With the purpose of clarifying the etiology and its characteristics of PCA infarction, we analyzed 60 consecutive patients with cerebral infarction involving occipital-or inferior temporal lobes. To elucidate the underlying causes of PCA infarcts, we reviewed medical records for clinical and laboratory risk factors, neuroimaging studies, echocardiog.ram, and angiographic findings. The com non causes of PCA infarcts were thrombotic, embolic, unknown, and miscellaneous causes in decreasing order. The most common symptom was hemianopsia or cortical blindness. Sensorimotor symptoms were present in 36 patients and confusion in 16 patients. Confusion was closely correlated with old age or infarcts outside the PCA territory(p<0.05). The patients of either thrombotic or embolic infarcts were older than those of miscellaneous or unknown causes(p<0.05). Bilateral occlusions were less common in thrombotic and embolic infarct in comparison with miscellaneous causes. Atrial fibrillation or sick sinus syndrome were the usual causes of embolic infarct. In miscellaneous causes of infarct, migraine were in four patients. Clinical outcome was better in unknown causes than in thrombotic or miscellaneous causes of infarct (p<0.05). These findings revealed that thrombosis was a worse prognostic factor than embolism as well as a leading cause of PCA infarct.
Atrial Fibrillation ; Blindness, Cortical ; Cerebral Infarction ; Embolism ; Hemianopsia ; Humans ; Infarction, Posterior Cerebral Artery* ; Medical Records ; Migraine Disorders ; Neuroimaging ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery* ; Risk Factors ; Sick Sinus Syndrome ; Temporal Lobe ; Thrombosis

From November 1987 to December 1995, 76 patients with periampullary cancer underwent resectional surgery in the department of surgery, Kosin medical college. The object of this study was to assess the prognostic factors of the periampullary cancer after pancreaticoduodenectomy. The postoperative mortality rate was 11.8%. Significant morbidity occurred in 39.5% of the patients, early reoperation was required in 9.2% of these patients, and the mean hospital stay was 21.7 days. Univariate analysis on all patients revealed that the survival rate was significantly related to the size of the tumor (> or =3.0 cm 13%, <3.0 cm 41.4%; p<0.05), lymph node status (invasion 8.7%, no invasion 31.8%; p<0.05) and the age of the patient (>50 20.5%, < or =50 34.5%; p<0.05). The site was less significant(distal CBD 27%, ampulla of Vater 16.7%, pancreas 9%, duodenum 2%; p>0.05). These results indicated that patients with a tumor size lesser than 3cm, without lymph node involvement, and under the age of 50 had a long term survival rate.
Ampulla of Vater ; Duodenum ; Humans ; Length of Stay ; Lymph Nodes ; Mortality ; Pancreas ; Pancreaticoduodenectomy* ; Reoperation ; Survival Rate

Children's rectal cancer is a very rare condition and its reported incidence is below 0.5%. The prognosis is very poor due to the advanced stage at diagnosis and a higher malignant potential. Recently some authors treated rectal cancer of children with surgery and they have had a better prognosis. We experienced a case of rectal cancer in a 12 year old boy treated with surgery and chemotherapy and reviewed related literature.
Child* ; Diagnosis ; Drug Therapy ; Humans ; Incidence ; Male* ; Prognosis ; Rectal Neoplasms*

Thyroid acropachy is a rare complication of Graves' disease, manifested by clubbing of the terminal phalanges, periosteal new bone formation and overlying soft tissue swelling, It may occur when the patient is hypothyroid, euthyroid or hyperthyroid. In most cases, it is a part of the syndrome, including exophthalmos and/or pretibial myxedema. The authors have experienced one case of thyroid acropachy and report with a review of the literature review. The patient a 56-year-old female with a characteristic feathery new bone formation on the medial side of the shaft of the left first metatarsal bone and overlying soft tissue swelling. However, there was no pretibial myxedema and clubbing of fingers. She was hypothyroid and treated with systemic corticosteroid for mild pain and persistent swelling. The treatment had temporarily improved the patient's condition.
Exophthalmos ; Female ; Fingers ; Graves Disease ; Humans ; Metatarsal Bones ; Middle Aged ; Myxedema ; Osteogenesis ; Thyroid Gland*

Hereditary ovarian cancer accounts for about 5% to 10% of the total ovarian cancer bnurden, The discase has been observed in context with three types of hereditary ovarian cancer prone syndrome : (1) site-specific ovarian cancer, (2) hereditary breast/ivarian cancer syndrome, (3) hereditary nonpolyposis colorectal cancer(Lynch syndrome II). Each of these syndmmcs is chracterized by autosomal dominant transmission of cancer, sigrdficant early age of onset, and exeess of multiple Iprimary cancers. Auuthor expxeriencecl six families with hereditaty ovarian cancer, two families with a site-spxific. ovarian cancer and four with a breast/ovarian cancer syndrome, and report these families.
Age of Onset ; Chymopapain ; Humans ; Ovarian Neoplasms*

