PURPOSE: The subconjunctival sparganosis is rare tissue helminthiasis which developed frequently in abdominal, urethral, ureteral and vertebral cases. Authors report a case of sparganosis in the subconjunctival mass. METHODS: A 51-year-old man with reddish non painful mass in his left eye on the subconjunctiva that was unresponsive to medications for 6months was evaluated and treated surgically. On surgical exploration, a white thread-like plerocercoid 0.2 x 4.7 cm in size was extracted from the subconjunctival mass and actively motile in the bottle filled with saline. It was confirmed as a typical sparganum under histologic examination. Three months after surgery, the lesion disappeared completely. RESULTS: Although rare, parasitic disease should be suspected in a palpable subconjuntival mass unresponsive to the medical treatment.
Helminthiasis ; Humans ; Middle Aged ; Parasitic Diseases ; Sparganosis* ; Sparganum ; Ureter

Osteogenic sarcoma is a malignant primary tumor of bone composed of a malignant connective tissue stroma with evidence of malignant osteoid, bone and/or cartilage formation. A 23 year old man was admitted to dental department of Yeungnam University hospital with chief complaint of swelling and pain on alveolar ridge of lower right molar region. It was certain of osteogenic sarcoma through clinical and radiographic features and biopsy. Surgical resection of the lesion was performed by partial mandibulectomy and resin plate insertion. By follow up check of the patient, we made good result of functional reconstruction without any sign of recurrence of the lesion.
Alveolar Process ; Biopsy ; Cartilage ; Connective Tissue ; Follow-Up Studies ; Humans ; Mandible* ; Molar ; Osteosarcoma* ; Recurrence

OBJECTIVES: To clarify the clinicopathologic features of borderline malignancy of the ovary and analyze the treatment and survival characteristics through the study of our cases. Study METHODS: 102 patients with borderline tumors of the ovary, aged from 14 to 79 years, treated between 1982 and 1999 at Seoul National University Hospital, were analyzed retrospectively for clinicopathologic features. Most informations about stage, treatment modality and prognosis were obtained by hospital record or contacting patient with telephone. RESULTS: There were 77 patients (75.5%) with stage Ia, 5 stage Ib, 11 stage Ic, 4 with stage II and 5 with stage III by the classification of FIGO. 72 patients (70.6%) were mucinous type and 28 (27.5%) were serous type, 1 endometrioid type, 1 mixed. Total abdominal hysterectomy, bilateral adnexectomy, and omentectomy were performed in 43 (42.2%) patients and fertility saving surgery in 43 patients(cystectomy in 11 patients, USO in 32 patients). Twenty two patients (21.6%) were treated with postoperative adjuvant chemotherapy. The median duration of follow up was 54.0 months (1-204 months) and 6 patients developed recurrence after several years from the primary operation. The ten-year eumulative survival rate was 92.2% and the only independent prognostic factors evaluated by Cox analysis in regards to corrected survival were the FIGO stage (p=0.0197). There was no difference in the ten-year survival rate between surgery types - conservative surgery versus full surgical staging. And there was no difference in the 10-year survival rate between treatment groups - surgery only versus surgery followed by adjuvant chemotherapy. CONCLUSIONS: FIGO stage is the only independent prognostic factor in the borderline ovarian tumors. There was no difference in the 10-year survival rate of barderline ovarian tumors between surgery alone versus surgery followed by adjuvant chemothearpy. The slow clinical course, low recurrence rate and good prognosis in our patients explained again the reason for therapeutic approach relying on surgery alone.
Chemotherapy, Adjuvant ; Classification ; Female ; Fertility ; Follow-Up Studies ; Hospital Records ; Humans ; Hysterectomy ; Mucins ; Ovary* ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate ; Telephone

