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

PURPOSE: Thrombocytosis is reported in patients with various tumors, including stomach, colon, ovarian, lung and pancreatic cancers. Some clinical reports have shown thrombocytosis to be a poor prognostic factor in cancer patients. However, in hepatocellular carcinoma patients, the incidence and clinical significance of thrombocytosis have not been clearly verified. In this study, the clinical significance of platelet counts was investigated in patients with hepatocellular carcinomas. METHODS: 212 patients with surgically proven hepatocellular carcinomas were enrolled in this study. The incidence, relationship with other clinicopathological factors, and the prognostic value of thrombocytosis were retrospectively evaluated. RESULTS: The incidence of thrombocytosis (> or =400, 000/ul) was 2.8% (6/212). The platelet counts were elevated in patients with a large sized tumor (p< 0.001), advanced TNM stage (p=0.009) and gross tumor thrombi in the portal vein (p=0.009). There was no difference in the survival between patients with low and high platelet counts. CONCLUSION: The incidence of thrombocytosis in hepatocellular carcinoma patients was very low. The platelet counts were elevated in patients with advanced hepatocellular carcinomas, but no prognostic significance was shown in this study.
Blood Platelets* ; Carcinoma, Hepatocellular* ; Colon ; Humans ; Incidence ; Lung ; Pancreatic Neoplasms ; Platelet Count* ; Portal Vein ; Retrospective Studies ; Stomach ; Thrombocytosis

BACKGROUND: Meicillin-resistant Staphylococcus aureus(MRSA) is a common cause of nosocomial infections worldwide. Identification of strains by molecular typing facilitates epidemiological studies and improves disease control This study was performed to determine the usefulness of mecA-associated hypervariable region(HVR) polymerase chain reaction (PCR) and random amplified polymorphic DNA(RAPD) analysis in the investigation of a nosocomial MRSA infections. METHODS: Methicillin-resistance was identified by NCCLS disk diffusion method using the oxacillin disk. And PCR was done for detection of mecA gene. Antimicrobial susceptibility test, HVR-PCR and RAPD using 3 primers were performed for epidemiological analysis on isolates of MRSA. RESULTS: During the period from 1997 Dec. to 1998 May, 120 strains of S. aureus were isolated from clinical specimens. Among them, 78 strains were MRSA, and 72 strains were mecA positive. The strains of mecA positive MRSA were classified into four types by antibiogram, six genotypes by HVR-PCR, and 29 groups by RAPD using three primers. The combination of HVR genotypes and RAPD analysis showed 43 different types in 72 mecA positive MRSA isolates The five strains which were repeatedly isolated from the same patients showed the same HVR genotypes and RAPD analysis. CONCLUSIONS: Antibiogram, HVR-PCR, and RAPD could classify MRSA isolates into only 4-6 types, respectively, but combination of these methods could improve the typability. And combination of results of RAPD analysis using three primers were better than that using one primer in epidemiological studies of MRSA because of same reasons. It can be concluded that molecular typing of MRSA using HVR-PCR and RAPD assay is useful in epidemiolgical investigation of nosocomial infections caused by MRSA, because of its simplicity and reproducibility.
Cross Infection ; Diffusion ; Epidemiologic Studies ; Genotype ; Humans ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Microbial Sensitivity Tests ; Molecular Typing ; Oxacillin ; Polymerase Chain Reaction ; Staphylococcus

PURPOSE: A spontaneous rupture is a rare but life-threatening complication in patients with a hepatocellular carcinoma (HCC). Whether this condition has any influence on the subsequent outcome following a resection is unclear. Therefore, the long-term results of liver resection were compared in patients with and without a tumor rupture. METHOD: This retrospective study was conducted on 17 patients with a spontaneous rupture of an HCC out of 256 with an HCC who underwent hepatic resection. RESULTS: Reduced hemoglobin and albumin, as well as increased leukocytosis, a poor Child Class, large tumor and portal vein tumor thrombosis were more frequent clinical findings in patients with a ruptured HCC. The postoperative complication and extrahepatic recurrence rates were similar between the two groups. The 1- and 3- year survival rates in the 17 patients with a ruptured HCC were 41.2 and 17.7%, respectively, while these were 80.3 and 48.3%, respectively, in the 239 patients without a rupture. However, when these patients were compared exclusively with the 8 patients with a corresponding AJCC/UICC 6th ed. TNM stage IIIB disease without a rupture (50 and 0%, respectively), no significant difference was found in the overall survival rates between the groups. CONCLUSION: The surgical outcomes of stage matched patients with and without a ruptured HCC were similar.
Carcinoma, Hepatocellular* ; Child ; Humans ; Leukocytosis ; Liver ; Portal Vein ; Postoperative Complications ; Prognosis* ; Recurrence ; Retrospective Studies ; Rupture ; Rupture, Spontaneous ; Survival Rate ; Thrombosis

The purpose of this study was to detect where the center of pressure in foot would be located at the end point of loading response and the terminal stance by the dynamic plantar pressure measurement. Seventeen adults who had the usual feet without a pathologic gait were evaulated simultaneously by the motion analysis using VICON 370, and the plantar pressure measurement using EMED-SF. Two devices were set in the 60 Hz frame. The foot was divided into 3 different zones; hindfoot, midfoot, and forefoot. The end point of loading response was located at the 1.92+/-1.46 frame distal to the hindfoot- midfoot borderline. The end point of terminal response was located at the 2.27+/-1.96 frame distal to the maximal pressure points of metatarsal head. Authors could differentiate each period of stance phase; the initial contact, loading response, mid-stance, terminal stance, and preswing, using the analysis of center of pressure by the dynamic plantar pressure measurement.
Adult ; Foot* ; Gait* ; Head ; Humans ; Metatarsal Bones

