PURPOSE: The aim of this study was to review the outcome of local control after the local excision for T1/T2 rectal cancers and, thus, to assess its effectiveness as an alternative to a more radical resection. METHODS: This retrospective study analyzed 23 patients with T1/T2 rectal cancer treated by local excision (LE), and their results were compared with the results for 22 patients with rectal cancer of the same stage treated by a radical resection (RR). All patients with pT2 lesions in the LE group received postoperative adjuvant chemoradiation. The outcomes were defined as 5-year local-recurrence-free survival (LRFS). The median follow-up was 72 (range, 40~92) months. RESULTS: Recurrence occurred in 4 patients (pT1, 1; pT2, 3) in the LE group and in 3 patients (all pT2) in the the RR group. One patient with vascular invasion (T2N1M0) in the RR group showed multiple liver metastases at 23 months postoperatively. The difference in 5-year LRFS was not statistically significant between the two groups. In the LE group, the 5-year LRFS for pT2 lesions was significantly less favorable than that for pT1 lesions (40% vs. 94%; P= 0.005). The 5-year LRFS for pT2 in the RR group was more favorable than that in the LE group, although the difference was not statistically significant (76.9% vs. 40%, P=0.138). CONSLUSIONS: Local excision provides a favorable local control for pT1 rectal cancers. A more radical resection, however, remains an effective surgical option for pT2 lesions because local excision, even combined with adjuvant chemoradiation, showed substantial local recurrences.
Follow-Up Studies ; Humans ; Liver ; Neoplasm Metastasis ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies

BACKGROUND: Bisphosphonates are now well established as successful antiresorptive agents for the prevention and treatment of osteoporosis. We investigated the effect of cyclic intravenous treatment with an aminobisphosphonate, pamidronate in cases of primary osteoporosis. METHODS: Eighteen patients with primary osteoporosis (bone mineral density BMD t-score < -2.5) received four courses of pamidronate (30 mg with 500 mL normal saline over 2 hours every 3 months). The serum biochemical parameters and bone turnover markers were measured before each treatment. The bone pain score, medication score, and the side effects were also monitored. BMD and simple spine X-ray were performed before and 1 year after of treatment. RESULTS: BMD at the lumbar spine (L2-4) significantly increased from 0.798+/-0.110 g/cm2 to 0.860+/-0.107 g/cm2 after 1 year of treatment with pamidronate: by +8.3+/-9.4% of baseline. BMDs at the femoral neck, Ward s triangle and the trochanter also increased, but not significantly. Serum total alkaline phosphatase (p<0.05) and urine deoxypyridinoline/creatinine (p=0.069) decreased with treatment. Other bone turnover markers were unchanged. The bone pain score decreased significantly. None of the patients experienced a new fracture during treatment. The frequency of the side effects following the first infusion was 61.1% (a transient fever and myalgia with flu-like symptoms in 10 patients and mild phlebitis in 1 patient). However, only two patients complained of flu-like symptoms after second infusion, and no patient complained following the third infusion. CONCLUSION: Cyclic intravenous treatment of pamidronate every three months was effective in increasing BMD and in the decreasing bone turnover rate, and was relatively well tolerated in primary osteoporotic women.
Alkaline Phosphatase ; Bone Density ; Bone Density Conservation Agents ; Diphosphonates ; Female ; Femur ; Femur Neck ; Fever ; Humans ; Myalgia ; Osteoporosis ; Phlebitis ; Spine

Malignant melanoma is a neoplasm of the skin and mucous membrane. Extragenital malignant melanoma that metastasizes to the ovary is seen rarely, and in only a few cases has the diagnosis been made before autopsy. The most common histologic feature that should raise the question of metastatic melanoma is the presence of numerous epitheloid cells with abundant eosinophilic cytoplasm. Despite advances in chemotherapy and immunotherapy the efficacy of treatment of advanced melanoma remains limited and the prognosis of metastatic disease remains guarded. We describe a case of malignant melanoma metastatic to the ovary and right axillae occurring one year and four months after diagnosis of cutaneous malignant melanoma on the patient's back.
Autopsy ; Axilla ; Cytoplasm ; Diagnosis ; Drug Therapy ; Eosinophils ; Female ; Immunotherapy ; Melanoma* ; Mucous Membrane ; Ovary* ; Prognosis ; Skin

This study was performed to observe the changes of glucose-related hormones and the morphological change including ultrastructure of the pancreatic islets in the male Otsuka Long-Evans Tokushima Fatty rat. Area under the curve (AUC) of glucose at the 30th (709 +/- 73 mg.h/dL) and at the 40th week (746 +/- 87 mg.h/ dL) of age were significantly higher than that at the 10th week (360 +/- 25 mg.h/ dL). AUC of insulin of the 10th week was 2.4 +/- 0.9 ng.h/mL, increased gradually to 10.8 +/- 8.3 ng.h/mL at the 30th week, and decreased to 1.8 +/- 1.2 ng.h/mL at the 40th week. The size of islet was increased at 20th week of age and the distribution of peripheral alpha cells and central beta cells at the 10th and 20th weeks was changed to a mixed pattern at the 40th week. On electron microscopic examination, beta cells at the 20th week showed many immature secretory granules, increased mitochondria, and hypertrophied Golgi complex and endoplasmic reticulum. At the 40th week, beta cell contained scanty intracellular organelles and secretory granules and apoptosis of acinar cell was observed. In conclusion, as diabetes progressed, increased secretion of insulin was accompanied by increases in size of islets and number of beta-cells in male OLETF rats showing obese type 2 diabetes. However, these compensatory changes could not overcome the requirement of insulin according to the continuous hyperglycemia after development of diabetes.
Animals ; Body Weight ; Diabetes Mellitus, Type 2/*metabolism/pathology ; Disease Models, Animal ; Glucagon/*metabolism ; Insulin/*metabolism ; Islets of Langerhans/*metabolism/pathology/ultrastructure ; Male ; Rats ; Rats, Inbred OLETF

