Successful Treatment of Intractable Bleeding Caused by Radiation-Induced Hemorrhagic Gastritis Using Oral Prednisolone: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

Radiation-induced hemorrhagic gastritis is an intractable and dangerous condition. We describe a 59-year-old female patient with radiation-induced hemorrhagic gastritis. The patient underwent postoperative radiation therapy with a dose of 54 Gy in 30 fractions after a radical operation for a Klatskin tumor. Radiation volume included the gastric antrum. Approximately three months after radiation therapy, she was admitted for melena and anemia. Esophagogastroduodenoscopy showed an area of bleeding in the gastric antrum that was so diffuse that effective laser coagulation was not feasible. After failure of various treatments and transfusion of 7,040 mL of packed red blood cells, we successfully stopped the hemorrhage using oral prednisolone treatment. Based on this case, we think that oral prednisolone treatment can be tried as a first treatment for potentially life-threatening radiation-induced hemorrhagic gastritis.

Thrombolytic Therapy Using Urokinase for Management of Central Venous Catheter Thrombosis

PURPOSE: The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis. MATERIALS AND METHODS: We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter. RESULTS: A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis. CONCLUSION: Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses.

What Are the Risk Factors for Complication in Transumbilical Single-Port Appendectomy?

PURPOSE: Along with the development of minimally invasive surgery, laparoscopic surgery has recently been adopted worldwide. In cases of laparoscopic appendectomy, single port appendectomy is increasingly being adopted due to its cosmetic advantages and reduced pain. This study was conducted to evaluate the risk factors associated with post-operative complications in single port appendectomy. METHODS: Forty-nine consecutive patients who underwent transumbilical single port appendectomy (TUSPLA) were enrolled in this study. We reviewed the initial WBC count, hsCRP, position of the appendix, and intra operative findings and then analyzed the data by univariate and multivariate analysis. RESULTS: Complications were observed in five of the 49 patients (10.2%). Specifically, wound complications were observed in three patients (6.1%), and periappendiceal fluid collection occurred in two patients (4.1%). Univariate analysis revealed a retrocecal type appendix (p=0.046) and overweight (BMI> or =23, p=0.034) as risk factors significantly correlated with the occurrence of complications. Conversely, retrocecal type appendix (p=0.121) and overweight (BMI> or =23, p=0.329) were not significantly correlated with complications upon multivariate analysis. CONCLUSION: For patients with a high risk of postoperative complications, including those with retrocecal appendix undergoing TUSPLA and obese patients, sufficient informed consent is necessary, and intensive monitoring for the incidence of complications must be considered postoperatively. However, further studies enrolling larger groups of patients should be conducted to confirm these findings.

Comparision of Needlescopic Appendectomy versus Conventional Laparoscopic Appendectomy in Children / 대한내시경복강경외과학회지

PURPOSE: This clinical study evaluated the feasibility of needlescopic appendectomy (NA) in young patients with acute appendicitis, and we compare the outcome of this new technique with that of conventional laparoscopic appendectomy (LA). METHODS: Two groups of young patients who underwent laparoscopic appendectomy at Sanggye Paik Hospital between January 2009 and December 2009 were studied. In the first group, a 2-mm instrument appendectomy was performed in 13 patients. These patients were compared with the second group, which were 21 patients who underwent conventional laparoscopic appendectomy. Statistical significance was set at p values<0.05. RESULTS: The patient demographics and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. Postoperative ileus was occurred in 3 patients who underwent LA, but there was no statistical difference between the both groups (p=0.154). The needlescopic group had a shorter mean operative time (p=0.65), but there was no statistically significance. The mean hospital stay was significantly shorter (p=0.026) in the needlescopic group than that in the conventional laparoscopic group. CONCLUSION: According to our experience, needlescopic laparoscopic appendectomy is a safe and feasible procedure as compared with that of conventional laparoscopic appendectomy in young patients.

What are Risk Factors Associated with Conversion to Open Appendectomy in Laparoscopic Appendectomy? / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic appendectomy has recently been performed more frequently than open appendectomy because of its advantages. Yet laparoscopic appendectomy has the risk of converting to open appendectomy. We evaluated the preoperative evaluation factors that can influence the rate of conversion to open appendectomy. METHODS: For the 255 patients admitted to our hospital, we reviewed their medical history, their clinical and laboratory examination etc. and the final diagnosis was made by CT scan. The preoperative characteristics of the patients who underwent laparoscopic appendectomy and the patients who were converted to open appendectomy were compared using univariate and multivariate analysis. RESULTS: Out of 255 patients who underwent laparoscopic appendectomy, 15 patients (5.8%) were converted to open appendectomy. The main reasons were adhesion and periappendiceal abscess formation. Periappendiceal fat infiltration (p=0.030) seen in the CT scan and perforation (p=0.019) were significant risk factors associated with converting to open appendectomy. CONCLUSION: Periappendiceal fat infiltration and perforation seen on preoperative CT scanning are important when considering performing laparoscopic appendectomy. Identifying the potential preoperative factors for conversion may assist surgeons when making decisions concerning the management of patients with appendicitis and for the judicious use of LA.

