A patient with extraskeletal cervical epidural Ewing's sarcoma who presented with cervical radiculopathy is reported. A 58-year-old woman presented with right posterolateral neck pain and upper extremity radiculopathy. The computed tomography myelography showed epidural and paravertebral masses on right side, with widening of the ipsilateral neural foramina at the C2-C3 level. On magnetic resonance images, the mass was isointense to soft tissue on T1-weighted images, hyperintense on T2-weighted images, and showed diffuse enhancement on GdTA enhanced T1-weighted images. The staged, combined posterior and anterior approach were done and the tumor mass was subtotally removed. During postoperative adjuvant chemotherapy with Cytoxane, Adriamycin, Vincristine, Prednisolone regimen, the patient died of severe compression of upper cervical cord by recurrent, extended tumor mass in the spinal canal.
Chemotherapy, Adjuvant ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Female ; Humans ; Middle Aged ; Myelography ; Neck Pain ; Prednisolone ; Radiculopathy ; Sarcoma, Ewing* ; Spinal Canal ; Upper Extremity ; Vincristine

In this retrospective study, 412 patients who had a curative resection with a lymph node dissection of higher level than D2 for gastric cancer at the Kwangju Christian Hospital from 1985 to 1991 were reviewed to analyze the dependence of their survival rate on lymph node metastasis results obtained by evaluating various metastatic patterns and on the spectrum of tumors(location, depth of invasion, size, and histologic type). The results are as follows: 1) Positive metastatic lymph nodes were found in 258(62.6%) of the 412 patients. When it came to the metastatic frequencies of each lymph node, No. 6 was involved in 40% of the cases(165 cases), No. 4 in 21.6%(87 cases), No. 3 in 20.1%(83 cases), No. 5 in 15%(62 cases), No. 8 in 14.3%(59 cases), No. 1 in 9.7%(40 cases), No. 7 in 8.9%(37 cases), and No. 9 in 8.2%(34 cases), which shows relatively higher metastatic frequencies for the perigastric lymph nodes than for the others. The 5-year survival rates for metastasis of various lymph nodes were 33.3% for No. 10, 20.4% for No. 3, 20% for No. 2, 20% for No. 13, 17.5% for No. 6, 16.6% for both No. 12 and 15, 15.7% for N0. 4, 12.9% for No. 5, 11.7% for N0. 9, 10.8% for No. 7, 8.4% for No. 8, 10% for both No. 1 and No. 11, 5.5% for No. 14 and 0% for No. 16. 2) When it came to the dependence of the metastatic frequencies of lymph nodes on the location of the gastric cancer, cancers in the lower third of the stomach showed the highest metastatic frequency in No. 6(39%), followed by No. 3(16.8%) and No. 4(16.2%) in that order. In the case of gastric cancer in the middle of the stomach, No. 6 showed the highest frequency at 48.6% followed by No. 3(26.3%), No. 4(23.6%), No. 5(17.1%), No. 8(17.1%), and No. 9(9.2%) in that order. In the case of gastric cancer in the upper third of the stomach, No. 3 showed the highest frequency at 47.6% followed by No. 1(47.6%), No. 4(38%), No. 6(23.8%), No. 5(19%), and No. 7(9.5%) in that order. This showed that in all lacations of gastric cancer, lymph node metastases were primarily observed among the perigastric N1 node group. 3) As the tumor invasion into the stomach wall grew deeper, metastases of the lymph nodes of N2 or higher groups increased. There was a significant difference in the metastatic frequencies of the lymph nodes between the proper muscle and the serosal layer. The survival rate dropped to a remarkable degree when the tumor invasion was deeper than the serosal layer. 4) Poorly differentiated adenocarcinomas were more frequently metastasized to the regional lymph nodes than well differentiated ones, and the metastasis extended to nonperigastric lymph nodes. The poorer the differentiation was, the lower the survival rate became. 5) The larger the size of the tumors was, the higher the lymph node metastatic frequency grew, reducing the survival rate. 6) When patients were in advanced stages of gastric cancer, the survival rate dropped considerably. 7) Based on the results mentioned above in which tumor invasion into the lymph nodes of N2 or higher groups were often observed and in which there were significant differences in the prognosis, we conclude that a gastrectomy with extensive lymphadenectomy at least up to the second node group(D2) might be the procedure of choice for advanced gastric cancer in order to improve the survival rate.
Adenocarcinoma ; Gastrectomy ; Gwangju ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach ; Stomach Neoplasms* ; Survival Rate*

