BACKGROUND: Most febrile neutropenic patients are treated in an aggressive manner. However, identification of low-risk patients may enable clinicians to administer risk-based treatment. The object of this study is to certify the factors associated with increased risk at the time of visiting the emergency department. METHODS: This is a retrospective study. We reviewed the medical records of 101 febrile neutropenic patients who had visited the emergency department of Seoul National University Hospital from January 1998 to August 1999. We assumed 22 risk prediction factors that could be assessed at admission to the emergency department and 5 factors that could be assessed during treatment course. To find independent risk-prediction factors, we analyzed these factors respectively by using multiple regression analysis. RESULTS: Tachycardia(aOR=136.5), altered mentality(aOR=28.8), decreased renal function(aOR=20.1), and significant comorbidity(aOR=17.2) are the independent factors associated with higher mortality. Altered mentality(aOR=31.6) and decreased renal function(CCr<75ml/min, aOR=5.4) are those associated with a higher incidence of septic shock. Independent factors associated with persistent(more than 3 days) fever are the early(within 10 days) onset of fever after last chemotherapy(aOR=8.8) and the existence of new pulmonary infiltrates on a simple chest X-ray(aOR=4.3). CONCLUSION: The stability of vital signs, the change of mentality, the renal function, the existence of significant comorbidity, the existence of new pulmonary infiltrates, and the rate of neutropenia are clinically useful risk-predication factors in febrile neutropenia at the time of visiting the emergency department.
Comorbidity ; Emergency Service, Hospital ; Febrile Neutropenia ; Fever ; Humans ; Incidence ; Medical Records ; Mortality ; Neutropenia ; Retrospective Studies ; Seoul ; Shock, Septic ; Thorax ; Vital Signs

No abstract available.
Thyroid Gland* ; Thyroid Nodule*

BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.
Death Certificates* ; Education ; Emergencies ; Mortality ; Retrospective Studies ; Seoul

More than 80% of cases of patients with sporadic primary hyperparathyroidism are caused by a single parathyroid adenoma. Therefore, traditional bilateral neck exploration has been replaced by minimally invasive parathyroidectomy (MIP) in recent years. Benefits, of MIP include decreased pain and complications, a shorter length of hospital stay, and improved cosmesis. Preoperative imaging studies for localization and intraoperative PTH assay (IoPTH) play an essential role for in MIP. The standard imaging studies are cervical ultrasound and 99mTc sestamibi scanning (with SPECT/CT), while 4D CT is attracting significant interest. The half-life of PTH is less than 5 minutes and PTH rapidly drops after the resection of target lesions. These characteristics of PTH enable IoPTH. If target lesions are localized by recent imaging studies and IoPTH is adopted, MIP can be performed successfully in patients with primary hyperparathyroidism.
Four-Dimensional Computed Tomography ; Half-Life ; Humans ; Hyperparathyroidism, Primary ; Length of Stay ; Neck ; Parathyroid Neoplasms* ; Parathyroidectomy* ; Surgical Procedures, Minimally Invasive ; Technetium Tc 99m Sestamibi ; Ultrasonography

PURPOSE: The aim of this study was to evaluate the effect of overexpression of heat shock protein 70 (HSP70) on the expression of inducible nitric oxide synthase and on the concentration of nitric oxide and to determine the mechanism for the relationship between HSP70 and inducible nitric oxide synthase (iNOS) in sepsis. METHODS: Experiments were performed on male Sprague-Dawley rats, and sepsis was induced by using cecal ligation and puncture (CLP). Glutamine (GLN) or saline was administered 1 h after initiation of sepsis. We acquired serum and lung tissues from the rats 12 h or 24 h after initiation of sepsis. We analyzed the concentration of nitric oxide, the expression of HSP70 in the lung, and the gene expression of iNOS in the lung. RESULTS: In CLP+GLN, glutamine given after initiation of sepsis enhanced the expression of HSP70 in the lung at 12 h (CLP+GLN vs. CLP:: 47.19 +/- 10.04 vs. 33.22 +/- 8.28, p = 0.025) and 24 h (CLP+GLN vs. CLP: 47.06 +/- 10.60 vs. 31.90 +/- 4.83, p = 0.004). In CLP+GLN, glutamine attenuated the expression of iNOS mRNA in the lung at 12 h (CLP+GLN vs. CLP: 4167.17 +/- 951.59 vs. 5513.73 +/- 1051.60, p = 0.025) and 24 h (CLP+GLN vs. CLP: 9,437.65 +/- 2,521.07 vs. 18,740.27 +/- 8,241.20, p = 0.016) and reduced the concentration of nitric oxide in serum at 12 h (CLP+GLN vs. CLP: 0.86 +/- 0.48 vs. 3.82 +/- 2.53 micromol/L, p = 0.016) and 24 h (CLP+GLN vs. CLP: 0.39 +/- 0.25 vs. 1.85 +/- 1.70 micromol/L, p = 0.025). CONCLUSION: The overexpression of HSP70 induced by the administration of glutamine in sepsis attenuated the gene expression of iNOS and reduced the concentration of nitric oxide.
Animals ; Gene Expression ; Glutamine ; Heat-Shock Proteins ; Hot Temperature ; HSP70 Heat-Shock Proteins ; Humans ; Ligation ; Lung ; Male ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II ; Punctures ; Rats ; Rats, Sprague-Dawley ; RNA, Messenger ; Sepsis

