BACKGROUND: In spite of the development of diagnostic tools, gallbladder carcinoma is often diagnosed at a late stage because of the lack of symptomatic awareness of patients in early stage. Early diagnosis and proper resectional treatment is, therefore, the most important factor for the prognosis. This study aims at the analysis of clinical characteristics and the effect of various modes of surgical treatment on long-term survival. METHODS: From January 1989 to December 1997 we operated on 132 patients with gallbladder carcinoma. Age, sex, stage distribution, clinical manifestations and mode of operations were analyzed. The cumulative survival rates were also analyzed for 107 patients who had been finally followed up, and the significance of survival difference was tested (p<0.05). RESULTS: The average age of 132 patients was 64 years old, and female patients suffered more frequent incidence than male patients by a ratio of 1.7:1. The distribution of patients according to the pathologic TNM staging showed early stage (stage 0 & I) accounted for only 9.8% whereas the advanced stages (stage II, III, IVa, IVb) accounted for the majority of the patients (90.2%). The chief complaints were abdominal pain (84.8%), indigestion, weight loss, palpable mass and so forth in a decreasing frequency order. Among the patients, 30 cases (22.7%) were irresectable, 50 cases (38%) were curative resected, and 52 cases (39%) were palliative resected. The overall cumulative survival rates of 107 patients were 53.7%, 41.7% and 30.1% for 1-year, 2-year and 5-year survival respectively. Although the 5-year survival rate of curative resected patients showed a significantly better survival rate (p<0.005) than that of non-curative resected patients, the different modes of combined radical surgery did not affect the survival rates. CONCLUSION: Combined curative resection ameliorated long-term survival of patients with gallbladder carcinoma. For the further evaluation of the efficacy of combined radical surgery on survival, more extensive data needs to be accumulated.
Abdominal Pain ; Dyspepsia ; Early Diagnosis ; Female ; Gallbladder* ; Hospital Distribution Systems ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Survival Rate ; Weight Loss

Temporal bone fracture is usually the result of blunt head injury as ossicular disruption or isolated dislocation of individual ossicles may occur after temporal bone trauma. The incus is particularly prone to displacement because of its fragile ligamentous support. We report a rare case of incus dislocation into the external auditory canal associated with an underlying temporal bone fracture.
Craniocerebral Trauma* ; Dislocations* ; Ear Canal* ; Head Injuries, Closed ; Head* ; Incus* ; Ligaments ; Temporal Bone

The present case first describes the spontaneous thigh hematoma induced by enoxaparin in a hemodialysis patient. A 64- year-old woman on a hemodialysis therapy was diagnosed with acute coronary syndrome, and treated with enoxaparin. Ten days after enoxaparin administration, diffuse swelling and pain developed suddenly in the right thigh without a history of trauma. There was a weak arterial pulse below the knee with an abrupt decrease of hemoglobin level. There were no significant abnormalities in the coagulation tests including the platelet count, prothrombin time, and activated partial thromboplastin time. Computed tomographic (CT) angiography and lower extremity arteriography were performed, which showed several bleeding foci involving branches of the right deep femoral artery. She was treated successfully by embolization at the bleeding sites, along with a transfusion.
Acute Coronary Syndrome ; Angiography ; Enoxaparin ; Female ; Femoral Artery ; Hematoma ; Hemoglobins ; Hemorrhage ; Humans ; Knee ; Lower Extremity ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Renal Dialysis ; Thigh

The first Leksell Gamma Knife unit(LGU-type B) for radiosurgery in Asia was installed in Asan Medical Center. Mechanical accuracy, output, dose profiles for each collimators were measure during acceptance test. Sixty eight patients (sixty nine cases) had undergone radiosurgery from May 1990 to September 1990. AVM cases were 24 cases (35%), acoustic tumor 10 (14%), pituitary adenoma 4 (6%), metastatic tumor 18 (26%), meningioma 6 (9%) and others 18 (26%). Dose of 25 Gy-100 Gy was delivered at one time according to disease, location and sizes.
Asia ; Chungcheongnam-do ; Humans ; Meningioma ; Neuroma, Acoustic ; Pituitary Neoplasms ; Radiosurgery

