No abstract available.
Adult* ; Humans

Inguinal hernia is the most frequent problem requiring surgery in children. Moreover, subsequent contralateral occurrence after repair of the symptomatic unilateral inguinal hernia(UIH) is not rare. This study is to evaluate the diagnostic value of inguinal ultrasonography (IUS) for potential bilateral inguinal hernia(BIH). A prospective study was performed for preschool children less than 6 years of age who were diagnosed as UIH from July 1999 to December 2000. We selected 58 cases with potential BIH, based on the past history, such as prematurity, ventriculo-peritoneal shunt, family history of BIH, hernia on the left side (LIH), age below 2, female, and contralateral positive silk glove sign on the physical examination. Screening with IUS and bilateral surgical exploration were applied on these cases. Forty-seven cases were males (81.0%) and 11 cases were females(19.0%). Thirty-four were infants. Symptomatic right inguinal hernia (RIH) were 28 (48.3%), and LIH were 30 cases (51.7%). Six cases had no evidence of contralateral patent process vaginalis (PPV) by IUS but showed contralateral PPV by operation, Two cases were suspicious to contralateral PPV under IUS, but operative findings were negative. Fifty cases showed contralateral PPV by IUS as well as operation. The detection rate of contralateral PPV under IUS was 86.2%. The preoperative IUS may reduce contralateral exploration.
Child* ; Child, Preschool ; Female ; Hernia ; Hernia, Inguinal* ; Humans ; Infant ; Male ; Mass Screening ; Physical Examination ; Prospective Studies ; Silk ; Ultrasonography* ; Ventriculoperitoneal Shunt

Purpose: Early recurrence of hepatocellular carcinoma (HCC) remains a challenging issue after hepatic resection (HR) because of the associated poor prognosis. Models for tumor recurrence after liver transplantation (MoRAL) have been designed to predict tumor recurrence in HCC patients in the liver transplantation setting. This study aimed to validate the predictability of MoRAL for HCC recurrence or patient death and to evaluate the predictors of early HCC recurrence in hepatectomy patients with treatment-naïve solitary HCC. Methods: This study included 443 patients with HCC recurrence after HR from January 2005 to December 2011. Patients were stratified into early recurrence (n = 312) and late recurrence (n = 131) groups according to the development of recurrence either within or more than 2 years after hepatectomy. Results: The median levels of alpha-fetoprotein and protein induced by vitamin K absence-II and the median MoRAL score were significantly higher in the early recurrence group than in the late recurrence group. Regarding pathologic characteristics, the median tumor size, prevalence of tumor grade 3 or 4, microvascular invasion, presence of tumor necrosis, and macrovascular invasion in the early recurrence group were greater than those in the late recurrence group.Multivariate analysis showed that tumor grade 3 or 4, microvascular invasion, and high preoperative MoRAL score were predisposing factors for early HCC recurrence after HR. Conclusion The MoRAL score can be used to predict early recurrence in patients with HCC who undergo curative HR.Using this model, other treatments could be considered for patients with early recurrence predicted after HR.

Within six months of the discovery of X-ray in 1895, the technology was used to scan the interior of the human body, paving the way for many innovations in the field of medicine, including an ultrasound device in 1950, a CT scanner in 1972, and MRI in 1980. More recent decades have witnessed developments such as digital imaging using a picture archiving and communication system, computer-aided detection/diagnosis, organ-specific workstations, and molecular, functional, and quantitative imaging. One of the latest technical breakthrough in the field of radiology has been imaging genomics and robotic interventions for biopsy and theragnosis. This review provides an engineering perspective on these developments and several other megatrends in radiology.
Biological Markers/analysis ; Biomedical Engineering ; Diagnosis, Computer-Assisted/*trends ; Diagnostic Imaging/*trends ; Equipment Design ; Genomics ; Humans ; Image Processing, Computer-Assisted/*trends ; Radiology Information Systems/*trends ; Robotics ; Systems Integration ; User-Computer Interface

