A clinical study was made of 14 cases of distal rectal cancer treated at the Department of Surgery, St. Mary's Hospital, Catholic University Medical College, from January 1995 to April 1996. The patients were treated in a modified Thomas Jefferson program and received high doses of preoperative radiation followed by a sphincter saving procedure. The results are as follows: 1) There were 5 male patients (35.7%) and 9 female patients(64.3%). There was also a large number of patients in their 50s and 60s. 2) The preoperative pathologic type was a moderately differentiated adenocarcinoma. 3) Rectal bleeding was the most common symptom, followed by tenesmus, constipation, anal pain, and a tarry stool. 4) At diagnosis, the Thomas Jefferson (T.J.) system was used for the clinical stage of the patients. The clinical stage of disease showed a preponderance of T.J. stage I (10 patients), T.J stage II, III, and IV occurred in 2, 1, and 1 patient, respectively. 5) The most common site was 0-3 cm above dentate line (8 patients), followed by 4-6 cm (5 patients) and > 7 cm (1 patient) above the dentate line. 6) The complications after preoperative radiation therapy were diarrhea (3 patients) and perianal dermatitis (5 patients). 7) After preoperative radiation therapy, one case showed pathologic complete remission. 8) The procedure was a Transanal Abdominal TransAnal proctosigmoidectomy and coloanal anastomosis (TATA) in 11 patients, a low anterior resection in 1 patient, an abdominal perineal resection in 1 patient, and a colostomy in 1 patient. 9) The pathologic stage showed a preponderance of Duke's B2 and B1; 5 were B2, 4 were B1, 3 were C2, 1 was D, and 1 was O. 10) The postoperative complications after colostomy repair in TATA were frequent defecation, tenesmus, anal pain at defecation, and rectovaginal fistulas which subsided 3 months after colostomy repair.
Adenocarcinoma ; Colostomy ; Constipation ; Defecation ; Dermatitis ; Diagnosis ; Diarrhea ; Female ; Hemorrhage ; Humans ; Male ; Postoperative Complications ; Rectal Neoplasms* ; Rectovaginal Fistula

No abstract available.
Antigens, Surface* ; Hepatitis B* ; Hepatitis*

Pacemaker implantation for patients with mechanical tricuspid valve is quite challengeable because lead insertion through prosthetic tricuspid valve may cause valve dysfunction or lead impingement. Also complications due to interrupt of anticoagulation should be considered. A 65 years old woman received AAI (atrium paced, atrium sensed, inhibited) pacemaker for sick sinus syndrome and mechanical mitral valve replacement for severe mitral steno-insufficiency at the same time 16 years before. She needed to undergo mechanical tricuspid valve replacement (TVR) because of severe tricuspid regurgitation despite of medical therapy. Complete atrioventricular block developed during the TVR operation and it was not recovered even after several days of temporary pacing. We decided left ventricular pacing through coronary sinus because ventricular lead could not pass mechanical tricuspid or mitral valve and also planned to continue oral anticoagulation therapy. We could find a place where high pacing output did not pace phrenic nerve with acceptable sensing, pacing threshold. The patient recovered well without any periprocedural complications. Left ventriclcular pacing lead implantation through coronary sinus without interruption of anticoagulation can be an alternative to epicardial pacing for patients with mechanical tricuspid valve.
Atrioventricular Block ; Coronary Sinus ; Female ; Humans ; Mitral Valve ; Phrenic Nerve ; Sick Sinus Syndrome ; Tricuspid Valve Insufficiency ; Tricuspid Valve*

Spontaneous spinal epidural hematoma is extremely rare. It can cause fatal complication such as permanent neurologic deficit. Even though the exact cause of epidural hematoma is not known in most cases, anticoagulation treatment is associated in some cases. In this situation, prompt reversal of anticoagulation and immediate decompression surgery is required. Seventy-year-old woman presesnted with sudden hemiplegia. She had history of hypertension, dyslipidemia, and paroxysmal atrial fibrillation and had taken antihypertensive agent, statin, and warfarin. She did not have any history of trauma and her international normalized ratio was within therapeutic range during follow-up and at the time of event. Physical examination revealed decreased right extremities' motor and sensory function but cognitive function was normal. Detailed neurologic examination and spinal magnetic resonance imaging identified extensive, spontaneous spinal epidural hematoma. After the reversal of anticoagulation with vitamin K injection, the patient underwent emergent hematoma removal surgery and recovered completely. Our case suggests epidural hematoma should be considered in sudden hemiplegia patients with anticoagulation therapy. Immediate reversal of anticoagulation and decompression surgery can avoid neurologic deficit.
Atrial Fibrillation ; Decompression ; Dyslipidemias ; Female ; Follow-Up Studies ; Hematoma* ; Hematoma, Epidural, Spinal ; Hemiplegia* ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypertension ; International Normalized Ratio* ; Magnetic Resonance Imaging ; Neurologic Examination ; Neurologic Manifestations ; Physical Examination ; Sensation ; Vitamin K ; Warfarin*

