PURPOSE: Sentinel lymph node (SLN) biopsy (SLNB) for patients with melanoma and breast carcinoma has been validated as an accurate method for assessing the status of lymph nodes. Although prophylactic modified radical neck dissection for patients with papillary thyroidcarcinoma is not performed routinely, central neck node dissection is currently considered to be part of the standard initial operation. Therefore, this study was conductedto determine the feasibility of SLNB for the evaluation of central neck lymph node status in patients with papillary thyroid carcinoma. METHODS: 116 patients (108 women, 8 men) preoperatively diagnosed with papillary thyroid carcinoma between 2004 and 2006 were prospectively studied. After 0.1 to 0.3 ml of 1.0% methylene blue dye was injected into the tumor, SLNB was performed, followed by total thyroidectomy and central neck node dissection. RESULTS: Preoperatively, in cases of papillary thyroid carcinoma without evidence of cervical lymph node metastasis, the identification rate of SLN in level 6 compartments was 93.1%. In addition, the overall accuracy of SLN at predicting the nodal status was 91.7%. Furthermore, the sensitivity, specificity, positive predictive value and negative predictive values were 85.7%, 100%, 100% and 83.3% respectively. CONCLUSION: The SLNB in the central compartment for papillary thyroid carcinoma is an acceptable and feasible technique for estimating the central neck lymph node status, therefore, it may be helpful in diagnosing metastases and avoiding unnecessary lymph node dissection in cases of papillary thyroid cancer. However further studies are necessary to improve the diagnostic accuracy prior to routine clinical use.
Biopsy ; Breast Neoplasms ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Melanoma ; Methods ; Methylene Blue ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Prospective Studies ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: We conducted this study to evaluate the feasibility and the safety of a delta-shaped gastroduodenostomy after totally laparoscopic distal gastrectomy (TLDG) and to know about the factors having influence on surgeons' performance of anastomosis and technical details of this operation. METHODS: The clinical characteristics and the surgical results of 57 consecutive patients with delta-shaped gastroduodenostomy after TLDG at Incheon St. Mary's Hospital were reviewed. The patients were divided into 2 groups (before and after 20 cases) and their clinical characteristics and surgical results were compared. The factors which influenced the anastomotic time and the technical details of the operation were also investigated. RESULTS: There was no difference in age, gender, body mass index, surgical results except for operation time, anastomotic time, and starting day of oral feeding between the 2 groups. The experience of the surgeon was the only factor that influenced the anastomotic time. CONCLUSION: Delta-shaped gastroduodenostomy is a feasible and safe procedure even in the early years of a surgeon's career. It could feasibly be done in less than 20 minutes in relatively experienced hands.
Body Mass Index ; Gastrectomy ; Hand ; Humans

PURPOSE: A cross-calibration equation is needed to compare bone mineral density measured by different dual X-ray absoptiometry systems. We performed this study to establish appropriate cross-calibration equations between two different dual X-ray absorptiometry systems. MATERIALS AND METHODS: Bone mineral density of anterior-posterior lumbar spine (L2-4 level) and femoral neck were measured in 109 women (55+/-11yr) using two different dual X-ray absorptiometry systems (Lunar EXPERT-XL) and Hologic QDR 4500-A). Bone mineral density values measured by two systems, including area, bone mass content, bone mineral density and percentile of young normals were compared and cross-calibration equations between two systems derived. RESULTS: The bone mineral density values of 109 women measured by Lunar system were 0.958+/-0.17 g/cm2 at L2-4 and 0.768+/-0.131 g/cm2 at femur neck, which were significantly higher (13+/-6% at L2-4 and 19+/-7% at femur neck, p<0.001) than those (0.851+/-0.144 g/cm2 at L2-4 and 0.649+/-0.108 g/cm2 at femur neck) by Hologic system. Bone mineral content and percentile of young normals measured by Lunar system were also significantly higher than those by Hologic system (p<0.001), whereas there was no difference in area (p>0.05). There was a high correlation between bone mineral density values of L2-4 and femoral neck obtained with both dual X-ray absortiometry systems (r=0.96 and 0.95, respectively). Cross-calibration equations relating the bone mineral density were Lunar=1.1287xHologic-0.0027 for L2-4 and Lunar=l.1556xHologic+0.0l82 for femoral neck. CONCLUSION:: We obtained cross-calibration equations of bone mineral density between Lunar EXPERT-XL and Hologic QDR 4500-A. These equations can be useful in comparing bone mineral density obtained by different dual X-ray absorptiometry systems.
Absorptiometry, Photon* ; Bone Density* ; Female ; Femur ; Femur Neck ; Humans ; Osteoporosis ; Spine

