CT was found to be highly accurate in predicting tumor size and assessing invasion of the surroundingstructures and distant metastasis. Also CT played an important role for determination of operability of esophagealcarcinoma. The CT findings with barium esophagogram in 21 patients with histologically proven esophageal carciomawere reviewed from Feb. 1985 to Feb. 1986 at the department of Radiology, Yonsei University ,College of Medicine.The results were as follows: 1. Number of patients in each stages were: 2 in stage 1, 6 in stage 2, 4 in stage 3,and 9 in stage 4. 2. Peak age distribution was in its 6th decasedes as 9 patiens (42.9%). Overall mean age was 60.8 years. Number of male patients were 19 and 2 of female. 3. Histologic types of esohageal carcinoma were 19cases of epidermoid (90.5%) and 2 cases of adenocarcinoma(9.5%). 4. The tumor location was 1 case in upper, 14cases(66.7%) in middle and 6 cases in lower one-third. 5. Various types of esophageal carcinoma were as follows: 3cases of fungating, 4 cases of infiltrating, 5 cases of ulcerofungating, and 9 cases of ulceroinfiltrating type.6. Average length of involvement in each stages were 4cm in stage 1, 5.5cm in stage 2, 8.8cm in stage 3, and 8.3cmin stage 4. The involved length was longer in advanced cases. In 11 cases(52.4%), the involved length was between4 and 8cm. 7. Angle of periaortic fat plane obliteration of the aortic circumference were as follows: Below 45degrees( 7 cases 33.3%), 45degrees-90degrees (3 cases 14.3%), over 90 degrees(11 cases, 52.4%). 8. Method oftreatment of esophageal carcinoma were as follows: Only radiotherapy in 11 cases(52.4%), radiotherapy withoperation in 5 cases, only operation in 1 cases, and no treatment in 4 cases. 9. Distant metastatic sites were:brain in 1, pericardium in 5, liver in 5, trachea in 2, bronchus in 9, and distant lymph node in 5 cases.
Age Distribution ; Barium ; Bronchi ; Female ; Humans ; Liver ; Lymph Nodes ; Male ; Methods ; Neoplasm Metastasis ; Pericardium ; Radiotherapy ; Trachea

Lymphoepithelioma-like carcinoma (LELC) that histologically resembles nasopharyngeal lymphoepithelioma has been reported in various sites including the stomach, salivary gland, lung, skin, thymus, tonsil and uterine cervix. LELC of the stomach was rarely reported after the first report by Burke et al. in 1990. More than 60% of them were associated with Epstein-Barr virus (EBV). Most commonly affecting elderly Asians with slight male predominance (M/F ; 1.2/1), it usually is located in the proximal portion of the stomach and distinguished from lymphoid-rich adenocarcinoma by the absence of definitive glandular differentiation in the LELC. We recently experienced 4 cases of LELC of the stomach associated with EBV. Patients consisted of two Korean females and two Korean males with one in 3rd decade, one in 5th decade and two in 6th decade. The tumors of all cases were located in the proximal portion of the stomach. Gross types were 1 Borrman type I, 2 Borrman type II and 1 early gastric carcinoma type IIc. The size of the tumors varied from 0.8 cm to 7 cm. Microscopic findings were similar in all 4 tumors.; The tumors were composed of syncytial nests of undifferentiated cells having vesicular nuclei with prominent nucleoli, admixed with abundant lymphoplasma cell infiltration in the stroma. Immunohistochemical staining revealed that the tumor cells were reactive for cytokeratin and the stromal lymphocytes were mostly T cells. There were dark hybridization signals in the nuclei of most of the tumor cells but no signals in the stromal lymphocytes in three cases on in situ PCR hybridization and on all cases PCR amplification for EBNA-1. It is concluded that LELCs of the stomach have distinctive histologic characteristics and the usual association with EBV. Further accumulation of these cases will define the prognosis.
Adenocarcinoma ; Aged ; Asian Continental Ancestry Group ; Cervix Uteri ; Female ; Herpesvirus 4, Human* ; Humans ; Keratins ; Lung ; Lymphocytes ; Male ; Palatine Tonsil ; Polymerase Chain Reaction ; Prognosis ; Salivary Glands ; Skin ; Stomach* ; T-Lymphocytes ; Thymus Gland

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

PURPOSE: Algorithms to get cross-sectional bone density pattern(transverse histogram) to predict the loosening of hip prosthesis using DXA(Dual X-ray Absorptiometry) have been developed. We performed this study to analyze the correlation between radiologic findings and densitometric pattern of the THRA(Total Hip Replacement Arthroplasty) patients. MATERIALS AND METHODS: Thirty-six hips of 32 THRA patients were evaluated. The duration between THRA and DXA was from 1 year 7 months to 15 years. On transverse histogram, the periprosthetic bone density patterns were classified as 3 types;type I, rigid fixation in 17, type II, definite loosening in 8, and type III, partial loosening in 11 cases. Surgical findings, plain X-ray findnings and transverse histogram using DXA were correlated. RESULTS: Among 14 cases performing revision for acetabular prosthesis loosening, 5 cases revealed loosening of fernoral stems while 9 cases revealed rigid fixation of femoral stems. Sensitivity was 100% for either plain X-ray or DXA. Specificity was 88%, 77% for plain X-ray and DXA respectively. CONCLUSION: This preliminary study reveals that periprosthetic bone density pattern on transverse histogram on DXA may be useful in the evaluation of the loosening. However, further study will be needed for clinical application.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Bone Density ; Hip ; Hip Prosthesis ; Humans ; Prosthesis Failure ; Sensitivity and Specificity

