PURPOSE: This prospective study was performed to evaluate the usefulness of preoperative radioimmu-noscintigraphy and intraoperative scintimetric examination (radioimmunoguided surgery: RIGS) using (99m)Tc-anti-CEA F(ab')(2), fragment. MATERIALS AND METHODS: Nineteen patients with rectal cancer underwent preoperative whole body planar scintigraphy at 4 hours after injection of (99m)Tc-anti-CEA F(ab')(2), fragment and SPECT imaging at 18 hours. Surgical operation was performed at 24 hours after injection. During laparotomy, radioactivities from intraabdominal viscera were measured by gamma probe. The radioac-tivities from excised tumor and lymph nodes were also measured and compared with pathology. RESULTS: All nineteen patients were confirmed to have adenocarcinomas in the rectum. Twenty-seven of 97 excised lymph node groups had metastasis and 2 patients had liver metastasis in pathology. Preoperative radioim- munoscintigraphy detected primary tumors in 11 patients (sensitivity 55%) and it couId not detect any lymph nodes or liver metastasis. All patients showed high radioactivity in the kidneys, liver, spleen, and major vessels in intraoperative measurement by gamma probe, and tumor activity was not discriminated from background activity. However, ra4ioactivity from excised tumor was higher than normal rectum (T/B ratio; 3.47+/-2.25). When excised lymph node activity/background activity ratio > 1,5 was considered as positive criteria of metastasis, sensitivity, specificity, positive and negative predictive values were 78.6%, 73.9%, 55.0% and 89.5%, respectively. CONCLUSION: Radioimmunoscintigraphy using (99m)Tc-anti-CEA F(ab')(2). has no additional value for preoperative staging and use of early RIGS using (99m)Tc-anti-CEA F(ab')(2)is inappropriate. For early RIGS using (99m)Tc labeled antibodies in rectal cancer patients, further development of more specific antibodies and methods to reduce background activity are needed.
Adenocarcinoma ; Antibodies ; Humans ; Kidney ; Laparotomy ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Pathology ; Pilot Projects* ; Prospective Studies ; Radioactivity ; Radioimmunodetection* ; Radionuclide Imaging ; Rectal Neoplasms* ; Rectum ; Sensitivity and Specificity ; Spleen ; Tomography, Emission-Computed, Single-Photon ; Viscera

BACKGROUND: Diclofenac is a nonsteroidal anti-inflammatory drug widely used as adjuvants for postoperative pain management with opioid sparing effect. The effect of diclofenac on postoperative opioid analgesia of morphine and meperidine was evaluated in 180 women after cesarean section. METHODS: One hundred eighty parturients were randomly allocated to four groups and each group had 45 women. The parturients were given loading dose of morphine in M group and meperidine in D group using intravenous patient controlled analgesia (PCA) device for up to 48 hours when the parturients awoke and complained abdominal pain. The parturients received diclofenac 75 mg every 12 hours intramuscularly followed by loading dose of morphine in MV group and meperidine in DV group. We evaluated the postoperative opioid requirement, numerical rating pain score, delivery/demand ratio, patient's satisfaction and side effects including respiratory depression, itching, nausea, urinary retention and dizziness. RESULTS: Diclofenac decreased over 40% of morphine or meperidine requirement and also pain score at 1, 2, 3, 6, 12, 24 and 48 hours in the use of PCA morphine and at 6, 12 and 24 hours in the use of PCA meperidine. And the incidence of sedation and itching decreased in MV and DV group. CONCLUSION: We concluded that diclofenac as adjuvant of opioid for postoperative pain after cesarean section could decrease requirement of morphine and meperidine, increase pain relief and decrease sedation and itching.
Abdominal Pain ; Analgesia ; Analgesia, Patient-Controlled ; Cesarean Section* ; Diclofenac* ; Dizziness ; Female ; Humans ; Incidence ; Meperidine* ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis* ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Urinary Retention

Carcinoma, Squamous Cell ; Cell Cycle ; Classification ; Cyclin D1 ; Cyclins ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Lymph Nodes ; Molecular Biology ; Mouth Neoplasms ; Neck ; Oncogenes ; Prognosis

