PURPOSE: The purpose of this study was to compare outcomes for surgical treatment with those for medical treatment of GB dyskinesia. METHODS: Retrospective analysis of medical records and telephone interviews of 67 patients diagnosed with GB dyskinesia was done at Pohang St. Mary's Hospital between January 2004 and December 2009. Group 1 (n=18) patients received laparoscopic cholecystectomy. Group 2 (n=49) patients received medical treatment. GB dyskinesia was the diagnosis if the patient had typical biliary colic symptoms without GB stones or other GI disease, and if the ejection fraction was less than 35% on Tc-99m-DISIDA scans. RESULTS: The average age of patients diagnosed with GB dyskinesia was 45.8 years old. The sex ratio was 15:52 (male:female). The average symptom duration was 25.4 days. All had RUQ and, or epigastric pain. There were no significant between group differences in age, sex ratio, symptom duration, symptoms, follow up period, and ejection fraction. In group 1, patient symptoms improved after treatment in 16 cases (88.9%); in group 2, patient symptoms improved in 19 cases (38.8%). Surgical treatment was significantly more effective than medical treatment. The reasons for choosing medical treatment were predominantly the preference of the doctors. CONCLUSION: Surgical treatment is a more effective treatment for GB dyskinesia than medical treatment. Therefore, laparoscopic cholecystectomy should be considered as the 1st line treatment of choice for GB dyskinesia.
Biliary Dyskinesia ; Cholecystectomy, Laparoscopic ; Colic ; Dyskinesias ; Follow-Up Studies ; Gallbladder ; Humans ; Interviews as Topic ; Medical Records ; Retrospective Studies ; Sex Ratio

PURPOSE: The purpose of this study was to compare the efficacy of curative emergency surgery for complicated colon cancer in terms of tumor recurrence and survival compared with that of elective surgery. METHODS: A total of 238 primary surgeries for colon cancer were performed. All patients were deemed to have undergone a curative resection. Patients were classified into an emergency surgery group for complicated colon cancers (n=40) and an elective surgery group for uncomplicated colon cancers (n=198). RESULTS: Emergency colonic cancers present at a more advanced stage (P=0.002). The postoperative mortality rate in the emergency group was significantly higher than it was in the elective group (15.0% vs. 2.5%, P= 0.004). There were differences between the two groups in tumor recurrence (32.5% vs. 13.1%, P=0.003), overall survival (52.5% vs. 71.7%, P=0.017), and disease-free survival (50.0% vs. 69.7%, P=0.016). However, after the patients were stratified according to tumor stage, no statistical differences were observed. CONCLUSIONS: When compared with uncomplicated colon cancers, complicated colon cancers present at a more advanced stage with a higher postoperative mortality and an overall worse prognosis. However, the difference decreases when patients are stratified according to the tumor stage. The negative prognostic efficacy of emergency surgery for complicated colon cancers appears to be confined to the perioperative period. Despite the more advanced stage of tumors in patients undergoing emergency surgery, the aim of the surgeon should be to offer a curative resection for better survival, if possible.
Colon* ; Colonic Neoplasms* ; Disease-Free Survival ; Emergencies* ; Humans ; Mortality ; Perioperative Period ; Prognosis ; Recurrence

