Soft-tissue sarcomas account for 1% of all solid tumors. Of these, less than 15% will occur in the retroperitoneum. Late diagnosis and large tumor size make retroperitoneal sarcomas difficult to resect. Resection with wide margins in all directions is rarely possible owing to proximity to vital structures. Radiation therapy is limited in dosage and, as with chemotherapy, has only been successful in a limited number of cases. These problems result in a poor prognosis. A series of patients with retroperitoneal sarcoma was reviewed with a focus on issues of surgical management and prognostic factors. A retrospective analysis of 12 patients with retroperitoneal sarcomas who had undergone operations at the Department of Surgery, Inje University Paik Hospital, Seoul, from 1980 through 1996 was performed. The mean age of the 10 adult patients was 51 years; the male-to-female ratio was 2:1. Eighty-three percent of the patients presented with an abdominal mass. The mean diameter of the tumors was 18.3 cm. Leimyosarcomas(33%) and liposarcomas(25%) comprised the majority of the histologic types. The tumor grades were I, II, and III in 3 cases each. Resection of the tumor was possible in 75%(9/12) of the cases, although 17% of the resections were incomplete. Resection of adjacent organs was required in 66% of the cases. The resectability rose from 60% in 80s to 86% in 90s, with no statistical significance, possibly due to the small number of cases in this series. There was no postoperative morbidity or mortality. Actuarial 1-, 3-, and 5-year survival rates after resection were 75%, 60%, and 30%, respectively. Four of the 7(57%) patients who underwent complete resections had recurrence 3 to 33 months after surgery; this was notable for grade II or III tumors only. Two patients with grade I tumors are alive 65 and 102 months respectively after complete resection and show no evidence of the disease. One patient who underwent an incomplete resection of the tumor died 50 months after the operation. Only the tumor grade was a significant prognostic factor(p=0.0207). In conclusion, a wide en-bloc resection of a retroperitoneal sarcoma with a clear margin in all directions is a prerequisite for long-term survival. Aggressive follow-up for the first 3 years after a complete resection of a high-grade tumor is justified.
Adult ; Delayed Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Mortality ; Prognosis ; Recurrence ; Retrospective Studies ; Sarcoma* ; Seoul ; Survival Rate

BACKGROUND : The incidence of breast cancer has steadily increased through the years. The establishment of the cause of breast cancer plays an important role for the diagnosis, management and prevention of breast cancer. METHODS : We analysed 241 cases of breast cancer that were treated during the 13 years from January 1985 to December 1997 at the Department of General Surgery, Inje University Paik Hospital, Seoul. RESULTS : The peak incidence of breast cancer was in the 5th decade (100 cases, 41.5%). The most common age of menarche ranged from 14 to 20 years (89.9%). The most common age of first full-term delivery ranged from 25 to 29 years (54.5%). The normal group was the most frequent body mass index (156 cases, 65.8%). The most common chief complaint was a painless palpable breast mass (166 cases, 68.9%). Most patients (181 cases, 75.1%) visited the hospital within 6 months of developing symptoms. The upper outer quadrant was the most frequent location for breast cancer (146 cases, 60.6%). The most common type of operative technique was a modified radical mastectomy (225 cases, 93.4%). The most common size of the breast mass ranged from 2 to 5 cm (151 cases, 62.7%). A pathologically positive axillary lymph node was present in 122 cases (52.4%). The predominant type of pathological classi fication was invasive ductal carcinoma (215 cases, 90.7%). According to the TNM system, the most common stage was stage II (161 cases, 66.8%). The five-year survival rates for the patients in stages I, II, III were 96.7%, 82.2%, 68.9%, respectively. CONCLUSIONS : We conclude that women with mass or mass-related symptoms needed more careful evaluation and aggressive approaches for discovering breast cancer.
Body Mass Index ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Diagnosis ; Female ; Humans ; Incidence ; Lymph Nodes ; Mastectomy, Modified Radical ; Menarche ; Seoul ; Survival Rate

PURPOSE: Neovascularization has been shown to be essential for the growth of solid tumors. Vascular endothelial growth factor (VEGF) is one of the most important mediators of angiogenesis, and recent studies have demonstrated that the p53 tumor suppressor gene plays an important role in controlling tumor angiogenesis. We examined the expression of VEGF and p53 as a function of microvessel density to evaluate its clinical significance in colorectal cancer and to investigate the correlation of VEGF and p53. METHODS: The study material included 20 patients who survived more than 5 years postoperatively without distant metastasis (non-metastasis group) and 21 patients who had synchronous (10 patients) and metachronous (11 patients) metastasis (metastasis group). Immunohistochemical staining for VEGF, p53 protein and factor VIII-related antigen was done. RESULTS: The expression rate of VEGF was 20% in non-metastatic tumors and 71% in metastatic tumors (p<0.05). The VEGF expression was not correlated with microvessel density. Otherwise, the microvessel density were 32.9 9.1 in non-metastatic tumors and 40.1 12.0 in metastatic tumors (p<0.05). VEGF expression was correlated with p53 over expression. CONCLUSION: VEGF expression might be a useful prognostic factor for metastasis in colorectal cancer. Also, our findings suggest the presence of a p53-VEGF pathway in colorectal cancer.
Colorectal Neoplasms* ; Genes, Tumor Suppressor ; Humans ; Microvessels ; Neoplasm Metastasis ; Vascular Endothelial Growth Factor A* ; von Willebrand Factor

