No abstract available.

No abstract available.
Pancreaticoduodenectomy*

No abstract available.
Doxorubicin* ; Drug Therapy, Combination* ; Etoposide* ; Fluorouracil* ; Mitomycin* ; Retrospective Studies* ; Stomach Neoplasms*

No abstract available.
Biopsy, Fine-Needle* ; Breast Neoplasms* ; Breast* ; Diagnosis*

No abstract available.
Aspirin* ; gamma-Globulins* ; Mucocutaneous Lymph Node Syndrome*

We report a case of ARC syndrome with arthrogryposis multiplex congenita, renal tubular insufficiency and cholestasis. The Patient presented in the early neonatal period with micrognathia, low set ears, high arched palate, multiple joint contracture, conjugated hyperbilirubinemia and failure to thrive. He died at the age of 1 month despite medical therapy. Findings of renal tubular insufficiency included persistent renal tubular acidosis, glucosuria, aminoaciduria, and proteinuria. Liver biopsy revealed intracellular and canalicular cholestasis, ballooning degeneration and giant cell formation of hepatocyte. Kidney sonography revealed medullary nephrocalcinosis. This association was first reported in 1973 by Lutz-Richner and Landolt and again in another family by Nezelof et al in 1979. Until now, 13 cases were reported worldwide. Except one case, all children died in infancy. Autosomal recessive inheritance is the most likely mode of transmission. We have experienced a case of ARC syndrome in a male neonate with signs and symptoms of lethargy, poor oral intake, direct hyperbilirubinemia, acidosis, and multiple joint contracture.
Acidosis ; Acidosis, Renal Tubular ; Arthrogryposis* ; Biopsy ; Child ; Cholestasis* ; Contracture ; Ear ; Failure to Thrive ; Giant Cells ; Hepatocytes ; Humans ; Hyperbilirubinemia ; Infant, Newborn ; Joints ; Kidney ; Lethargy ; Liver ; Male ; Nephrocalcinosis ; Palate ; Proteinuria ; Wills

Acute aortic occlusion is rare but poses a high mortality and morbidity. Prompt diagnosis and treatment is essential. Typical presentation is rest pain with bilateral absent femoral pulse. When the non-typical symptoms predominate such as paraplegia, acute abdomen or sudden-onset hypertension, diagnosis may be difficult. We experienced a case of acute aortic thrombosis who suddenly developed paraplegia and rapidly deteriorated within several hours. When the paraplegia developed, he was under treatment with heparin and urokinase, was thrombocytopenic, and the femoral arteries were pulsatile. Spinal cord compression due to bleeding complication had to be ruled out. Duplex sonography and lumbar CT scan were not diagnostic. Aortic thrombosis was diagnosed by abdominal CT scan. This case illustrates the need for high suspicion of acute aortic occlusion presenting with paraplegia especially in patients with associated atherosclerotic disease.
Abdomen, Acute ; Aorta ; Diagnosis ; Femoral Artery ; Hemorrhage ; Heparin ; Humans ; Hypertension ; Mortality ; Paraplegia* ; Spinal Cord Compression ; Thrombosis* ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator

PURPOSE: A feasible palliative care model for advance cancer patients is needed in Korea with its rapidly aging population and corresponding increase in cancer prevalence. This study describes the process involved in the development of a community-based palliative care (CBPC) model implemented originally in a Busan pilot project. MATERIALS AND METHODS: The model development included steps I and II of the pilot project, identification of the service types, a survey exploring the community demand for palliative care, construction of an operational infrastructure, and the establishment of a service delivery system. Public health centers (including Busan regional cancer centers, palliative care centers, and social welfare centers) served as the regional hubs in the development of a palliative care model. RESULTS: The palliative care project included the provision of palliative care, establishment of a support system for the operations, improvement of personnel capacity, development of an educational and promotional program, and the establishment of an assessment system to improve quality. The operational infrastructure included a service management team, provision teams, and a support team. The Busan Metropolitan City CBPC model was based on the principles of palliative care as well as the characteristics of public health centers that implemented the community health projects. CONCLUSION: The potential use of the Busan CBPC model in Korea should be explored further through service evaluations.
Aging ; Busan* ; Chronic Disease ; Humans ; Korea* ; Palliative Care* ; Pilot Projects ; Prevalence ; Public Health* ; Social Welfare

