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BACKGROUND: Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. METHODS: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. RESULTS: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax (n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complication free probability is significantly higher in group 1 (p = 0.040). CONCLUSIONS: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.
Catheterization ; Catheters ; Follow-Up Studies ; Humans ; Incidence ; Jugular Veins ; Medical Records ; Motor Activity ; Pneumothorax ; Retrospective Studies ; Subclavian Vein ; Vascular Access Devices ; Vena Cava, Superior ; Venous Thrombosis

It is a rare occurrence that cervical cancer and aplastic anemia are combined, but eight cases were reported since Fujiu's report in 1968. There has been no one who have reported the case of like this in Korea. And so, we report this case for the support of idea of treatment in aplastic anemia patient combined with cervical cancer. The knowledges required are early detection of malignancy and the individualization of the treatment according to the status of the patient, the bone marrow function saving procedure and the prevention of the patient from death involved with bleeding and sepsis induced by infection.
Anemia, Aplastic* ; Bone Marrow ; Hemorrhage ; Humans ; Korea ; Sepsis ; Uterine Cervical Neoplasms*

BACKGROUND: Overweight and obesity are associated with increased mortality and morbidity. Obesity is influenced by multiple factors, both genetic and environmental factors. We investigated the relationship between socioeconomic, behavioral, dietary, reproductive factors and body mass index(BMI). METHODS: The subject were 3000 adults who had visited the Health Screening and Diagnosis Center of Yeungnam University School of Medicine from February to June, 1997. We evaluated BMI and occupation, exercise, smoking, alcohol intake, total calory intake, fat and carbohydrate intake in both gender and reproductive factors in women. Then, we analyzed the association between BMI and such variables as above. RESULTS: 1629 men and 1371 women were analyzed. The mean BMI was 23.4+/- 2.8kg/M(2) in men, 22.9+/- 3.1kg/M(2) in women. In both gender, 9.7% of our population had BMl over 27. Mean BMI increased with age. Those who were active and light smokers( 20cigarette/day) had the lowest BMI in men. But no relationship was observed between BMI and exercise, smoking in women. Heavy alcohol drinkers(> 1cup/day) had higher BMI than other group in both gender. We found significant correlation between BMI and total calory intake, calory intake to recommended calory ratio in both gender. In women, the group whose number of parity was above 3 had significantly higher BMI than the other. And age at first birth was significantly correlated with BMI in a negative direction. CONCLUSIONS: Our results showed that BMI was associated with age, smoking, alcohol, total calory intake, calory intake to recommended calory ratio, parity, age at first birth. Socioeconomic class, exercise and diet composition appeared to have little influence.
Adult* ; Birth Order ; Body Mass Index* ; Diagnosis ; Diet ; Female ; Humans ; Male ; Mass Screening ; Mortality ; Obesity ; Occupations ; Overweight ; Parity ; Smoke ; Smoking ; Social Class

OBJECTIVE: Concurrent chemoradiotherapy is the idea where the chemotherapeutic agent acts as a radiosensitizer thus producing a synergistic effect between radiotherapy and chemotherapy. We evaluated the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) in loco-regionally advanced cervical cancer patients. METHODS: The medical records were retrospectively reviewed for 24 patients who underwent CCRT (cisplatin 70 mg/m2 on day 1, 29; 5-FU: 1000 mg/m2 on day 2-5 and 30-33 X 4 cycles), 26 patients who underwent weekly CCRT (cisplatin: 40 mg/m2 X 6 weeks) and 62 patients who had underwent radiation therapy alone for loco-regionally advanced cervical cancer at Ajou University Hospital. Toxicity was assessed according to the Gynecologic Oncology Group toxicity criteria. Statistical analysis was performed with chi- squre test. RESULTS: 2 year overall survival rate of patients only treated with RT was 75.0% (39/52). When this was compaired to CCRT, 83.3% (20/24) with monthly CCRT and 88.5% (23/26) with weekly CCRT of 2 year overall survival rates were attained. Recurrence rates were measured 2 years after each therapy done, they were 30.8% (16/52) with RT, 25.0% (6/24) with weekly CCRT, and 23.1% (6/26) monthly CCRT. During CCRT, grade 3 and 4 acute complication rates of nausea/vomiting (20.8% vs. 3.8%) and leukocytopenia (29.1% vs. 15.4%) was significantly higher in monthly group compared to weekly group (p<0.05). Weekly group had more patients who completed planned therapy compaired to monthly group (70.9% vs. 84.6%). CONCLUSION: CCRT improved overall survival rates and disease-free survival rate, but in some cases increased acute toxicity, and it is suggested that CCRT may be advantageous compared to radiation therapy for loco-regionally advanced cervical cancer. Weekly CCRT does not seem to afford distinct advantages in terms of acute toxicities over monthly CCRT, except for possible better patient compliance. Due to small size sample and short duration of follow up, further study of a large group of patients and the long survival rate is necessary.
Chemoradiotherapy* ; Disease-Free Survival ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Leukopenia ; Medical Records ; Patient Compliance ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms*

PURPOSE: To assess the usefulness of Gd-DTPA MRI in the evaluation of the characteristics of intracranial meningiomas and in the correlation with their histopathologic pattern. MATERIALS AND METHODS: We retrospectively analyzed the Gd-DTPA MRI findings in 22 cases of histologicalty-proven intracranial meningiomas. The images were assessed for signal intensity, internal texture, peritumoral edema, and enhancement characteristics. Computed tomograms were obtained in 18 cases and compared with MRI findings. RESULTS: Tl-weighted images were not particularly useful for discriminating pathologic subtype, but signal intensity on T2-weighted images were relatively well correlated with histopathologic findings. A heterogeneous texture produced by tumor vascularity, calcification, cystic foci, hemorrhagic necrosis, or psammoma body was relatively well shown on Gd-DTPA Tl-weighted image compared with that on T1- or T2-weighted image. Gd-DTPA Tl-weighted images revealed a dural tail sign in 19 cases(83%). Angioblastic type was slightly hypointense on Tl-weighted image and markedly hyperintense on T2-weighted image. Psammomatous type and firboblastic type were isointense on both T1- and T2-weighted image. Fibroblastic type was more densely enhanced than the other. The transitional, atypical, and papillary types showed tendency of heterogeneous enhancement. CONCLUSION: Gd-DTPA MRI was a useful imaging modality in evaluation of the characteristics of meningiomas and correlated well with the pathologic patterns.
Edema ; Fibroblasts ; Gadolinium DTPA* ; Magnetic Resonance Imaging* ; Meningioma ; Necrosis ; Retrospective Studies

PURPOSE: Laparoscopic cholecystectomy (LC) for treating acute cholecystitis (AC) is a technically demanding procedure even for experienced surgeons. The purpose of this study is to evaluate the clinical usefulness of the methods of gallbladder bed dissection for patients with acute cholecystitis. METHODS: We reviewed the medical records of 74 patients who were admitted for AC and they underwent early LC with ultrasonic shears dissection (UD) (n=40) or monopolar electrocautery dissection (MD) (n=34) at Kangnam Sacred Heart Hospital from August 2006 to December 2008. We compared many variables between the two methods. RESULTS: The mean operative time in the LC group with UD was 48.3 minutes versus 42.8 minutes for the MD group (p=0.163). The conversion rate was 5.0%, and the postoperative morbidity rate was 12.5% in the UD group, versus an 8.8% conversion rate and an 8.8% morbidity rate in the MD group (p=0.426 and 0.254). CONCLUSION: The use of UD in the dissection of the gallbladder bed has no specific advantage over MD for treating patients with acute cholecystitis, but further investigations are required to confirm this.
Cholecystectomy, Laparoscopic ; Cholecystitis, Acute ; Electrocoagulation ; Gallbladder ; Heart ; Humans ; Imidazoles ; Medical Records ; Nitro Compounds ; Operative Time ; Ultrasonics

A cholecystocolic fistula (CF) is an uncommon complication of the gallbladder and colonic disease. We report a case of a CF that was successfully managed by using a laparoscopic right hemicolectomy and cholecystectomy. A 49-yr-old woman was admitted to the Department of Internal Medicine because of intermittent and progressive right upper quadrant pain. She was obese (body mass index: 34 kg/m2) and had a previous history of three abdominal surgeries. She was diagnosed with a CF by using abdominal computed tomography. The fistula between the gallbladder and the hepatic flexure of the colon was also characterized by using technetium-99m diisopropyl iminodiacetic acid ((99m)Tc-DISIDA) cholescintigraphy, a double-contrast Barium enema, and colonoscopy. Multiple polyps with severe inflammation were observed around the orifice of the fistula. Because of the risk of malignancy and appendicolith on CT, a laparoscopic en block excision of the gallbladder and the right colon following adhesiolysis was performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. This case shows that the laparoscopic combined resection is safe and effective in the experienced hands of the laparoscopic surgeon even though a CF has traditionally been considered as a contraindication to laparoscopic surgery. While the incidence of successful management of biliary-enteric fistulas through laparoscopic repair is increasing, this is the first report of a laparoscopic combined resection of a CF in an obese patient with severe intraabdominal adhesion.
Barium ; Biliary Fistula ; Cholecystectomy ; Colectomy ; Colon ; Colonic Diseases ; Colonoscopy ; Enema ; Female ; Fistula ; Gallbladder ; Hand ; Humans ; Imino Acids ; Incidence ; Inflammation ; Internal Medicine ; Intestinal Fistula ; Laparoscopy ; Polyps

Prune-belly syndrome is a rare compound fetal anomaly, characterized by absence or hypoplasia of abdominal wall musculature associated with urinary tract abnormalities and cryptorchidism. The prenatal ultrasound diagnosis was based on the findings of a lower abdominal cystic echo caused by abnormal dilatation of the bladder, upward compression of small intestines and decreased amniotic fluid volume. We experienced a case of Prune-belly syndrome diagnosed by ultrasound in a 12 weeks fetus following to IVF-ET pregnancy. Termination was performed at 12 weeks and autopsy confirmed the distended bladder, absence of abdominal muscles and urethra. So, we reported this case with a brief review of literature.
Abdominal Muscles ; Abdominal Wall ; Amniotic Fluid ; Autopsy ; Cryptorchidism ; Diagnosis ; Dilatation ; Female ; Fetus ; Intestine, Small ; Male ; Pregnancy ; Prenatal Diagnosis ; Prune Belly Syndrome* ; Ultrasonography* ; Urethra ; Urinary Bladder ; Urinary Tract

BACKGROUND: Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. METHODS: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. RESULTS: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax (n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complication free probability is significantly higher in group 1 (p = 0.040). CONCLUSIONS: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.
Catheterization ; Catheters ; Follow-Up Studies ; Humans ; Incidence ; Jugular Veins ; Medical Records ; Motor Activity ; Pneumothorax ; Retrospective Studies ; Subclavian Vein ; Vascular Access Devices ; Vena Cava, Superior ; Venous Thrombosis