Background: Cyst enucleation, which extracts only the tumor with the application of Carnoy’s solution (CS), has been suggested as a conservative treatment with a low recurrence rate and morbidity. However, there has been a concern that CS’s contact with inferior alveolar nerve (IAN) can cause neurons to degenerate and cause sensory dysfunction. The purpose of this retrospective cohort study aimed to investigate the neurosensory function after surgical treatment with or without the application of CS. Methods: While controlling the effects of sex, age, follow-up period, and invasion size of the tumor, we performed the binary logistic regression analysis to examine whether or not the sensory function of the patients who were treated with CS (n = 19) for the cyst enucleation procedure was significantly different from those who were not treated with CS (n = 58) at the end of the follow-up period. Results: The logistic regression result showed that the use of CS was not significantly related to the normalness of sensory function at the end of the follow-up period. Rather, the invasion size of the cyst was significantly associated with sensory dysfunction. Conclusions CS may be used for patients who are diagnosed with OKC and UAM without much fear of its impact on sensory dysfunction. However, a small number of patients who were treated with CS experienced severe sensory damage and did not recover at the end of the follow-up period, suggesting the need for further analysis of these patients.

The entity of negative appendectomies still poses a dilemma in chlidren. Focused computed tomography (CT) scanning has become the diagnostic test of choice in many hospitals. However, the impact of CT scans on the diagnosis in children is unknown exactly. The purpose of this study was to critically evaluate CT scans for the evaluation of acute appendicitis in children, to review utilization of this diagnostic test in our appendicitis population and to determine if diagnostic accuracy has improved. A retrospective analysis of efficacy of CT scan for diagnosis of appendicitis in children was conducted. Children undergoing appendectomy for acute appendicitis were reviewed from 2007 to 2012. Perforation and negative appendectomy (removal of a normal appendix) rates were determined by the final pathologic report. Statistical comparison were made using the chi2 test and significance was assigned at p < 0.05. Five hundred four appendectomies were performed. Mean age was 10.1 +/- 3.21 years, and 62.7% were boys. Overall, 308 children (61.1%) underwent CT scanning, 100 (19.8%) had US performed, and 97 (19.2%) had no radiographic study. A pathologically normal appendix was removed in 8.7% (27 of 308) of CT patients, 9.0% (9 of 100) of US patients, and 11.3% (11 of 97) of patients without a study. The frequency of CT scanning increased from 29.7% (27 of 91) of all children in 2007 to 75.6% (59 of 78) in 2012, whereas utilization of US decreased from 30.8% (28 of 91) to 11.5% (9 of 78). During this time period the difference in the negative appendectomy rate did change significantly from 14% to 6%. Liberal use of CT scans in diagnosing appendicitis in children has resulted in a decreased negative appendectomy rate.
Appendectomy ; Appendicitis* ; Appendix ; Child* ; Diagnosis ; Diagnostic Tests, Routine ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed

This study aimed to identify the risk factors associated with acute hepatitis A virus (HAV) infection in the Korean population. Participants were recruited from five referral hospitals across the country in 2007 and from 11 hospitals in 2009. Patients with positive anti-HAV IgM antibody tests became the case group, while patients treated for non-contagious diseases at the same hospitals were recruited as controls. A total of 222 and 548 case-control pairs were studied in the 2007 and 2009 surveys, respectively. Data from the surveys were analyzed jointly. In a multivariate analysis, sharing the household with HAV-infected family members (OR, 6.32; 95% CI, 1.4-29.6), contact with other HAV-infected individuals (OR, 4.73; 95% CI, 2.4-9.4), overseas travel in 2007 (OR, 19.93; 95% CI, 2.3-174.4), consumption of raw shellfish (OR, 2.51; 95% CI, 1.8-3.5), drinking bottled water (OR, 1.64; 95% CI, 1.3-8.4), and occupation that involve handling food (OR, 3.30; 95% CI, 1.3-8.4) increased the risk of HAV infection. Avoiding contact with HAV-infected individuals and avoiding raw foods eating could help minimize the risk of hepatitis A infection. Immunization must be beneficial to individuals who handle food ingredients occupationally or travel overseas to HAV-endemic areas.
Acute Disease ; Adolescent ; Adult ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Food Handling ; Hepatitis A/*diagnosis/etiology/prevention & control ; Hepatitis A Antibodies/blood ; Humans ; Immunoglobulin M/blood ; Infant ; Infant, Newborn ; Interviews as Topic ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Referral and Consultation ; Risk Factors ; Seafood ; Travel ; Vaccination ; Young Adult

