PURPOSE: To evaluate the efficacy of combined treatment of metallic biliary stent placement and radiotherapy in malignant biliary obstruction. MATERIALS AND METHODS: Between January 1992 and February 1994, 22 patients with malignant biliary obstruction were treated with metallic biliary stent placement and radiotherapy. The causes of the obstruction included cholangiocarcinoma(n=14), gallbladder carcinoma(n=4), colon cancer(n=2), pancreatic head cancer (n=1), and stomach cancer(n=1). According to the sites of obstruction level, patient were divided into 2 groups; hilar obstruction(n=18) and common bile duct obstruction(n=4). The patients received dose of 45 Gray/18 fraction by external radiotherapy and 20Gy/8f by high dose rate brachytherapy with iridium--192 source through percutaneous transhepatic biliary drainage(PTBD) catheter. The duration of stent patency after placement, survival period and survival rate by Kaplan Meier method were calculated in dead and alive patients, respectively. RESULTS: In all 22 patients, the duration of stent patency was 5.5(1.3--18.5)months. Survival periods after stent placement and PTBD were 5.3(2.0--8.5 )months and 7.9(4.0--14.7)months respectively in 9 dead patients and 7.7(1.3--21.0)months and 9.5(2.3--23.0)months in 13 alive patients. In all 22 patients, the survival rates in 6, 12 and 18 months were 78.9%, 47.5 % and 35.6 %, respectively. CONCLUSIONS: The results with combined metallic biliary stent placement and radiotherapy for the palliative treatment of malignant biliary obstruction in this study was more favorable, as compared with those of the other authors with only metallic biliary stent placement.
Brachytherapy ; Catheters ; Colon ; Common Bile Duct ; Gallbladder ; Head and Neck Neoplasms ; Humans ; Palliative Care ; Radiotherapy* ; Stents* ; Stomach ; Survival Rate

A patient was admitted for catheter ablation of atrial fibrillation. Cardiac computed tomography and transesophageal echocardiography revealed the absence of the left atrial appendage. However, the right atrial appendage looked normal and the level of pro B-natriuretic peptide was within normal limits. Successful catheter ablation was performed without any procedural complications and the sinus rhythm was appropriately maintained for 10 months with an antiarrhythmic drug.
Atrial Appendage* ; Atrial Fibrillation ; Catheter Ablation ; Echocardiography, Transesophageal ; Humans

BACKGROUND AND OBJECTIVES: The number of permanent pacemakers (PPMs) implanted in patients in Japan and Korea differs significantly. We aimed to investigate the differences in decision making processes of implanting a PPM. MATERIALS AND METHODS: Our survey included 15 clinical case scenarios based on the 2008 AHA/ACC/HRS guidelines for device-based therapy of cardiac rhythm abnormalities (class unspecified). Members of the Korean and Japanese Societies of Cardiology were asked to rate each scenario according to a 5-point scale and to indicate their decisions for or against implantation. RESULTS: Eighty-nine Korean physicians and 192 Japanese physicians replied to the questionnaire. For the case scenarios in which there was a class I indication for PPM implantation, the decision to implant a PPM did not differ significantly between the two physician groups. However, the Japanese physicians were significantly more likely than the Korean physicians to choose implantation in class IIa scenarios (48% vs. 37%, p<0.001), class IIb scenarios (40% vs. 19%, p<0.001), and class III scenarios (36% vs. 18%, p<0.001). These results did not change when the cases were categorized based on disease entity, such as sinus node dysfunction and conduction abnormality. CONCLUSION: Korean physicians are less likely than Japanese physicians to favor a PPM implantation when considering a variety of clinical case scenarios, which probably contributes to the relatively small number of PPMs implanted in patients in Korea as compared with those in Japan.
Asian Continental Ancestry Group ; Atrioventricular Block ; Cardiology ; Decision Making* ; Humans ; Japan* ; Korea* ; Pacemaker, Artificial ; Sick Sinus Syndrome