Sclerosinng mesenteritis is a rare disease that occurs most often among middle aged man. Fewer than 200 cases have been reported in the literature. It is a benign mesenteric lesion characterized by fat necrosis, fibrosis and chronic inflammation. The pathogenesis of this disease is unclear through an autoimmune origin has been proposed. The disease is generally localized and self- limiting. Fatal case is rare but has been reported. In patients with biopsy proven sclerosing mesenteritis having a relentless downhill course, treatment with prednisolone and oral cyclophosphamide in isolated case report has lead to evident clinical and radiological responses. This is a report of a case of sclerosing mesenteritis, who presented to us with history of colicky abdominal pain and weight loss. She was treated with prednisone and intravenous cyclophosphamide pulse therapy and resulted in radiological and clinical improvement. Interestingly this case has associated with skin panniculitis and pleural thickening. The skin panniculitis also showed good response to prednisolone. Our case is the first in which sclerosing mesenteritis was associated with pleural thickening.
Abdominal Pain ; Biopsy ; Cyclophosphamide ; Fat Necrosis ; Fibrosis ; Humans ; Inflammation ; Middle Aged ; Panniculitis* ; Panniculitis, Peritoneal* ; Prednisolone ; Prednisone ; Rare Diseases ; Skin* ; Weight Loss

PURPOSE: Tumor response of patients with locally advanced rectal cancer after chemoradiation showed 60~70% of tumor volume reduction and T and N downstaging. Curative resection with total mesorectal excision should be followed for good oncologic outcomes. This study was designed to analyze the oncologic outcomes in patients who received preoperative chemoradiation followed by total mesorectal excision for locally advanced rectal cancer according to pathologic T and N stage. METHODS: Total 108 patients with locally advanced rectal cancer treated between 1989 and 2000. All patients were analyzed retrospectively and staged as T3, 4 N (+) by transrectal ultrasonography and pelvic MRI. All patients received a 5, 040 cGy of radiation over 5 weeks and systemic intravenous bolus chemotherapy 5 FU 450 mg/m2 and leucovorin 20 mg/m2 for 5 days was given during first and fifth weeks of radiation treatment, followed four to six weeks later by radical surgery. RESULTS: Among 108 patients there were 74 males and 34 females. Mean age was 54.4 years in male and 52.3 years in female. Mean follow up periods was 41.3 months. Complete follow up was in 96.4% of patients. Curative resection was done in 90 patients (83.3%). The most common type of surgery was low anterior resection in 40 (44.4%) and unresectable patients in 10 (9.3%). Postoperative morbidities were wound infection (n=10, 9.2%), anastomostic leakage (n=2, 1.9%), and anastomotic stricture (n=1, 0.9%). After chemoradiation, tumor stage were as follows: pathologic complete remission was in 7 (6.5%), pT1, T2 N0 (stage I) was in 21 (19.4%), T3N0 (stage II) was in 28 (25.9%) and T3 N (+) (stage III) was in 34 (31.5%). The rate of local recurrence was 10.7% in stage II and 20.6% in stage III. Systemic recurrence was 21.4% in stage II and 47.1% in stage III. 5 year survival rate according to T stage was T0 (100%), T1 (100%), T2 (79.5%), T3 (43.7%), T4 (33.3%) (p=0.0088). According to N stage, N (-)(72.0%) and N (+) (35.7%)(p=0.002). Among T3 patients, 5 year survival rate was N (-)(58.2%) vs. N (+)(32.0%)(P=0.0228). CONCLUSION: Preoperative chemoradiation followed by total mesorectal excision downstaged locally advanced rectal cancer and showed high resectability. Clinical outcomes correlated with pathologic T and N downstaging. Patients who did not show pathologic T and N downstaging showed high local and systemic failure and poor prognosis.
Constriction, Pathologic ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Leucovorin ; Magnetic Resonance Imaging ; Male ; Prognosis ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies ; Survival Rate ; Tumor Burden ; Ultrasonography ; Wound Infection