No abstract available.
Neuroectodermal Tumor, Melanotic

To evaluate the effects of the preoperative chemoradiation therapy(CRT) for rectal cancer. 31 rectal cancer patients received preoperative CRT. A total 3060cGy of radiation was given in 3 weeks, 180cGy for a fraction. 425mg/m2/day of 5-FU and 20mg/m2/day of leucovorin were continuously infused in the first 5 days of the preoperative radiation therapy. A IV injection of Mitomycin C 10mg/m2 was given on the first day. A digital rectal examination, endoscopy with biopsy, barium enema, chest X-ray, hepatobiliary ultrasonography & IV bolus CT were done before and after CRT. Clinically, 19 patients(61.3%) and pathologically, 16 patients(51.6%) showed reduced tumor size. In 7 patients (22.6%), there was no residual tumor in the pathologic specimen. Digital rectal examination was possible in 23 patients. 16(69.5%) of them had a decrease in height of ulcer margin on digital rectal examination. Seven of the fifteen patients showed decreased perirectal fat tissue infiltration. There was no severe toxicity which might delay the curative surgery. In conclusion, preoperative chemoradiation therapy in rectal cancer was very effective in reducing tumor size and perirectal fat tissue infiltration without considerable toxicity.
Barium ; Biopsy ; Digital Rectal Examination ; Endoscopy ; Enema ; Fluorouracil ; Humans ; Leucovorin ; Mitomycin ; Neoplasm, Residual ; Rectal Neoplasms ; Thorax ; Ulcer ; Ultrasonography

The ultimate goal of periodontal therapy is directed to arresting the progression of the disease, and regenerating the fibrous attachment. In order to achieve such treatment aim, the plaque and calculus must be eliminated and the physiological conditions of the root surface must be changed to facilitate the attachment and migration of the new fibroblasts, The method of changing the proper root surface conditions to promote the healing of periodontal tissue involves mechanical procedures, such as scaling and root planing, and chemical procedures such as tetracycline-HCl. However, the formation of a long junctional epithelium was most frequently observed type of healing. Thus, the aim of this study was to examine in vitro the influence of surface conditioning of dentin by TC-HCl on human gingival epithelial cell attachment. Human gingival epithelial cells were obtained from healthy retromolar pad area(under the age 23 years). Seventy two teeth extracted from severe periodontitis were used as study material. To evaluate the epithelial cell attachment to dentin, the prepared specimen was divided to four groups. For the control group, only scaling and root planing were carried out, and for the test group, 1 to 3, the concentration of the TC-HCl was 50, 125 and 250mg/ml, respectively. After cell cultivation time of 1-, 3-. 24 hour, for the indirect quantitative assessment of gingival epithelial cell attached to dentin sample, the absorbance of epithelial cell unattached to dentin was measured. The results were as follows; 1. There was no statistically significant difference between scaling and root planing group and TC-HCl 50mg/ ml, 125mg/ml and 250mg/ml group about absorbance of unattached epithelial cell to dentin sample(p>0.5). 2. As time passes, the absorbance of unattached gingival epithelial cell to dentin sample was decreased statistically significant(p<0.05). 3. There was no statistically significant difference among the TC-HCl group(p>0.05) We concluded that there was similar effect on gingival epithelial cell attachment between TC-HCl conditioning on root surface and only scaling and root planing treatment
Calculi ; Dentin ; Epithelial Attachment ; Epithelial Cells* ; Fibroblasts ; Humans ; Periodontitis ; Root Planing ; Tooth

Obturator hernia is a rare type of pelvic hernia and occurs most commonly in elderly and debilitated women. It is still a challenge for surgeons to diagnose precisely in early stages because of its nonspecific symptoms and consequently delayed diagnosis could lead to high morbidity and mortality. We experienced a 92-year old patient who was diagnosed as obturator hernia which was confirmed by computed tomography scan of the abdomen and pelvis. The operation was delayed due to the refusal of family members but eventually done after 12 days from initial diagnosis. After manual reduction of small bowel impacted into right obturator foramen, segmental resection of impacted small bowel and anastomosis was done. The hernial defect was closed by primary closure with Dexon suture material. After the operation, the patient was discharged without significant complications. We report here successful results of delayed operation for obturator hernia.
Abdomen ; Aged ; Benzenesulfonates ; Delayed Diagnosis ; Disulfiram ; Female ; Hernia ; Hernia, Obturator ; Humans ; Pelvis ; Sutures

