Extramammary Paget's disease is a rare malignant disease associated with underlying adenocarcinoma, or not. Two cases with a unique clinical presentation are described and we wish to call attention to the malignant potential of chronic scaly and erythematous lesions of perianal and genital area.
Adenocarcinoma ; Male ; Paget Disease, Extramammary* ; Penis* ; Scrotum*

Radical hysterectomy with pelvic lymph node dissection (RHPLD) was considered as primary management of cervical cancer (stage I and IIa). RHPLD provides for resection of paracervical and paravaginal tissues at the lateral pelvic walls, transaction of the uterosacral ligament, ligation of uterine vessels and excision of pelvic lymph node from the surrounding vessels. The urinary tract disturbance was the most frequent and significant postoperative complication. Among 82 patients who had undergone radical hysterectomy with pelvic lymph node dissection for cervical cancer from July 1983 to December 1989, 43 patients who were treated for urologic complications, were reviewed retrospectively. The age distribution was even from 4th to 6th decades. The common urologic complications were neurogenic bladder dysfunction 28 (34.2%). Ureteral injury 15 (18.3% ), UTI 12 (14.6% ), stress incontinence 5 (6.1%). Each urologic complication and its management are discussed.
Age Distribution ; Humans ; Hysterectomy* ; Ligaments ; Ligation ; Lymph Node Excision* ; Lymph Nodes* ; Postoperative Complications ; Retrospective Studies ; Ureter ; Urinary Bladder, Neurogenic ; Urinary Tract ; Uterine Cervical Neoplasms

We report a case of primary adenocarcinoma of the urethra in 62 years old female. Primary carcinoma of the female urethra is an uncommon malignancy that accounts for less than 0.02 per cent of all cancers occurring in women. Adenocarcinoma is rare in the literature. Whereas squamous cell carcinoma and transitional cell carcinoma, which comprise the majority of urethral malignancies, arise form the squamous or epithelial cells lining the urethra, adenocarcinoma arises form the periurethral glands.
Adenocarcinoma* ; Carcinoma, Squamous Cell ; Carcinoma, Transitional Cell ; Epithelial Cells ; Female* ; Humans ; Middle Aged ; Urethra*

No abstract available.
Cartilage* ; Fascia* ; Transplants* ; Tympanoplasty*

Carcinoma, Squamous Cell ; Disseminated Intravascular Coagulation ; Floors and Floorcoverings ; Humans ; Iliac Artery ; Male ; Mandible ; Mouth ; Neck Dissection ; Surgical Flaps

Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme ; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization ; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially In continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions. Quality in terms of accessibility and continuity highly varied among institutions. To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.
Accreditation ; Consumer Participation ; Cooperative Behavior ; Delivery of Health Care ; Education ; Financial Management ; Health Resources ; Humans ; Information Systems ; Korea* ; Occupational Health Services* ; Occupational Health* ; Primary Health Care ; Quality Improvement ; Questionnaires ; Social Welfare ; World Health Organization

The extension of HCC with tumor thrombus through the hepatic veins into the right atrium can cause sudden death due to heart failure and pulmonary embolism, even though the primary tumor may be relatively localized. We report a case of hepatic resection and tumor thrombectomy of hepatocellular carcinoma with tumor thrombus extending into right atrium using cardiopulmonary bypass and total hepatic vascular exclusion. A 65-year-old man, with a diagnosis of left liver mass, visited Yeungnam University Hospital. The patient had no noticeable edema in the lower extremities, but had dyspnea on exertion. Laboratory studies revealed a platelet count of 162 K/uL, total bilirubin of 1 mg/dL, albumin of 4.1 g/dL and a prothrombin time of 14.7 second. In addition, the retention of indocyanine green at 15 min was 13.5 %. The patient was anti-HCV was positive and his levels of alpha-fetoprotein and PIVKA-2 were 6.45 ng/mL and 582 mIU/mL, respectively. An abdominal CT scan, hepatic angiogram and echocardiogram showed a 4 cm sized HCC in the left lobe and a 4 to 5 cm sized tumor thrombus extending into the right atrium through the left and middle hepatic veins. No distant metastasis was detected in other studies. Total operative time, total duration of cardiopulmonary bypass and cardioplegic time were 13 hours, and 55 and 24 minutes, respectively. The total hepatic vascular exclusion time was 18 minutes. Unfortunately, the patients died 2 months later due to ARDS without being discharged from hospital.
Aged ; alpha-Fetoproteins ; Bilirubin ; Carcinoma, Hepatocellular* ; Cardiopulmonary Bypass* ; Death, Sudden ; Diagnosis ; Dyspnea ; Edema ; Heart Atria* ; Heart Failure ; Hepatic Veins ; Humans ; Indocyanine Green ; Liver ; Lower Extremity ; Neoplasm Metastasis ; Operative Time ; Platelet Count ; Prothrombin Time ; Pulmonary Embolism ; Thrombectomy* ; Thrombosis* ; Tomography, X-Ray Computed

