PURPOSE: To evaluate the enhancement patterns of nodular and massive hepatocellular carcinoma (HCC), with or without portal vein thrombosis, on three-phase spiral CT. MATERIALS AND METHODS: Contrast enhancement patterns in 61 patients with HCC were retrospectively analysed. Three-phase spiral CT images of the hepatic arterial dominant phase, portal dominant phase, and delayed phase were obtained 30, 60-70, and 360 seconds after the injection of contrast material was initiated. Tumors were divided into grossly nodular and massive type and enhancement patterns of HCC, with and without portal vein thrombosis, were compared. These patterns were divided into three groups, as follows: High/High/Low; High/Low/Low; Low/Low/Low. HCC with portal vein thrombosis was found in 21 of 61 cases ; this carcinoma without portal vein thrombosis was found in 40 cases. The nodular type accounted for 39 cases, and the massive type for 22. RESULTS: In 21 cases of HCC with portal vein thrombosis, the most common enhancement pattern was L/L/L, and was seen in 13 cases (62%); H/L/L was seen in eight (38%), but H/H/L was not seen. In 40 cases of HCC without portal vein thrombosis, the most common enhancement pattern was H/L/L, seen in 25 cases (63%) ; this was followed by L/L/L (11 cases ; 27%), and H/H/L (4 cases ; 10%). In the arterial dominant phase, among cases of HCC with portal vein thrombosis, low attenuation was more common (13/21) than high (8/21);among cases of HCC without portal vein thrombosis, high attenuation was more common (29/40) than low (11/40). Among 39 nodular-type cases, HCC with portal vein thrombosis was found in six (H/H/L and L/L/L: three each), and HCCwithout portal vein thrombosis was seen in 33 (H/L/L: 22; L/L/L: 7; H/H/L; 4). Among 22 cases of the massive type, HCC with portal vein thrombosis accounted for 15 (L/L/L: 10, H/L/L: 5), and seven cases without portal vein thrombosis were seen (L/L/L: 4 ; H/L/L : 3). CONCLUSION: On Three-phase spiral CT, HCC showed different enhancing patterns according tumor type and the presence of portal vein thrombosis.
Carcinoma, Hepatocellular* ; Humans ; Retrospective Studies ; Tomography, Spiral Computed* ; Venous Thrombosis

PURPOSE: To report three cases in which herpes simplex keratitis developed after initiation of latanoprost. METHODS: We experienced three patients with herpes simplex keratitis after latanoprost instillation, two patients with open angle glaucoma and one is congenital glaucoma. We preformed herpes simplex virus culture for two cases. RESULTS: One patient with history of herpes simplex keratitis, resolution when latanoprost was stopped; antiviral therapy could not eradicate herpes simplex keratitis until latanoprost was discontinued. The second patient with latanoprost associated herpes simplex keratitis cleared with discontinuation of latanoprost and start of antiviral therapy. The third patient had resolution, only when latanoprost was stopped. The result of viral cultures for two cases was negative. CONCLUSIONS: Clinicians should be aware of development or recurrence of herpes simplex keratitis when laranoprost is used for intraocular pressure control.
Glaucoma ; Glaucoma, Open-Angle ; Herpes Simplex* ; Humans ; Intraocular Pressure ; Keratitis, Herpetic* ; Recurrence ; Simplexvirus

OBJECTIVE: To investigate the current status and the basic information of cumulative traumatic disorder among workers. METHOD: The subjects were 198 workers, consisted of 100 shipspublisher workers, 155 telephone operators and 43 light workers. Workers were surveyed with a standardized self- administered questionnaire and examed by the occupational medicine doctors and physiatrists for the cumulative traumatic disorders. Laboratory tests, nerve conduction studies and X-rays of the C-spine and shoulders were performed in all subjects. RESULT AND CONCLUSION: Myofascial pain syndrome was the most frequent problem in the shipspublisher and telephone operators. As a result of the multiple logistic regression analysis, cycle time, palm pinch, lumbar and neck flexion were the significant variables accounting for the musculoskeletal symptoms.
Logistic Models ; Myofascial Pain Syndromes ; Neck ; Neural Conduction ; Occupational Medicine ; Prevalence* ; Surveys and Questionnaires ; Shoulder ; Telephone