Hereditary ovarian cancer accounts for about 5% to 10% of the total ovarian cancer bnurden, The discase has been observed in context with three types of hereditary ovarian cancer prone syndrome : (1) site-specific ovarian cancer, (2) hereditary breast/ivarian cancer syndrome, (3) hereditary nonpolyposis colorectal cancer(Lynch syndrome II). Each of these syndmmcs is chracterized by autosomal dominant transmission of cancer, sigrdficant early age of onset, and exeess of multiple Iprimary cancers. Auuthor expxeriencecl six families with hereditaty ovarian cancer, two families with a site-spxific. ovarian cancer and four with a breast/ovarian cancer syndrome, and report these families.
Age of Onset ; Chymopapain ; Humans ; Ovarian Neoplasms*

Status epilepticus (SE) is a neurological emergency that requires prompt diagnosis and treatment. Prognosis of SE depends mostly on the underlying illnesses and secondary brain damage from seizure activity. For early detection of poor prognostic factors in SE, we retrospectively analyzed 121 SE patients with their medical redords, laboratory findings, and neuroimaging studies. No single factor other than the previous history of seizure was associated with their prognosis. According to presence or absence of previous seizure history, they were divided into the first-ever seizure group (53 patients) and recurrent seizure group (68 patients). We compared both two groups in respect to demographic, neurological, and radiological features, response to antiepileptic drugs (AEDs), and short-term outcome of SE. The results stggest that the patients of the first-seizure group are older and have more frequent detectable etiological diseases, poor response to AEDs, and higher mortality, hence prognosis being worse than the recurrent-seizure group.
Anticonvulsants ; Brain ; Diagnosis ; Emergencies ; Humans ; Mortality ; Neuroimaging ; Prognosis ; Retrospective Studies ; Seizures* ; Status Epilepticus*

OBJECTIVE: This study was performed to identify the prognostic factor for survival of patients with recurrent cervical cancer. METHODS: Sixty-eight patients were diagnosed as recurrent cervical cancer at the Seoul National University Hospital from January, 1988 to December, 1998. Recurrence was defined as new evidence of tumor after 6 months of disease free survival. Retrospective analysis was done in terms of clinical features and the Cox proportional hazard model was used to identify independent variables associated with an improved survival rate. Histopathologic types were distributed as follows; squamous cell carcinoma in 70.6%, adenocarcinoma in 11.8%, adenosquamous cell carcinoma in 11.8%, and small cell carcinoma in 1.5%. Distribution of FIGO stage was as follows; stage I in 25.0%, stage II in 66.2%, and stage III in 4.4%. Sites of recurrence were as follows; central pelvic recurrence in 44.1%, pelvic side wall recurrence in 11.8%, and distant metastasis in 44.1% and the most common site of distant recurrence was extrapelvic lymph nodes (29.4%). 29.4% of recurrences were observed within the first 12 months after initial therapy, 50.0% within 2 years and 64.7% within 3 years. RESULTS: Positive rate of SCC-Ag at initial diagnosis was 45.2% with cutoff value of 2.0 ng/ml. Positive rate of SCC-Ag at the diagnosis of recurrence was 60.0%. Overall response rate to the treatment was 29.1%. Complete response rate was higher in central pelvic recurrrence than pelvic side wall recurrence and distant metastasis (P = 0.002) and also higher in normal SCC-Ag level (< or = 2.0 ng/ml) at the diagnosis of recurrence than elevated level (P = 0.032). Cumulative survival rates of 1 year after recurrence was 66.8%, 2 year 36.7%, and 5 year 18.7%. Central recurrence showed higher cumulative survival rate than pelvic side wall or distant recurrence (P = 0.029). The patients with elevated SCC-Ag level at the time of diagnosis of recurrence showed lower cumulative survival rate than those with normal SCC-Ag level (P < 0.001). Cox proportional hazard model showed that SCC-Ag elevation at the time of diagnosis of recurrence retained significant values in predicting survival(OR = 2.56; 95% CI = [1.22-5.39]; P = 0.01). CONCLUSION: SCC-Ag elevation at the diagnosis of the recurrence is a strong independent prognostic indicator for survival of patients with recurrent cervical cancer.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Disease-Free Survival ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate ; Uterine Cervical Neoplasms*

