A Case of Prolonged Hypogammaglobulinemia after Rituximab-Containing Chemotherapy in a Patient with Lymphoma / 대한내과학회지

Rituximab, an anti-CD20 monoclonal antibody, is an effective target agent against the B lymphocytes in B-cell lymphoid malignancies and various lymphoproliferative diseases. Moreover, the toxicity of rituximab is less severe than that of conventional cytotoxic agents, which has promoted the widespread application of rituximab in the treatment of B-cell lymphoma. However, depletion of B lymphocytes by rituximab, which leads to secondary hypogammaglobulinemia, can cause deterioration of humoral immunity. Although immune reconstitution after hematopoietic stem cell transplantation is known to prevent prolonged hypogammaglobulinemia, very few cases of long-standing hypogammaglobulinemia have been reported. We report herein a case of prolonged hypogammaglobulinemia after rituximab-containing chemotherapy and splenectomy in a patient with non-Hodgkin's lymphoma and discuss the clinical significance and pathogenetic mechanism of this phenomenon with a literature review.

Effects of an Education Program on Prevention of Malpractice using Precedent Cases related to Patient Safety in Safety Perception, Safety Control, Autonomy and Accountability in Clinical Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to identify the effects of an education program on safety perception, safety control, autonomy and accountability in clinical nurses. Precedent cases related to patient safety were used in the education program. METHODS: A quasi-experimental design with pretest and posttest measures was used. Participants in the study, 72 nurses in the experimental group, 71 nurses in the control group, were enrolled for 3 months. The education program was composed of the 20 precedent cases related to patient safety from home and foreign countries. RESULTS: The major findings of this study were as follows: Safety perception (p=.000), Safety control (p=.000), attitude toward autonomy (p=.000), and attitude toward accountability (p=.000) improved after the education program. CONCLUSION: The findings from this study indicate that an education program using precedent cases is an efficient method to improve behavior and change attitudes towards protecting patients' safety and preventing malpractice claims against nurses.

Analysis of the Recurrence after Surgical Treatment of the Hemangioma in the Extremities / 대한골관절종양학회지

PURPOSE: To analyse the risk factors for recurrence of hemangiomas in extremities after surgical treatment and to compare with those of trunk. MATERIALS AND METHODS: 120 cases of hemangioma with surgical treatments from June 1998 to September 2009 were analysed. 53 cases with surgical treatment on trunk in the same period were set to be the control group. We analyze several factors: age, location, site, size, histologic types and correlation between recurrence and each risk factor using logistic regression analysis. RESULTS: Recurrence rate was 11.7% in extremities and 9.4% in trunk. There were no correlation between recurrence and age, site, size, histologic type. But, there was stastically significant correlation between recurrence rate and location, especially hand, forearm, feet in extremities and head and neck in trunk. CONCLUSION: Recurrence after surgical treatment of hemangioma is highly prevalent in anatomical location such as, hand, foot and forearm those are difficult to achieve complete resection because of close to neurovascular structures. Careful observation should be needed owing to incomplete resection can occurs recurrence.

The effect of milrinone infusion on right ventricular function during coronary anastomosis and early outcomes in patients undergoing off-pump coronary artery bypass surgery / 대한마취과학회지

