No abstract available.
Multicystic Dysplastic Kidney* ; Ultrasonography*

Hemangiopericytomas, which used to be classified as the subtype of the meningiomas, like the angioblastic meningiomas or hemangiopericytic meningiomas, are rare in the central nervous system with an incidence of <1% of all central nervous system(CNS) tumors. In spite of a total surgical removal, hemangiopericytomas have a tendency of high local recurrence and distant metastasis. The authors report a case of hemaniogipericytoma recurred at the remote area from the primary site. The tumor recurred in the meninges of right temporal area after total removal of the tumor in the right parasaggital region including the falx.
Central Nervous System ; Hemangiopericytoma* ; Incidence ; Meninges ; Meningioma ; Neoplasm Metastasis ; Recurrence

PURPOSE: Phyllodes tumor is a rare fibroepithelial tumor of the breast, first described by Johannes Muller in 1838. Much has been written about phyllodes tumor, but very few widely accepted conclusions about its clinical behavior, treatment modality, and prognosis have been reached. This study aims to analyze the clinical, radiological, and pathological characteristics of phyllodes tumor of the breast. METHODS: The medical records of 41 patients with phyllodes tumor who had been treated between February 1982 and August 1998 at the Department of Surgery, Seoul National University Hospital, were retrospectively reviewed for clinical, radiological and pathological findings, treatment modalities, and follow-up results. RESULTS: Of these 41 cases, there were 28 cases (68.3%) of benign tumors and 13 cases (31.7%) of malignanat tumors. All patients were females, and the mean ages of onset were 33.2 years for benign tumors and 40.8 years for malignant tumors. Most patients, 100% of benign and 92.3% of malignant, presented with a papable mass in the breast. The median duration of illness was 2 months for malignant tumors and 8 months for benign tumors. The tumor size was greater than 10 cm in diameter in 5 cases (38.5%) of malignant tumors and in 3 cases (10.7%) of benign tumors. Only 4 cases were preoperatively diagnosed as having a phyllodes tumor by using radiological and fine needle aspiration cytology. Out of the 10 malignant cases reviewed, 5 cases were confirmed as malignant, and 5 cases were confirmed as borderline phyllodes tumors. Cellularity was moderate or above in all 5 malignant and 5 borderline cases. Atypism above moderate degree was found in 4 of 5 (80%) malignant tumors, in 3 of 5 (60%) borderline tumors, and in 4 of 24 (16.7%) benign tumors. Mitotic counts in all 5 malignant cases were 5 or more per 10 high power field while those in the 5 borderline tumors were 2-5 mitoses per 10 high power field. The most commonly performed operative procedures were a simple mastectomy (50%) for malignant tumors and a simple excision (64.3%) for benign tumors. Post-operative adjuvant therapy was done for 4 cases; out of these, 1 case had been initially diagnosed as a malignant phyllodes tumor, but the diagnosis was changed to a benign phyllodes tumor upon review. Of the 27 follow-up cases, recurrences developed in 3 cases (16.7%) of benign tumors. CONCLUSION: From the above results, there were no specific clinical features for differentiating benign from malignant phyllodes tumor preoperatively; therefore, we cannot help depending on the pathologic findings. Pathologic reviews showed that among several criteria, atypism, cellularity, and mitotic count were the most definite pathologic characteristics in differentiating benign from malignant phyllodes tumor. But much more experience and long-term follow-up may be needed to define optimal treatments and to analyze the prognosis for phyllodes tumors of the breast.
Biopsy, Fine-Needle ; Breast* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Mastectomy, Simple ; Medical Records ; Mitosis ; Phyllodes Tumor* ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Surgical Procedures, Operative

Esophageal perforation continues to be associated with high mortality - 20% to 30% - despite advances in surgical techniques. Traditional surgery has been the mainstay of treatment for perforation, but recent advances in endoscopic closure devices has increased therapeutic options for selected patients. Our patient had a fishbone-induced esophageal perforation. He was treated successfully with endoscopic clipping, antibiotics and parenteral nutrition. We report this case and provide a review of the relevant literature.
Anti-Bacterial Agents ; Esophageal Perforation ; Foreign Bodies ; Humans ; Parenteral Nutrition

