Between May 1990, and June 1994, 79 patients with malignant tumors were treated radiosurgically using a Leksell gamma unit at Asan Medical Center. Of these patients, 57 were metastatic brain tumor, 12 were glioblastoma multiforme (GM), 4 were primitive neuroectodermal tumor, 3 were malignant germ cell tumor, 2 were recurrent lymphoma, and 1 was adenoid cystic carcinoma of the orbit. Among 57 patients with metastatic tumors, 28 patients harboring 60 tumors were followed clinically and radiographically. The median marginal dose for these tumors was 30 Gy and the median survival rate was 15 months. Twenty-one tumors disappeared and 32 tumors decreased in size during 2 to 6 months after radiosurgery on computed tomographic or magnetic resonance imaging scans. All 12 patients with GM were treated with conventional radiation (6,240 approximately 6,500 cGy) after surgical resection or biopsy prior to radiosurgery (13 approximately 15 Gy to margin). The results were varied. Radiosurgical treatment of two recurrent lymphomas and three recurrent mixed germ cell tumors after radiation and chemotherapy provided rapid clinical improvement with disappearance of the tumor. However, new lesions appeared in two lymphomas and one mixed germ cell tumor within 3 to 4 months. One patient with adenoid cystic carcinoma of the orbit, who was treated radiosurgically prior to resection, is alive without recurrence 31 months after the treatment. Gamma knife radiosurgery appears to be the best alternative method to surgical excision plus radiation therapy for single and multiple cerebral metastases. It also provides rapid palliation of symptoms due to recurrent malignant tumors. And it may have an adjuvant role in the treatment of some tumors delaying local recurrence, if given prior to resection. However, the preliminary results for the malignant gliomas were inconclusive.
Adult ; Aged ; Brain Neoplasms/secondary/*surgery ; Female ; Follow-Up Studies ; Human ; Male ; Middle Age ; *Radiosurgery

Acute appendicitis is the most frequent cause of acute abdomen. However, bacteremia in patient with acute appendicitis is rare. A 34-year-old male patient presenting with fever and abdominal discomfort for two days showed leukocytosis, elevated C-reactive protein and erythrocyte sedimentation rate. Gram-negative rods were cultured in blood and empirical ceftriaxone was injected intravenously. On abdominal CT, wall enhanced and distended retrocecal appendix was recognized. Appendectomy was performed, which revealed suppurative inflammation without perforation. We report a case of acute appendicitis without perforation associated with Escherichia coli sepsis and atypical clinical manifestations in a healthy male.
Abdomen, Acute ; Adult ; Appendectomy ; Appendicitis ; Appendix ; Bacteremia ; Blood Sedimentation ; C-Reactive Protein ; Ceftriaxone ; Escherichia ; Escherichia coli ; Fever ; Humans ; Inflammation ; Leukocytosis ; Male ; Sepsis

This is a case of a 30-year-old man who was referred to our hospital for evaluation of a rapidly growing tumor in the left thyroid gland. It was palpated 2 weeks ago. But it was growing fast. A 4x3 cm mass was palpated in the left thyroid gland. Our impression was anaplastic thyroid carcinoma. Computed tomography finding indicated a thyroid malignant tumor and cytology result suggested spindle cell neoplasm. A lower anterior neck mass was resected and final histopathological result turns out to be a rhabdomyosarcoma (RMS). Although cervical RMS is very rare in adults, it has to be included for the differential diagnosis for the rapidly growing mass at thyroid gland.
Adult ; Diagnosis, Differential ; Humans ; Neck ; Rhabdomyosarcoma* ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: Totally extraperitoneal (TEP) hernia repair has gained in popularity in the past two decades. Despite the advantages TEP hernia repair, the approach is hindered by the relatively long learning curve of the surgery. We tried to estimate the necessary number of repetitions of TEP hernia repair in the learning curve using logarithmic and exponential function models. METHODS: We performed a retrospective review of all patients who underwent TEP hernia repair by a single surgeon consecutively at a single center. We calculated how many operations were needed to achieve a reduction in the expected operating time to mean operating time using logarithmic and exponential function models. RESULTS: In the 91 patients, the logarithmic function model predicted that 37 cases were needed to overcome the learning curve for TEP hernia repair while the exponential model predicted that 39 cases were needed. CONCLUSION: According to this study, at least 37 to 39 cases are needed in the overcome learning curve of TEP hernia repair. Further studies are needed to optimize surgical education and maximize quality.
Education ; Herniorrhaphy* ; Humans ; Learning Curve* ; Learning* ; Likelihood Functions ; Retrospective Studies

