OBJECTIVES: To estimate the weighting for the disability caused by major cancers in Korea using the Delphi method. METHODS: We selected 19 panelists to estimate the disability weighting of major cancers in Korea by using the Delphi method. To select the relevant kinds of cancers, we used National Death Certificate Data produced by the National Statistical Office in 1996. Then the stability of each delphi round was calculated by using the coefficient of variance. RESULTS: The disability weight of major cancers for males was pancreas cancer(0.36), liver cancer(0.35), esophageal cancer(0.30), stomach cancer(0.27), lung cancer(0.26), and colorectal cancer(0.30). The disability weight of major cancers for females was pancreas cancer(0.36), liver cancer(0.34), esophageal cancer(0.29), stomach cancer(0.28), lung cancer(0.26), and colorectal cancer(0.28). CONCLUSION: The results of this study will provide baseline data useful for the measurement of the burden of disease caused by cancers in Korea.
Death Certificates ; Female ; Humans ; Korea* ; Liver ; Lung ; Male ; Pancreas ; Stomach

The purpose of this study is to evaluate the applicability of intravenous atropine sulfate therapy in infantile hypertrophic pyloric stenosis (IHPS). From 1998 to 2000 among 35 cases of IHPS, pyloromytomy was performed in 13 (Group A), and intravenous atropine was given as a primary therapy in 22 cases (Group B). In group A, all cases were cured completely. In group B, 13 (59 %) out of 22 cases were successfully treated with atropine, but 9 were failed therapy, and required operation. The recovery period to normal feeding and the hospital stay of the successful atropine group were longer than those of pyloromyotomy, 8.6 days vs. 2.9 days and 13.2 days vs. 4.1 days, respectively. In conclusion, intravenous atropine therapy did not replace pyloromyotomy, but it might be an alternative for the selected patients with contraindications for operation.
Atropine* ; Humans ; Length of Stay ; Pyloric Stenosis, Hypertrophic*

No abstract available.
Female ; Ovarian Hyperstimulation Syndrome*

OBJECTIVE: Chronic subdural hematomas (CSDH) are more common on the left hemisphere than on the right. We verified this left predilection of CSDH and tried to explain the reason for this discrepancy. METHODS: We investigated the laterality of CSDH in 182 patients who were treated from January 2005 to December 2009. We examined the symmetry of the cranium and the location of the lesion. RESULTS: CSDH was more common on the left-side. The cranium was symmetric in 63 patients, asymmetric in 119 patients. The asymmetric crania were flat on the right-side in 77 patients, on the left-side in 42 patients. The density of the CSDHs was hypodense in 29 patients, isodense 132 patients, and the others in 21 patients. Bilateral hematomas were more common in the hypodense group. In the right flat crania, the hematoma was more commonly located on the opposite side of the flat side. While in the left flat crania, the hematoma was more common on the same side. CONCLUSION: CSDHs occurred more frequently on the left side. The anatomical asymmetry of the cranium influences the left predilection of CSDH.
Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Skull

Varix of the intraabdominal portion of the fetal umbilical vein is a rare entity. We present a case of varix of the intrafetal umbilical vein diagnosed by routine prenatal ultrasonography at 35 weeks of gestation. Color Doppler examination of the abnormal umbilical vein demonstrated turbulent flow through 23-mm diameter cystic dilatation of the fetal intra-abdominal umbilical vein consistent with a varix. No other sonographic abnormalities were detected, and a healthy infant was delivered at term.
Dilatation ; Humans ; Infant ; Pregnancy ; Ultrasonography ; Ultrasonography, Prenatal ; Umbilical Veins* ; Varicose Veins*