BACKGROUND AND OBJECTIVES: Age and gender are known to influence the mechanisms of paroxysmal supraventricular tachycardia (PSVT), but large scale data regarding this subject is limited. In addition, data regarding the mechanisms of PSVT in the Korean population is limited. In this study, we sought to investigate the different mechanisms of PSVT according to age and gender in Korean patients. SUBJECTS AND METHODS: Database of 3,176 patients diagnosed with PSVT excluded atrial flutter or atrial fibrillation and referred for electrophysiologic study from 1986 to 2004 was retrospectively analyzed. The mechanisms of PSVT were classified as: WPW syndrome (WPW), atrioventricular reentrant tachycardia (AVRT) due to a concealed bypass tract (CBT), atrioventricular nodal reentrant tachycardia (AVNRT), atrial tachycardia (AT). RESULTS: The mean age was 40.7+/-16.0 (1-90) and 53.3% of the patients were male. The mean age of females was significantly higher than males. (43.0+/-16.1 vs. 38.6+/-15.6, p<0.001) Overall, the dominant mechanism of tachycardia was AVRT at 62.6% (WPW: 31.1%, CBT: 31.5%), compared to AVNRT at 34.1 and AT at 3.1%. This was mainly due to the predominance of AVRT (74.2%; WPW: 38.1%, CBT: 361%) in male. The mechanisms of PSVT differed according to gender with 63.2% (1257/1988) of AVRT patients being males where as 64.6% (700/1084) of the AVNRT patients were females. The distribution of PSVT mechanisms differed according to gender. In males, the proportions of AVNRT : CBT : WPW were 22.7 : 36.1 : 38.1%, whereas in females the proportion was 47.2 : 26.3 : 23.0%. Age had a significant influence upon the mechanism of PSVT in both genders with an increasing proportion of AVNRT and a decreasing proportion of AVRT in the older age groups. AVRT was the dominant mechanism of PSVT in all age groups for males, where as AVNRT was the dominant mechanism of PSVT for females over 50 years of age. CONCLUSION: The mechanism of PSVT differs significantly according to age and gender. This may be due to the increased degeneration of accessory pathway with age and difference in the conduction properties of the accessory pathway according to gender. In Koreans, the overall dominant mechanism of PSVT was AVRT mainly due to it a greater male population.
Atrial Fibrillation ; Atrial Flutter ; Female ; Gender Identity ; Humans ; Male ; Retrospective Studies ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular* ; Wolff-Parkinson-White Syndrome

PURPOSE: Hemodialysis remains the most important support for patients with end stage renal disease, and vascular access is an essential component for their life. Since 1966, internal arteriovenous fistula (AVF) has been used widely today. If vessels were not available for AVF, the alternative would be used such as prosthetic graft. But in 1997, the National Kidney Foundation-Dialysis Outcome and Quality Initiative (DOQI) recommended increased use of native arteriovenous fistula to improve overall patency and curtail angioaccess costs. This retrospective study is to review our experience and to evaluate the overall patency rate and the influencing factors on the patency of the AVF. METHOD: From March 1995 through October 2000, 111 fistulas were created of 111 patients in Eulji university hospital. Among them, 106 cases were able to follow up survey. The statistical analysis used by SPSS package. RESULT: The male versus female ratio was 1.22:1 and the age distribution was occurred on from 3rd decade to 9th decade. the common causes of renal failure was hypertension, glomerulonephritis and diabetes (62.1%). the autogenous graft fistulas were performed in 101 cases (wrist/antecubital fossa. 101/3), Goretex graft fistula were 7 cases. The early graft failures were 12 cases (11.4%) and the causes was thrombosis or stricture, and immaturation, psudoaneurysm, venous hypertension in order of frequency. At 12, 24, 36 months, the assisted patency rates of AVF were 80.4, 76.5, 71.3%, respectively. CONCLUSION: We could get higher patency rate of AVF due to liberal use of native veins and aggressive intervention of the failing AVF as recommendation of DOQI.
Age Distribution ; Arteriovenous Fistula* ; Constriction, Pathologic ; Female ; Fistula ; Follow-Up Studies ; Glomerulonephritis ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Male ; Polytetrafluoroethylene ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Thrombosis ; Transplants ; Veins

