BACKGROUNDS: Reflux esophagitis has been known to be a frequent complication after a total gastrectomy. Reflux esophagitis is very annoying to the patients, so various types of reconstructions has been introduced to eliminate this complication. METHODS: This study is a retrospective clinical analysis of 34 patients with gastric cancer who were treated with a total gastrectomy from January 1989 to December 1997 at the Department of Surgery, Seoul Adventist Hospital. RESULTS: During 9 years, the operation was performed on 194 patients with gastric cancer, amomg which 34 (17.3%) were total gastrectomies. The peak age was in the 5th and the 6th decades (58.8%), and the sex ratio of males to females was 1.6:1. The sites of the stomach cancer were the cardia (C) in 10 cases (29.4%), the body (M) in 19 cases (55.9%), and the cardia and body in 5 cases (14.7%). The TNM classification was stage I in 15.6% of the cases, stage II in 15.6% of the cases, stage III in 62.5% of the cases, and stage IV in 6.3% of the cases. Three methods of alimentary tract reconstruction were used:a loop esophagojejunostomy with a Braun anastomosis (27), a Roux-en-Y esophagojejunostomy (6), and an uncut Roux procedure (1). The reflux esophagitis rates for patients treated with a loop esophagojejunostomy with a Braun anastomosis and for patients treated with a Roux-en-Y esophagojejunostomy were 25.9% and 16.7%, respectively. The perioperative mortality was 5.8%, and the causes of death were pneumonia and anastomotic leakage. The most common recurrent site was the anastomotic site. CONCLUSIONS: Reflux esophagitis developed more often after a loop esophagojejunostomy with a Braun anastomosis than after a Roux-en-Y anastomosis. This finding was not significant statistically. Thus, further study of more cases is needed.
Anastomosis, Roux-en-Y ; Anastomotic Leak ; Cardia ; Cause of Death ; Classification ; Esophagitis, Peptic* ; Female ; Gastrectomy* ; Humans ; Male ; Mortality ; Pneumonia ; Retrospective Studies ; Seoul ; Sex Ratio ; Stomach Neoplasms*

PURPOSE: Febrile seizure is the most common type of seizure affecting 3-4% of children. The recurrence rate of febrile seizure is approximately 33%. About 16% of children with a febrile seizure during the febrile illness have a recurrent seizure attack within 24 hours. This study aimed to investigate the optimum dose of diazepam to reduce the recurrence of febrile seizures in children who have had a febrile seizure attack. METHODS: The children with febrile seizure who were admitted to the Maryknoll hospital for in vestigation and treatment were retrospectively reviewed. The study group compromised 306 children. The febrile seizure was defined as seizure attack with fever(above 38degreeC) without evidence of intracranial infection or defined cause in children aged 6 months to 5 years. The children were divided into four groups according to dose of diazepam. Group I, 72 patients, received no diazepam therapy. Group II, 78 patients, received oral diazepam in a dose of 0.1 mg/kg every eight hours during the febrile illness, Group III, 87 patients, 0.2 mg/kg, and Group IV, 69 patients, 0.3 mg/kg, respectively. RESULTS: The seizure attack rate and the duration of admission were reduced in both Group III and Group IV. However, there was no difference in the side effects of the diazepam between group III and IV. CONCLUSION: Oral diazepam in a dose of 0.2 mg/kg effectively decreases both the seizure attack rate and the duration of admission.
Child ; Diazepam* ; Humans ; Recurrence ; Retrospective Studies ; Seizures* ; Seizures, Febrile*