PURPOSE: To evaluate the usefulness of preoperative MRI in the patient with recurrent anorectal fistula. MATERIALS AND METHODS: Fourteen patients with recurrent anorectal fistula underwent non-contrast MRI. In eight patients, T1-, T2- and proton-weighted images were taken in the axial, coronal and sagittal planes, and T1- andT2-weighted images taken in the axial and coronal planes were obtained from the other six. RESULTS: Fourteen cases of anorectal fistula and eight cases in which there was a combined abscess were detected. Preoperative MRI clearly showed the exact anatomical relationship with the anal sphincter, levator ani and surrounding soft tissue. In two cases in which there was fibrous scarring of the fistula tract, low signal intensities were seen on all MRI sequences. Preoperative information in the group in which only axial and coronal T1- and T2-weighted images were obtained was sufficient. CONCLUSION: Preoperative MRI in patients with recurrent anorectal fistula or suspected multiple fistulous tracts provide objective information concerning the anatomical location and extension of a fistula and combined abscess and could thus reduce the reoperation rate. An understanding of pathologic state through MRI signal intensity can help decide the most appropriate course of treatment.
Abscess ; Anal Canal ; Cicatrix ; Fistula* ; Humans ; Magnetic Resonance Imaging* ; Reoperation

PURPOSE: We wanted to evaluate the feasibility of using the suction pancreatic duct stent, which was designed to aspirate pancreatic fluid more actively around the pancreaticojejnostomy site during performance of pancreaticoduodenectomy for preventing pancreatic fistula. METHODS: In 7 consecutive pancreaticoduodenectomy patients, we inserted a PVC tube into the remnant pancreatic duct across the duct-to-mucosa type pancreaticojejunostomy at a 2 cm depth as a totally external pancreatic stent. This stent was connected with the aspiration bag of a Jackson- Pratt drain for generating negative pressure. We inserted another Jackson-Pratt drain beneath the pancreaticojejunosomy site and checked the amylase level in the body fluid and the serum at the postoperative 1st and 5th days for evaluating pancreatic leakage. We also checked the daily amount of pancreatic fluid obtained through the suction stent. Pancreatic fistula was defined as an amylase level in the body fluid >10,000 U/L on postoperative 1 day or an amylase level in the body fluid >3 times the serum amylase level on the postoperative 5th day. RESULTS: On postoperative day 1, the mean level of intraabdominal fluid amylase was 1,404 U/L (355~3,850 U/L). On the postoperative 5th day, the mean level of amylase in the body fluid was 40.3 U/L (12~144 U/L) and the mean level of serum amylase was 38.3 U/L (19~71 U/L). Even on the postoperative 1st day, we could collect a considerable amount of pancreatic fluid (mean: 55.6 ml (range: 9~169 ml)). There was no complication associated with pancreatic leakage. CONCLUSION: The suction pancreatic stent can be a feasible method to prevent pancreatic leakage. Additional randomized studies to compare the conventional pancreatic duct stent with the suction pancreatic duct stent are mandatory.
Amylases ; Body Fluids ; Humans ; Pancreatic Ducts ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Stents* ; Suction*

Primary omental tumors are rare, with most being metastatic, especially those from intra-abdominal organs. Breast and lung malignancies, as well as melanomas, are frequent causes of extra-abdominal cancers metastasizing to the omentum, peritoneum and mesentery. The case of a metastatic omental melanoma from the choroid of the eye was experienced, which formed a solitary mass in the omentum similar to that of a primary omental tumor. The patient was unaware of the nature of her eye disease following enucleation seven years previously. Concomitant liver metastases were also not identified on a CT scan, due to their relatively small sizes. Therefore, the metastatic melanoma was misconceived as a primary omental tumor until laparotomy and pathologic confirmation. This case shows that a metastatic melanoma can be presented as an abdominal mass, and should be considered in the differential diagnosis of an intra-abdominal mass.
Breast ; Choroid* ; Diagnosis, Differential ; Eye Diseases ; Humans ; Laparotomy ; Liver ; Lung ; Melanoma* ; Mesentery ; Neoplasm Metastasis ; Omentum ; Peritoneum ; Tomography, X-Ray Computed

