PURPOSE: Extensive involvement of the abdominal wall or the diaphragm by benign or malignant tumor usually has precluded wide excision. The major reason has been the lack of a satisfactory replacement for the abdominal wall or the diaphragm. When skin and subcutaneous tissues can be preserved, it is possible to restore the abdominal wall or diaphragm by using expanded polytetrafluoroethylene (GORE-TEX soft tissue patch). METHODS: From August 1993 to November 1999, we performed 6 reconstructions of the large abdominal wall or diaphragmatic defects using ePTFE following wide en bloc resection of the abdominal wall or diaphragm. RESULTS: The patients included 4 cases requiring a reconstruction of the abdominal wall. These consisted of one transverse colon cancer invading into the upper abdominal wall, a multiple teratoma recurring in the lower part of the abdominal wall, a recurrent cervix cancer inn the median line of the lower part of the abdominal wall, and an enormous desmoid tumor appearing in the right lower part of the abdominal wall. They were 22, 22, 8 and 4 months respectively after the surgical treatment. Diseases requiring extensive resection of the diaphragm included a case of hepatoma encroaching into the diaphragm and another case of a huge adrenal pheochromocytoma appearing in the right part of the diaphragm. They passed 8 and 4 months respectively following surgical treatment. There were no cases of wound infection or abdominal wall hernia, although seroma occurred in 2 cases (50%). CONCLUSION: In all 6 cases, a good result was achieved by restoring excised tissue using ePTFE graft after wide excision of tumors involving the abdominal wall or the diaphragm. Therefore, it may be possible to use this technique in cases of active excision of tumors that involve an extensive part of the abdominal wall or the diaphragm.
Abdominal Wall* ; Carcinoma, Hepatocellular ; Colon, Transverse ; Diaphragm ; Fibromatosis, Aggressive ; Hernia ; Humans ; Pheochromocytoma ; Polytetrafluoroethylene* ; Seroma ; Skin ; Subcutaneous Tissue ; Teratoma ; Transplants* ; Uterine Cervical Neoplasms ; Wound Infection

Taussig-Bing anomaly is infrequently associated with interrupted aortic arch and size discrepancy of great arteries makes it difficult to undergo arch recons- truction and arterial switch operation. A 20-day old male infant was admitted with the diagnosis of Taussig-Bing anomaly with type B interrupted aortic arch. Multi-organ failure, due to the diminution of ductal flow, was stabilized after 3 weeks of prostaglandin E1 and controlled ventilatory support. The surgical correction consisted of VSD closure, arterial swtich and extended aortic arch reconstruction. The marked disparity between the hypoplastic ascending aorta and the dilated main pulmonary artery was overcome by constructing distal neoaorta using both native ascending and descending aortic tissue. The patient was extubated on postoperative 2nd day. Postoperative catheterization showed no left ventricular outflow obstruction, no intracardiac shunt, and no incompetence of neoaortic valve.
Alprostadil ; Aorta ; Aorta, Thoracic* ; Arteries ; Catheterization ; Catheters ; Diagnosis ; Double Outlet Right Ventricle* ; Humans ; Infant ; Male ; Pulmonary Artery ; Ventricular Outflow Obstruction

Medicolegal autopsy is a vital tool for obtaining reliable injury mortality data. This study statistically analyzed data obtained from medicolegal autopsies performed in Korea in 2013. The aim of this study was to analyze various aspects of the 4,861 deaths that were categorized as unusual in Korea in 2013. A total of 4,861 deaths were analyzed by gender, age, manner of death, and cause of death. Of the 4,861 deaths, 3,542 (73.3%) were of men and 1,302 (26.7%) were of women. With respect to the manner of death, 54.4% were recorded as unnatural deaths, 38.8% were natural deaths, and 6.9% had unknown causes. Of the 2,642 unnatural deaths, 45.0% were determined to be accidental deaths, 26.3% suicidal, 16.9% homicidal, and 11.8% undetermined. Of the total number of unnatural deaths, 42.1% were trauma-related deaths, for which falling down accounted for 33.8%. Asphyxiation accounted for 16.0% of unnatural deaths, and of these, the predominant cause was hanging (58.8%). In addition, 14.4% of deaths were due to drowning, 12.9% poisoning, 11.0% thermal injuries, 1.8% complications arising from medical procedures, and 0.8% electrocution, starvation, or neglect. Among the 1,886 natural deaths, heart diseases accounted for 52.0% and vascular diseases accounted for 16.9%. Of the 196 deaths among children under the age of 10 years, 41.8% were recorded as unnatural deaths, 45.1% were natural deaths, and 1.5% had unknown causes.
Autopsy* ; Cause of Death ; Child ; Data Interpretation, Statistical ; Drowning ; Female ; Heart Diseases ; Humans ; Korea ; Male ; Mortality ; Poisoning ; Starvation ; Vascular Diseases