BACKGROUND: Tumor necrosis factor-alpha(TNF-alpha) has been thought to play a major role in neurological injury during global brain ischemia and subsequent reperfusion following resuscitation in cardiac arrest. So, we hypothesized that the elevation in TNF-alpha was dependent upon the duration of the global brain ischemia, and related to delayed neuronal damage. METHODS: Fourteen rats were divided two groups ; 1 minute-cardiac arrest group(n=7) and 3 minute-cardiac arrest group(n=7). we induced cardiac arrest by chest compression and damping of tracheal tube for 1 minute and 3 minutes respectively. And then, resuscitation was initiated. To measure the plasma activity of TNF-alpha, blood samples were drawn before and at the end of cardiac arrest, and 30, 60, 90, and 120 minutes after initiation reperfusion. At 72 hours after resuscitation, the ND(neurologic deficit) score was determined and the histopathologic outcome of hippocampal CA1 neuron was observed by the percent dead hippocampal CA1 neurons. RESULTS: 1. TNF-alpha level during the early reperfusion period(<2h) was significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(p=0.0001). 2. There was a no significant difference of neurologic deficit score between 1 min- and 3 min-cardiac arrest. 3. Percent dead hippocampal neurons were significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(9.1+/-1.2% vs 1.2+/-0.9%, p<0.05). CONCLUSION: The results suggest that longer duration of global brain ischemia causes a more profound increase in plasma TNF-alpha level during the early reperfusion period(<2h) and more delayed neuronal damage than lessor duration of global brain ischemia, and that increase in TNF-alpha level during the early reperfusion period(<2h) is related to delayed neuronal damage.
Animals ; Brain Ischemia ; Brain* ; Heart Arrest* ; Heart Arrest, Induced ; Necrosis ; Neurologic Manifestations ; Neurons ; Plasma ; Rats* ; Reperfusion ; Reperfusion Injury* ; Resuscitation ; Thorax ; Tumor Necrosis Factor-alpha*

BACKGROUND: Tumor recurrence is the most common cause of treatment failure, even after complete resection of early-stage non-small cell lung cancer (NSCLC). In this study, we investigated the prognosis of patients with early recurrence in order to identify independent risk factors related to early recurrence. METHODS: Between February 1995 and December 2012, 242 patients who underwent surgical resection for stage I NSCLC at Dong-A University Hospital were reviewed. The factors predicting overall survival (OS) and early recurrence were investigated. We also investigated the relationship between the patterns and period of recurrence and clinicopathological factors. RESULTS: For patients with stage IA and IB NSCLC, the 5-year OS rate was 75.7% and 57.3% (p=0.006), respectively. A multivariate Cox proportional hazards model demonstrated that gender (p=0.004), comorbidity number (p=0.038), resection type (p=0.002), and tumor size (p=0.022) were the statistically significant predictors of OS. Moreover, the multivariate analysis revealed that smoking history (p=0.023) and histologic grade (p=0.012) were the independent predictors of early recurrence. Additionally, only histologic grade (poor differentiation) was found to be significantly associated with a higher frequency of distant metastasis; there was no relationship between the patterns and period of recurrence and clinicopathological factors. CONCLUSION: The present study demonstrated that smoking history and histologic grade were independent prognostic factors for early recurrence within two years in patients with early-stage NSCLC. Patients with these predictive factors may be good candidates for adjuvant therapy.
Carcinoma, Non-Small-Cell Lung* ; Comorbidity ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis* ; Proportional Hazards Models ; Recurrence* ; Risk Factors ; Smoke ; Smoking ; Treatment Failure

Malignant transformation is a rare complication in a mature cystic teratoma of the ovary, usually being reported less than 2% of cases. The most common malignant tumor arising from a mature cystic teratoma of the ovary is a squamous cell carcinoma. However, adenocarcinoma is reported extremely rare, in most cases it was impossible to tell the source of the malignancy. We experienced a case of papillary carcinoma of thyroid glands arising from mature cystic teratoma of the ovary and report this case with a brief review of literature.
Adenocarcinoma ; Carcinoma, Papillary* ; Carcinoma, Squamous Cell ; Female ; Ovary ; Teratoma* ; Thyroid Gland*

