BACKGROUND: Primary tumor of the small bowel is uncommon less than 6% of all gastrointestinal tumors. Its symptoms and signs are nonspecific and its diagnosis is difficult. METHODS: We analyzed 43 patients with primary small bowel tumor who had undergone operations at the Chungnam National University Hospital from January 1990 to December 1997. RESULTS: 1) In total 43 cases, 19 cases (44.2%) were male and 24 cases (55.8%) were female, benign tumors were 13 cases (30.2%) and malignant tumors were 30 cases (69.8%). The mean age was 51 year. 2) The primary sites of benign tumors were the duodenum in 5, jejunum in 3, ileum in 5 cases. The primary sites of malignant tumors were the duodenum in 13, jejunum in 9, ileum in 8 cases. 3) Polyp was most common benign tumor (30.7%), and leiomyosarcoma was most common malignant tumor (43.3%). 4) The most common symptom was abdominal pain (65.1%), followed by melena (34.9%) and weight loss (20.9%). The most common sign was palpable mass (39.5%) and anemia (39.5%). 5) In the duodenal tumors, the detectabilities of endoscopy and upper gastrointestinal series were 68.8% and 71.4%, respectively. In the jejunal and the ileal tumors, the detectabilities of small bowel series were 62.5% and 71.4%, respectively and those of abdominal computed tomogram were 50.0% and 42.9%, respectively. The accuracy of preoperative diagnosis was 7 cases (53.8%) in benign and 20 cases (66.7%) in malignant tumor. 6) In cases of malignant tumor, curative resection was performed in 18 cases (60.0%), palliative resection was performed in 10 cases (33.3%), and bypass procedure was performed in 2 cases (6.7%). In cases of benign tumor, small bowel resection was performed in 9 cases and excision of duodenal polyp was performed in 2 cases. 7) The mean follow-up period of malignant tumor of 27 cases except 3 hospital mortality cases was 35 months. During this time, 7 cases were dead due to recurrence. The mean survival time of 7 mortality cases was 20.4 months, of them 4 cases were leiomyosarcoma, 2 cases were adenocarcinoma, and 1 case was lymphoma. CONCLUSIONS: Because diagnosis of small bowel tumor is difficult and confirmed in late stage, high degree of suspicion and endeaver to discover it is important.
Abdominal Pain ; Adenocarcinoma ; Anemia ; Chungcheongnam-do ; Diagnosis ; Duodenum ; Endoscopy ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Ileum ; Jejunum ; Leiomyosarcoma ; Lymphoma ; Male ; Melena ; Mortality ; Polyps ; Recurrence ; Survival Rate ; Weight Loss

BACKGROUND: Cystosarcoma phyllodes are relativly rare neoplasms of the breast and have an unpredictable clinical behavior. This study is to determine whether histological features correlate with clinical behavior, and which operation method affect recurrence. METHODS: This study reviewed the histological features and clinical outcomes in 12 patients with phyllode tumors of the breast diagnosed at Chungnam University Hospital from 1989 to 1998. RESULTS: The pathological results revealed benign forms were in 8 cases and malignant forms in 4 casese. As to the nature of the growth, the tumors in 10 cases grew rapidly 10 cases were rapid in nature, but two malignant tumors not. One of the 4 malignant tumors was high grade, the others were borderline. Eight (8) patients were had been treated conservatively (7 cases, wide tumor excision; 1 case, excisional biopsy), and 4 cases patients underwent radical operation (2 cases, modified radical mastectomy; other 2 cases, simple mastectomy). Only one patient with borderline malignancy, who underwent modified radical mastectomy, experienced recurrence. CONCLUSIONS: Tumor growth & histological features do not correlate with recurrence, and wide resection should to be primary treatement and axillary dissection is not worthwhile.
Breast* ; Chungcheongnam-do ; Humans ; Mastectomy, Modified Radical ; Phyllodes Tumor* ; Recurrence

