PURPOSE: To study the correlation between the outcome of the early postoperative period and the long-term outcome after surgery for partially accommodative esotropia. METHODS: The medical records of total 85 patients with partially accommodative esotropia, who underwent bilateral medial rectus muscle recession, and were followed-up at least 6 months, were retrospectively reviewed. The results were analyzed at 1 month, and 1 and 4 years after surgery. RESULTS: Of the 85 patients, 67 (78.8%) revealed postoperative deviation of less than 10 PD, 11 (12.9%) and 7 (8.2%) esotropia and exotropia more than 11 PD, respecrively, 1 month after surgery. At 1year postoperatively, 59 (77.6%), 8 (10.5%) and 9 (11.8%) showed acceptable deviation, undercorrection, and overcorrection, respectively. 4 years after surgery, 26 (81.2%) and 3 (9.4%) each showed acceptable deviation, undercorrection, and overcorrection, respectively. The results showed a tendency to become exotropic during the 4 years after surgery. CONCLUSIONS: In partially accommodative esotropia, it is essential that orthotropia or minimal esotropia should be present in the early postoperative period in order to obtain a good binocular alignment as the long term result. It is recommended that overcorrection be avoided in early postoperative exotropia.
Esotropia* ; Exotropia ; Humans ; Medical Records ; Postoperative Period ; Retrospective Studies ; Telescopes

The incidence of Kaposi's sarcoma increases in renal transplant patients who had immunosuppressive therapy. In Korea, 4 cases of Kaposi's sarcoma in renal transplant patients have been reported. All of these cases had skin lesions. We experienced pulmonary Kaposi's sarcoma in 25- year-old man proven by open lung biopsy. He had re ceived cyclosporine and prednisolone as immunosuppres sive agent for 8 months since renal transplantation. He admitted to the hospital because of fever and pulmonary nodules on chest X-ray, and he had no skin lesion. Sputum examinations were negative for microorganisms and malignancy. He had bloody and frothy secretions on bronchoscopic study, and BAL fluid examinations were negative for microorganisms and malignancy. Open lung biopsy was carried out which showed Kaposi's sarcoma nodules. Immunosuppressive agents were discontinued after diagnosis but pulmonay nodules progressed. He died of respiratory failure 10 days after diagnosis. Pulmonary Kaposi's sarcoma has to be considered in the differential diagnosis in immunosuppresed patients who present with fever and pulmonary nodules.
Biopsy ; Cyclosporine ; Diagnosis ; Diagnosis, Differential ; Fever ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation ; Korea ; Lung ; Lung Neoplasms ; Prednisolone ; Respiratory Insufficiency ; Sarcoma, Kaposi* ; Skin Manifestations* ; Skin* ; Sputum ; Thorax

PURPOSE: The aim of this study was to test the feasibility and the clinical usefulness of detection and measurement of distal left anterior descending coronary artery (LAD) flow using transthoracic echocardiography. METHODS: We prospectively examined 200 consecutive subjects(age 56+/-12 yrs, M:F=23:77). Of these subjects, 79 patients underwent coronary angiography. After obtaining the tubular color flow signals of distal LAD using an ultra-band transducer (5-12 MHz) with a special preset program of a low velocity range, the width and length of color Doppler signals, peak diastolic and systolic pulsed Doppler velocity (PDV) and velocity time integral(VTI) were measured. The echocardiographic findings of distal LAD flow were compared with the coronary angiogram. RESULTS: 1. In 142 of 200 subjects (71%), the color and pulsed Doppler signals with clear envelops were identified. 2. Forward biphasic flow in 86(60.6%) subjects and only diastolic flow in 56(39.4%) subjects were detected. 3.The mean length and width of color flow signals were 4.7+/-2.8mm (range 1.1-15.0 mm) and 1.6+/-0.7 mm (range 0.5-4.7 mm), respectively. 4.The mean PDV and VTI were 21.4+/-9.0 cm/sec(range 7.7-58.0 cm/sec) and 8.4+/-4.1 cm(range 2.8-26 cm), respectively. 5. The mean velocity range for obtaining the optimal Doppler signals of distal LAD was 13.0+/-4.2 cm/sec (range 6.4-32 cm/sec). 6. 14 of 22 (63%) subjects who distal LAD color flow signals were not identified showed the total or near total occlusion of LAD on the coronary angiogram. CONCLUSION: Detection and measurement of distal LAD flow are feasible in a high percentage of subjects by use of high frequency transthoracic Doppler echocardiography. The color and pulsed Doppler signals of distal LAD using transthoracic echocardiography at resting state may give the useful clinical information about coronary artery disease.
Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Echocardiography ; Echocardiography, Doppler ; Humans ; Prospective Studies ; Transducers

OBJECTIVE: The combination of vincristine and doxorubicin by continuous infusion was reported to reduce tumor mass more rapidly than standard regimens, which maybe a result of effect on more slowly proliferating plasma cells. We conducted a phase II study to determine the activity and safety of VAD (vincristine, doxorubicin, dexamethasone) chemotherapy, in which vincristine and doxorubicin are administered as a continuous infusion, for previously untreated multiple myeloma. METHODS: VAD chemotherapy (vincristine 0.4 mg/day 24 hour-continuous infusion, days 1~4; doxorubicin 9 mg/m2/day 24 hour-continuous infusion, days 1~4; dexamethasone 40 mg/day p.o. days 1~4) was given to eligible patients every 4 weeks and we assessed response and toxicity of the regimen. RESULTS: Between January 1991 and March 1997, total 25 patients entered this trial and 22 were evaluable. The complete response rate was 14%(3/22) and overall response rate was 59%(13/22, 95% C.I.: 38~80%). The time to response was 1.0~6.8(median 2.9) months. Progression free survival was 2~39+(median 11.5) months and the overall survival was 3+~42+(median 19.7) months. Toxicities of VAD regimen were leukopenia, infection, stomatitis and neurotoxicity, but there was no treatment-related death. CONCLUSION: VAD chemotherapy was tolerable, but not more active than the alkylating agent-based chemotherapy as a front-line treatment for the patients with multiple myeloma. But, because of its rapid response and relatively mild myelotoxicity, it could play a role for advanced or highly complicated disease and for remission induction before consolidation with high-dose chemotherapy.
Dexamethasone* ; Disease-Free Survival ; Doxorubicin* ; Drug Therapy* ; Humans ; Leukopenia ; Multiple Myeloma* ; Plasma Cells ; Remission Induction ; Stomatitis ; Vincristine*

PURPOSE: The purpose of our study was to evaluate the outcome of intensified induction therapy using the Vanderbilt regimen in patients with a poor prognosis non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: We retrospectively analyzed the results of two pilot studies, which enrolled the patients aged 60 years or less, with a previously untreated NHL of intermediate grade on the Working formulation, having 2 or 3 adverse prognostic factors on the age- adjusted International Prognostic Index. Patients received an intensified induction, with the regimen described by the Vanderbilt group. RESULTS: Thirty-five patients were analyzed. After induction, 29 patients (83%) achieved more than partial response (PR): 22 (63%) complete response (CR) and 7 (20%) PR. Three of the PRs were subsequently converted to CR following consolidation therapy. The overall CR rate, following the completion of treatment, was 71%. The 3-year overall survival (OS) rate of all patients was 53%. In the univariate analysis, age (50 years) was the only factor affecting the OS. The 3-year disease-free survival (DFS) rate of patients with CR was 68%. In the univariate analysis, age and bone marrow involvement were the factors affecting the DFS. Two patients died from the treatment-related toxicity of the induction therapy: one due to sepsis and the other due to congestive heart failure. CONCLUSION: Although the CR rate was relatively high, the OS or DFS of patients with a poor prognosis NHL, who had received the intensified induction using the Vanderbilt regimen, were no different from those that had received the conventional chemotherapy, as reported by the International Prognostic Index Project. However, the OS or DFS in the young patient groups were encouraging. To test the hypothesized benefits of our approach in the young patient groups, a larger cohort of patients aged 50 years or less should be studied.
Bone Marrow ; Cohort Studies ; Disease-Free Survival ; Drug Therapy ; Heart Failure ; Humans ; Lymphoma, Non-Hodgkin* ; Pilot Projects ; Prognosis ; Retrospective Studies ; Sepsis

