BACKGROUND: Surgical resection remains the mainstay of treatment for esophageal cancer. Despite recent advances in surgical therapy, i.e. en bloc resection and extended lymphadenectomy, the overall long-term prognosis of patients with esophageal carcinoma has not, however, improved during the last decades. One of the major reasons in its relatively high recurrence rate. MATERIAL AND METHOD: A retrospective review of recurrent patterns of cancer in 42 patients who underwent curative surgery for primary esophageal cancer was performed clinically and histo-phthologically. RESULT: Nineteen patients had developed recurrece during the 18 to 52 months(mean 34.2 nonths), 8 had local recurrences, 1 had both, and 11 had systemic recurrences. Twelve patients(63%) had developed recurrence within 1 year, 5 patients(26%) between 1 year to 2 patients(11%) after 2 years. The recurrence rate according to growth pattern of tumor or presence of microinvasive findings was not statistically significant, but it increased significantly in clinical tumor stage III than stage IIA, B and in patients with the number of metastatic lymph node over ten. CONCLUSION: Post-operative recurrences of esophageal cancer appear as a high rate even though curative wide resection was done. Several clinical and histo-pathological factors correlate with the recurrence.
Esophageal Neoplasms* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Prognosis ; Recurrence* ; Retrospective Studies

The occurence of pseudarthroses associated with neurofibromatosis is a well documented phenomenon, with the majority of reported cases in the tibia but quite rare in forearm,Only ten cases in the English-literature and one case in Korean-literature of this lesion revealed appearing in the bones of the forearm till now. Of these, four in solitary pseudarthroses of the ulna(4.5.15), five in a solitary lesion of the radius(7.8.10.16.17), and only two cases was on the both bones of the forearm(9.14). We are presenting the case report of a Korean adult male with the clinical stigmata and a positive familial history of neurofibrormotosis who had congenital pseudarthroses of both the radius and ulna of the right forearm. Therefore, the present case is the third to be reported. We treated him with by production of an one-bone forearm using a dual a onlay bone graft positioned in neutral of supination and pronation. A stable, functional extremity with good union of pseudarthroses were encountered.
Adult ; Christianity ; Extremities ; Forearm ; Humans ; Inlays ; Male ; Neurofibromatoses ; Neurofibromatosis 1 ; Pronation ; Pseudarthrosis ; Radius ; Supination ; Tibia ; Transplants ; Ulna

