No abstract available.
Chylothorax*

Occasionally, patients with gastrointestinal Crohn's disease (CD) develop granulomatous skin lesions at sites remote from the gastrointestinal tract, separated from other ulcerations by normal skin, a phenomenon that has been referred to as metastatic cutaneous CD. Although metastatic CD of the vulval region has been often reported in English literature, we could not find such cases with family history. We report a case of vulval CD occurring in siblings.
Crohn Disease* ; Gastrointestinal Tract ; Humans ; Siblings* ; Skin ; Ulcer ; Vulva*

No abstract available.
Child* ; Humans ; Subclavian Artery*

No abstract available.
Coronary Artery Bypass* ; Coronary Vessels*

PURPOSE: To determine the clinical value of the Siewert classification for gastic-cancer patients in Korea, we evaluated and compared the clinicopathologic factors of type II and type III cancer. MATERIALS AND METHODS: The medical records of 89 consecutive patients who had undergone surgery for an adenocarcinoma of the gastroesophageal junction (GEJ) at the Department of Surgery, Hanyang University Hospital, between Jun. 1992 and Dec. 2003 were reviewed retrospectively. RESULTS: There were one patient with type I, 12 pateints with type II and 77 patients with type III. During the same period, 1,341 patients underwent surgery for a gastric carcinoma, so proportion of GEJ cancer being 6.6%. The median follow- up duration was 31 months (range: 2~135 months), and the follow-up rate was 100%. Between type II and type III cancers, there were no significant differences in the clinicopathologic variables including age, sex, gross appearance, histologic type, depth of invasion, and pathologic stage. The longest diameter of the tumor was larger in type III (6.1+/-2.1 cm) than in type II (3.9+/-1.1 cm)(P=0.001). A total gastrectomy with Roux-en-Y esophagojejunostomy was done most frequently, while jejunal interposition was done in 3 cases of type II and 2 cases of type III. More than a D2 lymphadenectomy was done all cases. The numbers of dissected lymph nodes and metastatic lymph nodes in type II were 43.8 and 5.8 respectively, while they were 49.8 and 8.1 in type III, but the difference between the two groups were not statistically significant. The mean length of the proximal resection margin was 15+/-5 mm in type II and 21+/-13 mm in type III, but this difference was not statistically significanct. The time to recurrence after operation was 19.3 months in type II and 16.9 months in type III. The five-year survival rates of type II and III were 68.8% and 52.7% respectively, but difference was not significant. CONCLUSION: There were no significant differences in the clinicopathologic variables, including survival rate, between type II and type III cancers in Korean patients. According to these findings, it appears to be reasonable to classify type III cancer as a cardia cancer in a broad sense.
Adenocarcinoma* ; Cardia* ; Classification* ; Esophagogastric Junction ; Follow-Up Studies ; Gastrectomy ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes ; Medical Records ; Recurrence ; Retrospective Studies ; Survival Rate

No abstract available.
Cardiopulmonary Bypass*

PURPOSE: Fine-needle aspiration cytology (FNA) and frozen section biopsy (FS) have been used for the purpose of distinguishing benign lesions from malignancies and for deciding the operative procedures to be used in the management of the thyroid nodules. We performed this study the diagnostic value of the FNA, the need for the FS in intraoperative procedures, and to determine their values in deciding the extent of surgery. METHODS: The medical records of 365 consecutive patients who had undergone surgery for thyroid nodules at the Department of Surgery, Hanyang University Hospital, between Jan. 1996 and Dec. 1998 were reviewed retrospectively. FNA and FS were performed on all patients who underwent thyroid surgery during this period. Among them, 35 patients who were diagnosed as insufficient for diagnosis by FNA were excluded. RESULTS: Definitive histopathological diagnosis revealed benign lesions in 232 patients and malignancies in 98. A borderline group consisted of patients whose specimen were interpreted as follicular neoplasms by FNA and FS. Overall results for FNA and FS were: sensitivity, 98 versus 100; specificity, 97 versus 99; diagnostic accuracy, 97 versus 99%. Five patients who were diagnosed with benign lesions by FNA were rediagnosed by FS as having malignant lesions. The tinal diagnosis was a papillary carcinoma. Of the 45 patients who were interpreted borderline by FNA, 7 patients had benign lesions, and 38 were borderline by FS. Finally, 34 patients were diagnosed as having benign lesions and 11 as having malignancies. CONCLUSION: FNA has a high diagnostic accuracy for differentiatve diagnosis in the thyroid nodules. FS may be unnecessary for patients whose FNA results indicate malignancy especially papillary carcinoma, so routine use of FS for patients who were diagnosed as having a papillary carcinoma by FNA may be omitted. If FNA results are borderline, FS may be helpful to confirm a follicular neoplasm. If FNA indicates benign, FS seems to be necessary to decide the extent of surgery.
Biopsy ; Biopsy, Fine-Needle* ; Carcinoma, Papillary ; Diagnosis ; Frozen Sections ; Humans ; Medical Records ; Retrospective Studies ; Sensitivity and Specificity ; Surgical Procedures, Operative ; Thyroid Gland* ; Thyroid Nodule*