The aim of this study was to investigate if dietary Chlorella vulgaris (chlorella) intake would be effective on cadmium (Cd) detoxification in rats fed dietary Cd. Fourteen-week old male Sprague-Dawley (SD) rats weighing 415.0 +/- 1.6 g were randomly divided into two groups and fed slightly modified American Institute of Nutrition-93 Growing (AIN-93G) diet without (n=10) or with (n=40) dietary Cd (200 ppm) for 8 weeks. To confirm alteration by dietary Cd intake, twenty rats fed AIN-93G diet without (n=10) and with (n=10) dietary Cd were sacrificed and compared. Other thirty rats were randomly blocked into three groups and fed slightly modified AIN-93G diets replacing 0 (n=10), 5 (n=10) or 10% (n=10) chlorella of total kg diet for 4 weeks. Daily food intake, body weight change, body weight gain/calorie intake, organ weight (liver, spleen, and kidney), perirenal fat pad and epididymal fat pad weights were measured. To examine Cd detoxification, urinary Cd excretion and metallothonein (MT) concentrations in kidney and intestine were measured. Food intake, calorie intake, body weight change, body weight gain/calorie intake, organ weight and fat pad weights were decreased by dietary Cd intake. Urinary Cd excretion and MT concentrations in kidney and small intestine were increased by dietary Cd. After given Cd containing diet, food intake, calorie intake, body weight change, body weight gain/calorie intake, organ weights and fat pad weights were not influenced by dietary chlorella intake. Renal MT synthesis tended to be higher in a dose-dependent manner, but not significantly. And chlorella intake did not significantly facilitate renal and intestinal MT synthesis and urinary Cd excretion. These findings suggest that, after stopping cadmium supply, chlorella supplementation, regardless of its percentage, might not improve cadmium detoxification from the body in growing rats.
Adipose Tissue ; Animals ; Body Weight ; Body Weight Changes ; Cadmium ; Chlorella ; Chlorella vulgaris ; Diet ; Eating ; Humans ; Intestine, Small ; Intestines ; Kidney ; Male ; Metallothionein ; Organ Size ; Rats ; Rats, Sprague-Dawley ; Spleen ; Weights and Measures

The lateral rhinotomy signifies only an incision and not on operation and a lateral rhinotomy incision with osteotomy of the nasal bones provides access to the entire nasal cavity and maxillary, ethmoid, and sphenoid sinuses as well as the frontal sinus if the floor is removed, permitting removal of benign lesions at these sites and en bloc resection of the ethmoid labyrinth and the party wall between the nasal cavity and antrum with infiltrating tumors. The authors treated a tumor patient and a midfacial bone fracture patient via lateral rhinotomy approach and had a good result. So we report the cases with literature review.
Ear, Inner ; Fractures, Bone ; Frontal Sinus ; Humans ; Nasal Bone ; Nasal Cavity ; Osteotomy ; Sphenoid Sinus

OBJECTIVE: Ovarian failure is often common complication by the conditioning protocol used for bone marrow transplantation (BMT). To determine the frequency of recovery of ovarian function after allo-BMT and the major factor that predict recovery, we monitored ovarian function in 24 premenopausal women METHOD: Twenty-four women met the inclusion criteria, which were (1) moderate to severe aplastic anemia before BMT, (2) disease-free at least 18 month after transplantation, (3) age younger than 40 years and more than 3 years after menarche at transplantation and (4) regular menstrual periods before transplantation. Recovery of ovarian function was determined by regular menses without menopausal symptom and sign. we divided conditioning regimen to two groups, Group I : cytoxan alone(n=17), Group II : cytoxan plus total body irradiation (TBI)(n=7). RESULTS: All women became amenorrhea after BMT and the clinical characteristics were not significant between two groups. 17 patients who received only cytoxan all recovered ovarian function between 1 to 14 months(median : 7.28) after BMT. The median age at BMT of women with regained ovarian function was 26 years (range, 21 to 33) versus 30 (range, 21 to 37) for those who did not. The age at transplantation was not significant between two groups in our study and the most predictive independent factor in ovarian recovery is the presence of total body irradiation. None of women who received TBI regained ovarian function during 19-49 month follow up. CONCLUSION: Gonadal insufficiency due to pre-BMT conditioning is more severe in radiation based regimen than cytoxan alone. therefore, we recommend early hormone replacement therapy in radiation treated women to prevent the complication of premature menopause.
Amenorrhea ; Anemia, Aplastic* ; Bone Marrow Transplantation* ; Bone Marrow* ; Cyclophosphamide ; Female ; Follow-Up Studies ; Gonads ; Hormone Replacement Therapy ; Humans ; Menarche ; Menopause, Premature ; Whole-Body Irradiation

