Fracture in Sorokdo National Hospital / 나학회지

INTRODUCTION: There are insufficient researches about the causes and the actual condition of fracture in Hansen's disease. Hence, I would like to indicate the problem by analysing the actual condition of fractures in Sorocdo Hansen's disease and a link between electromotion scooter and fracture. MATERIAL AND METHODS: Object is 75 patients who were admitted at Sorocdo National Hospital due to fracture from 2003, January to 2006, December. The medical record was analysed by retrospectively. Patient's general feature and the feature related to accident were analysed. Moreover, use of electromotion scooter and the relation between them were researched. RESULTS: The proportion of males to females is 1.41:1. Average age is 73.6 and over 65 years old shows 78.7%(59 persons) which means fracture happens frequently at old age. Predominant percentage of fracture is occurred at summer(34.7%) and autumn(33.4%). In addiction, the number of fracture patients is increased surprisingly since electromotion wheelchair and scooter were introduced in 2005. Hip joint fracture(34.7%) and distal radius fracture (16.0%) are the main region. The major reasonsof fracture are falls(52.2%) and accidents related to electromotion scooter(17.9%). The mortality of patients who were treated surgically(4.9%) is meaningfully lower than that who received conservated treatment(23.5%). CONCLUSION: The aged population and the number of electromotion scooter are been increasing in Sorocdo. Therefore, We need to find the fundamental and specific measure to prevent fracture caused by falls and electromotion scooter accident. Furthermore, surgical treatment is required actively.

Biologic behavior of E-cadherin in Invasive Ductal Carcinoma of the Breast / 한국유방암학회지

PURPOSE : E-cadherin is a tumor suppressor adhesion molecule that has an anti-invasive role and it is often considered as a useful marker for differentiating the lobular types from the ductal types of breast cancer. Yet the biological functions of E-cadherin in the invasive ductal types of breast cancers are unclear. METHODS : The E-cadherin expression was assessed immunohistochemically in 84 case of surgically resected invasive ductal carcinoma. Only the membranous expression of E-cadherin was considered and its expression was categorized as positive (>95% stained) or negative (<95% stained). The relationship between the E-cadherin expression and tumor size, the lymph node status, the histologic grade, the ER and PR status, The HER2/neu and p53 expressions was studied by performing prospective aspect. RESULTS : We analyzed 84 invasive ductal carcinomas for the E-cadherin expressions. Variable degrees of E-cadherin expression were noted in 79 cases and the complete absence of its expression was noted in 5 cases(5.9%) which showed all HER2/neu positive and p53 negative. Positive expression of E-cadherin was noted in 66cases(78.5%). Significant associations were found between the E-cadherin expression and the tumor size and the estrogen receptor status. The expression of E-cadherin was not found to be related to the lymph node status, histologic grade, the progesteron receptor status, the HER2/neu and p53 expressions. CONCLUSION: We confirmed that there was a strong correlation between the negative membrane expressions of E-cadherin and the T-stages and a negative estrogen receptor status. E-cadherin immunostaining appears to have a minimal prognostic value and it can be efficiently used for determining tumor progression of invasive ductal carcinomas of the breast.

Acute abdomen in Hansen's disease / 나학회지

INTRODUCTION: The acute abdomen define as an acute abdominal condition which needs immediate decision for treatment. The retrospective study was conducted to evaluate the characteristic of the acute abdomen in Hansen's disease. MATERIALS AND METHODS: An analysis was made of the records of 53 patients in surgical department at the National Soocdo Hospital from January, 2003 through December, 2005 for 3 years. RESULTS: The sex ratio of male to female was 1:1.04, and the mean age was 75.1 years. The most prevalent age group was in between 71 to 75 years of age(24.5%). Common diseases of acute abdomen were gastrointestinal bleeding(28.3%), acute appendicitis(17.0%), biliary tract disease(15.1%), intestinal obstruction(15.1%) in order of frequency. The operation rate was 32.1%(17 case). As for operative procedure, appendectomy was done in 9 cases, cholecystectomy was done in 3 cases, subtotal gastrectomy was done in 2 cases , palliative gastrectomy and gastric primary closure with omental patch and adhesiolysis with small bowel primary closure was done in 1 case each. The overall mortality rate was 24.5%(13 case). CONCLUSION: Gastrointestinal bleeding and intestinal obstruction was more frequent than other old age group. The operation rate was low, and the mortality rate was high. This study suggests that more active and surgical treatment need in acute abdomen of Hansen's disease patients.

