BACKGROUND: It is controversial whether the delay of surgery for acute appendicitis by physician results in higher morbidity. Our present study explores this problem of physician delay on the postoperative outcome of patients with acute appendicitis. MATERIAL AND METHODS: Among 432 patients admitted for the presumptive diagnosis of acute appendicitis between Jan., 1995 and Dec., 1997, 358 patients with pathologically proven acute appendicits were analyzed. Physician delay from the hospital admission to the surgery was evaluated in relation to the stage of the disease at operation and postoperative outcome. RESULTS: Postoperative complications occurred signifficantly higher in advanced appendicitis group, than in simple appendicitis group. Postoperative oral consumption started significantly later and hospital days are significantly prolonged in those group. Both patient and physician delays significantly affect the stage of the disease. The finding that physician delay correlated with the stage, however, was denied by multivariate analysis. CONCLUSION: On the contrary to the patient delay, physician delay does not affect the stage of the acute appendicitis nor lead to increased incidence of postoperative complication. Physician delay to clarify the diagnosis is a reasonable strategy and it does not affect the outcome adversely.
Appendicitis* ; Diagnosis ; Humans ; Incidence ; Multivariate Analysis ; Postoperative Complications

Fetal teratomas rarely complicate pregnancy,having an incidance of only 20,000:1 to 40,000:1 of live births. Overthere, cervical teratomas are rare and accounts for only 5.5% of all neonatal teratomas. We have experienced a large cervical immature teratoma and present this case with a brief review of literatures.
Live Birth ; Teratoma*

In this retrospective study, 49 patients who were treated by surgical resection of colorectal cancer, confuted to proper muscle and confirmed histologically from 1979 to 1996 were included. To examine the significance of growth pattern in terms of polypoid growth(PG)(n=26; m,sm 5, pm 21) and non-polypoid growth(NPG)(n=23; m,sm 3, pm 20), we analyzed several clinocopathologic variables by x2 test and unpaired t-test, 5-year survival rate by Kaplan-Meier method and Log-Rank statistics according to growth type comparatively: 1) In the PG tumor, muscle elevation(P<0.0117) and association with adenoma(P<0.0001) were more frequent than in the NPG. 2) The NPG type showed smaller size(P<0.0172) and higher rate of lymph node metastasis(P=0.025) and higher tendency of lymphatic invasion(P=0.07) and poor differentiation(P=0.0693) and deeper invasion(P=0.0972) and worse 5-year survival(P=0.0607). 3) Otherwise there was no difference in inflammation, fibrosis, and angioinvasion. 4) The mean thickness of Outer Longitudinal Muscle(OLM) was thicker in rectum than colon(rectum 1.62 mm, colon 0.74 mm, p<0.0059) and pm cancer was more in rectum than in colon(rectum 10.3%, colon 4.0% , p=0.0057). In the view of results, NPG in early colorectal cancer may suggest the possibility of de novo cancer. NPG type was smaller in the size but more aggressive in lymph node metastasis, lymphatic invasion, invasion depth, tumor differentiation, 5-year survival rate. So it needs more thorough follow up. The higher incidence of pm cancer in rectum than in colon, is probably due to thicker OLM of rectum than that of colon.
Colon ; Colorectal Neoplasms* ; Fibrosis ; Follow-Up Studies ; Humans ; Incidence ; Inflammation ; Lymph Nodes ; Lymphatic Metastasis ; Rectum ; Retrospective Studies ; Survival Rate

PURPOSE: This study was conducted to determine whether low intensity regular exercise following dexamethasone treatment could attenuate steroid-induced muscle atrophy. METHOD: 36 Wistar-rats(90-110g) were divided into six groups: control group(C), dexamethasone treatment group(D), sedentary group after normal sedentary period(C+S), sedentary group after dexamethasone treatment period(D+S), exercise group after normal sedentary period(C+E), and excercise group after dexamethasone treatment period(D+E). D, D+S, and D+E groups received dexamethasone injection(5mg/Kg) for seven days whereas C, C+S, and C+E groups received normal saline injection. Both C+E and D+E groups ran on a treadmill for 60 minutes/day(20minutes/4hours) at 15m/min and a 10degreegrade for seven recovery days. RESULT: Post-weight(body weight before muscle dissection) of D group significantly decreased by 16.03%, and that of D+E group significantly increased by 15.51% compared with pre-weight(body weight before steroid treatment). Type II muscle(plantaris and gastrocnemius) weights of D group were significantly lower than those of C group. Myofibrillar protein contents of type II muscles of D group tended to decrease comparing with C group. In D+E groups, body weights and relative weights of typeII muscles(muscle weight(mg)/post-weight(g)) tended to increase comparing with D+S group. CONCLUSION: It is suggested that steroid- induced muscle atrophy can be ameliorated through low intensity regular exercise after dexamethasone treatment.
Animals ; Body Weight ; Dexamethasone ; Muscle Fibers, Fast-Twitch ; Muscles* ; Muscular Atrophy ; Rats* ; Weights and Measures

