No abstract available.
Neoplasm Metastasis* ; Stomach Neoplasms*

Hamartoma of the breast is a rare benign lesion presenting as palpable mass. They are, however, sometimes misdiagnosed by pathologist due to their resemblance to other benign or physiologic conditions of the breast. We report two cases of hamartomas of the breast. The clinical diagnosis was fibroadenoma in both cases. One patient was a 49-year-old woman presented with palpable mass for the duration of 5 months. Mammography showed a well demarcated round mass with homogeneous density which is slightly greater than the surrounding glandular tissue. Grossly it was a 3.5 3.0 2.0 cm sized round firm mass covered by thin fibrous tissue. Microscopically it was a well defined mass composed of variable amount of breast lobules, dilated ducts and adipose tissue surrounded by dense hyalinized connective tissue. The adipose tissue accounted for 30% of the entire lesion. Cellular atypism was not found. The other patient was a 18-year-old woman presented with palpable mass of the duration of 3 years, which was increased in size recently. Mammography demonstratesd a well delimited lobulated mass with lucent halo. Ultrasonography showed a well encapsulated low echoic mass admixed with high echoic areas. Grossly, it was a 4.0 4.0 2.0 cm sized well demarcated oval-shaped firm mass with translucent thin fibrous capsule.. Microscopic findings were similar to the former. The amount of adipose tissue was 20%.
Adipose Tissue ; Adolescent ; Breast* ; Connective Tissue ; Diagnosis ; Female ; Fibroadenoma ; Hamartoma* ; Humans ; Hyalin ; Mammography ; Middle Aged ; Ultrasonography

BACKGROUND: For the evaluation of pulmonary nrtery branches after operation of right ventricular outflow obstructive disease, we reviewed the usefulness of both simple X-ray and lung perfusion scan with 99mTc-macroaggregated albumin compared with cardiac angiography. METHODS: From March, 1986 to July, 1993, at Seoul National University Children;s Hospital, we chose 23 cases who underwent both simple X-ray and cardiac angiography among the patients who had distinct difference between right and left pulmonary blood flow in lung perfusion scan after operation of right ventricular outflow obstructive disease. So we calculated the ratio of right and left pulmonary blood flow and Spearman correlation coefficient. RESULTS: Of the 23 cases, 17 cases were tetralogy of Fallot, 4 cases pulmonary atresia, 1 case double outlet right ventricle, and 1 case truncus arteriosus. The mean age at poeration was 27 months, and the mean postoperative follow-up period was for 68 months. The correlation coefficient between cardiac angiography and simple X-ray was 0.86(p<0.01), and that beteen cardiac angiography and lung perfusion scan was 0.80(p<0.01). CONCLUSION: The cardiac angiography has been known as the best diagnostic tool for the evaluation of pulmonary artery branches after operation of right ventricular outflow obstructive ddisease, but we proposed that the lung perfusion scan should be widely used because its results were similar with those of cardiac angiography.
Angiography ; Double Outlet Right Ventricle ; Follow-Up Studies ; Humans ; Lung* ; Perfusion* ; Pulmonary Artery* ; Pulmonary Atresia ; Seoul ; Tetralogy of Fallot ; Truncus Arteriosus

To determine size and shape discrepancy between the bone of Korean women and the prostheses in total knee arthroplasty, the height(antero-posterior length) and width(medio-lateral length) of the distal femur and the proximal tibia were measured at the bone resection level for 104 knees of 62 female patients who underwent primary total knee arthroplasty and compared with the same parameters of the total knee prostheses designed by five different companies. On the condition that the height of the prostheses matched with each cases of the bone were optimal, the difference in the width was evaluated, and the criteria of the discrepancy were overhang if the width of the prosthesis was larger than bone, optimal if width of the prosthesis was same or smaller and difference was within 5 mm, and down-size if smaller and difference was over Smm. In femoral prostheses, 34.6% of all were optimal, 13.1%, overhang and 52.3%, down-size. In tibial prosthesis, 54.1% of all were optimal, 13.9%, overhang and 32%, down-size. In conclusion, although further investigation for clinical application is needed, there were discrepancies in size and shape between the femur and tibia of Korean women and total knee prostheses and improvement in design should be considered.
Arthroplasty* ; Female ; Femur ; Humans ; Knee Prosthesis ; Knee* ; Prostheses and Implants* ; Tibia

