BACKGROUND: To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD). METHODS: We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients were divided into two subgroups of CKD stage I–II and stage III. Kidney function, and survival outcomes were compared between groups. RESULTS: We included 1,756 patients with CKD I–II and 276 patients with CKD III in the final pair-matched analysis. Kidney function was significantly better preserved in the PN than in the RN group among all patients. However, the beneficial effect of PN on kidney function gradually disappeared over time in CKD III patients. The 5-year overall survival (OS) rates after PN and RN differed in patients with CKD I–II disease (99.4% vs. 96.5%, respectively, P = 0.015). The 5-year OS rates after surgery were not affected by mode of nephrectomy in CKD III patients (97.8% vs. 93.5%, P = 0.103). The 5-year cancer-specific survival rates did not differ between treatment groups in all CKD stage. Cox hazard analysis showed that the operative method was a significant factor for OS in CKD I–II patients (hazard ratio [HR], 0.320; confidence interval [CI], 0.122–0.840; P = 0.021). However, PN was not beneficial in terms of OS in CKD III patients (HR, 0.395; CI, 0.086–1.172; P = 0.117). CONCLUSION: PN is associated with a higher OS rate and better kidney function in patients with preoperative CKD stage I and II, but not in those with CKD stage III.
Carcinoma, Renal Cell* ; Humans ; Kidney* ; Methods ; Nephrectomy* ; Renal Insufficiency ; Renal Insufficiency, Chronic* ; Survival Rate*

This study was conducted to investigate long-term neurocognitive outcomes and to determine associated risk factors in a cohort of Korean survivors of childhood acute lymphoblastic leukemia (ALL). Forty-two survivors of ALL were compared with 42 healthy controls on measures of a neurocognitive test battery. We analysed potential risk factors (cranial irradiation, sex, age at diagnosis, elapsed time from diagnosis, and ALL risk group) on neurocognitive outcomes. ALL patients had lower, but non-significant full-scale intelligence quotient (FSIQ, 107.2 +/- 12.2 vs. 111.7 +/- 10.2), verbal intelligence quotient (VIQ, 107.7 +/- 13.6 vs. 112.2 +/- 11.4), and performance intelligence quotient (PIQ, 106.3 +/- 14.2 vs. 110.1 +/- 10.7) scores than healthy controls. However, patients treated with cranial irradiation performed significantly lower on FSIQ (102.2 +/- 8.1), VIQ (103.3 +/- 11.7), and PIQ (101.4 +/- 13.2) compared to non-irradiated patients and healthy controls. ALL patients also had poor attention, concentration, and executive functions. Among ALL survivors, cranial irradiation was a risk factor for poor FSIQ, being male was a risk factor for poor PIQ, and younger age was a risk factor for poor attention. Therefore, the delayed cognitive effects of ALL treatment and its impact on quality of life require continuing monitoring and management.
Adolescent ; Age Factors ; Child ; *Cognition ; Female ; Humans ; Intelligence ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality/*psychology ; *Survivors ; Tertiary Healthcare

OBJECTIVE: This study was undertaken to compare the diagnostic performances of magnetic resonance imaging (MRI), MR myelography (MRM) and myelography in young soldiers with a herniated lumbar disc (HLD). METHODS: Sixty-five male soldiers with HLD comprised the study cohort. A visual analogue scale for low back pain (VAS-LBP), VAS for leg radiating pain (VAS-LP), and Oswestry disability index (ODI) were applied. Lumbar MR, MRM, and myelographic findings were checked and evaluated by four independent radiologists, respectively. Each radiologist was asked to score (1 to 5) the degree of disc protrusion and nerve root compression using modified grading systems devised by the North American Spine Society and Pfirrmann and the physical examination rules for conscription in the Republic of Korea. Correlated coefficients between clinical and radiological factors were calculated. Interpretational reproducibility between MRI and myelography by four bases were calculated and compared. RESULTS: Mean patient age was 20.5 +/- 1.1. Mean VAS-LBP and VAS-LP were 6.7 +/- 1.6 and 7.4 +/- 1.7, respectively. Mean ODI was 48.0 +/- 16.2%. Mean MRI, MRM, and myelography scores were 3.3 +/- 0.9, 3.5 +/- 1.0, and 3.9 +/- 1.1, respectively. All scores of diagnostic performances were significantly correlated (p < 0.05). However, none of these scores reflected the severity of patients' symptoms. There was no statistical difference of interpretational reproducibility between MRI and myelography. CONCLUSION: Although MRI and myelography are based on different principles, they produce similar interpretational reproducibility in young soldiers with a HLD. However, these modalities do not reflect the severity of symptoms.
Cohort Studies ; Humans ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Male ; Military Personnel ; Myelography ; Physical Examination ; Radiculopathy ; Republic of Korea ; Spine