Despite major diagnostic advances, 10-30% of hepatic metastases of colorectal carcinoma remain undetected. In this study, CEA levels of peripheral (p-CEA), drainage venous blood(d-CEA) and gallbladder bile(b-CEA) in patients with colorectal cancer were determined to examine the significance of their CEA levels in predicting hepatic metastases. From January 1993 through May 1996, p-CEA, d-CEA and b-CEA were obtained in 50 colorectal carcinoma patients without gallbladder pathology. Synchronous hepatic metastases were found in 5 patients(Hm group) and 45 cases had no hepatic metastasis. Among the 27 cases who followed up over 2 years, metachronous hepatic metastases(Hr group) were found in 6 cases and remaining 21 cases had no metastases(Ho group). Elevation of p-CEA, d-CEA, and b-CEA was significantly correlated with lymph node metastases and hepatic metastasis. The b-CEA levels were significantly correlated with p-CEA(r=0.533926, p<0.0001) while d-CEA levels were not(r=0.276437, p=0.0520). Although all the levels of p-CEA, d-CEA, and b-CEA in Hr & Hm group were significantly higher than those in Ho group, d-CEA level was considered as most sensitive index in predicting hepatic metastases(mean 12.7 ng/ml in Ho, 88.6 in Hr, and 137.3 in Hm group. p<0.0001). The possible cut-off level of d-CEA was 40 ng/ml because all of the cases with d-CEA < 40 ng/ml had no hepatic metastasis nor hepatic recurrance, whereas 11 out of 12 patients with d-CEA > 40 ng/ml had hepatic metastases(5 synchronous, 6 metachronous). However it is impossible to establish the possible of b-CEA because of high false positive and negative rate in predicting metachronous hepatic metastases. In conclusion, it is suggested that d-CEA could be highly sensitive indicator for selecting high-risk patients of metachronous hepatic metastases of colorectal cancer.
Bile* ; Colorectal Neoplasms* ; Drainage* ; Gallbladder* ; Humans ; Lymph Nodes ; Neoplasm Metastasis* ; Pathology

PURPOSE: This study was designed to evaluate the effect of growth hormones on children with growth hormone deficiency(GHD) or idiopathic short stature(ISS). METHODS: Between January 1988 to July 2003, 45 patients(M26, F19) with GHD and 24 patients (M13, F11) with ISS were enrolled in this study. Height standard deviation score(Ht SDS) for chronological age(CA) and Ht SDS for bone age(BA) were obtained for each patient upon diagnosis and after growth hormone(0.1-0.15 IU/kg) was injected subcutaneously daily. RESULTS: Ht SDS for CA was -2.06+/-0.23 before treatment, -1.60+/-0.21 at one year, -1.52+/-0.23 at two years, -1.61+/-0.28 at three years, -1.60+/-0.31 at four years, and -1.54+/-0.32 at five years, showing a statistically significant increase for five years(P<0.05). Meanwhile, the values were -2.03+/-0.55 before treatment, -1.44+/-0.66 at one year, -0.14+/-1.06 at two years, -0.68+/-1.27 at three years, -1.16+/-0.96 at four years, and -1.37+/-0.94 at five years, in ISS, showing a statistically significant increase for the first three years(P<0.05) only. Ht SDS for BA in GHD was -0.53+/-0.19 before treatment, -0.39+/-0.18 at one year, -0.32+/-0.20 at two years, -0.43+/-0.22 at three years, -0.39+/-0.19 at four years, and -0.32+/-0.22 at five years, not showing a decrease, and the decrease in ISS was statistically not significant(P> or =0.05). CONCLUSION: Both groups exhibited significant increase in Ht SDS through growth hormone treatment, proving its efficacy. As for the evaluation of growth-related factors, the 1st year increase of Ht SDS was the most important factor in evaluation of growth effect in both groups. However, further study is required to investigate the effect of GH therapy on ISS.
Body Height ; Child ; Diagnosis ; Growth Hormone* ; Hormone Replacement Therapy ; Humans

Ovarian Pregnacy is a rare form of ectopic pregnacy. Its estimated overall incidence is highly variable, but improved diagnosis of acute hemoperitoneum of ovarian pregnancy may reveal a high incidence than reported earlier. Ovarian pregnancy occurs in the corpus luteum, and is usually accompanied with the rupture of the ovary and massive hemoperitoneum. It presents as a hemorragic ovary and frequently misdiagnosed as a ruptured corpus luteum. Risk facters to ovarian pregnacy include a history of pelvic inflammatory disease(PID), prior pelvic surgery, and use of an intrauterine contraceptive device(IUD). We have experienced two cases of ovarian pregnancy and reviewed it briefly.
Corpus Luteum ; Diagnosis ; Female ; Hemoperitoneum ; Incidence ; Ovary ; Pregnancy ; Pregnancy, Ectopic* ; Rupture

