No abstract available.
Depression*

This study was designed to evaluate the worth of preoperative chemoradiation therapy in the management of locally advanced rectal cancer. Between march 1993 and January 1997, 64 patients with adenocarcinoma of the rectum were treated with preoperative irradiation followed by operation by one surgeon at department of surgery, Chungnam national university hospital. Cancers were treated with high-dose radiation (45 to 54 Gy) with (group 2) or without (group 1) chemotherapy Preoperatively 64 Patients were analysed prospectively, of these, 15 cases were preoperative radiotherapy alone arm and 49 cases were preoperative radiotherapy plus chemotherapy arm. The average age of the patients were 56 years (range 38~67) in group 1 and 57 years (range 27~80) in group 2. Male to female ratio was 8 : 7 in group 1 and 30 : 19 in group 2. Most clinical stage of the primary tumor mass were 73 (80% in Group 1,96% in group 2), being palpated slightly fixed (40% in group 1, 43% in group 2) or fixed (13.3% in group 1, 24.5% in group 2). As to distance of tumor from anal verge, most patients ranged from 4 to 8 cm (53% in group 1, 63.3% in Group 2). Chemotherapy consisted of 2 cycles of 5-fluorouracil (500 mg/m2/day for S days) delivered as a continuous infusion or bolus therapy and low-dose leukovorin (20 mg/m2/day for 5 days). After six weeks resting period of radiation, definitive surgical approach was performed. Overall treatment related toxicity rate was similar in both group except erythema on perineal skin, which was more frequent in group 2 than in group 1. Most frequent postoperative complication was intestinal obstruction (7.8%) followed by wound infection (6.3%), but there was no significant difference between two groups. There was one case of postoperative mortality in group 2 patients at 44 days after operation due to pneumonia and sepsis combined with liver cirrhosis. Tumor depth was downstaged in 38.5% of group 1 and 70% of group 2 patients on preoperative CT staging, and nodal downstaging was more effective on the respect of postoperative pathological report. Overall recurrence rate was 38.5% in group 1 and 20.5% in group 2. Of these, failure occured first as a distant metastasis more frequently than as a local recurrence in both group. These data do suggest that the preoperative chemotherapy and radiotherapy used are as safe as preoperative radiotherapy alone. Futhermore, tumor and lymph node downstaging are more effective in combined arm. Preoperative chemotherapy will more promising in prevention of distant metastasis when treated in the period of least metastatic tumor burden. Whether combined arm will have greater or lesser survival awaits the completion of this relevant study.
Adenocarcinoma ; Arm ; Chungcheongnam-do ; Drug Therapy ; Erythema ; Female ; Fluorouracil ; Humans ; Intestinal Obstruction ; Leucovorin ; Liver Cirrhosis ; Lymph Nodes ; Male ; Mortality ; Neoplasm Metastasis ; Pneumonia ; Postoperative Complications ; Prospective Studies ; Radiotherapy ; Rectal Neoplasms* ; Rectum ; Recurrence ; Sepsis ; Skin ; Tumor Burden ; Wound Infection

The pancreas consists of two types of tissue arising from same primitive cells, but with entirely different functions. Although the adult human pancreas and fetal islet tissue have been the subject of numerous electron microscopic studies, little is known of the ultrastructure of the developing human exocrine pancreas. The purpose of the current study is to investigate development of endo and exocrine of pancreas, especially during the middle trimester of human fetal life, which is the period of acinar cell maturation. Fresh autopsy specimens of pancreas, taken from 15 human fetuses at the 12th (n=2), 13-16th (n=5), 17-20th (n=4), 21-24th (n=2) and 25-28th (n=2) weeks of gestation, were studied electron microscopically, and immunohistochemically. Antisera against insulin, somatostatin, glucagon, pancreatic polypeptide and gastrin, were used for immunohistochemistry. By the 12th week, primitive exocrine acini were identified and these were matured rapidly in the next 6 weeks. At the 17th week stage, ultrastructural examination revealed atypical zymogen granules in the acinar cells. These became progressively less numerous in the 21-28 week period when classical zymogen granules increased upto the level of adult stage. All the endocrine cells were found at the 12th week, forming primitive or mature islets. The relative ratio of endocrine cells at the 12th week was about 35.4%, 24.9%, 39.8%, 0.5% for A, B, D & PP cell, respectively. But at the 25th to 28th week of development, the relative numbers of A and D cells decreased somewhat, whereas those of the B cells increased. The PP cells were constant. The G cells were found at the 12th week of fetal period, which appeared through out the on period.
Adult ; Male ; Female ; Humans

