Background: Outcomes of traditional treatment for osteonecrosis of the femoral head (ONFH) are not always satisfactory. Hence, cell-supplementation therapy has been attempted to facilitate necrotic-tissue regeneration. Adipose-derived mesenchymal stem cell (ADMSC) transplantation is potentially advantageous over bone marrow-derived MSC implantation, but its outcomes for ONFH remain unclear. The aim of this study was to determine 2-year radiological and clinical outcomes of culture-expanded autologous ADMSC implantation for ONFH. Methods: Eighteen hips with necrotic lesions involving ≥ 30% of the femoral head were included. ADMSCs were harvested by liposuction and culture expanded for 3 passages over 3 weeks. With a 6-mm single drilling, ADMSCs were implanted into the necrotic zone. All patients underwent magnetic resonance imaging (MRI), single-photon emission computed tomography/computed tomography (SPECT/CT) at screening and 6 months, 12 months, and 24 months postoperatively. The primary outcome was the change in the size of necrotic area on MRI. Secondary outcomes were changes in clinical scores and radioisotope uptake on SPECT/CT. Conversion total hip arthroplasty (THA) was defined as the endpoint. Results: Preoperatively, the necrotic lesion extent was 63.0% (38.4%–96.7%) of the femoral head. The mean Harris hip score was 89.2, the University of California at Los Angeles (UCLA) score was 5.6, and Western Ontario and McMaster Universities Arthritis index (WOMAC) was 79.4. Three patients underwent THA and 1 patient died in an accident. Finally, 11 patients (14 hips) were available for ≥ 2-year follow-up. At the last follow-up, no surgery-related complications occurred, and 14 of 17 hips (82%) were able to perform daily activities without THA requirement. There was no significant decrease in lesion size between any 2 intervals on MRI.However, widening of high signal intensity bands on T2-weighted images inside the necrotic lesion was observed in 9 of 14 hips (64%); 11 of 14 hips (79%) showed increased vascularity on SPECT/CT at 2 years postoperatively. No significant differences were observed between preoperative and 24-month mean Harris hip score (89.2 vs. 88.6), WOMAC (79.4 vs. 75.7), and UCLA score (5.6 vs. 6.2). Conclusions Our outcomes suggest that culture-expanded ADMSC implantation is a viable option for ONFH treatment without adverse events.

The 2016 WHO diagnostic criteria for chronic myelomonocytic leukemia (CMML) require both absolute and relative monocytosis (≥1×10⁹/L and ≥10% of white blood cell counts) in peripheral blood. Moreover, myeloproliferative neoplasm (MPN) features in bone marrow and/or MPN-associated mutations tend to support MPN with monocytosis rather than CMML. We assessed the impact of the 2016 WHO criteria on CMML diagnosis, compared with the 2008 WHO criteria, through a retrospective review of the medical records of 38 CMML patients diagnosed according to the 2008 WHO classification. Application of the 2016 WHO criteria resulted in the exclusion of three (8%) patients who did not fulfill the relative monocytosis criterion and eight (21%) patients with an MPN-associated mutation. These 11 patients formed the 2016 WHO others group; the remaining 27 formed the 2016 WHO CMML group. The significant difference in the platelet count and monocyte percentage between the two groups indicated that the 2016 WHO criteria lead to a more homogenous and improved definition of CMML compared with the 2008 WHO criteria, which may have led to over-diagnosis of CMML. More widespread use of molecular tests and more sophisticated clinical and morphological evaluations are necessary to diagnose CMML accurately.
Bone Marrow ; Classification ; Diagnosis* ; Humans ; Leukemia, Myelomonocytic, Chronic* ; Leukocytes ; Medical Records ; Monocytes ; Platelet Count ; Retrospective Studies

We described here a patient who presented with symptoms of heart failure who was found to have severe bilateral impairment of atrioventricular inflow. Primary cardiac lymphoma (PCL) with extensive involvement of the two atria, pericardium and myocardium is an extremely rare tumor in immunocompetent patients. We report here a case of PCL in an immunocompetent patient with involvement of both atria and the atrial septum. The tumor had a butterfly shape. We could not do surgical excision because of the massive pericardiac invasion. The diagnosis was B-cell lymphoma and this was confirmed by the pericardiac biopsy.
Atrial Septum ; Biopsy ; Butterflies ; Heart Atria ; Heart Failure ; Heart Neoplasms ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Myocardium ; Pericardium