Survival Rate and Prognostic Factors in Perforated Colorectal Cancer Patients: A Case-Control Study

PURPOSE: Perforations are rare but serious complications in colorectal cancer. Controversy exists over whether to perform a radical operation because colorectal cancer perforation is considered as an advanced stage disease, and septic complications of peritonitis have been identified as being responsible for a poor prognosis. The aim of this study was to assess the correlation between the survival rate and the clinicopathological parameters that might be used as predictive factors of the prognosis for perforated colorectal cancer. METHODS: The analysis was based on 24 cases of perforated colorectal cancer (the case group), 48 cases of matching uncomplicated colorectal cancer (the control group), and 72 cases of the case and the control groups combined together (the combined group), all of which were identified during a 10-yr period in a single institution. RESULTS: The five-year survival rates of the perforated colorectal cancer patients and their matching controls were similar (P=0.484). No significant differences in the locations of the cancer, the pre-operative carcinoembryonic antigen (CEA) levels, the tumor sizes, the resection margins, or the numbers of the lymph nodes harvested were found between the two groups. A univariate analysis of the prognostic factors that influenced the case group revealed that adjuvant chemotherapy (P=0.004) was significantly correlated to a better five-year survival rate. A univariate analysis of the prognostic factors that influenced the five-year survival rate of the combined group revealed that the stage (P<0.001), the pre-op CEA level (P=0.018), the angio invasion (P=0.019), the perineural invasion (P=0.019), the number of harvested lymph nodes (P=0.004), and adjuvant chemotherapy (P=0.001) were significantly correlated to the five-year survival rate. The identified independent prognostic factors in the combined group were the stage (hazard ratio, 5.20), angio-invasion (hazard ratio, 2.81), and adjuvant chemotherapy (hazard ratio, 0.17). CONCLUSION: The clinical pathway of perforated colorectal cancer is similar to that of uncomplicated colorectal cancer. Therefore, perforated colorectal cancer patients should be recommended for treatment with the appropriate radical operation and adjuvant chemotherapy based on oncologic principles.

Bilaterality of Papillary Thyroid Carcinoma: Analysis of Clinicopathologic Factors and the Value of Preoperative Ultrasonography / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. The extent of the initial surgical treatment for PTC is still controversial and the bilaterality of PTC is an important factor for determining the extent of surgical resection. The aim of this study was to analyze clinicopathologic factors and the value of preoperative ultrasonography (PU) for bilateral tumor. METHODS: We retrospectively reviewed clinicopathologic factors and PU findings of 91 patients who underwent total thyroidectomy for PTC at the Dongguk University Ilsan Hospital from January 2006 to April 2009. RESULTS: Of the 91 patients, 28 (30.7%) had bilateral PTC in postoperative pathology. Of these 28 patients, only 18 patients (64.3%) were checked for bilateral PTC by PU findings and fine needle aspiration cytology. Sensitivity and specificity for bilaterality of PTC were 64.3% and 85.7%, respectively. The presence of benign nodules or malignant nodules in the same lobe in PU (P=0.008) and post-operative pathology (P=0.014) were statistically correlated with bilaterality. CONCLUSION: For the surgical care of PTC, bilaterality must always be considered, even though the tumor is diagnosed unilateral small PTC. PU in PTC patients has limited diagnostic value for bilateral PTC.

Expression Profiles of Retinoblastoma Protein and p27Kip1 According to HER2 Amplification Status in Primary Breast Cancer / 한국유방암학회지

