No abstract available.
Breast Neoplasms* ; Breast* ; Estrogens*

Surgery for a mid-esophageal lesion requires an open thoracotomy, But authors resected out a stenotic thoracic esphageal lesion with laparoscopic instrument without open thoracotomy. The patient was 50 years old woman with a long history of progressive dyaphagia. A small (3 cm in diameter) smooth ovoid submucosal mass lesion was found at 26 cm distal from incisor on both esophagoscopy and esophagogram. Two 5 mm and two 10 mm trocars were inserted into the right pleural cavity under general anesthesia with double lumen endotracheal tube, An induced pneumothorax by insuffulation of CO2 gas made lung collapse and a good exposure of esophagus. Transorally introduced esophagoscope helped to demonstrate the exact location of lesion and also to give a guide at safe excision of mass with prevention of mucosal perforation. The lesion was found to be a congromeration of an inflammed hilar lympnode and hypertorphic esophageal muscle. The entire lesion was carefully dissected from esphageal mucosa and resected out en bloc. A chest tube was introduced through a trocar site. The lung was reinflated immediately. Post-operatively patient was very comfortable. Laparoscopic surgery is very effective and safe, and it could be applied for the resection of lung bullae, benign pulmonary neoplasm and for an excision of benign esophageal tumor.
Anesthesia, General ; Chest Tubes ; Esophagoscopes ; Esophagoscopy ; Esophagus ; Female ; Humans ; Incisor ; Laparoscopy ; Lung ; Lung Neoplasms ; Middle Aged ; Mucous Membrane ; Pleural Cavity ; Pneumothorax ; Pulmonary Atelectasis ; Surgical Instruments ; Thoracotomy*

No abstract available.
Ganglia, Spinal* ; Longitudinal Ligaments*

We reviewed forty five cases of intracranial arteriovenous malformation (AVM) who were admitted in Seoul National University Hospital within recent 7 years; thirty one patients revealed intracerebral hemorrhage and fourteen patients showed seizure or progressived focal neurologic deficit as an initial presentation. To evaluate the natural history of AVM after initial hemorrhage, out of these 45 cases, we selected 22 cases who were, operated or not, observed naturally for at least 1 year. To know the post operative course, we also selected 18 cases who were operated on. Thses two groups were compared with respect to the mortality, morbidity, frequency of rebleeding or seizure, which were 9%, 27%, 55%, 27%, in the former, and 0%, 17%, 0%, and 28% in the latter. Among the 14 patients whose initial presentation was not intracranial bleeding, 9 had seizure, 5 had progressive focal neurologic deficit, and 4 had both. During the follow-up period (average 5 years), only one patient had intracranial bleeding. Seizures in this group were relatively well controlled by regular antiepileptic regimen. Out of the 2 cases who were operated for seizure control, one had considerable degree of neurologic deficit after operation. From above evidences, we tentatively conclude that the AVM with initial bleeding should be better operated on if accessible, whereas the AVM without initial bleeding should be best managed conservatively. For a more definite conclusion, large, radomized controlled studies should be done again which, however, may meet ethical problems.
Cerebral Hemorrhage ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Mortality ; Natural History ; Neurologic Manifestations ; Seizures ; Seoul

No abstract available.
Heart* ; Thoracic Surgery*

Metastatic brain parenchymal tumors are among the most important cause of death in patients with cancer, but many physicians didn't have any efforts to treat of metastatic tumors because of their poor responses of treatment. With the recent development of MR techniques, we could diagnose and treat them earlier. Recently many reports for prognostic factors of metastatic brain parenchymal tumors led to assume a more active attitude toward the diagnosis and treatment. We analysed 250 cases of metastatic brain parenchymal tumors diagnosed with the brain CT scan or MRI scan at Yonsei University, Severance Hospital from January, 1992 to December, 1995 and following results were obtained. 1. Metastatic brain parenchymal tumors are found in 254 cases(38.5%) of all intracranial neoplasms. 2. The most common primary tumor is lung cancer(154 cases, 61.6%) followed by breast cancer (30 cases, 12%), GI cancer (15 cases, 5.6%) in the order and melanoma (11.9%), rectal cancer (11.3%), lung cancer (8.6%) exhibit relatively high rate of intraparenchymal metastasis in the order. 3. The most common presenting symptom and sign is headache(52.8%) followed by motor deficit (32.4%), nausea and vomiting(21.6%). 4. Metastatic brain parenchymal tumors are detected simultaneously (73 cases, 28.8%), precociously (9 cases, 3.6%), after (153 cases, 61.2%) diagnosis of the primary tumor. Interval between the diagnosis of primary tumor and development of intracerebral metastasis is short in lung cancer (15.2 month) and long in breast cancer (43.1 month), nasopharyngeal cancer (51 month). In radiologic findings, the lesions were located in supratentorial areas in 186 cases, and in infratentorial in 36 cases. Ring type(63.6%) in enhancement is more than nodular type (33.2%). 5. Hemorrhages are found in 15 cases (7.6%) and calcifications in 2 cases. Density of lesions are hypodense(72.8%) than hyperdense on CT scan and high signal intensity in T1, or T2 weighted image of MRI are 66.7% and 88.9%. 6. Treatments for metastatic brain parenchymal tumors are conventional adiation therapy(165 cases, 66%), surgery(22 cases, 8.8%), gamma knife surgery (19 cases, 7.6%) in the order and there were 36 cases(14.4%) who didn't have any treatment. There are 132 cases(58.2%) who alive and 118 cases(47.2%) who dead. 7. Good predilicting findings in prognosis of metastatic brain parenchymal tumors are single lesion and supratentorial location. However, there are no significant value between prognosis and interval primary-to-metastasis, age, type of primary cancer, type of presenting symptom, size of edema.
Brain Neoplasms* ; Brain* ; Breast Neoplasms ; Cause of Death ; Diagnosis ; Edema ; Hemorrhage ; Humans ; Lung ; Lung Neoplasms ; Magnetic Resonance Imaging ; Melanoma ; Nasopharyngeal Neoplasms ; Nausea ; Neoplasm Metastasis ; Prognosis* ; Rectal Neoplasms ; Tomography, X-Ray Computed