PURPOSE: This study was attemped to investigate the prognostic factors for the outcome of stage I renal cell carcinoma after radical nephrectomy. MATERIALS AND METHODS: Twenty nine patients treated from 1984 to 1995 at Kyung Hee University Medical Center were studied retrospectively. All of them were diagnosed with pathologic Robson stage I renal cell carcinoma after radical nephrectomy. RESULTS: Males were affected three times more frequently than females. The tumor was detected on the right kidney in 15 cases, and on the left in 14. Average follow up period was 36.6 months, average disease free interval was 29.4 months and median survival was 30 months. During the follow up, 9 patients (31.0%) expired due to liver and lung metastasis at postoperate 21.6 months on average. Eleven patients (37.9%) developed distant metastasis in the follow up. There was no local recurrence of tumor. Seventeen patients were diagnosed incidentally without clinical symptoms. In our retrospective study for stage I renal cell carcinoma, there were no predictive prognostic parameters for predicting the outcome of patients, except for the incidental diagnosis of the tumor. CONCLUSIONS: These results suggest that incidental diagnosis of the tumor may be the most important prognostic factor for the outcome of stage I renal cell carcinoma. Although the patients were confirmed as stage I renal cell carcinoma pathologically after radical nephrectomy, close follow up is very important, because of high incidence of metastasis. We recommand that chest X-ray, abdominal ultrasonogram and bone scan should be checked at 3 months interval for postoperative one year even though stage I renal cell carcinoma.
Academic Medical Centers ; Carcinoma, Renal Cell* ; Diagnosis ; Early Diagnosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Kidney ; Liver ; Lung ; Male ; Neoplasm Metastasis ; Nephrectomy ; Recurrence ; Retrospective Studies ; Thorax ; Ultrasonography

Reconstruction in the head and neck region uses a wide range of surgical flaps for defect closure. The methods range from local, mostly myocutaneous flaps, and skin grafts to free microsurgical flaps. Reconstructive surgery must conserve the appearance and mimic the original function. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. To achieve these goals, a thin reliable flap that is close to the face and neck region with a good match of the skin texture and a smooth, hairless skin surface is needed. So we used a flap from the shoulder region which provides an optimum skin texture to match the neck and face. This supraclavicular flap is a fasciocutaneous island flap, which has a vascular pedicle extending from the transverse cervical artery with two accompanying veins. Moreover, the tunneling method improves the donor site by reducing scarring. We hereby introduce the anatomic characteristics and effectiveness of this method.
Arteries ; Cicatrix ; Head* ; Humans ; Myocutaneous Flap ; Neck* ; Shoulder ; Skin ; Surgical Flaps ; Tissue Donors ; Transplants ; Veins

BACKGROUNDS: Katz index of ADL and Barthel index of ADL have been used to evaluate the function of disabled elderly in Korea. But no ADL scale reflecting Korean's own language expression and culture has been developed and verified yet. METHODS: Descriptions of basic activities which needed others' help were collected from 190 Korean disabled elderly. The collected results were categorized into basic activities of daily living and instrumental activities of daily living, and then in each domain such as bathing, shopping, etc. Preliminary instrument items were selected by the judgement of the expert committee, considering the frequency of the responses and the importance of each item. A preliminary questionnaire was developed based on the selected items. The preliminary questionnaire was pretested twice, and corrected by the results. Finally a scholar on Korean literature verified the questionnaire on the grammar and context. RESULTS: A total of 408 basic activities of daily living and 242 instrumental activities of daily living were collected. The activities were categorized into 7 domains of ADL(dressing, washing face and hand, bathing, eating, transfer, toileting, continence) and 10 domains of IADL(decorating, housework, preparing meals, laundry, outgoing for a short distance, using transportation, shopping, handling money, using telephone, taking medicine) CONCLUSIONS: We developed a Korean Activities of Daily Living(K-ADL) scale and Korean Instrumental Activities of Daily Living(K-IADL) scale reflecting Korean elderly's own language expression and culture.
Activities of Daily Living ; Aged ; Baths ; Eating ; Hand ; Housekeeping ; Humans ; Korea ; Meals ; Surveys and Questionnaires ; Telephone ; Transportation