PURPOSE: Even though traumatic pancreatic injuries occur in only 0.2% to 4% of all abdominal injuries, the morbidity and the mortality rates associated with pancreatic injuries remain high. The aim of this study was to evaluate the clinical outcomes of traumatic pancreatic injuries and to identify predictors of mortality and morbidity. METHODS: We retrospectively reviewed the medical records of 26 consecutive patients with a pancreatic injury who underwent a laparotomy from January 2000 to December 2010. The data collected included demographic data, the mechanism of injury, the initial vital signs, the grade of pancreatic injury, the injury severity score (ISS), the revised trauma score (RTS), the Glasgow Coma Scale (GCS), the number of abbreviated injury scales (AIS), the number of associated injuries, the initial laboratory findings, the amount of blood transfusion, the type of operation, the mortality, the morbidity, and others. RESULTS: The overall mortality rate in our series was 23.0%, and the morbidity rate was 76.9%. Twenty patients (76.9%) had associated injuries to either intra-abdominal organs or extra-abdominal organs. Two patients (7.7%) underwent external drainage, and 18 patients (69.3%) underwent a distal pancreatectomy. Pancreaticoduodenectomies were performed in 6 patients (23.0%). Three patients underwent a re-laparotomy due to anastomosis leakage or postoperative bleeding, and all patients died. The univariate analysis revealed 11 factors (amount of transfusion, AAST grade, re-laparotomy, associated duodenal injury, base excess, APACHE II score, type of operation, operation time, RTS, associated colon injury, GCS) to be significantly associated with mortality (p<0.05). CONCLUSION: Whenever a surgeon manages a patient with traumatic pancreatic injury, the surgeon needs to consider the predictive risk factors. And, if possible, the patient should undergo a proper and meticulous, less invasive surgical procedure.
Abbreviated Injury Scale ; Abdominal Injuries ; APACHE ; Blood Transfusion ; Colon ; Drainage ; Glasgow Coma Scale ; Hemorrhage ; Humans ; Injury Severity Score ; Laparotomy ; Medical Records ; Pancreatectomy ; Pancreaticoduodenectomy ; Retrospective Studies ; Risk Factors ; Vital Signs

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

BACKGROUND/AIMS: Discrimination between intrahepatic metastasis (IM) and de novo multicentric occurrence (MO) in multiple hepatocellular carcinoma (HCC) is important not only for the study of hepatocarcinogenesis but also for determination of therapeutic strategies. The purpose of this study is to evaluate the clonality of multiple or recurrent hepatocelluar carcinoma by using AP-PCR. METHODS: Paraffin-embedded blocks of 9 multiple synchronous hepatocellular carcinomas, one recurrent hepatocellular carcinoma and one combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma were used. None of the tumors was larger than 3.3 cm in diameter. Microdissection was done by using sterile 27 gauge needles and microscope. Two different arbitrary primers (AR3, ZF3) were utilized in AP- PCR. The clonality of tumor was assessed by DNA band pattern (DNA fingerprint) of PCR product. RESULTS: Eight of nine multiple synchronous hepatocellular carcinomas had distinctly different DNA fingerprints. One recurrent hepatocellular carcinoma and one combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma also had different DNA fingerprints. CONCLUSION: AP-PCR is a simple and very powerful method for determining the clonality of multiple hepatocellular carcinomas. The majority of multiple, small-sized hepatocellular carcinomas have different clonalities and it seems that a significant number of multiple hepatocellular carcinomas are of multicentric, de novo nature.
Carcinoma, Hepatocellular* ; Cholangiocarcinoma ; Discrimination (Psychology) ; DNA ; DNA Fingerprinting ; Microdissection ; Needles ; Neoplasm Metastasis ; Polymerase Chain Reaction* ; Population Characteristics*

BACKGROUND/AIMS: Hepatocellular carcinoma is a typical hypervascular tumor. Growth of tumor and their metastases are dependent on factors that stimulate vessel formation (angiogenesis). Vascular endothelial growth factor (VEGF) has been reported to play an important role in angiogenesis in hepatocellular carcinoma. The present study examined VEGF expression immunohistochemically in hepatocellular carcinoma in clinicopathological prognostic factors. METHODS: We examined the VEGF expression and microvessel density in specimens surgically removed from 37 HCC patients by immunohistochemical methods. RESULTS: The expression rate on VEGF was 43.2% in tumor cells. The degree of VEGF expression was significantly correlated with cumurative survival rate (p=0.034). But the degree of VEGF expression did not correlate with any clinicopathological characteristics (p.0.05). VEGF expression demonstrated no correlation with microvessel density (p=0.064). CONCLUSIONS: Our findings suggest that VEGF expression can be useful prognostic factor (survival rate) of hepatocellular carcinoma.
Carcinoma, Hepatocellular* ; Humans ; Microvessels* ; Neoplasm Metastasis ; Survival Rate ; Vascular Endothelial Growth Factor A*

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