BACKGROUND: Although several hospital-based stroke studies were published, there has not been any reliable data representing the clinical characteristics of stroke in Korea. We analyzed the clinical characteristics of patients with ischemic stroke registered in the Korean Stroke Registry (KSR), which is the largest prospective hospital-based nation-wide stroke registry in Korea. METHODS: The KSR provided standardized protocols for collecting data, which includes the data of demographics, subtypes of stroke, risk factors, and neurological outcome at discharge. The brain imaging studies, including CT or MRI, were performed in all cases. RESULTS: KSR registered 10,811 patients of acute ischemic stroke between Nov. 2002 and Jun. 2004. The large-artery atherosclerosis was the most common subtype (37.3%), followed by small vessel occlusion (30.8%). Hypertension (65.4%) was the most common risk factor, followed by smoking (34.5%) and diabetes (28.3%). Although most of the hypertensive and diabetic patients had been diagnosed before the stroke, less than 45.4% and 32.5% of them were under regular control. The steno-occlusive lesion of extracranial carotid artery was only 29.3% and the ratio of intra- to extracranial artery disease was more than 2 in KSR. Only 20.5% of patients were admitted within 3 hours after stroke onset and 2.1% were treated with intravenous thrombolysis. In-hospital case-fatality was 5.2%, which is relatively comparable to those of previous studies. CONCLUSIONS: The KSR provided informative data in understanding the clinical characteristics of ischemic stroke in Korea. Further analysis of KSR will facilitate clinical trials and development of guidelines for the management of stroke patients.
Arteries ; Atherosclerosis ; Carotid Arteries ; Cerebrovascular Disorders ; Demography ; Epidemiology ; Humans ; Hypertension ; Korea ; Magnetic Resonance Imaging ; Neuroimaging ; Prospective Studies* ; Registries ; Risk Factors ; Smoke ; Smoking ; Stroke*

PURPOSE: The pecten band can be defined as a fibrous tissue on the lowermost part of internal anal sphincter and may cause anal outlet obstruction, but its role is debatable. We evaluated the functional roles of the pecten band in hemorrhoids patients. METHODS: Three hundred sixteen hemorrhoids patients who underwent operations from January 1998 to April 2003 were analyzed for anal function according to presence or absence of a pecten band by using anorectal manometry and the constipation score. RESULTS: The numbers of males and females were 167 and 149. The overall pecten band positive was 63.6% (201/316), and pecten band positive was 84.6% (33/39) in patients who had previous anal surgery while it was 60.6% (168/277) in patients who had no history of surgery (P= 0.002). Pure hemorrhoids patients showed an 18.3% positive rate while patients with hemorrhoids and other conditions, such as anal fissure, fistula, or stricture, showed a 95.7% positive rate (P=0.00). Maximal resting anal pressures (mmHg, Mean+/-SD) and constipation score were 78.9+/-24.7 and 7.88+/-3.8 in the positive group and 67.1+/-22.2 and 4.55+/-2.8 in the negative group (P=0.00, 0.00). Postoperatively, the constipation score decreased significantly from 7.25 to 2.82 (P=0.003). CONCLUSIONS: The pecten band seems to be associated with anal outlet obstruction, and a pecten band releasing operation may be considered according to its presence or absence.
Anal Canal ; Constipation ; Constriction, Pathologic ; Female ; Fissure in Ano ; Fistula ; Hemorrhoids* ; Humans ; Male ; Manometry ; Pecten*

PURPOSE: Although popliteal artery injuries are uncommon, the consequent lack of management protocols may contribute to the high level of outcome morbidity. METHOD: We retrospectively reviewed the records of popliteal artery trauma treated at our institution in the past 5 years. RESULT: In 15 patients [male 13, female 2, median age 45.9 (15-73)] there were 13 cases of blunt trauma, mainly motorcycle accident. Most patients presented with severe signs of ischemia when they arrived at the emergency unit. Most commonly skeletal injury was accompanied (fracture 13, nerve injury 7). Some delays occurred between injury and treatment in every cases. Bypass using the contralateral long saphenous vein was the predominant procedure for arterial injury. Our limb salvage rate was 66.7% (10/15), but all patients needed more than two additive operations, and finally had persistent neurologic disability. CONCLUSION: Popliteal artery injury, especially in Korean urban society, was mainly caused by blunt trauma from traffic accidents and the results remain challenging.
Accidents, Traffic ; Emergency Service, Hospital ; Female ; Humans ; Ischemia ; Limb Salvage ; Lower Extremity* ; Motorcycles ; Popliteal Artery* ; Retrospective Studies ; Saphenous Vein