BACKGROUND: During coronary anastomosis in off-pump coronary artery bypass surgery (OPCAB), hemodynamic alternations can be induced by impaired diastolic function of the right ventricle. This study was designed to examine the effect of milrinone on right ventricular function and early outcomes in patients undergoing OPCAB. METHODS: Forty patients undergoing OPCAB were randomly assigned in a double-blind manner to receive either milrinone (milrinone group, n = 20) or normal saline (control group, n = 20). Hemodynamic variables were measured after pericardiotomy (T1), 5 min after stabilizer application for anastomosis of the left anterior descending coronary artery (LAD, T2), the obtuse marginalis branch (OM, T3), the right coronary artery (RCA, T4), 5 min after sternal closure (T5), and after ICU arrival. The right ventricular ejection fraction (RVEF) and right ventricular volumetric parameters were also measured using the thermodilution technique. For evaluation of early outcomes, the 30-day operative mortality and morbidity risk models were used. RESULTS: There was no significant difference in hemodynamic variables, including mean arterial pressure, between the 2 groups, except for the cardiac index and RVEF. The cardiac index and RVEF were significantly greater at T3 in the milrinone group than in the control group. CONCLUSIONS: Continuous infusion of milrinone demonstrated a beneficial effect on cardiac output and right ventricular function in patients undergoing OPCAB, especially during anastomosis of the graft to the OM artery, and it had no adverse effect on early outcomes.

Treatment of the Proximal Femoral Fractures with Proximal Femoral Nail Antirotation (PFNA)

PURPOSE: To analyze the clinical and radiologic results of treatments in proximal femoral fracture with Proximal Femoral Nail-Antirotation (PFNA). MATERIALS AND METHODS: We retrospectively reviewed the results of 21 cases of proximal femoral fracture treated with PFNA from September 2006 to October 2007 which could be followed up for minimum of more than a year. The mean age was 61.5 (20~88) years old. Male were involved in 12 cases, female in 9 cases. The mean follow up was 14.3 (12~18) months. The Garden alignment index, Cleveland index, tip apex distance were evaluated by post-operative radiologic evaluation and complications of bone union, failure of internal fixation and deformity were evaluated by follow up radiologic findings. Clinical results were assessed by social function score of Jensen and mobility score of Parker and Palmer at last follow up. RESULTS: All fractures were united and the mean time to bone union was 15.7 (13~18) weeks. Garden alignment index showed good results of above 'good' in 15 cases (71.4%), Cleveland index showed 14 cases (66.4%) positioning in zone 5 and tip apex distance showed 17.81 (+/-5.65~27.52) mm in radiologic findings. The mean sliding of blade was 1.32 (0.34~2.94) mm in follow up radiologic findings and fracture of distal locking screw area was found in 1 case as a complication. Among 21 cases, the function before injury was completely recovered in 15 cases (71.4%) which were assessed by social function score of Jensen and 13 cases (61.9%) by mobility score of Parker and Palmer. CONCLUSION: We think that PFNA is effective osteosynthetic device for proximal femur fracture with satisfactory radiologic and clinical outcomes.

The Clinical Characteristics and Risk Factors of Upper Digestive Lesions that are due to Ingestion of Caustic Material

PURPOSE: Though caustic injury of the upper digestive tract can lead to severe sequelae, there are few clinical studies on this subject. This study was undertaken to evaluate the clinical characteristics, the endoscopic findings and the risk factors of the upper digestive lesions in patient with caustic ingestion injury. METHODS: We retrospectively reviewed the medical records of 137 patients who ingested caustic materials and who visited to our emergency room from January, 2000 to June, 2009. RESULTS: The most common ingested agent was sodium hypochlorite (44.5%), followed by acetic acid (19.7%), hydrochloric acid (11.7%) and lye (8.0%). Ingestion for suicidal attempt (62.0%) was more frequent than accidental ingestion (30.7%). Grade IIa injury was the most frequent finding on endoscopy of the esophagus and Grade I injury was the most frequent finding on endoscopy of the stomach. For the late sequelae, there were 9 cases (6.6%) of esophageal stricture and 2 cases (1.5%) of gastric outlet obstruction. The initial signs and symptoms did not correlate with the development of stricture, but leukocytosis, and grade III injury were related to the risk of developing stricture. CONCLUSION: Caustic injury of the upper gastrointestinal tract is frequently observed on early endoscopy and it can cause significant late sequelae such as stricture. Therefore, it is necessary to evaluate these patients with regular follow up endoscopic examinations for the management of late sequelae.