The causes of the chylothorax can be classified to the congenital cases, such as the atresia of thoracic duct and thoracic duct-pleura fistula, and the acquired ones, such as thoracic surgery, trauma, malignant disease, venous thrombosis, infection and so on. We experienced a case of left chylothorax in a 10-year-old girl with a lymphangiomatosis of left thorax extending from axillar to buttock. She first received the two weeks of conservative management, which was unsuccessful to subside the chylothorax. Then she was taken the partial pleurectomy and chemical pleurodesis under the thoracoscopy as a surgical intervention, but this is also insufficient to reduce the chylous effusion. Finally she received 10 times of radiotherapy on left thorax, then the chylothorax is controlled completely.
Buttocks ; Child ; Chylothorax* ; Female ; Fistula ; Humans ; Pleurodesis ; Radiotherapy* ; Thoracic Duct ; Thoracic Surgery ; Thoracoscopy ; Thorax* ; Venous Thrombosis

PURPOSE: The purpose of this study was to research the properties of some chemically cured methacrylate polymers such as MMA, HEMA, TEG-DMA, bis-GMA, GMA. MATERIAL AND METHOD: 5 kinds of methacrylates were selected and added 2% tertiary amine and benzoyl peroxide to make a chemically curable polymer. 25 micron crushed silicas which are treated with silane were selected as filler, they were added into methacrylate monomer until the consistency did not changed by the load of 500gram. All of the experimental resins were 5 kinds, and a serial test was done with 3 kinds of items including the filler contents, the tensile strength, and the bond strength. The number of specimen were 10 for each group. Filler contents were obtained by reducing the specimens to ashes at 600 degrees C for 1 hour. The specimens with the dimension of 6mm in diameter and 3mm thick were immersed in 37+/-1degrees C distilled water for 24 hours before test, and tensile strength were measured with cross-head speed 1mm/min. Shear bond strength were measured on the specimens attached to bovine enamel etched with 37% phosphoric acid for 1 minute. RESULTS: 1. Maximum filler incorporation was the highest as 75.5% on MMA, and the least as 53.4% on bis- GMA(p<0.0001). 2. The tensile stregth were MMA 141.3, GMA 154.3, TEG-DMA 157.4, bis-GMA 161.4 MPa, and HEMA showed the highest value, 226.9MPa(p=0.0004). 3. The bond strength were GMA 10.1, TEG-DMA 11.7, HEMA 12.2, bis-GMA 13.3 MPa, and MMA showed the highest value, 15.3MPa, however statistical significances were not (p=0.3838). 4. TEG-DMA and HEMA were not different on the aspect of maximum filler contents and shear bond strength(p>0.05). CONCLUSION: HEMA can be used as an another diluent substituting TEG-DMA with the increased strength and with the constant bond strength and the constant filler contents.
Benzoyl Peroxide ; Bisphenol A-Glycidyl Methacrylate ; Dental Enamel ; Methacrylates ; Polymers* ; Silicon Dioxide ; Tensile Strength ; Water

PURPOSE: M. pneumoniae is knwon as a common causative agents of respiratory infection in school children. But, it tends to occur in infants and younger children recently. This study was performed to evaluate the incidence and clinical manifestations of M. pneumoniae pneumonia in infants. METHOD: A total of 142 children(33 infants{Group I : Infants group; 0-2 years} and 109 children{Group II : Children group; 3-6 years}) was admitted with M. pneumoniae pneumonia from January through December 1998. We reviewed medical records and evaluated the incidence, clinical manifestations and laboratory findings. RESULT: Number of patients with M. pneumoniae pneumonia in 0 to 2 years of age(infants group) comprised 23.2% of the total in contrast to 57.1% in 3 to 6 years of age group and 19.7% in 7 to 12 years of age group. Seasonal distribution showed the highest frequency in autumn in infant and children groups(45.5% and 39.4% respectively). The most frequent symptom was cough(90.9% and 96.3%, respectively), followed by sputum(81.8% and 90.8%, respectively), fever(72.7% and 66.0%, respectively) and rhinorrhea(72.7% and 64.0%, respectively). The common physical findings on admission were crackle(84.8% and 80.7%, respectively), wheezing(30.3% and 18.3%, respectively) and throat injection(39.4% and 35.8%, respectively). WBC count was within normal range in both groups(90.9% and 89%, respectively) and CRP was lower than 0.8 mg/dL in 63.6% of infant group and 54.1% of children group. The most common radiologic finding was bronchopneumonia in both groups (47% and 38%, respectively). CONCLUSION: Number of the patients with Mycoplasma pneumoniae pneumonia in infants age from 0 to 2 years comprised 23.2% of the total. Clinical manifestations of Mycoplasma pneumonia in infants were similar to those of older children. We recommened Mycoplasma pneumoniae should be considerd as a causative agent even in infant with respiratory infection.
Bronchopneumonia ; Child ; Humans ; Incidence ; Infant* ; Medical Records ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pharynx ; Pneumonia* ; Pneumonia, Mycoplasma* ; Reference Values ; Seasons

