Infectious complications such as wound infection and intra-abdominal abscess are rarely fatal, but perplexing to both patients and surgeons, and still remain asserious problem after appendectomy in about 5% of the patients. To be helpful to reduce post-appendectomy complications, authors retrospectively analyzed 229 cases of appendectomy performed during the period of one year, from January 1 through December 31, 1995, to find out contributing factors to the post-appendectomy infectious complications such as wound infection or intra-abdominal abscess. The results were as follows. 1) Infectious complications are more common in patients with four or more days of symptom. 2) Infectious complications are more common in patients with complicated appendicitis such as gangrenous or perforated appendicitis. 3) Preoperative antibiotics are helpful to prevent infectious complications in cases of complicated appendicitis. 4) There is no difference in the incidence of infectious complications between the immediate operations and overnight delayed operations in patients who were admitted in the late evening or at night. 5) There is no difference in the incidence of infectious complications between operators: staff surgeons who exclusively operated on patients with complicated appendicitis and residents(with or without supervision of staff surgeons) who mostly operated on patients with simple appendicitis. This means technical superiority has its role in preventing infectious complications. Early diagnosis and operation before the gangrenous change or perforation are warranted. Preoperative antibiotics are effective in cases of complicated appendicitis, but not in cases of simple appendicitis. But the lack of objective criteria to decide complicated appendicitis before the operation remains problem, and prospective study to solve this problem is needed. Technical perfectness is required to protect the wound and to remove the appendix without contamination. Preventive measures are also important to prevent the infectious complications in cases of inevitably contaminated wounds or inta-abdominal spaces.
Abdominal Abscess ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Appendix ; Early Diagnosis ; Humans ; Incidence ; Organization and Administration ; Retrospective Studies ; Wound Infection ; Wounds and Injuries

PURPOSE: Rotter's nodes are removed in the course of a radical mastectomy, however they are not routinely removed in a modified radical mastectomy and breast conserving surgery, although they can be. Having been relatively ignored, the prognostic value and correlation of Rotter's nodes with axillary nodal status have rarely been reported or systematically studied. The aims of the present study were to assess the frequency and pattern of Rotter's node metastasis in breast cancer patients, and to compare the incidence of axillary lymph node metastasis and Rotter's node. We also investigated the rate of skip metastasis. METHODS: In order to investigate the predictability of axillary node positivity, we compared the status of axillary lymph nodes and the pathological prognostic markers. In 580 consecutive mastectomies performed for breast carcinomas between 1987 and 1999, axillary and Rotter's nodes were routinely dissected and separately sampled during mastectomy. RESULTS: The mean number of axillary lymph nodes and Rotter's nodes were 19.5 and 0.9. Axillary lymph nodes metastases were found in 47.2% of all patients. The frequency of axillary lymph node metastasis and the involvement of a higher level of axillary lymph node were significantly increased with increasing tumor size. However, metastasis at Rotter's nodes did not follow this pattern. Rotter's nodes were anatomically present in 39.8% of patients and an average of 2.3 lymph nodes was found in the interpectoral region. Rotter's metastases were found in 5% of all patients, and 10.6% of those with axillary lymph node metastases. The number of Rotter's nodes metastases was higher as the metastases were found at a higher level (p<0.05). CONCLUSION:The presence of axillary metastases was related to histologic grade, nuclear grade and lymphovascular invasion, but was not related to the mitotic index or perineural invasion. It is apparent that the potential risks from Rotter's and skip metastases were not great in all patients, although the routine excision of Rotter's nodes should be applied to patients with more locally advanced disease (T2-3, N1-N2).
Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lymph Nodes ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mitotic Index ; Neoplasm Metastasis