PURPOSE: Human epidermal growth factor receptor-2 (HER-2)/neu amplification affects the cell proliferation through the modulation of multiple G1 cell cycle regulators in breast tumor cells. We performed this study to investigate whether retinoblastoma protein (pRB) and p27Kip1 were differently expressed according to the HER2 amplification status in human breast cancer. METHODS: HER2 amplification was assayed by fluorescence in situ hybridization and the expression of cell cycle regulators were assayed by immunohistochemistry on 153 consecutive invasive breast cancers. The proliferative activity of breast cancer was analyzed according to the HER2 amplification and cell cycle protein expression status. RESULTS: HER2 amplification was observed in 39 (25.5%) of 153 breast cancers. In the HER2 amplified breast cancers, the pRB expression was significantly increased (p=0.011) whereas there was no significant relationship between HER2 amplification and p27Kip1 expression. There was an inverse correlation between pRB expression and Ki-67 labeling index in the HER2 amplified breast cancers (p=0.036). In contrast, Ki67 labeling index was significantly decreased as p27Kip1 expression increased in HER2 non-amplified breast cancers (p=0.028). In HER2 non-amplified breast cancers, we could not observe any association between the pRB expression and Ki67 labeling index. CONCLUSION: The proliferation of the breast cancers was associated with pRB expression in HER2 amplified tumors whereas it was associated with p27Kip1 expression in HER2 non-amplified tumors. The results of the current study indicate that the cell proliferative activity of the breast cancer is under different growth signal pathways according to HER2 amplification status.

A Case of Peripheral T-cell Lymphoma Presenting with Small Bowel Perforation / 대한소화기내시경학회지

Malignant lymphoma of the gastrointestinal tract is a rare lesion that comprises 1~4% of all the malignant neoplasms of the gastrointestinal tract. The incidence of intestinal T-cell lymphoma is much lower than that of the B-cell type. Intestinal T-cell lymphoma can sometimes carry a very poor prognosis because these patients are often diagnosed at advanced stages. These patients mostly present with nonspecific symptoms such as weight loss, abdominal pain or diarrhea and more frequently with features of small bowel obstruction or perforation. We report here on a case of a malignant small intestinal T-cell lymphoma that presented with perforation. A 51-year-old female had emergency operation because of small bowel perforation and she was diagnosed withperipheral T-cell lymphoma on the post-operative pathologic report.

Factors that Influence Selecting the Imaging Modality for Diagnosing Acute Appendicitis

PURPOSE: The aim of this study is to evaluate the advanced radiographic imaging that's used for making the diagnosis of an acute appendicitis, and also the factors that influence selecting the imaging modality. METHODS: We retrospectively reviewed the data of 420 patients who underwent an appendectomy as an emergency procedure in our hospital from January 1, 2005, to December 31, 2006. All the cases were categorized into three groups by the radiologic imaging tests. One was the ultrasonography (US) only group, another was the computed tomography (CT) only group and the third was both the US and CT scan group. Age, gender, height, weight, the Alvarado score (AS) and the body mass index (BMI) were compared between the 3 groups. I assessed the reason for choosing computed tomography (CT) to assist in making the diagnosis. RESULTS: Four hundred twenty patients underwent operative exploration under the presumed diagnosis of appendicitis. Of those, 348 patients underwent US, 48 underwent CT scanning and 24 underwent both US and CT scanning. The mean age and BMI were significantly higher in the CT only group (P<0.001 and P=0.008, respectively). The most common reason for choosing CT scanning was that the physician suspected other diseases other than appendicitis due to an atypical presentation on the physical examination. CONCLUSION: US was the most commonly used radiologic imaging study for making the diagnosis of appendicitis. CT was more frequently used for the old or obese patients for making the differential diagnosis.

The Effect of S-100B Protein and Risk Factors on Indication of Cranial Computed Tomography in Patients with Minor Head Injury

PURPOSE: S-100B protein is a reliable biomarker of brain injury. The clinical decision rules for screening of a cranial computed tomography (CCT) in minor head injury patients remain controversial. The purpose of this study was to determine whether S-100B protein and risk factors for minor head injury patients can provide meaningful insights to improve initial CCT scanning of patients with MHI. METHODS: Fifty patients with MHI were enrolled in this prospective study from July 2007 to September 2007. All patients who fulfilled the following inclusion criteria were enrolled: history of head trauma, initial GCS score of 14 to 15, and one or more clinical findings. Risk factors of patients presented in this study included age younger than 2 years or above sixty years, focal neurologic deficit (FND), post-traumatic seizure, skull fracture, extra-cranial injury, coagulopathy, previous neurologic deficit and ingestion of toxicants (drugs or alcohol). A venous blood sample for assessment of S-100B protein was drawn and a CCT scan was undergone. The reference value of S-100B protein was 0.105 microgram/L. All CCT findings were confirmed by radiologists. RESULTS: Of the 50 patients studied, 15 patients exhibited trauma-relevant intracranial lesions on the CCT scan (CCTpositive). The subgroups of CCT-positive and -negative showed no statistically difference in S-100B level (p=0.068). Of the fifty patients, thirteen had no risk factors (RF). However, statistically significant differences were observed in S-100B level when the subgroups were classified into RF-positive and RF-negative groups (p=0.016). The CCTpositive findings of 13 patients with no RF were identified with 100% sensitivity, 54.6% specificity, 28.6% positive predictive value and 100% negative predictive value through assessment of S-100B protein level. CONCLUSION: In patients with MHI, S-100B protein level and risk factors may give us reliable predictive information prior to CCT screening in emergency department.