PURPOSE: To determine the prognostic values of the hematologic parameters checked preoperatively in gastric cancer patients, we evaluated and compared the relationship between hematologic parameters and clinicopathologic factors of gastric cancer patient. MATERIALS AND METHODS: The medical records of 357 consecutive patients who had undergone surgery for gastric cancer at the Department of Surgery, Hanyang University Hospital, between Dec. 2,000 and Dec. 2003 were reviewed. To exclude any adverse effect of invasive procedures to hematologic parameters, the samples taken immediately at outpatient department was used. The normal range of serum albumin was defined above 3.5 g/dl, serum hemoglobin above 12 g/dl, and serum platelet count under 400x10(3)/microliter. Patients were defined as group 1 when any of these parameters was abnormal, and defined as group 2 when all parameters were normal. The relationships between hematologic parameters and survival rate were investigated. RESULTS: The mean values of platelet count increased, but level of serum albumin and serum hemoglobin decreased significantly according to the advancement of the disease stage (P=0.000). The differences of depth of tumor invasion and lymph node metastasis between the group 1 and the group2 was statistically significant (P=0.001). Three-year survival difference between group 1 and group 2 was significant (P=0.037). CONCLUSION: The hematologic parameters checked preoperatively in patients of gastric cancer are simple and cheap, meanwhile reflect the general condition of the patients. Any presence of anemia, hypoalbuminemia, or thrombocytosis can predict the progression of the disease and poor survival rates.
Anemia ; Humans ; Hypoalbuminemia ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Outpatients ; Platelet Count ; Prognosis ; Reference Values ; Serum Albumin ; Stomach Neoplasms* ; Survival Rate ; Thrombocytosis

PURPOSE: Fine-needle aspiration cytology (FNA) and Frozen section biopsy (FS) have been used to distinguish benign lesions from malignancies and for deciding the extent of operative procedures to be used in the management of thyroid nodules. We performed this study in order to determine the diagnostic value of FNA, the need for FS in intraoperative procedures, and their value in deciding the extent of surgery. METHODS: The medical records of 365 consecutive patients who had undergone surgery for thyroid nodules at the Department of Surgery, Hanyang University Hospital, between Jan. 1996 and Dec. 1998 were reviewed retrospectively. Both FNA and FS were performed on all patients who underwent thyroid surgery during this period. Among these, 35 patients who were diagnosed as insufficient for diagnosis by FNA were excluded. RESULTS: Definitive histopathological diagnosis revealed benign lesions in 232 patients and malignancies in 98. A borderline group consisted of patients whose specimens were interpreted as follicular neoplasms by FNA and FS. The overall results for FNA and FS were as follows: sensitivity, 98 versus 100; specificity 97 versus 99; and diagnostic accuracy, 97 versus 99%. Five patients who were diagnosed with benign lesions by FNA were rediagnosed by FS as having malignant lesions. The final diagnosis was papillary carcinoma. Of the 45 patients who were interpreted borderline by FNA, 7 patients had benign lesions and 38 were borderline by FS. Finally, 34 patients were diagnosed as having benign lesions and 11 as having malignancies. CONCLUSION: FNA has a high diagnostic accuracy for the differential diagnosis of thyroid nodules. FS may be unnecessary for patients whose FNA results indicate malignancy, particularly in cases of papillary carcinoma, therefore the routine use of FS for patients who have been diagnosed as having a papillary carcinoma by FNA may be omitted. If FNA results are borderline, FS may be helpful in confirming a follicular neoplasm. If FNA indicates a benign status, FS seems to be necessary to decide the extent of surgery.
Biopsy ; Biopsy, Fine-Needle* ; Carcinoma, Papillary ; Diagnosis ; Diagnosis, Differential ; Frozen Sections ; Humans ; Medical Records ; Retrospective Studies ; Sensitivity and Specificity ; Surgical Procedures, Operative ; Thyroid Gland* ; Thyroid Nodule*

PURPOSE: Superficially spreading (SS) early gastric cancer (EGC) is characterized by wide horizontal extension without deep vertical invasion. It is a relatively rare form of EGC, and it's clinicopathological (C-P) characteristics are not evident. This study aimed to clarify their C-P characteristics. MATERIALS AND METHODS: We defined SS EGC as invading less than the submucosal layer that measured more than 60 mm in diameter or wider than 5 x 5 cm (25 cm2) in width. The C-P characteristics and prognosis were compared between 69 patients with SS EGC and 319 patients with the common type EGC (EGC except SS type). RESULTS: For SS EGC, lymph node metastases, Lauren's diffuse type, lymphatic invasion were significantly higher than in common type EGC. In patients with SS EGC, all of the metastatic lymph nodes were anatomically distributed within the paragastric region, with fewer along the left gastric artery and common hepatic artery. In 6 cases of SS EGC with resection margins less than 10 mm, there was no death during the follow-up period (4 to 13 years after operation) if margins were not involved. Age (>58 yrs), tumor site (upper 1/3), lymph node metastasis, submucosal invasion were statistically significant poor prognostic factor in univariate survival analysis. In multivariate survival analysis, age and lymph node metastasis were independent prognostic factors. However, tumor diameter or width was not a significant prognostic factor. CONCLUSION: Although SS EGC has histologically distinct properties, gastrectomy with free surgical margins and appropriate lymph node dissection (D1+beta) could be a suitable treatment.
Arteries ; Follow-Up Studies ; Gastrectomy ; Hepatic Artery ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms*