No abstract available.
Plasmapheresis* ; Prednisolone* ; Purpura, Thrombotic Thrombocytopenic*

PURPOSE: There are several modalities to reattach the amputated auricle. Although microvascular replantation can achieve the best outcome, it is technically difficult. Conventional composite graft is technically easy, but uniformly unsuccessful. Our successful experience of reattachment using postauricular subcutaneous pocket is presented. METHODS: The amputated tissue was placed in its anatomical position with buried sutures. The amputated part is dermabraded to remove the epidermis and outer layer of dermis(Fig. 1, Center, left). Postauricular skin flap was then raised and the reattached dermabraded ear was buried beneath the flap(Fig. 1, Center, right). Two weeks after the original surgery, the buried ear was removed from its pocket(Fig. 1, Below, left). RESULTS: The ear was reepithelialized spontaneously in 7 days. In 3 months, the reattached ear shows satisfactory appearance without contour deformity(Fig. 1, Below, right). CONCLUSION: This technique provides increase in contact surface between the amputated segment and the surrounding tissues which supply blood, serum, oxygen and nutrients, maximizing the probability of "take". Minimally injured dermis can be healed from spontaneous reepithelialization and provides minimal contour deformity. We have used this non-microsurgical technique with very satisfying outcome.
Amputation, Traumatic ; Congenital Abnormalities ; Dermis ; Ear ; Ear Auricle ; Epidermis ; Oxygen ; Replantation ; Skin ; Sutures ; Transplants

PURPOSE: To retrieve the retracted flexor tendon, additional incision and wide dissection are conventionally required. We introduce minimal-incision tenorrhaphy using 1cm-long incision and minimal dissection. METHODS: Transverse incision about 1cm in length is made over the level of retracted tendon. Nelaton's catheter is advanced into tendon sheath from distal primary laceration wound to emerge proximally through the incisional wound. A catheter is sutured to proximal tendon in end-to- end fashion. By gently pulling the catheter, retracted tendon is delivered to distal wound. Tenorrhaphy with core suture and epitendinous suture is then carried out. RESULTS: This retrieving technique provides minimal incision, minimal dissection, minimal bleeding, minimal injury to tendon end, and shorter operation time with preservation of vincula tendinum and pulley system. CONCLUSION: In case of flexor tendon rupture with retraction, this operative method is believed to allow reliable and effective tenorrhaphy and excellent postoperative outcomes.
Catheters ; Hemorrhage ; Lacerations ; Rupture ; Sutures ; Tendon Injuries ; Tendons

Patients with Peutz-Jeghers syndrome often suffer from complications of polyps, such as intussusception, bowel obstruction, and bleeding. Another major problem of these patients is malignancy through the hamartoma-adenoma-carcinoma sequence. If the complications and the cancer risk of small intestinal polyps are to be reduced, early detection of these polyps and a polypectomy are important. Traditionally, a small bowel series, small bowel enteroclysis, and conventional endoscopy have been used for the proper evaluation, and management of polyps. Recently, several reports showed the advantages of enteroscopy and intraoperative endoscopy for achieving a more complete polypectomy of the small intestine. However, CT enteroclysis, which has been introduced as a reliable, less invasive, and tolerable diagnostic tool for small intestinal disease, may be useful for the evaluation of patients with gastrointestinal polyposis. We report the case of a patient with Peutz-Jeghers syndrome who had small-bowel polyposis and a rectal adenocarcinoma and who underwent preoperative CT enteroclysis and intraoperative endoscopy.
Adenocarcinoma ; Endoscopy ; Hemorrhage ; Humans ; Intestinal Diseases ; Intestinal Polyps ; Intestine, Small ; Intussusception ; Peutz-Jeghers Syndrome* ; Polyps