Gastrointestinal system involvement is one of the principal complications seen in the recipients of hematopoietic stem cell transplantation (HSCT), and it is also a major cause of morbidity and death in these patients. The major gastrointestinal complications include typhlitis (neutropenic enterocolitis), pseudomembranous enterocolitis, viral enteritis, graft-versus-host disease, benign pneumatosis intestinalis, intestinal thrombotic microangiopathy, and post-transplantation lymphoproliferative disease. As these patients present with nonspecific abdominal symptoms, evaluation with using such imaging modalities as ultrasonography and CT is essential in order to assess the extent of gastrointestinal involvement and to diagnose these complications. We present here a pictorial review of the imaging features and other factors involved in the diagnosis of these gastrointestinal complications in pediatric HSCT recipients.
Child ; *Diagnostic Imaging ; Gastrointestinal Diseases/*diagnosis/*etiology ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans

PURPOSE: Reconstruction of the soft tissue defect exposing Achilles tendon is a formidable challenge because of the paucity of soft tissue and relatively poor blood supply. This article describes the reconstruction of soft tissue defect exposing Achilles tendon using gracilis muscle free flap and split-thickness skin graft. METHODS: From 2000 to 2005, four patients with soft tissue defect exposing Achilles tendon and infection were operated using gracilis muscle free flap and split-thickness skin graft. The defect size ranged from 3.5 to 5cm wide and 6.5 to 8cm long. The mean postoperative follow-up was twenty months. RESULTS: All the flaps were survived without necrosis and infection. We obtained the satisfactory results with good functional and aesthetical outcomes. All cases showed good results with the characteristics of a relatively thin flap without additional debulking procedure. CONCLUSION: Gracilis muscle free flap with split thickness skin graft could be a good option for reconstruction of soft tissue defect of posterior ankle, exposing Achilles tendon with minimal morbidity of the donor site.
Achilles Tendon* ; Ankle ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Necrosis ; Skin* ; Tissue Donors ; Transplants*

PURPOSE: Allevyn(R)(Smith & Nephew, England) is a type of polyurethane foam material with good wound discharge absorption. Acticoat(R)(Smith & Nephew, England) is a silver coated dressing material which is effective in infected wound. The purpose of this study is to compare the effects of dry gauze, Acticoat(R) and Allevyn(R) on infected full-thickness wound healing in rat. METHODS: One hundred and twenty rats were divided into 3 groups: group I(dressing with dry gauze, n=40), group II(dressing with Allevyn(R), n=40), group III(dressing with Acticoat(R), n=40). A 15x15mm square full-thickness wound was made on the dorsum and left open for 24 hours. The size of wound defects were measured each dressing changes. The histological evaluation was performed on the 3rd day, 7th day, 14th day, 21th day. RESULTS: After the wound was left open for 24 hours, typical findings of bacterial infection was observed. After the 7th day, group III showed larger area of epithelialization, smaller defect size compared to those of two other groups. Complete replacement by fibrotic scar tissue was observed in group III with no signs of inflammation on the 14th day. By day 21, the average defect size in group III was decreased from initial 100% to 3.63%. while in group I and II, it was decreased to 62.66% and 53.62%, respectively. CONCLUSION: Acticoat(R) is an effective tool in the treatment of infected wound.
Absorption ; Animals ; Bacterial Infections ; Bandages ; Cicatrix ; Inflammation ; Polyurethanes ; Rats* ; Silver ; Skin* ; Wound Healing ; Wounds and Injuries*