Splenic hamartomas are rare benign tumors, which are usually small in size and asymptomatic and which are discovered incidentally at surgery or autopsy. The authors report on a case of splenic hamar toma in a 35-year-old man with intermittent left upper quardrant pain, who underwent an elective splenc tomy. Final pathology confirmed diagnosis of a hamartoma of the red pulp in the spleen. The patient's symptoms were resolved after the splenectomy. A splenic hamartoma should be kept in mind in the differential diagnosis of splenic tumors. The authors suggest that a splenectomy is indicated in cases where malignancy cannot be excluded and in cases of associated clinical symptoms or hematologic disorders.
Adult ; Autopsy ; Diagnosis ; Diagnosis, Differential ; Hamartoma* ; Humans ; Pathology ; Spleen* ; Splenectomy

PURPOSE: To report a case of a patient who underwent penetrating keratoplasty due to acute hydrops six years after undergoing a bilateral LASIK procedure. METHODS: A 19-year old male patient with -2.75 diopter myopia received a bilateral LASIK operation at a local clinic. Forty-seven months later, -2.00 cyl axis 130o astigmatism was induced in his left eye and additional surgery was performed to correct the LASIK-induced astigmatism. The patient was referred to our hospital 16 months after the secondary operation due to reduced visual acuity in his left eye. He was diagnosed with keratectasia and acute hydrops, and penetrating keratoplasty was performed. RESULTS: The retrospective analysis of the corneal topography prior to the LASIK surgery revealed that the inferior minus superior(I-S) value was 1.25 in the right eye and 1.3 in the left eye. At the time of the first evaluation at out hospital, a slit lamp examination showed an approximate 8 x 7.5mm sized area filled with aqueous humor between the corneal flap and residual stroma, and Descemet's membrane rupture was observed. Furthermore, the histopathological section of the patient's cornea confirmed keratocytes with myxoid degeneration and edematous change. CONCLUSIONS: In young patient, particularly those with suspicious asymptomatic keratoconus, LASIK and further enhancement surgery afterwards should be considered and approached in a cautious and deliberate manner.
Male ; Humans

Two hundred cases of surgically repaired hypospadias at Pusan University Hospital in the past sixteen half years were surveyed and analyzed. Of 200 patients, 99(49.5%) were corrected in their preschool age. The number of patients with the distal type and proximal type of hypospadias performed in 134(67%) of 200 and the success rate was 84.3 per cent(113 of 134). One stage repair was performed in 66(33.0%) of 200 and the success rate are as follows : King, 100%(7 of 7), MAGPI, 100.0% (4 of 4), Mathieu, 100.0%(5 of 5), Hodgson ( I , III), 75%(12 of 16), and preputial island flap including Duckett, Hodgson XX and double faced technique, 67.6% (23 of 34). The most common postoperative complication was fistula.
Busan ; Female ; Fistula ; Humans ; Hypospadias* ; Male ; Postoperative Complications

No abstract available.
Foot ; Hand

INTRODUCTION: The practicing of patient-centered medical services means a change in the pattern of the nature of doctor-patient relationship. The doctor oriented relationship is now moving to the pattern that patients resolve problems autonomously and participate in the decision-making in medical services. Authors performed this study to investigate the patient centeredness and influencing variables in medical students. METHODS: Authors recruited 94 medical students before psychiatric clinical clerkship and all subjects were assessed by structured questionales including socio-demographic data, frequency of receiving doctor-patient relationship lectures, Minnesota multiphasic personality inventory (MMPI), Meyers-Briggs type indicator (MBTI), the authoritarian personality scale (AP), job satisfaction scale (JS), patient practitioner orientation scale (PPOS), problem-solving decision-making scale (PSDM), and Beisecker locus of authority in decision-making scale (BLAS), and the questionnaire of JS, PPOS, PSDM, and BLAS were rechecked after psychiatric clinical clerkship. RESULTS: After psychiatric clinical clerkship, the score of JS, PPOS were higher than before. The group who had a good memory for taking a doctor-patient relationship lecture showed higher scores of the BLAS and PSDM than unexposed group. The AP was related with MBTI, correlated with the subscale of MMPI, however, inversely correlated with PPOS after psychiatric clinical clerkship. CONCLUSION: The authoritarian personality trait was related not only with other personality trait including introversion and psychopathic deviation (Pd) but also with patient-centeredness. Taking a lecture in doctor-patient relationship is positively related to the patient-centeredness.
Clinical Clerkship ; Humans ; Introversion (Psychology) ; Job Satisfaction ; Lectures ; Memory ; MMPI ; Surveys and Questionnaires ; Students, Medical*

