A Case of Pulmonary Sarcoidosis in a 6-year-old Girl / 소아알레르기및호흡기학회지

Sarcoidosis is a rare multisystemic granulomatous disease. The lungs, lymph nodes, eyes, skin and liver are the most commonly involved. There are two distinct forms of sarcoidosis in children. One is early-onset(younger) childhood sarcoidosis characterized by skin rash, uveitis, and arthritis occurring before age 4 years. The other is late-onset(older) childhood sarcoidosis characterized by involvement of the lungs, the common radiographic finding is bilateral hilar lymph node enlargements, similar to the adult manifestation. We report a case of late-onset childhood sarcoidosis in a 6-year-old girl which is the first pediatric pulmonary sarcoidosis reported in Korea.

Clinicopathologic Features of Colorectal Cancer with Liver Metastases

PURPOSE: The aim of this study was to clarify the clinicopathologic features in colorectal cancer with liver metastases and to evaluate their clinical significance. METHODS: From August 1996 to April 2002, 545 patients, who underwent radical surgery for primary colorectal cancers, were analyzed retrospectively. RESULTS: Colorectal cancers with and without synchronous liver metastases at the time of the surgery were 36 and 509 cases, respectively. Of the 509 cases without metastases, 34 cases had metachronous liver metastases by April 2002, but the others did not. Serosal, vascular, perineural, and lymph node invasions, as well as increased preoperative CEA levels, were more frequently observed in those with synchronous liver metastases than it was in those without metastases (P<0.05). According to multivariate analyses, lymph node invasion was statistically significant as an independent variable in those with synchronous metastases (P=0.009). Serosal, vascular, and lymph node invasions, increased preoperative CEA levels, DNA ploidy, and positive lateral resection margins were more frequently observed in those with metachronous liver metastases than it was in those without metastases (P<0.05). According to multivariate analyses, vascular invasion was statistically significant in those with metachronous metastases (P=0.015). CONCLUSIONS: Lymph node and vascular invasions appear to be significant determinants for synchronous and metachronous liver metastases in colorectal cancers. Therefore, close observation and careful postoperative follow-up is needed for such patients.

Change of Anorectal Function after Low Anterior Resection for Rectal Cancer

PURPOSE: The anorectal function after a low anterior resection for rectal cancer recovered progressively by 6 12 months after the operation, but the mechanisms and the recovery process are not well understood. The aim of this study was to correlate postoperative anorectal function after low anterior resection with physiologic parameters. METHODS: Sixty-seven patients who underwent a low anterior resection for rectal cancer were studied. The control group was consisted of normal persons. Anorectal physiologic studies were conducted for 6 months postoperatively by using defecographys, anorectal manometry and electomyogram of pudendal nerve. RESULTS: The postoperative anorectal function was gradully improved with time. Defecograms showed that the resting, squeezing, and straining anorectal angles were not significantly increased. Anorectal manometry showed that the threshold volume and the urgency volume were not significantly decreased but the maximal tolerable volume was decreased remarkably. The maximal resting pressure significantly decreased but the maximal squeezing pressure were not. The pudendal nerve electromyograms were not significantly different between the two groups. The patients were divided by based on the anastomosis level. The short anastomosis group showed more impairment in the urgency volume and the maximal resting pressure than that of the long anastomosis group. CONCLUSION: The neorectal volume and the level of anastomosis were important for changes in the anorectal function after a low anterior resecton. Gradual improvement of symptoms resulted from a resected rectal adapted to a neorectal volum.

Greater Omental Torsion

Primary or idiopathic greater omental torsion is an uncommon cause of an acute surgical abdomen. The etiology of omental torsion is as yet unknown. The preoperative diagnosis is usually hard, and generally made at laparotomy, due to the objective rareness and absence of typical symptoms. Resection of the infarcted segment is the treatment of choice, offering rapid recovery, and reducing the possibility of adhesion formation. A case of primary omental torsion is reported, with a review of the literature.