Cavernous hemangioma in the gastrointestinal tract is a rare benign vascular lesion, which can produce massive or persistent blood loss. Herein, we present two cases of gastrointestinal hemangiomas that could not be resected completely and were treated with estrogen because of multiple involvement of the gastrointestinal tract and viscera, including the anal canal. A 49-year-old male presented with unknown chronic melena and anemia. Preoperative work-up could not reveal the definite cause of bleeding. During exploration, hemangioma scattered in whole small bowel was identified and feeding vessel ligation was performed. Postoperative recurrent bleedings were controlled by additional estrogen therapy. A 25-year-old young woman had suffered from painless anal bleeding with subsequent anemia since her youth. She had diffuse carvernous hemangioma in the large intestine involving the anal canal and uterus. Total proctocolectomy and ileal-pouch anal anastomosis was performed, however the uterine hemangioma was left intact because the patient wanted to be pregnant. She was also treated with estrogen, postoperatively. It is suggested that estrogen may be a good alternative treatment modality for gastrointestinal hemangioma that can not be removed completely.
Adolescent ; Adult ; Anal Canal ; Anemia ; Estrogens ; Female ; Gastrointestinal Tract ; Hemangioma ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Intestine, Large ; Ligation ; Male ; Melena ; Middle Aged ; Uterus ; Viscera

PURPOSE: This study was undertaken to investigate the prognostic significance of lymphatic invasion (LI), vessel invasion (VI), and neural invasion (NI) in gastric cancer and their correlations with other standard prognostic variables, such as the TNM stage. METHODS: The case histories of 100 gastric adenocarcinoma patients who had undergone a curative resection from 1992 to 1996 at Taegu Hyosung- Catholic University Hospital, Taegu, Korea were analyzed retrospectively. The Chi-Square test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rate were assessed using the log-rank test. The cox regression method was used for evaluation of independent prognostic significance. RESULTS: The 2-year survival rate was significantly lower (p<0.05) in LI (+) and NI (+) cases. The correlation between the T stage and LI, VI, and NI was statistically significant. Also, the correlation between the N stage and LI, VI, and NI was statistically significant. In the lymph node (+) group (n=43), the 2-year cumulative survival rate was higher in LI (-), VI (-), and NI (-) cases, but this result was not statistically significant. In the lymph node (-) group (n=57), the 2-year cumulative survival rate was higher in LI (-), VI (-), and NI (-) cases, but only the result for the NI (-) group was significant. Multivariate analysis demonstrated that LI, VI, and NI were not significant factors influencing the prognosis, although they were significant in the univariate analysis. CONCLUSION: This study identifies LI, VI, and NI as possible prognostic factor in gastric adenocarcinoma cases, but more careful research is needed.
Adenocarcinoma ; Daegu ; Humans ; Korea ; Lymph Nodes ; Multivariate Analysis ; Prognosis* ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

PURPOSE: This study was designed to establish the experimental background of intra- peritoneal hyperthermo-chemotherapy in gastrointestinal cancer. MATERIALS AND METHODS: We established stomach cancer cell lines; KATO-III, MKN45, AMC1 and colon cancer cell lines; AMC5, AMC6, CloneA, CCL188, C106, KM-12C. We performed chemosensitivity test by using MTT assay and calculated ICso of each chemotherapeutic agent. We confirmed antitumor effect of hyperthermia at 40C and 43C and antitumor synergistic effect with each chemotherapeutic agent at 40C and 43C. RESULTS: The ICso was calculated in 7 (78%) of 9 cell lines for 5-FU, 6 (67%) for MMC, 5 (56%) for ADM, 1 (11%) for CDDP and VP-16. Antitumor effect of hyperthermia at 40C was not found, but, that at 43C was found except KATO-III and AMC6. In stomach cancer cell lines, antitumor synergistic effect of hyperthermia with anticancer drugs at 43C was found in VP-16 for MKN45 and KATO-III and in all of 5 drugs for AMC1. In colon cancer cell lines, this effect at 43C was found in all of 5 drugs for CCL188, in S-FU, CDDP, ADM for AMC5, in 5-FU, MMC, ADM, VP-16 for CloneA, KM-12C, and in 5-FU, CDDP, MMC, ADM for C106. CONCLUSION: Hyperthermia itself had antitumor effect at 43C. Hyperthermo-chemotherapy had antitumor synergistic effect, especially at 43C.
Cell Line* ; Colonic Neoplasms ; Etoposide ; Fever* ; Fluorouracil ; Gastrointestinal Neoplasms* ; Stomach Neoplasms