OBJECTIVE: The aim was to evaluate whether the differences of PG concentration in follicular and peritoneal fluid during preovulatory phase exist between the women with and without endometriosis. MATERIAL AND METHODS: Twenty-three patients with endometriosis, 8 were stage I-II and 15 were stage III-IV, and another 23 patients without endometriosis were undergone laparotomy during late follicular phase. Peritoneal fluid from 46 patients and follicular fluid from 42 patients were obtained, and these samples were analyzed double times for PGF2alpha, PGE2 and estradiol. RESULTS: The mean level of PGF2alphain the peritoneal fluid was significantly higher in the group with endometriosis than in the control(P=0.0293), especially more significant in stage I-II endometriosis. Although there was no significant difference of PGF2alphaconcentration in the follicular fluid between the groups, the stage III-IV endometriosis group showed slightly higher PGF2alphalevel than both the stage I-II group and the control(P=0.0604). And also, there was significant positive correlation with the level of PGF2alphaand estradiol in the follicular fluid only in the endometriosis group(r=0.4988, P=0.0154), not in the control. However, there was no difference in the level of PGE2 and estradiol in the peritoneal or follicular fluid between the groups. CONCLUSION: Some alterations of PGF2alphalevel exist in the women with endometriosis. These are significantly higher PGF2alphalevel in peritoneal fluid with mild endometriosis and slightly higher PGF2alphalevels in follicular fluid with extensive endometriosis during preovulatory phase, which suggest that PGF2alphamay play some roles in subfertility associated with endometriosis.
Ascitic Fluid* ; Dinoprost* ; Dinoprostone ; Endometriosis* ; Estradiol ; Female ; Follicular Fluid ; Follicular Phase* ; Humans ; Infertility ; Laparotomy

PURPOSE: Taxol (Paclitaxel) is a new generation of chemotherapeutic drug proven to be effective in the treatment of many cancers. In this study, to further demonstrate the differential effect of the tumor suppressor gene, p53, on the Taxol-induced apoptosis in osteogenic sarcoma cell lines, we used p53-defected SaOS2 cells and wild type p53-expressed U2OS cells. MATERIALS AND METHODS: The cell viability was measured by the XTT assay. To examine whether the differential expressions of p53, in U2OS and SaOS2 cells, were associated with Taxol-induced apoptosis, DNA fragmentation assays were performed on both cytosolic and genomic DNA. Since the cleavage of poly (ADP-ribose) polymerase (PARP) is primarily responsible for apoptosis, the cleavage of PARP, and the expression of cyclin B1, polo-like kinase, Bax, Bcl-xL, Bcl-2 in U2OS and SaOS2 cells were compared by Western blot analyses. RESULTS: The cell viability of the p53-defected SaOS2 cells was markedly decreased with Taxol treatment. Whereas, the cell viabilities due to 6-mercaptopurine and adriamycin were no different between the U2OS and SaOS2 cells. Treatment with Taxol induced a ladder- like pattern of DNA fragments, which is a biochemical hallmark of apoptosis, consisting of multiples of approximately 180-200 base pairs, in a dose-dependent manner in the SaOS2 cells, but insignificantly with the U2OS cells. When the cells were treated with Taxol, the 89 kDa cleavage product of PARP clearly appeared as a function of time in the SaOS2 cells, but not in the U2OS cells. The Taxol-induced apoptosis in p53 defected-osteogenic sarcoma cells was associated with the PARP cleavage as a result of the increased activity of caspase 3, and the high expressions of cyclin B1 and PLK. Bax, as a proapoptotic factor, was increased in the SaOS2cells, but the Bcl-xL and Bcl-2 were decreased when the cells were exposed to 10miceoM Taxol. CONCLUSION: From these results, it was concluded that p53-defected SaOS2 cells are much more sensitive to Taxol-induced apoptosis than p53-expressed U2OS cells.
6-Mercaptopurine ; Apoptosis* ; Base Pairing ; Blotting, Western ; Caspase 3 ; Cell Line ; Cell Survival ; Cyclin B1 ; Cytosol ; DNA ; DNA Fragmentation ; Doxorubicin ; Genes, Tumor Suppressor ; Osteosarcoma* ; Paclitaxel ; Phosphotransferases ; Sarcoma