Clinical Analysis of Inhalation Burn

PURPOSE: The mortality rate of burn patients dying from burn shock or sepsis is declining owing to improved treatment methods such as advances in fluid therapy and antibiotic application. Over the past 10 years, however, damage to the trachea and the lungs caused by inhalation of poisonous gases in closed spaces and the resulting complications have become the primary causes of death for burn patients. The purpose of this study is to appraise the clinical significance of inhalation burn by focusing the analysis on the mass- produced burn patients from a recent short period. METHODS: This study involved 23 patients who were admitted to the Department of General Surgery from the Emergency Room at the Inha University Hospital after suffering burns in a fire that broke out at a pub in Inchon, Korea, on 30 October 1999. RESULTS: The average age was 16.6 and most of the patients were adolescents. The average of the total burn surface was 7%, with 17 patients (73.9%) having less than 5%. A bronchoscopy was applied to all the patients. A total of 13 patients (56.5%) had intubation. Of these, 4 had a tracheostomy three days after hospitalization. Of the 23 patients who were the subjects of this clinical study, 12 patients, accounting for 52.2% of the total, developed pneumonia. Two people also developed tracheal stenosis and both of them underwent a tracheal resection and anastomosis. Four patients had to receive psychiatric treatment due to post traumatic stresss disorder. None of the 23 patients died. CONCLUSION: In the case of burns suffered in confined areas, an inhalation burn, rather than the mere size of the burn, will have a greater bearing on fatality and the occurrence of pulmonary complications. For this reason, one cannot overemphasize the importance of preventing fire by taking appropriate safety precautions and keeping the surroundings clear of inflammable materials. However, once burn injury occurs, every effort should be made to ensure that there will be minimum after effects and scars through earliest possible intervention.

The Influence of DNA Ploidy, Index and Lymph Node Status on Disease Free Survival in Patients with Colorectal Cancer

The DNA flow cytometric analysis in colorectal cancer has been studied for more than 10 years as an independent prognostic factor or a factor correlated with other preexistent prognostic factors, such as the depth of invasion, lymph node status, histologic differentiation, etc. To clarify the influence of DNA contents (DNA ploidy, DNA index) and lymph node status on disease free survival in colorectal cancer, we investigated the relationship between them, retrospectively. METHODS: This study included 198 patients with curatively resected Dukes' stage A, B, and C colorectal cancer who had taken DNA flow cytometric analysis from June of 1996 to March of 1999 at Department of Surgery, Inha University Hospital. RESULTS: In over all twelve-month disease free survival, there were 92.5% in DNA diploid and 74.3% in DNA aneuploid tumors. And so forth, there were 78.0% in positive and 91.9% in negative lymph node tumors. In the event of a DNA index greater and lesser than 1.15, the twelve-month disease free survival was 72.9% and 92.7%, respectively. These results were statistically significant (p<0.05). Therefore, patients with a negative lymph node, diploid colorectal cancer or DNA index lesser than 1.15 had a longer disease free survival than those with a positive lymph node, aneuploid one or DNA index greater than 1.15. CONCLUSIONS: In conclusion, there seems to be a significant relationship between DNA contents and lymph node status on disease free survival. Thus, these factors are considered to be valuable in predicting the recurrence of colorectal cancer.

Clinical Significance of Lymph Node Micrometastasis in Dukes' Stage A&B Colorectal Cancer: An Immunohistochemical Study

PURPOSE: Lymph node metastasis is the most important prognostic factor in colorectal cancer. However, 20~30% of patients with lymph node negative colorectal cancer die of recurrent disease. We investigated whether the detection of micrometastasis is of any clinical significance in Dukes' stage A & B colorectal cancer. METHODS: Ninety patients who underwent curative resection of colorectal cancer from Aug. of 1996 to Jan. of 1999 were entered the study. For examination, we used paraffin blocks of lymph nodes which were metastasis-free by conventional histopathology. After preparation of tissue blocks using the serial sectioning technique, the specimens were stained with immunohistochemical method using anticytokeratin antibody. And the hematoxylin-eosin staining was repeated. RESULTS: We disclosed micrometastases in 15 of 90 cases, mostly located in subcapsular sinuses. And in 8 of 15 cases, we also found metastases in repeated H&E staining. There were no significant relationship between the detection of micrometastases and the depth of wall invasion, the histological grade and the status of lymphovascular invasion. With median follow-up of 15 months, we found no significant difference in recurrence between the micrometasis positive and negative groups. CONCLUSIONS: The result showed that the micrometastasis of lymph node in colorectal caner might increase the risk for development of tumor recurrence. But because of small numbers of recurrent cases and relatively short follow-up period, there was no statistically significant relationship between micrometastasis negative and positive groups.