No abstract available.
Echocardiography, Transesophageal* ; Mitral Valve Insufficiency*

We reviewed 49 cases of moderate or severe pericardial effusion on which we performed pericardiocentesis and percutaneous pericardial biopsy from Jan. 1987 to Sep. 1989. Of these, 11 cases were performed percutaneous pericardial biopsy in order to diagnose confirmative. We studied clinical manifestation including physical examination, ECG, and radiology, etiology and complication of pericardiocentesis and percutaneous pericardial biopsy. The results are as belows : 1) The physical examination of pericardial effusion were neck vein engorgement(73.5%), priction rub(25.5%), and pulsus paradoxus(4%). The ECG findings were low voltage(77.6%) and electrical alternans(16.5%), and most common x-ray finding was cardiomegaly (81.6%). 2) Underlying diseases were as follows : neoplastic disease(40.8%), tuberculosis(18.4%) systemic lupus erythematosus(10.2%), hemopericardium(8.2%), chronic renal failure(6.1%), congestive heart failure(4.1%), idiopathic pericarditis(4.1%), GVHD(2.0%), pyopericardium(2.0%), rheumatic carditis(2.0%), and postpericardiotomy syndrome(2.0%), in order. 3) Special etiologic diagnosis of neoplasm were lung cancer(50%), adenocarcinoma of unknown origin(20%), Malignant lymphoma(15%), stomach cancer(5%), hepatoma(5%), and malignant thymoma(5%), in order. From the percutaneous pericardial biopsy, the authors confirmed 36% by finding two cases of malignancy and two cases of tuberculosis. On the other hand, only one case was confirmed in cytology. These result in a rather low rate of diagnostic confirm. There were 8 cases of complication : hypotension(8.2%), premature ventricular contraction(6.1%) and ventricular tachycardia (2.0%) without death cases. In percutaneous pericardial biopsy, only two cases of hypotension were found with no death case. The result obtained from the above 11 cases of percutanous pericardial biopsy is not enough to make conclusive statement concerning rate of diagnostic confirmation and complication. We expect better results by examining more cases in the future.
Adenocarcinoma ; Biopsy* ; Cardiomegaly ; Diagnosis ; Electrocardiography ; Estrogens, Conjugated (USP) ; Hand ; Heart ; Humans ; Hypotension ; Lung ; Neck ; Pericardial Effusion ; Pericardiocentesis* ; Physical Examination ; Stomach ; Tachycardia, Ventricular ; Tuberculosis ; Veins

Atrial flutter, a common rhythm disturbance, was first described over 80 years ago. Despite extensive investigations, several important issues remain unresolved concerning its exact mechanism and management. Present therapeutic strategies often appear effective to prevent and terminate atrial flutter. However, controlled trial and definitive studies comparing the various treatment options are surprisingly scarce. Here we report on a study of 9 episodes of spontaneous atrial flutter(AF)(flutter wave cycle length 224+/-39 msec) treatedd by transesophageal atrial pacing(TAP) in 9 patients(7 men and 2 women; mean age 56.9 yrs). TAP was effective in 5 patients : sinus rhythm resumption was immediate in 3 patients and followed a short period of atrial fibrillation in 2 patients. TAP was unsuccessful in 4 patients. All the patients tolerated the procedure well. These data strongly support the immediate first choice use of TAP in AF therapy.
Atrial Fibrillation ; Atrial Flutter* ; Female ; Humans ; Male