PURPOSE: We conducted a prospective non-randomized clinical study to evaluate the efficacy and toxicity of the preoperative concurrent chemoradiotherapy for locally advanced unresectable rectal cancer. MATERIALS AND METHODS: Between January 1995 and June 1998, 37 consecutive patients with locally unresectable advanced rectal cancer were entered into the study. With 3- or 4- fields techniuqe, a total of 45 Gy radiation was delivered on whole pelvis, followed by 5.4 Gy boost to the primary tumor in some cases. Chemotherapy was done at the first and fifth week of radiation with bolus i.v. 5-Fluorouracil (FU) 370~450 mg/m2, days 1~5, plus Leucovorin 20 mg/m2, days 1~5. Of 37 patients, 6 patients did not receive all planned treatment course (refusal in 4, disease progression in 1, metastasis to lung in 1). Surgical resection was undergone 4~6 weeks after preoperative concurrent chemoradiotherapy. RESULTS: Complete resection rate with negative margins was 94% (29/31). Complete response was seen in 7 patients (23%) clinically and 2 patients (6%) pathologically. Down staging of tumor occured in 21 patients (68%). Treatment related toxicity was minimal except grade III & IV leukopenia in 2 patients, respectively. CONCLUSION: Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer was effective in inducing down staging and complete resection rate. Treatment related toxicity was minimal. Further follow up is on-going to determine long term survival following this treatment.
Chemoradiotherapy* ; Disease Progression ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Leukopenia ; Lung ; Neoplasm Metastasis ; Pelvis ; Prospective Studies ; Radiation Dosage ; Rectal Neoplasms*

Cumulative trauma disorders were surveyed in a cross-sectional study of 100 male ship yard workers and 43 male office workers. And baseline checklist for risk assessment of cumulative trauma disorders was applicated in a ship making process. Cases of cumulative trauma disorders were defined using physical examinations and electronic diagnostic methods. Data on demographics, individual factors (medical condition), work organization and psychosocial aspects of work were obtained by questionnaire. Association between the above factors and cumulative trauma disorders were assessed by multiple logistic regression models. 29(29 %) participants of male shipyard workers and 4(9.2 %) study subjects of male office workers met our case definitions for cumulative trauma disorders. The myofascial pain syndrome of neck muscles(12 % of participants) and carpal tunnel syndrome(5 % of participants) were the major two medical conditions in shipyard workers. The odds of male shipyard workers for cumulative trauma disorders to male office workers was 3.15 after adjustment of age(95 % C.I. :2.25-5.44). And the variables such as duration of present job, HIVD condition, and surges in workload were associated at least one of the cumulative trauma disorders in the final models (p<0.05) . This study indicates that work related upper extremity musculoskeletal disorders are relatively common among shipyard workers, and shows that the psychosocial factors is not likely to be related to the occur rences of these disorders in heavy workers. Also we developed baseline checklist for risk assessment of cumulative trauma disorders. The checklist was unique in that its expected users were industrial hygienists and occupational healthing nurses who did not have much ergonomic background and in that it was targeted to Korean workers in various types. As the first application of the checklist, shipyard workers were evaluated.
Checklist* ; Cross-Sectional Studies ; Cumulative Trauma Disorders* ; Demography ; Humans ; Logistic Models ; Male ; Myofascial Pain Syndromes ; Neck ; Occupational Health ; Physical Examination ; Psychology ; Questionnaires ; Risk Assessment* ; Ships ; Upper Extremity

