RESUMO
BACKGROUND: A hepatocellular carcinoma (HCC) is an awesome malignancy; survival time is usually less than 1 year once symptoms and signs appear, irrespective of treatment. Screening tools are now available that make it possible to detect a preclinical HCC, which is usually small and surgically resectable. We studied the prognosis after hepatic resections of HCCs smaller than 5 cm and tried to clarify which effective treatments correlated with high survival rates by comparing the outcomes of major hepatic resections with those of limited hepatic resections. METHODS: Of the 105 cases treated from January 1, 1990, to December 31, 1998, at Asan Medical Center, all proved surgically to be small HCCs and pathologically to be HCC types. There were two categories of patients: those receiving a major hepatic resection (n=48) and those receiving a limited hepatic resection (n=57). RESULTS: The median age was 53 (range, 33-69), and the male:female ratio was 42:6 in the major resection group. The median tumor size was 3.4 cm, and the median resection margin was 2.6 cm. Major resections were done in 48 cases, including right lobectomies (32 cases), left lobectomies (9 cases), central bisegmentectomies (3 cases), extended left lobectomies (3 cases) and extended right lobectomy (1 case). The median age was 52 (range, 30-76), and the male:female ratio was 46:11 in the limited resection group. The median tumor size was 3.2 cm, and the median resection margin was 1.2 cm. Limited resections were done in 57 cases, including left lateral segmentectomies (12 cases), right posterior segmentectomies (10 cases), #6 subsegmentectomies (7 cases), left medial segmentectomies (7 cases), right anterior segmentectomies (6 cases), nonanatomical partial hepatectomies (5 cases), #5 #6 subsegmentec-tomies (2 cases), #8 subsegmentectomies (2 cases), caudate lobectomies (2 cases), #5 subsegmentectomies (2 cases), #5 subsegmentectomy caudate lobectomy(1 case), and #2 subsegmentectomy (1 case). The cumulative 5-year survival rate of the two groups was 69%. The cumulative 5-year disease-free survival rate of the major resection group was better than that of the limited resection group (80% vs 53%, p=0.01). CONCLUSIONS: Problems, including the relatively high recurrence rate after a limited hepatic resection, remain to be solved. It is necessary to perform adjuvant therapy to prevent recurrence in patients receiving a limited hepatic resection. We advocate a major hepatic resection for primary small hepatocellular carcinomas in order to prevent recurrence. Preoperative portal vein embolization can be a good modality in patients who will undergo major hepatic resections.
Assuntos
Humanos , Carcinoma Hepatocelular , Intervalo Livre de Doença , Hepatectomia , Programas de Rastreamento , Mastectomia Segmentar , Veia Porta , Prognóstico , Recidiva , Taxa de SobrevidaRESUMO
BACKGROUND: With improvements in the performance of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing hepatobiliary and pancreatic diseases, anomalous unions of the pancreaticobiliary duct (AUPBD) have come to our attention in recent years. Such unions are thought to be a factor in the development of carcinomas of the pancreaticobiliary system. The purpose of the present study was to evaluate the clinical analysis of AUPBD for proper treatment. METHODS: During the past 4 years from January 1, 1993, to December 31, 1997, 28 adult patients with AUPBD, in whom the pancreaticobiliary ductal union and terminal biliary tract were opacified by ERCP, were seen at Asan Medical Center. We divided the types of AUPBD according to Kimura's classification. RESULTS: The ages of the patients (20 women and 8 men) with this anomaly ranged from 16 to 68 years. The patients' main complaints were abdominal pain (16 cases), indigestion (10 cases), jaundice (4 cases), and fever (2 cases). The common channel measured on direct cholangiograms was 15 mm to 42 mm long. All of the patients whose anomalies were confirmed by ERCP had combined diseases (benign diseases 20 cases, malignant diseases 8 cases). Of the 20 patients with benign diseases, the 15 patients who underwent operative treatments had no recurrent findings or symptoms, but all of the 5 patients who underwent conservative treatments had recurrent pancreatitis or indigestion. These 5 patients will still need to be followed up. For the 8 patients with malignant diseases, the 3 who did not undergo operations died of far-advanced cancer. Among the remaining 5 patients who underwent operative treatments, 1 patient died of cancer recurrence, but 4 patients have been alive since their operations. CONCLUSIONS: We think that all ERCP examinations have to be carried out with AUPBD in mind. It is important to remove the place that causes bile stasis and to stop backflow of pancreatic juice intothe bile duct in managing patients with this anomaly. Therefore, a prophylactic cholecystectomy and reconstruction of the biliary tract are both necessary in treating AUPBD.
Assuntos
Adulto , Feminino , Humanos , Dor Abdominal , Bile , Ductos Biliares , Sistema Biliar , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Classificação , Dispepsia , Febre , Icterícia , Pancreatopatias , Suco Pancreático , Pancreatite , RecidivaRESUMO
Under normal circumstances, attempts are made to match the recipient of an orthotopic liver transplant with the best available donor in terms of organ and body size. Occasionally, it may happen that a child's liver is transplanted into an adult recipient, either because of the need for an urgent transplantation when only a small donor is available or because there is no child recipient transplantable with the graft. After a child-donor's liver was transplanted into an adult recipient, we had the opportunity to observe the change in the size of the allograft over time by using serial computed tomography scans to evaluate change in graft size. Reported here are the results of the small-for-size live transplantation at Asan Medical Center.
Assuntos
Adulto , Criança , Humanos , Aloenxertos , Tamanho Corporal , Fígado , Doadores de Tecidos , TransplantesRESUMO
OBJECTIVES: This is a descriptive study which was carried out to identify characteristics of the chronic mentally ill and their families in a rural area and the influencing factors on family burden. METHODS: Data was collected for seven months beginning April 1, 1998 by questionnaire from chronic mentally ill patients and their families in two towns and seven townships of the rural areas of Kyonggi Province. In additional to the mental diagnosis of the mentally ill patients, family burden was measured by interviewing the other family members using the questionnaire developed by Pai & Kapur (1981). Of those interviewed, 103 patients were selected for final analysis. RESULTS: Of 103 mentally ill patients, 36.1% of the subjects were not under treatment. In particular, of 29 patients with schizophrenia, 48.3% of the subjects had stopped taking medication and 6.9% of the subjects had never been treated. According to the results of a specialized examination by a psychologist, 81% of patients were in need of hospitalization. Most primary caregivers were parents. Of the 101 primary caregivers in the study, 39.6% were over 65 years old. In case of death of the primary caregiver, 50.5% of these 101 mentally ill patients would not have anyone to care for them. Of the various kinds of family burden, primary caregivers most often reported psychological stress. Overall, the families of dementia and schizophrenia patients complained of the most family burden. Through univariative analysis, the variables of sex, education and current treatment type of the patients, the relationship with the patient and marital status of the primary caregiver and the number of people living together in the household showed significant correlation with the family burden of schizophrenia patients. Univariative analysis also showed that there were a number of variables which were correlated to the family burden in mentally retarded patients. Concerning the need for mental health services, the most common requests were for entitlement to disability benefits and housing programs. CONCLUSIONS: Community mental health services in rural areas must be developed, planned and executed in consideration of the local situation. In particular, the development of various family support programs is needed in order to mitigate emotional, mental and economic burdens and carry out a positive role to care for and rehabilitate patients.