The Surgical Outcomes of Exotropia in Children with a Short Preoperative Work-Up

PURPOSE: We performed this study to evaluate the surgical outcome of exotropia in children younger than 10 years with a short, preoperative work-up. METHODS: The study subjects included 18 children who had received surgery for exotropia with preoperative work-ups less than 3 months. They were followed for more than 3 months after surgery. The age, symptoms, visual acuity, refractive errors, binocularity at surgery, and surgical results were analyzed. RESULTS: The average age of the subjects was 9.6 years old, and the preoperative angle of deviation was 25 prism diopters (PD). Most of them (89%) showed intermittent exotropia and myopia. None of them had amblyopia or anisometropia. Of the 18 patients, 16 (89%) were able to fuse at near and distance, and 14 patients showed good stereopsis equal to or less than 200 sec of arc by the Titmus test. The surgery was performed on the basis of the maximum angle, and inferior oblique myectomy was simultaneously performed in three patients. At the postoperative 15 months, 13 (72%) of the 18 patients showed a deviated angle less than 10PD, and exotropia recurred in 5 (28%) patients. CONCLUSIONS: The preoperative visual acuity and binocularity were relatively good, and the surgical outcome was also good in exotropic children younger than 10 years with a short preoperative work-up.

The Role of Preoperative Chest CT in the Evaluation of a Colorectal Adenocarcinoma

PURPOSE: The most common metastatic site of colorectal adenocarcinomas is the liver, and the next common site is the lung. Pulmonary metastasis has been reported to be more common in rectal cancer (esp. lower rectum) than in colon cancer, and for pulmonary survival metastasis, a hepatic metastatectomy results in longer. Likewise, for hepatic metastasis, a pulmonary metastatectomy may prolong survival, and many reports of longer survival after a pulmonary metastatectomy have been published. We compared chest CT to chest PA as a preoperative diagnostic tool for the detection of pulmonary metastasis. METHODS: The retrospective analysis was done for 369 consecutive patients with preoperative chest CT and chest PA who had a histologically-proven adenocarcinoma. RESULTS: The detection rates of pulmonary metastases by preoperative chest PA and preoperative chest CT were 3.5% (13/369) and 8.4% (31/369), respectively. Pulmonary metastases were confirmed by surgical pathology and follow up for over 6 months to have occurred in 22 patients. Chest PA's sensitivity and specificity for metastasis of colorectal cancer were 45% and 99%, respectively, and the positive predictive value was 76.9%. Chest CT had a sensitivity of 86%, a specificity of 96%, and a predictive positive value of 61.2% for pulmonary metastasis. CONCLUSIONS: Chest CT was more sensitive than chest PA in identifying pulmonary metastasis. Also, the detection rate for pulmonary metastasis by using chest CT was higher than that by using chest PA. Chest CT may be more useful in the diagnosis of pulmonary metastasis than chest PA as a preoperative work-up tool. The preoperative chest CT may help surgeons make decisions in the treatment for patients with a colorectal adenocarcinoma.

Clinical Significance of Preoperative High Serum CEA Value in Patients with Colorectal Cancer

PURPOSE: The preoperative s-CEA level are correlated to the extent of the tumor and distant metastasis in patients with colorectal cancer. This study was performed to analyze patterns of distant metastasis and survival rate according to the levels of preoperative s-CEA and evaluate the significance of chest CT and bone scan as methods of preoperative staging work-up in patients with high s-CEA level (>or=20 ng/ml). METHODS: A retrospective study was performed on 1,136 colorectal cancer patients who underwent surgery in Asan medical center between 1989 and 1995. These patients were classified into 3 groups according to preoperative s-CEA level (group A: or=6,or=20). We scrutinized the patterns of metastasis and compared the survival rates between the groups. Another study was, then, conducted prospectively on the basis of the above results. One hundred and sixty nine patients with s-CEA level (>or=20 ng/ml) were routinely examined by chest CT and bone scan for preoperative metastatic work-up in addition to the conventional work-up. Statistical analysis was performed by chi-squared test, Kaplan-Meier and log-rank test. RESULTS: The preoperative s-CEA level and the tumor stages were significantly correlated (P=0.009). The distant metastasis rates in group A, B, and C were 22.7% (163/719), 49.1% (115/234), 76.5% (140/183), respectively (P=0.000). Five year survival rate of each group were significantly different in far advanced stage, stage III (0.71 vs. 0.61 vs. 0.51 : P=0.002) and stage IV (0.21 vs. 0.10 vs. 0.05 : P=0.004). In stage I and II, however, we couldn't find statistical differences. Among 169 patients with s-CEA level above 20ng/ml, 52 (30.7%) had liver metastasis. Twenty three patients (13.6%) had lung metastasis. Twenty (11.8%) cases of pulmonary metastasis were found on chest CT scan and 3 cases on chest X-ray or abdominal CT scan. Only 4 (2.4%) cases, however, had bone metastasis on bone scan. CONCLUSIONS: These results suggest that the high preoperative s-CEA level seemed to be closely correlated with distant metastasis and prognosis. A meticulous preoperative staging work-up including chest CT scan is recommended in patients with high preoperative s-CEA level.