Transesophageal echocardiography(TEE) is a new acoustic window to the cardiac structures and great vessels via retrocardiac esophagus. Because of the close relation between the esophagus and the heart, higher transducer frequencies can be applied, therefore leading to improved resolution and more accurate images than transthoracic echocardiography. We describe our experience with the first 353 awake patients. The procedure was well tolerated by the patients and associated with no major complications, within examination 10 to 20 minutes. Clinical diseases which appear to be suited for TEE includes 1) evaluation of native valve diseases, particulary mitral valve, pathologic valvular abnormalities and color Doppler regurgitant flows ; 2) assesment of prosthetic heart valves to better define malfunction and important pathologic associations ; 3) congenital heart disease, particularly atrial septal defect ; 4) endocarditis and detection of vegetations and complications ; 5) detection of thrombus and tumors, size, location, morphology, stalk ; and 6) aortic pathology including atherosclerosis, aneurysm and dissection. We conclude that transesophageal echocardiography is a new imaging technique that is rapidly evolving into a major tool for general cardiac imaging in a variety pathologic conditions and is a safe and useful tool in patients. Future advances in probe technology will continue to expand its applications.
Acoustics ; Aneurysm ; Atherosclerosis ; Echocardiography ; Echocardiography, Transesophageal* ; Endocarditis ; Equidae ; Esophagus ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Valves ; Humans ; Mitral Valve ; Pathology ; Thrombosis ; Transducers

PURPOSE: This study was designed to explore quality of life (QOL) in patients with stomach cancer by using the World Health Organization Quality of Life (WHOQOL) Instrument-Korean version. MATERIALS AND METHODS: Thirty-one (31) patients with stomach cancer after curative resection were recruited with informed consent. Age- and gender-matched hospital staff served as controls. The 100-item WHOQOL Instrument, including physical domain, psychological domain, social domain, independence domain, environment domain, and spiritual domain, was employed for the all subjects. RESULTS: In patients with stomach cancer after operation, only two domains, physical and independence, were associated with worse quality of life. In those domains, patients with advanced stage, with total gastrectomy, with adjuvant chemotherapy, and early or late postoperative period (< or =2 years or >5 years after operation), could be perceived of having a worse quality of life. CONCLUSION: Not only scientific objective success but also individual subjective perception of condition could be important for managing patients with stomach carcinomas after curative resection. In this context, the WHOQOL reflecting multi-dimensional state of well being could be a useful tool across a variety of cultural and value systems in the world.
Chemotherapy, Adjuvant ; Drug Therapy ; Gastrectomy ; Humans ; Informed Consent ; Postoperative Period ; Quality of Life* ; Stomach Neoplasms* ; Stomach* ; World Health Organization

Ventricular tachycardia is an important tachyarrhythmia which is encountered commonly in clinical field. The accompanying manifestations could be variable just from palpitation to sudden cardiac death. The classification of this arrhythmia has not completly settled yet, but in a broad way this arrhythmia is classified according to the prescence or abscence or underlying heart disease, especially coronary artery disease. Recently, therapeutic modalities for this arrhythmia have been changed a lot from classical antiarrhythmic drugs to radiofrequency ablation or ICD implantation although there are still some problems to overcome. We experienced a case of 34-year-old female having an incessant ventricular tacycardia which was abolished after endomyocardial biopsy performed to differentiate underlying myocardial pathology.
Adult ; Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Biopsy* ; Catheter Ablation ; Classification ; Coronary Artery Disease ; Death, Sudden, Cardiac ; Female ; Heart Diseases ; Humans ; Pathology ; Tachycardia ; Tachycardia, Ventricular*

PUPOSE: This study was designed to investigate the validity of WHOQOL-BREF (Brief form of the World Health Organization Quality of Life Assessment Instrument) and to explore quality of life (QOL) by using WHOQOL-BREF in patients with stomach cancer after a curative resection. MATERIALS AND METHODS: Fifty (50) patients with stomach cancer after a curative resection were recruited with informed consents. Age- and gender matched hospital staffs served as controls. The 100-item WHOQOL instrument was employed for the all subjects. The scores of the WHOQOL-BREF, which is a short version (26 questions) of the WHOQOL, and includes four domains (physical, psychological, social, and environmental), were compared with those of WHOQOL. RESULTS: The scores of the WHOQOL-BREF were significantly correlated with those of the WHOQOL in all domains. Two domains, physical and social, were associated with worse quality of life in patients with stomach cancer after a curative resection. CONCLUSION: The WHOQOL-BREF is a valid instrument that is useful for evaluating the quality of life in patients with stomach cancer.
Humans ; Quality of Life* ; Stomach Neoplasms* ; Stomach* ; World Health Organization