Retrorectal tumors are particularly rare among the adult population, occurring in 1 of 40,000 hospital admissions. Clinical diagnosis is difficult and is often delayed because of vague symptoms. This study aimed to investigate the clinicopathological features of retrorectal tumors. Between January 1999 and March 2005, 10 patients were diagnosed with retrorectal tumors at the Department of Surgery, Yonsei University Medical Center, and their medical records were reviewed. We analyzed chief complaints, imaging studies, surgical approaches and pathologic examinations. Out of 10 patients, 8 were female and 2 were male. The mean age was 42.8 years. Four patients had no symptoms. Perianal and abdominal pain were the most common presentations. CT and MRI were the most frequently performed imaging studies. Surgery was performed in 9 patients. Postoperative pathologic diagnosis was possible in 9 patients. An epidermal cyst was the most common tumor (4 patients); others included a mature teratoma, an adenocarcinoma from a tail gut cyst, a duplication cyst, a neurogenic tumor, and a smooth muscle cell tumor. Imaging techniques like CT scans, MRI and TRUS are helpful to determine the size and the extent of a tumor and its relationship to the surrounding anatomical structures for the operative approach. A surgical resection is the standard of treatment and demonstrates good results and a good prognosis.
Abdominal Pain ; Academic Medical Centers ; Adenocarcinoma ; Adult ; Epidermal Cyst ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Medical Records ; Myocytes, Smooth Muscle ; Prognosis ; Teratoma

A 68-year-old man developed mild quadriparesis 1 month prior to presentation. At 4 days before presentation, he developed dysarthria and more severe quadriparesis, predominantly on the left side of the body. MRI revealed edematous lesions in the medulla and throughout the spinal cord. Angiography showed a right tentorial dural arteriovenous fistula (DAVF). Despite successful treatment achieved by endovascular embolization, there was no improvement in the weakness of either leg. Early diagnosis of tentorial DAVF is important to prevent neurological complications such as encephalomyelopathy and hemorrhage.
Aged ; Angiography ; Central Nervous System Vascular Malformations* ; Dysarthria ; Early Diagnosis ; Hemorrhage ; Humans ; Leg ; Magnetic Resonance Imaging ; Quadriplegia ; Spinal Cord

PURPOSE: Although advances in technology have reduced the risk of ceramic implant fractures in total hip arthroplasty, these injuries do occur and their treatment remains challenging. There is a lack of studies reporting on the effectiveness of ceramic components in revision hip arthroplasty after ceramic bearing fracture. The aim of this study is to evaluate clinical and radiologic outcomes of revision surgery with ceramic-on-ceramic components after ceramic bearing fractures in young (i.e., under 60 years old) and active patients. MATERIALS AND METHODS: Eight patients who, from May 2004 to November 2011, underwent ceramic-on-ceramic revision surgery following a ceramic component fracture and had more than 6 years follow up were enrolled in this study. All eight patients were male with mean ages at first and revision surgeries of 39 years (range, 31–50 years) and 43.8 years (range, 33–60 years), respectively. There were 6 and 2 cases of ceramic liner and ceramic head fractures, respectively. The average time from the first operation to revision surgery was 54.3 months (range, 9–120 months), and the average follow up period was 9.7 years (range, 6–13.3 years). RESULTS: At the last follow up, all patients showed improvement in Harris hip score and pain relief and there were no cases of loosening or osteolysis. CONCLUSION: Revision total hip arthroplasty using ceramic-on-ceramic components after ceramic component fracture is a feasible and appropriate surgical option in young and active patients.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Ceramics ; Follow-Up Studies ; Head ; Hip ; Hip Prosthesis ; Humans ; Male ; Osteolysis