BACKGROUND: The goal of this study is to identify the factors that predict mortality in elderly trauma patients. METHOD: We reviewed retrospectively the medical record of 144 cases of geriatric trauma admitted to Kyungpook National University Hospital firm January 1998 to December 1998. We evaluated the general characteristics, mechanisms of injury, Revised Trauma Score(RTS), Injury Severity Score(ISS), Probability of survival(Ps) by TRISS(Trauma and Injury Severity Score) method, amount of blood transfused, preexisting disease, complications, length of stay, and mortality. RESULTS: 1. The mean age was 75.39+/-7.89 years old, and male to female ratio was 0.89 : 1. 2. The mechanisms of injury were primarily frills(56.3%) followed by bicycle or motorcycle(13.9%), and pedestrian injuries(13.2%) and motor vehicle accidents(6.9%). 3. The mean Glasgow Coma Scale(GCS), RTS and ISS ate 13.3+/-3.5, 7.2+/-1.4 and 14.2 +/-11.6 respectively. 4. The actual mortality rate was 18.1% (26/144). But by TRISS method, predicted mortality rate was 9.3%(12.5/144), excess mortality rate was 108% and Z score was 3.99 indicating that actual number of death exceed predicted number of death. 5. Between the survivors and nonsurvivors, the insults were significantly different as follows ; systolic blood pressure(141.9+/-28.3 vs. 116.8+/-48.7 mmHg), GCS(14.3+/-2.0 vs. 9.0 +/-5.1), RTS(7.8+/-0.7 vs 5.4+/-2.3), ISS(11.3+/-5.6 vs 27.2+/-20.2), Ps by TRISS(0.97+/-0.06 vs 0.65+/-0.37), preexisting diseases(50.8 vs 69.8%). CONCLUSION: Geriatric patients are more likely to die after trauma than other age groups. The cause of higher actual mortality rate compared to predicted mortality rate was considered as the higher incidence of delayed death due to sepsis or multiple organ failure. In order to reduce the mortality, even with relatively stable initial vile sign, invasive hemodynamic monitoring and intensive treatment are recommended and also, prevention and treatment of nosocomial infection are very important.
Aged ; Coma ; Cross Infection ; Female ; Gyeongsangbuk-do ; Hemodynamics ; Humans ; Incidence ; Length of Stay ; Male ; Medical Records ; Mortality* ; Motor Vehicles ; Multiple Organ Failure ; Preexisting Condition Coverage ; Retrospective Studies ; Sepsis ; Survivors

Prosthetic valve endocarditis(PVE) is not infrequent and one of the serious complications of cardiac valve replacement despite advances in antimicrobial therapy, diagnostic techniquens and surgical procedures. Although the incidence of PVE may be declining, the absolute number of cases of this infection is increasing. In patients with a prosthetic valve, fever, a regurgitant heart murmur, peripheral manifestations of infective endocarditis and postitive blood cultures, the diagnosis of PVE is evident. We have reviewed our experience with 13 patients with PVE from October 1976 through August 1983. During this period valve replacements were performed in 686 patients, with an infection rate of 1.9%. PVE currently accounts for approximately 14% of the total number of cases of infective endocarditis seen at Seoul national University Hospital. PVE occurred more often after multiple valve replacement than after replacement of single valve alone. Blood cultures were positive in 69% cases of PVE. Systemic emboli could be seen in 54% of patients with PVE and overall mortality was about 23%.
Diagnosis ; Endocarditis* ; Fever ; Heart Murmurs ; Heart Valves ; Humans ; Incidence ; Mortality ; Seoul

No abstract available.
Heart Septal Defects, Atrial*

The simultaneous occurrence of a renal cell carcinoma and a urothelial carcinoma in the same kidney is uncommon. Here we report the case of a 79-year-old woman with ipsilateral synchronous renal cell carcinoma and urothelial carcinoma. She was referred to our hospital for gross hematuria and right flank pain. A computed tomography scan showed a 15x20 mm enhanced lesion on the upper calyx and a 12x15 mm mass on the lateral aspect of the right kidney. We thus suspected a renal pelvis tumor and performed right hand assisted laparoscopic nephroureterectomy with bladder cuff excision (HALSNU). Gross findings were multiple, pale yellowish papillary masses on the upper and lower major calices, of which the largest one measured 16x20 mm. A separated solid mass measuring 12x16 mm was also noted on the anterior midportion of the kidney. The former was a urothelial carcinoma and the latter was a chromophobe renal cell carcinoma. We present a rare case of a chromophobe renal cell carcinoma and a urothelial carcinoma in the same kidney.
Aged ; Carcinoma, Renal Cell ; Female ; Flank Pain ; Hand ; Hematuria ; Humans ; Kidney ; Kidney Pelvis ; Urinary Bladder