No abstract available.
Constriction, Pathologic ; Stents

Further understanding of male human papillomavirus (HPV) infection is necessary to prevent infection in men, as well as transmission to women. In our current study, we investigated patterns of HPV infection and genotype distributions in male genital warts using the Anyplex II HPV28 Detection kit. We reviewed the medical records of 80 male patients who presented to 5 neighborhood clinics in Ulsan, Korea, for the treatment of genital warts between April 2014 and January 2015. All patients underwent HPV genotyping. The prevalence and characteristics of HPV infection were analyzed, and the patterns of HPV infection according to age were assessed. Among the study patients, 13 (16.3%) were negative for HPV infection, 46 (57.3%) were infected with low-risk HPV, and 21 (26.3%) were infected with high-risk HPV. Patients with multiple HPV infection were more likely to have high-risk HPV infection (P = 0.001). The prevalence of HPV infection was much higher in samples obtained by tissue excision due to a definite lesion (P = 0.001). There were no differences in high-risk HPV infection (P = 0.459), multiple HPV infection (P = 0.185), and recurrence at diagnosis (P = 0.178) according to age. HPV-6 and HPV-11 were the most common type overall (39.7% and 13.8%, respectively). HPV-16 and HPV-18 were the most common high-risk infections (both 3.4%). HPV infection is not only commonly encountered in male genital warts, but is also accompanied by high-risk HPV and multiple infections.
Adult ; Condylomata Acuminata/epidemiology/*pathology/virology ; DNA, Viral/genetics/metabolism ; Genotype ; Human papillomavirus 11/*genetics/isolation & purification ; Human papillomavirus 16/genetics/isolation & purification ; Human papillomavirus 18/genetics/isolation & purification ; Human papillomavirus 6/*genetics/isolation & purification ; Humans ; Male ; Middle Aged ; Prevalence ; Real-Time Polymerase Chain Reaction ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors

BACKGROUND: Coronary artery bypass graft (CABG) surgery is performed more frequently than before in Korea. Central nervous system (CNS) complications are often the major prognostic determinants following the surgery. We carried out a prospective study to clarify the incidence and risk factors of neurologic complications after CABG surgery. METHODS: A consecutive series of 150 patients undergoing 152 CABG operations from March 1995 to July 1997 by one cardiac surgeon was evaluated by a team of neurologists before and after the surgery. The patients received extensive preoperative examinations including the evaluation of intracranial & extracranial cerebral artery disease. RESULTS: In 44 operations (28.9%), we detected various neurologic complications, including encephalopathy (36 operations, 23.7%), cerebral infarction (5 operations, 3.3%), and seizure (7 operations, 4.6%). Eight patients died postoperatively including one due to neurologic complication. On univariate analysis, age, degree of intracranial artery disease (ICAD), duration of bypass time, hypotension index, duration of ventricular assistant device (VAD), intraoperative event, intra- or postoperative arrhythmia, reoperation, and postoperative bleeding were statistically significant risk factors of CNS complications (p< 0.05). After multivariate analysis, however, age alone remained significant (p=0.02). The degree of ICAD showed marginal significance (p=0.06). CONCLUSIONS: The incidence of CNS complication in the patients undergoing CABG surgery was 28.9%. Our results showed that age was an independent risk factor of CNS complications. And the possibility of ICAD as a risk factor was suggested. Further study with a large number of patients would be necessary to prove the above suggestion.
Arrhythmias, Cardiac ; Arteries ; Central Nervous System* ; Cerebral Arterial Diseases ; Cerebral Infarction ; Coronary Artery Bypass* ; Coronary Vessels* ; Hemorrhage ; Humans ; Hypotension ; Incidence ; Korea ; Multivariate Analysis ; Prospective Studies ; Reoperation ; Risk Factors ; Seizures ; Transplants

Three cases of cerebrospinal fluid (CSF) rhinorrhea and anterior skull base defects were successfully treated by applying mucoperichondrial free graft through the endonasal endoscopic technique. The causes of the skull base defects were trauma in two cases and endoscopic sinus surgery in one case. The defects were located in the sphenoid sinus in one case and the fovea ethmoidalis in two cases. In these cases, contralateral side septal mucoperichondrial free grafts were used to seal the defects and were supported with fibrin glue and Spongostan(R). Endoscopic repair with mucoperichondrial free graft appeared to be a safe and successful approach to the treatment of the anterior skull base defects.
Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Fibrin Tissue Adhesive ; Skull Base ; Sphenoid Sinus ; Transplants*