OBJECTIVES: X-rays are widely used in medical examinations. In particular, chest X-rays are the most frequent imaging test. However, observations are usually recorded in a free-text format. Therefore, it is difficult to standardize the information provided to construct a database for the sharing of clinical data. Here, we describe a simple X-ray observation entry system that can interlock with an electronic medical record system. METHODS: We investigated common diagnosis indices. Based on the indices, we have designed an entry system which consists of 5 parts: 1) patient lists, 2) image selection, 3) diagnosis result entry, 4) image view, and 5) main menu. The X-ray observation results can be extracted in an Excel format. RESULTS: The usefulness of the proposed system was assessed in a study using over 500 patients' chest X-ray images. The data was readily extracted in a format that allowed convenient assessment. CONCLUSIONS: We proposed the chest X-ray observation entry system. The proposed X-ray observation system, which can be linked with an electronic medical record system, allows easy extraction of standardized clinical information to construct a database. However, the proposed entry system is limited to chest X-rays and it is impossible to interpret the semantic information. Therefore, further research into domains using other interpretation methods is required.
Electronic Health Records ; Humans ; Semantics ; Thorax

PURPOSE: Sarcomatoid hepatocellular carcinoma (HCC) is a rare neoplasm and it has been found in only 1.8% of the surgically resected HCC patients, and in only 3.4~9.4% of the autopsied HCC cases. The pathogenesis of this tumor has't yet been thoroughly clarified, and such a tumor has been variously referred to as spindle cell carcinoma, sarcomatoid carcinoma, pseudosarcoma, or carcinosarcoma. There is only a little difference between the clinical characteristics of the sarcomatoid HCC and those of ordinary HCC. The diagnosis of the sarcomatoid HCC is made by pathological and immunohistochemical techniques after surgical resection, biopsy, or autopsy. METHODS: We reviewed the 10 cases of pathologically confirmed sarcomatoid HCC that were registered at the Yonsei University Medical Center from 1992 to 2004. RESULTS: Surgical operation was performed in seven cases, and curative resection was done only in five. Three patients were treated with chemotherapy or transarterial chemoem-bolization (TACE) with or without concurrent radiotherapy after the diagnosis of sarcomatoid HCC by liver biopsy. Six patients expired within 4 months after the diagnosis. The 6 month and 12 month survival rates for sarcomatoid HCC were 40% and 20%, respectively. The 6 month survival rates for radical resection and non-radical resection were 60% and 0%, respectively. The difference in cumulative survival according to the treatment of sarcomatoid HCC was statistically significant. CONCLUSION: The prognosis of sarcomatoid HCC is very poor; therefore, curative resection, adjuvant chemoradiotherapy, and close follow-up are necessary for patients suffering with sarcomatoid HCC.
Academic Medical Centers ; Autopsy ; Biopsy ; Carcinoma, Hepatocellular ; Carcinosarcoma ; Chemoradiotherapy, Adjuvant ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Prognosis ; Radiotherapy ; Survival Rate

Pancreatic cancer is a disease with poor prognosis mainly due to low resection rates and late diagnosis. To increase resectability and improve survival rates, a better understanding of pancreatic cancer pathogenesis and more effective screening techniques are required. New methods, such as genetic and molecular alterations, may suggest novel approaches for pancreatic cancer diagnosis and treatment. We immunohistochemically investigated 44 formalin-fixed, paraffin-embedded specimens of pancreatic ductal adenocarcinoma using monoclonal anti-p16 antibodies and monoclonal anti-p53 antibodies. The expressions of p16 and p53 proteins were compared using the Chi-square test with SPSS. Disease-free survival was analyzed using the Kaplan-Meier method, verified by the Log- Rank test. Loss of p16 expression was noted in 20 (45.5%) cases and aberrant p53 protein expression was detected in 14 (31.8%) cases. Loss of p16 expression was associated with a higher incidence of lymph node metastasis (p=0.040) and a more advanced stage (p=0.015), although there was no significant correlation between p16 expression and survival. Aberrant p53 protein expression correlated with histologic grade (p= 0.038). Disease-free survival rate was significantly lower in the aberrant p53 protein positive group compared to the negative group (p=0.029). From our results, we suggest that p53 is not a prognostic factor; however, p16 and p53 genes do play important roles in the progression of pancreatic ductal adenocarcinoma.
Adult ; Aged ; Female ; Genes, p16 ; Genes, p53 ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms/*chemistry/genetics/mortality/pathology ; Protein p16/*analysis ; Protein p53/*analysis ; Sex Characteristics

