BACKGROUND: The present study was aimed to determine the alterations of hemodynamics and embolic composition during the course of total knee replacement. METHODS: A retrospective analysis was performed using data acquired from 20 patients who underwent 10 unilateral and 10 bilateral total knee replacement under general anesthesia. Transesophageal echocardiography and Swan-Ganze catheterization were placed following induction of anesthesia, then images and changes were recorded throughout the procedure. All patients were performed using fluted intramedullary rods inserted into an overdrilled femoral entrance hole in conjunction with the application of a tourniquet. RESULTS: We found echogenic emboli in 8 out of 20 patients during cannulation of the femoral canal and performing femoral and tibial saw cuts, then we detected echogenic emboli in all 20 patients during tourniquet deflation. Echogenic emboli consistently filled the right atrium and ventricle with very small size embolic materials for 19 7 minutes during total knee replacement. Heart rate exhibited no change, Mean arterial pressure decreased and mean pulmonary artery pressure increased after tourniquet deflation. After tourniquet deflation, free fatty acid increased in lipid profile. No patient had postoperative complications related echogenic emboli. CONCLUSION: All patients exhibited echogenic emboli during certain stages of total knee replacement. Although all patients were asymtomatic in our study, one should be cautioned when performing total knee replacement in patients with little physiologic reserve and large embolic events.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Arthroplasty, Replacement, Knee* ; Catheterization ; Catheters ; Echocardiography, Transesophageal* ; Heart Atria ; Heart Rate ; Hemodynamics* ; Humans ; Postoperative Complications ; Pulmonary Artery ; Retrospective Studies ; Tourniquets

Melanocytes grown in the pure monolayer culture lack the three-dimentional organization and the cellular interactions that exist in vivo. These can be partially overcome by growing melanocytes together with other epidermal cells in cultured skin equivalent models. In this study, skin equivalents were prepared by seeding mixtures of cultured human keratinocytes and melanocytes in ratio 10 : 1 onto artificially constructed dermis. They were cultured in DMEM/F12 (1 : 1) for 4 days and then lifted to the air-liquid interface and maintained in DMEM/F12 (3 : 1) for 10 days. Histological and electronmicroscopic examinations of the cultured skin equivalants revealed a structure that closely resembled human interfollicular epidermis; 1. Melanocytes, were identified by positive staining with melanoma-specific antibodies (NKI/C3 and S-100 protein) and prominent cytoplasm with rich cell organelles, were located in the basal layer. 2. Melanocytes contained predominently early stage melanosomes and prominent Golgi apparatus. Mature melanins, were usually abundant in normal skin, were hardly seen both in melanocytes and in neighbouring keratinocytes. 3. Melanocytes were surrounded by keratinocytes but did not form intercellular junctions with them. 4. Keratinocytes were charaterized by microfilament bundles and intercellular junctions such as desmosomes and hemidesmosomes with neighbouring keratinocytes and artificial dermis. The melanocyte in the above skin equivalents had a strong resemblance to the one of normal human skin and therefore this model can be used as artificial skin for the transplantation and in the investigation of melanocytes' role to the UV stimuli.
Actin Cytoskeleton ; Antibodies ; Cytoplasm ; Dermis ; Desmosomes ; Epidermis ; Golgi Apparatus ; Hemidesmosomes ; Humans ; Intercellular Junctions ; Keratinocytes ; Melanins ; Melanocytes* ; Melanosomes ; Organelles ; Skin* ; Skin, Artificial

BACKGROUND: Lung cancer incidence is gradually leveling off in developed countries but is continuing to rise in Korea. Because of the rapid increasing in smoking prevalence among women and youngers, the lung cancer incidence is expected to increase within next three and four decades. The aims of the present study are to analyses the smoking habits in patients with lung cancer and to evaluate of the relative risk of smoking habits in patients with lung cancer. METHOD: The present investigation was hospital-based, case control study. It included data from 93 case subjects with lung cancer and 1132 controls with disease unrelated to smoking using smoking history questionnaire by direct personal interview. RESULT: Compared with non-smoker, those who smoked more than 50 years had an odds ratio for lung cancer of 8.8(1.8-20.7). The odds ratios was 8.5(3.5-20.7) for those whose total number of cigarettes per days exceeded 41 and 5.5(2.3-13.3) for men with started habitual smoking less than 20 years old. The risk was increased in men with more than 41 pack years of cigarette smoking(OR:5.5, 95% CI:2.6-11.9). Odds ratios associated with cigarette smoking were 2.5(1.1-5.8), 5.1(2.6-10.4) for exsmoker and current smoker, respectively and 2.2(1.0-4.6) for non-filter smoker with more than 16 years. CONCLUSION: There was a clear dose-response relationship between the risk of lung cancer and smoking. We conclude that smoking dose is important risk factor for lung cancer and smoking habits may be, also.
Case-Control Studies ; Developed Countries ; Female ; Humans ; Incidence ; Korea ; Lung Neoplasms* ; Lung* ; Male ; Odds Ratio ; Prevalence ; Surveys and Questionnaires ; Risk Factors ; Smoke* ; Smoking* ; Tobacco Products ; Young Adult