PURPOSE: We performed this study to evaluate the clinical presentation as well as the proper surgical intervention for ovarian metastasis from gastric cancers and these tumors were identified during postoperative follow-up. This will help establish the optimal strategy for improving the survival of patients with this entity. MATERIALS AND METHODS: 22 patients (3.2%) with ovarian metastasis were noted when performing a retrospective chart review of (693) females patients who had undergone a resection for gastric cancer between 1981 and 2008. The covariates used for the survival analysis were the patient age at the time of ovarian relapse, the size of the tumor, the initial TNM stage of the gastric cancer, the interval to metastasis and the presence of gross residual disease after treatment for Krukenberg tumor. The cumulative survival curves for the patient groups were calculated with the Kaplan-Meier method and they were compared by means of the Log-Rank test. RESULTS: The average age of the patients was 48.6 years (range: 24 to 78 years) and the average survival time of the 22 patients was 18.8 months (the estimated 3-year survival rate was 15.8%) with a range of 2 to 59 months after the diagnosis of Krukenberg tumor. The survival rate for patients without gross residual disease was longer than that of the patients with gross residual disease (P=0.0003). In contrast, patient age, the size of ovarian tumor, the initial stage of gastric adenocarcinoma, the interval to metastasis and adjuvant chemotherapy were not prognostic indicators for survival after the development of ovarian metastasis. CONCLUSIONS: Early diagnosis and complete resection are the only possible hope to improve survival. As the 3-year survival rate after resection of Krukenberg tumor is 15.8%, it seems worthwhile to consider performing tumorectomy as the second cytoreduction.
Adenocarcinoma ; Chemotherapy, Adjuvant ; Early Diagnosis ; Female ; Follow-Up Studies ; Humans ; Krukenberg Tumor ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

PURPOSE: Muscular artery differs from elastic artery in physical properties and constituents of the arterial wall. To investigate the difference between muscular and elastic arteries, we measured the pulse wave velocities (PWVs) in lower extremity muscular arteries (femoral ankle PWV, faPWV) and abdominal elastic arteries (brachial femoral PWV, bfPWV), and searched for the relationships between the PWVs of muscular, elastic arteries and the risk factors of arteriosclerosis. METHODS: 184 normal volunteers were enrolled in the study. Among them, the ratios of male/female, smoker/non-smoker, and hypertension/normal were 81/103, 66/118, and 63/121, respectively. Using volume plethysmography, faPWV and bfPWV were measured. The risk factors of arteriosclerosis in this study were age, gender, smoking, hypertension, body mass index, low density lipoprotein, high density lipoprotein, triglyceride, hemoglobin A1C, and white blood cell. RESULTS: The PWVs of lower extremity muscular arteries (faPWVs) were significantly faster than those of abdominal elastic arteries (bfPWVs) (right, P<0.001; left, P<0.001) Multiple regression analysis revealed that the independent risk factors of the PWV were age (right, P<0.001; left, P<0.001) and gender (right, P=0.008; left, p=0.014) in abdominal elastic arteries. However, in lower extremity muscular arteries, hypertension (right, P<0.001; left, P<0.001) as well as age (right, P<0.001; left, P<0.001) and gender (right, P=0.009; left, P=0.001) were other significant independent risk factors. CONCLUSION: The PWVs of lower extremity muscular arteries were significantly faster than those of abdominal elastic arteries. The significance of hypertension in faPWV suggests that hypertension is an important risk factor in inducing arterial stiffness, especially in lower extremity muscular arteries.
Animals ; Ankle ; Arteries ; Arteriosclerosis ; Body Mass Index ; Extremities ; Hemoglobins ; Humans ; Hypertension ; Lipoproteins ; Lower Extremity ; Plethysmography ; Pulse Wave Analysis ; Risk Factors ; Smoke ; Smoking ; Vascular Stiffness

The clinical characteristics of fistula-in-ano in infants are different from those of older children, and its treatment remains controversial. We suggest that fistula-in-ano in infants has a congenital etiology. To verify this hypothesis and to settle the controversies regarding fistula-in ano in infants, a retrospective analysis of 29 patients less than 2 years of age with anal fistulae treated between 1994 and 2009 at Samsung Changwon Hospital were reviewed retrospectively. Twenty two patients were male and mean age at diagnosis was 7.2+/-5.2 months. Eleven out of 22 cases had previous surgical drainage for perianal abscess. 18 patients had fistulotomy (81.8%) and four had fistulectomy (18.2%). Cryptotomies with fistulectomy were performed in 10 patients (45.5%) who had involved crypt. There was one recurrence. These results suggest that fistula-in-ano in young children less than two years of age is different from those in older children or adults. Fistulotomy is suggested to be the recommended treatment of choice. A future study involving non-operative management would be required to explore all treatment options.
Abscess ; Adult ; Child ; Drainage ; Humans ; Infant ; Male ; Rectal Fistula ; Recurrence ; Retrospective Studies

