No abstract available.
Proliferating Cell Nuclear Antigen* ; Stomach Neoplasms*

Tissue expansion in breast reconstruction is a invaluable alternative surgical procedure. the advent of permanent expander prosthesis eliminated a second operative procedure for removal of the expander and replacement with another permanent implant. When we consider the choice of method for breast reconstruction, we have to take account of the extent of mastectomy, past-medical history of the patient, timing of operation, and patient's motivation. It is still accepted that autogenous Breast reconstruction is the best choice of the mothed. As autogenous breast reconstruction increase in popularity, however, it requires longer operation time, more complicated technique, and careful attention to donor site. Autogenous breast reconstruction is also not good candidate for the patients who have diabetes, vascular disease, smoking, obesity, previous history of cesarean section, or further pregnancy planning. We have performed 10 immediate breast reconstructions after modified radical mastectomy using the permanent expander prosthesis, manufactured by Mentor corporation. Among these cases, 8 patients underwent cesarean section and 2 patients pregnancy. Although this method has advantages of simple technique, minimal morbidity, and low cost, it has some limitations for orientals. First, it is inevitable in superior fullness of the reconstructed breast because of round shape of the expander. Second, it is difficult to get ptotic breast because of thick and inelastic characteristics of oriental skin. Third, the ratio of expander base to projection is not appropriate for orientals because of their smaller chest size. We experienced 2 cases of spontaneous deflation for its manufactural defect itself. In our experience, we would like to suggest that new type of permanent expander prosthesis should be innovated.
Breast* ; Cesarean Section ; Female ; Humans ; Mammaplasty* ; Mastectomy ; Mastectomy, Modified Radical ; Mentors ; Moths ; Motivation ; Obesity ; Pregnancy ; Prostheses and Implants* ; Skin ; Smoke ; Smoking ; Surgical Procedures, Operative ; Thorax ; Tissue Donors ; Tissue Expansion ; Vascular Diseases

In many cases the breast reconstruction surpasses the goal of a normal breast mound appearance in clothing and achieves a result that, in time, may look almost normal in the unclothe state. Breast reconstructions with autologous transverse rectus abdominis myocutaneous (TRAM) flaps are well known to produce the most aesthetically excellent results. the pedicled to TRAM flap cannot be used in high risk patient such as obese or smoking patients due to partial flap necrosis. But, the free TRAM flap have more robust blood supply and less donor site morbidity than the pedicled TRAM flap and is therefore the currently preferred technique in western. However, the free TRAM flaps has a problem related to the anastomotic failure which has been reported as high as 6% to 10%. Moreover many Korean women have smaller sized breast than western women and have no risk factors compromising flap circulation. So the single pedicled TRAM flap can be safely used for breast reconstruction without any flap necrosis. 60% of the elevated flap area has a sufficient volume to mold a new breast that matches with the contralateral breast and the unneccessary distal portion of the flap that has the marginal circulation can be resected. In this study we review our 20 consecutive cases of breast reconstruction using the pedicled TRAM flap and have a conclusion that the pedicled TRAM flap produce an aesthetically acceptable new breast in Korean mastecotmy patients without any flap necrosis or donor site morbidity.
Breast* ; Clothing ; Female ; Fungi ; Humans ; Mammaplasty* ; Necrosis ; Rectus Abdominis* ; Risk Factors ; Smoke ; Smoking ; Tissue Donors

BACKGROUND: Primary lymphoma of the gastrointestinal tract is an unusual disease for which the optimal management strategy has not been clearly defined. The role of surgery in the management of primary gastrointestinal lymphoma remains controversial. METHODS: We retrospectively reviewed the management and the outcome of 55 patients a diagnosis of gastrointestinal lymphoma who were treated at Kyung-Hee University Medical Center during the period 1986-1997. Thirty-seven of them underwent a resection for cure, and 23 patients of them underwent chemotherapy. 18 patients underwent chemotherapy only. Radiation therapy was excluded due to the small number of patients. Surgery consisted of wide local resection of the primary tumor (curative for stages I and II, and palliative for stages III and IV), and regional lymph nodes, with re-establishment of bowel continuity. Chemotherapy involved 6-10 courses of CHOP-B (cyclophosphamide, adriamicin, vincristine, prednisone, and bleomycin). Survival curves were calculated by using the Kaplan and Meier method. RESULTS: The mean age was 51 years (range: 3-82), the peak incidence of age was the fifth decades (34%), and the male-to-female ratio was 1.3:1. Common signs and symptoms at presentation were abdo minal pain (n=46), palpable mass (n=28), nausea/vomiting (n=26), and weight loss (n=18). The diagnostic sensitivities of ultrasound, contrast radiography, endoscopic biopsy, and computed tomography were 52%, 57%, 76%, and 78%, respectively. The primary tumor sites were the stomach (n=18), the terminal ileum & cecum (n=15), the small bowel (n=13), and the large bowel (n=9). The respective cumulative overall 5-year survival rates for stage I, II, III tumors were 89%, 74%, and 43% (p<0.05). The respective overall 5-year survival rate for resection only, resection with chemotherapy, and chemotherapy only were 100%, 78%, and 40% (p<0.05). By the Kaplan-Meier method, the prognostic factors of survival were stage and curative resection (p<0.05). CONCLUSION: A curative resection in a stage I, II lymphoma confined to the gastrointestinal tract and to regional involvement may improve patient survival.
Academic Medical Centers ; Biopsy ; Cecum ; Diagnosis ; Drug Therapy ; Gastrointestinal Tract* ; Humans ; Ileum ; Incidence ; Lymph Nodes ; Lymphoma* ; Prednisone ; Radiography ; Retrospective Studies ; Stomach ; Survival Rate ; Ultrasonography ; Vincristine ; Weight Loss

