Seoul, South Korea
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Strong V.E.,Sloan Kettering Cancer Center | Song K.Y.,Seoul St Marys Hospital | Park C.H.,Seoul St Marys Hospital | Shah M.,Sloan Kettering Cancer Center | And 2 more authors.
Annals of Surgery | Year: 2010

Objective: To compare disease-specific survival (DSS) between the US and Korea following R0 resection for gastric carcinoma (GC). Summary background data: Many studies have described decreased 5-year survival after curative gastrectomy for GC in the West compared with the East. Although clinicopathological presentations of GC are known to vary widely between Eastern and Western countries, including histology, tumor location, and stage at presentation, it remains unclear whether these factors account for differences in survival. Methods: All patients undergoing curative intent resections (R0) for GC (1995-2005) were evaluated in 2 independent, single-institution prospectively maintained databases from the US (711 patients) and Korea (1646 patients). Patients receiving neoadjuvant chemotherapy were excluded from this analysis. Patient, surgical and pathologic variables were compared. DSS was determined via multivariate analysis using prognostic variables from an internationally validated GC nomogram that estimates the probability of 5-and 9-year survival. Results: Age and body mass index were significantly higher in US patients. Location of tumors was more often proximal in the United States (39% vs. 9%, P < 0.0001) and distal in Korea (54% vs. 33%, P < 0.0001). Korean patients had more early stage tumors (42% vs. 28% stage Ia, P < 0.0001) with a higher number of lymph nodes identified (97% vs. 79%, ≥15 lymph nodes, P < 0.0001). The 5-year DSS was higher in Korea than in the United States. After multivariate analysis, applying factors used in the nomogram, DSS of Korean GC patients remained significantly better than that of US patients (HR = 1.3, 95% CI; 1.0-1.6, P = 0.008). Conclusion:S This study demonstrates better survival for GC patients in Korea compared with the US as determined by multivariate analysis with a validated gastric cancer nomogram. Multiple possibilities can explain this difference. Copyright © 2010 by Lippincott Williams & Wilkins.


Van Rhee F.,University of Arkansas for Medical Sciences | Wong R.S.,Chinese University of Hong Kong | Munshi N.,Dana-Farber Cancer Institute | Rossi J.-F.,Montpellier University Hospital Center | And 18 more authors.
The Lancet Oncology | Year: 2014

Background: Multicentric Castleman's disease is a rare lymphoproliferative disorder driven by dysregulated production of interleukin 6. No randomised trials have been done to establish the best treatment for the disease. We assessed the safety and efficacy of siltuximab-a chimeric monoclonal antibody against interleukin 6-in HIV-negative patients with multicentric Castleman's disease. Methods: We did this randomised, double-blind, placebo-controlled study at 38 hospitals in 19 countries worldwide. We enrolled HIV-negative and human herpesvirus-8-seronegative patients with symptomatic multicentric Castleman's disease. Treatment allocation was randomised with a computer-generated list, with block size six, and stratification by baseline corticosteroid use. Patients and investigators were masked to treatment allocation. Patients were randomly assigned (2:1) to siltuximab (11 mg/kg intravenous infusion every 3 weeks) or placebo; all patients also received best supportive care. Patients continued treatment until treatment failure. The primary endpoint was durable tumour and symptomatic response for at least 18 weeks for the intention-to-treat population. Enrolment has been completed. The study is registered with ClinicalTrials.gov, number NCT01024036. Findings: We screened 140 patients, 79 of whom were randomly assigned to siltuximab (n=53) or placebo (n=26). Durable tumour and symptomatic responses occurred in 18 (34%) of 53 patients in the siltuximab group and none of 26 in the placebo group (difference 34·0%, 95% CI 11·1-54·8, p=0·0012). The incidence of grade 3 or more adverse events (25 [47%] vs 14 [54%]) and serious adverse events (12 [23%] vs five [19%]) was similar in each group despite longer median treatment duration with siltuximab than with placebo (375 days [range 1-1031] vs 152 days [23-666]). The most common grade 3 or higher were fatigue (five vs one), night sweats (four vs one), and anaemia (one vs three). Three (6%) of 53 patients had serious adverse events judged reasonably related to siltuximab (lower respiratory tract infection, anaphylactic reaction, sepsis). Interpretation: Siltuximab plus best supportive care was superior to best supportive care alone for patients with symptomatic multicentric Castleman's disease and well tolerated with prolonged exposure. Siltuximab is an important new treatment option for this disease. © 2014 Elsevier Ltd.