Two cases of urachal anomaly (1 urachal cyst and 1 patent urachus) are reported in a neonate and an eleven-year old boy, respectively. In case 1, the patient was born after an uncomplicated pregnancy to a mother who had taken progesterone during the first trimester. Because of breech presentation, cesarian section was elected to deliver a male baby weighing 2.3 kg who showed abdominal distension. The patient died of respiratory difficulty several minutes after birth. At autopsy, there was a large cyst in the midpoint of the abdominal and pelvic cavity. This round cyst was composed of two components, urachus and urinary bladder. No area of umbilicocystic fistula was present. The lining epithelium was chiefly of transitional type. Assocaited anomalies were segmental stenosis of posterior urethra, absence of abdominal musculature, bilateral polycystic kidney of Potter type IV, hydroureter, and hypoplasia of lungs. Low set ears, micrognathia and club foot were also present. In case 2 the patient was 11-year old boy. He had suffered from intermittent urinary dribbling from umbilicus since early infancy, whenever the abdominal pressure was increased. The patency of urachus was confirmed by fistulography. And the urachal anomaly was surgically removed. Histopathologically the resected patent urachus consisted of pseudostratified columnar to transitional epithelium resting on fibrous stroma mixed with well formed smooth muscle bundles.
Pregnancy ; Female ; Male ; Infant, Newborn ; Humans ; Cysts

No abstract available.
Down Syndrome* ; Humans ; Infant* ; Leukemia, Megakaryoblastic, Acute*

No abstract available.
Adult ; Hidradenitis ; Humans

In order to evaluate the radio-protective advantage of an enhanced dynamic wedge (EDW) over a physical wedge (PW), we measured peripheral doses scattered from both types of wedges using a 2D array of ion-chambers. A 2D array of ion-chambers was used for this purpose. In order to confirm the accuracy of the device, we first compared measured profiles of open fields with the profiles calculated by our commissioned treatment planning system. Then, we measured peripheral doses for the wedge angles of 15 degrees, 30 degrees, 45 degrees, and 60 degrees at source to surface distances (SSD) of 80 cm and 90 cm. The measured points were located at 0.5 cm depth from 1 cm to 5 cm outside of the field edge. In addition, the measurements were repeated by using thermoluminescence dosimeters (TLD). The peripheral doses of EDW were (1.4% to 11.9%) lower than those of PW (2.5% to 12.4%). At 15 MV energy, the average peripheral doses of both wedges were 2.9% higher than those at 6MV energy. At a small SSD (80 cm vs. 90 cm), peripheral dose differences were more recognizable. The average peripheral doses to the heel direction were 0.9% lower than those to the toe direction. The results from the TLD measurements confirmed these findings with similar tendency. Dynamic wedges can reduce unnecessary scattered doses to normal tissues outside of the field edge in many clinical situations. Such an advantage is more profound in the treatment of steeper wedge angles, and shorter SSD.
Heel ; Silver Sulfadiazine ; Toes