The authors analysed 33 cases of metastatic spinal tumors admitted to the department of neurosurgery, Hanyang University Hospital from January 1983 to December 1992. During this period, we operated 12 cases of 33 cases. The results were as follows : 1) The common incidence of age was fifth decade, the most frequent primary site of metastatic tumors was lung, and the thoracic region was the most common site of metastatic tumors. 2) The most common complaints of patients were pain, weakness of extremities and sphincter disturbance in order. 3) The indication to surgical treatments comprises spinal instability, aggravation of neurologic symptom, diagnosis in doubt, known radioresistance of tumor and intractable pain. Anterior approach was used in cervical area for tumor removal and fusion and posterior approach was used in the thoracolumbar area for decompressive laminectomy. The result was better in surgery group. 4) Early identification of spinal metastasis were considered to be important for better prognosis. 5) The survival rate of the primary lesion may imfeuence on the pregnosis of metastatic spinal tumor.
Diagnosis ; Extremities ; Humans ; Incidence ; Laminectomy ; Lung ; Neoplasm Metastasis ; Neurologic Manifestations ; Neurosurgery ; Pain, Intractable ; Prognosis ; Survival Rate

The colostomy may cause considerable discomfort as well as surgical, psychological and esthetic problems. The ostomates probably suffer most from fecal incontinence, even though many attempts have been made to eliminate the problems related to the spontaneous colonic emission. Hence the aims of this study are to survey ostomates' satisfaction with colostomy irrigation. METHODS: This medical survey attempts to assess the degree of satisfaction that ostomates are satisfied with the quality of their lives and the extent to which they are affected in doing their jobs and sexuality. The survey was conducted for 146 ostomates, who responded to the questionnaire at the 3rd & 4th Workshop for Stoma Rehabilitation for Ostomates in 1998 and 1999 developed by the Department of Surgery, Kyung Hee University Hospital. The irrigation group was formed with 66 cases (45.2%) and the non-irrigation group 80 cases (54.8%). In assessment of the satisfaction of sexuality, the irrigation group was composed of 37 cases (male: 22 cases, female: 15 cases) and the non-irrigation group 48 cases (male: 30 cases, female: 18 cases). RESULTS: It is found out that the ratio of male to female is 1.5:1 (97:59) and by the age distribution, the ostomates in their 50's and 60's constitute 67.1%: by the cause of stoma operation, malignancy consists of 133 cases (91.1%), Inflammatory Bowel Disease (IBD) 6 cases, the others 7 cases. As for the degree of the satisfaction of ostomates for their life quality, it is found that 52 cases (78.9%) of the irrigation group and 71 cases (88.8%) of the non-irrigation group (p<0.05) reveal dissatisfaction. As for the degree of the satisfaction of the ostomates for the extent to which they are affected in doing their social activities, dissatisfaction is revealed in 52 cases (78.9%) in the irrigation group and in 64 cases (80.0%) in the non-irrigation group (p>0.05). As for the degree of the satisfaction of the ostomates for the sexuality in male, dissatisfaction is revealed in 13 cases (59.1%) of the irrigation group and in 23 cases (76.7%) of the non-irrigation group (p<0.05). In the case of female, the dissatisfaction is observed in 8 cases (53.3%) of the irrigation group and in 13 cases (72.2%) of the non-irrigation group (p<0.05). CONCLUSIONS: This medical survey clearly shows high dissatisfaction rates especially in the non-irrigation group, and the better significant satisfaction was shown in the quality of life and sexuality between the male and the female in the irrigation group. Therefore, colostomy irrigation may be an effective method for the management of colostomy.
Age Distribution ; Colon ; Colostomy* ; Education ; Fecal Incontinence ; Female ; Humans ; Inflammatory Bowel Diseases ; Male ; Quality of Life ; Surveys and Questionnaires ; Rehabilitation ; Sexuality

