We introduce a new operative method for acute epidural hematoma(AEDH) through small craniotomy. Between January 1999 and December 2001, 63 patients underwent craniotomy in our hospital to evacuate an acute posttraumatic epidural hematoma. Among these, we operated 18 patients with linear scalp incision and about 4 X 4cm sized small craniotomy. After operation, neurological symptoms were improved and there were no significant postoperative complications in all patients. This operative method is simple and less time consuming. It can be done under the local anesthesia and may be useful to all AEDH without severe brain swelling, subdural hematoma and intracerebral hematoma.
Anesthesia, Local ; Brain Edema ; Craniotomy* ; Hematoma* ; Hematoma, Subdural ; Humans ; Postoperative Complications ; Scalp

Sarcoma is a malignant tumor originated from bone, cartilage, fat tissue, nerve, blood vessel, bone marrow, endothelium, etc. and for this reason it exhibits considerable variation not only clinical but histologic appearance. Osteosarcoma occurs chiefly in young persons and in patients older than 40 years it is usually associated with Paget's disease, irradiated bone, multiple hereditary exostosis or polyostotoc fibrous dysplasia and sometimes with preceding trauma. Radiographically it is divided into three forms: an osteoblastic or sclerosing type, an osteolytic type, and mixed type. Histologically it is divided into osteoblastic type, chondroblastic type, fibroblastic type. The treatment of osteosarcoma is radical excision, combined chemotherapy but the prognosis is poor and overall 5-year survival rate is 20-40%. We present two different type sarcomas of 22-year-old male and 56-year-old male patients which we performed surgical excision, combined chemotherapy and radiation therapy.
Blood Vessels ; Bone Marrow ; Cartilage ; Chondrocytes ; Drug Therapy ; Endothelium ; Exostoses ; Fibroblasts ; Humans ; Male ; Mandible* ; Middle Aged ; Nerve Tissue ; Osteoblasts ; Osteosarcoma* ; Prognosis ; Sarcoma ; Survival Rate ; Young Adult

OBJECTIVE: To determine pathologic variables associated with overall survival and disease free survival of patients with endometrial cancer. METHODS: Survival of 81 endometrial cancer patients treated with primary surgery between January 1997 and December 2003 at our center was compared about various histopathologic variables. All patients underwent complete surgical staging including pelvic +/- paraaortic lymph node dissection. Survival analyses were performed by the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by Cox's proportional hazards model using likelihood-ratio statistics based on the conditional parameter estimate (Conditional). RESULTS: With regard to disease free survival, univariate analysis revealed no significant differences in subgroups according to age category, grade and adjuvant radiotherapy. However, significant differences in disease free survival were found between stage I+II and stage III, and between endometrioid type and the others type. Among these significant subgroups, the Cox-proportional hazards model showed that stage was the only independent prognostic factor. There were no significant differences in the overall survival of patients in subgroups according to age category and adjuvant radiotherapy. But, significant differences in overall survival were found in subgroups according to stage, histology and grade. Multivariate analysis revealed that stage was the only independent significant adverse prognostic effect. CONCLUSION: Our results showed that only stage was an independent prognostic factor of disease free survival and overall survival in endometrial cancer patients.
Disease-Free Survival ; Endometrial Neoplasms* ; Female ; Humans ; Lymph Node Excision ; Multivariate Analysis ; Proportional Hazards Models ; Radiotherapy, Adjuvant