OBJECTIVES: In most DEHP exposure assessment studies, single spot urine sample was used. It could not compare the exposure level among studies. Therefore, we are going to represent the necessity of selection of proper sampling time of spot urine for assessing the environmental DEHP exposure, and the association urinary DEHP metabolites with steroid hormones. METHODS: We collected urine and plasma from 25 men. The urine sampling times were at the end of the shift (post-shift) and the next morning before the beginning of the shift (pre-shift). Three metabolites of DEHP {mono(2-ethylhexyl) phthalate [MEHP], mono-(2-ethyl-5-hydroxyhexyl)phthalate [MEHHP], and mono(2-ethyl-5-oxohexyl)phthalate [MEOHP]} in urine were analyzed by HPLC/MS/MS. Plasma luteinzing hormone, follicle stimulating hormone, testosterone, and 17beta-estradiol were measured at pre-shift using a ELISA kit. A log-transformed creatinine-adjusted urinary MEHP, MEHHP, and MEOHP concentration were compared between the post- and pre-shift. The Pearson's correlation was calculated to assess the relationships between log-transformed urinary MEHP concentrations in pre-shift urine and hormone levels. RESULTS: The three urinary metabolite concentrations at post-shift were significantly higher than the concentrations in the pre-shift (p<0.0001). The plasma hormones were not significantly correlated with log-transformed creatinine - adjusted DEHP metabolites. CONCLUSIONS: To assess the environmental DEHP exposure, it is necessary to select the urine sampling time according to the study object. There were no correlation between the concentration of urinary DEHP metabolites and serum hormone levels.
Adult ; Diethylhexyl Phthalate/analogs & derivatives/pharmacokinetics/*urine ; Estradiol/blood ; Follicle Stimulating Hormone/blood ; Humans ; *Laboratories, Dental ; Luteinizing Hormone/blood ; Male ; Middle Aged ; Occupational Exposure/*analysis ; Phthalic Acids/urine ; Specimen Handling/*methods ; Testosterone/blood ; Time Factors

Diffuse leukoencephalopathy is a well-known complication of methotrexate in intrathecal or high dose intravenous administration, especially when it is combined with cranial radiation therapy. However, low dose intravenous methotrexate induced leukoencephalopathy has not been reported previously. A 46-year-old female was administered intravenous methotrexate and 5-fluorouracil with oral cyclophosphamide after a modified radical mastectomy for breast cancer. After six cycles of chemotherapy, she developed rapidly progressing dementia and upper motor neuron signs. Brain MRI showed bilaterally symmetric white matter lesion without gadolinium enhancement. Laboratory investiga-tion showed no evidence of brain metastasis. This case suggests that low dose intravenous methotrexate can induce dif-fuse leukoencephalopathy.
Administration, Intravenous ; Brain ; Breast Neoplasms ; Cyclophosphamide ; Dementia ; Drug Therapy ; Female ; Fluorouracil ; Gadolinium ; Humans ; Leukoencephalopathies* ; Magnetic Resonance Imaging ; Mastectomy, Modified Radical ; Methotrexate* ; Middle Aged ; Motor Neurons ; Neoplasm Metastasis

BACKGROUND: Definite criteria for determining severity of organophosphate poisoning have not been made. Discovery of the third neuromuscular syndrome, the intermediate syndrome, have made it more complicating then ever. Objectives of this study is to determine early prognostic factors of outcome and development of a new treatment algorithm. METHOD: 74 patients admitted to Severance hospital with acute organophosphate poisoning during 5 years were included. We made a protocol concerning the initial consciousness level, QTc interval, PVC, serum cholinesterase, the intermediate syndrome, total hospital, ICU day, length of ventilator support, disposition and have done a study retrospectively. Multiple regression and Chi-square was used as statistical analysis. Significant statistical P-value was 0.05. RESULTS: The total hospital days were prolonged as serum cholinesterase levels were lower, the age was older and mental status graver.(p<.05) The length of ventilatory support was prolonged when patient's serum cholinesterase level was very low, they were unconscious and serum cholinesterase level not recovered to 500 IU/ml within initial 3 days. The intermediate syndrome was significantly related to the prolonged cholinesterase inhibition. CONCLUSION: As an early prognostic factor for the length of ventilatory support in organophosphate poisoning, 1) level of concsiousness and 2) serum cholinesterase level at admission, 3) recovery to more than 500 IU/ml within initial 3 days are useful. Especially when the serum cholinesterase level is not recovered to more than 500 IU/ml within initial 3 days, it is essential to observe closely for the possibility of an intermediate syndrome.
Cholinesterases ; Consciousness ; Humans ; Organophosphate Poisoning* ; Retrospective Studies ; Ventilators, Mechanical