BACKGROUNDING/AIMS: It has been nearly established that liver resection for colorectal metastases is a relatively safe procedure with survival benefit to patients. This study was performed to evaluate if the liver resection for colorectal metastases is effective method and to determine the appropriate therapeutic modality. METHODS: Between January 1995 and January 1999, sixteen patients who had liver resectin for metastatic colorectal carcinoma at our hospital were analyzed retrospectively. RESULTS: Wedge resection was performed in 7 patients, segmentectomy in 3 patients, and lobectomy in 6 patients. The median survival time was 26 months and cumulative 1 and 4-year survival rate were 83.1% and 34.6%, respectively. Extent of hepatic resection had marginally influenced the survival(p=0.0514). No prognostic factor was related significantly to survival. Recurrence in remaining liver following the anatomical liver resection was significantly low compared with wedge resection( 12.5% vs. 71.5%, p=0.035). CONCLUSION: Liver resection is an effective and safe treatment for colorectal liver metastases. The anatomical liver resection decreased recurrence rate in the remnant liver. The curative resection with an adequate surgical margin will improve outcome.
Colorectal Neoplasms ; Humans ; Liver* ; Mastectomy, Segmental ; Neoplasm Metastasis* ; Recurrence ; Retrospective Studies ; Survival Rate

Mesenchymal chondrosarcomas are very rare tumors, and they are more aggressive in comparison to the conventional type tumors. They can occur in any location containing mesenchymal cells, but most of them arise in the lower extremities, the leptomeninges and the eye orbits. Other sites are very uncommon and they represent approximately 1% of all chondrosarcomas; these rare tumor locations carry a poor prognosis. In this report, we present a case of extraskeletal mesenchymal chondrosarcoma of the pancreas. We could find only one case of extraskeletal mesenchymal chondrosarcoma with pancreatic metastasis from thigh in our PubMed-line search. We describe here a case of primary originating mesenchymal chondrosarcoma of the pancreas in a 40-year old man who presented with abdominal pain, and this is the first report of the pancreas as the primary origin of mesenchymal chondrosarcoma.
Abdominal Pain ; Adult ; Chondrosarcoma ; Chondrosarcoma, Mesenchymal* ; Humans ; Lower Extremity ; Neoplasm Metastasis ; Orbit ; Pancreas* ; Prognosis ; Thigh

PURPOSE: The present study was performed to assess the outcomes in patients with colonic perforation and to determine the prognostic factors for mortality. METHODS: The cases of 42 patients who underwent surgery for colonic perforation between March 1999 and September 2008 were retrospectively reviewed. Age, sex, American Society of Anesthesiologists (ASA) classification, presence of preoperative shock, duration of symptoms, cause of perforation, location of perforation, degree of peritonitis, and the Mannheim Peritonitis Index (MPI) score were analyzed for their association with early outcome by using univariate and multivariate analyses. RESULTS: Diverticulitis (46%, 19 patients) and colorectal cancer (36%, 15 patients) were the most common causes of noniatrogenic colonic perforation, and the sigmoid colon was the most common site of perforation (60%, 25 patients). The postoperative mortality was 21.4% (9 patients). The mortality in patients with preoperative shock, with a MPI score of more than 25, and with Hinchey stage III or IV peritonitis were 70.0%, 57.1%, and 53.3%, respectively (P<0.001). No statistical difference was observed in postoperative mortality with regard to age, sex, ASA classification, duration of symptoms, cause of perforation, and location of perforation. According to the multivariate analysis, preoperative shock proved to be the only significant prognostic factor for mortality (P=0.027) (odds ratio: 19.8, 95% confidence interval: 1.4-276.9). CONCLUSION: Preoperative shock, a MPI score of more than 25, and Hinchey stage III or IV peritonitis were associated with high postoperative mortality in patients with colonic perforation. Especially, more intensive management and interest are required for patient s with preoperative shock due to colonic perforation.
Colon ; Colon, Sigmoid ; Colorectal Neoplasms ; Diverticulitis ; Humans ; Multivariate Analysis ; Peritonitis ; Retrospective Studies ; Shock