OBJECTIVE: The regulation of apoptosis is influenced by various gene products including Bcl-2, which has been known to be anti-apoptotic. In addition, telomerase, a ribonucleoprotein that synthesizes telomeres, has been detected in many human neoplasms. In the current study, we present the anti-apoptotic effect by Bcl-2 expression and telomerase activity in the human brain tumors. METHODS: A total of 76 cases of surgically resected brain tumors were studied. Telomerase activity was detected by the telomeric repeat amplification protocol assay and Bcl-2 protein was examined by the Western blot analysis. Apoptosis of the specimens was also detected by DNA fragmentation analysis. RESULTS: Telomerase activity and apoptosis were detected in 65.8%(50 of 76) and 21.1%(16 of 76) respectively. Telomerase activity was correlated to apoptosis inversely(p<0.05). Bcl-2 was also expressed in 23.7%(18 of 76) and apoptosis detected in 11.1%(2 of 18) with Bcl-2. In 18 cases with Bcl-2, telomerase activity was expressed in 77.8%(14 of 18) and apoptosis was not induced in 85.7%(12 of 14) with telomerase activity. However, apoptosis was not detected in 4 cases with Bcl-2 and negative telomerase activity. Their difference of anti-apoptotic numbers between two groups was significant(p<0.05). In 36 cases with negative Bcl-2 and positive telomerase activity, apoptosis was not detected in 72.2%(26 of 36). In 22 cases without Bcl-2 and telomerase activity, apoptosis was not detected in 81.8%(18 of 22). Their difference between two groups was not significant statistically. CONCLUSION: Our results suggest that apoptosis may be modulated by telomerase activity of the human brain tumors with Bcl-2. And also, we may expect that apoptosis can be induced effectively by the inhibition of telomerase activity and Bcl-2 in the brain tumors.
Apoptosis* ; Blotting, Western ; Brain Neoplasms* ; Brain* ; DNA Fragmentation ; Humans ; Ribonucleoproteins ; Telomerase* ; Telomere

BACKGROUND: Arterial emboli remain an important cause of acute arterial ischemia. Despite simplification of operative techniques, the substantial morbidity and mortality still associated with an acute embolus remain a challenge to the vascular surgeon. We wanted to know the adequate evaluation and treatment modality for this limb threatened condition, and to evaluate the results according to etiology, location, time interval before starting treatment, clinical conditions, and limb survival rate. MATERIAL AND METHODS: A retrospective review was conducted on 91 patients who treated for acute lower leg thromboembolism between Jan. 1992 and Dec. 1997. RESULTS: There were 73 men and 18 women and most prevalent age group was in the 5th and 6th decades (53.8%). Over all amputation rate was 25.3% and mortality rate was 5.5%. Cardiac problem was the most common etiologic factor. Associated diseases were cardiac problem (37.4%), hypertension (35.2%), cerebrovascular accident (17.6%), and diabetes (15.4%). Interval from attack to definite therapy, within 24 hours in 14 cases (15.4%), 1~3 days in 23 (25.3%), after 4 days in 54 (59.3%) were noted. The locations were aorta and iliac in 25.3%, femoral in 38.5%, popliteal in 19.8%, tibial in 4.4%, and 15.4% in graft site in other of frequency. Clinical categories were grade I in 9.9%, IIa in 40.7%, IIb in 30.8%, and III in 18.7%. According to Eagle's criteria, low risk group were 34 cases (37.4%), moderate risk group were 39 cases (42.9%), and high risk group were 18 cases (19.8%). Of the 91 patients, conservative treatment in 2 (2.2%), thrombolytic therapy in 33 (36.3%), thromboembolectomy in 56 (61.5%), bypass in 16 (17.6%), endarterectomy and vessel ligation were performed. The 1-month and 1-year limb salvage rates were 73.4% and 71.1%, respectively. Especially, salvage rates in the Department of Vascular Surgery were 84.9% and 83.7%, whereas that of Thoracic and Orthopedic Surgery were 44.4% and 33.0% (p=0.0001). CONCLUSIONS: Cardiac problem especially atrial fibrillation was the most common etiologic factor. Prompt balloon catheter embolectomy performed under local anesthesia is a safe, simple, and effective method of treatment and the preferred mode of management in the great majority of patients. Nonoperative management with thrombolytic agents or high-dose heparin therapy alone is occasionally indicated in highly selected patients. The prognosis of acute arterial thromboembolism of lower extremity can be improved by early detection, early adequate treatment, and the involvement of a qualified vascular surgeon.
Amputation ; Anesthesia, Local ; Aorta ; Atrial Fibrillation ; Catheters ; Embolectomy ; Embolism ; Endarterectomy ; Extremities ; Female ; Fibrinolytic Agents ; Heparin ; Humans ; Hypertension ; Ischemia ; Leg ; Ligation ; Limb Salvage ; Lower Extremity ; Male ; Mortality ; Orthopedics ; Prognosis ; Retrospective Studies ; Stroke ; Survival Rate ; Thromboembolism* ; Thrombolytic Therapy ; Transplants