OBJECTIVES: Recent genetic studies have suggested a preferential transmission of the Dopamine D5 receptor gene (DRD5) 148bp marker allele. The aim of this study is to test the association between DRD5 and ADHD. METHODS: 106 Korean children with ADHD and their parents were analyzed using the transmission disequilibrium test (TDT) and haplotype-based haplotype relative risk test (HHRR). And also the ADHD children were compared with 212 age and gender matched normal controls. RESULTS: We found the evidence for an association of short alleles of DRD5 dinucleotide repeat polymorphism in both case control and family based studyies. Additionally, we observed some evidence for biased transmission of allele 152 bp and 144 bp. CONCLUSION: Our results lend credence to the notion that the relationship between ADHD and DRD5 is complex. The number of cases and informative transmissions in our study were small, therefore it would be premature to make any conclusions concerning the role of DRD5 in ADHD. Further work is needed to support these findings.
Alleles ; Attention Deficit Disorder with Hyperactivity* ; Bias (Epidemiology) ; Case-Control Studies* ; Child ; Dinucleotide Repeats ; Dopamine* ; Haplotypes ; Humans ; Parents ; Receptors, Dopamine D5*

OBJECTIVES: Recent genetic studies have suggested a preferential transmission of the Dopamine D5 receptor gene (DRD5) 148bp marker allele. The aim of this study is to test the association between DRD5 and ADHD. METHODS: 106 Korean children with ADHD and their parents were analyzed using the transmission disequilibrium test (TDT) and haplotype-based haplotype relative risk test (HHRR). And also the ADHD children were compared with 212 age and gender matched normal controls. RESULTS: We found the evidence for an association of short alleles of DRD5 dinucleotide repeat polymorphism in both case control and family based studyies. Additionally, we observed some evidence for biased transmission of allele 152 bp and 144 bp. CONCLUSION: Our results lend credence to the notion that the relationship between ADHD and DRD5 is complex. The number of cases and informative transmissions in our study were small, therefore it would be premature to make any conclusions concerning the role of DRD5 in ADHD. Further work is needed to support these findings.
Alleles ; Attention Deficit Disorder with Hyperactivity* ; Bias (Epidemiology) ; Case-Control Studies* ; Child ; Dinucleotide Repeats ; Dopamine* ; Haplotypes ; Humans ; Parents ; Receptors, Dopamine D5*

PURPOSE: Carcinomas of the ampulla of Vater have a higher resection rate, lower recurrence rate and more favorable prognosis than other malignant tumors of the periampullary region. This is because they usually presents with symptoms at an early stage due to their special anatomic location. Because of their relative low incidence, there have been few reports on the patterns and risk factors of a recurrence after a curative resection. The aim of this study was to evaluate the patterns and risk factors of a recurrence after a curative resection of ampulla of Vater cancer. METHODS: The medical records of 87 regularly followed-up patients from a total of 102 patients with a carcinoma of the ampulla of Vater, who had undergone a curative surgery between January 1992 and December 2002, were retrospectively reviewed. Of these patients, 37 were diagnosed as recurrent, with the patterns and clinicopathological risk factors of the recurrence analyzed. RESULTS: The average time to recurrence after a curative resection was 29.3+/-35.3 months, with liver metastasis being the most frequent (40.5%). The mean age of the patients in which a recurrence occurred was 54.9+/-10.1 years. There were 18 male and 19 female patients. The average tumor size in the recurred group was 2.5+/-2.0 cm. The recurrences were classified as early and late if they occurred within 18 months and after 18 months, respectively. The risk factors affecting an early recurrence were the gross morphology of tumor(ulcer formation) and cell differentiation (poorly differentiated). A univariate analysis showed lymph node metastasis to be a statistically significant risk factor, but age, gender, degree of tumor invasion depth and cell differentiation were not statistically significant. CONCLUSION: Lymph node metastasis is the most important risk factor affecting a recurrence after a curative resection of ampulla of Vater cancer, with the tumor gross morphology and cell differentiation important factors in an early recurrence. Further study on postoperative chemotherapy or radiotherapy in patients with lymph node metastasis, an ulcerative tumor type or poorly differentiated cell type, with a long-term follow-up on many patients will be needed.
Ampulla of Vater* ; Cell Differentiation ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Incidence ; Liver ; Lymph Nodes ; Male ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Radiotherapy ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Ulcer

PURPOSE: A carcinoma of the ampulla of Vater has more favorable prognosis than other malignant tumors of the periampullary region, because it is symptomatic at an early stage. However, local resection of an ampullary carcinoma remains controversial. The aim of this study was to evaluate the treatment results of ampulla of Vater carcinomas, according to operation type in low risk group patients. METHODS: The records of 17 low risk group patients, among 120 patients with ampulla of Vater cancer, who underwent curative surgery beyween 1992 and 2002, were reviewed. All specimens were critically reviewed by a single expert pathologist. The relationship between surgical outcomes and operation type were assessed. RESULTS: There were 10 men and 7 women, with a median age of 57.8 years. 13 of the 17 patients underwent the Whipples operation or a PPPD, and 4 underwent a transduodenal local resection (TDLR). The operation time was shorter in the TDLR group, and was statistically significant. Among the 17 patients, only one had a recurrence in the inguinal area 33 months after the PD. CONCLUSION: Transduodenal local resection is a recommendable operation for low risk Ampulla of Vater cancer patients. During the operation, it is essential to accurately evaluate the depth of invasion, cell differentiation and positivity of the resection margin using frozen sections.
Ampulla of Vater* ; Cell Differentiation ; Female ; Frozen Sections ; Humans ; Male ; Prognosis ; Recurrence