OBJECTIVES: To assess innate and humoral immune responses in middle ear effusion of obese pediatric patients with otitis media with effusion (OME). METHODS: We evaluated 219 children with OME, of whom 21 were obese and 198 were non-obese. We compared the expression in middle ear effusion of mRNAs encoding toll-like receptors (TLR) 2, 4, 5, and 9; nucleotide-binding oligomerization domains (NOD) 1 and 2; retinoic acid-inducible gene (RIG)-I; interleukins (IL)-6, -10, and -12; interferon (IFN)-gamma; and tumor necrosis factor (TNF)-alpha mRNAs. We also compared the expression of immunoglobulins IgG, IgA, and IgM and the bacterial detection rate in the two groups. RESULTS: TLR2-mediated expression of IL-6 mRNA, TLR4-mediated expression of IL-6 and IL-10 mRNA, TLR5-mediated expression of IL-6, IL-10, and TNF-alpha mRNA, TLR9-mediated expression of IL-6 mRNA, and NOD2-mediated expression of IL-6, IL-12, and TNF-alpha mRNA were significantly lower in obese than in non-obese children (P<0.05). However, concentrations of IgG, IgA, and IgM in middle ear effusion were lower in obese than in non-obese children, but none of these differences was significant (P>0.05). CONCLUSION: Mean body mass index was higher and pattern-recognition receptor-mediated cytokine mRNA expression was lower in obese than in non-obese children with OME.
Bacteria ; Body Mass Index ; Child* ; Humans ; Immunity, Humoral ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Interferons ; Interleukin-10 ; Interleukin-12 ; Interleukin-6 ; Interleukins ; Obesity ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; RNA, Messenger* ; Toll-Like Receptors ; Tumor Necrosis Factor-alpha

PURPOSE: To determine the clinical feature, surgical management of primary and recurrent disease, predictive factors for outcome, and impact of multimodality therapy in retroperitoneal sarcoma. MATERIALS AND METHODS: 60 patients were confirmed pathologically as soft-tissue sarcoma of the retroperitoneum by operation or needle biopsy in Seoul National University Hospital from 1983 to 1995. A retrospective analysis was performed. RESULTS: The abdominal mass was common presenting symptom. Histologically liposarcomas(25%) and leiomyosarcomas(23.3%) were most common, and MFHs(11.7%) and malignant schwannomas(11.7%) followed. The overall 5 year survival rate was 54.6%. Complete resection was possible in 51.7% of patients and strongly predicts outcome (<0.0001). These patients had a median survival of 130 months compared to 20 months for those undergoing partial resection and 9 months for those with unresectable tumors. 11(35%) of completely resected patients have had local recurrence. These patients underwent reoperation when feasible. Complete resection of recurrent disease was performed in 10 patients(90%), with a 42 months median survival time after reoperation. Resection of adjacent organ was performed in 19 patients. 14 of these were completely resected, and showed 100% of 5 year survival rate. Tumor grade was not a significant predictor of outcome. Gender, histologic type, encapsulation, stage, resectability, combined resection were significant prognostic factors by univariate analysis. But resectability was only independent prognostic factor on mutivariate analysis. Radiation therapy and chemotherapy could not be shown to have significant impact on survival. CONCLUSION: Complete resection is the most important prognostic factor of retroperitoneal sarcoma. Extensive and aggressive surgery must be considered including resection of adjacent organs. Multiple resection seems to improve survival in recunent cases.
Biopsy, Needle ; Drug Therapy ; Humans ; Recurrence ; Reoperation ; Retrospective Studies ; Sarcoma* ; Seoul ; Survival Rate