BACKGROUND: In general, pulse pressure of a VPC depends on its prematurity and the site of origin. The pulse pressure of a VPC with a short coupling interval or originating from the left ventricle tends to be smaller. However, the hemodynamic change of a VPC originating from the right ventricular outflow tract (RVOT) is not well elucidated. In addition to their prematurity and the site of the origin of VPCs, the left ventricular filling profile (Ei/Ai ratio) during preceding control beats may affect the occurrence of a subsequent pulse deficit. The purpose of this study is to evaluate the hemodynamic change of different coupling intervals of VPCs originating from the RVOT. Furthermore, this study evaluates whether the left ventricular filling profile during preceding control beats significantly affects the occurrence of pulse deficits by VPCs. METHODS: In 12 open-chest dogs anesthetized with a -chloralose, sinus node crushing was done, and then a single bipolar ventricular pacing using sutured epicardial electrodes was done at 3 different sites: left ventricular apex (LVA), right ventricular apex (RVA), RVOT. At each site, a single bipolar pacing was done with a different coupling interval: 500 msec, 450 msec, 400 msec, 350 msec, 300 msec. During the production of VPCs, the mitral filling flow velocity and aortic TVI (time-velocity integral) using pulsed wave Doppler echocardiography, the femoral arterial pressure, the pulmonary arterial pressure, the electrocardiogram, and the intracardiac electrocardiogram were simultaneously recorded. RESULTS: The arterial pressure during VPC with a short coupling interval was significantly smaller regardless of the site of origin (p<0.05). The arterial pressure with VPCs originating from the RVOT was significantly more reduced than those from the RVA at a same coupling interval (p<0.05). However, the arterial pressure with originating from the LVA was insignificantly reduced than those from the RVOT. The pulmonary arterial pressure with originating from the RVOT was significantly reduced more than those from the LVA at a same coupling interval, except at the coupling interval of 500 msec (p<0.05). However, the pulmonary arterial pressure with VPCs originating from the RVA was insignificantly reduced than those from the RVOT. The aortic TVI during VPCs originating from the LVA was significantly reduced than those from the RVA or the RVOT at a same coupling interval (p<0.05). However, when the aortic TVI during VPCs originating from the RVOT was compared to that during VPCs from RVA, the former was significantly reduced at certain coupling interval (450 msec, p<0.05). A significant positive correlation was observed between the Ei/Ai ratio of preceding control beats and the pulse deficit coupling intervals during VPCs (p<0.05). CONCLUSION: The above results show that the origin of the site and the coupling interval of VPCs play a major role in determining hemodynamic outcomes during the occurrence of VPCs. The hemodynamic changes during VPCs originating from the RVOT seem to be similar with those during VPCs originating from the RVA. Furthermore, there is a positive correlation between the left ventricular filling pattern (Ei/Ai ratio) of preceding sinus beats and the pulse deficit coupling intervals of VPCs.
Animals ; Arterial Pressure ; Blood Pressure ; Dogs* ; Echocardiography, Doppler ; Electrocardiography ; Electrodes ; Heart Ventricles ; Hemodynamics* ; Sinoatrial Node ; Ventricular Premature Complexes*

PURPOSE: This study was to evaluate the efficiency of routine performance of a batch of tests in the clinical staging work-up of cervical carcinoma. MATERIALS AND METHODS: The medical records were reviewed for 1,393 consecutive cervical carcinoma patients who underwent pretreatment staging work-up in Seoul National University Hospital from January 1988 to December 1997. The impression stage -which is designated ten tatively by the findings of pelvic examination and biopsy-, the results of staging work-up, and the finally allotted FIGO clinical stage were reviewed. The annual trend of stage distribution and the positive yields of tests were evaluated. RESULTS: Annual trend shows that Ia is increasing. The positive yield of chest x-ray was 0.22% (3/1, 379; Ib: 1, IIa: 1, IIb: 1), intravenous pyelography (IVP) 2.50% (31/1, 242; Ib: 2, IIa: 4, IIb: 17, IIIb: 8), cystoscopy 0.55% (6/1, 093; IIb: 4, IIIb: 2), and proctosigmoidoscopy 0.086% (1/1, 157; Ib: 1). After completing the staging work-up, 29 patients (2.08%) were upstaged. The routine performance of IVP in impression stage Ia and cystoscopy in impression stage IIa or less was considered inefficient. The routine performance of proctosigmoidoscopy was considered inefficient because of its very low yield. CONCLUSION: The selective performance of tests according to the impression stage during staging work-up is recommended to minimize the unnecessary treatment delay, cost, and patients' discomfort.
Cystoscopy ; Gynecological Examination ; Humans ; Medical Records ; Seoul ; Sigmoidoscopy ; Thorax ; Urography ; Uterine Cervical Neoplasms