Ethylmalonic encephalopathy is a rare syndrom characterized by developmental delay, acrocyanosis, petechiae, chronic diarrhea, and ethylmalonic, lactic, and methylsuccinic aciduria. We report the MRI finding of ethylmalonic encephalopathy including previously unreported intracranial hematoma.
Diarrhea ; Hematoma ; Magnetic Resonance Imaging* ; Purpura

PURPOSE: Gemcitabine is the most active agent to treat unresectable pancreatic cancer. The superiority of combining other drugs with cisplatin is still controversial; therefore, we performed a retrospective analysis of gemcitabine versus gemcitabine combined with cisplatin to determine the treatment outcomes for patients with locally advanced or metastatic pancreatic cancer. MATERIALS AND METHODS: From 2001 to 2007, we enrolled 60 patients who were treated with gemcitabine or gemcitabine combined with cisplatin for locally advanced or metastatic pancreatic cancer. Gemcitabine 1, 000 mg/m2 (G) was administrated at day 1 and day 8 every 3 weeks. Cisplatin 60 mg/m2 was added at day 1 every 3 weeks to the gemcitabine schedule (GP). RESULTS: Number of G: GP was 34: 26, locally advanced to metastatic ratio was 35% to 65% in group G and 46% to 54% in group GP. Median follow up duration was 29 months. The median number of chemotherapy cycles was 4 (range: 2~11) for the G group, and 4 (range: 1~11) for the GP group. The response rate of the G and GP groups was 17% and 11%, respectively. The progression free survival (PFS) was 4.5 months and 2.8 months, respectively, for the G and GP groups. The overall survival (OS) was 10.7 and 8.7 months respectively, for the G and GP groups, but there is no statistically significant difference of the PFS (p=0.2396) and OS (p=0.4643) between the 2 groups. The hematological toxicity profile was similar (the grade III neutropenia and thrombocytopenia was 4.4% and 3.1%, respectively, in G group, and 7.5% and 2.8%, respectively, in the GP group). But non-hematological toxicities such as skin rash, abnormal liver function and nausea/vomiting were observed in 3 patients of the GP group. On the prognostic factor analysis, no factors predicted a longer PFS and OS for both the G and GP groups. CONCLUSIONS: Gemcitabine single treatment might be more tolerable and it had the same efficacy compared to cisplatin combination treatment in this retrospective study.
Appointments and Schedules ; Cisplatin ; Deoxycytidine ; Disease-Free Survival ; Exanthema ; Follow-Up Studies ; Humans ; Liver ; Neutropenia ; Pancreatic Neoplasms ; Retrospective Studies ; Thrombocytopenia

Methods: In total, 55 patients with SIFs were retrospectively investigated in this study. The study population was divided into lumbosacral fusion (n=20) and non-fusion (n=35) groups. Subsequently, the patients’ demographic characteristics, comorbidities, medication history, results of diagnostic imaging studies, and bone mineral density were assessed. The fracture patterns were classified either according to the five typical types (H-pattern bilateral vertical plus horizontal component, unilateral vertical only, bilateral vertical only, unilateral vertical plus horizontal component, and horizontal only fracture) or atypical types. Results: In total, 44 of 55 patients (80%) suffered from more than one senile disease and received corresponding medications that caused secondary osteoporosis. A total of 12 patients had S1 lumbosacral fixation. Moreover, three of these 12 patients who developed a SIF immediately after a lumbosacral fracture had an unstable sacral U fracture. The remaining nine patients showed fracture patterns similar to the non-fusion patients. Single-photon emission computed tomography (SPECT)/computed tomography (CT) can identify fracture recurrence in previously healed fractures. In total, 24 patients (43.6%) had fractures of the pelvis, femur, and thoracolumbar spine. Conclusions SIF develops in elderly patients with multiple adult diseases that can induce secondary osteoporosis. Such fractures may occur in the patients with instrumented lumbosacral fusion. Importantly, some patients showed stress fractures after multilevel instrumented lumbosacral fusion, whereas others showed insufficiency fractures. The different fracture patterns correspond to different grades of SIF, and SPECT/CT can easily identify the fracture status.