BACKGROUND : There is so different between Doctors at managing the patient with intestinal obstruction. Some prefer conservative management and prefer to delay the operation. But others prefer the early operation. So, we have studied in order to compare the clinical difference between early operation and delayed operation for intestinal obstruction. METHODS : This clinical report is based on a review of the records of 226 patients with intestinal obstruction that have been managed at the Department of General Surgery, Seventh Adventist Hospital in Seoul, during about 4 years from January, 1994 to October, 1997. RESULTS : 1) Male to female ratio was 2.32 : 1. The most frequent age group was within 1 year. 2) The common causes of intestinal obstruction were postoperative adhesion (35.8%), intussusception (19.1%), hernia (16.6%) and neoplasm (8.6%). 3) The chief complaints on admission were abdominal pain in 142 cases (62.8%), nausea and vomiting in 110 cases (48.7%), bloody stool in 43 cases (19.0%) and fever in 27 cases (11.9%). The physical findings were abdominal tenderness in 117 cases (51.8%), increased peristalsis in 98 cases (43.4%) and abdominal distension in 64 cases (28.3%). 4) The previous abdominal operation leading to intestinal obstruction were appendectomy in 16 cases (27.6%), small bowel operation in 13 cases (23.4%), gastro-duodenal operation in 9 cases (15.5%) and gynecologic operation in 7 cases (12.1%). 5) In patients who admit because of intestinal obstruction due to previous operation, most of them entered in hospital within 6months after previous operation. 6) Among 226 cases, 46 cases (20.4%) had emergency operation, 64 cases (28.3%) had only conservative treatment and 116 cases (51.3%) had elective delayed operation 7) In patients who was cured with only conservative management, 12 cases (18.8%) of them stayed for 1day on hospital and 32 cases (50%) of them stayed for 1 or 2 days. 8) Exploratory laparotomy was performed in 162 cases. The types of obstruction were composed of 36 cases (22.2%) of strangulated obstruction and 126 cases (77.8%) of simple obstruction. The frequency of strangulated obstruction was 14 cases (38.9%) when the early operation were done, and that ofstrangulated obstruction was 22 cases (61.1%) when the delayed operation were done. There was significant difference between early operation group and delayed operation. 9) As for operative procedure, adhesiolysis was done in 38 cases (23.5%), bandlysis was done in 30 cases (26.1%), manual reduction and incidental appendectomy was done in 28 cases (17.3%). 10) The incidence of postoperative complication was 46 cases (28.4%) and the most cause of death was septic shock. CONCLUSIONS : The early operation for the patient who suffered from intestinal obstruction due to previous operation is better than delayed operation.
Abdominal Pain ; Appendectomy ; Cause of Death ; Emergencies ; Female ; Fever ; Hernia ; Humans ; Incidence ; Intestinal Obstruction* ; Intussusception ; Laparotomy ; Male ; Nausea ; Peristalsis ; Postoperative Complications ; Seoul ; Shock, Septic ; Surgical Procedures, Operative ; Vomiting

PURPOSE: Acute mountain sickness (AMS) commonly occurs when unacclimatized individuals ascend to altitudes above 2500 m. Acetazolamide, a carbonic anhydrase inhibitor (CAI), is recommended for AMS prophylaxis, but may have adverse effects such as paresthesia. Methazolamide has the same pharmacologic effect, but diffuses more rapidly into tissue and is more potent than acetazolamide. But, little is known about methazolamide as an AMS prophylactic agent. This study was conducted to prospectively compare metazolamide with acetazolamide for its preventive effect for AMS in adolescents. METHODS: Nineteen adolescents aged 13~18 years attempting an ascent of Mt. Kalapatar (5500 m) were randomly divided to receive acetazolamide (n=10) or methazolamide (n=9). Oxygen saturation (SpO2) and pulse rate were measured at each altitude. The incidence of AMS was calculated using the Lake Louise questionnaire. Difference in incidence between two groups was analyzed using generalized estimating equation. Difference in Lake Louise scores (LLS) was analyzed using linear mixed model testing. RESULTS: Overall incidence of AMS was 68.4%. Fatigue or malaise was the most frequent symptom (94.7%) followed by headache (84.2%). SpO2 decreased as the altitude increased (p<0.001). There was no difference in SpO2 and pulse rate between the two groups (p=0.44). There was no difference in LLS (p=0.22) and incidence of AMS (p=0.07) between the two groups with increasing altitude. Paresthesia was less common in the methazolamide group, but was not statistically different (p=0.35). CONCLUSION: Methazolamide is equally effective as acetazolamide in preventing AMS among adolescents.
Acetazolamide ; Adolescent ; Aged ; Altitude ; Altitude Sickness ; Carbonic Anhydrases ; Fatigue ; Headache ; Heart Rate ; Humans ; Incidence ; Lakes ; Methazolamide ; Oxygen ; Paresthesia ; Prospective Studies ; Surveys and Questionnaires