BACKGROUND: Many methods are available for the monitoring of spinal cord injury during an operation. During anesthesia, somatosensily evoked potentials (SSEP) may undergo substantial changes in the latencies and amplitudes which may be interpreted as pathological. It is essential for the anesthesiologist to know the potential interactions between anesthetic drugs and neurophysiologic responses during operation. The depressant effect of inhalation agents on the central nervous system exceeds commonly used intravenous anesthetics. Therefore, intravenous anesthesia is preferred to inhalation agents. This study was designed to compare the effects of intravenous anesthetics (propofol and fentanyl) and inhalational anesthetics (enflurane and nitrous oxide) used in the operation room. METHODS: According to the inclusion criteria of ASA I-II, 40 patients who were free of neurologic disease with electric abdominal operations were randomly selected. The baseline of the SSEPs were recorded with stimulation of the posterior tibial nerve at the ankle. After obtaining the baseline (preinduction) of the SSEPs, intravenous anesthetics (propofol 10 mg/kg/h, fentanyl 1 2 microgram/kg) and inhalational anesthetics (end tidal enflurane concentration 1.0 vol %, 50% nitrous oxide in oxygen) were administered. 30 minutes after induction (steady state), additional SSEPs were recorded. Mean arterial pressure, heart rate, temperature and arterial blood carbon dioxide tension were monitored. RESULTS: There were no significant differences in the baseline of SSEPs between the intravenous anesthetics group and the inhalational anesthetics group. There were no significant differences in latencies and amplitudes between the preanesthesia state and the postanesthetia state in the intravenous anesthetics group. But the inhalational anesthetics group revealed prolonged latencies in the postanestesia state as compared with their preanesthesia state. CONCLUSIONS: The above findings suggest that the use of intravenous anesthetics can be beneficial to intraoperative SSEP monitoring for possible damage to the central nervous system during operations.
Anesthesia ; Anesthesia, Intravenous ; Anesthetics* ; Anesthetics, Intravenous ; Ankle ; Arterial Pressure ; Carbon Dioxide ; Central Nervous System ; Enflurane ; Evoked Potentials* ; Fentanyl ; Heart Rate ; Humans ; Inhalation ; Nitrous Oxide ; Spinal Cord Injuries ; Tibial Nerve

No abstract available.
Diabetes Mellitus, Type 2* ; Humans

OBJECTIVE: This study is designed to demonstrate a relationship between reconstruction methods of the craniectomy site and the development of postoperative complications including headache, tinnitus, and operation site pain after microvascular decompression(MVD) in patients with hemifacial spasm. METHODS: This study included 44 consecutive patients who underwent MVD due to hemifacial spasm from 1995 to 2001. Craniectomy site was reconstructed with only Gelfoam(group 1) in 20, the bone dust and Gelfoam(group 2) in 11, the bone chips and Gelfoam(group 3) in 13. Group 1, 2 were studied retrospectively and group 3 was studied prospectively on the postoperative complications. RESULTS: Postoperatively, wound infection occurred in 3(6.8%), headache in 14(31.8%), operation site pain in 17(38.6%), tinnitus in 15(34.1%), hearing loss in 1(2.2%). Wound infection was noticed in 5% of group 1, 18.2% of group 2, and none of group 3. Headache developed in 45% of group 1, 27.3% of group 2, and 15.4% of group 3. Operation site pain was noticed in 50% of group 1, 27.3% of group 2, 15.4% of group 3. Tinnitus revealed in 45% of group 1, 18.2% of group 2, 30% of group 3. CONCLUSION: Reconstruction of the craniectomy site with the bone chips in patients with hemifacial spasm might have effects on diminution of the postoperative headache, operation site pain and wound infection.
Dust ; Headache ; Hearing Loss ; Hemifacial Spasm* ; Humans ; Postoperative Complications ; Prospective Studies ; Retrospective Studies ; Tinnitus ; Wound Infection

Background: This study aimed to explore the time interval distribution pattern between the Physicians Order for Life-Sustaining Treatment (POLST) form completion and death at a tertiary hospital in South Korea. It also examined the association between various independent parameters and POLST form completion timing. Methods: A total of 150 critically ill patients admitted to Korea University Guro Hospital between June 1, 2018 and December 31, 2018 who completed the POLST form were retrospectively analyzed and included in this study. Data were analyzed with descriptive statistics, and group comparisons were performed using the chi-square test for categorical variables. Fisher’s exact test was also used to compare cancer versus non-cancer groups. Results: More than half the decedents (54.7%) completed their POLST within 15 days of death and 73.4% within 30 days. The non-cancer group had the highest percentage of patients (77.8%) who died within 15 days of POLST form completion while the colorectal (39.1%) and other cancer (37.5%) groups had the lowest (P=0.336). Conclusion Our findings demonstrated a current need for more explicit guidance to assist physicians with initiating more timely, proactive end-of-life discussions.