BACKGROUND: Atrial fibrillation (Af) after open heart surgery may result in hypotension, heart failure, embolic complication and prolongation in length of hospital stay. Several studies have investigated the efficacy of pharmacological prophylaxis in reducing the incidence of Af after cardiac surgery. The pericardial sac represents a natural physical barrier and provides a drug receptacle to restrict drug delivery to the heart. The overall objective of this study was to determine whether the pericardial sac could function as a delivery chamber for antiarrhythmic drugs. We investigated whether quinidine delivered into the pericardial sac exerted an effect on atrial and ventricular refractoriness, impulse generation, and conduction. METHODS: All animals were anesthetized with alpha-chloralose. After a sternotomy, the pericardium was opened and cradled to produce a "container" of approximately 30 ml. Experimental animals received quinidine, 3.33 mg/ml, dissolved in Krebs-Henseleit solution instilled into their pericardial sacs for 30 minutes. Baseline and 5, 10 and 30 minutes postinstillation electrophysiologic studies were performed. Plasma quinidine levels were measured at each of the time intervals in three different sites i.e., right ventricle (RV), aortic root and femoral vein (FV). RESULTS: Baseline systolic (SAP) and diastolic aortic pressure (DAP) were 148+/-16.8 mmHg, and 111+/-23.9 mmHg, respectively. Both SAP and DAP were significantly decreased at 5, 10 and 30 minutes after instillation of quinidine solution into pericardial sac. In electrocardiographic parameters, the increase in sinus cycle length and corrected QT interval were significantly greater compared with baseline at each of the time intervals after instillation of quinidine solution into pericardial sac. All electrophysiologic parameters including 1:? AV conduction, effective refractory period (ERP) of RA and RV were significantly increased compared with baseline at three time points. Quinidine concentrations in RV and aorta were significantly higher than in FV at three time points. In RV and aorta, quinidine concentrations at 30 min were significantly lower than those at 5 and 10 min postinstillation periods. There were significant correlations between plasma quinidine levels and corrected QT interval or RAERP. CONCLUSION: Above results showed that quinidine instilled into the pericardial sac migrates transmurally and produces significant prolongation of effective refractory period and may appear to prevent various arrhythmias including atrial fibrillation after cardiac surgery.
Animals ; Anti-Arrhythmia Agents ; Aorta ; Arrhythmias, Cardiac ; Arterial Pressure ; Atrial Fibrillation ; Chloralose ; Electrocardiography ; Electrophysiology ; Femoral Vein ; Heart ; Heart Failure ; Heart Ventricles ; Hypotension ; Incidence ; Length of Stay ; Pericardium ; Plasma ; Quinidine* ; Sternotomy ; Thoracic Surgery

OBJECTIVE: To prospectively evaluate the feasibility, safety, and survival of laparoscopic surgical staging in patients with locally advanced cervical cancer. METHODS: From Oct 2001 to Jul 2006, a total of 83 consecutive patients were eligible for inclusion and underwent laparoscopic surgical staging. RESULTS: Three patients with intraoperative great vessel injury and 1 patient in whom the colpotomizer was unable to be inserted were excluded. Laparoscopic surgical staging was feasible in 95.2% (79/83). Immediate postoperative complications were noted in 12 (15.2%) patients. Prolonged complications directly related to operative procedures numbered 2 (2.5%), and were trocar site metastases. The mean time from surgery to the start of radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) was 11 (5-35) days. All patients tolerated the treatment well and completed scheduled RT or CCRT without disruption of treatment and additional admission. The rate of modification of the radiation field after surgical staging was 8.9% (7/79). Five-year progression-free survival and overall survival (OS) rates were 79% and 89%, respectively. The OS of patients with microscopic lymph node metastases, which were fully resected, were comparable to those of patients without lymph node metastasis. However, the OS of patients with macroscopic lymph node metastases that were fully resected were poorer compared with those of patients without lymph node metastasis. CONCLUSION: Pretreatment laparoscopic surgical staging is a feasible and safe treatment modality. However the survival benefit of debulking lymph nodes or full lymph node dissection is not clear.
Chemoradiotherapy ; Disease-Free Survival ; Glycosaminoglycans ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Postoperative Complications ; Prospective Studies ; Surgical Instruments ; Surgical Procedures, Operative ; Uterine Cervical Neoplasms