Cumulative trauma disorders were surveyed in a cross-sectional study of 100 male ship yard workers and 43 male office workers. And baseline checklist for risk assessment of cumulative trauma disorders was applicated in a ship making process. Cases of cumulative trauma disorders were defined using physical examinations and electronic diagnostic methods. Data on demographics, individual factors (medical condition), work organization and psychosocial aspects of work were obtained by questionnaire. Association between the above factors and cumulative trauma disorders were assessed by multiple logistic regression models. 29(29 %) participants of male shipyard workers and 4(9.2 %) study subjects of male office workers met our case definitions for cumulative trauma disorders. The myofascial pain syndrome of neck muscles(12 % of participants) and carpal tunnel syndrome(5 % of participants) were the major two medical conditions in shipyard workers. The odds of male shipyard workers for cumulative trauma disorders to male office workers was 3.15 after adjustment of age(95 % C.I. :2.25-5.44). And the variables such as duration of present job, HIVD condition, and surges in workload were associated at least one of the cumulative trauma disorders in the final models (p<0.05) . This study indicates that work related upper extremity musculoskeletal disorders are relatively common among shipyard workers, and shows that the psychosocial factors is not likely to be related to the occur rences of these disorders in heavy workers. Also we developed baseline checklist for risk assessment of cumulative trauma disorders. The checklist was unique in that its expected users were industrial hygienists and occupational healthing nurses who did not have much ergonomic background and in that it was targeted to Korean workers in various types. As the first application of the checklist, shipyard workers were evaluated.
Checklist* ; Cross-Sectional Studies ; Cumulative Trauma Disorders* ; Demography ; Humans ; Logistic Models ; Male ; Myofascial Pain Syndromes ; Neck ; Occupational Health ; Physical Examination ; Psychology ; Questionnaires ; Risk Assessment* ; Ships ; Upper Extremity

OBJECTIVE: To evaluate correlation the of histological variables and the clinical features of microinvasive cervical cancer with the depth of invasion and to establish the adequate therapeutic modality. METHODS: One hundred and thirty-seven patients with microinvasive cervical cancer diagnosed by FIGO (1994) staging were reviewed, who were treated by conization, type I hysterectomy, type II hysterectomy and type III hysterectomy, in Gil Medical center from January 1997 to December 2001. We divided the depth of invasion to three groups of less than 1 mm, 1-3 mm and 3-5 mm. RESULTS: The age of the 137 women ranged from 24 to 71 years (mean age 47.4 years). The number of patients with FIGO stage IA1 and IA2 were 112 and 24, respectively. Of surgically treated 135 patients, lymph node involvement was present in 1 patient with a depth of invasion of less than 1 mm, 2 patients with 1-3 mm and 1 patient with 3-5 mm. Lymph-vascular space involvement was present in 3 patients with 1-3 mm, 4 patients with 3-5 mm. Transient bladder dysfunction was the most common complication after surgical procedures, occupying 5.6%. Other surgical complications included lymphedema (3.6%), wound complication (3.6%), ureter injury (1.1%), lymphocele (1.1%), anal incontinence (1.1%) and dyspareunia (1.1%). CONCLUSION: A management should be individualized. Patients with a depth of invasion of less than 1mm and clear resection margin may be managed by conization. Further follow-up study for a necessity of lymphadenectomy for the group with the depth of invasion of 1-3 mm irrespective of lymph-vascular space involvement is demanded.
Conization ; Dyspareunia ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Lymphedema ; Lymphocele ; Ureter ; Urinary Bladder ; Uterine Cervical Neoplasms* ; Wounds and Injuries

