PURPOSE: This retrospective study was aimed to determine prognostic factors after radical resection of an ampullary carcinoma. METHODS: Medical records of patients with adenocarcinoma of the ampulla of Vater who had undergone pancreaticoduodenectomy between Dec. 1994 and May 2002 were reviewed. This study included 59 men and 40 women with a mean age of 58.9 years. 62 patients underwent Whipple procedures, 36 patients, pylorus preserving pancreaticoduodenectomy and 1 patient, total pancreatectomy. Actuarial survival rates were calculated using the Kaplan-Meier method. A Cox proportional hazards model was used to test the independent predictors of survival. P<0.05 was considered statistically significant. RESULTS: The overall 5-year survival rate was 45.4% with 3% mortality and 34.3% morbidity. According to the pTNM stage, the 5-year survival rates were 91.7%, 54.3%, 28.5% and 0% at stages I, II, III, and IV (P<0.01), respectively. The patient survival was significantly impaired by the depth of invasion, lymph node metastasis and intraoperative transfusion (P<0.05). In a multivariate analysis, only lymph node metastasis was a statistically independent prognostic factor. CONCLUSION: pTNM stage is a good prognostic indicator for an ampullary carcinoma after pancreaticoduodenectomy and patients with lymph node metastasis should be identified as high risk and considered as candidates for further adjuvant therapy.
Adenocarcinoma ; Ampulla of Vater ; Female ; Humans ; Lymph Nodes ; Male ; Medical Records ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Pancreatectomy ; Pancreaticoduodenectomy ; Proportional Hazards Models ; Pylorus ; Retrospective Studies ; Survival Rate

BACKGROUND AND OBJECTIVES: Spontaneous progression of severe congestive heart failure is structurally characterized by cellular degeneration and multiple foci of myocardial cell death. The cardiac troponin I (cTnI), one of the subunits of the troponin regulatory complex, binds to actin and inhibits interaction between actin and myosin. cTnI is uniquely expressed in the adult human myocardium, and an increase in its circulating levels is highly indicative of myocardial injury. In this study, we addressed the usefulness of cTnI as a sensitive and specific molecular marker for severity in patients with congestive heart failure. MethodscTnI, creatinin kinase-MB (CK-MB), and myoglobin were assessed in 59 patients with severe congestive heart failure diagnosed by the echo-cardiography and gated equilibrium blood pool heart scan. Also we assesed cTnI, creatinin kinase-MB (CK-MB), and myoglobin in 25 persons without cardiac disease in echocardiography. RESULTS: 1) The cTnI con-centration was 89.6+/-69.3 pg/mL in patients with congestive heart failure and its level was greater than that of the control group (22.4+/-17.1, p=0.001). 2) The cTnI level differed significantly according to left ventricular ejection fraction (EF), 117.3+/-73.8 pg/mL in patients with EF\<40% (28 patients), 66.3+/-44.5 pg/mL in patients with EF> or =40% (31 patients), 22.4+/-17.1 pg/mL in the control group (25 persons) (p=0.001). CONCLUSION: cTnI was useful as a specific and sensitive serum molecular marker in patients of congestive heart failure. And its level reflected the severity of congestive heart failure.
Actins ; Adult ; Cell Death ; Echocardiography ; Equidae ; Estrogens, Conjugated (USP)* ; Heart ; Heart Diseases ; Heart Failure* ; Humans ; Myocardium ; Myoglobin ; Myosins ; Stroke Volume ; Troponin I* ; Troponin*

PURPOSE: Despite many reports on laparoscopic-assisted colectomies (LAC) over the past decade, the feasibility of their use in both benign and malignant disease of the colon is not clear. The purpose of this study was to evaluate the feasibility and safety of LAC for the treatment of colonic diseases. METHODS: Between April 2000 and August 2002, we attempted a laparoscopic-assisted colectomy in 95 patients (LAC group). We excluded 3 patients who had converted to open surgery. The surgical outcomes were compared with 92 matched patients who underwent conventional open surgery during the same period (open group), focusing on the results of the surgery, postoperative recovery, complications and oncologic clearance. Between the two groups, there were no significant differences in age, Dukes stage, and type of resection. RESULTS: There were 29 benign and 63 malignant diseases. The mean operating time for the LAC group and the open group were 167.9 and 95.1 minutes, respectively (P<0.00). However, the time taken for passing gas (40.4 hours vs 56.7 hours)(P=0.02) and the length of hospital stay (7.9 days vs 8.6 days) (P=0.07) were significantly shorter in the LAC group than in the open group. Nine patients in the LAC group had complications (9.7%): anastomotic site bleeding (4), chyle leakage (3), urinary retention (1), and ileus (1). All were treated conservatively. There were no differences in complication rates between the groups. The average number of harvested lymph nodes was 20.9 (2~64) in the LAC group and 21.5 (4~60) in the open group (P=0.49). The average distal resection margins were 3.7 (2.0~9.0) cm in the LAC group and 3.3 (1.0~5.0) cm in the open group (P=0.21) for an anterior resection and 3.2 (1.0~7.0) cm in the LAC group and 2.3 (0.7~7.0) cm in the open group for a low anterior resection (P=0.48). CONCLUSIONS: This study showed that LAC had an advantage over open surgery in terms of earlier recovery. Oncological clearance (the number of lymph nodes removed and the resection margins) did not differ between the two procedures. Thus, LAC is a feasible technique in the treatment of colon disease with acceptable morbidity. However, long-term data from a randomized trial is needed.
Case-Control Studies* ; Chyle ; Colectomy* ; Colon ; Colonic Diseases ; Hemorrhage ; Humans ; Ileus ; Length of Stay ; Lymph Nodes ; Retrospective Studies* ; Urinary Retention