Analysis of the Deformities of the Foot after Tibial Fracture and Outcome of the Surgical Treatment / 대한족부족관절학회지

PURPOSE: We wanted to evaluate the relating factors for deformities of the foot after tibial fracture and the outcome of respective surgical treatment. MATERIALS AND METHODS: We studied thirty-two patients (thirty-five feet) who had foot deformities after tibia fracture. The age, gender, shape, location, concurrent soft tissue injury and operative treatment of tibial fracture were analysed and outcome of the surgical treatment was investigated. RESULTS: Deformities of the foot mostly occurred in open fractures of Gustilo type 3 or closed fracture with severe soft tissue injury. Variable surgical treatments such as simple release, lengthening, Z-plasty and osteotomy were performed. The AOFAS ankle-hind foot scale was improved from average of 37.3 points preoperatively to an average of 77.2 points at the last follow up. The Maryland foot score was from 42.9 to 90.2 and AOFAS Lesser Toe Metatarso-phalangeal interphalangeal scale was from 42.9 to 90.5. Radiological correction was also improved from 21.9 degrees to 7.9 degrees (Meary angle), from 112.2 to 138.5 (Hibb's angle) and from 33.8 to 25.9 (Calcaneal pitch). CONCLUSION: We proposed that great care should be taken of treatment for the tibial fracture and early detection and proper management of the foot deformities are crucial.

A Study of the Prepregnancy Body Mass Index and Two-month-postpartum Weight Loss in the Uncomplicated Term Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To determine the mean two-month-postpartum weight loss, standard deviations and the 10th, 25th, 50th, 75th, and 90th percentiles in the uncomplicated term pregnancy and to examine association between prepregnancy body mass index and two-month-postpartum weight loss. METHODS: We analyzed the two-month-postpartum weight loss data from 175 women who had healthy singleton term pregnancy in Han-il Hospital (Jan 2002-Dec 2002). Data were categorized in three groups according to body mass index. RESULTS: Mean two-month-postpartum weight loss was 9.46 +/- 3.42 kg. There was no statistically significant difference between prepregancy BMI groups and two-month-postpartum weight loss. The more weight gained during pregnancy, the more that was lost at two-month-postpartum. Parous women retained more of their pregnancy weight. Compared with women who delivered vaginally, women who delivered cesarean experienced greater weight loss at two-month-postpartum. CONCLUSION: More careful postpartum care according to the two-month-postpartum weight loss table is needed to prevent long-term obesity.

A Study of the Monthly Weight Gains of Noncomplicated Pregnancies / 대한주산의학회잡지

OBJECTIVE: Mean weight gains, standard deviations were calculated for each gestational months and the 10th, 25th, 50th, 75th, and 90th percentiles were determined. And the influence of prepregnancy body mass index and/or parity on monthly weight gain was investigated. METHODS: We analyzed the monthly weight gain data from 876 women who had healthy sigleton term pregnancy in Han-il Hospital(Jul 2001-Jun 2002). Data were categorized in three groups according to the prepregnancy body mass index. RESULTS: The monthly weight gain table has been determined and 'Sigmoid(S) shaped' monthly weight gain curve was presented. Primipara and multipara have less weight gain than nullipara in the 5th and the 7th-11th months. Monthly weight gains adjusted for parity and age were significantly different among prepregnancy body mass index groups from the 4th month. CONCLUSIONS: More careful prenatal care according to the monthly weight gain-gestational month tables is needed to prevent a lot of complications which may be associated with abnormal weight gain during pregnancy.