In this retrospective study, 412 patients who had a curative resection with a lymph node dissection of higher level than D2 for gastric cancer at the Kwangju Christian Hospital from 1985 to 1991 were reviewed to analyze the dependence of their survival rate on lymph node metastasis results obtained by evaluating various metastatic patterns and on the spectrum of tumors(location, depth of invasion, size, and histologic type). The results are as follows: 1) Positive metastatic lymph nodes were found in 258(62.6%) of the 412 patients. When it came to the metastatic frequencies of each lymph node, No. 6 was involved in 40% of the cases(165 cases), No. 4 in 21.6%(87 cases), No. 3 in 20.1%(83 cases), No. 5 in 15%(62 cases), No. 8 in 14.3%(59 cases), No. 1 in 9.7%(40 cases), No. 7 in 8.9%(37 cases), and No. 9 in 8.2%(34 cases), which shows relatively higher metastatic frequencies for the perigastric lymph nodes than for the others. The 5-year survival rates for metastasis of various lymph nodes were 33.3% for No. 10, 20.4% for No. 3, 20% for No. 2, 20% for No. 13, 17.5% for No. 6, 16.6% for both No. 12 and 15, 15.7% for N0. 4, 12.9% for No. 5, 11.7% for N0. 9, 10.8% for No. 7, 8.4% for No. 8, 10% for both No. 1 and No. 11, 5.5% for No. 14 and 0% for No. 16. 2) When it came to the dependence of the metastatic frequencies of lymph nodes on the location of the gastric cancer, cancers in the lower third of the stomach showed the highest metastatic frequency in No. 6(39%), followed by No. 3(16.8%) and No. 4(16.2%) in that order. In the case of gastric cancer in the middle of the stomach, No. 6 showed the highest frequency at 48.6% followed by No. 3(26.3%), No. 4(23.6%), No. 5(17.1%), No. 8(17.1%), and No. 9(9.2%) in that order. In the case of gastric cancer in the upper third of the stomach, No. 3 showed the highest frequency at 47.6% followed by No. 1(47.6%), No. 4(38%), No. 6(23.8%), No. 5(19%), and No. 7(9.5%) in that order. This showed that in all lacations of gastric cancer, lymph node metastases were primarily observed among the perigastric N1 node group. 3) As the tumor invasion into the stomach wall grew deeper, metastases of the lymph nodes of N2 or higher groups increased. There was a significant difference in the metastatic frequencies of the lymph nodes between the proper muscle and the serosal layer. The survival rate dropped to a remarkable degree when the tumor invasion was deeper than the serosal layer. 4) Poorly differentiated adenocarcinomas were more frequently metastasized to the regional lymph nodes than well differentiated ones, and the metastasis extended to nonperigastric lymph nodes. The poorer the differentiation was, the lower the survival rate became. 5) The larger the size of the tumors was, the higher the lymph node metastatic frequency grew, reducing the survival rate. 6) When patients were in advanced stages of gastric cancer, the survival rate dropped considerably. 7) Based on the results mentioned above in which tumor invasion into the lymph nodes of N2 or higher groups were often observed and in which there were significant differences in the prognosis, we conclude that a gastrectomy with extensive lymphadenectomy at least up to the second node group(D2) might be the procedure of choice for advanced gastric cancer in order to improve the survival rate.
Adenocarcinoma ; Gastrectomy ; Gwangju ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach ; Stomach Neoplasms* ; Survival Rate*