BACKGROUND AND OBJECTIVES: Bondy operation is a type of modified radical mastoidectomy whose operation window is through an external auditory canal via removal of superior and posterior walls without management of the middle ears. However, the usefulness of this operation is unclear. This study aimed to review our clinical experience of modified Bondy operations and to clarify its usefulness. MATERIALS AND METHODS: Fifteen patients underwent a modified Bondy operation at the Department of Ajou University Hospital between 1996 and 2010. Their clinical data were retrospectively reviewed including age, gender, chief complaint, diagnosis, pure tone average (PTA, a mean threshold of 0.5, 1, 2, and 3 kHz before and 3 months after the operation), otoscopic finding, temporal bone computed tomography, and recurrence rate. RESULTS: The mean age of the 15 patients was 35.3+/-14 (range 18-65) years. Post-operative diagnosis of all cases was cholesteatoma (nine attic, three external auditory canal, one sinus, and two recurrent). Pre- and postoperative PTAs were 27.4+/-18.3 dBHL and 26.0+/-10.7 dBHL, respectively (p=0.72). No postoperative recurrence or complications were noted over at least a 3-month follow-up. CONCLUSIONS: Modified Bondy operation is a good option to preserve hearing and prevent recurrence after operations in cases of cholesteatoma with relatively preserved middle ears.
Cholesteatoma ; Ear Canal ; Ear, Middle ; Hearing ; Humans ; Recurrence ; Retrospective Studies ; Temporal Bone

BACKGROUND AND OBJECTIVES: Bondy operation is a type of modified radical mastoidectomy whose operation window is through an external auditory canal via removal of superior and posterior walls without management of the middle ears. However, the usefulness of this operation is unclear. This study aimed to review our clinical experience of modified Bondy operations and to clarify its usefulness. MATERIALS AND METHODS: Fifteen patients underwent a modified Bondy operation at the Department of Ajou University Hospital between 1996 and 2010. Their clinical data were retrospectively reviewed including age, gender, chief complaint, diagnosis, pure tone average (PTA, a mean threshold of 0.5, 1, 2, and 3 kHz before and 3 months after the operation), otoscopic finding, temporal bone computed tomography, and recurrence rate. RESULTS: The mean age of the 15 patients was 35.3+/-14 (range 18-65) years. Post-operative diagnosis of all cases was cholesteatoma (nine attic, three external auditory canal, one sinus, and two recurrent). Pre- and postoperative PTAs were 27.4+/-18.3 dBHL and 26.0+/-10.7 dBHL, respectively (p=0.72). No postoperative recurrence or complications were noted over at least a 3-month follow-up. CONCLUSIONS: Modified Bondy operation is a good option to preserve hearing and prevent recurrence after operations in cases of cholesteatoma with relatively preserved middle ears.
Cholesteatoma ; Ear Canal ; Ear, Middle ; Hearing ; Humans ; Recurrence ; Retrospective Studies ; Temporal Bone

PURPOSE: The increasing incidence and mortality of Methicillin-resistant Staphylococcus aureus (MRSA) colonization or blood-stream infection is an important problem in neonatal intensive care unit (NICU). The aims of this study are to evaluate the effective eradication of MRSA through the aggressive isolation program with or without the use of 2% chlorhexidine-gluconate (CHG) and to investigate significant risk factors of MRSA colonization in NICU. METHODS: This study is a retrospective collected data among 414 neonates admitted to a NICU from June 1, 2007, through October 31, 2009. We divided the groups into 3 periods according to isolation program or the use of 2% CHG. RESULTS: The aggressive isolation program decreased the incidence of MRSA colonization and the additional use of 2% CHG has reduced much more the incidence of MRSA colonization and bacteremia. Days of hospitalization, use of central line, days of using central line, presence of respiratory distress syndrome (RDS) or bronchopulmonary dysplasia (BPD), isolation program, and isolation program + use of CHG were significant factors associated with MRSA colonization or bacteremia in univariate logistic regression analysis. Days of using central line and isolation program + use of CHG were significant after in multivariate logistic regression analysis. CONCLUSION: Hand hygiene, active MRSA surveillance culture, isolation, contact isolation, nursing/doctor cohorts and the use of 2% CHG as skin sterilizer were effective in eradicating to MRSA. The effort of shortening the days of using central line is also necessary.
Bacteremia ; Bronchopulmonary Dysplasia ; Chlorhexidine ; Cohort Studies ; Colon ; Hand Hygiene ; Hospitalization ; Humans ; Incidence ; Infant, Newborn ; Infection Control ; Intensive Care, Neonatal ; Logistic Models ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Risk Factors ; Skin

