PURPOSE: Recurrent colorectal cancers have important and difficult diagnostic and treatment problems. The purpose of this study is to evaluate the rationale and the efficacy of surgical re-treatment for patients with recurrence following curative surgery for colorectal cancer. METHODS: From January 1991 to December 2002, we experienced 60 (20.9%) patients with recurred colorectal cancer among 287 patients who had curative operations in our hospital. These 60 patients were divided into three groups. Patients in group 1 had curative-intent resections, patients in group 2 had palliative resections, and patients in group 3 had conservertive treatment. The groups consisted of 17 (28.3%), 10 (16.7%) and 33 (55.0%) patients, respectively. We analyzed retrospectively those groups for any recurrence pattern and for survival. RESULTS: Of the 60 patients with recurrent colorectal cancer, in 20 (33.3%) patients the cancer recurred in the colon, and in 40 (66.7%) it recurred in the rectum. Local recurrence was seen in 9 (15.0%) patients, liver metastasis in 25 (41.7%), and pulmonary metastasis in 13 (21.7%). The 1- and 3-, and 5-year survival rates were 86.5%, 31.7%, and 15.9%, respectively, for group 1, 33.3%, 0%, and 0% for group 2, and 28.9%, 4.4%, and 4.4% for group 3. The median survival period was 31 months for group 1, 8 months for group 2, and 7 months for group 3. CONCLUSIONS: Although evaluation was difficult owing to the small number of patients with recurrent colorectal cancer, a significant difference in survival rates was observed between the treatment groups. On the basis of these results, we think that curative-intent aggressive surgery for recurrent colorectal cancer in appropriately selected cases can clearly prolong survival when compared with palliative resections and conservative treatment.
Colon ; Colorectal Neoplasms* ; Humans ; Liver ; Neoplasm Metastasis ; Rectum ; Recurrence ; Retrospective Studies ; Survival Rate

Renal artery disease is one of the significant factors that lead to compromise renal function and/or aggravate hypertension in the elderly population. Since the non-surgical treatment of renal artery stenosis, percutaneous transluminal renal angioplasty, is available, it is possible to cure the decreased renal function and exacerbated hypertension. However, bilateral renal artery occlusion (BRAO) that brings about anuria and azotemia is rare. In this communication, we'd like to describe a patient who developed acute renal failure due to BRAO. His renal function was completely recovered after successful implantation of stents into both renal arteries. We are unaware of prior reports documenting the beneficial effect of a distal embolic protection device, the PercuSurge GuardWire system (Medtronic, Minneapolis, MN, USA), in a clinical setting as described here. The GuardWire arm, a device for transient distal balloon occlusion during angioplasty or stent placement, allows recovery of any liberated plaque by aspiration before restoration of antegrade flow, and thereby performs a double service. We'd like to strongly recommend that stent implantation with adjunctive distal protection is essential to obtain a complete restoration of distal blood flow although there is sufficient collateral blood flow in elderly patients with BRAO and azotemia.
Acute Kidney Injury ; Aged ; Angioplasty ; Anuria ; Arm ; Azotemia ; Balloon Occlusion ; Embolic Protection Devices* ; Humans ; Hypertension ; Renal Artery Obstruction ; Renal Artery* ; Stents*

BACKGRAOUND/AIMS: The biologic nature of polypoid lesions of gallbladder is difficult to define before surgical intervention and operative indication is still controversial. The aim of this study is to provide surgical guideline for polypoid lesions of gallbladder. METHODS: Clinical data were retrospectively correlated with the histopathologic characteristics of polypoid lesions of gallbladder in 48 patients who had cholecystectomy from January 1992 to August 2002 in the Department of Surgery, Kang-nam General Hospital Public Corporation. RESULTS: There were 40 benign polypoid lesions including 30 cholesterol polyps, 5 adenomas, 4 inflammatory polyps and 1 adenomyomatous hyperplasia and 8 malignant polypoid lesions. Data analysis showed that neoplastic polypoid lesions of gallbladder correlated significantly with size and malignant polypoid lesions of gallbladder correlated significantly with size and age. CONCLUSION: The risk factor for neoplasm was the size of the polypoid lesions of gallblaldder (> or =10 mm) and the risk factors for malignancy were the size of the polypoid lesions of gallblaldder (> or =10 mm) and age (> or =50). Surgical intervention should be considered when a polypoid lesion of the gallbladder is larger than 10 mm and patient is older than 50 years.
Adenoma ; Cholecystectomy ; Cholesterol ; Gallbladder* ; Hospitals, General ; Humans ; Hyperplasia ; Polyps ; Retrospective Studies ; Risk Factors ; Statistics as Topic