BACKGROUND AND OBJECTIVES: he patients with atrial septal defect generally have no symptoms in the childhood, and have nonspecific symptoms such as dyspnea on exertion, fatigue, and palpitation even in the late period of adult. Thus delayed diagnosis for whom surgical correction was undoubtedly needed remains to be resolved. Accordingly, the simple and noninvasive method such as electrocardiography in patients with atrial septal defect having the nonspecific symptoms or having no symptoms warrants to be developed. This study was performed to see whether the crochetage pattern on R wave in inferior limb leads is effective for the electrocardiographic diagnosis of atrial septal defect and relates to the magnitude of left to right shunt. METHODS: Our subjects were 129 patients diagnosed as the atrial septal defect by the echocardiography and cardiac catheterization from January 1992 to June 1998. We selected 57 persons, as control group, who showed the normal findings under the echocardiography and also showed the incomplete right bundle branch block on the electrocardiography. We compared the frequency of the crochetage pattern in inferior limb leads between the two groups. Also we compared the frequency of the crochetage pattern before operation and after operation according to the quantity of the left to right shunt in the operated 40 patients with atrial septal defect. RESULTS: ) The crochetage pattern was observed in 61.2% in patients with atrial septal defect and its frequency was greater than that of the control group (38.6%, p=0.005). 2) The crochetage pattern was disappeared by the operation in 16/29 patients (55.2%, p=0.001). 3) The frequency of disappearance of the crochetage pattern after operation differed significantly according to shunt severity: 72.2% for a Qp/Qs> or =3.0 group, 18.2% for a Qp/Qs<3.0 group (p=0.015). CONCLUSION: The crochetage pattern on R wave in inferior limb leads was helpful to the electrocardiographic diagnosis of the atrial septal defect. The disappearance of the crochetage pattern after operation was correlated with shunt severity.
Adult ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Delayed Diagnosis ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography* ; Extremities* ; Fatigue ; Heart Septal Defects, Atrial* ; Humans

PURPOSE: To evaluate the relationship between the level of screw fixation and the stability of the segment of endplate fracture after posterior pedicle screw instrumentation for thoracic and lumbar burst fractures. MATERIALS AND METHODS: The 41 patients of burst fractures who had been operated with pedicle screw instrumentation were retrospectively evaluated. The patients were divided into two groups by the levels of screw fixation. One group was treated with screws fixed by one-level to the direction of fractured endplate (One-level group, 16 cases). The other group was treated with screws fixed by two-level to the direction of endplate fracture (Two-level group, 25 cases). The two groups were compared by the radiographic changes of kyphotic angle between the day of surgery and 6 months after surgery. RESULTS: At the 6 months, one-level group showed the change of kyphotic angle of 17.5+/-2.4 degrees, which was different from two-level group of 5.2+/-0.8 degrees (p=0.000). CONCLUSION: In posterior pedicle screws fixation for thoracic and lumbar burst fractures, 2 vertebrae to the direction of the endplate fracture should be included to prevent the postoperative kyphotic change.
Humans ; Retrospective Studies ; Spine