The aim of this study was to examine the anti-proliferative and anti-inflammatory effects of ezetimibe/simvastatin (E/S) after drug-eluting stent (DES) implantation in a porcine coronary restenosis model. Pigs were randomized into two groups in which the coronary arteries (23 pigs) had DES. Stents were deployed with oversizing (stent/artery ratio 1.3:1) in porcine coronary arteries. Fifteen pigs were taken 10/20 mg of E/S and eight pigs were not taken E/S. Histopathologic analysis was assessed at 28 days after stenting. In neointima, most inflammatory cells were lymphohistiocytes. Lymphohistiocyte count was not different between two groups (337+/-227 vs. 443+/-366 cells, P=0.292), but neointima area was significantly smaller (1.00+/-0.49 mm2 vs. 1.69+/-0.98 mm2, P=0.021) and percent area stenosis was significantly lower (23.3+/-10% vs. 39+/-19%, P=0.007) in E/S group compared with control group. There were no significant differences in fibrin score (1.99+/-0.79 vs. 1.81+/-0.88, P=0.49), endothelial score (1.75+/-0.66 vs. 1.80+/-0.59, P=0.79), and the percent of endothelium covered lumen (43+/-21% vs. 45+/-21%, P=0.84) between E/S group and control group. Combined therapy with ezetimibe and simvastatin inhibits neointimal hyperplasia, but does not inhibit inflammatory infiltration and arterial healing after DES implantation in a porcine coronary restenosis model.
Animals ; Anticholesteremic Agents/administration & dosage ; Azetidines/*administration & dosage ; Coronary Restenosis/diagnosis/drug therapy/*etiology ; *Disease Models, Animal ; Drug Combinations ; Drug Implants/administration & dosage ; Drug-Eluting Stents/*adverse effects ; Female ; Graft Occlusion, Vascular/diagnosis/*drug therapy/*etiology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage ; Simvastatin/*administration & dosage ; Swine ; Treatment Outcome

The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation acute myocardial infarction (STEMI) undergoing PCI in the Korean Acute Myocardial Infarction Registry (KAMIR) were assigned to either of two groups: a group with Gp IIb/IIIa inhibitor (n=476) or a group without Gp IIb/IIIa inhibitor (n=2,059). These groups were further subdivided according to the use of LMWH with low dose UFH (n=219) or UFH alone (n=257). The primary end points were cardiac death or myocardial infarction during the 30 days after the registration. The primary end point occurred in 4.1% (9/219) of patients managed with LMWH during PCI and Gp IIb/IIIa inhibitor and 10.8% (28/257) of patients managed with UFH and Gp IIb/IIIa inhibitor (odds ratio [OR], 0.290; 95% confidence interval [CI], 0.132-0.634; P=0.006). Thrombolysis In Myocardial Infarction (TIMI) with major bleeding was observed in LMHW and UFH with Gp IIb/IIIa inhibitor (1/219 [0.5%] vs 1/257 [0.4%], P=1.00). For patients with STEMI managed with a primary PCI and Gp IIb/IIIa inhibitor, LMWH is more beneficial than UFH.
Acute Disease ; Aged ; Drug Therapy, Combination ; Female ; Hemorrhage ; Heparin/*therapeutic use ; Heparin, Low-Molecular-Weight/*therapeutic use ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/epidemiology/mortality/*therapy ; Myocardial Revascularization ; Odds Ratio ; Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors/metabolism ; Prognosis ; Registries

BACKGROUND: This is the first annual data on the surveillance of intensive care unit (ICU) module by the Korean Nosocomial Infections Surveillance System (KONIS) from July 2007 through June 2008. METHODS: The KONIS performed a prospective surveillance for nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 96 ICUs in 56 hospitals. Nosocomial infection (NI) rates were calculated as the numbers of infections per 1,000 patient-days or device-days. RESULTS: A total of 2,637 NIs were found during the study period; 1,391 UTIs (1,365 cases were urinary catheter-associated), 667 BSIs (563 were central line-associated), and 579 PNEUs (357 were ventilator-associated). The rate of urinary catheter-associated UTIs was 4.43 cases per 1,000 device-days (95% confidence interval, 4.20-4.67) and urinary catheter utilization ratio was 0.84 (0.839-0.841). The rate of central line-associated BSIs was 2.83 (2.61-3.07) and the utilization ratio was 0.54 (0.538-0.542). The rate of ventilator-associated PNEUs was 2.49 (2.25-2.76) and the utilization ratio was 0.39 (0.388-0.392). Although the ventilator utilization ratios were lower in the hospitals with less than 900 beds than in the hospitals with more than 900 beds, the rates of ventilator-associated PNEUs were higher in the smaller hospitals than in the larger ones. CONCLUSION: This result suggests that ongoing targeted surveillance and implementation of proven infection control strategies are needed.
Cross Infection ; Infection Control ; Critical Care ; Intensive Care Units ; Pneumonia ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical

Technisium ((99m)Tc) is one of the most widely used radioactive isotopes for diagnosis in nuclear medicine. In general, technisium is produced inside the so called (99m)Tc generator which is usually made out of lead to shield relatively high energy radiation from (99)Mo and its daughter nuclide (99m)Tc. In this paper, a GEANT4 simulation is carried out to test the safety of the (99m)Tc generator, taking the Daiichi product with radioactivity of 500 mCi as an example. According to the domestic regulation on radiation safety, the dose at 10 cm and 100 cm away from the surface of shielding container should not exceed 2.0 mSv/h and 0.02 mSv/h, respectively. The simulated dose turned out to be less than the limit, satisfying the domestic regulation.
Nuclear Family ; Nuclear Medicine ; Radioactivity ; Radioisotopes