PURPOSE: The optimal surgical technique for inguinal hernia repair continues to be debated. This study was designed to investigate optimal surgical procedures in inguinal or femoral hernia. METHOD: We analyzed 153 cases of herniorrhaphy on inguinal or femoral hernias between August 1996 and November 2000. We divided patient into four groups according to the methods of hernia repair, i.e., 1) 78 cases of laparoscopic herniorrhaphy, 2) 42 cases of Lichtenstein herniorrhaphy, 3) 24 cases of Bassini herniorrhaphy and 4) 9 cases of McVay herniorrhaphy. RESULTS: The patient in the laparoscopic and Lichtenstein herniorrhaphy groups needed shorter hospital stays than those in the Bassini or McVay herniorrhaphy groups. The severity of pain was assessed by the total amount and duration of nonsteroidal anti-inflammatory drug injections, which was minimal in the laparoscopic group. There were no differences in complications between the groups. One patient in the laparoscopy group had a hernia recurrence and was reoperated with Lichtenstein herniorrhaphy. We compared two tension-free herniorrhaphies with each other. The numbers of patients not needing analgesic injections were more in the laparoscopic than the Lichtenstein herniorrhaphy group, reflecting less pain in the former group. Hospital stays were also shorter in the laparoscopic than the Lichtenstein herniorrhaphy group. CONCLUSION: We concluded that tension-free herniorrhaphy is superior to tension herniorrhaphy in terms of postoperative pain & recovery. Of the tension-free herniorrhaphies, laparoscopic herniorrhaphy is associated with less postoperative pain and shorter hospital stays than Lichtenstein herniorrhpahy.
Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Laparoscopy* ; Length of Stay ; Pain, Postoperative ; Recurrence

PURPOSE:Carotid endarterectomy may benefit patients with bilateral carotid stenosis by improving cerebrovascular hemodynamics of ipsilateral as well as contralateral cerebral hemispheres. We investigated cerebrovascular hemodynamics after carotid endarterectomy in patients with contralateral carotid occlusion by acetazolamide stress brain SPECT. MATERIALS AND METHODS: Subjects were 14 symptomatic patients (all men, mean age 66 yrs) with carotid stenosis (> 50%) with contralateral carotid occlusion. Acetazolamide stress Tc-99m ECD brain SPECTs were performed within 2 weeks before and after carotid endarterectomy using one day protocol. Cerebral blood flow (CBF) and cerebrovascular reserve (CVR) were assessed visually. In 12 patients, correlation between the patency of proximal anterior cerebral or anterior communicating arteries (A1/A-comm) and the improvement of CBF or CVR after endarterectomy was assessed. RESULTS: Preoperative SPECT showed reduced CBF in 2 ipsilateral and 10 contralateral hemispheres. CVR was reduced in 4 ipsilateral and 9 contralateral hemispheres. Of 12 hemispheres with reduced CBF, 2 hemispheres (16.7%) showed improvement of CBF after endarterectomy. However, reduced CVR was improved in all 4 ipsilateral and 7 of 9 (78%) of contralateral hemispheres after endarterectomy. Three of 4 with stenotic A1/A-comm and 4 of 8 with patent A1/A-comm had reduced contralateral CVR. Reduced contralateral CVR improved in all 3 patients with stenotic A1/A-comm and 3 of 4 with patent A1/A-comm. CONCLUSION: Acetazolamide stress brain SPECT demonstrated improvement of compromised cerebrovascular reserve in not only ipsilateral but also contralateral hemispheres of patients with contralateral carotid occlusion after carotid endarterectomy, and may, therefore, be useful for evaluating cerebral blood flow and cerebrovascular reserve after carotid endarterectomy.
Acetazolamide* ; Arteries ; Brain Ischemia ; Brain* ; Carotid Stenosis* ; Cerebrum ; Endarterectomy ; Endarterectomy, Carotid* ; Hemodynamics ; Humans ; Male ; Tomography, Emission-Computed, Single-Photon*