PURPOSE: Surgical axillary dissection to determine the status of nodes remains as a part of the standard operation in the management of breast cancer. Rotter's nodes are removed in the course of a radical mastectomy but they are not routinely removed in a modified radical mastectomy and breast conserving surgery, although they can be. Having been relatively ignored, the prognostic value and correlation of Rotter's nodes with axillary nodal status have been rarely reported or systematically studied. The aim of the present study was to access the frequency and pattern of Rotter's node metastasis in breast cancer patients, and compare the incidence of axillary lymph node metastasis and Rotter's node. We also investigated the rate of skip metastasis. MATERIALS AND METHODS: To investigate the predicting axillary node positivity, we compared the status of axillary lymph node and pathological prognostic markers. In 580 consecutive mastectomy performed for breast carcinomas between 1987 to 1999, axillary and Rotter's node were routinely dissected and separately sampled during mastectomy . RESULTS: The mean number of axillary lymph node and Rotter's nodes were 19.5 and 0.9. Axillary lymph nodes metastases were found in 47.2% of all patients. Frequency of axillary lymph node metastasis and involvement of higher level of axillary lymph node were significantly increased by increasing tumor size. But metastasis at Rotter's nodes was not following this pattern. Rotter's nodes were anatomically present in 39.8% of patients and average 2.3 lymph nodes were found in the interpectoral region. Rotter's metastases were found in 5% of all patients, and 10.6% of those with axillary lymph nodes metastases. Number of Rotter's nodes metastases were higher as the metastases were found to higher level(P<0.05). CONCLUSION: The presence of axillary metastases were related to histologic grade, nuclear grade and lymphovascular invasion, but not related to mitotic index and perineural invasion. In summary, number of axillary lymph node and metastatic rate of axillary lymph nodes were similar to western reports. It is apparent that potential risk from Rotter's and skip metastases were not great in all patients, but routine excision of Rotter's nodes should be applied to patients with more locally advanced disease.
Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lymph Nodes ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mitotic Index ; Neoplasm Metastasis

No abstract available.
Humans ; Hypophosphatemia*

PURPOSE: Rotter's nodes are removed in the course of a radical mastectomy, however they are not routinely removed in a modified radical mastectomy and breast conserving surgery, although they can be. Having been relatively ignored, the prognostic value and correlation of Rotter's nodes with axillary nodal status have rarely been reported or systematically studied. The aims of the present study were to assess the frequency and pattern of Rotter's node metastasis in breast cancer patients, and to compare the incidence of axillary lymph node metastasis and Rotter's node. We also investigated the rate of skip metastasis. METHODS: In order to investigate the predictability of axillary node positivity, we compared the status of axillary lymph nodes and the pathological prognostic markers. In 580 consecutive mastectomies performed for breast carcinomas between 1987 and 1999, axillary and Rotter's nodes were routinely dissected and separately sampled during mastectomy. RESULTS: The mean number of axillary lymph nodes and Rotter's nodes were 19.5 and 0.9. Axillary lymph nodes metastases were found in 47.2% of all patients. The frequency of axillary lymph node metastasis and the involvement of a higher level of axillary lymph node were significantly increased with increasing tumor size. However, metastasis at Rotter's nodes did not follow this pattern. Rotter's nodes were anatomically present in 39.8% of patients and an average of 2.3 lymph nodes was found in the interpectoral region. Rotter's metastases were found in 5% of all patients, and 10.6% of those with axillary lymph node metastases. The number of Rotter's nodes metastases was higher as the metastases were found at a higher level (p<0.05). CONCLUSION: The presence of axillary metastases was related to histologic grade, nuclear grade and lymphovascular invasion, but was not related to the mitotic index or perineural invasion. It is apparent that the potential risks from Rotter's and skip metastases were not great in all patients, although the routine excision of Rotter's nodes should be applied to patients with more locally advanced disease (T2-3, N1-N2).
Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lymph Nodes ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mitotic Index ; Neoplasm Metastasis

Extra-axial medulloblastoma is a rare phenomenon. We report a case in a 5-year-old boy who presented with nausea, vomiting, and gait disturbance. He was treated with total removal of the tumor. This is the first case of an extra-axially located medulloblastoma occurring in the cerebellar hemisphere posteriolateral to the cerebellopontine angle in Korea. Although the extra-axial occurrence of medulloblastoma is rare, it should be considered in the differential diagnosis of extra-axial lesions of the posterior fossa in children.
Cerebellopontine Angle ; Cerebellum ; Cerebrum ; Child ; Child, Preschool ; Diagnosis, Differential ; Gait ; Humans ; Korea ; Male ; Medulloblastoma* ; Nausea ; Vomiting