BACKGROUND: The Modified Mallampati classification is a simple, easily reproducible, widely used test, which is performed with the patient in a sitting position with the tongue protruded and without phonation. It is more convenient when an assessment of modified Mallampati classification is performed while the patient is in a supine position on the operating table. The purposes of this study are to compare the correlation between the modified Mallampati classification in the supine and sitting positions, and the laryngoscopic grades of Cormack and Lehane. METHODS: The data were collected from a total of 224 (98 male) patients older than 18 years of age undergoing elective surgery. The assessment of the modified Mallampati classification was performed two times to the same patient; once while the patient was in a sitting position, and the 2nd time in a supine position on the operating table. Assessment of the modified Mallampati classification in a supine position was performed in the absence of tongue protrusion and the presence of performed phonation. RESULTS: There were significant correlations between assessments of the modified Mallampati classifications (sitting position and supine position) and the laryngoscopic grades of Cormack and Lehane. CONCLUSIONS: Assessment of the Mallampati classification in the supine position had a significant correlation with laryngoscopic grades. We suggest that assessment of Mallampati classification in the supine position can be used as one of the predicting factors for difficult intubation.
Classification* ; Humans ; Intubation ; Operating Tables ; Phonation ; Supine Position* ; Tongue

Removal of blunt esophageal foreign bodies using Foley catheter under a fluoroscopic guidance is a well-recognized procedure. However, since this procedure is rather cumbersome and uncomfortable to the patient, the authors tried to find an easier and more convenient modified technique. For 10 patients with esophageal foreign body, we tried the method to the patients who is lying in the right lateral decubitus position and 3 assistants hold head. arms, trunk and legs of the patients without tilting the table and without using immobilizer. Foley catheter is inserted through nostril, nasal cavity and pharynx to esophagus. In order to identify the Foley catheter in esophagus, 0.025 inch short wire was inserted in the Foley catheter. The balloon of a Foley catheter was inflated by 10cc of air, and the syringe was kept attached to the Foley catheter during the procedure. After passage of the foreign body through the upper esophageal sphincter, the balloon was deflated immediately and the foreign body was removed through the mouth. We successfully removed in removing all the blunt esophageal foreign body with ease. This modified method is also fast, safe and efficient.
Arm ; Catheters* ; Deception ; Esophageal Sphincter, Upper ; Esophagus ; Foreign Bodies* ; Head ; Humans ; Leg ; Methods* ; Mouth ; Nasal Cavity ; Pharynx ; Syringes

No abstract available.
Blood Platelets*

No abstract available.
Colorectal Neoplasms*

PURPOSE: The purpose was to evaluate the procedure-related complications of the TIPS and its clinical significance. MATERIALS AND METHODS: The materials consisted of 52 patients who had 57 TIPS procedures for the management of variceal bleeding due to portal hypertension. To detect the occurrence of complications during transhepatic needle puncture(from hepatic vein to the portal vein), contrast material was injected with the withdrawl of the puncture needle. RESULTS: Procedure-related complications occurred in 28 patients (54%) among 52 patients. The corn lications were biliary tree puncture(15 cases), transperitoneal puncture(14 cases), stent malposition(3 cases) stent migration(1 case), hepatic arteries puncture(1 case), splenic vein perforation(1 case), and paroxysmal tricular tachycardia(1 case). Three patients had acute stent thrombosis with rebleeding immediately after procedure. The procedure was repeated in two patients. One patient was expired due to rebleeding. CONCLUSION: The procedure related complications were clinically insignificant in most instances, when stent thrombosis or proxysmal ventricular tachycardia was developed.
Biliary Tract ; Esophageal and Gastric Varices ; Hepatic Artery ; Hepatic Veins ; Humans ; Hypertension, Portal ; Needles ; Portasystemic Shunt, Surgical* ; Punctures ; Splenic Vein ; Stents ; Tachycardia, Ventricular ; Thrombosis ; Zea mays

The clinical and pathological features of a paraganglioma arising in the cauda equina is described and compared with previous reports. The right microscopic fetures were similar to those of paragangliomas from other sites, with a 'Zellballen' pattern of cells containing arzyrophil granules. Immunohistocytochemical stains for neurone specific enolase, S-100 protein, cytokeratin were positive, but stains for glial fibrillary acidic protein were negative. Electron microscopy showed densely staining membrane-bound granules, cilia like structures and fibros bodies in the cytoplasm. The last two features only occur in paragangliomas from this site. The pathological findings suggest that paragangliomas in this site arise from pre-existing paraganglia, possibly of the visceral autonomic group.