This is a retrospective clinical analysis of 156 patient with colorectal cancer who were surgically treated from January 1988 to June 1996 at the Department of Surgery, Seoul Adventist Hospital. The results are as follows: 1) The peak age incidence was in the 7th decade (31.4% of the cases), and the sex ratio of males to females was 1.03 : 1. 2) The most common location of the tumor was the rectum in 77 cases (49.4%); next were the sigmoid colon in 25 cases (16.0%) and the ascending colon in 25 cases (16.0%). 3) In the right colon, the most frequent symptoms and signs were abdominal pain, a palpable mass, weight loss; in the left colon and rectum, bloody tarry stool and bowel- habit change were the most common symptoms and signs. 4) The duration of the symptoms and signs prior to admission was most commonly less than 3 month (46.8% of the cases). 5) The diagnostic methods were digital rectal examination, sigmoidoscopy, colonofiberoscopy, barium enema, and abdominal CT. In two cases,an exploratory laparotomy was done. Also, 2.8 studies were done per patient. 6) The operations performed included an abdominoperineal resection in 36 cases (24.0%) and a right hemicolectomy (18.7%). The operability was 96.2%, and the total resectability was 79.5%. 7) The staging of the tumor was performed during the initial operation according to the Aster Coller classification and the TNM classification. Stages C2 (33.8%) and B2 (29.1%) and T3N0M0 were the most frequent stages in both classification. 8) The most common histologic type was an adenocarcinoma (96.8%). 9) The most common macroscopic finding was of the annular type (59.6%) 10) The most common distant metastasis sites were the pelvic organs and the liver. 11) The most frequent postoperative complication was wound infection (14.7%). The complication rate and perioperative mortality were 32.7% and 2%, respectively.
Abdominal Pain ; Adenocarcinoma ; Barium ; Classification ; Colon ; Colon, Ascending ; Colon, Sigmoid ; Colonic Neoplasms ; Colorectal Neoplasms* ; Digital Rectal Examination ; Enema ; Female ; Humans ; Incidence ; Laparotomy ; Liver ; Male ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Rectal Neoplasms ; Rectum ; Retrospective Studies ; Seoul ; Sex Ratio ; Sigmoidoscopy ; Tomography, X-Ray Computed ; Weight Loss ; Wound Infection

Epidermal cysts slowly growing, intradermal or subcutaneous tumors that usually cease growing after having reached 1 to 5 cm in diameter. We report a case of giant epidermal cyst on the scapular region with the appearance of well delineated huge mass measured 19×17×14cm in size. Its clinical and surgical management are illustrated.
Epidermal Cyst

Epidermoid cyst originating within the diploic space of the bony orbit is rare. The authors describe two cases of epidermoid cyst of the orbit. The clinical presentation was dependent on the location of the slowly expanding epidermoid cyst. Proptosis caused by intraorbital extension of the mass was the presenting sign in both case. The finding in orbit CT scan appeared to be specific for intradipolic epidermoid cyst. Their clinical presentations and surgical management were briefly discussed.
Epidermal Cyst ; Exophthalmos ; Orbit* ; Tomography, X-Ray Computed

Epilepsy affects more than 0.5% of the world population and is known to be associated with a large genetic component eliciting an electrical hyperexcitability in the central nervous system. However, its pathogenic mechanisms remain poorly understood. In order to gain greater molecular incite in the pathogenesis in epilepsy, we analyzed proteomes of human cerebral cortices. Quantitative proteome analysis was used to compare signals corresponding to individual proteins between epileptic cerebral cortices from patients with temporal lobe epilepsy and age-matched non-epileptic subjects. To minimize individual variations, gender and age of the patients were matched. Changes of several spots were consistent among 6 pairs of epileptic patients and nonepileptic subjects. One of the spots was identified as the mitochondrial type Mn-superoxide dismutase (Mn-SOD) confirmed by Western blot analysis with Mn-SOD antibody and enzyme activity assay. Such results were agreeable with chemical and physical parameters given by the 2-dimensional electrophoresis (2-DE) gel. Mn-SOD was consistently down-regulated in epileptic cerebral cortices compared with those of nonepileptic subjects. Our results demonstrate a clear link between pathogenesis of epilepsy and SOD. Additionally, we identified four proteins that were consistently over-expressed in all epileptic temporal neocortices specimens and the other four proteins that were found to be expressed less than non-epileptic control subjects. These proteomic data provide cellular markers in the understanding mechanism of the epilepsy pathogenesis.
Adult ; Biological Markers/analysis ; Brain Chemistry ; Case-Control Studies ; Cerebral Cortex/chemistry/*metabolism ; Down-Regulation ; Electrophoresis, Gel, Two-Dimensional ; Epilepsy/genetics/*metabolism ; Female ; Humans ; Male ; Middle Aged ; Mitochondria/chemistry/genetics/*metabolism ; Nerve Tissue Proteins/chemistry/genetics/*metabolism ; Proteomics ; Research Support, Non-U.S. Gov't ; Superoxide Dismutase/analysis/genetics/*metabolism ; Up-Regulation