OBJECTIVE: The purpose of this study was to define the effect of the changes of left ventricular ejection fraction (LVEF) on long-term major adverse cardiac events (MACEs) in patients with acute myocardial infarction (AMI). METHODS: Clinical analysis was performed on 1,188 AMI patients who completed follow- up 2-dimensional (2D) echocardiography after one year and clinical follow-up for 5 years. These patients were divided into three groups according to the LVEF change ratio: group A [increased LVEF change ratio, N=626], group B [decreased LVEF change ratio<20%, N=414], group C [decreased LVEF change ratio≥20%, N=148]. RESULTS: Initial low LVEF group and normal LVEF group showed no differences in MACEs. The mean initial and follow-up LVEF were 54.4±12.2% and 60.4±12.3% in the group A, 54.6±13.0% and 47.9±12.1% in the group B, and 56.5±12.6% and 39.9±11.6% in the group C (p=0.71). Total MACEs occurred in 62 (9.9%) patients in the group A, 83 (20.0%) patients in the group B, 44 (29.7%) patients in the group C during 5-year clinical follow-up (p=0.01). Initial low EF (<45%) was not a risk factor for long-term MACEs (Odd ratio (OR), 1.686; 95% confidence index (CI), 0.861-2.862, p=0.065), but the LVEF change ratio was a strong risk factor for long-term MACEs (OR, 3.731; 95% CI, 2.039-6.828, p=0.001). MACE-free survivals of patients with initial low LVEF and patients with low LVEF during follow-up period showed no significant differences (p=0.731). CONCLUSION: Initial low LVEF is not a predictor of long-term MACEs, but the decreased LVEF ratio during follow-up period is a strong predictor of long-term MACEs.
Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction* ; Prognosis ; Risk Factors ; Stroke Volume ; Ventricular Dysfunction, Left*

No abstract available.
Accessory Atrioventricular Bundle ; Electrocardiography ; Tachycardia*

Total thyroidectomy has been used to treat benign or malignant thyroid diseases. However, concern about the postoperative complications after the extensive and aggressive operation makes surgeons reluctant to do total thyroidectomy. Instead, in many cases, less invasive and less complicating subtotal thyroidectomy has replaced it. But total thyroidectomy is required to eradicate bilateral and multiple nodules, diffuse toxic goiter, and thyroid cancer that cannot be cured by subtotal thyroidectomy. To evaluate the effectiveness and complications of total thyroidectomy, we reviewed retrospectively 81 patients who received total thyroidectomy from June 1987 to August 1993 according to the age, sex, clinical symptoms, duration of symptom, diagnoses, operative modalities, pathologies, postoperative complications and thyroid function. The results are as follows: 1) Male to female ratio was 1 to 4.8 (male:14, female:67). The sixth decade included 27 % of patients, and showed the peak incidence. 2) The most common symptom was the palpable mass on the precervical area or in the thyroid (96%). Palpitation (15%) and voice change (12%) were present in descending order. 3) On the duration of symptom, patients' visiting hospital after one to two years occupied the largest portion (26%). Three to four years occupied 19 cases (23%), and cases of more than five years were 17 cases (21%). Masses of 2 to 3 cm in diameter were the most common size (27%) and of 2 to 5 cm occupied more than half(59%). Most of the patients visited the hospital after full-blown of mass or symptoms. 4) Sixty five cases were cancers, and 16 cases were benign diseases. Modified radical neck dissection was done in 7 cases, suspicious of local lymph node invasion during the operation. Radical neck dissection was done in 6 cases with palpable cervial nodes. 5) The order of accuracy of preoperative diagnostic modality was thyroid scan (86%), frozen section (83%), and fine needle aspiration biopsy(80%). These result seemed different compared with the recent diagnostic value of fine needle aspiration biopsy, but might be due to the technique. 6) Pathological classification is composed of differentiated cancer (80%), toxic goiter (16%), nodular goiter (6%), adenomatous goiter (2%), and Hashimoto's thyroiditis (1%). Papillary cancer occupied 92 percent of cancer. Lymph node metastasis showed diffuse distribution according to the mass size. 7) No deaths were reported. The most common complication was hypocalcemia (38%), most of which was transient and 61 per cent of which was symptomatic. It usually persisted less than 7 days, and only 3 cases continued more than 7 days (3.7%). The other complications were hoarseness (19%), bleeding (7%), and the recurrent laryngeal nerve injury(1%). 8) Follow up on the postoperative thyroid function was available on 66 patients (81%). Of those, forty six patients (70%) were euthyroid, 2 (18%) were hypothyroid, and 8 (12%) were hyperthyroid. The cause of the hyperthyroid status after total thyroidectomy might be due to the medication for the thyroid supplementation or to the time of serum measurement shortly after the medication. We think that total thyroidectomy could be done without additional risk compared with subtotal thyroidectomy, if it were done meticulously. We suggest that total thyroidectomy should be considered for the treatment of diffuse thyroid diseases and carcinomas.
Biopsy ; Biopsy, Fine-Needle ; Classification ; Diagnosis ; Female ; Follow-Up Studies ; Frozen Sections ; Goiter ; Goiter, Nodular ; Hemorrhage ; Hoarseness ; Humans ; Hypocalcemia ; Incidence ; Lymph Nodes ; Male ; Neck Dissection ; Neoplasm Metastasis ; Pathology ; Postoperative Complications ; Recurrent Laryngeal Nerve ; Retrospective Studies ; Thyroid Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Thyroiditis ; Voice