BACKGROUND: The HER-2/neu proto-oncogene (also known as c-ErbB-2) encodes a 185 kD transmembrane glycoprotein with intrinsic tyrosine kinase activity. Many studies revealed the correlation between the aberrant overexpression of HER-2/neu oncogene and poor prognosis of the malignant tumors such as breast, stomach, colon, lung cancers. But the significance of HER-2/neu oncogene overexpression as a prognostic factor in ovarian cancer remains controversial. OBJECTIVE: The aims of this study were to assess the prevalence of HER-2/neu oncogene amplification by polymerase chain reaction(PCR) and to evaluate the prognostic significance of HER-2/neu oncogene overexpression in terms of chemo-responsiveness and survival rate. MATERIALS AND METHODS: This study included 32 patients with advanced ovarian cancers(24 epithelial ovarian cancers, 2 Brenner tumors, 2 malignant mixed miillerian tumors, 2 granulosa cell tumors, 1 struma ovarii, 1 Krukenberg tumor). All patients had underwent staging laparotomy, and postoperative adjuvant chemotherapy with platinum-based combination chemotherapy. PCR was performed using tissues preserved in liquid nitrogen at the time of debulking operation. Overexpression of HER-2/neu oncogene was defined as being equal to or greater than 1.5 a.u. We analyzed whether the HER-2/neu overexpression correlated with chemoresponsiveness and 5-year survival rate(5-YSR). RESULT: HER-2/neu oncogene amplification was present in all of the ovarian cancers(32/32). Significant overexpression[gene copy number(GCN) > or =1.5 a.u.] was present in 13 of 32 ovarian cancers(41%) and 12 of 24 epithelial ovarian cancers (50%). The clinical response rate to chemotherapy in high copy group(GCN > or = 1.5 a.u.) was 67%(8/12) and that of low copy group(GCN<1.5 a.u.) was 92%(11/12)(p>0.05). Pathologic response rate to chemotherapy was 0%(0/5) and 50%(3/6), respectively(p>0.05). 5-YSR was 8% in high copy group and 25% in low copy group, but this difference was not statistically significant(p=0.17). CONCLUSION: HER-2/neu overexpression might be a poor prognostic factor, but this difference was not definitely elucidated by satistical analytsis in this study. Larger scaled prospective randomized study is needed to define the prognostidc significance of the HER-2/neu overezpression in ovarian cancer.
Breast ; Brenner Tumor ; Chemotherapy, Adjuvant ; Colon ; Drug Therapy ; Drug Therapy, Combination* ; Glycoproteins ; Granulosa Cell Tumor ; Humans ; Laparotomy ; Lung Neoplasms ; Nitrogen ; Oncogenes* ; Ovarian Neoplasms* ; Polymerase Chain Reaction ; Prevalence ; Prognosis ; Protein-Tyrosine Kinases ; Proto-Oncogenes ; Stomach ; Struma Ovarii ; Survival Rate

Backgrouad & Aims: Cyclophosphamide, adriamycin and cisplatin(CAP) combination chemo- therapy improved the response rate in the treatment of advanced epithelial ovarian cancer, and it has been the gold standard. However, adriamycin is a rather toxic drug, and there is still confusion concerning the choice of adriamycin to be included in optimal regimen. The present study was designed to compare the activity and toxicity of combination regimens in advanced epithelial ovarian cancer between CAP and CTP which substitutes adriamycin with pirarubicin(THP- adriamycin). PATIENTS AND METHODS: From March 1995 to December 1997, 47 patients with FIGO stage III-IV epithelial ovarian cancer who were diagnosed after initial cytoreductive surgery were divided into two groups at random: (1) The case group were treated with CTP(500/40/50 mg/m2) as a first line chemotherapy. (2) The control group were treated with CAP(500/50/50 mg/m2) as that of case group. Clinical characteristics, response rates and toxicities according to Gynecologic Oncology Group criteria were compared between those treated with CAP and CTP respectively. RESULTS: Forty one patients out of 47 were evaluable and the number of patients in case and control group was 22 and 19 respectively. There was no significant differences in patient characteristics such as age, stage, histologic type between two groups. Clinical complete response rate was 50.0%(11/22) in patients treated with CTP regimen and 47.4%(9/19) with CAP regimen and there was no significant difference between two groups. Second look operation was undergone in 10 patients of CTP group and 7 patients of CAP group who showed clinical complete response and the pathologic complete response rate was 27.3%(6/22) with CTP and 21.1%(4/19) with CAP. The incidence of leukocytopenia of grade 3 or 4 was more frequently occurred in CAP group(52.6%, 10/19) than CTP group(22.7%, 5/22). There was no significant difference in the incidence of other toxicitied such as hepatic, renal and G-I toxicities. Suspicious cardiac toxicity according to the finding of EKG was seen in 15.8%(3/19) only with CAP regimen and all of them showed decreased cardiac function in gated blood pool scan. There were no significant differences in risponse rates between two groups, but the incidence of cardiac toxicity and leukocytopenia o f grade 3 or 4 was more frequently occurred in CAP group than CTP group. CONCLUSION : CTP regimen has comparable response rates to CAP regimen, with lower incidence of hematolohic and cardiac toxicity.
Cyclophosphamide* ; Cytidine Triphosphate ; Doxorubicin* ; Drug Therapy ; Drug Therapy, Combination* ; Electrocardiography ; Humans ; Incidence ; Leukopenia ; Ovarian Neoplasms*