The term myotubular myopathy (MTM) implies a maturational arrest of fetal muscle during the myotubular stage of development at 8-15 weeks of gestation. Characteristic muscle histopathology consists of small hypotrophic muscle fibers with centrally placed nuclei and a surrounding clear area devoid of myofibrils. X-linked recessive inheritance is the most common trait. Autosomal recessive and autosomal dominant forms are less frequently reported. The clinical diagnostic criterion for X-linked MTM has relied on a positive family history and the demonstration of the presence of characteristic biopsy findings from affected male subjects. Additional features may include perinatal onset, severe hypotonia, respiratory failure, dysphagia, thin ribs, contractures of the hips or knees, puffy eyelids and ophthalmoplegia. The prognosis is often fatal, and most patients die within the first year of life from respiratory failure. The authors report a case of presumed X-linked MTM with severe hypotonia, muscle weakness and respiratory failure at birth.
Biopsy ; Contracture ; Deglutition Disorders ; Eyelids ; Hip ; Humans ; Knee ; Male ; Muscle Hypotonia ; Myofibrils ; Myopathies, Structural, Congenital* ; Ophthalmoplegia ; Parturition ; Pregnancy ; Prognosis ; Respiratory Insufficiency ; Ribs ; Wills

Axillofemoral bypass has been the preferred procedure for high risk patients who have aorto-iliac occlusive disease since the introduction of the procedure by Blaisdell in 1963. Widespread use of axillo- femoral bypass was limited in the past because long-term patency rates were inferior to aorto-femoral bypass. Since the mid-1980s, patency rates achieved with axillofemoral bypass have improved with the use of the externally supported prosthesis and the evolution of surgical thchnique. Reported pimary patency of axillo-femoral bypass is in excess of 70% at 5 years. Nowadays axillo-femoral bypass is a procedure of choice in elderly patients with associated comorbid risk factors, and its results is comparable to aorto-femoral bypass.The authors experienced one case of graft malfunction due to kinking of the graft at mid-portion which may not be infrequent.
Aged ; Humans ; Prostheses and Implants ; Risk Factors ; Transplants

Aneurysmal disease of visceral arteries is found in only 0.2% of the general population. Aneurysms that involve the splenic artery account for more than 60% of all visceral aneurysms8,10). The hepatic artery is involved in 20%, whereas the celiac trunk is involved in 4.5% and the superior mesenteric artery in 5.5%. The remaining 10% include those of the branches of the superior mesenteric artery, the gastroduodenal, the pancreaticoduodenal arteries and the inferior mesenteric artery(5,13)). The etiology of visceral aneurysms include atherosclerosis, medial degeneration, infection, fibromuscular dysplasia, dissection and congenital anomalies(2,12,13)). The size and anatomic location of the aneurysm should be considered to determine the correct surgical treatment. The authors report a case of aneurysmal dissection of the superior mesenteric artery in a 56-year-old male patient who had acute abdominal pain and massive melena. Resection of dissecting aneurysm and PTFE interposition was performed, and post-operative course was uneventful.
Abdominal Pain ; Aneurysm ; Aneurysm, Dissecting ; Arteries ; Atherosclerosis ; Fibromuscular Dysplasia ; Hepatic Artery ; Humans ; Male ; Melena ; Mesenteric Artery, Superior ; Middle Aged ; Polytetrafluoroethylene ; Splenic Artery