PURPOSE: This study was conducted to evaluate outcomes in adult patients with Burkitt lymphoma (BL) or Burkitt-like lymphoma treated with an rituximab plus hyper-CVAD (R-hyper-CVAD) regimen by focusing on tolerability and actual delivered relative dose intensity (RDI). MATERIALS AND METHODS: Patients > or = 20 years of age and pathologically diagnosed with BL or Burkitt-like lymphoma were treated with at least one cycle of R-hyper-CVAD as the first-line treatment in this study. Eligible patients' case report forms were requested from their physicians to obtain clinical and laboratory data for this retrospective study. RESULTS: Forty-three patients (median age, 51 years) from 14 medical centers in Korea were analyzed, none of which were infected with human immunodeficiency virus. The majority of patients had advanced diseases, and 24 patients achieved a complete response (75.0%). After a median follow-up period of 20.0 months, 2-year event-free and overall survival rates were 70.9% and 81.4%, respectively. Eleven patients (25.6%) were unable to complete the R-hyper-CVAD regimen, including six patients due to early death. The RDIs of adriamycin, vincristine, methotrexate, and cytarabine were between 60% and 65%, which means less than 25% of patients received greater than 80% of the planned dose of each drug. Poor performance status was related to the lower RDIs of doxorubicin and methotrexate. CONCLUSION: R-hyper-CVAD showed excellent treatment outcomes in patients who were suitable for dose-intense chemotherapy. However, management of patients who are intolerant to a dose-intense regimen remains problematic due to the frequent occurrence of treatmentrelated complications.
Adult ; Burkitt Lymphoma ; Cytarabine ; Doxorubicin ; Drug Therapy ; Follow-Up Studies ; HIV ; Humans ; Korea ; Lymphoma* ; Methotrexate ; Retrospective Studies ; Survival Rate ; Vincristine

We assessed the success rate of empirical antifungal therapy with itraconazole and evaluated risk factors for predicting the failure of empirical antifungal therapy. A multicenter, prospective, observational study was performed in patients with hematological malignancies who had neutropenic fever and received empirical antifungal therapy with itraconazole at 22 centers. A total of 391 patients who had abnormal findings on chest imaging tests (31.0%) or a positive result of enzyme immunoassay for serum galactomannan (17.6%) showed a 56.5% overall success rate. Positive galactomannan tests before the initiation of the empirical antifungal therapy (P=0.026, hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.10-4.69) and abnormal findings on the chest imaging tests before initiation of the empirical antifungal therapy (P=0.022, HR, 2.03; 95% CI, 1.11-3.71) were significantly associated with poor outcomes for the empirical antifungal therapy. Eight patients (2.0%) had premature discontinuation of itraconazole therapy due to toxicity. It is suggested that positive galactomannan tests and abnormal findings on the chest imaging tests at the time of initiation of the empirical antifungal therapy are risk factors for predicting the failure of the empirical antifungal therapy with itraconazole. (Clinical Trial Registration on National Cancer Institute website, NCT01060462)
14-alpha Demethylase Inhibitors/adverse effects/therapeutic use ; Adolescent ; Adult ; Aged ; Antifungal Agents/adverse effects/*therapeutic use ; Aspergillosis/complications/*drug therapy ; Candidiasis/complications/*drug therapy ; Coccidioidomycosis/complications/drug therapy ; Febrile Neutropenia/complications/drug therapy ; Female ; Hematologic Neoplasms/complications/drug therapy/*microbiology ; Humans ; Itraconazole/adverse effects/*therapeutic use ; Male ; Mannans/blood ; Middle Aged ; Prospective Studies ; Treatment Outcome ; Young Adult

Background/Aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. Conclusions Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.