No abstract available.
Aneurysm* ; Coronary Disease ; Coronary Vessels*

Stress cardiomyopathy (SCMP) is characterized by a transient left ventricular dysfunction associated with apical ballooning and compensatory hyperkinesias of the basal segments after emotional or physical stress, but inverted or mid-ventricular variants of SCMP have also been described. Although catecholamine excess has been suggested as a possible pathophysiologic mechanism of SCMP, the etiology of SCMP is still unknown. Here, we report a case of inverted type of SCMP with clinical presentation mimicking acute coronary syndromes. The cause or precipitating stressor was unclear initially, but pheochromocytoma has been demonstrated as a cause of SCMP during clinical follow-up at out-patient clinic in the present case. Catecholamine-producing tumors should be included in the evaluation or management of SCMP, even though initial clinical manifestations are not suggestive for pheochromocytoma.
Acute Coronary Syndrome ; Cardiomyopathies ; Follow-Up Studies ; Humans ; Hyperkinesis ; Outpatients ; Pheochromocytoma* ; Takotsubo Cardiomyopathy* ; Ventricular Dysfunction, Left

PURPOSE: To evaluate changes in quality of life (QoL) in patients with neurogenic bladder treated with clean intermittent catheterization (CIC), who changed from a multiple use catheter (MUC) to single use catheter (SUC). METHODS: The Modified Intermittent Self-Catheterization Questionnaire (mISC-Q) was used to determine potential changes in patients'QoL as a result of switching from MUC to SUC. The mISC-Q consists of questions within four categories: ease of use, convenience, discreetness, and symptomatic benefit. Answers were graded as Strongly agree (+2), Agree (+1), Not sure (0), Disagree (−1), and Strongly disagree (−2). Overall patient QoL, as well as by sex, disease (presence of augmentation cystoplasty), and catheterization route (via urethra or urinary diversion), were analyzed. RESULTS: Thirty-eight patients (21M:17F; mean age: 21.7±5.3 y) submitted questionnaires. For ease of use, SUC was significantly better than MUC (score: 0.364, P=0.002) in all patients. Patients with catheterization via the urethra showed significant favor for SUC in ease of use (score: 0.512, P<0.001) and convenience (score: 0.714, P=0.011), but patients with catheterization via the abdominal stoma of urinary diversion gave negative scores in all categories, though no categories were significant. CONCLUSION: This study suggested that changing from MUC to SUC may lead to improvements in QoL, especially regarding ease of use. This benefit was clearly found in patients with catheterization via urethra rather than abdominal stoma of urinary diversion.
Catheterization ; Catheters* ; Humans ; Intermittent Urethral Catheterization* ; Quality of Life* ; Urethra ; Urinary Bladder, Neurogenic* ; Urinary Diversion