The Clinical Study of Abdominopelvic Actinomycosis

PURPOSE: Abdominal actinomycosis is a rare chronic suppurative infectious disease, caused by a gram-positive bands Actinomyces israelii organism. The pathogens produces a characteristic granulomatous inflammatory fibrosis and mass lesion. Actinomycosis is usually divided into three clinical types; cervicofascial, thoracic and abdominopelvic. This study was designed to investigate the clinical or radiologic variability and the meanings of the diagnostic differentiality of abdominopelvic actinomycosis when patients present with an unusual abdominal mass or abscess. METHODS: The medical records of 19 patients treated at the Departments of Surgery and Obstetrics and Gynecology, Dong-A University Hospital were reviewed. The clinical characteristics, diagnostic evaluation and surgical treatment results were retrospectively analyzed. RESULTS: Of the 19 patients, 7 cases involved the colon and 11 the uterus and ovary with one case also involving the retroperoneum and ureter. Most cases (84.2%) had predisposing factors of disease progression, including intrauterine device (IUD), abortion, previous surgery, appendicitis and diverticulitis. The common presentations of the patients were abdominal pain (57.8%) and a palpable mass (15.7%). Preoperatively, no case was diagnosed as actinomycosis, but misconceived as a pelvic abscess, ovarian or colon cancers, a mesenteric origin mass, a lymphoma, periappendiceal abscess, acute appendicitis, uterine myoma, dysfunctional uterine bleeding or endometriosis. Explorations were performed in all patients. Eighteen cases were cured following surgery with subsequent antibiotics. However, one case recurred due to incompletion of antibiotics following surgical drainage. CONCLUSION: Abdominopelvic actinomycosis should be included as a differential diagnosis when an unusual abdominal mass presents on abdominal CT or ultrasound. Appropriate antibiotics, as well as surgery, are important in the treatment of abdominopelvic actinomycosis.

Treatment Result of Laparoscopic Versus Open Splenectomy in Benign Splenic Diseases

PURPOSE: The purpose of this study was to compare the clinical outcomes between laparoscopic (LS) and conventional open splenectomies (OS) in benign splenic diseases. METHODS: We retrospectively reviewed the medical records of patients who had undergone a splenectomy between June 1991 and April 2004. The patients' demographics and operative outcomes were also evaluated. RESULTS: Fifty-four patients were identified; LS and OS were performed in 41 and 13 patients, respectively. The age, gender and operative times between the two groups were similar. The time to resumption of oral intake was faster in the LS patients (2.0 +/- 0.9 vs. 4.0 +/- 5.1 days; P<0.0001). The length of hospital stay was shorter in the LS patients (4.0 +/- 2.4 vs. 12.0 +/- 7.4 days; P<0.0001). There were also significantly lower perioperative complications in the LS compared to the OS patients (4.8 vs. 38.5%; P=0.0017). In the patients with idiopathic thrombocytopenic purpura (ITP), there were no differences in the detection rate of an accessory spleens and the treatment response between the two groups. CONCLUSION: This study shows that LS is a safer than OS, and is an excellent surgical method: earlier diet tolerance, shorter hospital stay and fewer perioperative complications, with good cosmesis. Also, there was no difference in the surgical responses to treatment between the two procedures. Therefore, LS can become the gold standard for the treatment of benign diseases of the spleen.