Cancer of the gallbladder, the fifth most common malignant disease of the digestive system, is almost always associated with an unfavorable prognosis, and the clinical outcome has not improved much during the past couple of decades. This study was intended to analyze our surgical experience and to evaluate the prognostic significance of clinicopathologic factors for primary carcinoma of the gallbladder. We retrospectively reviewed the data of 113 patients with gallbladder carcinomas operated on over a period of 9 years from Jan. 1987 to Dec. 1995 at our surgical Department. In addition, a comparison with an analysis of cases from the last 10 years and a review of the disease are presented. The sex ratio (M : ) was 1.02 : , and mean age was 58.9 years. The most common presenting complaint was abdominal pain, followed by nausea and vomiting, and weight loss. An accurate preoperative diagnosis was made in 57.5% of the patients. The most common histologic type was adenocarcinoma (85.8%). A curative resection was done in 57 cases (51.4%). The overall 5-year survival rate was 21.1%, and in curative resected patients, the rates according to AJCC stage I, II, and III were 100%, 42.3%, and 14.6%, respectively. In the curative resected group, a univariate logrank analysis of 16 clinicopathologic factors showed that depth of invasion, macroscopic finding, histologic grading, lymphatic metastasis, and tumor location were significant prognostic factors. Multivariate Cox-regression analysis of these five profound factors demonstrated that only the depth of invasion was an independent variable. An analysis of survival rates according to the significant depth of invasion was done, and the 5-year survival rates for T1, T2, T3, and T4 were 72.4%, 30.2%, 8.7%, and 0%, respectively. When our data were compared with those of a previous study, the rate of curative resection and the operative mortality in our study were found to be improved over those of the earlier study. However, no progress has been made in survival during the last 10 years. In conclusion, long-term survival may be achieved by early diagnosis with a curative, radical operation, and the establishment of adjuvant therapy is required for advanced T-lesions of the gallbladder carcinoma.
Abdominal Pain ; Adenocarcinoma ; Diagnosis ; Digestive System ; Early Diagnosis ; Gallbladder Neoplasms* ; Gallbladder* ; Humans ; Lymphatic Metastasis ; Mortality ; Nausea ; Prognosis ; Retrospective Studies ; Sex Ratio ; Survival Rate ; Vomiting ; Weight Loss

Uterine carcinosarcomas are rare and highly aggressive tumors with a poor prognosis. Due to early metastasis and disease progression, it is known to be far more aggressive than matched grade 3 endometroid endometrial carcinomas. Five-year survival for stage IV is reported to be 10% and overall survival for stage IVB is expected to be very poor. The authors report one case after experiencing long-term survival (over 5 years) for stage IVB carcinosarcoma of uterus. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed to 56 year old patient for uterine myoma. On pathology report, uterine carcinosarcoma was diagnosed and image studies were performed. With the impression of stage IVB uterine carcinosarcoma, 6 cycles of chemotherapy (ifosfamide and cisplatin) was conducted as adjuvant. Up to recently (over 5 years), she maintains good performance scale without evidence of tumor recurrence or disease progression.
Carcinosarcoma ; Disease Progression ; Endometrial Neoplasms ; Female ; Humans ; Hysterectomy ; Myoma ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Uterus

BACKGROUND: Although steroid is one of the most widely used therapeutic measures for brain edema, its effect on brain edema after intracerebral hemorrhage (ICH) remains to be clarified. We performed this study to evaluate the efficacy of high dose methylprednisolone and conventional dose dexamethasone on the development of brain edema after experimental ICH. METHODS: Fifty-four male Sprague-Dawley rats, weighing 350-450 g, were used. ICH was made by stereotaxic injection of autologous arterial blood (0.13ml) into the right caudatoputamen. The animals were divided into three groups (n = 18 each). Group A received intraperitoneal(IP) injection of normal saline at 8-hour interval. Group B received dexamethasone (0.2mg/kg IP 30minutes after blood injection and 0.1mg/kg IP every 8h thereafter). Group C received methylprednisolone (30 mg/kg IP 30 minutes after ICH, 15mg/kg IP at 2 h after initial dose, and every 8h thereafter). We sacrificed the rat after 3 days and the development of brain edema was determined by measuring brain water content. We compared brain water content in each group. RESULTS: Water content of the right hemisphere was slightly lower in the methylprednisolone-treated rats than other groups; mean + S.D. in group A, B, and C was 80.94 + 0.66%, 80.56 + 0.70%, and 80.42 + 0.91%, respectively. However, there was no statistical significance ( p > 0.1) by the ANOVA test. The difference of the mean water contents between the two hemispheres was slightly higher in the saline-treated group than other groups, but without statistical significance ( p > 0.1). CONCLUSION: We could not find any significant reduction of the brain water content in the groups treated with steroid regardless of the doses. Our results do not warrant the popular steroid therapy in patients with ICH.
Animals ; Brain ; Brain Edema* ; Cerebral Hemorrhage* ; Dexamethasone ; Humans ; Male ; Methylprednisolone ; Rats ; Rats, Sprague-Dawley