OBJECTIVE: Cerebral edema develops in the brain tumors by loosening of the endothelial tight junction. Tight junction(TJ) proteins, such as occludin and claudin bind adjacent cells tightly. Authors examine the expression rate of occludin in human brain tumors to evaluate the effect of altered expression of occludin on cerebral edema. METHODS: Seventy surgical specimens stored at -70degrees C were used. It included 14 astrocytic tumors, 27 meningiomas, 12 scwannomas, 7 pituitary adenomas, 6 hemangioblastomas, and 4 craniopharyngiomas. After protein extraction, expression of occludin was investigated by Western blot analysis. The tumors were classified according to World Health Organization(WHO) classification. RESULTS: The expression rates of occludin in brain tumors were: glioma (8/14=57.1%), meningioma (16/27=59.3%), schwannoma (10/12=83.3%), pituitary adenoma (6/7=85.7%), hemangioblastoma (6/6=100%), and craniopharyngioma (3/4=75.0%). The expression rate in glioma and meningioma was lower than other brain tumors. In gliomas, high grade tumor (1/4=25.0%) exhibited lower expression rate of occludin than low grade one (7/10=70.0%). CONCLUSION: These results suggest that the expression of occludin is different among the various kinds of brain tumors. In gliomas, its expression is correlated with the histological grade. It may indicate that occludin plays a role in the development of edema in the brain tumors.
Blotting, Western ; Brain Edema ; Brain Neoplasms* ; Brain* ; Classification ; Craniopharyngioma ; Edema ; Glioma ; Hemangioblastoma ; Humans ; Meningioma ; Neurilemmoma ; Occludin* ; Pituitary Neoplasms ; Tight Junctions* ; World Health ; World Health Organization

OBJECTIVES: Telomerase, a ribonucleoprotein adds telomere repeats to the ends of telomeres to compensate for the progressive loss. A favorable prognosis associated with low or no telomerase activity in some tumors, and cells transfected with antisense human telomerase lost telomeric repeats and die. We studied about the relationship between telomerase activity and apoptosis in the human brain tumors. MATERIAL AND METHODS: Between July 1998 and December 1999, 62 patients with brain tumors underwent surgery and their surgical specimens were obtained. Telomerase activity was investigated by telomeric repeats amplification protocol(TRAP) assay. Apoptosis was also evaluated by DNA fragmentation analysis. Differences and correlation in data were analyzed using Mann-Whitney test and Wilcoxon-signed rank test. RESULTS: Expression rate of telomerase activity and apoptosis were 80% and 30% in malignant gliomas, 33% and 0% in low grade gliomas, 63% and 38% in meningiomas, 67% and 33% in pituitary adenomas, 33% and 33% in metastatic tumors, 67% and 17% in acoustic neurinomas, 100% and 100% in pineoblastomas, 100% and 0% in the hemangioblastoma, respectively. There was no significant difference of telomerase activity and apoptosis between histological types. But a significant difference was noted in the expression of telomerase activity between malignant gliomas and low grade gliomas(p = 0.022). Brain tumors with telomerase activity expressed the lower rate of apoptosis. A significant correlation was also found between telomerase activity and absence of apoptosis in the human brain tumors(p = 0.005). CONCLUSIONS: Our data suggests that telomerase may protect from apoptosis of the human brain tumors and also may play an important role in the biological malignancy of the gliomas.
Apoptosis* ; Brain Neoplasms* ; Brain* ; DNA Fragmentation ; Glioma ; Hemangioblastoma ; Humans* ; Meningioma ; Neuroma, Acoustic ; Pinealoma ; Pituitary Neoplasms ; Prognosis ; Ribonucleoproteins ; Telomerase* ; Telomere