the patterns of locoregional recurrence of pathologic T3N0 (pT3N0) lower rectal cancer omitting postoperative radiotherapy (RT) and explore the potential of modification of a RT field. MATERIALS AND METHODS: From Jan 2003 to Nov 2011, 35 patients omitting preoperative or postoperative RT for pT3N0 lower rectal cancer were included. We defined the lower rectal cancer as the tumor with the inferior margin located below the virtual line-a convergent level between rectal wall and levator ani muscle. All patients had radiologic examinations for recurrence evaluation during the follow-up duration. RESULTS: The median follow-up duration was 66.4 months (range, 1.4 to 126.1 months). Eight (22.9%) of the 35 patients had recurrence. Three (8.6%) was local recurrence (LR) only, 3 (8.6%) was distant metastasis (DM) only, and 2 (5.7%) was LR with DM. All LR were located at primary tumor sites. The overall survival rate, LR-free survival rate, and DM-free survival rate at 5 years was 79.8%, 83%, and 87%, respectively. All LR developed from tumors over 5 cm. However, there was no statistical significance (p = 0.065). There was no other risk factor for LR. CONCLUSION: Even though the patients included in this study had pathologically favorable pT3N0 rectal cancer, LR developed in 14.3% of patients. Most of the LR was located at primary tumor sites prior to surgery. Based on these findings, it might seem reasonable to consider postoperative RT with a smaller radiation field to the primary tumor site rather than the conventional whole pelvic irradiation.
Follow-Up Studies ; Humans ; Muscles ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; Recurrence ; Risk Factors ; Survival Rate

Wegener`s granulomatosis (WG) is a multisystem disorder of unknown origin characterized by necrotizing granulomatous vasculitis. WG usually affects the upper respiratory tract, lungs, and kidneys with focal glomerulonephritis, but almost any organ can be affected. The ureter is primarily an unusual location for lesions of WG. A 30-year-old woman presented with intermittent right flank pain and hematuria. A renal ultrasound demonstrated unilateral hydronephrosis and a retrograde pyelography revealed a filling defect at right mid ureter and a computed tomography displayed marked concentric thickening of the right ureteral wall which was mimicking ureteral tumor. At nephroureterectomy, the right ureter was found to be obstructed by dense, intramural fibroinflammatory reaction. There was a necrotizing granulomatous vasculitis in the muscle layer of the ureter. Our case represents the rare occurrence of WG presenting ureteral bstruction.
Adult ; Female ; Flank Pain ; Glomerulonephritis ; Hematuria ; Humans ; Hydronephrosis ; Kidney ; Lung ; Respiratory System ; Ultrasonography ; Ureter* ; Urography ; Vasculitis

PURPOSE: Iliac vein compression syndrome (IVCS) is a clinical condition accompanied by deep vein thrombosis (DVT) secondary to the compression of the left common iliac vein between the right common iliac artery and the lumbar vertebrae. The purpose of this study was to find differences in the clinical characteristics between IVCS and other DVT and to analyze the therapeutic outcomes of IVCS. METHODS: A total of 140 patients with DVT visited the Emergency Department of Seoul National University Hospital from January 2000 to December 2002. Of those patients, 20 patients were diagnosed as IVCS (14.3%). The medical records of patients with both IVCS and DVT were retrospectively reviewed and compared. RESULTS: All patients with IVCS presented with swelling confined to the left lower extremity. The IVCS group showed a higher incidence of females, more cardiovascular disease, and fewer malignancies than did the DVT group. There were no significant differences in age, other underlying diseases, abnormalities of coagulation, and the incidences of pulmonary embolism between two groups. Anticoagulation with heparin (100%), thrombolysis with urokinase (95%), balloon angioplasty (80%) and metallic stent insertion (75%) were performed for the treatment of IVCS. The prognosis fot the stent insertion group tended to be better, but the difference was not statistically significant. CONCLUSION: We suggest that IVCS should be considered in patients who present with swelling confined to the left lower extremity, are females, and have a cardiovascular disease. A multicenter study seems to be needed for further evaluation of IVCS.
Angioplasty, Balloon ; Cardiovascular Diseases ; Emergencies* ; Emergency Service, Hospital* ; Female ; Heparin ; Humans ; Iliac Artery ; Iliac Vein* ; Incidence ; Lower Extremity ; Lumbar Vertebrae ; May-Thurner Syndrome* ; Medical Records ; Prognosis ; Pulmonary Embolism ; Retrospective Studies ; Seoul ; Stents ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis*

