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 & AIMS: Management of ovarian carcinoma presents most commonly by surgery and subsequent platinum-based chemotherapy, but most patients will have either residual or recurrent disease. Taxol, a new antimicrotubule agent, has been indicated as a salvage measure after failure of first-line or subsequent chemotherapy. The purpose of this study is to investigate the efficacy and toxicity of Taxol used as a salvage therapy. MATERIALS & METHODS: Between January 1994 and Jun 1996, 19 patients aged 38-64 years(median 52) with ovarian carcinoma were given Taxol-containing regimen. Taxol was administered at a dose of 135mg/m2 intravenously with cisplatin or carboplatin every 3 weeks. The patients who treated with Taxol only were received 175mg/m2 intravenously with same interval. The median treatment cycle was 6.6 cycles(range, 3 to 15 cycles). Patient's response were evaluated with tumor marker(CA-125) and CT or MRI before and after chemotherapy. Responses and toxicities were defined according to the Gynecologic Oncology Group criteria. (continue)
Carboplatin ; Cisplatin ; Drug Therapy* ; Humans ; Magnetic Resonance Imaging ; Ovarian Neoplasms ; Paclitaxel* ; Salvage Therapy*

Even though malignant potential of vaginal intraepithelial neoplasia(VaIN) may be low, the prevalence is increasing and the mean age at diagnosis is decreasing. Various treatment options have been used for the eradication of ValN, but most effective standard protocol is not present because it is a rare disease. Laser vaporization was used to treat 7 patients with VaIN diagnosed at Department of Obstetrics and Gynecology, Seoul National University Hospital between 1992 to 1996. The patients were from 40 to 70 years of age with a mean 57 of years. All patients had a history of radical or simple hysterectomy, and final pathologic diagnosis were as follows : cervical cancer(n=5), cervical intraepithelial neoplasia(n=l), leiomyoma(n=l). Vaginal intrae-pithelial neoplasia(VaIN) was identified between 4 months and 8 years after first operation. All lesions were unifocal disease and found at the upper one third of the vagina. Treatment was performed with a CO2 laser unit and colposcope. Four(57%) out of seven patients had general anesthesia for the purpose of treatment. Patients were followed up for an average of 16.8 months with regular cytologic evaluation, colposcopy and biopsy. Failure of therapy was defined as evidence of intraepithelial neoplasia in any one of these three parameters. Only one patients showed persistent disease and the others remain free of disease. The success rate of therapy was 85.7%(6/7). (continue)
Anesthesia, General ; Biopsy ; Colposcopes ; Colposcopy ; Diagnosis ; Gynecology ; Humans ; Hysterectomy ; Laser Therapy ; Lasers, Gas* ; Obstetrics ; Prevalence ; Rare Diseases ; Seoul ; Vagina ; Volatilization*