PURPOSE: Pneumatosis intestinalis (PI) is increasingly being detected in recent years with the more frequent use of computerized tomography (CT). The present study was performed to evaluate the clinico-radiologic characteristic presentation of PI and to determine the prognostic factors for mortality. METHODS: Fifteen patients who were diagnosed with PI on CT between June 2000 and May 2010 were retrospectively reviewed. Age, sex, location of PI, presence of portal vein gas, time to diagnosis, American Society of Anesthesiologists (ASA) classification, Acute Physiology And Chronic Health Evaluation II (APACHE II), acidosis, shock, and other associated findings were analyzed for their association with outcome. RESULTS: Fifteen patients (7 males and 8 females, average age, 60.3 years) were diagnosed with PI. Mortality rate was 47% (7 patients). The mortality rate in patients with septic shock, APACHE II score (18), acidosis (pH<7.36) were all 100%, 87%, 100%, respectively (P<0.05). Age, sex, location of PI, portal vein gas, time to diagnosis, ASA classification, associated findings did not show statistical difference. CONCLUSION: Shock, APACHE II score (18) and acidosis were associated with high mortality in patients with PI. So, more intensive management and interest are recommended in patients with shock, APACHE II score (18), and acidosis due to PI.
Acidosis ; APACHE ; Female ; Humans ; Male ; Portal Vein ; Retrospective Studies ; Shock ; Shock, Septic

Traumatic abdominal wall hernia (TAWH) is an unusual type of hernia that may follow direct blunt trauma to the abdomen. Moreover, TAWH that is caused by bicycle handlebars is a rare finding. Despite an overall increase in the incidence of blunt abdominal trauma, the cases of TAWH remain rare, probably due to the elasticity of the abdominal wall for resisting the shear forces generated by a traumatic impact. Although the first case was described by Selby in 1906, very few cases of TAWH have been reported in the literature. Also, "Handlebar hernia" was described by Dimyan et al. in 1980. These injuries are localized hernias resulting from local blunt trauma to the abdominal wall from an object with insufficient force to penetrate the skin, yet this trauman is able to disrupt the deeper tissues of the muscle and fascia. The significance of such hernias is underestimated, and although they can be not immediately life-threatening, they can be fatal if associated with such complications as incarceration and strangulation. We describe here a case of traumatic handlebar hernia in a 55-year old man who presented with left lower quadrant pain that was caused by a motorcycle accident.
Abdomen ; Abdominal Wall ; Elasticity ; Fascia ; Hernia* ; Humans ; Incidence ; Middle Aged ; Motorcycles ; Skin

Anorectal trauma associated with retained rectal foreign body is an infrequent clinical problem, but presents a challenge to physicians taking care of patients with this problem. We report a case of rectal foreign body (glass cup) extracted by laparotomy. A 49-year-old male with a history of alcoholism presented to the emergency room four days after inserting a glass cup into his rectum. He complained of vague anal pain and failure to pass flatus or stool for four days. He had attempted to extract the glass cup using various methods (digital, instrumental manipulation, enema), none of which was successful. Computed tomography revealed a glass cup lodged in the rectum, without complication. The patient was brought to the operating room, administered spinal anesthesia, and placed in lithotomy position after failure of extraction in the emergency room. Although the object was palpable, it could not be extracted either manually or by the use of forceps. We decided to perform an emergent laparotomy under general anesthesia. After the abdomen was opened, an attempt was made to milk the object toward the distal rectum. However, this proved to be impossible secondary to severe rectal mucosal edema. The glass cup was eventually extracted through performing a colotomy at the rectosigmoid junction, with primary repair. The patient's postoperative course was uneventful, and he was discharged on the eighth postoperative day.
Abdomen ; Alcoholism ; Anesthesia, General ; Anesthesia, Spinal ; Edema ; Emergencies ; Flatulence ; Foreign Bodies ; Glass ; Humans ; Laparotomy ; Male ; Middle Aged ; Milk ; Operating Rooms ; Rectum ; Surgical Instruments

PURPOSE: As average life expectancies are prolonged, the elderly population is steadily increasing. The increasing number of elderly persons has been accompanied by cases of acute appendicitis in the elderly. In order to understand the clinical significance and to improve the treatment of elderly patients with appendicitis. we analyzed patients over 60 years of age with appendicitis. METHODS: We retrospectively reviewed the medical records of 268 patients over 60 years of age who were pathologically diagnosed with appendicitis. We analyzed the patients' clinicopathologic factors and outcomes, dividing them into 3 age groups: 60~69, 70~79, 80 and over. RESULTS: Of the 268 patients, there were 109 male and 159 female. The sex ratio was 1:1.46. The numbers of patients in each group were 169 (63.1%) in the 60-69 group, 73 (27.2%) in the 70~79 group, and 26 (9.7%) in the over 80 group. There was no difference in the leukocyte count and the time delay in surgical treatment between the groups. In the older groups, compared to the younger groups, there were more frequent paramedian and median incisions in the operation (P=0.02), a longer duration of postoperative admission (P=0.001) and starvation after the operation (P<0.001). In the pathologic findings, the gangrenous and abscess stages of appendicitis were more frequent in the older groups than in the younger groups (P<0.001). CONCLUSIONS: Early aggressive diagnostic intervention, such as ultrasound and CT, is essential in managing appendicitis in elderly patients who complain of vague abdominal pain.
Abdominal Pain ; Abscess ; Aged* ; Appendicitis* ; Female ; Humans ; Leukocyte Count ; Life Expectancy ; Male ; Medical Records ; Retrospective Studies ; Sex Ratio ; Starvation ; Ultrasonography