PURPOSE: Decreased expression of beta-catenin has been known to be associated with tumor metastasis. However, the clinical relationship between the degree of expression and the prognosis in colorectal cancer (CRC) remains unclear. In this study, we evaluated the prognostic value of beta-catenin expression in CRC patients with liver metastasis. METHODS: Paraffin embedded blocks were obtained from 70 patients who underwent potentially curative resection for CRC with liver metastasis. Samples from normal colon mucosa, primary CRC and metastatic liver lesion were prepared in tissue microarrays and were stained by immunohistochemistry with monoclonal antibody against beta- catenin. The membranous beta-catenin expression was assessed and the beta-catenin expression difference between primary CRC and metastatic liver lesion was analysed in relation to overall survival as well as disease free survival rates. RESULTS: In beta-catenin expression, preserved expression (score >6) was observed in 42.0%, and 21.9% of primary CRC tumor samples and tumor samples from metastatic liver lesion respectively. The degree of beta-catenin expression in metastatic liver lesion was significantly lower than that in primary CRC (P=0.022). According to the difference of beta-catenin expression score between primary CRC and liver metastasis, patients were classified as group 'A' and 'B'. Group 'A' was defined as patients showing remarkably decreased expression of beta-catenin in metastatic liver lesion in that the difference of the score was three or more. Group 'B' was defined as patients showing maintained or increased beta-catenin expression in metastatic liver lesion in comparison to primary CRC, in that the difference of beta-catenin expression score was less than three. Overall survival rate and disease free survival rate were significantly better in group 'B' than group 'A' (P=0.02, P=0.002). CONCLUSIONS: Decreased expression of beta-catenin in metastatic liver lesion may be a poor prognostic marker in colorectal cancers with liver metastasis. A further large-scaled investigation is necessary to define the role of beta-catenin in CRC.
beta Catenin* ; Colon ; Colorectal Neoplasms* ; Disease-Free Survival ; Humans ; Immunohistochemistry ; Liver* ; Mucous Membrane ; Neoplasm Metastasis* ; Paraffin ; Prognosis ; Survival Rate

Occult bleeding of the gastrointestinal tract is a major cause of iron deficiency anemia. Even with endoscopic evaluation of the upper and the lower gastrointestinal tract in these patients, in 30~50% of the cases, the cause of bleeding still remains undiscovered. Wireless capsule endoscopy (WCE) is a novel method of evaluating the small bowel mucosa by using a small capsule equipped with a camera and transmission device. Complications of WCE include impaction within the gastrointestinal tract, sometimes requiring surgical removal. The authors report a case of capsule impaction in the small bowel in a patient evaluated for anemia due to occult gastrointestinal tract bleeding. The patient is a 19 year-old female with a history of anemia since age 4. The stool guaiac test was positive, but upper and lower gastrointestinal tract endoscopy showed no abnormalities, so WCE was done. A short segment of circular ulcers with lumen narrowing were seen in the distal jejunum. Seven days after ingestion of the capsule, the patient denied passage of the capsule. Small bowel enteroclysis was performed, and the capsule was seen along with a segment of lumen narrowing distal to the site of retention. Surgery was done, and upon laparoscopic examination, the entire bowel appeared normal. Retrieval of the capsule was done along with a resection of an 8 cm segment of the small bowel. Three linear ulcers were seen in the resected bowel specimen. Pathology revealed no evidence of Crohn's disease or tuberculosis. The patient is still on iron supplements, but her hemoglobin level remains stable at 11~12 g/dl.
Anemia ; Anemia, Iron-Deficiency ; Capsule Endoscopy* ; Crohn Disease ; Eating ; Endoscopy ; Female ; Gastrointestinal Tract ; Guaiac ; Hemorrhage ; Humans ; Iron ; Jejunum ; Lower Gastrointestinal Tract ; Mucous Membrane ; Pathology ; Tuberculosis ; Ulcer ; Young Adult

PURPOSE: Local excision, including transanal endoscopic microsurgery (TEM), has become an alternative to the classic radical operation for early rectal cancer. However, radical resection for rectal cancer is necessary for advanced tumor, poor differentiation, a narrow resection margin, and positive lymphovascular invasion. This study presents the factors related to recurrence in patients who required secondary radical surgery after TEM, but did not undergo the operation. METHODS: From November 1994 to December 2004, 167 patients underwent TEM for rectal cancer. Thirty-six of those patients were included in this study. Inclusion criteria were poor differentiation, a mucinous carcinoma, invasion to a proper muscle layer, lymphovascular invasion, and a positive resection margin. RESULTS: Twelve of the 36 patients underwent a secondary radical operation, but 24 of them did not due to poor general condition or refusal. One of 12 patients (8.3%) who underwent a secondary radical operation had a systemic recurrence. Five of 24 patients (20.8%) who did not receive surgery had recurrences; 3 of 5 were local recurrence, and the others were distant metastases. Among the 24 patients who did not undergo a secondary radical operation, there were no recurrences in 2 cases of poor differentiation or mucinous carcinoma and in 2 cases of positive resection margin. There were 2 cases of recurrences in the 7 patients (25.0%) who had lymphovascular invasion, 1 case in the 1 patient (100%) who had a T3 lesion, 3 cases in the 17 patients (12.5%) who had T2 lesions. CONCLUSIONS: In high-risk patients, TEM followed by radical surgery is most beneficial in preventing local recurrence. A radical operation is strongly recommended especially if pathologic results after TEM shows T3 lesions or lymphovascular invasion.
Adenocarcinoma, Mucinous ; Disulfiram ; Humans ; Microsurgery* ; Neoplasm Metastasis ; Rectal Neoplasms* ; Recurrence