Takotsubo cardiomyopathy (TTC) is an infrequent cardiac syndrome characterized by acute onset chest pain with apical ballooning on echocardiography. It is often triggered by severe emotional or physical stress, and in contrast to acute myocardial infarction (AMI), the regional wall motion abnormality returns to normal within days. Here, we describe a 62-year-old female who presented with acute onset chest pain during treatment for a liver abscess. We presumed a diagnosis of AMI because of ST segment elevation on electrocardiography and elevated cardiac enzyme levels. However, the patient's coronary arteries were normal on angiography, and apical ballooning was seen on echocardiography. A diagnosis of TTC was made, and the patient was managed with intensive cardiopulmonary support using vasopressors in our hospital's medical intensive care unit. The patient's symptoms improved, but persistent severe left ventricular dysfunction was detected on follow-up echocardiography. After 5 weeks, a new apical mural thrombus appeared, and anticoagulation therapy was started. The apical ballooning persisted 3 months later, although the patient's overall ejection fraction was slightly improved. The apical thrombus was completely resolved without any embolic event. Non-adrenergic inotropics can be recommended in TTC with shock, and clinicians should keep in mind the potential risk of thrombus formation and cardioembolism.
Adrenergic beta-Antagonists/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Catecholamines/blood ; Chest Pain ; Diuretics/therapeutic use ; Female ; Humans ; Middle Aged ; Takotsubo Cardiomyopathy/*diagnosis/drug therapy/pathology ; Thrombosis ; Ventricular Dysfunction, Left/diagnosis/drug therapy/pathology

Acute infection increases disease activity in patients with systemic lupus erythematosus(SLE) and causes life threatening complication such as acute renal failure or ischemic bowel disease. We here report a case of acute renal failure and ischemic bowel disease complicated by acute pyelonephritis in a patient with SLE. A 19-year-old woman was admitted for high fever and right flank pain. Urine examination revealed acute pyelonephritis. Thrombocytopenia, proteinuria, positive antinuclear antibody and anti-dsDNA, false positive VDRL confirmed SLE. The pyelonephritis improved with antibiotic treatment, but oliguria and abdominal pain and ascites newly developed. Kidney biopsy and abdominal computed tomography revealed lupus nephritis type IV and ischemic bowel disease, respectively. After methylprednisolone and cyclophosphamide treatment, the patient improved.
Abdominal Pain ; Acute Kidney Injury* ; Antibodies, Antinuclear ; Ascites ; Biopsy ; Cyclophosphamide ; Female ; Fever ; Flank Pain ; Humans ; Kidney ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Methylprednisolone ; Oliguria ; Proteinuria ; Pyelonephritis* ; Thrombocytopenia ; Young Adult

Surgical process of oral and maxillofacial area as well as dental treatment are stressful situations to the patients. It is well known that serum level of stress hormones including adrenocorticotropic hormone(ACTH) and cortisol increase when the body is exposed to stress. However, there have been few studies on demographic and clinical factors related with stress. Therefore, the purpose of this study was to supply data to cope with stress more comprehensively and efficiently by analyzing the effect of factors related with stress in addition to surgical procedure. Prospective cohort study method was selected. Serum levels of ACTH and cortisol were measured by sampling bloods pre-operatively and post-operatively from 45 patients who had been operated at the Bundang Jesaeng Hospital department of oral and maxillofacial surgery. To evaluate factors associated with stress, patients were classified according to gender, age, method of payment(insurance or self), experiences of operation, kind of operations(expected operations or unexpected operations). Relative risk was calculated to assess relationships between changes of serum level of ACTH and cortisol and factors related with stress, whereas Chi-square analysis was executed to evaluate statistical significance. With regard to serum level of ACTH, relative risk was 1.3 in the group of the patients who were less than 40 years old. With regard to serum level of cortisol, relative risk was 1.8 for women compared with men, 1.4 in the group of the patients who were less than 40 years old and 1.6 in the group of the patients who had not experienced any other operations. In addition to surgical procedure, factors related with stress included gender, age, method of payments, experiences of operation and kind of operations. Therefore, we should provide comprehensive schemes to reduce stress of the patients going through oral and maxillofacial surgery.
Adrenocorticotropic Hormone ; Adult ; Cohort Studies ; Female ; Hospital Departments ; Humans ; Hydrocortisone ; Male ; Prospective Studies ; Surgery, Oral*