OBJECT: In this study, to evaluate the putative role of telomerase in gynecologic malignancies (cervical ca, ovarian ca, endometrial ca), we measured telomerase activity in malignant gynecologic tumor tissues and normal tussues, and compared it with prognostic factors in cervical cancer. To evaluate the correlation of telomerase activity and human papillomavirus (HPV) infection in cervical cancer, the analysis of HPV E6 gene was performed. METHOD: Specimens were obtained from 51 women who underwent gynecologic radical operation and 13 normal tissues (from December 1995 to December 1996) in the Department of Obstetrics and Gynecology, Kyung-Hee Univ. Medical Center. With Telomerase PCR ELISA (Boehring Mannheim), modified TRAP (Telomere Repeat Amplication Protocol), we examined telomerase activity of 32 cervical carcinomas, 11 ovarian carcinomas, 8 endometrial carcinomas, 5 normal cervical tissues, 4 normal ovarian tissues and 4 normal endometrial tissues. The analysis of HPV E6 gene was performed by PCR amplication. We compared the abnormally high telomerase activity with prognostic factors, also compared the telomerase activity with the expression of HPV E6 gene in cervical cancer tissues. RESULT: We detected the abnormally high telomerase activity in all cervical carcinomas, 10 of 11 (90.9%) ovarian carcinomas, 6 of 8 (75.0%) endometrial carcinomas, but couldn't detect in each normal tissues. There was statistically no significant difference of telomerase activity levels according to age, clinical stage, pathology, differentiation, LN involvement, depth of invasion and tumor size except lymphovascular space invasion in cervical carcinomas (p<0.05). According to the analysis of HPV E6 gene, 29 of 32 (90.6%) in 32 cervical cancer tissues showed HPV E6 positivity. So it was considered that telomerase activation was closely related with the expression of HPV E6 gene. CONCLUSION: Telomerase activation is associated with immortalization or malignant transformation of gynecologic cancers. The expression of HPV E6 gene is considered to activate telomerase in cervical cancer.
Endometrial Neoplasms ; Enzyme-Linked Immunosorbent Assay ; Female ; Gene Expression* ; Gynecology ; Humans ; Obstetrics ; Ovarian Neoplasms ; Pathology ; Polymerase Chain Reaction ; Telomerase* ; Uterine Cervical Neoplasms*

PURPOSE: This study was conducted to confirm the effects of octreotide in patients with variceal bleeding. METHODS: We performed a retrospective analysis of 26 patients with variceal bleeding, who visited the Emergency Center of Seoul National University Hospital from January 1st to June 31st, 1996, the control group, and a prospective analysis of 28 patients with variceal bleeding, who visited the Emergency Center of Seoul National University Hospital from March 1st to August 31st, 1999, for the octreotideinfused group. The octreotide-infused group recieved a continuous infusion of octreotide, 25 microgram/hr, for 5 days after an initial bolus of 50 microgram. When active bleeding continued over 1 hour, over 5 pints of packed-RBC were needed for transfusion within 24 hours, or when the systolic blood pressure was under 90 mmHg, a ballon tamponade with Sengstaken-Blackemore tube was used. T-test and X2 test were used for statistical analysis(p<0.05). RESULTS: Forty-one patients were male(octreotide-infused group 22, control group 19) and 13 were female(octreotide-infused group 6, control group 7). The mean age was 55 years(octreotide-infused group 56 years, control group 52 years). There were no significant differences in vital signs, hemoglobin/hematocrit levels, and Child-Pugh's classifications between the octreotide-infused group and the control group initially. There was a significant difference in the rates of early bleeding control within 24 hours(p<0.05), but there were no significant differences in the rates of rebleeding, mortality within 1 week, and use of a balloon tamponade. CONCLUSION: Variceal bleeding is a serious complication of liver cirrhosis and has a high mortality rate. Octreotide is an effective vasoactive agent for control of early bleeding. Thus, octreotide should be used first before endoscopic definitive therapies, to stabilize the vital signs of patients and to secure a field for endoscopic procedures.
Balloon Occlusion ; Blood Pressure ; Classification ; Emergencies ; Esophageal and Gastric Varices ; Hemorrhage* ; Humans ; Liver Cirrhosis ; Mortality ; Octreotide* ; Prospective Studies ; Retrospective Studies ; Seoul ; Varicose Veins* ; Vital Signs