PURPOSE: Circumferential resection margin (CRM) involvement is a well-known predictor for poor prognosis in rectal cancer. However, the significance is controversial in some studies. Accordingly, this study attempted to examine the prognostic impact of CRM involvement in stage III rectal cancer. MATERIALS AND METHODS: Between January 1990 and December 2007, a total of 449 patients who underwent curative resection followed by complete adjuvant chemoradiotherapy for stage III rectal cancer located within 12 cm from the anal verge were selected. Patients were divided into a CRM-positive group (n=79, 17.6%) and a CRM-negative group (n=370, 82.4%). RESULTS: With a median follow-up of 56.6 months, recurrent disease was seen in 53.2 and 43.5% of the CRM-positive and CRM-negative group, respectively. CRM involvement was an independent prognostic factor for 5-year systemic recurrence-free survival (HR: 1.5, CI: 1.0-2.2, p=0.017). However, no significant difference was observed for local recurrence rate between the two groups (13.0 and 13.5%, respectively, p=0.677). CONCLUSION: In this study, local recurrence rate did not differ according to CRM involvement status in stage III rectal cancer patients, although CRM involvement was shown to be an independent poor prognostic factor. Accordingly, validation of the results of this study by further large prospective randomized trials is warranted.
Aged ; Biological Markers ; Chemoradiotherapy/*methods ; Female ; Fluorodeoxyglucose F18/pharmacology ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Positron-Emission Tomography ; Prognosis ; Rectal Neoplasms/diagnosis/*surgery/*therapy ; Recurrence ; Surgical Procedures, Operative ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND: Long-term survival after surgical correction of mitral regurgitation is associated with preservation of left ventricular systolic function after operation. And mitral valve repair has been suggested to provide a better postoperative left ventricular systolic function. Accordingly, we intended to compare the operative results of mitral valve repair with those of mitral valve replacement and search for preoperative predictors of postoperative left ventricular systolic function. METHOD: The clinical features, echocardiographic measurements, and cardiac catheterization results of 75 patients operated between January 1984 and December 1994 for acquired pure mitral regurgitation were analyzed. RESULTS: Of the 75 patients, 39 patients had mitral valve repair, and 36 patients had mitral valve replacement. When the outcomes of mitral valve repair and mitral valve replacement were compared, left ventricular ejection fraction decreased significantly after surgery inboth groups but postoperative left ventricular ejection fraction was greater in valve repair group than in valve replacement group. Data analysis of preoperative variables showed that echocardiographic left ventricular end-diastolic diameter(p<.05), but not other clinical and echocardiographic variables, were predictors of postoperative left ventricular systolic function. CONCLUSION: After surgical correction of chronic organic mitral regurgitation, left ventricular dysfunction is frequent and valve repair decreases the severity of left ventricular dysfunction. And the most powerful predictor of postoperative left ventricular systolic function is preoperative left ventricular end-diastolic diameter measured by echocardiography.
Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Statistics as Topic ; Stroke Volume ; Ventricular Dysfunction, Left

PURPOSE: Expression of adhesion molecules is significantly correlated with the invasion and the metastasis of colorectal cancer. The aim of this study is to identify the importance of the expressions of E-cadherin and beta-catenin as a prognostic factor in T2 colorectal cancer. METHODS: Forty-five cases of primary T2 colorectal cancers were selected between February 1997 and February 2000. We evaluated the membranous expressions of E-cadherin and beta-catenin by using immunohistochemisty and analyzed the relationship with various clinicopathologic parameters. RESULTS: Loss of membranous E-cadherin was significantly associated with histologic differentiation (P=0.023), vascular invasion (P<0.001), lymphatic invasion (P<0.001), and lymph-node metastases (P=0.001). Similar patterns were observed in the expression of beta-catenin. The correlation between the E-cadherin and the beta-catenin expressions was statistically significant (P<0.001). In the multivariate analysis, neither the loss of expression of E-cadherin nor beta-catenin is a risk factor affecting lymph-node metastasis in T2 colorectal cancers. However, there were significant differences in the 5-year disease-free survival rates between the positive (+/-, +) and the negative (-) expression groups of E-cadherin and beta-catenin (P=0.015, 0.03). CONCLUSIONS: This study suggests that loss of membranous expression of E-cadherin and beta-catenin molecules correlates with poor prognostic factors and indicates invasion and metastasis in T2 colorectal cancer, which, therefore, might be predictive of short survival in these patients.
beta Catenin ; Cadherins ; Colorectal Neoplasms ; Disease-Free Survival ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Risk Factors