Clinical Evaluation of Risk Factors in Elderly patients with Reflux Esophagitis / 대한소화관운동학회지

BACKGROUND/AIMS: The elderly patients with reflux esophagitis are less likely to feel or report their symptoms than the younger patients, even though they are more prone to complications such as bleeding, stricture or Barrett's esophagus. In this study we tried to investigate risk factors in the elderly patients who had endoscopically diagnosed reflux esophagitis. METHODS: Clinical data of six hundred and eighty seven patients with reflux esophagitis were reviewed. RESULTS: Among the 687 patients with reflux esophagitis, two hundred and thirteen (31%) were 60 or more than 60 years old. The frequency of accompanying hiatal hernia in the elderly group (age>or=60) was significantly higher than the younger group (age<60) (16.9%, 36/213 vs. 3.4%, 16/474, p<0.05). There was significant difference according age in the female group (0.9%, 1/114 vs. 22.7%, 22/97, p<0.05). The frequency of atropic gastritis was significantly higher in the elderly group than in the younger group , while other factors such as smoking, H. pylori and peptic ulcer disease were not different between the two groups. CONCLUSION: Among the risk factors of reflux esophagitis, the existence of hiatal hernia seems to be suggested more relevant to the development of this condition in the elderly group.

Clinical Evaluation of Risk Factors in Elderly patients with Reflux Esophagitis / 대한소화관운동학회지

BACKGROUND/AIMS: The elderly patients with reflux esophagitis are less likely to feel or report their symptoms than the younger patients, even though they are more prone to complications such as bleeding, stricture or Barrett's esophagus. In this study we tried to investigate risk factors in the elderly patients who had endoscopically diagnosed reflux esophagitis. METHODS: Clinical data of six hundred and eighty seven patients with reflux esophagitis were reviewed. RESULTS: Among the 687 patients with reflux esophagitis, two hundred and thirteen (31%) were 60 or more than 60 years old. The frequency of accompanying hiatal hernia in the elderly group (age>or=60) was significantly higher than the younger group (age<60) (16.9%, 36/213 vs. 3.4%, 16/474, p<0.05). There was significant difference according age in the female group (0.9%, 1/114 vs. 22.7%, 22/97, p<0.05). The frequency of atropic gastritis was significantly higher in the elderly group than in the younger group , while other factors such as smoking, H. pylori and peptic ulcer disease were not different between the two groups. CONCLUSION: Among the risk factors of reflux esophagitis, the existence of hiatal hernia seems to be suggested more relevant to the development of this condition in the elderly group.

Atypical Mesoblastic Nephroma: A case report

Congenital mesoblastic nephroma (CMN) is generally considered to be a rare benign renal tumor in neonates, requiring only total excision. However, an atypical mesoblastic nephroma (AMN) may behave aggressively, in contrast to a congenital mesoblastic nephroma. AMN shows atypical gross and microscopic features such as hemorrhage, necrosis, high cellularity, and a mitotic index. We report a case of atypical mesoblastic nephroma which presented in a 2 month-old male infant. Grossly, the tumor involved the upper and the midportion of the left kidney. On section, the cut surface was flesh,which was hemorrhagic necrotic, multicystic degenerative, grayish-white, and heterogenous. Microscopically, the tumor showed a high degree of cellularity and an arrangement of monophagic ovoid spindle cells in sheets and vague interlacing bundles. The individual tumor cells showed fusiform to oval nuclei, indistinct scanty pale-eosinophilic cytoplasm, and many mitotic features.

The Effect of Anoxia and Reoxygenation on the Production of Prostaglandin I2 from the Endothelial Cells of Umbilical Vein