Comparison of Laparoscopy-Assisted by Conventional Open Distal Gastrectomy and Extraperigastric Lymph Node Dissection in Early Gastric Cancer

PURPOSE: A laparoscopy-assisted gastrectomy with lymph node dissection for gastric cancer is considered technically more complicated than the open method. To evaluate the short-term surgical validity, the surgical outcome of the laparoscopy-assisted distal gastrectomy (LADG) with extraperigastric lymph node dissection was compared with that of the conventional open distal gastrectomy (CODG) in patients with early gastric cancer. METHODS: One hundred and forty-seven patients with early gastric cancer received a radical distal gastrectomy during 2002 and 2003, where a LADG was performed on 71 patients. The clinicopathological characteristics, postoperative outcomes and courses, and the postoperative morbidities and mortalities were compared between the two groups. Data were retrieved from the stomach cancer database at Dong-A University Medical center. RESULTS: Baseline characteristics, including gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, tumor size, T stage, and lymph node metastasis, were similar between the two groups. No significant differences were found between these groups in terms of the number of retrieved lymph nodes with respect to D1+(D1+no. 7) and D1+beta (D1+no. 7, 8a, and 9) lymphadenectomies. In the LADG group, the wound size was smaller (P <0.0001), but the operation time was longer (P=0.0001) than in the CODG group. The perioperative recovery was faster in the LADG than in the CODG group, as reflected by the shorter hospital stay (P=0.0176) and less additional analgesics (P=0.0370). The serum albumin level in the LADG was higher (P=0.0002) on day 7 than that in the CODG group, and the leukocyte count in the LADG lower (P=0.0445) on day 1 than that in the CODG gruop. There were no significant differences in the postoperative morbidities and mortalities between the two groups. CONCLUSIONS: Our data confirmed that a LADG with an extraperigastric (no. 7, 8, and 9) lymph node dissection was a feasible and acceptable surgical technique for early gastric cancer. From a surgical point of view, a LADG with an extraperigastric lymph node dissection is suggested to be a preferred surgical option for patients with early gastric cancer. Its oncological validity awaits larger and prospective multicenterd trials.

The Clinical Analysis of 25 Cases of Bezoars

PURPOSE: Bezoars are defined as retained concretions of animal or vegetable material in the gastrointestinal tract, and can be classified as trichobezoar, phytobezoar, trichophytobezoar or concretion. The purpose of this study was to review and analyze 25 cases of bezoar. METHODS: The medical records of 25 patients, treated between February 1995 and November 2004, were reviewed. The clinical characteristics, as well as the diagnostic evaluations and results of surgical treatment, were also analyzed retrospectively. RESULTS: Of the 25 patients, 13 men and 12 women, the bezoars were in the stomach, ileum or in both the stomach and ileum in 17, 5 and 2 cases, respectively, with 1 case in the esophagus. Bezoars are usually caused by an altered gastric physiology, with impaired gastric emptying as a result of surgery, such as subtotal gastrectomy, antrectomy or truncal vagotomy with pyloroplasty. The treatment of bezoars depends on their composition and location. A gastric bezoar can be treated by endoscopic removal, although not all cases can be completely removed. Small bowel bezoars are usually discovered on exploration due to an intestinal obstruction, with surgical removal being the standard treatment method in such cases. CONCLUSION: A bezoar occurs mainly in patients who have previously undergone a gastric operation. Surgeons should keep in mind the possibility of bezoars in patients presentingan intestinal obstruction following a past gastric operation. The treatment principle for bezoars used to be surgery, but recently gastric bezoars are often treated by gastrofiberscopy.

Gastric Cancer Occurring in a Patient with Plummer-Vinson Syndrome: A case report

Plummer-Vinson syndrome (sideropenic dysphagia) is characterized by dysphagia due to an upper esophageal or a hypopharyngeal web in a patient with chronic iron deficiency anemia. The main cause of dysphagia is the web of the cervical esophagus, and an abnormal motility of the pharynx or the esophagus is found to play a significant role in the above cause. Patients with this syndrome are thought to be precancerous because squamous cell carcinomas of the hypopharynx, oral cavity, or esophagus take place in 10% of those patients. However, for Plummer-Vinson syndrome to be combined with gastric cancer is most unusual. We report the case of a 43-year-old woman who was first found to have stomach cancer under a diagnosis of Plummer-Vinson syndrome and who recovered after surgery.

Primary Abscess of the Falciform Ligament

Surgical lesions of the falciform ligament are rare, but most often present clinically as a cystic abdominal mass, and less often an abscess. A falciform ligament lesion can present as an acute abdomen, when a cyst undergoes torsion or becomes abscessed. Secondary inflammation of the falciform ligament may seed from an infection in the gallbladder, liver or umbilicus. Here, a case of primary abscess of the falciform ligament is reported, with a review of the literature.