Thirteen patients with malignant germ cell tumars of the ovary have been treated with a combination chemotherapy. The age of the patients ranged from ll to 50 years and there was no history of radiation therapy of chemotherapy except operation, Stage distributions are as follow ; 2 pstients are stage IV, 3 are stage II and remainied 8 are stage I. 4 patients with immature teratama and 2 patients with mixed germ cell tumor received VAC chemotherapy, as primary therapy, and among them 1 lost to follow up but remained 5 cases live without evidence of disease 39 to 83 gnontha. There were 3 patients with endodermal sinus tumor and 1 received VAC and remeined 2 received FVB as primary chemotherapy, Of them 1 died of disease after 9 months of oyeration and the other 2 live now with no evidence of disease. There were 2 patiente with dysgerminoma and 2 with primary ovarian choriocarcinoma. 1 patient with dysagerminoma and 1 wit choriocarcinoma were died because of chemotherapy toxicity, 1 patient with dysgerminoma, who refused further ehemotherapy after l course of chemot.herapy, died of progressive disease. l patient wit choriocarcinoma now live well without evidence of disease at 35 months. The combination chemotherapy using VAC or PVB regimen represents an effective treatment for malignant. germ cell turnars of the ovary and reveals moderate oxicity.
Choriocarcinoma ; Drug Therapy ; Drug Therapy, Combination* ; Dysgerminoma ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Humans ; Lost to Follow-Up ; Neoplasms, Germ Cell and Embryonal* ; Ovary ; Pregnancy

BACKGROUND: Changes in the volume of the fluid space expanded by i.v. infusion of crystalloid solution have been analysed recently using mathematical models. The models are based on the assumption that the body strives to maintain volume homeostasis of fluid spaces and that the rate of restoration is a function of deviation from resting volume. METHODS: In this work mathematical models were developed to represent the kinetics of volume changes of fluid spaces associated with infusion of Ringer's solution. Based on the characteristics of fluid transportation, two expansion models were tested. The single-fluid space model has a single volume into which fluid is fed and from which fluid is left, and the two-fluid space model has another space in addition to the first volume so that fluid exchanges between these two spaces are possible. Volunteers (six men) were given Hartman's solution for 30 min and the changes in blood hemoglobin were detected. RESULTS: From the comparison with experimental data, the single-fluid space model was found to represent adequately in all volunteers, however, two-fluid space model was found to represent 75% of volunteers. CONCLUSIONS: These models may be useful in the description and analysis of the effects of i.v. fluid therapy.
Blood Volume ; Body Fluids* ; Fluid Therapy ; Homeostasis ; Kinetics ; Models, Theoretical ; Space Simulation ; Transportation ; Volunteers

PURPOSE: Infiltrating lobular carcinoma of the breast was known to have a high incidence of multicentricity and bilaterality in patients. We analyzed the clinical features of infiltrating lobular breast cancer. MATERIALS AND METHODS: We studied 29 patients with infiltrating lobular carcinoma of the breast, from Jan. 1980 to Mar. 1997 in the Department of Surgery, Seoul National University Hospital. RESULTS: The age of the patients ranged from 32 to 71 years with an average of 45.2 years. The main complaining symptom was a painless mass. The diameter of the tumor ranged from 0.7 to 7 cm with a mean size of 2.8 cm. The axillary lymph node was positive for malignancy in 12 cases. The number of multicentric breast cancers were 7 cases (24.1%), and the number of bilateral breast cancers were 3 cases (10.3%). The estrogen receptor was positive in 66.7%, and the progesterone receptor was positive in 75% of the cases. There were one local recurrence and three distant metastases during a mean follow-up period of 4.5 years. The 5-year survival rate and 5-year disease free survival rate were 89.6% and 88.6%, respectively. CONCLUSION: Infiltrating lobular breast cancers are at greater risk of developing multicentricity and bilaterality than nonlobular breast cancers. Careful program of frequent follow-up examinations and thorough histopathological studies are needed for patients with infiltrating lobular breast cancers.
Breast Neoplasms* ; Breast* ; Carcinoma, Lobular ; Disease-Free Survival ; Estrogens ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Receptors, Progesterone ; Recurrence ; Seoul ; Survival Rate