Endometrial mucinous adenocarcinoma occurs in 1-9% of endometrial adenocarcinomas and adenocarcinoma with squamous differentiation in approximately 25%. We report a rare case of mucinous adenocarcinoma with squamous differentiation in a 53-year-old woman. Curetting biopsies of the endometrial lesion were taken twice after hormone replacement therapy, which lasted for four months. Because the squamous differentiation was so extensive, the initial diagnosis based on each curetting specimen was squamous papilloma. A total hysterectomy was performed and the tumor was revealed to be a mucinous adenocarcinoma with squamous differentiation. We subsequently discussed the pathogenesis and prognosis of this type of tumor.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Biopsy ; Diagnosis ; Endometrial Neoplasms ; Female ; Hormone Replacement Therapy ; Humans ; Hysterectomy ; Middle Aged ; Mucins* ; Papilloma ; Prognosis

No abstract available.
Eosinophilia ; Eosinophils ; Folliculitis ; Mucous Membrane ; Naproxen ; Skin Diseases, Vesiculobullous

No abstract available.
Eosinophilia ; Eosinophils ; Folliculitis ; Mucous Membrane ; Naproxen ; Skin Diseases, Vesiculobullous

PURPOSE: In the treatment of breast cancer, neoadjuvant chemotherapy (NAC) is useful to reduce breast cancer size before surgical intervention. Patients who achieve a pathologic complete response (pCR) to NAC have improved overall survival (OS). However, the relationship between prognosis and partial response is yet unclear. In this study, we evaluated prognostic factors and the tumor response ratio (TRR) method among patients who received NAC. METHODS: Clinicopathologic factors were evaluated to predict OS. The TRR was calculated by dividing pathologic tumor size by clinical tumor size. TRRs were then categorized into four groups, and the survival times for the different TRR groups were compared using statistical evaluation. RESULTS: Clinical N stage (p=0.02), overall stage (p=0.04), pathologic N stage (p=0.03), hormone receptor status (p=0.01), and lymphovascular invasion (p=0.02) were significantly associated with OS. Pathologic overall stage and TRR did not correlate with OS. Patients with a pCR exhibited the best survival rates using the current staging system and the TRR method. CONCLUSION: Clinicopathologic factors can be easily applied to predict OS, and clinicians could use these parameters until an accurate, simple, and highly discriminatory methods is developed to assess breast cancer patients with a partial.

PURPOSE: The aim of this study was to evaluate whether a simple verbal instruction regarding the rescuer gazing point can improve the depth of chest compressions (CCs) in the hands-only cardiopulmonary resuscitation (CPR). METHODS: Participants who took part in basic life support training courses for lay-rescuers were eligible for inclusion in this prospective, single-blinded, cluster randomized controlled study. After the training courses, both the control and the intervention groups performed the hands-only CPR for two minutes on a manikin placed on the ground. Immediately prior to CCs, instructors provided the intervention group with brief verbal instructions to look in the opposite direction of the adducted arm after placing the heel of the hand on the mid-sternum. RESULTS: One hundred and twenty-two participants (61 for each group) were enrolled in this study. The intervention group showed significantly deeper CCs than the control group (47.9±8.2 mm vs. 43±8.4 mm, p<0.01); however, there were no significant differences between the two groups in the quality of chest recoil, CC rate, or duty cycle of CCs. However, the frequency of incorrect hand position was higher in the intervention group when compared with the control group (10.3 [2.3-35.7] vs. 5.7 [0-33.0], p=0.036) CONCLUSION: Instructions to look in the opposite direction of the adducted arm during CCs improved the mean depth of CCs without significant adverse effects on the quality of recoil, CC rate, or duty cycle of CCs. However, the frequency of incorrect hand position was higher in the intervention group than the control group.
Arm ; Cardiopulmonary Resuscitation* ; Education ; Hand ; Heart Massage ; Heel ; Manikins ; Prospective Studies ; Thorax*