Familial adenomatous polyposis (FAP) is an inherited autosomal dominant syndrome caused by germ-line mutations of the adenomatous polyposis coli (APC) gene. Clinical diagnosis of familial adenomatous polyposis is usually based on the presence of >100 colonic adenomas, which, if left untreated, progress to colorectal cancer, typically at age under 40 years. Attenuated adenomatous polyposis coli is a variant of familial adenomatous polyposis and also has been described as "hereditary flat adenoma syndrome". Attenuated adenomatous polyposis coli is recognized by the occurrence of <100 (> or =5 or > or =10) colonic adenomas. It is tend to be located proximal to splenic flexure and a later onset of colorectal carcinoma than familial adenomatous polyposis. PURPOSE: This study was performed to analyze the clinicopathologic features of suspicious attenuated adenomatous polyposis coli, to document the occurrence of colorectal carcinoma, and to assess the definition of attenuated adenomatous polyposis coli. METHODS: From June 1989 to June 1998, we reviewed 773 cases of colonic adenomas and compared with three groups (Group I, II, III) at Asan Medical Center. Median follow-up period was 16.4 months (range, 1 to 102 months). RESULTS: The incidence of suspicious attenuated adenomatous polyposis coli (Group II) was 4.9%. The most common symptom was anal bleeding (36.9%). Median size and number of adenomas were 1.0 cm (0.2 to 7.5 cm), 2 (1 to 43), respectively.Location of adenoma was prevalent at right colon in Group II (P<0.05). In respect to the occurrence of carcinoma in situ (CIS), it was more frequently presented in Group II (13.5%) and Group III (13.6%) whereas 4.1% in Group I (P<0.05). Recurrence rates within 12 months after polypectomy or surgery in Group II was 13.5% whereas 5.6% in Group I (P<0.05). CONCLUSIONS: Histopathology revealed suspicious attenuated adenomatous polyposis coli with villous component to be relatively correlated with occurrence of colorectal carcinoma. In suspicious attenuated adenomatous polyposis coli (Group II), the interval of the recurrence of the polyps was shorter than the control group with right colonic predominancy. These findings might be associated with genetic codominance of APC gene or other mutator genes.
Adenoma ; Adenomatous Polyposis Coli* ; Carcinoma in Situ ; Chungcheongnam-do ; Colon ; Colon, Transverse ; Colorectal Neoplasms ; Diagnosis ; Follow-Up Studies ; Genes, APC ; Germ-Line Mutation ; Hemorrhage ; Incidence ; Polyps ; Recurrence

Tailgut cyst is a rare congenital lesion in retrorectal space. The clinical significance of tailgut cyst presents its morbidity that occurs in the unrecognized and incompletely treated lesion. A forty four year-old female patient visited with lower abdominal pain during defecation. Preoperative abdominopelvic MRI and endorectal ultrasonography revealed a retrorectal mass suggestive of leiomyoma, dermoid cyst, teratoma, or duplication cyst of rectum. She underwent complete resection of retrorectal mass by transsphincteric approach. The mass was multilocular cyst lined by multiple types of epithelium. It was histologically confirmed as a tailgut cyst. She recovered uneventfully. This report includes the case and a brief review of tailgut cyst.
Abdominal Pain ; Defecation ; Dermoid Cyst ; Epithelium ; Female ; Humans ; Leiomyoma ; Magnetic Resonance Imaging ; Rectum ; Teratoma ; Ultrasonography