Park H.-Y.L.,Catholic University of Korea | Park H.-Y.L.,Seoul St Marys Hospital | Shin H.-Y.,Catholic University of Korea | Shin H.-Y.,Uijungbu St Marys Hospital | And 2 more authors.
American Journal of Ophthalmology | Year: 2014

Purpose To compare the detection rates of identifying the posterior border of the sclera and lamina cribrosa and measurement reproducibility of scleral and laminar thicknesses using the enhanced depth imaging (EDI) of Heidelberg Spectralis optical coherence tomography (OCT) and swept-source OCT. Design Cross-sectional design. Methods Both EDI-OCT and swept-source OCT images were obtained in 32 myopic glaucoma patients. Subfoveal choroidal, subfoveal scleral, and central laminar thicknesses were measured from obtained B-scan images. Each measurement was performed at 3 locations by 2 masked observers. The detection rates and measurement reproducibility were evaluated from selected B-scans. Results The posterior border of the sclera was visible in 10 eyes (31%) using EDI-OCT. This was improved to be visible in 17 eyes (53%) using swept-source OCT. According to the McNemar χ2 test, the detection rate of the posterior border of the sclera was significantly different between EDI-OCT and swept-source OCT (P = 0.008). The detection rate of the posterior border of the lamina cribrosa was similar for the 2 devices. In highly myopic eyes, the detection rate of the posterior border of the sclera and lamina cribrosa was not statistically different between EDI-OCT and swept-source OCT. Intersystem ICCs was 0.769 (95% CI, 0.714-0.893) for subfoveal scleral thickness and 0.900 (95% CI, 0.887-0.917) for laminar thickness. The mean subfoveal scleral thickness was 464.32 ± 213.24 μm using EDI-OCT and 650.26 ± 222.30 μm using swept-source OCT. There was statistical difference in the measured subfoveal scleral thickness by the 2 devices (P = 0.018). Conclusions Compared with EDI-OCT, swept-source OCT had an advantage in imaging the posterior sclera. Imaging the lamina cribrosa was similar when using both devices.


Lim Y.W.,Seoul St Marys Hospital | Kwon S.Y.,St Marys Hospital | Sun D.H.,Sun Hospital | Kim Y.S.,Seoul St Marys Hospital
Clinical Orthopaedics and Related Research | Year: 2011

Background: Stainless steel is one of the most widely used biomaterials for internal fixation devices, but is not used in cementless arthroplasty implants because a stable oxide layer essential for biocompatibility cannot be formed on the surface. We applied a Ti electron beam coating, to form oxide layer on the stainless steel surface. To form a thicker oxide layer, we used a microarc oxidation process on the surface of Ti coated stainless steel. Modification of the surface using Ti electron beam coating and microarc oxidation could improve the ability of stainless steel implants to osseointegrate. Questions/purposes: The ability of cells to adhere to grit-blasted, titanium-coated, microarc-oxidated stainless steel in vitro was compared with that of two different types of surface modifications, machined and titanium-coated, and microarc-oxidated. Methods: We performed energy-dispersive X-ray spectroscopy and scanning electron microscopy investigations to assess the chemical composition and structure of the stainless steel surfaces and cell morphology. The biologic responses of an osteoblastlike cell line (SaOS-2) were examined by measuring proliferation (cell proliferation assay), differentiation (alkaline phosphatase activity), and attraction ability (cell migration assay). Results: Cell proliferation, alkaline phosphatase activity, migration, and adhesion were increased in the grit-blasted, titanium-coated, microarc-oxidated group compared to the two other groups. Osteoblastlike cells on the grit-blasted, titanium-coated, microarc-oxidated surface were strongly adhered, and proliferated well compared to those on the other surfaces. Conclusions: The surface modifications we used (grit blasting, titanium coating, microarc oxidation) enhanced the biocompatibility (proliferation and migration of osteoblastlike cells) of stainless steel. Clinical Relevance: This process is not unique to stainless steel; it can be applied to many metals to improve their biocompatibility, thus allowing a broad range of materials to be used for cementless implants. © 2010 The Association of Bone and Joint Surgeons®.