PURPOSE: To evaluate the usefulness of color Doppler ultrasonography in the differential diagnosis of breast masses. MATERIALS AND METHODS: We prospectively evaluated to pathologically proven breast lesions. Forty-three were benign (39 fibroadenomas, two papillomas and two lipoma) and 27 were malignant (25 infiltrating ductal cardinomas, one mucinous carinoma and one atypical medullary caricinoma). In 32 cases, we categorized color signal from 0 to III, according to the degree of vascularity, and analysed peak systolic velocity (PSV) and resistive index (RI). RESULTS: Color signals of malignant lesions tended to be high grade (II, III), whereas those of benign lesions tended to be low (0, I), and the difference was statistically significant (P<0.005). In the analysis of spectral waveform , correlation between RI, PSV and malignancy was statistically significant (P<0.02). RI above 0.7 and PSV above 10 were the highest recorded values for sensitivity and specificity. CONCLUSION: Color Doppler ultrasound is a useful modality to distinguish benign from malignant breast masses. Malignancy is suggested when the color signal is grade II or III, the resistive index is higher than 0.7, and peak systolic velocity is higher than 10cm/sec.
Breast* ; Diagnosis, Differential ; Fibroadenoma ; Mucins ; Papilloma ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography ; Ultrasonography, Doppler, Color*

Breast cancer is a major public health problem. 1 woman in 8 will have breast cancer develop during her lifetime in America. As in the United States, long-term increases in the incidence of breast cancer are being observed worldwide. The high incidence of breast cancer in the female population is provide the rationale for screening. The principal purpose of screening for breast cancer is to reduce mortality from the disease through early diagnosis and treatment. It is demonstrate that mortality from breast cancer can be reduced as much as 30% in a screened population. Thus the authors tried screening for breast cancer by mammography with education in breast self examination and classified mammographic parenchymal pattern of the breast in the National Medical Center. The results obtained were summarized briefly as follows:1) Between 1995-5 and 1995-7, 329 women over aged 35 in National Medical Center were invited for screening by mammography with education in breast self examination and mammographic parenchymal pattern of the breast. 2) 294(89.3 percentage) women in 329 were attended for screening and mammographic parenchymal pattern of the breast. 3) A group of 16 women(4.9 percentage) was called for further assessment. 4) 5 women(1.7 percentage) had suspicious lesions and proceeded to surgical biopsy; 4 lesions proved fibrocystic disease and 1 lesion proved fat necrosis and dystrophic calcification. 5) The mammographic parenchymal pattern of the breast showed the number of women according to classification: 20%, 23%, 50%, 7% for N1, P1, P2, DY type, respectively. 6) The malignant lesion was not detect. The results are not statistically significant. But periodic mammography screening of asymptomatic women shows that a satisfactory cancer detection can be achievable. Follow-up of women over aged 35 in the National Medical Center is continuing.
Americas ; Biopsy ; Breast Neoplasms* ; Breast Self-Examination ; Breast* ; Classification ; Early Diagnosis ; Education ; Fat Necrosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Mammography ; Mass Screening* ; Mortality ; Public Health ; United States

The major pathogenesis of acute respiratory distress syndrome (ARDS) is an inflammatory process that results from a diversity of injuries to the body. Due to the various cytokines and vasoactive peptides released from the endothelium, the vascular permeability is increased; the migration of inflammatory cells and the leakage of plasma proteins then occur and edema develops in the alveolus. There is a hypothesis that the impairment of alveolar recruitment in ARDS is caused by a defect of the surfactant system and the resultant increase of alveolar surface tension. This has been studied in pediatric patients in ARDS; after the administration of surfactant, hypoxia, respiratory symptoms and survival chances were improved. To alleviate the major pathogenic mechanism in this disease, that is to say, inflammation of the lung, steroids have been used and studied as another treatment modality for ARDS, and it has been concluded that the administration of low dose methylprednisolone may improve patients' symptoms and survival rates. We report here on a case of a young infant admitted with ARDS, who, after the intratracheal administration of 120 mg/kg surfactant, on PaO(2)/FiO(2) was elevated. Subsequent low doses of methylprednisolone were given, and the symptoms did not recur, and no fibrotic change was shown during the follow-up period of 2 months.
Anoxia ; Blood Proteins ; Capillary Permeability ; Cytokines ; Edema ; Endothelium ; Follow-Up Studies ; Humans ; Infant ; Inflammation ; Lung ; Methylprednisolone* ; Peptides ; Respiratory Distress Syndrome, Adult* ; Steroids ; Surface Tension ; Survival Rate