PURPOSE: The two staging system, which divides the tumors into limited disease (LD) and extensive disease (ED) has been widely accepted as a major prognostic determinant in small cell lung cancer (SCLC). However this system has provoked several controversial issues in defining stage categories, for instance, ipsilateral pleural effusion as LD or ED. Furthermore, identification of favorable subgroups in the same stage has been recognized as an important factor to determine appropriate treatment strategies. In this study, we performed a retrospective analysis in an attempt to resolve the controversial issues about staging and identify the patient group with favorable prognosis based on this two staging system. MATERIALS AND METHODS: The clinical data of 233 patients with SCLC treated from 1990 to 1996 at Korea Cancer Center Hospital were retrospectively analyzed for this study. All patients were treated with chemotherapy containing cisplatin and/or radiotherapy. The independent prognostic factors for survival were identified by multivariate analysis using Cox's proportional hazards model. RESULTS: Performance status (relative risk of death [RR]:2.89), number of metastasis (RR:2.2), response to treatment (RR:2.2) as well as stage (RR:1.77) were identified as independent prognostic factors for survival in patient with SCLC. The median survival of patients with ipsilateral pleural effusion (13 months) which was categorized as ED was similar to that of patients with contralateral mediastinal or supraclavicular lymph nodes (13.8 months) or other LD patients (13.7 months). This result suggests that ipsilateral pleural effusion should be categorized as LD. In LD, response to treatment was the only independent prognostic factor (RR:2.34) and thoracic radiotherapy moderately improved survival as compared with combination chemotherapy alone (17.7 months vs. 10.4 months, p=0.06). In ED, the patient group with a good performance status (ECOG 0-1), normal range of serum alkaline phophatase, and metastasis less than 2 sites showed significantly prolonged survival, comparing with other ED patients (11.2 months vs. 7.2 months, p=0.0001). CONCLUSION: As a result of survival analysis, we confirmed independent prognostic factors such as stage and performance status in SCLC. We could recommend that LD category include patients with ipsilateral pleural effusion as well as those with contralateral lymphadenopathy. In ED, the survival in patients with favorable prognostic factors was comparable to LD, suggesting this patient group may be a candidate for aggressive therapy.
Cisplatin ; Drug Therapy ; Drug Therapy, Combination ; Factor Analysis, Statistical* ; Humans ; Korea ; Lymph Nodes ; Lymphatic Diseases ; Multivariate Analysis ; Neoplasm Metastasis ; Pleural Effusion ; Prognosis ; Proportional Hazards Models ; Radiotherapy ; Reference Values ; Retrospective Studies ; Small Cell Lung Carcinoma*

BACKGROUND: Primary lymphoma of the breast is rare disease, accounting for 1.7% to 2.2% of extranodal lymphoma and 0.38% to 0.7% of non-Hodgkin's lymphoma. The aim of this study was to evaluate the clinicopathological features and treatment outcome of patients with primary breast lymphoma (PBL). METHODS: We conducted retrospective review of cases of non-Hodgkin's lymphoma diagnosed at Korea Cancer Center Hospital between 1989 and 2002. Nine of the 1050 cases fulfilled the criteria for PBL. RESULTS: All patients were women (median age, 45 years) and they usually had breast masses that had recently become enlarged. Six cases involved the breast alone (stage IE), whereas three cases also involved the ipsilateral lymph nodes (stage IIE). Histopathologic studies revealed diffuse large B cell in 7 cases, marginal zone B cell lymphoma in 1 case, small lymphocytic lymphoma in 1 case. Immunohistochemical analysis revealed B-cell phenotype in all cases. Modified radical mastectomy and chemotherapy was done in 4 cases, modified radical mastectomy and chemoradiotherapy was done in 1 case, chemoradiotherapy was done in 1 case, modified radical mastectomy alone was done in 1 case, chemotherapy alone was done in 1 case, and radiotherapy alone was done in 1 case. All cases achieved a complete remission, but median overall survival was 12 months. CONCLUSION: PBL represented 0.9% of all non-Hodgkin's lymphomas in our institute. The most frequent pathologic type was diffuse large B-cell lymphoma. There was no uniform approach to the treatment of PBL. The patients showed very poor prognosis irrespective of the type of treatment modality.
B-Lymphocytes ; Breast* ; Chemoradiotherapy ; Drug Therapy ; Female ; Humans ; Korea ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymph Nodes ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Non-Hodgkin ; Mastectomy, Modified Radical ; Phenotype ; Prognosis ; Radiotherapy ; Rare Diseases ; Retrospective Studies ; Treatment Outcome

BACKGROUND: Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. METHODS: We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. RESULTS: Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8+/-12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). CONCLUSIONS: There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.
Acute Coronary Syndrome ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Death ; Dyslipidemias ; Follow-Up Studies ; Heart* ; Hospitals, University ; Humans ; Hypertension ; Incidence ; Korea ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Prospective Studies ; Risk Factors ; Smoke ; Smoking ; Stents