Khoury H.J.,Emory University | Cortes J.E.,University of Houston | Kantarjian H.M.,University of Houston | Gambacorti-Passerini C.,University of Milan Bicocca | And 9 more authors.
Blood | Year: 2012

Bosutinib, a dual Src/Abl tyrosine kinase inhibitor (TKI), has shown potent activity against chronic myeloid leukemia (CML). This phase 1/2 study evaluated the efficacy and safety of once-daily bosutinib 500 mg in leukemia patients after resistance/intolerance to imatinib. The current analysis included 118 patients with chronic-phase CML who had been pretreated with imatinib followed by dasatinib and/or nilotinib, with a median follow-up of 28.5 months. In this subpopulation, major cytogenetic response was attained by 32% of patients; complete cytogenetic response was attained by 24%, including in one of 3 patients treated with 3 prior TKIs. Complete hematologic response was achieved/maintained in 73% of patients. On-treatment transformation to accelerated/blast phase occurred in 5 patients. At 2 years, Kaplan-Meier- estimated progression-free survival was 73% and estimated overall survival was 83%. Responses were seen across Bcr-Abl mutations, including those associated with dasatinib and nilotinib resistance, except T315I. Bosutinib had an acceptable safety profile; treatment-emergent adverse events were primarily manageable grade 1/2 gastrointestinal events and rash. Grade 3/4 nonhematologic adverse events (> 2% of patients) included diarrhea (8%) and rash (4%). Bosutinib may offer a new treatment option for patients with chronic-phase CML after treatment with multiple TKIs. This trial was registered at www.clinicaltrials.gov as NCT00261846. © 2012 by The American Society of Hematology.


Kim M.-K.,Seoul St Marys Hospital | Kim H.-S.,Catholic University of Korea
Hemodialysis International | Year: 2013

Although the buttonhole cannulation method is now widely used as an alternative to the rope-ladder method in most countries, only the latter method is used in Korea. This study was performed to investigate clinical benefit of the buttonhole technique for arteriovenous fistula (AVF) cannulation in maintenance hemodialysis (HD) patients. Thirty-two patients receiving HD via mature AVF were included and AVF cannulation was performed by 20 experienced nurses. During the 8 weeks, AVFs were cannulated by the rope-ladder method with 15-gauge sharp needles. After creating of 2 pairs of tunnel tracks by sharp needles for 7 weeks, AVFs were cannulated by the buttonhole method using 15-gauge blunt needles during the 16 weeks. Vascular access blood flow rate (BFR), dialysis venous pressure (DVP), and dialysis adequacy (Kt/V) were measured within the first week of the two cannulation methods. Cannulation pain, hemostasis time, and nurse's stress were evaluated at the end of the two methods. There were no statistical differences in vascular access BFR (P=0.139), DVP (P=0.152), and dialysis adequacy (P=0.343) between the two methods. However, the buttonhole method shortened hemostasis time (P=0.001) and decreased cannulation pain (P=0.001) as well as nurse's stress (P=0.001) compared with the rope-ladder method. In conclusion, the buttonhole cannulation method improves hemostasis time, cannulation pain, and nurse's stress without a change in vascular access BFR and dialysis adequacy in HD patients. Hemodialysis International © 2012 International Society for Hemodialysis.