PURPOSE: Drainage of the peritoneal cavity after abdominal surgery has been routinely practiced, although few data exist to scientifically support the efficacy of such an approach. In gastric cancer surgery, drainage is regarded as an essential procedure to keep the peritoneal cavity clear after extended lymphadenectomy and, also, to facilitate early detection of hemorrhage, and anastomotic or duodenal stump leakage. In this context, we planned a randomized prospective trial of drainage use after gastrectomy with extended lymphadenectomy. METHODS: Between February and July 2001, 170 patients who underwent gastrectomy with extended lymphadenectomy were randomly allocated to either a non-drainage (n=84) or drainage group (n=86). The primary outcome measure was the complication rate. Additional outcome measures were operation time, requirements of rescue analgesics, changes in the level of serum albumin and hemoglobin, and hospital stay. RESULTS: Demographic details, preoperative physical status, and pathologic features were not different between the two groups. Incidences of total gastrectomy and splenectomy among total gastrectomies were similar in both groups. However, operation time was shorter in the non-drainage group than in the drainage group (P=0.022). There were no differences in surgical outcome, including changes in hemoglobin and albumin levels, requirement for rescue analgesics, time to flatus or soft diet, and length of hospital stay. Complication rates were not different between the two groups(P=0.691), nor in the patterns of complication in either group. There was no operative mortality or reoperation. CONCLUSION: Based on these results, routine abdominal drainage should not be mandatory or even standard after gastrectomy with extended lymphadenectomy for gastric cancer.
Analgesics ; Diet ; Drainage ; Flatulence ; Gastrectomy ; Hemorrhage ; Humans ; Incidence ; Length of Stay ; Lymph Node Excision ; Mortality ; Outcome Assessment (Health Care) ; Peritoneal Cavity ; Prospective Studies ; Reoperation ; Serum Albumin ; Splenectomy ; Stomach Neoplasms*

OBJECTIVE: Although anterior cervical discectomy and fusion (ACDF) is the standard treatment for degenerative cervical disc disease, concerns regarding adjacent level degeneration and loss of motion have suggested that arthroplasty may be a better alternative. We have compared clinical and radiological results in patients with cervical disc herniations treated with arthroplasty and ACDF. METHODS: We evaluated 53 patients treated for cervical disc herniations with radiculopathy, 21 of whom underwent arthroplasty and 32 of whom underwent ACDF. Clinical results included the Visual Analogue Scale (VAS) score for upper extremity radiculopathy, neck disability index (NDI), duration of hospital stay and convalescence time. All patients were assessed radiologically by measuring cervical lordosis, segmental lordosis and segmental range-of-movement (ROM) of operated and adjacent disc levels. RESULTS: Mean hospital stay (5.62 vs. 6.26 days, p<0.05) and interval between surgery and return to work (1.10 vs. 2.92 weeks, p<0.05) were significantly shorter in the arthroplasty than in the fusion group. Mean NDI and extremity VAS score improved after 12 months in both groups. Although it was not significant, segmental ROM of adjacent levels was higher in the fusion group than in the arthroplasty group. And, segmental motion of operated levels in arthroplasty group maintained more than preoperative value at last follow up. CONCLUSION: Although clinical results were similar in the two groups, postoperative recovery was significantly shorter in the arthroplasty group. Although it was not significant, ROM of adjacent segments was less in the arthroplasty group. Motion of operated levels in arthroplasty group was preserved at last follow up.
Animals ; Arthroplasty ; Convalescence ; Diskectomy ; Extremities ; Follow-Up Studies ; Humans ; Length of Stay ; Lordosis ; Neck ; Radiculopathy ; Return to Work ; Upper Extremity

PURPOSE: Adenosquamous carcinoma, a rare malignant tumor of the stomach, is characterized by two different cell components, one adenomatous and the other squamous component. Its clinicopathologic feature and prognosis are quite different from the ordinary adenocarcinomas. We report our experience of 9 such cases. MATERIALS AND METHODS: Clinical and pathologic features were reviewed for the 9 patients who undenwent gastrectomies and were confirmed as adenosquamous carcinoma by pathologists during the 10-year period of from 1987 to 1998. Postoperative adjuvant therapy and prognosis were also reviewed. RESULTS: The ages of 6 male and 3 female patients ranged from 30 to 59, with the median age of 48. Total gastrectomy was done in 4 cases, while other underwent subtotal gastrectomy. Curative resection was done in four cases. Fourteeen additional organs were resected concomitantly due to suspicious tumor invasion and among them 9 organs were histologically confirmed for tumor invasion. The mean tumor size was 7.4 cm (2.5-27 cm) and all cases were pathologically advanced. One case showed peritoneal seeding and 3 cases showed hepatic metastases. There were 7 cases of stage IV disease by the UICC TNM classification (5th ed.) and the other two were stage II and stage IIlb respectively. Eight cases received postoperative adjuvant chemotherapy comprising S-FU, DDP, adriamycin, picibanil or VP-16. Of 9 patients, 6 died and the overall 5-year survival rate was 15.3%. CONCLUSION: Adenosquamous cancer of stomach is regarded as a disease of unfavorable prognosis, which was confirmed by this study. The treatments were not quite different from those for other stomach cancers. Although more cases and further investigations are essential for complete understanding of the clinical prognosis and proper treatment of the gastric adenosquamous cancer, early diagnosis, curative resection and close postoperative follow-ups are currently available options for better outcome of this disease.
Adenocarcinoma ; Carcinoma, Adenosquamous* ; Cellular Structures ; Chemotherapy, Adjuvant ; Classification ; Doxorubicin ; Early Diagnosis ; Etoposide ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Male ; Neoplasm Metastasis ; Picibanil ; Prognosis ; Stomach ; Stomach Neoplasms ; Survival Rate