BACKGROUND: Straight raising of the legs in the supine position or Trendelenburg positioning has been used to treat hypotension or shock, but the advantages of these positions are not clear and under debate. We performed a crossover study to evaluate the circulatory effect of full flexion of the hips and knees in the supine position (exaggerated lithotomy), and compare it with straight leg raising. METHODS: This study was a prospective randomized crossover study from the tertiary care unit at our university hospital. Twenty-two patients scheduled for off-pump coronary artery bypass surgery were enrolled. Induction and maintenance of anesthesia were standardized. Exaggerated lithotomy position or straight leg raising were randomly selected in the supine position. Hemodynamic variables were measured in the following sequence: 10 min after induction, 1, 5, and 10 min following the designated position, and 1 and 5 min after returning to the supine position. Ten min later, the other position was applied to measure the same hemodynamic variables. RESULTS: During the exaggerated lithotomy position, cerebral and coronary perfusion pressure increased significantly (P < 0.01) without a change in cardiac output. During straight leg raising, cardiac output increased at 5 min (P < 0.05) and cerebral and coronary perfusion pressures did not increase except for cerebral perfusion pressure at 1 min. However, the difference between the two groups at each time point in terms of cerebral perfusion pressure was clinically insignificant. CONCLUSIONS: Full flexion of the hips and knees in the supine position did not increase cardiac output but may be more beneficial than straight leg raising in terms of coronary perfusion pressure.
Anesthesia ; Cardiac Output ; Coronary Artery Bypass, Off-Pump ; Cross-Over Studies ; Hemodynamics ; Hip ; Humans ; Hypotension ; Knee ; Leg ; Perfusion ; Prospective Studies ; Shock ; Supine Position ; Tertiary Healthcare

BACKGROUND: Internet use is taking place as a necessary part in modern life. Recently, internet use among adolescents has bocome a prominent social problem. In accordance with assessment of internet using pattern and addiction, this study analyzed addiction, this study analyzed addiction-relating factors. According to analysis of intimate relating factor, this study attempted to provide appropriate countermeasure. METHODS: The author had performed physical examination on the subjects on May, 2001. The subjects were elementary, middle, and high school students. Among them, 913 students were surveyed with questionnaires. Among the 193 students, elementary school students were 222, middle school 369, high school 291, and 31 did not complete the survey. Addiction-relating factors were sex, age, frequency, mostly connected web-site, time, and place. Young's scale was used as internet addiction assessment, 70 points, and above were used as criteria for internet addiction. RESULTS: There were 32 addicted students among the subjects. By sex, male students were 7, female students 25. By age, elementary school student was 1, middle school students 9, and high school students 22. In frequency, 424 students used the internet more than 5 times per week among all subjects. 30 students used the internet more than 5 times per week among addicted students. CONCLUSION: Internet use of chatting sire is an intimate addiction-relating factor. Therefore, substitute activity which can reduce computer using time, and frequency should be encouraged. Especially, avoiding chatting site is considered a preventive methive of addiction during the computer using time.
Adolescent* ; Factor Analysis, Statistical* ; Female ; Humans ; Internet* ; Korea* ; Male ; Physical Examination ; Social Problems ; Surveys and Questionnaires

No abstract available.
Exostoses ; Fingers ; Korea