The purpose of this study was to report and discuss the diagnosis and treatment of obstructive atelectasis secondary to pus obstruction in a patient who had developed a maxillofacial abscess, and to review the literature on similar cases. Persistently discharging pus within the oral cavity can act as an aspirate, and may lead to obstructive atelectasis. Additionally, maxillofacial surgery patients should be carefully assessed for the presence of risk factors of obstructive atelectasis, such as, epistaxis after nasotracheal intubation, oral bleeding, and mucus secretion. Furthermore, patients with these risk factors should be continuously followed up by monitoring SPO₂, breath sounds, and chest x-ray.
Abscess ; Anesthesia, General ; Diagnosis ; Epistaxis ; Hemorrhage ; Humans ; Intubation ; Mouth ; Mucus ; Pulmonary Atelectasis ; Risk Factors ; Suppuration ; Surgery, Oral ; Thorax

PURPOSE: We studied the risk factors for loco-regional recurrence and distant metastasis in patients following treatment of operable breast carcinoma with a modified radical mastectomy. METHODS: 374 breast cancer patients were treated by modified radical mastectomy between 1989 and 1999 at the Department of Surgery, Korea University College of Medicine. The median age of the patients was 48.3 years old. The duration of the mean follow up period was 53.6 months. By reviewing the patients' medical records, we constructed a database cataloguing disease recurrence, age, menstruation, pathology, tumor size, nodal status, stage and the presence of hormonal receptor. Statistical analysis was done by SPSS for Windows 9.0. RESULTS: Of the original 374 patients screened, one was excluded for the development of bone metastasis preoperatively. Within the remaining patients, 61 (16.3%) experienced recurrence following surgery. Among the recurred patients, loco-regional recurrence developed in 27 patients (7.5%) and distant metastases in 33 patients (9.1%). The 5 year survival rate was 90.5% in non-recurred patients, 34.9% in locoregionally recurred patients and 30.0% in systematically recurred patients respectively (p=0.00). On the multivariate analysis, tumor size (T stage), lymph node status (N stage) and overall pathologic stage were associated with loco-regional recurrence and the absence of estrogen receptor was associated with distant metastasis following the mastectomy. CONCLUSION: The risk factors for loco-regional recurrence following modified radical mastectomy were tumor size and nodal status. Moreover, distant metastasis was more frequent in patients lacking estrogen receptor. Due to the poor survival rate of the loco-regionally recurred patients, we should regard local recurrence as a poor prognostic sign.
Risk Factors ; Neoplasm Metastasis ; Breast Neoplasms

PURPOSE: We studied the risk factors for loco-regional recurrence and distant metastasis in patients following treatment of operable breast carcinoma with a modified radical mastectomy. METHODS: 374 breast cancer patients were treated by modified radical mastectomy between 1989 and 1999 at the Department of Surgery, Korea University College of Medicine. The median age of the patients was 48.3 years old. The duration of the mean follow up period was 53.6 months. By reviewing the patients' medical records, we constructed a database cataloguing disease recurrence, age, menstruation, pathology, tumor size, nodal status, stage and the presence of hormonal receptor. Statistical analysis was done by SPSS for Windows 9.0. RESULTS: Of the original 374 patients screened, one was excluded for the development of bone metastasis preoperatively. Within the remaining patients, 61 (16.3%) experienced recurrence following surgery. Among the recurred patients, loco-regional recurrence developed in 27 patients (7.5%) and distant metastases in 33 patients (9.1%). The 5 year survival rate was 90.5% in non-recurred patients, 34.9% in loco- regionally recurred patients and 30.0% in systematically recurred patients respectively (p=0.00). On the multivariate analysis, tumor size (T stage), lymph node status (N stage) and overall pathologic stage were associated with loco-re-gional recurrence and the absence of estrogen receptor was associated with distant metastasis following the mastectomy. CONCLUSION: The risk factors for loco-regional recurrence following modified radical mastectomy were tumor size and nodal status. Moreover, distant metastasis was more frequent in patients lacking estrogen receptor. Due to the poor survival rate of the loco-regionally recurred patients, we should regard local recurrence as a poor prognostic sign.
Breast Neoplasms* ; Breast* ; Estrogens ; Female ; Follow-Up Studies ; Humans ; Korea ; Lymph Nodes ; Mastectomy ; Mastectomy, Modified Radical* ; Medical Records ; Menstruation ; Multivariate Analysis ; Neoplasm Metastasis ; Pathology ; Recurrence* ; Risk Factors ; Survival Rate