For the measurement of the bone quantity, various methods have been used. Recently, the methods such as a microdensiometry, single photon absorptiometry, quantitative computed tomography were introduced. However, these methods are expensive modalities to be used in daily clinical practice. For the evaluation of the osteoporosis, author's observed Saville's grades, spine contral score and spine fracture on the simple spine roentgenograms of 346 patients over 40 years of age who were exsmined due to their backache at the Department of Orthopedadic Surgery, Kang Nam St. Mary's Hospital, Seoul, and following results were obtained: 1. The percentile incidence of osteoporosis with regard to age and sex : (1) The percentile incidence of osteoporosis over Saville's Grade I was 59.2%(205 of 346 persons); in males 47.4%(55 of 116 persons) and in females 65.2%(150 of 230 persons). (2) The percentile incidence of osteoporosis over Grade 1 in 5th decade was 27.2%(17.1% in males and 33.9% in females), 55.8% in 6th decade(46.6% in males, and 60.4% in females), 78.1% in 7th decade(64.7% in males, and 82.9% in females), 93.7% in 8th decade(87.5% in males and 97% in females), and 100% in both sexes of 9th decade. (3) The percentile incidence of Grade 1 osteoporosis in 5th decade was 23.9%, and in 6th decade it was 46.7%. Thus, Grade I osteoporosis was most common in these age groups. In 7th and 8th decades, Grade I osteoporosis was more common in males, while in the females ot these age groups Grade II was more common. There was no sex difference in the incidence of osteoporosis after the age of 80. Grade IV osteoporosis was found only in a woman who had hysterectomy 7 years ago, and has suffered from Parkinsonism for 3 years. (4) The overall incidence of Grade I osteoporosis was 34.6%, and Grade II was 21.3 %. The incidence of osteoporosis over Grade III was 1.7% in males, and 6.5% in females. 2. Incidence of osteoporosis assessed by Barnett's central score and its correlation with Saville's assessment: (1) The central score obtained at the 3rd lumbar spine ranged from 71.4 to 106.4. The number of cases were 16 in the score range of 70 to 80, 93 in the score range of 101 to 110, and 5 in the score range of 111 to 120. In consequence the most high incidence was in the score range of 91 to 100. (2) Grade O Oxteoporosis corresponded with the central score of 96.4 on an average (range : 86.8 to 106.4), Grade I corresponded with 91.6 (range : 85.7–103.1), Grade II corrosponded with 86.4 (range : 78.3–96.9), Grade III corresponded with 79.4 (range : 71.4–91), and Grade IV corresponeded with 75.8. (3) Barnett defined the spine is osteoporotic, when the central score is below 80. However, in this study only 16 patients(4.6%) had the score below 80. No bodies having Grade 0 and I osteoporosis had the score below 80; of those 16 patients having the score below 81, 5 were Grade II, 10 Grade III, and one Grade IV. Through this study, it is clesr that there is no correlation in these two assessing methods. The central score below 80 was found in severely porotic patients such as Grade III and IV, but was not found in most cases of Grade I and II osteoporotic patients. (4) The vertebral defromity was found only in 38 cases (10.9%), and it was found only in 18.9% of osteoporosis patients. The percentile incidence of deformity was 5.3% of Grade I, 31% of Grade II and 52.9% of Grade Ill. (5) Of these deformities, wedge-shaped one was found in 6 cases of Grade I porosis, 20 of Grade II, and 3 of Grade III. Cod-fish vertebrae (biconcave) were found in 2 of Grade II and 4 of Grade III. The flattened body was found in 1 of Grade II and 2 of Grade III. Thus, biconcave and flattened vertebrae were found only in the porotics over Grade II severity. (6) In 24 cases, one body was deformed, and in 14 cases multilevel vertebral deformities were found. In these 20 cases had deformity in the Ll, 10 cases each in T12 and L2, 7 cases in L3, 6 cases in L4, and 4 cases in Tll. In summary, the most deformities were in the dorsolumbar region. (7) Fracture was induced by trauma in the 11 cases(29%), among which 10 were wedgeshaped, and the rest was flattened. The biconcave vertebra was found not to be related with injury.
Absorptiometry, Photon ; Back Pain ; Congenital Abnormalities ; Female ; Humans ; Hysterectomy ; Incidence ; Male ; Osteoporosis ; Parkinsonian Disorders ; Seoul ; Sex Characteristics ; Spine

BACKGROUND/AIMS: The role of dietary factors in the pathogenesis of irritable bowel syndrome (IBS) is still unclear. The aim of this study was to compare IgG4 levels to common food antigens between patients with IBS and healthy controls. METHODS: Thirty-two patients diagnosed as IBS according to the Rome III criteria (12 diarrhea subgroup; 20 non-diarrhea subgroup) and 32 sex and age-matched healthy controls participated in the study. Serum IgG4 titers to 90 common foods were measured in each subject. The number of subjects with positivity defined as the cut-off value ≥ 0.7 U/mL was compared. RESULTS: Patients with IBS had significantly higher IgG4 titers to wheat, leek and taro compared to those of controls. Serum IgG4 titers to ginger, cocoa, walnut, white radish, onion, and lettuce in IBS patients tended to be higher than controls. IgG4 titers to wheat, gluten and gliadin in the diarrhea subgroup, and lettuce, leek and taro in the non-diarrhea subgroup tended to be higher compared with controls. The number of subjects with positivity to apple, orange, lettuce, and leek was significantly higher in IBS patients than controls. The number of subjects with positivity to apple, orange, gluten, and gliadin in the diarrhea subgroup, and egg white, pineapple, soybean, lettuce, and leek in the non-diarrhea subgroup was significantly higher compared with controls. CONCLUSIONS: Serum IgG4 antibody levels to some common foods are abnormally elevated in IBS patients. The type of foods with abnormally elevated serum IgG4 titers in the diarrhea subgroup may be different from that in the non-diarrhea subgroup.
Ananas ; Cacao ; Citrus sinensis ; Colocasia ; Diarrhea ; Egg White ; Ginger ; Gliadin ; Glutens ; Humans ; Immunoglobulin G* ; Irritable Bowel Syndrome* ; Juglans ; Lettuce ; Onions ; Raphanus ; Soybeans ; Triticum