PURPOSE: In previous studies, therapeutic hypothermia (HT) in hemorrhagic shock (HS) had beneficial effects on the hemodynamic and metabolic parameters, and on the survival. The mechanism is uncertain. We hypothesized that the suppression of inducible nitric oxide synthase (iNOS) and NF-kappaB could be associated with the beneficial effects of therapeutic HT in HS. METHODS: Sixteen male Sprague-Dawley rats were randomized to normothermia (36~37degrees C, NT group) or moderate hypothermia (27~30degrees C, HT group). They underwent volumecontrolled (2 ml/100 g weight) HS (90 minutes) and partial resuscitation with shed blood (1 ml/100 g). RESULTS: In the HS and post-resuscitation phase, the mean arterial pressures were higher in the HT group than in the NT group and PaO2 was higher in the HT group than in the NT group. The lactate level was lower in the HT group than in the NT group (1.1+/-1.1 nmol/L vs 6.4+/-5.0 nmol/L, p=0.021). Serum concentrations of IL-1 beta and IL-6 and activated p65 NF-kappaB levels in the lung tissue were higher in NT group than in the HT group (p<0.05). Lung malondialdehyde contents and the expression of iNOS mRNA were significantly decreased in the HT group compared to the NT group (63.8+/-6.2 nmol/g vs 44.6+/-4.5 nmol/g, p<0.001; 1313.0+/-924.4 vs 9088.4+/-3984.0 arbitrary units, p<0.001, respectively). CONCLUSION: These data suggest that in HS, therapeutic HT inhibits lipid peroxidation, activation of NF-kappaB, and gene expression of iNOS in the lung. These factors might be the mechanism of the beneficial effects of HT in HS.
Animals ; Arterial Pressure ; Cytokines ; Gene Expression ; Hemodynamics ; Humans ; Hypothermia ; Interleukin-1beta ; Interleukin-6 ; Lactic Acid ; Lipid Peroxidation ; Lung ; Male ; Malondialdehyde ; NF-kappa B ; Nitric Oxide Synthase Type II ; Rats ; Rats, Sprague-Dawley ; Resuscitation ; RNA, Messenger ; Shock, Hemorrhagic

Atlantoaxial subluxation causing spinal cord compression at the craniovertebral junction may develop in patients with rheumatoid or psoriatic arthritis. There have been only a few reports of atlantoaxial subluxation in patients with psoriatic arthritis in the world. The authors report a case of psoriatic arthritis with atlantoaxial subluxation accompaning periodontoid pannus formation. This 53-year-old man with a 3-year history of psoriatic skin lesion presented with nuchal pain and myelopathy. We performed decompression by C1 total laminectomy with transarticular screw fixation and obtained remarkable improvement in motor function and immediate postoperative stability.
Arthritis, Psoriatic* ; Decompression ; Humans ; Laminectomy ; Middle Aged ; Skin ; Spinal Cord Compression ; Spinal Cord Diseases

PURPOSE: To know the feasibility of ED observation unit treatment for acute pyelonephritis (APN) in women with diabetes or older age. METHODS: From January 2006 to February 2007, we enrolled adult women APN patients with diabetes or older age (65 years old or more) prospectively, and managed them with predetermined written protocol including intravenous ciprofloxacin, anti-pyretics, anti-emetics, and hydration. After 6 hour observation, we evaluated the patients to be admitted or not according to the protocol (the after group). From May 2003 to December 2005, data of ED visited APN patients were collected retrospectively for comparison (the before group). We compared the admission rates, re-visits to ED, and ultimate admission rates in older or diabetic patients in the before- and after-protocol group. RESULTS: 55 and 39 diabetic cases were enrolled respectively in the before- and after group respectively. The initial admission rate in diabetic patients was significantly lower in the after group (31.6% vs 76.4% p<0.001) and the revisit rate was not significantly different (p=0.586). In older patients, 95 and 57 cases were enrolled respectively. The initial admission rate was significantly lower in after group (69.5% vs 42.1%) and the revisit rate was not statistically different (p=0.452). CONCLUSION: For diabetic and older women patients with APN, ED observation unit treatment protocol can be applied safely and shows significant decrease in admission rate.
Adult ; Aged* ; Antiemetics ; Ciprofloxacin ; Clinical Protocols* ; Diabetes Mellitus ; Female* ; Humans ; Prospective Studies ; Pyelonephritis* ; Retrospective Studies