No abstract available.
Echocardiography, Transesophageal* ; Mitral Valve Insufficiency*

3-Methylcrotonyl-CoA carboxylase(MCC) is a biotin-dependent enzyme involved in the leucine metabolism. We describe a patient with MCC deficiency who manifested with Reye syndrome-like illness with status epilepticus, metabolic acidosis, hypoglycemia, hyperammonemia, elevated liver enzymes and neurologic impairments after a viral gastroenteritis and then suffered from Lennox-Gastaut syndrome. Urinary organic acid analysis revealed increased excretions of 3-hydroxyisovaleric acid and 3-methylcrotonylglycine. This patient was managed with a leucine restriction diet and supplementation of biotin and carnitine, which was not so effective. He suffered from neurologic sequelae such as Lennox-Gastaut syndrome, motor and cognitive impairements.
Acidosis ; Biotin ; Carnitine ; Diet ; Gastroenteritis ; Humans ; Hyperammonemia ; Hypoglycemia ; Leucine ; Liver ; Metabolism ; Status Epilepticus

Bullous pemphigoid (BP) is a chronic autoimmune subepidermal blistering disease that usually occurs in the elderly. Two types of clinical variants exist. The generalized form typically involves the lower abdomen, groin, thighs and inner arms. The localized forms of BP include (1) mucous membrane pemphigoid or cicatrical pemphigoid, (2) localized scarring pemphigoid or Brunsting-Perry pemphigoid, and (3) localized nonscarring pemphigoid. We report here on a case of localized nonscarring pemphigoid on the face of a 71-years-old man.
Abdomen ; Aged ; Arm ; Blister ; Cicatrix ; Groin ; Humans ; Mucous Membrane ; Pemphigoid, Bullous ; Thigh

The most frequent ectopic locations of endometriosis include, in descending order of frequency, the ovaries, uterine ligaments, the rectovaginal septum, and peritoneum covering the pelvic organs, that is, uterus, fallopian tubes, rectum, sigmoid colon, and bladder. Endometriosis at the site of episiotomy scar and abdominal scar following cesarean section are very rare conditions among the extrapelvic endometriosis. We have experienced two cases of endometriosis. One occurred from episiotomy scar and the other occurred from abdominal scar following cesarean section. The diagnosis of scar endometriosis is suggested if the symptoms are cyclic or in association with the patient's menstrual cycle. We can use ultrasonography, computerized tomography, magnetic resonance imaging to differentiate from other tumors. Surgical excision is the method of choice for diagnosis and treatment. We report the two cases with review of rare extrapelvic endometriosis.
Cesarean Section* ; Cicatrix* ; Colon, Sigmoid ; Diagnosis ; Endometriosis* ; Episiotomy* ; Fallopian Tubes ; Female ; Ligaments ; Magnetic Resonance Imaging ; Menstrual Cycle ; Ovary ; Peritoneum ; Pregnancy ; Rectum ; Ultrasonography ; Urinary Bladder ; Uterus

The dispatch life support(DLS) copes with the emergent situations with the pre-arrival instructions. The instructions are made based on the logical branch which simulates and reflects the knowledge and decision processes of the emergency medical dispatcher. The present practice of the emergency fire-fighting offices in our country is such that the identification of the emergency caller and other administrative affairs are principal, and there is not any systematic standard medical instruction by use of communications system. The emergency medical system(EMS) is defined as the integrated system which can provide the emergency patients with the proper supports with a timely manner and it is essential to construct the emergency medical communication system which connects the patient with all the people involved in the situation. This study focuses on development of the basic DLS model in the emergency communication model. The model comprises of the systematic and standard instructions which can be used for the recovery of the emergency patient. 32 AMPDS, one items of the Heart! Respiratory Arrest are selected, and the communication treatment protocols are prepared for development of DSL model for this items. The DSL will help the communications between the patients and emergency medical dispatchers, and will make the medical dispatcher control the situation by providing a patient with medical instructions before his arrival.
Clinical Protocols ; Emergencies* ; Heart ; Humans ; Logic

Transesophageal echocardiography(TEE) is a new acoustic window to the cardiac structures and great vessels via retrocardiac esophagus. Because of the close relation between the esophagus and the heart, higher transducer frequencies can be applied, therefore leading to improved resolution and more accurate images than transthoracic echocardiography. We describe our experience with the first 353 awake patients. The procedure was well tolerated by the patients and associated with no major complications, within examination 10 to 20 minutes. Clinical diseases which appear to be suited for TEE includes 1) evaluation of native valve diseases, particulary mitral valve, pathologic valvular abnormalities and color Doppler regurgitant flows ; 2) assesment of prosthetic heart valves to better define malfunction and important pathologic associations ; 3) congenital heart disease, particularly atrial septal defect ; 4) endocarditis and detection of vegetations and complications ; 5) detection of thrombus and tumors, size, location, morphology, stalk ; and 6) aortic pathology including atherosclerosis, aneurysm and dissection. We conclude that transesophageal echocardiography is a new imaging technique that is rapidly evolving into a major tool for general cardiac imaging in a variety pathologic conditions and is a safe and useful tool in patients. Future advances in probe technology will continue to expand its applications.
Acoustics ; Aneurysm ; Atherosclerosis ; Echocardiography ; Echocardiography, Transesophageal* ; Endocarditis ; Equidae ; Esophagus ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Valves ; Humans ; Mitral Valve ; Pathology ; Thrombosis ; Transducers