Spontaneous intracranial epidural hematoma (EDH) due to dural metastasis of hepatocellular carcinoma is very rare. A 53-year-old male patient with hepatocellular carcinoma, who was admitted to the department of oncology, was referred to department of neurosurgery because of sudden mental deterioration to semicoma with papillary anisocoria and decerebrate rigidity after transarterial chemoembolization for hepatoma. Brain computed tomography (CT) revealed large amount of acute EDH with severe midline shifting. An emergent craniotomy and evacuation of EDH was performed. Active bleeding from middle cranial fossa floor was identified. There showed osteolytic change on the middle fossa floor with friable mass-like lesion spreading on the overlying dura suggesting metastasis. Pathological examination revealed anaplastic cells with sinusoidal arrangement which probably led to spontaneous hemorrhage and formation of EDH. As a rare cause of spontaneous EDH, dural metastasis from malignancy should be considered.
Anisocoria ; Brain ; Carcinoma, Hepatocellular ; Cranial Fossa, Middle ; Craniotomy ; Decerebrate State ; Floors and Floorcoverings ; Hematoma, Epidural, Cranial ; Hemorrhage ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neurosurgery

BACKGROUND: Laparoscopic cholecystectomy has become the gold-tandard treatment for symptomatic gallbladder diseases. The evaluation and the treatment of common duct pathology is an essential component in the surgical management of biliary tract disease. The purpose of the present study was to identify the value and the importance of laparoscopic cholangiography compared to endoscopic retrograde cholangiography (ERC) in a laparoscopic cholecystectomy and to suggest the role of laparoscopic cholangiography in the management of patients undergoing laparoscopic cholecystectomy. METHODS: A laparoscopic cholecystectomy was attempted in two hundred six consecutive patients treated at Hallym University between January 1993 and December 1996. Patients were divided into three groups: In group I, 167 patients were examined with preoperative ERC while in group II, 17 patients were examined with laparoscopic cholangiography; Group III included 22 patients who were not examined with preoperative ERC or laparoscopic cholangiography. RESULTS: The average age was 52.78 years in group I, 45.62 years in group II, and 49.22 years in group III. The average operative time was 76.88 minutes in group I, 131.47 minutes in group II, and 85.22 minutes in group III. The operative time in group II was longer than that in group I (p<0.001). The duration of postoperative hospitalization was 4.9 days in group I and 4.11 days in group II, but this difference was not statistically significant (p=0.166). Conversion to an open cholecystectomy was 17/167 (10%) in group I, 1/17 (5%) in group II and 5/22 (22%). No complications or deaths occurred that were due to laparoscopic cholangiography. The postoperative complications in group I/II/III included bile leakage (3/0/2), bleeding in the bed of the gallbladder (5/0/0), wound bleeding (2/1/1), recurrent common duct stones (2/0/0), subcutaneous emphysema (4/1/0), shoulder pain (12/3/0), and wound infections (15/2/1). CONCLUSIONS: Although cholangiography may not be indicated for all patients undergoing a laparoscopic cholecystectomy, it will eventually be required. We conclude that laparoscopic cholangiography, as well as ERC, is a good method for evaluating the biliary tree. Laparoscopic cholangiography is clinically useful in patients who have negative ultrasonography and a dilated bile duct. Also, laparoscopic cholangiography has many advantages, especially at a teaching hospital: it outlines the anatomy of the extrahepatic biliary tree, identifies anomalies of surgical importance in time before iatrogenic damage is inflicted, detects stones in the cystic duct, discovers unsuspected stones, and develops experience with the technique. However, it is technically diffult to cannulate cystic duct and extends the operating time.
Bile ; Bile Ducts ; Biliary Tract ; Biliary Tract Diseases ; Cholangiography* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cystic Duct ; Gallbladder ; Gallbladder Diseases ; Hemorrhage ; Hospitalization ; Hospitals, Teaching ; Humans ; Operative Time ; Pathology ; Postoperative Complications ; Shoulder Pain ; Subcutaneous Emphysema ; Ultrasonography ; Wound Infection ; Wounds and Injuries