BACKGROUND: This study is to evaluate the effectiveness and application of Lecompte procedure as a treatment for various complex cardiac anomalies with pulmonary outflow tract obstruction. Methods: Between July 1988 and December 1997, 44 patients underwent Lecompte procedure in Seoul National University Children's Hospital. The male to female ratio was 24 to 20 and the mean age was 29.2 months (range, 3 to 83). Of these patients, 28 (63.6%) had transposition of great arteries with ventricular septal defect and pulmonary stenosis (or pulmonary atresia), 14 (31.8%) had double outlet right ventricle with pulmonary stenosis (or pulmonary atresia), and so on. The principles of the technique are 1) extension of the ventricular septal defect or conal resection, 2) construction of a intracardiac tunnel connecting the left ventricle to the aorta, and 3) direct connection, without a prosthetic conduit, of the pulmonary trunk to the right ventricle. RESULTS: There were 3 in-hospital deaths and their causes were sustained hypoxia, myocardial failure, and sepsis, respectively. There was 1 late death due to sepsis. Reoperations were performed in 6 patients who had pulmonary outflow tract obstructions (4 cases), residual muscular ventricular septal defect (1 case), and recurrent septic vegetation (1 case). The cumulative survival rates by the Kaplan-Meier method were 92.7%, 92.7%, and 92.7% at 1, 2, and over 4 years. The reoperation free survival rates were 92.7%, 92.7%, and 70.2% at 1, 3, and over 5 years. Among the risk factors for the operative death, aortic cross clamping time had statistical significance (p<0.05) and all the risk factors for the recurrent pulmonary stenosis such as age, pulmonary artery index, and materials used for the pulmonary outflow tract reconstruction had no statistical significance (p>0.05). CONCLUSIONS: Our review suggests that Lecompte procedure is an effective treatment modality for various complex cardiac anomalies with pulmonary outflow tract obstruction. Repair in early age is possible and the rates of mortality and morbidity are also acceptable.
Anoxia ; Aorta ; Constriction ; Double Outlet Right Ventricle ; Female ; Heart Diseases* ; Heart Failure ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Heart* ; Humans ; Male ; Mortality ; Pulmonary Artery ; Pulmonary Valve Stenosis ; Reoperation ; Risk Factors ; Seoul ; Sepsis ; Survival Rate ; Transposition of Great Vessels

Persistent cloaca is a very rare congenital anomaly with a single common perineal opening for the genital urinary and gastrointestinal tract, which is caused by abnormal formation of the urorectal septum. It has an incidence of 1 in 50,000 to 1 in 125,000 births and is much more common in females and in twin pregnancies. Pathologic findings of persistent cloaca include dilated bowel, hydrocolpos, urethral obstruction, hydronephrosis and oligohydramnios caused by obstruction of the bladder, vagina and intestine. Failure of the paired m llerian ducts to fuse also usually results in duplication of the uterus and vagina. Currently, the diagnosis depends on the prenatal sonography but the diagnosis may be very difficult due to the complex nature of the anomaly and variable appearances. We present a case of persistent cloaca with one opening confirmed by autopsy after therapeutic termination which was initially diagnosed by prenatal sonography.
Autopsy ; Cloaca* ; Diagnosis ; Female ; Gastrointestinal Tract ; Humans ; Hydrocolpos ; Hydronephrosis ; Incidence ; Intestines ; Oligohydramnios ; Parturition ; Pregnancy ; Pregnancy, Twin ; Urethral Obstruction ; Urinary Bladder ; Uterus ; Vagina