PURPOSE: We studied the risk factors for loco-regional recurrence and distant metastasis in patients following treatment of operable breast carcinoma with a modified radical mastectomy. METHODS: 374 breast cancer patients were treated by modified radical mastectomy between 1989 and 1999 at the Department of Surgery, Korea University College of Medicine. The median age of the patients was 48.3 years old. The duration of the mean follow up period was 53.6 months. By reviewing the patients' medical records, we constructed a database cataloguing disease recurrence, age, menstruation, pathology, tumor size, nodal status, stage and the presence of hormonal receptor. Statistical analysis was done by SPSS for Windows 9.0. RESULTS: Of the original 374 patients screened, one was excluded for the development of bone metastasis preoperatively. Within the remaining patients, 61 (16.3%) experienced recurrence following surgery. Among the recurred patients, loco-regional recurrence developed in 27 patients (7.5%) and distant metastases in 33 patients (9.1%). The 5 year survival rate was 90.5% in non-recurred patients, 34.9% in loco- regionally recurred patients and 30.0% in systematically recurred patients respectively (p=0.00). On the multivariate analysis, tumor size (T stage), lymph node status (N stage) and overall pathologic stage were associated with loco-re-gional recurrence and the absence of estrogen receptor was associated with distant metastasis following the mastectomy. CONCLUSION: The risk factors for loco-regional recurrence following modified radical mastectomy were tumor size and nodal status. Moreover, distant metastasis was more frequent in patients lacking estrogen receptor. Due to the poor survival rate of the loco-regionally recurred patients, we should regard local recurrence as a poor prognostic sign.
Breast Neoplasms* ; Breast* ; Estrogens ; Female ; Follow-Up Studies ; Humans ; Korea ; Lymph Nodes ; Mastectomy ; Mastectomy, Modified Radical* ; Medical Records ; Menstruation ; Multivariate Analysis ; Neoplasm Metastasis ; Pathology ; Recurrence* ; Risk Factors ; Survival Rate

Eosinophilic gastroenteritis is an uncommon disorder of stomach, small bowel and colon characterized by peripheral blood eosinophilia, eosinophilic infiltration of the gut wall, and variable clinical symptoms. This disease was first described by Kaijser in 1937, and its cause was poorly understood. It may be related to allergy, which combines allergic rhinitis, allergic asthma, atopic dermatitis, food allergy and elevated IgE. The clinical symptoms and signs are variable according to the extents and depths of the eosinophilic infiltration. Endoscopic findings may show normal, nodular, ulcerative, or hemorrhagic mucosal changes, and biopsy findings reveal eosinophilic infiltration of mucosal and muscular layer. We diagnosed and treated a case of diffuse serosal eosinophilic gastroenteritis associated with ascites in a patient with allergic asthma who had severe abdominal pain, distention and watery diarrhea, and she dramatically responded to corticosteroid therapy.
Abdominal Pain ; Ascites* ; Asthma ; Biopsy ; Colon ; Dermatitis, Atopic ; Diarrhea ; Edema* ; Eosinophilia ; Eosinophils* ; Food Hypersensitivity ; Gastroenteritis* ; Humans ; Hypersensitivity ; Immunoglobulin E ; Rhinitis ; Stomach ; Ulcer

BACKGROUND/AIMS: Although early recognition and treatment with effective antibiotics have lead to improvements in the prognosis of patients with spontaneous bacterial peritonitis (SBP), it remains to be a serious complication in cirrhotic patients. This study was designed to evaluate the clinical manifestations and prognosis of patients with liver cirrhosis and SBP in Korea. METHODS: This was a multicenter retrospective study examining 157 episodes of SBP in 145 patients with cirrhosis. SBP was diagnosed based on a polymorphonuclear cell count in ascitic fluid of >250 cells/mm3 in the absence of data compatible with secondary peritonitis. RESULTS: The mean age of the cohort was 56 years, and 121 (77%) of the 157 episodes of SBP occurred in men. Microorganisms were isolated in 66 episodes (42%): Gram-negative bacteria in 54 (81.8%), Gram-positive in 11 (16.7%), and Candida in 1. Isolated Gram-negative organisms were resistant to third-generation cephalosporin in 6 cases (17%), to ciprofloxacin in 11 (20.8%), and to penicillin in 33 (62.3%). The treatment failure and in-hospital mortality rates were 12.1% and 21%, respectively. A high Model of End-Stage Liver Disease (MELD) score, SBP caused by extended-spectrum beta-lactamase-producing organisms, and hepatocellular carcinoma were independent prognostic factors of high in-hospital mortality. CONCLUSIONS: SBP remains to be a serious complication with high in-hospital mortality, especially in patients with a high MELD score.
Anti-Bacterial Agents ; Ascitic Fluid ; Candida ; Carcinoma, Hepatocellular ; Cell Count ; Ciprofloxacin ; Cohort Studies ; Fibrosis ; Gram-Negative Bacteria ; Hospital Mortality ; Humans ; Liver ; Liver Cirrhosis ; Liver Diseases ; Male ; Penicillins ; Peritonitis ; Prognosis ; Retrospective Studies ; Treatment Failure