Kim S.W.,Seoul St Marys Hospital
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi | Year: 2012

The incidence and severity of Clostridium difficile infection (CDI) has increased over the past decades. It is related to the emergence of hypervirulent strains and increased use of antibiotics. The incidence of refractory CDI to standard therapies and the risk for recurrent CDI are also increasing. Current guidelines recommend the first recurrence to be treated with the same agent used for the initial episode. However, data are lacking to support any particular treatment strategy for severe refractory CDI or cases with multiple recurrence. Treatments currently available for CDI are inadequate to prevent recurrence. Widely used method for managing a subsequent recurrence involves tapering followed by pulsed doses of vancomycin. Other potentially effective strategies for recurrent CDI are use of other antibiotics such as fidaxomicin, nitazoxanide, rifaximin, tigecycline, and teicoplanin. There are efforts to recover gut microflora and to optimize immune response to CDI. These include use of probiotics, fecal microbiota transplantation, intravenous immunoglobulin, monoclonal antibodies directed against C. difficile toxins, and active vaccination. However treatment of patients with refractory CDI and those with multiple CDI recurrences is based on limited clinical evidence, and there is an ongoing need for continued research to improve the outcomes these patients.


Ha K.-Y.,Seoul St Marys Hospital | Oh I.-S.,Catholic University of Korea
Clinical Orthopaedics and Related Research | Year: 2011

Background: Sparganosis is a rare parasitic infection caused by the plerocercoid tapeworm larva of the genus Spirometra. Case Description: We report the case of a 67-year-old man with a mass over the anteromedial surface of the proximal extremity of the tibia. We surgically excised a bursa containing Spirometra larvae. Literature Review: Sparganosis is a rare parasitic infection. We found no cases of lower extremity sparganosis combined with bursitis reported in the literature. Purposes and Clinical Relevance: Sparganosis should be considered in the differential diagnosis of soft tissue tumors, especially among patients who frequently have consumed mountain water or raw snakes or frogs. © 2011 The Association of Bone and Joint Surgeons®.


Hwang H.S.,Seoul St Marys Hospital | Park C.W.,Catholic University of Korea | Joo C.-K.,Seoul St Marys Hospital
Cornea | Year: 2013

PURPOSE: To present a novel noncontact meibography system with anterior segment optical coherence tomography (OCT), which is widely used in clinics for the anterior segment (cornea, anterior chamber angle, etc.), and compare the results with preexisting infrared meibography. METHODS: This research was carried out at the Seoul St Mary's Hospital with 2 volunteers. Preexisting infrared meibography was performed on the subjects, and photographs of the meibomian gland were taken again with the anterior segment OCT. With the anterior segment OCT, a tomogram of the meibomian gland could be taken and a picture of the whole meibomian gland could be taken from the infrared images for monitoring. RESULTS: The resolution of the preexisting infrared meibography was a pixel size of 640 × 480. In the anterior segment OCT, the meibomian glands were clearly identified just beneath the palpebral conjunctiva. There was no problem in grading the meibomian gland with the infrared images for monitoring. The resolution was 239 × 178 or 129 × 95 pixels, depending on the save option of the photograph. CONCLUSIONS: This novel meibography using anterior OCT yielded meibomian gland tomograms without any additional equipment, and overall infrared meibography was possible for grading. We believe this new technique will be useful in clinics for meibomian gland dysfunction and the like. Copyright © 2012 by Lippincott Williams & Wilkins.


Choi J.A.,Catholic University of Korea | Chung S.-H.,Seoul St Marys Hospital
Eye and Contact Lens | Year: 2011

PURPOSE:: We investigated the utility of a combination of autologous serum eye drops and a silicone-hydrogel (SH) lens in the treatment of persistent epithelial defects (PEDs). METHODS:: Eight patients who had distinct PED conditions were treated with 50% (v/v) autologous serum eye drops in combination with silicone hydrogel contact lenses and prospectively observed. RESULTS:: The pathogenesis of PEDs included Sjo″gren-type dry eye syndrome, graft-versus-host disease, toxic keratitis, limbal cell deficiency, superior limbic keratoconjunctivitis, and neurotrophic keratitis. The patients had PEDs for 90±81.76 days (range: 30-240 days). Before the initiation of the combined treatment, three patients had already been unsuccessfully treated with SH lenses, and five patients had received serum eye drops alone. The PEDs of the eight eyes healed after a treatment period of 11.8±4.9 days. No visible deposits were noted on the surface of any contact lens. CONCLUSIONS:: These findings demonstrate that the combination of an SH lens and serum eye drops may be effective in the treatment of intractable PEDs. © 2011 Lippincott Williams & Wilkins, Inc.

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