PURPOSE: Currently many clinicians have recommendsprostate biopsy when the level of prostate specific antigen (PSA) is higher than 4.0 ng/ml. However, recently the prostate cancer detection rates werereported to be about 20% at PSA level 2.5 to 4.0 ng/ml. Therefore, an increasing amount of hospitals have recommends lowering the PSA cut off level to 2.5 ng/ml. We retrospectively evaluated the prostate cancer detection rate and pathologic characteristics of patients with PSA level of 2.5 to 4.0 ng/ml and we compared this with the patients who had PSA level in the range of 4.1 to 10.0 ng/ml. MATERIAL AND METHODS: We analyzed the data of 515 patients who received prostate biopsy in the range of PSA level 2.5 to 10 ng/ml. The clinical characteristics, cancer detection rate and pathologic findings of the biopsy were compared between the PSA 2.5-4.0 ng/ml group and PSA 4.1-10.0 ng/ml group. RESULTS: Cancer detection rates in patients who underwent biopsy were 18.1% and 22.4% at PSA 2.5 to 4.0 and 4.1 to 10.0 ng/ml, respectively. Mean Gleason scores were found 6.4+/-0.5 and 6.6+/-0.7 and high grade cancers with Gleason score 7 or more were found in 50% and 58.4% of patients with cancer with PSA 2.5 to 4.0 and 4.1 to 10.0 ng/ml, respectively. There were no significant difference between the 2 groups in cancer detection rates and pathologic findings on biopsy including mean Gleason score and high grade cancers with Gleason score 7 or more between two groups. CONCLUSION: There were no significant difference in cancer detection rates and pathologic findings between PSA 2.5-4 ng/ml group and PSA 4.1-10 ng/ml group. These results suggest that a lower PSA cutoff should be considered as an indication for prostate biopsy in the Korean population.
Biopsy ; Humans ; Neoplasm Grading ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies

PURPOSE: The purpose of this work was to review the oncologic outcomes and the operative safety of a tumor- specific mesorectal excision (TSME) for resectable rectal cancer. The risk factors for recurrence and survival were analyzed, and the changes in the sphincter-preserving rate with time were analyzed. METHODS: A total of 1,276 patients with rectal cancer who underwent curative surgery between 1989 and 2003 were analyzed retrospectively. The enrolled patients were registered in the Colorectal Cancer Database and were followed prospectively. RESULTS: The pathologic stages were stage I in 330 (25.9%), II in 403 (31.6%), and III in 543 (42.6%). Postoperative complications developed in 263 patients (20.6%). The rates of anal sphincter preservation were 32.6% between 1989 and 1993, 56.8% between 1994 and 1998, and 69.4 % between 1999 and 2003. With a mean follow-up of 69.4 months, the overall local recurrence (LR) rate was 5.4%. The 5-year LR rates were 3.8% in stage I, 4.7% in stage II, and 8.4% in stage III (P=0.016). A multivariate analysis revealed that the risk factors affecting LR were pN (0.005) and preoperatively increased serum CEA (P=0.008). The 5-year cancer-specific survival rates were 93.8% in stage I, 84.5% in stage II, and 64.5% in stage III (P=0.021). A multivariate analysis revealed that the factors affecting cancer-specific survival were pN (P=0.012) and circumferential resection margin (P<0.001). CONCLUSIONS: TSME for resectable rectal cancer showed acceptable operative morbidity and excellent oncologic outcomes. The trend toward sphincter preservation was obvious, and the shortening of the distal resection margin without deteriorating the oncologic outcomes was one of the major enabling factors.
Anal Canal ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Postoperative Complications ; Prospective Studies ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate

PURPOSE: A colorectal carcinoma is the fourth most common malignancy in the world. Unfortunately, only approximately 20% of the liver metastases are resectable at the initial presentation. Neoadjuvant chemotherapy has been used for downsizing in unresectable disease. In addition, the use of newer biologic agents, such as cetuximab and bevacizumab, has much improved responses in patients with unresectable colorectal liver metastases. The aim of this study was to report on patients who had received a curative resection following neoadjuvant chemotherapy including a molecularly targeted agent for unresectable colorectal liver metastases. METHODS: Following the neoadjuvant chemotherapy using cetuximab plus FOLFIRI (irinotecan and infused fluorouracil plus leucovorin) or bevacizumab plus FOLFOX (oxaliplatin and infused fluorouracil plus leucovorin), 10 patients with initially unresectable colorectal liver metastases underwent a curative surgical resection between September 2005 and June 2007. RESULTS: One patient underwent a right lobectomy, three patients a segmentectomy and five a wedge resection with or without radiofrequency ablation. With a median postoperative follow-up of 14 months (range, 1 to 22 months), five recurrences (50%) occurred. The common toxic effects were grade 2/3 skin toxicity (60%), grade 4 hematologic toxicity (20%), grade 3 gastrointestinal toxicity (10%), and grade 3 neurologic toxicity (10%). CONCLUSIONS: Our preliminary data suggests that neoadjuvant chemotherapy including a molecularly targeted agent may improve resectability in patients with initially unresectable colorectal liver metastases although a high recurrence rate exists. Randomized prospective studies comparing neoadjuvant chemotherapy including a targeted agent in cases of unresectable colorectal liver metastases are warranted.
Antibodies, Monoclonal, Humanized ; Bevacizumab ; Cetuximab ; Colorectal Neoplasms ; Fluorouracil ; Follow-Up Studies ; Humans ; Liver ; Mastectomy, Segmental ; Neoplasm Metastasis ; Recurrence ; Skin

PURPOSE: A single institute trial of combination chemotherapy, with paclitaxel and cisplatin, in patients with metastatic breast cancer, having failed previous combination chemotherapy, was performed. MATERIALS AND METHODS: Patients were only eligible for this study if there disease had progressed, following treatment with previous chemotherapy, in either an adjuvant or a metastatic setting. Paclitaxel 175 mg/m2 was administered as a 3-hour continuous infusion on day 1, and cisplatin 80 mg/m2 was administered for 2 hours on day 2, with adequate hydration. This was repeated every 3 weeks, and continued until one of the following events occurred: disease progression, unacceptable adverse effect or treatment refusal by the patient. Intercurrent palliative radiotherapy, or concurrent hormonal therapy, was permitted, depending on each patient's status. All the endpoints were evaluated under the principle of intention to treat analysis. RESULTS: A total of 24 patients entered the study, and 18 had at least one measurable lesion, but 6 did not. The objective response rate of the 18 patients was 50%(9/18). Two were complete responses and seven showed partial responses. The median response duration, progression free and overall survival were 5.3 months (range, 4~18), 6 months (95% CI, 5~7) and 12 months (95% CI, 7~17), respectively. 67% of the planned dose was administered. Out of a total 135 cycles administered, about 20% of cycles showed grade 3 or 4 leukopenia and 7% showed grade 3 thrombocytopenia. Two patients suffered from pneumonia, and one experienced neutropenic fever. Mucositis, greater than grade 3, existed in three cases. No treatment related deaths were reported. CONCLUSION: The combination chemotherapy, with paclitaxel and cisplatin, was active in the treatment of metastatic breast cancer patients having failed previous chemotherapy.
Breast Neoplasms* ; Breast* ; Cisplatin* ; Disease Progression ; Drug Therapy ; Drug Therapy, Combination* ; Fever ; Humans ; Intention to Treat Analysis ; Leukopenia ; Mucositis ; Paclitaxel* ; Pneumonia ; Radiotherapy ; Thrombocytopenia ; Treatment Refusal