OBJECTIVE: The purpose of this study was to evaluate intrauterine fetal death and to elucidate the etiology of intrauterine fetal death. METHODS: This is a clinical study of 153 cases of fetal death in utero (FDIU) among 11,866 deliveries at Holy Family Hospital during Mar. 1995 to Feb. 2002. RESULTS: 1. The average incidence of FDIU was 1.29%. 2. The age distribution of mother with FDIU was between 16 to 45 year old and was highest in the 25 to 29 year old age group (45%). 3. The parity of mothers with FDIU was the highest in nulliparous group (58.5%) and there was a decreased tendency with high parity. 4. There were 80 cases (52.1%) with previous history of abortion and 8 cases (5.2%) with previous history of FDIU. 5. The highest incidence rate of FDIU was shown at 20~24 weeks of gestation (36.6%) and in the fetus weighted less than 1,000 gm (56%), and the sex ratio of male versus female fetus was 1.29:1. 6. The mode of delivery FDIU was labor induction (54.3%), laparotomy (15.2%), spontaneous labor (30.4%). The indication for laparotomy were placental abruption, previous cesarean section state, twin and maternal death. As the gestational age and fetal weight decreased, the mean time interval from start of labor induction to fetal expulsion and the variety of labor induction became increase. 7. The etiology factors of FDIU was unexplained causes (44%), congenital anomaly (17%), cord complication (14%) in order. CONCLUSION: The proper antenatal care should be taken of fetuses on the basis of risk factors of antepartum and intrapartum so that unnecessary intrauterine fetal death might be able to be prevented.
Abruptio Placentae ; Adult ; Age Distribution ; Cesarean Section ; Female ; Fetal Death* ; Fetal Weight ; Fetus ; Gestational Age ; Humans ; Incidence ; Laparotomy ; Male ; Maternal Death ; Middle Aged ; Mothers ; Parity ; Pregnancy ; Risk Factors ; Sex Ratio ; Twins

The aim of this study was to examine the hypoglycemic effect of chlorella in 6 week-old type 2 diabetic Goto-Kakizaki (GK, n=30) rats and 6 week-old normal Wistar (n=30) rats. Animals were randomly assigned to 3 groups respectively, and were fed three different experimental diets containing 0%, 3% or 5% (w/w) chlorella for 8 weeks. In diabetic GK rats, the insulinogenic-indices were not significantly different among the groups. The concentrations of fasting plasma glucagon and hepatic triglyceride, and the insulin/glucagon ratios of the GK-3% chlorella and GK-5% chlorella groups were significantly lower than those of the GK-control group. The HOMA-index and the concentrations of fasting blood glucose and plasma insulin of the GK-3% chlorella and GK-5% chlorella groups were slightly lower than those of the GK-control group. In normal Wistar rats, the insulinogenic-indices were not significantly different among the normal groups, but that of the Wistar-5% chlorella group was slightly higher than the other groups. The concentrations of fasting blood glucose and plasma insulin, and the HOMA-index of the Wistar-5% chlorella group were a little higher, and the fasting plasma glucagon concentration and the insulin/glucagon ratio of the Wistar-5% chlorella group were significantly higher than those of the Wistar-control and Wistar-3% chlorella groups. In conclusion, this study shows that the glucose-stimulated insulin secretion was not affected by the intake of chlorella, which could be beneficial, however, in improving insulin sensitivity in type 2 diabetic GK and normal Wistar rats.
Animals ; Blood Glucose ; Chlorella ; Chlorella vulgaris ; Diet ; Fasting ; Glucagon ; Hypoglycemic Agents ; Insulin ; Insulin Resistance ; Plasma ; Rats ; Rats, Wistar

The paper by Lee YJ et al. [1] was printed with spelling errors.