PURPOSE: We report a case of presumed noninfectious endophthalmitis following intravitreal triamcinolone acetonide injection. METHODS: A 63-year-old female patient was treated with intravitreal triamcinolone acetonide for diabetic macular edema in her right eye. Two days after the injection, the patient complained of decreased visual acuity but didn't visit the hospital until five days after the injection. Visual acuity had dropped to hand motion, and the slit lamp examination showed 3+ cells and hypopyon in the anterior chamber. In the vitreous there was a dense haze completely obscuring the view of the fundus. RESULTS: The position of the hypopyon was gravity dependent and shifted with changes in the patient's head position. Vitreous taps and culture were performed followed by the intravitreal injection of vancomycin and ceftazidime. The anterior chamber had cleared and hypopyon resolved completely eight days after the original injection, but the diffuse vitreous haze remained. The vitreous haze resolved slowly over four weeks and visual acuity recovered to baseline vision. CONCLUSIONS: In the presence of inflammation signs after intravitreal triamcinolone acetonide injection, the differentiation of infectious endophthalmitis from noninfectious endophthalmitis is mandatory. The pseudohypopyon was distinguishable from an infective or inflammatory hypopyon by its shifting position, which was dependent upon the patient's head position. Close observation and differential diagnosis are needed to avoid unnecessary surgical intervention.
Anterior Chamber ; Ceftazidime ; Diagnosis, Differential ; Endophthalmitis* ; Female ; Gravitation ; Hand ; Head ; Humans ; Inflammation ; Intravitreal Injections* ; Macular Edema ; Middle Aged ; Triamcinolone Acetonide* ; Triamcinolone* ; Vancomycin ; Visual Acuity

BACKGROUND: Papillary thyroid cancer has a high frequency of lymph-node metastasis, but the methods for detecting and treating of lymph-node metastases remains controversial. We reviewed clinical analyses for lymph-node metastases. METHODS: Were retrospectively reviewed charts of 120 patients with papillary thyroid cancer who were treated from July 1994 to February 1997. Clinical aspects and the relationship between age, sex, tumor size, extracapsular invasion, multicentricity of the tumor and lymphadenopathy and the rate of lymph-node metastasis were investigated. RESULTS: Modified neck dissection was done in 97 patients, and lymph node metastases were detected in 72 patients (74.2%). Lymph-node meatastases were detected in 3 patients during routine central compartment neck dissection. The overall lymph-node metastasis was 62.5% (75 of 120). The mean number of metastastic nodes was 5.67, and the most frequent site was level VI. Lymph-node metastases were more frequent at a young age and for large sized tumors, extracapsular invasion and preoperatively palpable lymphadenopathy. CONCLUSIONS: The lymph-node metastatic rate is high for preoperatively palpable lymph node, tumor sizes over 4 cm, and extracapsular invasion (p<0.05). To reduce the recurrence rate, the surgeon shoud do a modified neck dissection on such above patients.
Humans ; Lymph Nodes* ; Lymphatic Diseases ; Neck Dissection ; Neoplasm Metastasis* ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms*

Primary tumors of the heart are rare, three quarter of the tumors are benign, and nearly half of the benign heart tumors are myxomas. Cardiac myxoma usually originate in the left atrium about 75 percent, however, only 3 to 4 percent of myxoma are detected in the left ventricle. We report on a 32 years old woman with left ventricular myxoma who presented with shortness of breath, chest tightness, and general weakness. Acute pulmonary embolism and left ventricular myxoma were found on a perfusion lung scan and echocadiogram. A mass located on septal wall of left ventricle was excised en bloc. The patient recovered uneventfully and careful follow up has be performed periodically.
Adult ; Dyspnea ; Female ; Follow-Up Studies ; Heart ; Heart Atria ; Heart Neoplasms ; Heart Ventricles ; Humans ; Lung ; Myxoma* ; Perfusion ; Pulmonary Embolism* ; Thorax