BACKGROUND: This study was conducted to compare the accuracy of computered tomography(CT) and sonography(US) in diagnosing acute appendicitis and to analyze the radiologic factors which influence the result. METHODS: We retrospectively studied the cases of 53 patients who were suspected of having appendicitis and who were examined by CT and US covered a three-year period. The final diagnosis was determined from the surgico-pathologic diagnosis and clinical follow-up for two months, as well as from the discharge diagnosis. RESULTS: Thirty-eight(38) patients had acute appendicitis; 15 patients did not. In the analysis, CT and US, respectively, revealed sensitivities of 89.5% and 73.7%, specificities of 93.3% and 60.0%, positive predictive values of 97.1% and 82.4%, negative predictive values of 77.8% and 47.4%. Among patients diagnosed with acute appendicitis, 10 patients were discordant in the US and the CT examinations; CT findings were correct in 8 and US findings in 2. Among non-appendicitis patients, 5 patients were discordant in the US and the CT examinations; CT was correct in 5 and US in 0. Nighteen(19) patients had complications such as an abscess or a perforation. Among these patients, the degree and the extent of the complication were accurately evaluated by CT in 15 patients and by US in 5 patients. CONCLUSION: CT is more accurate than US in diagnosing and excluding acute appendicitis. The use of CT will substantially decrease unnecessary laparotomies and post-operation complications.
Abscess ; Appendicitis* ; Diagnosis ; Follow-Up Studies ; Humans ; Laparotomy ; Retrospective Studies

Although sporadic cases of transient fetal ascites have been described, pulmonary hypoplasia or hydrops fetalis may occur as potentially lethal complications of isolated fetal ascites. Antenatal fetal paracentesis may be useful in improving neonatal pulmonary function, however rapid accumulation of fluid after paracentesis usually required repetitive invasive procedures. We successfully treated an isolated fetal ascites with peritoneo- amniotic shunt. Under the ultrasonographic guidence, we inserted a Double-Basket Catheter into the left lower quadrant of fetal abdominal wall at the end of second trimester. Shunt remained in place until the fetus was delivered at term. The peritoneo-amniotic shunt can improve fetal outcome and avoid repeated paracentesis before delivery.
Abdominal Wall ; Ascites* ; Catheters ; Female ; Fetus ; Humans ; Hydrops Fetalis ; Paracentesis ; Pregnancy ; Pregnancy Trimester, Second

OBJECTIVE: Since the accuracy of Pap smear for cervical neoplasm has been questioned, a number of adjunctive tests have been developed. The purpose of this study was to evaluate the accuracy of speculoscopy, a magnified chemiluminescent examination, as compared with that of the Pap smear in the screening of cervical neoplasm. METHODS: A total of 41 women were included in the study. We conducted Pap smear, speculoscopy, and punch biopsy to all subjects. Targeted biopsies were obtained from any suspicious lesions that were found with positive speculoscopy. Women with negative speculoscopy underwent random biopsies. The data were analysed using McNemar's test. RESULTS: Thirty-one out of 41 biopsy specimen were found to have cervical lesion that were worse than CIN I, including 8 cases of invasive cancer. The sensitivity and specificity of Pap smear were 74.2% and 70.0%, respectively. Those of speculoscopy were 93.5% and 60.0%, respectively. When these two tests were combined, the sensitivity was raised to 96.8%, but the specificity declined to 50.0%. Among 9 cases of ASCUS on Pap smear, 6 cases were found to have cervical pathology worse than CIN II, and these were positive on speculoscopy. CONCLUSION: Speculoscopy combined with a Pap smear can increase the detection of cervical lesions compared with the Pap smear alone. In the cases of ASCUS on Pap smear, speculoscopy may be more useful to detect significant pathology.
Biopsy ; Female ; Humans ; Mass Screening* ; Pathology ; Sensitivity and Specificity ; Uterine Cervical Neoplasms*