BACKGROUND: Thrombopoietin (TPO) is a major cytokine which plays a critical role in the regulation of thrombopoiesis and megakaryopoiesis. Since the kidney is one of the TPO-producing organs, it is hypothesized that TPO deficiency in end stage renal disease can give rise to thrombocytopenia. However, serum TPO levels and their clinical significance in maintenance hemodialysis patients with thrombocytopenia are not completely evaluated. The aim of the present study was to compare the percentage of reticulated platelets and serum TPO levels between non-thrombocytopenic group (platelet count > or =150x109/L, non-T group) and thrombocytopenic group (platelet count <150x109/L, T group) and to investigate the local and/or systemic effect of the TPO on the platelet count in hemodialysis patients. METHODS: We measured the percentage of reticulated platelets and serum TPO levels in samples obtained from venous returns of arteriovenous fistula (AVF) and contralateral peripheral veins in 44 hemodialysis patients. Serum reticulated platelets were measured by flow cytometry and serum TPO levels were determined with a commercially available ELISA kit. Patients with a history of HBV/HCV infection and hepatobiliary disease were excluded. RESULTS: Reticulated platelets of T group (4.57+/-2.32%) were significantly lower than non-T group (7.79+/-3.62%) (p<0.05). Serum TPO levels obtained from venous return of AVF in T group (78.37+/-15.48 pg/mL) were lower than non-T group (98.15+/-35.05 pg/mL) (p<0.05). Serum TPO levels obtained from contralateral peripheral veins in T group (77.20+/-17.28 pg/mL) were lower than non-T group (104.73+/-38.45 pg/mL) (p<0.01). There were no statistically significant difference of serum TPO levels between venous return of AVF and contralateral peripheral veins in T group. CONCLUSION: Decreased circulating reticulated platelets and serum TPO levels despite low platelet counts in comparison with normal platelet counts in hemodialysis patients, suggesting that the feedback mechanism, the TPO producing organ and bone marrow is not working with effect in the regulation of thrombopoiesis. An alteration in the production and regulation of TPO level is not influenced by local factor like an AVF endothelium.
Arteriovenous Fistula ; Bone Marrow ; Endothelium ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Humans ; Kidney ; Kidney Failure, Chronic ; Platelet Count ; Renal Dialysis* ; Thrombocytopenia* ; Thrombopoiesis ; Thrombopoietin* ; Veins

BACKGROUND: In breast surgery, regional anesthesia rather than primary anesthesia has been mainly used for postoperative analgesia. Serratus anterior plane block is a new method for ultrasound-guided thoracic wall block. It is less invasive and relatively safer than conventional regional anesthetic techniques. CASE: We report a case of breast surgery under serratus anterior plane block as primary anesthesia with monitored anesthesia for a 78-year-old patient with a medical history of cardiopulmonary resuscitation due to stress-induced cardiomyopathy caused by pneumonia. CONCLUSIONS: Serratus anterior plane block might be simple and effective technique for breast surgery when a lesion is located on lateral side.
Aged ; Analgesia ; Anesthesia ; Anesthesia, Conduction ; Breast ; Cardiomyopathies ; Cardiopulmonary Resuscitation ; Humans ; Methods ; Pneumonia ; Thoracic Wall

BACKGROUND: In breast surgery, regional anesthesia rather than primary anesthesia has been mainly used for postoperative analgesia. Serratus anterior plane block is a new method for ultrasound-guided thoracic wall block. It is less invasive and relatively safer than conventional regional anesthetic techniques.CASE: We report a case of breast surgery under serratus anterior plane block as primary anesthesia with monitored anesthesia for a 78-year-old patient with a medical history of cardiopulmonary resuscitation due to stress-induced cardiomyopathy caused by pneumonia. CONCLUSIONS Serratus anterior plane block might be simple and effective technique for breast surgery when a lesion is located on lateral side.

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure

BACKGROUND: Onychomycosis, especially toenail onychomycosis has become one of the common fungal infection and has historically been regarded as a cosmetic rather than medical problem by many patients, even by physicians. Recently, however, there are several reports that this is a refractory disease which may cause a deleterious effect on patients' quality of life (QOL). OBJECTIVE: The purpose of this study was to investigate the impact of toenail onychomycosis on QOL in Korea and to assess the changes of QOL after treatment. METHODS: Total 1004 patients with toenail onychomycosis which was confirmed by clinical findings and KOH preparation were enrolled at 47 dermatologic centers in Korea, and interviewed with standardized QOL questionnaire before and after systemic antifungal treatment. Responses to the questionnaire were scored by f-point scale (0~4) and averaged, and were analyzed for 5 dimensions of emotional impact, social impact, symptom and functional impact, patients' views concerning treatment, and relationship with doctor. RESULTS: 1. Before and after treatment, the most serious impact was emotional dimension showing 1.90 and 1.30 in average score (AS), and social (AS: 1.14 and 0.83) and symptom and functional impact (AS: 1.05 and 0.92) was also affected. 2. In female rather than male, statistically more significant impact on patients' QOL was observed in all dimensions. 3. After treatment, 3 of 5 dimensions were improved significantly - emotional dimension (AS: from 1.90 to 1.30), social dimension (AS: from 1.14 to 0.83), patients' view concerning treatment(AS: from 1.34 to 1.02) 4. The degree of patients' satisfaction at the therapeutic effect was very high - 62.4% (immediately after. treatment) and 65.8% (9 months after initiation of treatment) of patients answered excellent or good. CONCLUSION: This study confirms that toenail onychomycosis has significant Impact on the overall QOL of patients. Also the effect of antifungal therapy on patients' QOL were satisfactory. Therefore, both doctor and patient should pay more attention to the treatment of onychomycosis.
Female ; Humans ; Korea* ; Male ; Nails* ; Onychomycosis* ; Quality of Life* ; Social Change ; Surveys and Questionnaires