PURPOSE: The treatment of choice for well-differentiated thyroid cancer is surgical excision. However, the operation method is still controversial. Also, the operation method has been changing gradually. Thus, we reviewed the records of patients with well-differentiated thyroid cancer who had received operations in our hospital to assess the trend in surgical procedure, and to determine the proper procedure, method, considering both recurrence and complications. METHODS: We retrospectively analyzed the cases of 452 patients with differentiated thyroid cancer who had received operations from January 1989 to December 1998. We divided the 10 years into two periods; period I was from 1989 to 1993 (254 patients) and period II was from 1994 to 1998 (198 patients). We analyzed recurrences and complications according to the operation method, including neck lymph-node dissection. The incidences and locations of lymph- node metastasis were taken into account, too. The statistical analysis was done by using the Fisher's exact test. RESULTS: In period I, 147 patients (58%) received a total thyroidectomy, and in period II, all patients received total thyroidectomy. In period I, 24 patients (9.4%) had a recurrence, and in period II, 13 patients (6.6%) had a recurrence. In period I, 55 patients (21.7%) had postoperative hypoparathyr oidism, and in period II, 38 patients (19.2%) had postoperative hypoparathyroidism. In period I, 15 patients (5.9%) had postoperative hoarseness, and in period II, 7 patients (3.5%) had postoperative hoarseness. Two hundred eighty-one patients (62.2%) had lymph-node metastasis, and the anterior neck region was the most common site of metastasis (60.2%). CONCLUSION: In the operation method for differentiated thyroid cancer, the trend is toward a total thyroidectomy away from a lobectomy. Also, a skillful and experienced surgeon can reduce the incidence of postoperative complications. Thus the best operation method for differentiated thyroid cancer is a total thyroidectomy, including a preventive anterior-neck lymph-node dissection, which is done by a skillful and experienced surgeon.
Hoarseness ; Humans ; Hypoparathyroidism ; Incidence ; Neck ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

No abstract available.
Complement System Proteins* ; Otitis Media with Effusion* ; Otitis Media* ; Otitis*

OBJECTIVES: AGUS often reflects an immediate cervical cancer precursor such as a HSIL mimicking an endocervical glandular lesion. In this study, we attempted to assess the clinical significance of a cytologic diagnosis of atypical glandular cells of undetermined significance (AGUS) and determine the usefulness of the human papillomavirus (HPV) DNA testing as the triage strategies in evaluating AGUS. METHODS: Between 1994 and 1998, 67,730 Papanicolaou smears were evaluated at Kangnam and Uijongbu St Mary's Hospital. There were 87 (0.13%) cases of AGUS smears during that time. Colposcopy was performed on all women, and HPV DNA testing was performed on 11 persons. RESULTS: Mean age of these patients was 45.8 years. Histologic diagnosis of AGUS were kolocytosis and CIN-I in 6 (6.9%), CIS in one, endometrial hyperplasia in 2 (2.3%), endometrial adenocarcinoma in 7 (8.0%), cervical adenocarcinoma in 14 (16.1%) and cervical squamous cell carcinoma in 2 (2.3%) cases. Endometriosis was 8.9% under 46 years old and none in over 46. CIN was 8.9% and 7.2%, respectively. Cervical adenocarcinoma was 6.7% under 46 and 19.1% over 46. Endometrial cancer was 4.4% and 11.9%, respectively. The risk of cervical cancer and endometrial cancer was high in the AGUS with Adenocarcinoma ; Carcinoma, Squamous Cell ; Colposcopy ; Diagnosis ; DNA* ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometriosis ; Female ; Human Papillomavirus DNA Tests ; Humans ; Middle Aged ; Papanicolaou Test ; Triage ; Uterine Cervical Neoplasms