PURPOSE: Chest injuries in multiple trauma patients are major predisposing factor for increased length of stay in intensive care unit, prolonged mechanical ventilator, and respiratory complications such as pneumonia. The aim of this study is the evaluation of lung injury score as a risk factor for prolonged management in intensive care unit (ICU). METHODS: Between June to August in 2011, 46 patients admitted to shock and trauma center in our hospital and 24 patients had associated chest damage without traumatic brain injury. Retrospectively, we calculated injury severity score (ISS), lung injury score, and the number of fractured ribs and performed nonparametric correlation analysis with length of stay in ICU and mechanical ventilator support. RESULTS: Calculated lung injury score(<48 hours) was median 1(0-3) and ISS was median 30(8-38) in study population. They had median 2(0-14) fractured ribs. There were 2 bilateral fractures and 2 flail chest. Ventilator support was needed in 11(45.8%) of them for median 39 hours(6-166). The ISS of ventilator support group was median 34(24-34) and lung injury score was median 1.7(1.3-2.5). Tracheostomy was performed in one patient and it was only complicated case and ICU stay days was median 9(4-16). In correlation analysis, Lung injury score and ISS were significant with the length of stay in ICU but the number of fractured ribs and lung injury score were predicting factors for prolonged mechanical ventilator support. CONCLUSION: Lung injury score could be a possible prognostic factor for the prediction of increased length of stay in ICU and need for mechanical ventilator support.
Brain Injuries ; Critical Care ; Flail Chest ; Humans ; Injury Severity Score ; Intensive Care Units ; Length of Stay ; Lung ; Lung Injury ; Multiple Trauma ; Pneumonia ; Retrospective Studies ; Ribs ; Risk Factors ; Self-Help Groups ; Shock ; Thoracic Injuries ; Thorax ; Tracheostomy ; Trauma Centers ; Ventilators, Mechanical

PURPOSE: We investigated the relationship between BRCA mutations and the distribution of familial cancers other than breast or ovary in high-risk breast cancer patients. METHODS: Patients with breast cancer who had at least one of the following risk factors were enrolled: reported family history of breast or ovarian cancer; 40 years of age or younger age at diagnosis; bilateral breast cancer; or male gender. Genetic testing for BRCA mutation and questionnaires about personal and family histories of malignancies were performed. RESULTS: Among the 238 eligible patients, 49 (20.6%) patients had BRCA1/2 mutations, which were more frequent in patients with multiple risk factors (p<0.0001). There were 271 members of 156 (65.5%) families who had histories of other primary cancer. The distribution of the families was 119 (63.0%) and 37 (75.5%) in the BRCA-negative and positive group, respectively (p=0.0996). Multiple familial cancers occurred in 70 families, which were significantly more frequent in BRCA-positive families (p=0.0034). By ordinal logistic regression, the occurrence of multiple familial cancers was associated with BRCA mutations (p=0.0045), not with other risk factors. The most common site of disease was the stomach, which is the most common in nationwide. And the proportional incidence of pancreatic cancer (6.8%) was significantly higher than that of nationwide cancer statistics (2.4%, p=0.0137). CONCLUSION: BRCA mutations in high-risk breast cancer patients were associated with multiple risk factors and multiple family members with other primary cancers. Genetic counseling based on accurate information should be provided to families with BRCA mutation carriers.
Breast ; Breast Neoplasms ; Female ; Genetic Counseling ; Genetic Testing ; Humans ; Incidence ; Logistic Models ; Male ; Ovary ; Pancreatic Neoplasms ; Risk Factors ; Stomach ; Surveys and Questionnaires

Embryonal carcinoma, a very rare ovarian germ cell tumor, involves pure and mixed phenotypes. Pure-type embryonal carcinoma has never been reported in postmenopausal women. The current case was, thus, misdiagnosed as an epithelial ovarian carcinoma based on radiologic findings. Herein, we describe the case of ovarian embryonal carcinoma in a 75-year-old woman along with a literature review. Magnetic resonance imaging findings were suggestive of epithelial ovarian malignancy associated with endometrioma, including ureteral invasion. The patient underwent complete surgical staging, and a pathologic diagnosis of pure-type embryonal carcinoma was made. The patient’s postoperative course was uneventful, and adjuvant chemotherapy was administered. Embryonal carcinoma in the postmenopausal woman is a clinical challenge owing to the possibility of its misdiagnosis as epithelial ovarian carcinoma. To the best of our knowledge, this is the first report of pure-type ovarian embryonal carcinoma in a postmenopausal woman, with a description of the clinicopathologic characteristics and review of the relevant literature.