Microscopic analysis of bone is very useful method for estimating age at death of individual identification, diagnosing metabolic disorder or dietary deficiency in bone tissue, and differentiating human bone or not when applied to fragmentary skeletal remains. The purpose of this study was to establish a systematic method for preparing bone tissues by manual grinding method and offer help in application of related histomorphometric field such as estimating age at death. For this, human bone tissues of rib and femur from cadavers were prepared and considered histomorphological variations of osteon with light microscope. As results of this study, Type II osteons, smaller versions of Intact osteons (Type I) that form by radial remodeling of a preexisting Haversian canal, were distinguished from double-zonal osteons, one of the osteons that exhibit hypercalcified ring within their concentric lamellae, by the lack of an internal reversal line and the parallel contours of lamellae, and it is possible to suggest metric basis for drifting osteons as counting one osteon with the exception of size measurement. By applying this method of present study, one could easily make a bone tissue all oneself that would be helpful for establishing basic data in physical and forensic anthropology.
Bone and Bones ; Cadaver ; Femur ; Forensic Anthropology* ; Haversian System ; Humans ; Ribs

BACKGROUND AND OBJECTIVES: Plasma B-type natriuretic peptide (BNP) can be increased in patients with renal insufficiency (RI). The aim of this study was to evaluate the diagnostic value of BNP for systolic heart failure (HF) in patients with moderate to severe RI. SUBJECTS AND METHODS: Between Aug 2002 and May 2004, 433 patients found to have systolic HF or moderate to severe RI were included. The patients were divided into 3 groups (group I; only HF, group II; only RI, group III; HF and RI). The severity of RI was graded according to the calculated creatinine clearance (Ccr); moderate 30< or =Ccr<60, severe 15< or =Ccr<30 or end stage renal disease (ESRD) Ccr<15 mL/min. RESULTS: The mean age of the patients was 67.6+/-12, and 49% were male. There were significant differences in the mean BNP levels between group III and the other two groups (p<0.001); group I (n=65, 837.3+/-884), group II (n=137, 1049.4+/-1332) and group III (n=231, 1738.3+/-1501 pg/mL). A weak negative correlation was note between BNP and Ccr (r=-0.335, p<0.001) in patients with RI. As the renal function deteriorated, the mean BNP of groups II and III was found to be elevated (moderate 625.5+/-574, 1183.0+/-1056; severe 760.5+/-1211, 2205.4+/-1470; ESRD 2157.6+/-1831, 3209.9+/-1900 pg/mL, p<0.05), with the mean BNP of group III being higher than that of group II for each grade (p<0.05). From the ROC curve, the optimal cut-off point of BNP for the diagnosis of systolic HF in patients with RI was 829 pg/mL (accuracy 68%, sensitivity 66% and specificity 70%, p<0.001). CONCLUSION: In the case of patients with moderate to severe RI, a higher BNP cut-off point for the diagnosis of systolic HF and a relatively lower diagnostic accuracy of BNP should be considered.
Creatinine ; Diagnosis ; Heart Failure ; Heart Failure, Systolic* ; Humans ; Kidney Failure, Chronic ; Male ; Natriuretic Peptide, Brain ; Plasma ; Renal Insufficiency* ; ROC Curve ; Sensitivity and Specificity

Percutaneous venous angioplasty and stent placement is a effective procedure in the treatment of central venous stenosis and occlusion. But multiple repeat interventions are occasionally required due to restenosis. Self expandable stent is preferred to balloon expandable stent in case of brachiocephalic vein stenting due to anatomic consideration and veinous characteristics. We reported two cases of successful recanalization using self expandable stent of the occlusive kinked in-stent restenosis of the previous balloon expandable stent at left brachiocephalic vein occlusion.
Angioplasty ; Brachiocephalic Veins* ; Constriction, Pathologic ; Humans ; Renal Dialysis ; Stents*

BACKGROUND: This study is aimed at the pathoanatomic correlates of depression and anxiety in acute stroke patients including subcortical lesion(periventricular hyperintensity, deep white matter hyperintensity, subcortical gray matter hyperintensity). METHODS: Sixty nine patients with acute stoke were recruited. Their brain lesions were measured using Brain MRI. Depressive or anxiety symptoms were rated by Beck depression inventory(BDI) or Beck anxiety inventory, respectively. RESULTS: There were significant correlation between depression and periventricular hyperintensity and deep white matter hyperintensity in acute stroke patients. There are no significant pathoanatomic correla- tions between anxiety and brain lesions on MRI. CONCLUSION: Our findings suggest that the white matter lesion may increase the risk of depression after stroke. Prevention of asymptomatic cerebrovascular lesion could decrease the risk of depression in acute stroke patients as well as the risk of stroke.
Anxiety* ; Brain ; Depression* ; Humans ; Magnetic Resonance Imaging ; Stroke*