BACKGROUND AND OBJECTIVES: The myocardial protective effect of ischemic preconditioning is well known. However, the mechanism is remains unclear. The purpose of this study is to determine the role of adenosine, protein kinase C, KATP channel and the change of monophasic action potential duration on cardioprotective effect of ischemic preconditioning in cat. Materials AND METHODS: In this experiment, 66 cats were allocated into 7 groups:control (n=10), ischemic preconditioning (n=10), adenosine pre-treated (n=10), SPT (8-p-sulfophenyl theophylline) pre-treated (n=9), polymyxin B pre-treated (n=9), glibenclamide pre-treated (n=9) and nicorandil pre-treated (n=9) groups. Ischemic preconditioning was performed in ischemic preconditioning, SPT pre-treated, polymyxin B pre-treated and glibenclamide pre-treated groups by 3 episodes of 5 minutes ischemia and 10 minutes reperfusion. All animals were subjected to 40 minutes of ischemia and 40 minutes reperfusion. Monophasic action potential duration at 50% repolarization (MAP50) was measured in the ischemic and non-ischemic area respectively by epicardial probe throughout the experiment. The effect of ischemic preconditioning was determined by infarct size (% area at risk). RESULTS: Ischemic preconditioning, adenosine pre-treatment and nicorandil pre-treatment groups demonstrated a significant reduction in infarct size (26+/-4%, 25+/-4% and 34+/-8% infarction of the risk zone, respectively, p<0.01, p<0.01 and p<0.05 vs. control) with respect to control (41+/-8% infarction of the risk zone). However, pretreatment with SPT, polymyxin B or glibenclamide abolished the effect of ischemic preconditioning. Ischemic preconditioning group exhibited a significant reduction of MAP50 duration in the ischemic area during preconditioning;at the first preconditioning 128+/-11 msec vs. 144+/-10 msec control, at the second preconditioning 110+/-10 msec vs.147+/-10 msec control (p<0.01), at the third preconditioning 114+/-10 msec vs. 145+/-11 msec control (p<0.05). But, pretreatment with SPT, polymyxin B and glibenclamide prevented the reduction of MAP50 in the ischemic area during ischemic preconditioning. During 40 minutes ischemia, the shortening of MAP50 was more pronounced in the preconditioned group than in control group;at 5 minutes 112+/-13 msec vs. 124+/-10 msec control, at 10 minutes 89+/-12 msec vs. 133+/-11 msec control (p<0.05 ), at 20 minutes 93+/-12 msec vs. 136+/-11 msec control (p<0.05), and at 30 minutes 107+/-19 msec vs. 144+/-14 msec control (p<0.05). In adenosine pre-treated group, the MAP50 was significantly shortened than control group throughout 40 minutes occlusion period;at 5 minutes 90+/-8 msec (p<0.05), at 10 minutes 77+/-9 msec (p<0.05), at 20 minutes 92+/-8 msec (p<0.05), and at 30 minutes 103+/-8 msec (p<0.05). Nicorandil pretreatment pronounced the ischemic shortening of MAP50 in ischemic area and the effect was significant during early ischemic period;at 10 minutes 98+/-22 msec (p<0.05 vs. control). In pretreatment groups with SPT, polymyxin B or glibenclamide, the ischemic preconditioning of MAP50 measured in non-ischemic area was not significantly different compared with control group. MAP50 measured in ischemic area during reperfusion was not significantly different between groups. CONCLUSION: Based on this study, adenosine receptor-protein kinase C-KATP channel activation and monophasic action potential duration shortening during ischemia play an important role in myocardial protection during ischemic injury.
Action Potentials* ; Adenosine* ; Animals ; Cats* ; Glyburide ; Infarction ; Ischemia ; Ischemic Preconditioning* ; Nicorandil ; Phosphotransferases ; Polymyxin B ; Protein Kinase C* ; Protein Kinases* ; Receptors, Purinergic P1* ; Reperfusion