PURPOSE: Acute urinary retention is one of the most severe complications in patients with benign prostatic hyperplasia (BPH). We investigated the efficacy of age, International Prostatic Symptom Score (I-PSS), quality of life (QOL) score and various parameters obtained by transrectal ultrasonography (TRUS) as predictors of acute urinary retention. MATERIALS AND METHODS: Of 153 patients with BPH, who underwent transurethral resection of the prostate, 72 were treated due to acute urinary retention (retention group) and 81 due to lower urinary tract symptoms (symptomatic group). TRUS was used to calculate the total prostate (TP) and transitional zone (TZ) volumes, the transitional zone index (TZ index=TZ volume/TP volume) and the elongation ratio (ER=the ratio of the maximal anteroposterior to transverse diameter of the prostate). To compare the usefulness of various parameters between the retention and symptomatic groups, the area under the receiver-operating characteristic (ROC) curve was calculated for each parameter. RESULTS: There were significant differences in the TP and TZ volumes, the TZ index and the elongation ratio between both groups, but no significant differences in age, I-PSS or QOL score. In the retention group, the most effective cutoff values were 40cc, 20cc, 0.55 and 0.75 for the TP volume, the TZ volume, the TZ index and the elongation ratio, respectively. The area under the ROC curves were 0.894, 0871, 0843 and 0771 for the TZ index, the elongation ratio, the TZ volume and the TP volume, respectively. CONCLUSIONS: The TP and TZ volumes, the TZ index, and the elongation ratio are useful predictors of acute urinary retention in patients with BPH. The TZ index is the most useful predictor, and may be a useful parameter in selecting the treatment for BPH.
Humans ; Lower Urinary Tract Symptoms ; Prostate ; Prostatic Hyperplasia* ; Quality of Life ; ROC Curve ; Ultrasonography ; Urinary Retention*

Mural nodules in ovarian mucinous tumors, whether benign, borderline, or malignant, have been described by several authors since Prat and Scully first described sarcoma or sarcoma-like mural nodules occurring in association with mucinous epithelial neoplasia in 1979. Three distinct types of the mural nodule have been identified; i. e., 1) sarcoma-like lesion, 2) true mesenchymal sarcome, and 3) anaplastic carcinoma simulating a sarcoma. Mural nodules of sarcomatous and carcinomatous foci associated with mucinous ovarian tumors should be separated from sarcoma-like nodules because of the poor prognosis of the former compared to the favorable prognosis of the latter. We experienced a case of ovarian mucinous cystadenocarcinoma with sarcoma-appearing mural nodule of anaplastic carcinoma occurred in a 59-year-old woman and reported with brief review of the literatures.
Carcinoma* ; Cystadenocarcinoma, Mucinous* ; Female ; Humans ; Middle Aged ; Mucins* ; Ovary ; Prognosis ; Sarcoma

Injuries to the pelvic nerve plexus following major pelvic ablative surgery are commonly observed conditions in urologic field and often related to voiding difficulty with flaccid type of neurogenic bladder. The pathophysiological background for voiding difficulty is unknown and also it is difficult to investigate in human. The present study was undertaken to investigate the functional changes on the bladder and urethra in major pelvic ganglion denervated rats (experimental group). Injury to the pelvic nerve plexus was created by selective removal of bilateral major pelvic ganglions of mature Sprague-Dawley rats (male, 250-300 gm). One week after operation, urodynamic evaluation and NADPH diaphorase histochemistry were performed in each rat. The whole bladder wet weight and residual urine of experimental group significantly increased to 1.6 times and 29 times that of control group, respectively. For urodynamic investigations, the bladder and the urethra were completely disconnected by means of ligation between the bladder neck and the proximal urethra, and simultaneous recordings of the intravesical and proximal urethral pressure were performed. During simultaneous urethro-vesical filling in experimental group, vesical contraction and urethral relaxation were not induced. However, an administration of L-arginine (120 mg/kg intravenously), a nitric oxide substrate, resulted in a gradual decrease in urethral pressure when the bladder pressure was reached at submaximal level. On NADPH diaphorase histochemistry in control group, a large number of NADPH positive nerve fibers were found in the proximal urethra, whereas those were found less commonly in the bladder. In experimental group, the number of NOS positive nerve fibers in the bladder was similar to that in control group. But in the proximal urethra, the number of NOS positive nerve fibers (84.7 +/- 12.7) decreased significantly in contrast to that (185.9 +/- 56.3) in control group. These results indicate that failure to empty in neurogenic bladder may be resulted from relaxation impairment of bladder outlet, which can be explained by the reduction of neuronal NOS in the proximal urethra in experimental group.
Animals ; Arginine ; Denervation ; Ganglion Cysts* ; Humans ; Ligation ; NADP ; NADPH Dehydrogenase ; Neck ; Nerve Fibers ; Neurons* ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type I* ; Rats* ; Rats, Sprague-Dawley ; Relaxation ; Urethra* ; Urinary Bladder* ; Urinary Bladder, Neurogenic ; Urodynamics