PURPOSE: Stomach cancer is the most prevalent extracolonic malignancy of the many primary cancers that occur together with colorectal cancer in Koreans. The purpose of this study was to evaluate the characteristics of patients who present with double primary cancer of the stomach and colorectum. METHODS: From Sep. 1994 to Dec. 2004, in 4,305 patients were diagnosed with colorectal cancer. Among these patients, 51 patients were diagnosed synchronously or metachronously as also having stomach cancer. The mean age these patients was 60.8 years and the median follow up duration was 31.0 months. RESULTS: The incidence of double primary cancer of the stomach and colorectum was 1.2% of the total colorecal cancer patients and they were 0.6% of the total stomach cancer patients. There were 17 (33.3%) metachronous cases and 34 (66.7%) synchronous cases. For the metachronous cases, the mean interval was 15 months (12~98) and detection methods were postoperative CT, symptom of second a cancer, and routine endoscopic examination. In synchronous cases, second cancer was detected by routine endoscopic examination, preoperative radiologic evaluation, and intraoperative exploration. Intraoperatively the detected cancers were all colorectal cancer during the operation for stomach cancer. The stage of the colorectal cancer was higher than that of the stomach cancer in 30 cases. Local or systemic recurrences were seen in 9 cases (17.6%), and 7 cases were recurrence of colorectal cancer. The 5-year disease free survival rates was 55.8%. CONCLUSION: The incidence of cancer arising from colorectum and stomach has been reported to be increasing. Careful attention should always be paid to the possible presence of a second cancer in preoperative or postoperative evaluation of cancer patients.
Colonic Neoplasms ; Colorectal Neoplasms ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Neoplasms, Second Primary ; Recurrence ; Stomach Neoplasms ; Stomach*

OBJECTIVES: The aim of this study was to evaluate the psychiatric function and quality of life of the chemical workers who had been exposed to long-term, low-level organic solvents in the Y industrial complex. METHODS: A total of 144 male workers, of whom 82 were in the exposed group and 60 in the unexposed-control group, were evaluated by using Symptom Checklist-90-R(SCL-90-R), series of neuropsychological tests(critical flicker fusion threshold, CFFT); choice reaction time, CRT; compensatory tracking task, CTT); digit symbol substitution test, DSS), and the Korean version of the SmithKline Beecham Quality Of Life scale(KvSBQOL). For the statistical analyses, comparisons of the means of the two groups were performed for each variable with two-tailed t-test as well as ANCOVA including age and education as covariates. RESULTS: For the SCL-90-R, the nine symptom scales and the three global indices were clinically within normal range in both groups. However, the scores on the symptom scales of 'somatization', 'depression', 'hostility' and 'phobic anxiety', and those on the global indices of 'global severity index' and 'positive symptom total', were significantly higher in the exposed group than in the unexposed group. In terms of the neuropsychological function and the quality of life, there wes no significant difference between the two groups. CONCLUSIONS: These findings suggested that the long-term exposure to mixed organic solvents, even at the low level below the permissible exposure limit, might induce some psychiatric problems.
Education ; Flicker Fusion ; Humans ; Male ; Mental Health ; Quality of Life* ; Reaction Time ; Reference Values ; Solvents* ; Weights and Measures

PURPOSE: Decreased expressions of E-cadherin and beta-catenin are known to be associated with tumor metastases. but the clinical relationship between the degree of expression and the prognosis in colorectal cancer remains unclear. In this study, the expressions of E-cadherin and beta-catenin in stage II colorectal cancer patients were evaluated and their relation with metachronous distant metastasis analyzed. METHODS: From the patients who underwent a curative resection for stage II colorectal cancer, 25 who had a recurrence after surgery due to distant metastasis (group with recurrence) were selected, and matched with 25 patients who did not have a recurrence (group without recurrence). Paraffin embedded blocks from these patients and samples from normal colon, primary colon cancer were prepared in tissue microarrays and were stained by immunohistochemistry. The expressions were classified as grades 0, 1, 2, or 3 compared to those of normal tissue. RESULTS: The mena age of the patients was 55.7 years, with a median follow up period of 73.7 months. There are no significant differences in the clinicopathological data between the groups with recurrence and without recurrence. There were no significant differences in the degrees of E-cadherin and beta-catenin expression between the two groups (P=0.16, 0.10), or in the 5-year survival and disease free survival rates between the high and low expression groups (degree > or =2.5 and < or =2, respectively) of E-cadherin and beta-catenin. CONCLUSION: The expressions of E-cadherin and beta-catenin may not play a prognostic role in the prediction of metachronous distant metastasis in stage II colorectal cancers patients.
beta Catenin* ; Cadherins* ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Neoplasm Metastasis* ; Paraffin ; Prognosis ; Recurrence