The staged decompression(posterior and anterior) of foramen magnum was performed in the patient with Chiari I malformation associated with basilar invagination. Three years prior to admission, the patient was admitted due to ataxia and dysmetria. After the posterior decompression of foramen magnum, the patient's cerebellar sign improved significantly. But spastic gait disturbace was noted two years later. We performed a transoral anterior decompression to relieve brain stem compression, and an occipitocervical fusion with contoured rod to prevent possible instability. Following the operation, the spasticity improved. The authors believe this sets the successful staged decompression of Chiari I malformation associated with basilar invagination.
Ataxia ; Brain Stem ; Cerebellar Ataxia ; Decompression* ; Foramen Magnum ; Gait Disorders, Neurologic ; Humans ; Muscle Spasticity

PURPOSE: The gastric cancer is most frequent malignant disease in Korea. With increase of GNP and social welfare, lot of people pay attention to that. But many of gastric cancer patients who were diagnosed, are advanced -stage III or more- case and produces poor result of treatment. Nowadays many surgeons report that the resection of cancer mass and radical lymph node dissection, which called systematic lymph node dissection, can increase the longterm survival rate and curability of patients. For this purpose Maruyama and his colleagues made a program to predict the 5 year survival rate, cause of death, and the status of lymph node metastases. We put the basic datas of pateints in AGC into Maruyama's program and compare its result to final histologic reports. We would check sesitivity, specificity, positive predictive value, negative predictive values between Maruyamas program and hitologic reports. MATERIALS AND METHODS: From Sep. 1995 to Sep. 1996, We operated 55 patients with gastric cancer with this program in GNUH. We checked the histopathologic reports and put the data into the prediction program. The datas were sex, age, maximal size of tumor, differentiation, gross type and location. We compared status of lymph node metastases, TNM stages between the reports of histopathology and that of predictive program. RESULTS: In early stages the sensitivity and specificity of the program showed poor result but in advanced stages did not. The distribution of lymph node metastasis showed a same pattern. The patterns of perigastric lymph node metastasis were somewhat different according to the location of tumor. But its significance was not confirmed. We analysed the metastaic rate between lymph node groups and compared with the results between two reports. The sensitivity, and negative predictive value were 100% in each groups, and positive predictive value was also high. CONCLUSION: The systematic lymph node dissection is an effective and safe procedure in the surgical treatment of gastric cancer. We suggest that the techniques should be standardized and popularized in Korea. This procedure will improve the survival rate of gastric cancer patients and decrease the local recurrence of gastric cancer.
Cause of Death ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis* ; Recurrence ; Sensitivity and Specificity ; Social Welfare ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: Acute aortic dissection associated with high mortality rate has an extremely poor prognosis if early diagnosis and treatment are not received. Recently, with advanced computed tomography and echocardiography, diagnostic rate is higher and early operation is possible. Therefore preoperative medical therapy at ER(emergency room) lowered the mortality rate. This study was done to analyze the results with preoperative management at ER and operations, retrospectively. MATERIAL AND METHOD: A series of 42 patients treated surgically for acute aortic dissections from 1991 to 2001 were included in this study. There were 18 males and 24 females. Mean age was 51.1 years. The admission course through emergency and outpatient department(OPD) was 34 and 8 respectively. RESULT: 26 patients underwent ascending aorta replacement-7 combined aortic valve replacements, 7 patients underwent descending aorta replacements and 9 patients received Bentall's operation. At emergency department, 20 patients received antihypertensive drugs and beta-receptor blockers and 6 patients died. 22 patients did not receive antihypertensive and beta-receptor block drugs and 10 patients died. There were 16(38%) overall deaths. CONCLUSION: Early diagnosis at ER or OPD is essential for acute aortic dissection, and it is important to select the most appropriate noninvasive interventions as possible. Therefore, preoperative drug therapy at ER is suggested according the patient conditions.
Aneurysm, Dissecting ; Antihypertensive Agents ; Aorta ; Aorta, Thoracic ; Aortic Valve ; Drug Therapy ; Early Diagnosis ; Echocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Humans ; Male ; Mortality ; Outpatients ; Preoperative Care ; Prognosis ; Retrospective Studies

