No abstract available.
Infarction*

Axillary dissection is still important for the management of breast cancer, even in conservative surgery. The status of axillary lymph nodes is the most valuable prognostic factor and marker for adjuvant therapy. Classical open surgery has led to significant morbidity such as big scar, limitation of shoulder motion, nerve damage, accumulation of seroma, and lymphedema. Recently, Suzanne et al(1996) reported endoscopic axillary dissection after liposuction. The advantage of this technique is the reduction of complications and a shortening of the hospital stay, as well as cosmetic effect. We report here the results of 25 breast cancer cases in which the patient received an endoscopic axillary dissection. A Partial mastectomy was done for 22 cases and a total mastectomy was performed for 3 cases. Average number of axillary lymph nodes removed was 15.4. Axillary drain tubes were removed 4.5 days postoperatively on average. Almost none of the cases were not experienced shoulder motion immediately after the operation. In conclusion, endoscopic axillary dissection has reduced morbidity compared with, and has revealed a similar number of axillary lymph nodes removed as classical open axillary dissection.
Breast Neoplasms* ; Breast* ; Cicatrix ; Endoscopy ; Humans ; Length of Stay ; Lipectomy ; Lymph Nodes ; Lymphedema ; Mastectomy, Segmental ; Mastectomy, Simple ; Seroma ; Shoulder

No abstract available.
Diagnosis* ; Hemangioma* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: The purpose of this study was to evaluate the CT findings of phytobezoar associated with small bowel obstruction. MATERIALS AND METHODS: In 19 patients with phytobezoar associated with small bowel obstruction, two of whom had underlying small bowel disease, we analyzed the morphological characteristics of phytobezoars and changes in the bowel and perienteric regions, as revealed by abdominal Ct imaging. RESULTS: On CT, phytobezoars appeared as single or multiple, gas-containing masses in 17 patients (89%) and as a solid mass without gas in the remaining two (11%). An encapsulating wall was noted in six patients (32%). Among the 17 without underlying small bowel disease, the bowel wall was thickened in 13 (76%) at the obstructed site and/or the bowel proximal to the obstruction. Mesenteric vascular engorgement and haziness were seen in 18 patients (95%) and a small amount of ascites in six (32%). MR images of one patient showed the phytobezoar as a hypointense mass on all sequences. CONCLUSION: CT imaging is useful for the diagnosis of phytobezoar associated with small bowel obstruction.
Ascites ; Bezoars ; Diagnosis ; Humans ; Tomography, X-Ray Computed

OBJECTIVE: To determine the effect of myomectomy as a treatment for infertility and to define the factors that influence reproductive outcomes MATERIALS AND METHODS: During the period from January 1995 to December 2001, on 39 patients who suffered from infertility and habitual abortion underwent transabdominal myomectomy at the Department of Obstetrics and Gynecology in Chonbuk National University Hospital. RESULTS: Pregnancy occurred in 31 women. The mean age was 32.3 years. The pregnancy rates in women with or without associated factors in addition to myoma were 55.5% and 71.4%, respectively, and those in women with <2 years versus >2 years of infertility were 73.7% and 55%, respectively. In case of women with myoma on lateral side, pregnancy rate was 33.3%. Considering the size, women with a myoma, 30~50 mm in size had higher pregnancy rate (81.2%). The 24-month cumulative probability of conception was 91% in patients <30 years of age, 55.5% in patients 30~35years of age, and 40% in patients >35 years of age. CONCLUSION: Our results suggest a benefit of myomectomy in infertile patients. Factors affecting the pregnancy rate after myomectomy in theses patients are the age of the patient, the duration of infertility, the site of myoma, and the size of myoma <50 mm. However, women should be counseled carefully before surgery because the determinants of outcome appear to be independent of treatment.
Abortion, Habitual ; Female ; Fertilization ; Gynecology ; Humans ; Infertility ; Jeollabuk-do ; Myoma ; Obstetrics ; Pregnancy ; Pregnancy Rate

BACKGROUND: Elevation in plasma homocysteine has been widely studied as an independent risk factor for atherosclerosis. And epidemiologic studies have demonstrated that the persons who take the folate and vitamin B6 have lower incidence of atherosclerotic vascular disease and lower plasma homocysteine level. But, not yet the effects of vitamin B6 and folate on the level of plasma homocysteine and brachial artery dilation on healthy subjects was not evaluated. METHODS: We evaluated the effects of 50 mg of vitamin B6 and 1 mg of folate on endothelial function, plasma homocysteine levels to one healthy postmenoausal woman and nineteen men in a randomized, double-blind, placebo-controlled, crossover design. RESULTS: In our study, supplement of vitamin B6 and folate significantly lowered plasma homocysteine level (placebo : folate =6.56 +1.55 micromol/L vs. 5.37 +1.04 micromol/L, p=.001). But, there were no statistically significant increament of flow-mediated dilation (FMD) compared to placebo (placebo : folate =5.12 +3.26% vs. 6.69 +2.60%, p=.070) and there were no significant correlation between the improvement of homocysteine level and increament of flow mediated dilation on healthy subjects. CONCLUSION: Compared to persons with absolute or relative hyper-homocysteinemia, our study did not show such favorable effects in healthy persons. So further studies must to be held to discover the effect of folate and vitamine B6 in healthy persons.
Atherosclerosis ; Brachial Artery* ; Cross-Over Studies ; Female ; Folic Acid* ; Homocysteine* ; Humans ; Incidence ; Male ; Plasma* ; Risk Factors ; Vascular Diseases ; Vitamin B 6* ; Vitamins*