PURPOSE: To evaluate various sepsis screening tests, individually and in combination, to formulate a guideline for the diagnosis of neonatal sepsis. METHODS: The study was a retrospective cohort study. It took place at the neonatal intensive care unit of the Paediatric Department, Il Sin Christian Hospital, Busan, Korea, over a period of 68 months from 1st, April, 2001 to 31st, December, 2005. This study evaluated 100 neonates having clinical features of sepsis and 100 normal asymptomatic neonates and used screening tests including C-reactive protein (CRP), total leukocyte count (TLC), absolute neutrophil count (ANC), immature neutrophils to total neutrophil count ratio (I/T ratio), thrombocytopenia, degenerative changes in the neutrophils and gastric aspirate cytology (GAC) for the diagnosis of neontal sepsis. RESULTS: The sensitivity of CRP and ANC was high. CRP had 86 percent sensitivity for group-A (proven sepsis) and 74 percent sensitivity for group-B (probable sepsis) and 94 percent specificity for group-A, B. ANC had sensitivity of 72 percent for group-A and 62 percent for group-B and 86 percent specificity for group-A, B. For group-A, sensitivity, specificity of GAC for polymorphs was 74 percent and 94 percent respectively. As for sensitivity, specificity of platelet count for group-A was 64 percent and 89 percent respecively. The sensitivity, specificity and predictive values (PV) of the individual tests and different test combinations were also calculated for group-A and B. CONCLUSION: For the detection of culture negative cases in neonatal sepsis, screening tests including CRP, TLC, ANC, thrombocytopenia, cytoplasmic vacuolization in the neutrophils and GAC for polymorphs have high sensitivity. A combination of three tests has higher sensitivity.
Busan ; C-Reactive Protein ; Cohort Studies ; Cytoplasm ; Diagnosis ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Leukocyte Count ; Mass Screening* ; Neutrophils ; Platelet Count ; Retrospective Studies ; Sensitivity and Specificity ; Sepsis* ; Thrombocytopenia

PURPOSE: The incidence of shigellosis had been decreased due to the use of antibiotics and the improvement of environmental sanitation but recently increases again. Shigellosis occurrs in mass outbreak through unsanitized meal preperation refered from welfare facility and school. We observed epidemic aspect and clinical coarse of childhood shigellosis. METHODS: from December 2001 to January 2002, 22 inpatients with shigellosis in Dongbu Municipal Hospital were observed epidemiologically, clinically and microbiologically. RESULTS: 1. The sexual ratio was 1:1 and mean age was 5.5+/-1.4 years (14 months to 11 years). 2. The clinical manifestations were following: diarrhea (95.5%), high feve (10%) and asymptomatic (4.5%). The mean duration was 3.9+/-2.1 days (1 to 12 days). All patients had no complication and normal serologic test. 3. S. sonnei was cultured in rectal swab, and was resistant to TMP/SMX and ampicillin, but susceptible to ampicillin/sulbactam and the 3rd generation cephalosporins. 4. The patients were treated by antibiotics with conservative treatment including electrolytes and fluid therapy for 5 days, resulting in improvement confirmed by negative reaction on stool culture. 5. These cases were all occurred in mass outbreak in day care center and were suspected to be secondary infection by members of family. CONCLUSION: This shigellosis occurred in day care center was secondary infection due to S. sonnei and had mild clinical coarse and improvement after antibiotic treatment.
Ampicillin ; Anti-Bacterial Agents ; Cephalosporins ; Child ; Coinfection ; Day Care, Medical ; Diarrhea ; Dysentery, Bacillary* ; Electrolytes ; Fluid Therapy ; Hospitals, Municipal ; Humans ; Incidence ; Inpatients ; Meals ; Sanitation ; Serologic Tests

No abstract available.
Dinoprostone* ; Membranes* ; Rupture* ; Suppositories*

High tibial osteotomy is a useful procedure in the treatment of early stage osteoarthritis of the knee which is confined to the medial compartment. But long term follow-up study of high tibial osteotomy has not been provided yet and its prerequisite for a successful result still remains unrevealed. Since the osteoarthritis can progress after the osteotomy, it may result in the loss of correction and recurrence of pain and require conversion to total knee replacement arthroplasty. We studied clinically and radiologically the long term result of high tibial osteotomy in 11 patients(16 knees) who had been treated at the Department of Orthopaedic surgery of Seoul Paik Hospital during the period from January, 1978 to May, 1989, and follow-up for longer than 4 years. Preoperative mean varus angle was 6.4 degrees and immediate postoperative mean valgus angle was 8.6 degrees and final mean valgus angle was 4.7 degrees. The average loss of correction angle was 3.9 degrees. At 2-year follow-up, the results of 16 knees were as follows; excellent in six knees, good in seven knees. The final results at average 7.2-year follow-up were excellent in four knees, good in six knees and one knee was converted to total knee replacement arthroplasty. The results showed deterioration of clinical results and loss of correction with time after osteotomy. However, in more than half of the cases the results were good or excellent at the final follow-up, We, therefore, conclude that high tibial osteotomy is still a useful procedure in osteoarthritis of the knee if performed with a precise surgical technique and an adequate overcorrection more than 10 degrees.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Knee ; Osteoarthritis ; Osteotomy ; Recurrence ; Seoul