"Pseudomyxoma peritonei is a clinical entity in which the peritoneal surface and omentum are involved with gelatinous, mucinous implants, and often massive gelatinous ascites. Most cases originate from ruptured ovarian mucinous cysts or appendiceal mucoceles, and involve only the intraperitoneal cavity. But there is much confusion about its etiology, clinical manifestation, treatment, and prognosis. We experienced a case of pseudomyxoma peritonei originating from the mucinous cystic tumor of borderline malignancy in unilateral ovary with rupture. A case of pseudomyxoma peritonei is reported with a brief review of the literature."
Female ; Gelatin ; Mucins ; Mucocele ; Omentum ; Ovary ; Prognosis ; Pseudomyxoma Peritonei* ; Rupture

PURPOSE: The incidence of papillary thyroid carcinoma (PTC) arising from the isthmus is low; however, these tumors have aggressive clinical and pathological features. Moreover, the existing guidelines regarding the extent of surgery for this type of tumor are unclear. METHODS: This study enrolled 282 patients who underwent total thyroidectomy with bilateral central lymph node dissection. The patients were divided into 2 groups based on the location of the median line of the PTC. Group I included patients in whom the median line was located between the lateral margins of the trachea; group II included all others. We compared the 2 groups and conducted a multivariate analysis to assess risk factors for contralateral node metastasis from a PTC arising from the isthmus. RESULTS: Patients in group I had significantly higher frequencies of extrathyroidal extension and central lymph node metastasis. Group I also had a higher frequency of contralateral node metastasis, and a tumor size >1.0 cm was identified as an independent risk factor for contralateral node metastasis among patients in this group. CONCLUSION: Bilateral central lymph node dissection could be considered for patients with isthmic PTCs >1.0 cm in size who have clinically suspicious node metastasis.
Humans ; Incidence ; Lymph Node Excision* ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Trachea

BACKGROUND: Compared with common well-differentiated thyroid carcinomas, the genetic alterations underlying the development and progression of anaplastic thyroid carcinomas(ATC) are still uncharacterized. Comparative genomic hybridization(CGH) is a cytogenetic technique that can identify gains and losses in the DNA sequence copy number in tumors. METHODS: The authors studied the changes in the DNA copy number due to CGH in paraffin-embedded tissue blocks of 17 ATC cases, and tried to ascertain whether the genomic changes correlate with the clinicopathological parameters including patients' age, sex, primary tumor size, lymphovascular invasion, extrathyroid extension, regional node metastasis and immunohistochemical expression of cyclin D1. RESULTS: Fourteen of the 17 samples(82.4%) showed chromosomal changes, with a mean number of gains or losses per carcinoma of 3.6(range 2~6; 30 gains and 21 losses). The most frequently detected imbalance was the gain of chromosome 1q, which was seen in 35.7% of cases, particularly commonly in ATC associated with a papillary thyroid carcinoma. Other commonly occurring gains were present in 11q13 and 19(28.6%, respectively). Genomic amplification was detected in all four cases showing the 11q13 gain. Genomic losses were commonly noted in 3q, 6q, 18q andchi(21.4%, respectively). When numerical CGH alterations were compared to the clinicopathological parameters, there were no significant correlations(P>0.05). Cyclin D1 expression was noted in sixteen of the 17 cases(94.1%), but the extent of cyclin D1 expression was not correlated with the numerical CGH alterations(P>0.05). CONCLUSION: Taken together, the aberrations of 1q, 3q, 6q, 11q13 and 18q are relatively common in ATC, and may play an important role it developement. These findings should lead to the characterization of tumor suppressor genes and oncogenes that are potentially involved in the carcinogenesis of ATC. The amplification of 11q13 is characteristically found, but cyclin D1 in this region may be innocent of the aggressiveness of these carcinomas.
Base Sequence ; Carcinogenesis ; Comparative Genomic Hybridization* ; Cyclin D1 ; Cytogenetic Analysis ; DNA ; Genes, Tumor Suppressor ; Neoplasm Metastasis ; Oncogenes ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: It has been reported that in 62.5% of cases of incurable cancer pain, the complaint is due to myofascial pain syndrome. Trigger point injections using dibucaine hydrochloride help patients with such cancer pain. This study evaluated the efficacy of trigger point injections for alleviating pain in patients with advanced cancer. METHODS: Twenty patients with advanced cancer who had a life expectancy of 6 months or less and had been diagnosed with myofascial pain syndrome were treated with trigger point injections. Prior to treatment, a Visual Analog Scale (VAS) was used to measure the resting pain level and discomfort upon application of pressure on the site of pain. These values were compared with last treatment measurements. RESULTS: The mean pre-treatment VAS scores for pain at rest and upon application of pressure on the pain site were 7.3 and 9.0, respectively. These scores decreased significantly to 1.95 and 3.2, respectively, after the treatment (P<0.05). CONCLUSION: Trigger point injection is an alternative and effective pain control modality for advanced cancer patients with myofascial pain syndrome.
Dibucaine ; Humans ; Life Expectancy ; Myofascial Pain Syndromes ; Trigger Points ; Visual Analog Scale