With recent progress in treatment modalities, mortality from upper gastrointestinal (UGI) bleeding has decreased appreciably. The aim of this study was to establish how UGI bleeds are managed in Korean patients with cirrhosis and to evaluate treatment outcomes. A total of 479 episodes of acute UGI bleeding in 464 patients with cirrhosis were included during a six-month period at nine tertiary medical centers. Treatment outcomes were assessed by failure to control bleeding, rebleeding and mortality. The source of bleeding was esophagogastric varices in 77.7% of patients, nonvariceal lesions in 15.9%, and undefined in 6.5%. For control of bleeding, endoscopic and pharmacologic treatments were used in 74.7% and 81.9% of patients, respectively. Variceal ligation was a major technique for endoscopic treatment (90%), and terlipressin and somatostatin were the main pharmacologic agents used (96.4%). Initial hemostasis was achieved in 86.8% of cases, but rebleeding occurred in 3.8% and 16.8% of cases within five days and six weeks of hemorrhage, respectively. Five-day and six-week mortality were 11.3% and 25.9%, respectively. Survival of patients with variceal bleeding seems to be remarkably improved than previous reports, which may suggest the advances in hemostatic methods for control of variceal hemorrhage..
Adult ; Aged ; Cohort Studies ; Female ; Gastrointestinal Hemorrhage/mortality/*therapy ; Hemostatic Techniques ; Humans ; Infection/epidemiology ; Liver Cirrhosis/*complications ; Lysine Vasopressin/analogs & derivatives/therapeutic use ; Male ; Middle Aged ; Treatment Outcome

We report here a rare case of mesenteric Castleman's disease presenting as a mesenteric mass. A 13-year-old female child was admitted to our hospital complaining of intermittent vague abdominal pain. She had hypochromic anemia, thrombocytosis and an elevated erythrocyte sedimentation rate (ESR). Ultrasonography and computed tomography indicated an intra- abdominal mass might represent a lymphoma or gastrointestinal stromal tumor or leiomyoma, but the definitive preoperative diagnosis couldn't be confirmed. The surgical resection of the mass revealed the mesenteric hyaline vascular- type Castleman's disease.
Adolescent ; Female ; Giant Lymph Node ; Humans ; *Mesentery ; Tomography, X-Ray Computed

BACKGROUND/AIMS: While gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea. METHODS: The data of 1,308 episodes of GVB (males:females=1062:246, age=55.0+/-11.0 years, mean+/-SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated. RESULTS: The initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P<0.001] and the treatment modality: endoscopic variceal ligation, endoscopic variceal obturation, and balloon-occluded retrograde transvenous obliteration vs. endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and balloon tamponade (OR=0.221, P<0.001). Rebleeding developed in 11.5% of the patients, and was significantly associated with Child-Pugh score (OR=1.159, P<0.001) and treatment modality (OR=0.619, P=0.026). The GVB-associated mortality was 10.3%; mortality in these cases was associated with Child-Pugh score (OR=1.795, P<0.001) and the treatment modality for the initial hemostasis (OR=0.467, P=0.001). CONCLUSIONS: The clinical outcome for GVB was better for the present cohort than in previous reports. Initial hemostasis failure, rebleeding, and mortality due to GVB were universally associated with the severity of liver cirrhosis.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Endoscopy ; Esophageal and Gastric Varices/*diagnosis/mortality/therapy ; Female ; *Gastrointestinal Hemorrhage ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prognosis ; Republic of Korea ; Retrospective Studies ; Sclerotherapy ; Severity of Illness Index ; Treatment Outcome ; Young Adult