We reoport a case of multiple basal cell carcinoma in a 51-year-old male who have taken a herb medication for right hemiplegia during 30 years. The patient had a 15-year history of the black colored, ulcerated nodules on left forehead and erythematous, protruded masses on back. Also, he had a 6-year history of black colored, ulcerated nodules on right temporal area of scalp and brownish, flat plaques on anterior chest, Biopsy specimens from lesions revealed typical histopathologic findings of the basal cell carcinoma. Wide excision with graft was done. One year later, he was expired due to lung carcinoma.
Biopsy ; Carcinoma, Basal Cell* ; Forehead ; Hemiplegia ; Humans ; Lung ; Male ; Middle Aged ; Scalp ; Thorax ; Transplants ; Ulcer

In order to identify the relationship between the patient's age and the presence of another disease, and the postoperative complications and mortality, we reviewed the medical records of 6156 patients admitted to the Department of Surgery, Dae Jeon Eul Ji General Hospital, during the period from January 1991 through December 1995. There were 1546 geriatric patients(>65 years of age) and 4610 adult patients (age between 16 and 64). Six hundred sixty-five patients (43%) in the geriatric group had one or more concurrent diseases preoperatively, whereas 1127 patients (24.4%) in adult group did. Postoperative complications were more frequent in the geriatric group: 21.6% (310 patients) in the geriatric group vs 15.2%(217 patients) in the adult group. Geriatric patients who had more than one concurrent disease and who underwent an emergency operation showed a higher postoperative complication rate than those who had only one concurrent disease and who underwent elective surgery. The postoperative mortality was also higher in the geriatric group: 3.8%(48 patients) in the geriatric group vs 0.7% (32 patients) in the adult group. The most frequent cause of postoperative death in the geriatric group was sepsis. The geriatric patients who had a concurrent disease account for 16.4% of postoperative complications and 1.5% of the mortalities, whereas those who did not have any concurrent disease account for 2.67% and 0.2%, respectively. Among 1127 adult patients who had a concurrent disease, 124 (11.0%) had postoperative complications and 24 (2.2%) died postoperatively. In conclusion, the elderly patients more frequently had one or more concurrent diseases, and these patients had higher postoperative complication and mortality rates, especially after emergency operations. Accordingly, it is crucial for the surgeon to completely evaluate and manage any concurrent diseases in elderly patients preoperatively.
Adult ; Aged ; Daejeon ; Emergencies ; Hospitals, General ; Humans ; Medical Records ; Mortality ; Postoperative Complications ; Sepsis

A retrospective study of 274 patients who presented with constipation was done. The following results were obtained by recording colonic transit time. The male to female ratio was 72 : 197, and most patients were in their third and fifth decade, each age group accounting for 21% of total number. Associated symptoms were anal discomfort(33%), abdominal discomfort (25%), hematochezia (23%), reduced stool caliber (11%), and tenesmus (8%). As a result, 223 patients had normal transit time and 51 patients had abnormal transit time. Eighty-six patients with normal transit time and 51 patients with abnormal transit time underwent barium enema or colonoscopic examination. Abnormal lesions such as polyps and diverticulums were found in 10 patients with normal transit time and 7 patients with abnormal transit time. Therefore barium enema and colonoscopic examination in the patients with abnormal transit time were meaningful (P=0.024). Eighteen out of 25 patients with normal transit time and 8 (67%) of 12 patients with abnormal transit time showed abnormal defecogram results. The rectocele was the most frequent cause of abnormality in defecogram. Abnormal anal manometry results were obtained in 5 (22%) of 23 patients with normal transit time and 3 (50%) of 6 patients with abnormal transit time. Three types were classified in the patients with abnormal transit time. With type II patients, anal manometry findings were normal and 2 patients showed abnormal results in defecogram. With type III patients, 5 (43%) of 12 patients showed abnormal results in defecogram and 3 (50%) of 6 patients had abnormal anal manometry findings. Conclusively, if abnormal transit time is found in the patients with chronic consipation, further evaluations such as barium enema or colonoscopic examination are necessary. And even in the patients without any abnormality in transit time, selected performance of defecogram and anal manometry depending on clinical symptoms are preferable.
Barium ; Colon* ; Constipation* ; Diverticulum ; Enema ; Female ; Gastrointestinal Hemorrhage ; Humans ; Male ; Manometry ; Polyps ; Rectocele ; Retrospective Studies