Epidemiological Study of Heart Disease in Korea: 5 Year Interval Change

In order to investigate the trend of prevalence of heart disease in Korea, statistical observation was made on 19,239 cases of medical in-patients who were treated in 3 general hospitals, Korea University Hospital, Seoul Red Cross Hospital and Seoul Adeventist Hospital, on 73,484 cases of medical out-patients who were seen at Korea University Hospital and Seoul Adventist Hospital during the period of 5 years, from 1972 through 1976, on 7,746 cases of medical in-patients during the period of 10 years (1967 through 1976), and on 50,083 cases of medical out-patients during the period of 15 years (1962 through 1976) who were treated in Korea University Hospital. The results obtained were as follows. 1. Heart disease was 5.5% (male 5.4%, female 5.7%) of medical out-patients and 16.1% (male 16.7%, female 15.5%) of medical in-patients. 2. The incidence of heart disease was increased with the increase of age in both out-patients and in-patients. The incidences of heart disease in out-patients by age group to the total out-patients of each age group were 1.8% in 15~40 year group, 10.2% in 41~60 year group and 18.4% in over 61 year group, and those in in-patients were 5.0% in 15~40 year group, 24.4% in 41~60 year group and 30.8% in over 61 year group. 3. The incidences of individual heart disease to 4,074 cases with heart disease (male 1,986, female 2,088) of out-patients were as follows. Rheumatic myocarditis was 0.5% (male 0.6%, female 0.5%), mitral valvular disease 8.3% (male 5.8%, female 10.6%), aortic valvular disease 3.1% (male 3.9%, female 2.2%), mitral and aortic valvular disease 0.7% (male 1.3%, female 0.7%), hyper tension 72.0% (male 72.8%, female 71.0%), myocardial infarction 0.7% (male 1.2%, female 0.2%), angina pectoris 2.2% (male 3.1%, female 1.4%), atherosclerotic heart failure 4.5% (male 4.8%, female 4.1%), pericarditis 0.4% (male 0.6%, female 0.3%), idiopathic myocardiopathy 0.5% (male 0.5%, female 0.6%), postpartum myocardiopathy 0.3% in female, cor pulmonale 0.3%(male 0.2%, female 0.4%) and congenital heart disease 1.4% (male 1.8%, female 1.1%). 4. Incidences of individual heart disease to total 3,091 cases with heart disease (male 1,573, female, 1,518) of in-patients were as follows. Rheumatic myocarditis was 0.4% (male 0.5%, female 0.3%), mitral valvular disease 8.1% (male 5.1%, female 11.2%), aortic valvular disease 1.1% (male 1.3%, female 0.8%), mitral and arotic valvular disease 0.3% (male 0.3% female 0.4%), hypertension 69.6% (male 71.3%, female 68.5%), myocardial infarction 2.8% (male 4.3%, female 1.4%), angina pectoris 1.7% (male 2.0%, female 1.3%), atherosclerotic heart failure 7.5%(male 7.7%, female 6.8%), pericarditis 0.8% (male 0.9%, female 0.8%), idiopathic myocardiopathy 1.3% (male 1.3%, female 1.3%), postpartum myocardiopathy 0.7% in female, cor pulmonale 1.5% (male 1.5%, female 1.6%) and congenital heart disease 0.5% (male 0.4%, female 0.5%). 5. There was no significant seasonal variation of the incidences of individual heart diseases. 6. The incidences of rheumatic valvular heart disease, coronary heart disease and congenital heart disease of medical out-putients of Korea University hospital by 5-year-period for 3 consecutive periods (1962 through 1976) were increased and those of hypertension and cor pulmonale were decreased. 7. The incidneces of coronary heart disease and idiopathic myocardiopathy of medical in-patients of Korea University Hospital by 5-year-period for 2 consecutive periods (1967 through 1976) were increased and those of rheumatic myocarditis, hypertension and postpartum myocardiopathy were decreased. There was no change in incidence of rheumatic heart disease including rheumatic myocarditis, and congenital heart disease. 8. The trend of increasing prevalence of coronary heart disease, especially angina pectoris, was noted. Although hypertension was decreased in relative incidence, the total number of patients with hypertension was increased. This seems to suggest that hypertension tends to increase.