BACKGROUND AND OBJECTIVES: To evaluate the brain MR angiography(MRA) as a tool of diagnosis and follow up study in acute ischemic stroke. METHODS: We reviewed 90 patients of acute ischemic stroke who received thrombolytic therapy and underwent brain MRI with MRA from September 1994 to July 1995. They were divided into two groups according to carotid system and vertebrobasilar system and then positive MRA findings were defined as stenosis or occlusion of vessels in relation with MRI lesions. RESULTS: The positive MRA was shown more than 80% in large arteries and lower than 23% in small arteries. And also the MRA was shown the degree stenosis and underlying vessel abnormalities but could not precisely analyze the degree of improvement of vascular patency in this study. CONCLUSIONS: The MRA as a routine method addition to the MRI provides relatively reliable and noninvasive screening test and provides information that can be more complete evaluation and prognosis in patients of acute ischemic stroke.
Angiography* ; Arteries ; Brain ; Constriction, Pathologic ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Mass Screening ; Prognosis* ; Stroke* ; Thrombolytic Therapy ; Vascular Patency

OBJECTIVE: In the thoracic spine, insertion of a pedicle screw is annoying due to small pedicle size and wide morphological variation between different levels of the spine and between individuals. The aim of our study was to analyze radiologic parameters of the pedicle morphometry from T1 to T8 using computed tomographic myelography (CTM) in Korean population. METHODS: For evaluation of the thoracic pedicle morphometry, the authors prospectively analyzed a consecutive series of 26 patients with stable thoracic spines. With the consent of patients, thoracic CTM were performed, from T1 to T8. We calculated the transverse outer diameters and the transverse angles of the pedicle, distance from the cord to the inner cortical wall of the pedicle, and distance from the cord to the dura. RESULTS: Transverse outer pedicle diameter was widest at T1 (7.66 +/- 2.14 mm) and narrowest at T4 (4.38 +/- 1.55 mm). Transverse pedicle angle was widest at T1 (30.2 +/- 12.0degrees) and it became less than 9.0degrees below T6 level. Theoretical safety zone of the medial perforation of the pedicle screw, namely, distance from the cord to inner cortical wall of the pedicle was more than 4.5 mm. CONCLUSION: Based on this study, we suggest that the current pedicle screw system is not always suitable for Korean patients. Computed tomography is required before performing a transpedicular screw fixation at the thoracic levels.
Humans ; Myelography ; Prospective Studies ; Spine ; Thoracic Vertebrae

Although the standard treatment of gastric cancer is still radical subtotal or total gatrectomy, minimal invasive surgery is a primary issue in early gastric cancer, because quality of life is very important if the disease is curable. Laparoscopic total gastrectomy has not yet met widspread acceptance owing to the technical difficulties and has not been reported in Korea. The authors used the Handport system(TM), which enables introducing one of the surgeon's hands into the abdominal cavity while maintaining pneumoperitoneum. The patient was a 38-year old man. His chief complaint was hematemesis. Emergency esophagogatroscopy revealed cardiac ulcer with active bleeding. Sclerotherapy was successfully done and the patient was stabilized. Follow-up gastroscopic examination and biopsy demonstrated moderately differentiated adenocarcinoma in the ulcer area. The surgery was done electively. The operator's left hand was inserted into the abdomen through the right upper quadrant via the Handport system. An additional 10 mm working port was made in the left upper quadrant. Laparoscopy was inserted through the umbilical port. An Ultrashear(R) was used for dissection of omentum and perigastric vessels. D1 plus alpha lymph node dissection was performed completely. Roux-en-Y esophagojejunostomy was done for reconstruction through the Handport site. Opeation time was 6 hours and blood loss was 500 ml. No transfusion was required. The patient recovered uneventfully and was discharged at 16 postoperative days. In terms of recovery and quality of life laparoscopic total gastrectomy is a technically feasible and reasonable option for the treatment of early gastric cancer.
Abdomen ; Abdominal Cavity ; Adenocarcinoma ; Adult ; Biopsy ; Emergencies ; Follow-Up Studies ; Gastrectomy* ; Hand ; Hand-Assisted Laparoscopy ; Hematemesis ; Hemorrhage ; Humans ; Korea ; Laparoscopy ; Lymph Node Excision ; Omentum ; Pneumoperitoneum ; Quality of Life ; Sclerotherapy ; Stomach Neoplasms ; Ulcer