Congenital cystic adenomatoid malformation and Extralobar Pulmonary sequestration are very rare congenital anomalies. We experienced a 4 year-old female patient who had Congenital cystic adenomatoid malformation in her lower lobe of left lung. We accidently found extralobar pulmonary sequestration associated with Congenital cystic adenomatoid malformation at operation field. The resection of the left lower lobe and the extralobar pulmonary sequestration were performed. The arterial supply of the extralobar pulmonary sequestration was one anomalous artery arised from the thoracic aorta. The Venous drainage of expralobar pulmonary sequestration was intercostal vein into the azygous vein. The patient was discharged without any problem.
Aorta, Thoracic ; Arteries ; Bronchopulmonary Sequestration* ; Child, Preschool ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Drainage ; Female ; Humans ; Lung ; Veins

Background: The prognostic consequences of transient hemodynamic deterioration due to cardiac displacement, which is most severe during left circumflex artery (LCX) grafting in off-pump coronary artery bypass surgery (OPCAB) are unknown. This study aimed to investigate the association between mixed venous oxygen saturation (SvO2) < 60% during LCX grafting and the occurrence of composite of morbidity endpoints. Methods: Data of patients who underwent elective OPCAB between January 2010 and December 2019 were reviewed. Logistic regression analysis was performed to detect risk factors for the composite of morbidity endpoints, defined as 30-day or in-hospital mortality, postoperative myocardial infarction, prolonged mechanical ventilation > 24 h, cerebrovascular accident, and acute kidney injury. Results: Among 1,071 patients, the composite of morbidity endpoints occurred in 303 (28%) patients. SvO2 < 60% during LCX grafting was significantly associated with the composite of morbidity (OR: 2.72, 95% CI [1.60, 4.61], P < 0.001) along with advanced age, chronic kidney disease, ratio of early mitral inflow velocity to mitral annular early diastolic velocity, and EuroSCORE II. Other major hemodynamic variables including the cardiac index were not associated with the outcome. Additional regression analysis revealed pre-operative anemia as a predictor of SvO2 < 60% during LCX grafting (OR: 2.09, 95% CI [1.33, 3.29], P = 0.001). Conclusions A decrease in SvO2 < 60%, albeit confined to the period of cardiac displacement, was associated with a 2.7-fold increased risk of detrimental outcomes after OPCAB, implying the prognostic importance of this transient deterioration in oxygen supply-demand balance.

Patients with a functional gastrointestinal disorder (FGID) frequently report abdominal discomfort and bloating after ingesting specific foods. However, evidence on the relationship between foods and symptoms is lacking. In addition, the diagnosis of food hypersensitivity and food intolerance does not seem to be established yet. Food hypersensitivity can be divided into immunologically mediated and non-immunologically mediated forms. The immunologically mediated forms are specifically termed food allergies, whereas the non-immunologically mediated forms are referred to as food intolerances. Various diagnostic tools are required to make an accurate diagnosis of a food allergy or a food intolerance. First, a thorough examination of the history and basic tests to rule out other organic diseases are needed. Next, diagnostic tests for immunoglobulin E-mediated food allergies are required and diseases, such as celiac disease and lactose intolerance, should be differentiated. A diagnosis for non-celiac gluten sensitivity (NCGS) is also required. A double blind, randomized, placebo-controlled, dietary challenge test can be used for diagnosing NCGS and food intolerance. Diagnostic tests for food intolerance, in which scientific evidence is lacking, may result in a misdiagnosis of food hypersensitivity or food intolerance in patients with a FGID. Therefore, an accurate diagnosis of food hypersensitivity or food intolerance based on reliable tests is required.
Celiac Disease ; Diagnosis ; Diagnostic Errors ; Diagnostic Tests, Routine ; Food Hypersensitivity ; Gastrointestinal Diseases ; Glutens ; Humans ; Immunoglobulins ; Lactose Intolerance