Miller-Fisher syndrome is an acute poly-neuropathy typically characterized by the triad of ophthalmoplegia, ataxia, and areflexia. Other poly-neuropathy diseases include Guillain-Barre syndrome and Bickerstaff brainstem encephalitis. However, not all cases of Miller-Fisher syndrome have the typical three symptoms. These diseases have been differentiated by clinical manifestations and anti-GQ1b IgG antibody testing. In Miller-Fisher syndrome, anti-GQ1b IgG antibody is present in over 95% of patients; however, the frequency is not so high in normal subjects or in those with other poly-neuropathy diseases. Infectious illnesses, such as respiratory diseases and gastrointestinal diseases, usually precede Miller-Fisher syndrome. In general, Miller-Fisher syndrome is a self-limiting illness; however, a few cases of Miller-Fisher syndrome progressing to respiratory failure have been reported, particularly in children. In this case, we report abnormal angiographic findings. We report a case of atypical Miller-Fisher syndrome with internal carotid artery stenosis treated with prednisolone.
Ataxia ; Brain Stem ; Carotid Artery, Internal ; Carotid Stenosis ; Child ; Encephalitis ; Gastrointestinal Diseases ; Guillain-Barre Syndrome ; Humans ; Immunoglobulin G ; Miller Fisher Syndrome ; Ophthalmoplegia ; Polyneuropathies ; Prednisolone ; Respiratory Insufficiency

Human tails or caudal cutaneous appendages are rare congenital anomalies with lesions usually arising from the midline of the lumbosacrococcygeal area. There have been only around 70 cases reported in literature. A 4-month-old male infant born as the 1st child of a dizygotic twin was presented with a penis-shaped mass of 4-cm in the coccygeal area. The mass was entirely covered by skin without any skin defect and was connected to the midline skin of the posterior coccygeal area by a stalk. Magnetic resonance images showed fat density of the mass without any demonstrable communication with the spinal canal nor any underlying central nervous system anomalies. The patient underwent a simple surgical excision of the mass without residual effects and complications. Histopathologic examination of the mass revealed lobules of mature adipose tissue, fibromuscular soft tissue, small vessels and nerves with normal hair follicles on the skin.
Adipose Tissue ; Central Nervous System ; Child ; Hair Follicle ; Humans ; Infant ; Magnetic Resonance Spectroscopy ; Male ; Skin ; Spinal Canal ; Twins, Dizygotic

In this study, we evaluated accuracy and usefulness of CyberKnife Respiratory Tracking System (SynchronyTM, Accuray, USA) about a moving during stereotactic radiosurgery. For this study, we used moving phantom that can move the target. We also used Respiratory Tracking System called Synchrony of the Cyberknife in order to track the moving target. For treatment planning of the moving target, we obtained an image using 4D-CT. To measure dose distribution and point dose at the moving target, ion chamber (0.62 cc) and gafchromic EBT film were used. We compared dose distribution (80% isodose line of prescription dose) of static target to that of moving target in order to evaluate the accuracy of Respiratory Tracking System. We also measured the point dose at the target. The mean difference of synchronization for TLS (target localization system) and Synchrony were 11.5+/-3.09 mm for desynchronization and 0.14+/-0.08 mm for synchronization. The mean difference between static target plan and moving target plan using 4D CT images was 0.18+/-0.06 mm. And, the accuracy of Respiratory Tracking System was less 1 mm. Estimation of usefulness in Respiratory Tracking System was 17.39+/-0.14 mm for inactivity and 1.37+/-0.11 mm for activity. The mean difference of absolute dose was 0.68+/-0.38% in static target and 1.31+/-0.81% in moving target. As a conclusion, when we treat about the moving target, we consider that it is important to use 4D-CT and the Respiratory Tracking System. In this study, we confirmed the accuracy and usefulness of Respiratory Tracking System in the Cyberknife.
Four-Dimensional Computed Tomography ; Prescriptions ; Radiosurgery ; Track and Field