The successful revascularization and reperfusion of ischemia are still associated with high systemic complication rates and severe local tissue injuries. The morality rates after revascularization have been reported to range from 10% to 20% and the amputation rates from 12% to 22%. It is well recognized that the microvasculature is highly sensitive to ischemia-reperfusion (I/R) and that the initial damage of endothelial cells contributes to I/R-induced tissue injury. In an effort to define the mechanisms responsible for reperfusion-induced vascular injury number of in vitro models have been developed to stimulate the responses of endothelial cells to I/R. Because of its simplicity, many investigators have used monolayers of cultured endothelial cells exposed to anoxia and reoxygenation as a model system to minic I/R-induced vascular changes in vivo. The endothelium serves as an important modulator of vascular homeostases by secreting various levels of both thrombotic and antithrombotic agents. One of the important product of endothelial cells, prostaglandin I2 or prostacyclin (PGI2) helps to maintain hemostasis through its involvement in coagulation, platelet activation, leukocyte migration and adhesion, vascular tone regulation and growth control. PGI2 synthesis is a readily quantifiable index of endothelial cell perturbation and thus serves as a marker for the identification of injurious stimuli. Endothelial cells were isolated from human umbilical vein and cultured in M-199 medium plus 20% fetal calf serum. Purity of culture was determined by immunological fluorescent staining of factor VIII related antigen, phase-contrast microscopy. TRK 790 radio-immunoassay kit was used for the measuring of 6-keto-PGF1 alpha released by endothelial cells. The results were as follows: 1) The concentration of PGI(2) released from the cultured endothelial cells was 33.44 +/- 2.26 pg/1 105 cells/mL 2) Incubation of endothelial cells with anoxia and reoxygenation resulted in PGI(2) release of 42.98 +/- 2.29 pg/1x10(5) cells/ml and 62.44 2.11 pg/1 105 cells/ml, respectively. 3) Incubation of endothelial cells with allopurinol (20 mumol/L) decreased the PGI(2) release to 40.68 +/- 2.99 pg/1x10(5) cells/ml. In conclusion, our data showed that the damage of endothelial cells in reoxygenotion group was significantly increased comparing anoxia group (p<0.005) and that allopurinol can inhibit reoxygenation-induced injury of endotheial cells.

Thin-Section CT with Air Insufflation Technique for Bladder Carcinoma: CT Findings of Superficial Bladder Carcinoma

PURPOSE: The staging of bladder carcinoma is a major determinant of operative management. CT of bladder carcinoma has been widely used to diagnose external extension (pT3b and over), but tumors confined to the bladder wall (from pT1 to pT3a) are poorly delineated. The authors describe CT findings of the superficial bladder carcinoma (below T1, stage A) in thin section CT with air insufflation technique (air insufflation-CT) to facilitate early detection and to aid correct staging of the superficial bladder carcinoma. MATERIALS AND METHODS: The materials consisted of proved 24 cases (1'9 patients, single tumor: 16 patients, multiple tumors :3 patients) of stage A bladder carcinomas. Air insufflation-CT was performed by the infusion of approximately 200 mL of air into the bladder via a Foley catheter. After the routine pelvic CT, bladder tumors were re-scanned with 1.5 to 5 mm thickness and intervals. RESULTS: The superficial bladder carcinomas were detected as nodular(5 cases, 20.8%), papillary(15 cases, 62.5%), pyramidal(2 cases, 8.3%), and domed(2 cases, 8.3%) forms on air insufflation CT. These tumors were classified into three types according to the size of the tumoral neck:type I(pedundulated polypold tumor:4 cases, 16.6%), type II(polypid tumor with short neck :13 cases, 54.2%), and type Ill(sessile tumor :7 cases, 29. 2%). The mean size(tumoral width x height x base o, neck/stalk) of the tumors was 22 x 20 x 16mm. The average tumoral sizes according to each type of the superficial tumors were type 1:22 x 25 x 6mm, type 11:23 x 22 x 18mm, and type III :18 x 15 x 18mm. The mean width of the type I--II tumoral necks was 15mm. The mean length of the type I tumoral neck(pedicle) was 2.5mm. Papillary fronds of the tumors were seen in 10 cases(41.7%) of 24 superficial tumors. Outer margin of the involved bladder wall was smooth in all cases. CONCLUSION: Thin-sectin CT with air insufflation technique for bladder carcinoma was useful in tumoral demonstration, and characteristics of the superficial bladder carcinomas were small polypold tumors had a short neck mostly and smooth outer wall of the involved bladder wall.

A case of lower esophageal rupture due to compressed air to mouth / 대한이비인후과학회지

No abstract available.