Fatal complications including cerebral edema and neurologic collapse occur during treatment of diabetic ketoacidosis(DKA). A 6-week-old female infant with fever, dehydration and drowsy mental status was diagnosed as DKA and neurologically deteriorated during treatment. The cranial computed tomography scan revealed multifocal brain infarctions of the left caudate nucleus, bilateral frontal periventricular white matter, and right parietal cortex. A moderate amount of hemorrhage was also noted in both lateral ventricles. She recovered rapidly with supportive treatment over time. The clinical course and radiologic findings of this patient emphasize the importance of brain infarction as a cause of persistent neurologic loss in children with DKA.
Brain Edema ; Brain Infarction* ; Brain* ; Caudate Nucleus ; Child ; Dehydration ; Diabetic Ketoacidosis* ; Female ; Fever ; Hemorrhage* ; Humans ; Infant* ; Lateral Ventricles ; Rabeprazole

There is a widespread belief that nasogastric decompression in gastric cancer surgery allows better surgical field and leads to the reduction of postoperative complications. The aim of this study was to evaluate whether gastric cancer surgery can be safely performed without nasogastric decompression. From March to June 2000, 119 patients with gastric adenocarcinoma were randomized into either a tubeless group (n=56) or an intubated group (n=63). Exclusion criteria included a history of upper gastrointestinal bleeding and pyloric obstruction. No remarkable difference was found in the incidence of complications in the tubeless and intubated groups (mean 10.9%, p=0.945). The incidence of nasogastric tube insertion in the tubeless group was similar to the incidence of nasogastric tube reinsertion in the intubated group (p=0.747). Time to pass flatus was not different in the two groups (p=0.054), nor was the length of hospital stay (p=0.148). These results suggest that gastric cancer surgery can be performed safely without nasogastric decompression.
Adult ; Aged ; Comparative Study ; Female ; Human ; *Intubation, Gastrointestinal ; Male ; Middle Age ; Postoperative Complications/etiology ; Prospective Studies ; Stomach Neoplasms/*surgery

We reviewed 26 cases of cardiac rhabdomyoma in children which were diagnosed between 1986 and 1991 in Seoul National University Children's Hospital. Twenty-two cases were associated with tuberous sclerosis. Total tumor count was 58 and mean tumor count per patient was "daehakgyo".23. Their cardiac rhabdomyomas were diagnosed from fetal period through 12 years after birth. Median age was 9."uiwon" months. Fifteen patients were males and rest 11 patients were females. Cardiac symtoms and signs at initial diagnosis were present in 12 cases. They consisted of cardiac murmur in "hakgyo", arrhythmia in 8 and congestive heart failure in "daehakgyo" cases (one with murmur and the other with arrhythmia). Cardiomegaly was seen in 9 cases on chest X-ray and other "byeongwon" case showed abnormal left cardiac border. Electrocardiography and 24 hour Holter monitorings showed arrhythmia in 15 cases. Clinically significant arrhythmias were found in 7 cases on 24 hour Holter monitorings. They consisted of 1with frequent premature ventricular contractions, "daehakgyo uigwadaehak" with frequent premature atrial contractions, "daehakgyo" with atrial tachycardia and "daehakgyo uigwadaehak" with atrio-ventricular block ("daehakgyo" cases of atrio-ventricular block had other arrhythmias also). The locations of tumors were left ventricle in 21, interventricular septum in 21, right ventricle in 13 and atrium in "daehakgyo uigwadaehak" tumors. Mean tumor count per patient in fetal period and infancy was "daehakgyo".86 and it was statistically much more than that after infancy which was "byeongwon".5. Mean tumor area which was calculated on two dimensional echocardiography was larger in fetal period and infancy(128.9 +/- 38.2mm2)than that after infancy(47.8 +/- 11.2mm2). Mean relative tumor area to aortic root dimension was also significantly larger in fetal period and infancy than that after infancy ("daehakgyo".07vs 0.30). In tuberous sclerosis, mean mass area and mean relartive tumor area to aortic root dimension in fetal period and infancy was significantly larger than those in patients after infancy. Of 26 cases, tumorectomy was done in "daehakgyo uigwadaehak" cases due to hemodynamic obstruction and arrhythmia. One case died immediately after operation and the other "daehakgyo" cases are still alive with the follow up period of 30 and 44 months each. Of the 7 patients with significant arrhythmia on 24 hour Holter monitorings, pacemaker insertion was done in "byeongwon" case who received tumorectomy and other 1 case was treated with anti-arrhythmic drugs. All the other patients did not need anti-arrhythmic drugs or other management.
Arrhythmias, Cardiac ; Atrial Premature Complexes ; Cardiomegaly ; Child* ; Diagnosis ; Echocardiography ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Failure ; Heart Murmurs ; Heart Ventricles ; Hemodynamics ; Humans ; Male ; Parturition ; Rhabdomyoma* ; Seoul ; Tachycardia ; Thorax ; Tuberous Sclerosis ; Ventricular Premature Complexes