PURPOSE: Early assessment of injury severity is important in management of major trauma patients. In general, hypotensive major trauma patients show more severe outcomes from injuries compared with normotensive major trauma patients. In this study, we analyzed the clinical features of severe trauma patients with initial hypotension and attempted to determine the prognostic factors of mortality in these patients. METHODS: A retrospective study was conducted within our hospital. Review of trauma registry data identified 679 major trauma patients (Injury severity score, ISS>15). From January 2011 to December 2013, all major trauma patients with initial systolic blood pressure lower than 90 mmHg were included (N=77). The patients were divided into two groups - those who survived and those who expired - and the differences in initial and final values were compared between the two groups. RESULTS: Out of a total of 77 patients, 55 patients survived and 22 patients died. The data showed almost no difference in heart rate between the two groups. The expired group showed low Glasgow Coma Scale (GCS) score, systolic blood pressure, revised trauma score, initial pH, and follow-up pH, as well as higher age, ISS, initial lactate, prothrombin time (PT), international normalized ration (INR), and follow-up lactate, compared with the survived group. In multivariate logistic analysis, age (p=0.034, OR 1.071), GCS (p=0.006, OR 0.61), initial base excess (p=0.042, OR 0.57), and follow-up base excess (p=0.041, OR 0.799) were independently associated with mortality. CONCLUSION: The patient's age, initial GCS, initial base excess and follow-up values of base excess were good prognostic factors for mortality in the expired major trauma patients with initial hypotension.
Blood Pressure ; Emergency Service, Hospital* ; Follow-Up Studies ; Glasgow Coma Scale ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypotension* ; Lactic Acid ; Mortality* ; Multiple Trauma ; Prothrombin Time ; Retrospective Studies

A cross-sectional study was conducted to assess the association between perceived occu-pational psychosocial stress at work and the work-related musculoskeletal disorders (WRMSD) among employees using video display terminals. The study included 111 female telecommunication employees from three companies at ChungBuk province. Cases of WRMSD were defined using symptom questionnaire and physical examination conducted by rehabilitation specialist. Information on demographics, individual factors, and perceived psychosocial stress, were obtained by self-administered questionnaire. For assessing perceived psychosocial stress, we used variables from 'job strain model' proposed by Karasek. Associations between perceived psychosocial stress and WRMSD were assessed by multiple logistic regression models. Forty nine (44% to the total) subjects met our operational definition for WRMSD. Age, seniority, housing load were not associated with WRMSD. Perceived psychosocial stress was associated with WRMSD [odds ratio=3.28, 95% confidence interval: 1.05-10.19]. This study suggests that perceived occupational psychosocial stress is related to the prevalence of WRMSD.
Chungcheongbuk-do ; Computer Terminals* ; Cross-Sectional Studies ; Demography ; Female ; Housing ; Humans ; Logistic Models ; Physical Examination ; Prevalence ; Questionnaires ; Rehabilitation ; Specialization ; Telecommunications

Emphysematous cystitis is a rare disease that is associated with diabetes mellitus, neurogenic bladder, chronic genitourinary infection, and malignancy. Fever, chill, abdominal pain, and urinary difficulties were the most frequent presenting symptoms associated with emphysematous cystitis. We report a case of incidentally detected asymptomatic emphysematous cystitis in a 67 years old female patient with diabetic nephropathy. We review characteristic features of all 19 cases that has been reported in korean medical journals till now. Risk factors for this condition appear to be female sex, old age, and diabetes mellitus.
Abdominal Pain ; Aged ; Cystitis* ; Diabetes Mellitus ; Diabetic Nephropathies ; Female ; Fever ; Humans ; Korea* ; Rare Diseases ; Risk Factors ; Urinary Bladder, Neurogenic