Serous cystic neoplasm (SCN) of the pancreas is considered a benign tumor with almost no malignant potential. Most surgeons agree that asymptomatic SCN requires only regular observation. However, several complexities and interference with organ preservation during the operation, may develop when a huge symptomatic tumor is treated with surgery. So, the purpose of this study is to develop a potential management plan based on a literature review and by describing three recent cases of SCN of the pancreas. We suggest that SCNs be responded to with a timely and appropriate surgical intervention - before they require clinical attention.
Cystadenoma, Serous ; Organ Preservation ; Pancreas

BACKGROUND: Periampullary diverticulum has been commonly discovered during endoscopic retrograde cholangiopancreatography(ERCP) in patients with various pancreaticobiliary diseases such as cholelithiasis and its clinical significance has been noted. Recently, periampullary diverticulum is known to be associated with choledocholithiasis, various pancreatobiliary diseases and intestinal symptoms. Our aims of study was to investigate characteristics of periampullary diverticulum and to determinate the positive relationship between periampullary diverticulum and choledocholithiasis, and to determinate whether periampullary diverticulum influences on the cannulation rate and complication performing ERCP and endoscopic sphincterotomy(EST). METHODS: We reviewed 162 of 594 cases, which had periampullary diverticulums on ERCP during the past 6 years, and investigated size, location and number of periampullary diverticulums with special reference to the location of cholelithiasis. We also compared success rate and complication rate of ERCP and EST in cases with or without periamullary diverticulum. RESULTS: The incidence of periampullary diverticulum was 27.3%(male 48.1%, female 51.9%). and increased after 50 years old. In anatomical characteriastics of periampullary diverticulum, most of the diverticulum was single(90.1%). Size was usually smaller than 1cm(48.8%) and was seperated from ampulla of Vater, type III(59.2%). Choledocholithiasis was more frequently found in patients with periampullary diverticulum(58.9%) than in patients without diverticulum(43.1), especially in type II(attatching type). Failure rate of ERCP was 14.8% with periampullary diverticulum and was 14.6% without it. Bleeding, one of serious complications of EST, was noted in 4 patients with periampullary diverticulum, and one patient was operated to control the bleeding. CONCLUSIONS: Periampullary diverticulum might be related with choledocholithiasis, but usually does not interfere with procedure of ERCP.
Ampulla of Vater ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Cholelithiasis ; Diverticulum* ; Female ; Hemorrhage ; Humans ; Incidence ; Middle Aged

The purpose of study was to determine the incidence of hip fracture in 2001, to compare this with that of 1991, and to identify possible causes of change. Patients aged 50 yr or more living in Gwangju City and Chonnam Province, Korea, and who sustained a fracture of the hip during 2001 were investigated. Only patients who were admitted to hospitals for primary treatment of the first hip fracture were selected. There were 1,152 patients. A comparison of fracture incidences for 1991 and 2001 showed considerable increase during the 10-yr period. The total annual number of hip fractures rose from 247 in 1991 to 1,152 in 2001 and the fracture incidence also increased remarkably from 3.3 persons per 10,000 population in 1991 to 13.3 in 2001, representing a 4-fold increase over 10-yr. The reasons for this rising trend of hip fracture were not fully explained. However, an increase in the elderly population, an increase in osteoporosis, and an increase in injurious falls could partly account for the observed increase.
Age Distribution ; Aged ; Aged, 80 and over ; Comparative Study ; Female ; Hip Fractures/*epidemiology ; Humans ; Incidence ; Korea/epidemiology ; Male ; Middle Aged ; Sex Distribution