OBJECTIVE: In the present study, we evaluated the effect, safety and radiological outcomes of cervical hybrid surgery (cervical disc prosthesis replacement at one level, and interbody fusion at the other level) on the multilevel cervical degenerative disc disease (DDD). METHODS: Fifty-one patients (mean age 46.7 years) with symptomatic multilevel cervical spondylosis were treated using hybrid surgery (HS). Clinical [neck disability index (NDI) and Visual Analogue Scale (VAS) score] and radiologic outcomes [range of motion (ROM) for cervical spine, adjacent segment and arthroplasty level] were evaluated at routine postoperative intervals of 1, 6, 12, 24 months. Review of other similar studies that examined the HS in multilevel cervical DDD was performed. RESULTS: Out of 51 patients, 41 patients received 2 level hybrid surgery and 10 patients received 3 level hybrid surgery. The NDI and VAS score were significantly decreased during the follow up periods (p<0.05). The cervical ROM was recovered at 6 and 12 month postoperatively and the mean ROM of inferior adjacent segment was significantly larger than that of superior adjacent segments after surgery. The ROM of the arthoplasty level was preserved well during the follow up periods. No surgical and device related complications were observed. CONCLUSION: Hybrid surgery is a safe and effective alternative to fusion for the management of multilevel cervical spondylosis.
Arthroplasty ; Chimera ; Dichlorodiphenyldichloroethane ; Follow-Up Studies ; Humans ; Prostheses and Implants ; Spine ; Spondylosis ; Total Disc Replacement

Tuberculosis may be difficult to diagnose when it presents in an uncommon extrapulmonary site. Although there has been a resurgence of abdominal tuberculosis in immunocompromised patients, which is largely due to the extensive use of immunosuppressive drugs and the increasing incidence of a human immunodeficiency virus infection, splenic tuberculosis is rare, particularly in the immunocompetent patients. Almost all cases of splenic tuberculosis present as multiple hypoechoic foci on sonography or multiple focal hypodense lesions on contrast enhanced computed tomographic scan. To our knowledge, splenic tuberculosis is an extremely rare condition. An 80-year-old man was found to have a large solitary splenic mass mimicking a splenic neoplasm on sonography and contrast enhanced computed tomographic scan. A diagnostic splenectomy revealed a large solitary mass in the spleen, which was consistent with splenic tuberculosis microscopically. We report a rare case of splenic tuberculosis in an elderly man presenting as a large solitary splenic mass on sonography and contrast enhanced computed tomographic scan.
Aged ; Aged, 80 and over ; HIV ; Humans ; Immunocompromised Host ; Incidence ; Spleen ; Splenectomy ; Splenic Neoplasms ; Tuberculosis ; Tuberculosis, Splenic*

PURPOSE: This study was performed to evaluate the value of repeated CT scans for the non-operative management of patients with clinically stable blunt splenic trauma. METHODS: 49 consecutive patients with blunt splenic trauma were prospectively studied. Of these, 29 (59.2%) were initially managed non-operatively according to their clinical status and initial CT findings. A repeat CT scan was obtained within 7 days of admission. RESULTS: Of the 29 non-operatively managed patients, 5 (17.2%) required delayed surgical intervention: 3 presented with a change in thier clinical status, whereas the other 2 did not. In all 5 patients, a repeat CT scan revealed a deteriorating appearance of the splenic injury: active bleeding or an increased hematoma in 3, with splenic artery pseudoaneurysms in the other 2. CONCLUSION: This initial experience suggests that a repeat CT scan can provide valuable clinical information in selected cases on the diagnosis and management of a splenic injury to document the healing or progression of the injury.
Aneurysm, False ; Diagnosis ; Hematoma ; Hemorrhage ; Humans ; Prospective Studies ; Spleen ; Splenic Artery ; Tomography, X-Ray Computed*