Osteoclast like giant cells (OGCs) are infrequently encountered in a number of malignancies in extraosseous sites, such as the breast, pancreas, liver, stomach, thyroid gland, and other organs. Immunohistochemical stains demonstrate that the OGCs are of monocytic or histiocytic origin and probably represent a distinctive host response to the tumor. The OGCs show strong reactivity with CD68, and no reactivity with cytokeratin or polyclonal antibody to carcinoembryonic antigen (CEA). We experienced a 70 year old man who presented with epigastric pain and weight loss, and found synchronous duodenal carcinoma with OGCs and gastric adenocarcinoma. Histological examination showed an undifferentiated carcinoma with evenly scattered OGCs in the duodenum and liver metastases. OGCs were never seen to undergo mitotic division or exhibit atypia. By immunohistochemistry, neoplastic cells were diffusely positive for vimentin and focally positive for CAM 5.2 (low molecular weight cytokeratin), but OGCs were positive for only vimentin. He underwent palliative gastrojejunostomy for intestinal obstruction due to a large duodenal neoplasm. We report a case of synchronous double primary cancer of gastric adenocarcinoma and duodenal carcinoma with OGCs in a 70 year old man which was proved histopathologically.
Adenocarcinoma* ; Aged ; Breast ; Carcinoembryonic Antigen ; Carcinoma ; Coloring Agents ; Duodenal Neoplasms ; Duodenum ; Gastric Bypass ; Giant Cells* ; Humans ; Immunohistochemistry ; Intestinal Obstruction ; Keratins ; Liver ; Molecular Weight ; Neoplasm Metastasis ; Osteoclasts ; Pancreas ; Stomach ; Thyroid Gland ; Vimentin ; Weight Loss

BACKGROUND: To review the important features and treatment modalities of phalloides syndrome. METHOD: We performed a retrospective analysis of 16 patients with phalloides syndrome who visited the Emergency Center of Seoul National University ospital, Uijongbu St. Mary 's Hospital, Gachon Medical College Hospital, and Kyungpook National University Hospital from July 1st to August 31st, 1998. Mann-Whitney U test was used for statistical analysis(p < 0.05). RESULTS: 9 were male and 7 were female. The mean age was 54 years(men 46 years, women 65 years). Fourteen cases(88%) occurred in Kyungpook area. All cases of phalloides syndrome RESULT:ed from mistaking toxic mushrooms for edible mushrooms. The doses of ingestion of mushroom were not available because the patient could not remember the exact amounts. The identification of mushrooms in 4 cases was confirmed by mycologist, 6 cases by mushroom photoatlas, and remained 6 cases were not confirmed. The initial symptoms of mushroom poisoning were abdominal pain, nausea, and watery diarrhea. The time intervals from the ingestion of mushroom to the onset of symptom were from 6 to 13 hours(mean 11.3 +/-2.68 hours). The laboratory data showed the increased GOT and GPT, prolonged prothrombin time, elevated serum creatinine level, and decreased platelet count. The initial management of phalloides mushroom poisoning was done conservatively, but the early specific treatments such as gastrointestinal decontamination, administration of activated charcoal, IV penicillin or silymarin were not perfomed in all cases. The mortality rate was 18.8%. There were significant differences in total bilirubin, prothrombin time, platelet count, and serum creatinine between survival and non-survival group(p<0.05). CONCLUSION: It is important to know the morphological differences between edible and toxic mushroom for prevention of phalloides syndrome. If the patient with acute gastroenteritis has a history of mushroom ingestion, the emergency physician should suspect phalloides syndrome and start early proper treatment. For the identification of mushroom, it is desirable to contact a mycologist.
Abdominal Pain ; Agaricales ; Bilirubin ; Charcoal ; Creatinine ; Decontamination ; Diarrhea ; Eating ; Emergencies ; Female ; Gastroenteritis ; Gyeongsangbuk-do ; Humans ; Male ; Mortality ; Mushroom Poisoning ; Nausea ; Penicillins ; Platelet Count ; Prothrombin Time ; Retrospective Studies ; Seoul ; Silymarin