PURPOSE: Ampulla of Vater cancer has a more favorable prognosis than other malignant tumors of the periampullary region, but prognostic factors have not been identified. The aim of this study was to evaluate the prognostic factors of ampulla of Vater cancer from a single hospital experience. METHODS: The medical records of the 102 patients with ampulla of Vater cancer which underwent curative surgery between 1992 and 2002, were reviewed. All specimens were critically reviewed by an expert pathologist. The relationships between survival and the clinicopathological variables were assessed. RESULTS: In 120 patients that presented with ampulla of Vater cancer, 102 (85%) were resected. The 5 year survival rate was 69.1%. A univariate analysis showed the survival was closely related to gender, the tumor gross morphology, invasion depth and lymph node metastasis. A multivariate analysis identified two significant factors; the depth of invasion and gender. Twenty nine of the 102 patients suffered a recurrence. CONCLUSION: The depth of invasion and gender were independent significant prognostic factors of resectable ampulla of Vater cancer. Careful observation is essential for liver metastasis after surgery, especially in patients that have these factors.
Ampulla of Vater* ; Humans ; Liver ; Lymph Nodes ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Survival Rate*

Intraductal papillary mucinous tumor (IPMT) of the pancreas, a lesion consisting of mucin-producing cells with neoplastic potential, is characterized by duct ectasia, mucin hypersecretion, often extensive papillary intraductal growth, varying degrees of cytologic atypia, and relatively indolent growth. The clinical presentation of IPMT of the pancreas is characterized by chronic or recurrent attacks of abdominal discomfort often in association with low level pancreatic enzyme elevations. Less commonly these lesions may be detected as asymptomatic radiographic abnormalities. Interestingly, a case of a minute IPMT (2 mm in height and 7 mm in length, adenoma) in the main pancreatic duct presenting with acute pancreatitis in a 55 year-old man has been reported in the Japanese literature. Recently, we also experienced a case of a minute IPMT in a branch pancreatic duct causing repeated bouts of acute pancreatitis in a 75 year-old man. A filling defect at the neck of the main pancreatic duct seen on an endoscopic retrograde pancreatogram performed after recovery of the second attack of acute pancreatitis led the patient to undergo an exploratory laparotomy. After a near-total pancreatectomy was carried out, a minute (3 x 7 mm) IPMT of borderline malignancy was discovered in a branch duct at the head portion near the pancreatic neck without any lesions in the main pancreatic duct. Surprisingly, despite the resective surgery the patient died of carcinomatosis 8.5 months after the operation. We herein report a case of a minute but aggressive IPMT of the pancreas with a review of the literature.
Acute Disease ; Aged ; Case Report ; Cholangiopancreatography, Endoscopic Retrograde ; Human ; Male ; Mucins/secretion* ; Pancreatic Ducts/pathology ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/complications* ; Pancreatitis/etiology* ; Recurrence ; Tomography, X-Ray Computed

The clinical presentation of intraductal papillary mucinous tumor (IPMT) of the pancreas is characterized by chronic or recurrent attacks of abdominal discomfort often in association with low level pancreatic enzyme elevations. The episodes of pancreatitis due to IPMT of the pancreas are usually mild in severity. Recently, however, we experienced a case of IPMT of the pancreas causing severe acute pancreatitis with a protracted course in a 65 year-old woman. Initially, she presented with pancreatic ascites and hyperenzynemia without duct ectasia and mucus extrusion through the papillary orifice. Refeeding caused aggravation of hyperenzynemia and abdominal pain. The 4th follow-up abdominal computed tomography taken about 2 months after admission only revealed marked dilatation of the main pancreatic duct. Distal pancreatectomy disclosed IPMT, combined type and carcinoma in situ histologically. The patient has been followed for 2 years after operation with an uneventful clinical course. We herein report a case of IPMT of the pancreas with an unusual presentation.
Abdominal Pain ; Aged ; Ascites ; Carcinoma in Situ ; Dilatation ; Dilatation, Pathologic ; Female ; Follow-Up Studies ; Humans ; Mucins* ; Mucus ; Pancreas* ; Pancreatectomy ; Pancreatic Ducts ; Pancreatitis*