BACKGROUND: Increasing evidences from experimental studies indicate that apoptosis may be inversely related to angiogenesis in tumor progression. MATERIAL AND METHOD: To explore how apoptosis correlates with tumor angiogenesis, we measured the apoptotic index(AI) using the terminal deoxynucleotidyl transferase method(Apop Tag In Situ Apoptosis Detection Kit, ONCOR) and the intratumoral microvessel density using the anti-CD31 monoclonal antibody in non-small cell lung cancer. RESULT: Statistical analysis revealed an inverse correlation between AIs and intratumoral microvessel densities in squamous cell lung carcinoma(Spearman rank correlation coefficient r=- 0.229, p=0.047). CONCLUSION: The results of this study demonstrated that the amount of apoptosis in squamous cell lung carcinoma may be influenced by the extent of neovascularization. This suggests that tumor angiogenesis may contribute to a reduction of apoptosis in tumor cells.
Apoptosis* ; Carcinoma, Non-Small-Cell Lung* ; DNA Nucleotidylexotransferase ; Lung ; Lung Neoplasms ; Microvessels*

A case of peripheral superior cerebellar artery aneurysm was treated using neuroendovascular therapy. Not only its rarity but also some specific considerations for diagnostic and therapeutic approach of peripheral superior cerebellar artery aneurysms will be discussed herein.
Aneurysm* ; Arteries*

OBJECTIVES: We have aimed to estimate the direct and indirect costs of treating out-patients with schizophrenia in Korea, to use this fundamental data for the effective management and proper distribution of the medical resource. METHOD: To estimate the direct cost, we surveyed the medical cost and time of two hundred and eighty-nine out-patients with schizophrenia for six months. And the lost productivity as many months was converted into the indirect cost. Those of eighty-two coronary heart disease patients were also estimated as a comparison group. RESULTS: An unemployement rate of schizophrenic patients was 72.1 percent. Moreover the ratio of the laborer in the sample was, even if employed, 64.5 percent. The mean direct cost of schizo-phrenic patients was, about 815,000 won, higher than that of coronary heart disease, 715,000 won however it was not statistically significant. The former was also estimated 2.5 times more than the latter for the indirect cost, or 6,456, 000 won versus 2,589,000 won. CONCLUSION: Schizophrenia is a relatively costly illness compared to other chronic illness, so the systematic estimation of the cost is necessary to provide mental health service of high quality.
Chronic Disease ; Coronary Disease ; Efficiency ; Humans ; Korea* ; Mental Health Services ; Outpatients* ; Schizophrenia*

BACKGROUND AND OBJECTIVES: The pathologic Q wave was once considered to be a sign of transmural myocardial infarction (MI), but the exact meaning of the pathologic Q wave remains to be elucidated. To evaluate the meaning of the pathologic Q wave using magnetic resonance imaging (MRI) investigations, which has recently emerged as a state-of-the-art diagnostic modality within cardiology. SUBJECTS AND METHODS: Thirty eight consecutive patients with acute myocardial infarction were enrolled in this study. MRI and coronary angiography were performed in all patients during their admission. A 32 segment model was used to analyze the MRI findings. Just before MRI, the electrocardiograms of all the patients were checked and the presence of the pathologic Q wave evaluated. The ischemic territories in each patient were quantified by the number of dysfunctional segments. Myocardial necrosis was determined by the area of delayed hyperenhancement in contrast enhanced MRI, and the myocardial necrosis index per segment was defined as the ratio of the hyperenhanced area to that of the entire segment. The total necrosis index was defined as the sum of all the myocardial necrosis indices in a patient, and the average necrosis index of dysfunctional segment (ANI) was calculated from the total necrosis index/number of dysfunctional segments in a patient. The transmurality of infarction was also assessed. RESULTS: Of all 38 patients, 26 showed a pathologic Q wave on ECG (Group A), whereas the other 12 did not (Group B). The number of dysfunctional segments, total necrosis index and frequency of transmural infarction (defined by infarct transmurality> or = 75% of wall thickness) were no different between the two groups. The infarct transmurality over 25 or 50% and ANI were significantly different between the two groups. In a multivariate analysis, an infarct transmurality over 50% and ANI were significant factors in determining the presence of a pathologic Q wave. CONCLUSION: By an in vivo analysis of myocardial necrosis, as determined by MRI in acute myocardial infarction, an infarct transmurality over 50% and average necrosis index of dysfunctional segments (ANI) might be significant factors in the genesis of a pathologic Q wave.
Cardiology ; Coronary Angiography ; Electrocardiography ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Multivariate Analysis ; Myocardial Infarction* ; Necrosis

Primary cardiac malignancy is very rare. Angiosarcoma is the most frequent malignant cardiac tumor and associated with a very unfavourable outcome. We report the case of an cardiac angiosarcoma complicated with cardiac tamponade revealed by echocardiography with pericardiocentesis and confirmed histopathologically in a 25 years old man.
Adult ; Cardiac Tamponade* ; Echocardiography ; Heart Neoplasms ; Hemangiosarcoma* ; Humans ; Pericardiocentesis