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

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

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

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: Limited data is available about the relative effects of laser wavelengths when conducting endovenous laser treatment (EVLT) for saphenous vein incompetence. We performed this study to compare the safety and efficacy between EVLT with using an 810 nm and a 1,320 nm laser. METHODS: 147 incompetent saphenous veins in 101 consecutive patients who were treated with EVLT were included in this study. We divided them into two groups: 810 in the nm laser group (Group A: 85 saphenous veins in 52 patients) and 1,320 in the nm laser group (Group B: 62 saphenous veins in 49 patients). The patients were evaluated with Doppler sonography to evaluate the results of the treatment at 1 and 3 months after the procedure. Symptomatic improvement was compared between the groups according to the venous clinical severity score (VCSS), the Averdeen varicose vein symptom severity score (AVSS), the complications, the recurrences and the recanlization rate. RESULTS: There was a statistically significant difference in an average linear endovenous energy density (LEED) between two groups. During the mean follow-up of 139 days in Group A and 116 days in Group B, more complications occurred in Group A (42.3%) than that in Group B (32.7%). The postoperative clinical improvement was similar between the two groups for the VCSS and AVSS. The ultrasonography (USG)-proved recanalizaton rates at postoperative 1 and 3 months were 1.2% and 4.3% in Group A and 1.6% and 1.9% in Group B, respectively. Recurrences occurred in only 2 cases in Group A. CONCLUSION: EVLT with a 1,320 nm laser had a tendency to develop fewer complications, recurrences and USG-proven recanalizations of the saphenous veins. Long-term data from large randomized prospective trials is needed to confirm the safety and efficacy of this operative procedure.
Follow-Up Studies ; Humans ; Recurrence ; Saphenous Vein ; Varicose Veins

Gastrointestinal stromal tumor (GIST) is the most common non-epithelial tumor in the gastrointestinal tract. Although GIST occurs mainly in the gastrointestinal tract, it also occurs, rarely, in non-gastrointestinal tract and in this case, it is often named as extra-gastrointestinal stromal tumor (EGIST). We experienced a 68-year-old male patient who had been diagnosed preoperatively with accidentaloma of the left adrenal gland by computed tomography, and finally diagnosed as primary retroperitoneal malignant GIST, postoperatively. The operation was performed via anterior abdominal approach, and complete surgical resection was done for a 7 cm sized retroperitoneal tumor near the left adrenal gland. Primary retroperitoneal malignant GIST was the final pathologic diagnosis and the size of the tumor was 6.5 cm and the mitotic count was 7 per high-power field. Diffuse strong positive staining for c-kit protein, CD34 and negative staining for desmin were observed in a immunohistochemistry test. We report here the unusual case of primary retroperitoneal malignant GIST mimicking adrenal mass.
Adrenal Glands ; Aged ; Desmin ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Male ; Negative Staining ; Polyenes ; Proto-Oncogene Proteins c-kit

Whereas extramammary Paget's disease commonly occurs in the apocrine gland rich skin areas, ectopic extramammary Paget's disease develops in the skin areas that are devoid of apocrine glands. We experienced the case of a 34 year-old female patient who had a skin lesion in the upper outer quadrant of the right breast for 5 years and that lesion was diagnosed as Paget's disease according to the punch biopsy. There was no other underlying malignancy, and so wide excision was performed. The final pathologic diagnosis was Paget's disease confined to the epidermis and the size of the tumor was 3.0x1.1 cm. Positive staining for cytokeratin 7, epithelial membrane antigen and negative staining for S-100 protein and HMB-45 was observed on the immunohistochemical tests. We report here on an extremely unusual case of ectopic extramammary Paget's disease of the breast skin, and we include a review of the relevant literature.
Apocrine Glands ; Biopsy ; Breast ; Epidermis ; Female ; Humans ; Keratin-7 ; Mucin-1 ; Negative Staining ; Paget Disease, Extramammary ; S100 Proteins ; Skin