PURPOSE: To compare a laparoscopic common bile duct (CBD) exploration with the open method with regards to the clinical outcome in the treatment of a CBD stone. METHODS: A comparative study was performed on 88 patients who underwent surgical treatment for a CBD stone at Ewha Womans University Mokdong Hospital from February 1997 to December 2001. The patients were divided into three groups; a group treated by a laparoscopic CBD exploration (group L, n=59), a group treated by open surgery (group O, n=22), and a group converted to open surgery during laparoscopic treatment (group C, n=7). The medical records were reviewed, and the follow-ups study of the quality of life was assessed with a questionnaire on the symptoms associated with cholangitis. RESULTS: Among the 3 groups, there was no difference in the preoperative status of the patients (age, sex, preoperative comorbidity and previous abdominal operation history). The mean operating time were 230.7 minutes in group L, 182.0 minutes in group O, and 247.9 minutes in group C (P>0.05). The time to diet and hospital stay was longer in group C than the others (P<0.05). The postoperative complications were 10.5% in group L, 40.9% in group O and 14.3% in group C. The symptoms of cholangitis by the questionnaire during the follow-up period were 2.7% in group L, 33.3% in group O, and 66.7% in group C. CONCLUSION: Laparoscopic CBD exploration has acceptable operative difficulties, less morbidity, and good follow-up quality of life compared to the open method in treating CBD stones.
Cholangitis ; Common Bile Duct* ; Comorbidity ; Diet ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Medical Records ; Postoperative Complications ; Quality of Life ; Surveys and Questionnaires

OBJECTIVE: Post-traumatic cerebral infarction (PTCI) is one of the most severe secondary insults after traumatic brain injury (TBI), and is known to be associated with poor outcome and high mortality rate. We assessed the practical incidence and risk factors for the development of PTCI. METHODS: We conducted retrospective study on 986 consecutive patients with TBI from the period May 2005 to November 2012 at our institution. The definition of PTCI was made on non-enhanced CT scan based on a well-demarcated or fairly discernible region of low attenuation following specific vascular territory with normal initial CT. Clinical and radiological findings that related to patients' outcome were reviewed and statistically compared. RESULTS: PTCI was observed in 21 (2.1%) patients. Of various parameters, age (p=0.037), initial Glasgow coma scale score (p<0.01), brain herniation (p=0.044), and decompressive craniectomy (p=0.012) were significantly higher in patients with PTCI than patients who do not have PTCI. Duration between accident and PTCI, patterns of TBI and vascular territory of PTCI were not specific. The mortality rates were significantly higher in patients with PTCI than without PTCI. CONCLUSION: The development of PTCI is rare after TBI, but it usually results in serious outcome and high mortality. Early recognition for risks and aggressive managements is mandatory to prevent PTCI.
Brain ; Brain Injuries* ; Cerebral Infarction* ; Craniocerebral Trauma ; Decompressive Craniectomy ; Glasgow Coma Scale ; Hernia ; Humans ; Incidence* ; Mortality ; Retrospective Studies ; Risk Factors* ; Tomography, X-Ray Computed

OBJECTIVE: The objective of this study was to compare the incidence of ventricular shunt placement for shunt-dependent hydrocephalus (SDHC) after clipping versus coiling of ruptured aneurysms. MATERIALS AND METHODS: A retrospective review was conducted in 215 patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent surgical clipping or endovascular coiling during the period from May 2008 to December 2011. Relevant clinical and radiographic data were analyzed with regard to the incidence of hydrocephalus and ventriculo-peritoneal shunt (VPS). Patients treated with clipping were assigned to Group A, while those treated with coiling were assigned to Group B. RESULTS: Of 215 patients (157 clipping, 58 coiling), no significant difference in the incidence of final VPS was observed between treatment modalities (15.3% vs. 10.3%) (p = 0.35). Independent risk factors for VPS for treatment of chronic hydrocephalus were as follows: (1) older than 65 years, (2) poorer Hunt-Hess grade IV and V, (3) Fisher grade III and IV, and (4) particularly initial presence of an intraventricular hemorrhage. CONCLUSION: In this study comparing two modalities for treatment of aneurysm, there was no difference in the incidence of chronic hydrocephalus requiring VPS. A significantly higher rate of shunt dependency was observed for age older than 65 years, poor initial neurological status, and thick SAH with presence of initial intraventricular hemorrhage. By understanding these factors related to development of SDHC and results, it is expected that management of aneurysmal SAH will result in a better prognosis.
Aneurysm ; Aneurysm, Ruptured ; Hemorrhage ; Humans ; Hydrocephalus* ; Incidence* ; Prognosis ; Retrospective Studies ; Risk Factors* ; Subarachnoid Hemorrhage* ; Surgical Instruments ; Ventriculoperitoneal Shunt