Although acute appendicitis is one of the most common surgical diseases, very rare but serious complications can occur including retroperitoneal abscess complicated by acute appendicitis. The early diagnosis of retroperitoneal abscess is often difficult and delayed because its clinical course is often insidious and does not present with typical symptoms of acute appendicitis. We experienced a 65-year-old male patient who was diagnosed with acute appendicitis with retroperitoneal abscess. As the retroperitoneal abscess was not fully removed via emergency operation, postoperative percutaneous drainage was performed but not effective. Retroperitoneal abscess can be cured by 2nd operation with retroperitoneal approach. We report here an unusual case of retroperitoneal abscess complicated by acute appendicitis.
Abscess ; Aged ; Appendicitis ; Drainage ; Early Diagnosis ; Emergencies ; Humans ; Male

PURPOSE: The POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score was developed to predict post-operative mortality and morbidity rates. The aim of this study was to validate the POSSUM physiologic score (POSSUM-P) in emergent operations for peptic ulcer complications. METHODS: We retrospectively collected data on patients who underwent emergent operation for peptic ulcer complications at Boramae Hospital between January 2003 and April 2009. The data included patients' characteristics (underlying disease, medication, duration of symptoms), operative characteristics (operation method, morbidity, and mortality) and the items for the POSSUM-P (basic information (age, sex, etc.), circulatory and respiratory signs, electrocardiogram, blood pressure, hemoglobin, white blood cell count, potassium level, sodium level, urea level and Glasgow coma scale). The POSSUM-P was calculated and compared according to the morbidity and mortality. RESULTS: One hundred and twelve patients were included. As for operation methods, primary repair (48.2%) was most common, followed by truncal vagotomy with pyloroplasty (27.7%). Thirty-seven patients had morbidities including wound infections (20), pneumonias (14), fluid collections (9), and so on. Eight patients died due to sepsis or pulmonary edema. The means of POSSUM-P were significantly different between patients with and without mortality (37.8 vs. 19.2, P<0.001) and between patients with and without morbidity (26.7 vs. 17.3, P<0.001). Those were different between patients with and without postoperative pneumonia and wound infection (P=0.002 and P=0.029, respectively). CONCLUSION: The POSSUM physiologic score could help to predict the mortality or morbidity after emergency operation for complications of peptic ulcer disease, especially postoperative pneumonia or wound infection.
Blood Pressure ; Coma ; Electrocardiography ; Emergencies ; Hemoglobins ; Humans ; Leukocyte Count ; Peptic Ulcer ; Pneumonia ; Potassium ; Pulmonary Edema ; Retrospective Studies ; Sepsis ; Sodium ; Urea ; Vagotomy, Truncal ; Wound Infection

PURPOSE: While pediatric observation units (POU) have become a common practice in hospitals throughout developed countries, there has been no report about POUs in Korea so far. The aims of this study were to analyze our one-year's experience of the POU and to decide which disease entities are suitable for the POU. METHODS: All children admitted from March 2006 to February 2007 to the POU at the Department of Pediatrics in Our Lady of Mercy Hospital were included in this study. Data were collected from retrospective reviews of their medical records. RESULTS: There were a total of 1,076 POU admissions. Median age of patients was 2.4 years and median length of hospital stay 14.0 hours. The most common diagnoses were gastroenteritis (42.7%), pharyngotonsillitis (19.1%), bronchiolitis (7.8%), pneumonia (5.5%) and febrile seizure (5.2%). Overall, 7.5% of the POU patients required subsequent inpatient admissions due to hospital stays of longer than 48 hours. The disease entities that were most likely to require inpatient admission were pneumonia (17.0%), febrile seizure (12.5%) and asthma (11.5%). Diseases that allowed successful discharge from the POU were gastroenteritis (4.6%), upper respiratory tract infection (5.8%), such as otitis media and pharygnotonsillitis and seizure disorder (6.4%). Compared with the previous year when the POU was not in operation, there was a statistically significant reduction in the average length of hospital stays (from 4.69 to 3.75 days), as well as a rise in the bed turnover rate (from 78.8 to 98.2 patients/ bed). CONCLUSION: Our study shows that the POU is efficient for the management of children with certain acute illnesses. Based on this study, we suggest that the POU be used as a new modality which links between the outpatient, inpatient, and emergency departments in the field of pediatrics in Korea.
Asthma ; Bronchiolitis ; Child ; Day Care, Medical ; Developed Countries ; Diagnosis ; Emergency Service, Hospital ; Epilepsy ; Gastroenteritis ; Humans ; Inpatients ; Korea* ; Length of Stay ; Medical Records ; Otitis Media ; Outpatients ; Pediatrics ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies ; Seizures, Febrile