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

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

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

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: 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

Bronchogenic cyst arises from anomalous budding of the primitive foregut during embryonic development and it represents a part of the spectrum of bronchopulmonary foregut malformations. Approximately two-thirds of the malformations are found within the mediastinum, and one-third are found in the lung parenchyma. The prevalence of bronchogenic cyst is unknown, presumably because most patients are asymptomatic. Incidentally detected bronchogenic cysts are usually removed at the time of diagnosis. We do not know how and why bronchogenic cysts grow. We recently experienced a case of rapidly growing mediastinal mass in a young adult, and this presented as a huge mass that had newly developed within one year. This mass was pathologically confirmed to be a bronchogenic cyst. We report on this case of a rapidly growing bronchogenic cyst, which is a rare characteristic of this type of cyst.
Bronchogenic Cyst ; Embryonic Development ; Female ; Humans ; Lung ; Mediastinum ; Pregnancy ; Prevalence ; Young Adult

PURPOSE: This comparative study analyzed the relationship between the preoperative diagnostic tumor size and the postoperative pathologic tumor size for breast cancer patients and benign breast tumor patients. METHODS: We analyzed the clinicopathological information of 191 breast cancer patients and 187 benign breast tumor patients by conducting a retrospective chart review. The preoperative diagnostic tumor sizes were measured using physical examination, mammography and sonography in the benign breast tumor patients and they were additionally measured by computerized tomography and magnetic resonance imaging in the breast cancer patients. Body mass index (BMI) was defined as the ratio of the body weight in kilograms to the square of height in meters. RESULTS: The tumor sizes measured by mammography (r=0.66) and physical examination (r=0.87) were highly correlated to the pathologic tumor size in the breast cancer patients and benign the breast tumor patients, respectively. Physical examination and magnetic resonance imaging had a tendency to overestimate the tumor size and sonography underestimated the pathologic tumor size in the breast cancer patients. The correlation coefficient for the physical examination was increased when the patient age was less than 50 years and the BMI was less than 25. Multiple regression analysis revealed that assessing the tumor size according to physical examination, mammography and sonography were effective for determining estimation of pathologic tumor size in the benign breast tumor patients, but assessing the tumor size by physical examination and sonography was not effective for determining the tumor size in breast cancer patients. CONCLUSION: Mammography and physical examination can be useful to estimate the pathologic tumor size in breast cancer patients and benign breast tumor patients, respectively. Physical examination can be useful to estimate the size when a breast tumor is palpable, the age of a patient is less than 50, and the BMI is less than 25.
Body Mass Index ; Body Weight ; Breast ; Breast Neoplasms ; Humans ; Magnetic Resonance Imaging ; Mammography ; Physical Examination ; Retrospective Studies ; Tumor Burden