PURPOSE: To determine the usefulness of the Sequential Organ Failure Assessment (SOFA) score for prediction of mortality in operated patients with sepsis due to intra-abdominal infection. METHODS: Eighty-eight septic patients operated on from January 2004 to June 2008 were evaluated retrospectively. The SOFA scores were measured four times in each patient: initial score, post-op (post-operation) score, POD1 (first post-operative day) score, and POD2 (second post-operative day) score. The maximum score and mean score were obtained from these measurements. These scores were compared between groups of patients classified by mortality. D scores (D0, D1, D2) reflecting the differences between subsequent scores were compared between the surviving group and deceased group according to re-operation. RESULTS: The initial, post-op, POD1, POD2, maximum, and mean scores showed statistically significant differences between the surviving group and deceased group. D1 and D2 showed statistically significant differences between surviving group and deceased group. CONCLUSION: The sequential measurement of SOFA score is a useful prediction system for patients with sepsis due to intra-abdominal infection.
Humans ; Intraabdominal Infections ; Retrospective Studies ; Sepsis

PURPOSE: Aging and atherosclerotic changes enhance the stiffness of the arterial wall, and the pulse wave travels faster in stiffer vessel. Measurement of the brachial ankle pulse wave velocity (baPWV) is a non-invasive method for evaluating the stiffness of the vessel wall. We investigated the relation between the baPWV and risk factors for atherosclerosis. METHOD: We studied 180 subjects (38 male and 142 female; mean age 46 years, range 24 to 76 years). The instrument used for evaluating the baPWV was a Vasoguard (VIASYS Healthcare, Dublin, Ohio, USA), and measurements were performed in the right arm and in both ankles. Data were analyzed using Pearson correlation, t-test, and multiple regression analysis. Multiple regression analysis was performed for age, sex, smoking, hypertension, height, weight, body mass index (BMI), total cholesterol, LDL, HDL, TG, and HbA1c. RESULT: Right and left baPWVs were significantly increased (P<0.05) in subjects with the following risks: older age, high body weight, high BMI, high total cholesterol, high LDL, high TG, high HbA1c, and low HDL. Right and left baPWVs were also significantly increased (P<0.05) in male subjects with a history of smoking and hypertension. Multiple regression analysis showed that age, sex, and LDL were independent determinants of the right and left baPWVs. CONCLUSION: This study provides evidence that increased age, male gender, and high serum LDL levels are risk factors that contribute to arterial stiffness. Measurement of the baPWV may be a useful method for evaluating vascular status.
Aging ; Animals ; Ankle ; Arm ; Body Weight ; Cholesterol ; Cholesterol, LDL ; Delivery of Health Care ; Glycosaminoglycans ; Humans ; Hypertension ; Male ; Ohio ; Pulse Wave Analysis ; Risk Factors ; Smoke ; Smoking ; Vascular Stiffness

PURPOSE: We performed this study to evaluate the clinical presentation of, as well as the surgical intervention for, ovarian metastasis from colorectal cancers identified during postoperative follow-up. METHODS: Twelve cases (2.4%) of ovarian metastasis were observed among retrospective chart review of 493 females patients who underwent a resection of colorectal cancer between 1981 and 2006. The covariates used for the survival analysis were patient age at the time of ovarian relapse, size of the tumor, initial TMN stage of the colon cancer, the interval to metastasis, and the presence of gross residual disease after treatment for a Krukenberg tumor. The cumulative survival curves for the patient groups were calculated with the Kaplan-Meier method and were compared by means of the Log-Rank test. RESULTS: The average age of the patients was 48.9 years, ranging from 24 to 71 years, and the average survival time of the 12 patients was 19.6 months (estimated 3-year survival rate was 16.7%), with a range of 3 to 59 months after the diagnosis of a Krukenberg tumor. The survival rate for patients without gross residual disease was longer than that of patients with gross residual disease (P=0.0003). In contrast, patient age, size of the ovarian tumor, initial stage of the colon adenocarcinoma, and interval to metastasis were not prognostic indicators for survival after the development of ovarian metastasis. CONCLUSIONS: Our results suggest that, in general, most cases with ovarian metastasis have poor prognosis and that the absence of residual disease after treatment is a favorable prognostic factor in cases of a Krukenberg tumor of colon origin.
Adenocarcinoma ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Krukenberg Tumor ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

Various minimally invasive surgical techniques in some cases of early gastric cancer are becoming common practice. However, there are rare cases of advanced cancer with distant metastasis although the invasion of the gastric wall is limited to the mucosa and/or submucosa (defined as early gastric cancer according to UICC-TNM classification). We report two cases of early gastric cancer with distant metastasis (stage IV). Both tumors were defined as early cancer because they were confined to the submucosa. One was a type IIa early cancer, histologically classifiable as a signet ring cell carcinoma (according to the Japanese Classification of Gastric Carcinoma and UICC-TNM classification); the other was a surface spreading type IIb IIc, classifiable as a signet ring cell carcinoma, too. Stage IV factors were ovarian metastasis (Krukenberg tumor) in the former and N3 in the latter case.
Adult ; Carcinoma, Signet Ring Cell/*pathology/secondary ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Stomach Neoplasms/*pathology