BACKGROUND/AIMS: There is a paucity of national guideline for colorectal cancer screening and polyp diagnosis in Korea. Thus, we investigated the present state of colorectal cancer screening and polyp diagnosis methods using web-based survey to use as reference data for developing a guideline. METHODS: A multiple choice questionnaires of screening recommendations was sent via e-mail to members of the Korean Association for the Study of Intestinal Diseases and primary care physicians who participated in the national colonoscopy surveillance program. Among 425 colonoscopists, a total 263 colonoscopists replied (response rate, 61.9%). RESULTS: The most commonly recommended starting age for colorectal cancer screening and polyp diagnosis was 50 years old in the average risk group, and 40 years old in groups who had a family history of colon cancer (64.3% and 65.0% respectively). Surgeons had a tendency to recommend screening in younger people than internist do. Ninety-eight percent of physicians recommended screening colonoscopy to asymptomatic, average-risk patients as a first choice. Only 2% of physicians chose sigmoidoscopy as a screening tool. When the initial colonoscopy showed a negative finding, over 60% of internists repeated the exam 5 years later, whereas 62% of surgeons did so within 3 years. CONCLUSIONS: The starting age of colorectal cancer screening and the interval of the colorectal polyp examination are not uniform in various medical environments, and there is a discrepancy between the practical recommendations and western guidelines. Thus, a new evidence-based national practice guideline for colorectal cancer screening and polyp diagnosis should be developed.
Adult ; Age Factors ; Asian Continental Ancestry Group ; Colonic Polyps/*diagnosis/surgery ; Colonoscopy ; Colorectal Neoplasms/*diagnosis ; Data Collection ; Early Detection of Cancer ; Female ; Health Care Surveys ; Humans ; *Internet ; Male ; Middle Aged ; Physician's Practice Patterns ; Questionnaires ; Republic of Korea

BACKGROUND/AIMS: There is a paucity of information on postpolypectomy surveillance currently practiced in Korea. Thus, we investigated the present state of postpolypectomy surveillance in Korea using a web-based survey. METHODS: A multiple choice questionnaire was used to determine the preferred surveillance modality, the colonoscopic surveillance interval used in 11 case scenarios, and clinical factors influencing surveillance intervals. The form was sent via e-mail to members of the Korean Association for the Study of Intestinal Diseases and primary care physicians involved in a colonoscopy surveillance program. Of 425 colonoscopists contacted, 263 replied (response rate, 62%). Of the respondents, 94% were internists and 54% practiced in tertiary referral hospitals. RESULTS: All respondents chose colonoscopy as a preferred surveillance modality following polyp removal. Colonoscopy at 3 years was the most frequent answer after removal of 1 or 2 tubular adenoma(s) <1 cm in size, while 1 year was the most frequent answer after removal of an advanced adenoma or > or =3 adenomas, and 6 months was the most frequent choice after removal of adenoma with high-grade dysplasia or a sessile polyp > or =2 cm. The agreement rate for the time of first surveillance between preferred guideline recommendations and respondent answers was in the low range at 14-43%. CONCLUSIONS: A significant disagreement exists between current postpolypectomy surveillance practices of Korean colonoscopists and preferred guideline recommendations. This discrepancy may be due to the fact that the guidelines do not reflect recent studies and the specific medical environment in Korea. Thus, there is a need to develop new evidence-based Korean guidelines for postpolypectomy surveillance.
Adenoma ; Colonic Polyps ; Colonoscopy ; Colorectal Neoplasms ; Electronic Mail ; Humans ; Intestinal Diseases ; Korea ; Physicians, Primary Care ; Polyps ; Referral and Consultation ; Surveys and Questionnaires

BACKGROUND/AIMS: There are no evidence-based, procedural guidelines to appropriately perform a colon polypectomy. Thus, we investigated the treatment modality for colon polypectomy in Korea, using a web-based e-mail survey. METHODS: A questionnaire of preferred treatment modality for colon polypectomy was sent via e-mail to members of the Korean Association for the Study of Intestinal Diseases and primary care physicians who performed colonoscopies as a screening or surveillance program nationwide. Among 425 colonoscopists who were sent the e-mail, 263 replied. We analysed data from 252 colonoscopists who had performed colon polypectomies. RESULTS: The stopping time for antiplatelet and anticoagulation therapy before a colon polypectomy had a tendency to increase and the restarting time for these drugs was delayed as polyp size increased. Colonoscopists preferred cold biopsy removal for polyps <5 mm in size and a hot snare polypectomy after injecting normal saline and epinephrine mixture for polyps > or =5 mm in size. More than half of colonoscopists preferred observation rather than additional procedures for adenomas with incomplete resection. In contrast, most colonoscopists recommended additional procedures, such as endoscopic mucosal resection, endoscopic submucosal dissection or surgery for an advanced adenoma with incomplete resection. The most preferred prophylactic treatment for immediate postpolypectomy bleeding was hemoclipping. CONCLUSIONS: Various treatment modalities were used for a colon polypectomy because there are few guidelines for performing a colon polypectomy based on a critical review of the available data. Further well-designed, prospective studies are needed to develop evidence-based guidelines for colon polypectomy.
Adenoma ; Biopsy ; Cold Temperature ; Colon ; Colonoscopy ; Electronic Mail ; Epinephrine ; Hemorrhage ; Humans ; Intestinal Diseases ; Korea ; Mass Screening ; Physicians, Primary Care ; Polyps ; SNARE Proteins ; Surveys and Questionnaires

There are indirect evidences to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary outpatient clinics and secondary and tertiary medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, PubMed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient's condition and the available courses of action.
Adenomatous Polyps ; Ambulatory Care Facilities ; Cohort Studies ; Colonoscopy ; Colorectal Neoplasms ; Consensus ; Humans ; Incidence ; Korea ; Polyps ; Prospective Studies ; Standard of Care