Analysis of the CT and Clinical Findings of Perforated Blunt Small Bowel Injury according to the Elapsed Time since Accident

PURPOSE: The high mortality and morbidity rates associated with traumatic rupture of the small bowel have been attributed to the clinical difficulty of establishing an early diagnosis. CT scan is the most widely used tool for the diagnosis of blunt abdominal trauma, but its accuracy in diagnosing small bowel perforation is still controversial. This study was conducted to determine the overall and time-dependent diagnostic value of abdominal CT and the clinical findings of small bowel perforation. METHODS: The clinical data and CT images of 21 patients with small bowel perforation after blunt trauma were retrospectively analyzed. The patients were divided into the early and late elapsed time groups based on the elapsed time of 8 hours from the initial trauma to the time of evaluation. RESULTS: Any changes of the vital signs, including hypotension, tachycardia or fever, were observed in only half of the patients. Signs of peritonitis were evident in 7/11 of the early lapse group and in 10/10 of the late lapse group. The most common CT finding of small bowel perforation was free peritoneal air (17 of 21 patients), followed by segmental bowel wall thickening (15/21), high density ascites (14/21), an intermesentric fluid collection (13/21) and mesentic fat obliteration (11/21). Extraluminal air and segmental bowel wall thickening were detected more frequently in the late lapse group (P=0.03 and 0.01, respectively). In the one patient, bowel perforation was not evident at the initial evaluation according to the clinical findings and CT, but the follow-up CT exam showed specific findings for bowel perforation. CONCLUSION: CT scanning is a sensitive and effective modality for the evaluation of small bowel perforation, but this is less sensitive during the earlier post traumatic period. Therefore, careful clinical and radiological follow up is necessary for suspected cases, and even when an initial evaluation shows negative findings for bowel injury.

Effect of Alcohol on Base Deficit in Trauma

PURPOSE: Alcohol intake is commonly found in injured patients, and alcohol affects base deficit independently with trauma. The purpose of this study was to evaluate the effect of alcohol on base deficit in trauma patients. METHODS: Data was retrospectively collected from trauma patients over 18 years of age who were admitted at the emergency center between October 2005 and July 2006. Blood sampling for alcohol level, base deficit evaluation were done within first hour for all patients. Patients were divided according to the serum alcohol level into an alcohol group(serum alcohol level> or =10 mg/dl) and a non-alcohol group. The patients were also stratified into minor (ISS or =16) injury groups according to their injury severity score (ISS). RESULTS: The study enrolled 63 patients of whom 37 fell into the alcohol group and 26 into the non-alcohol group. The mean alcohol level within the alcohol group was 210+/-85 mg/dl. Base deficit and serum lactate were not found to be significantly different in minor and major injuries, and ISS, base deficit were not significantly different with serum alcohol level. Base deficit was somewhat higher on average but not statistically significant in the non-alcohol group than in the alcohol group (-3.0+/-4.5 vs. -1.8+/-6.7 mmol/L, p=0.444). The base deficit was higher for the major injury-alcohol group than for the major injury-non-alcohol group, but this difference also did not achieve statistical significance (-4.6 +/-5.8 vs -2.4+/-8.1 mmol/L, p=0.117) CONCLUSION: In the severely injured patients, base deficit appears to be increased with alcohol but we found no statistically significant differences in base deficit and ISS between alcohol group and non-alcohol group of injured patients.

Clinical Analysis of Facial Bone Fractures

PURPOSE: As modern civilization and transportation systems have developed, the incidence of facial bone fractures has increased. The purpose of this study was to develop a criteria for proper use of computed tomography in cases of facial bone fracture, so that an accurate diagnoses can be made and proper treatment can be given. METHODS: This study included patients who visited the emergency center from March 2005 to December 2005. A total of 513 patients received facial bone computed tomography. The patients were divided into 2 groups: 242 patients who were diagnosed with facial fractures, and 271 patients without facial fractures. General, physical, and neurological examinations were analyzed to determine the degree of correlations with facial fractures. RESULTS: In facial fractures group, the sex ratio was 2.7:1 (M:F=177:65). The patients were mainly younger. There were two common causes of injuries; 117 cases (48.3%) were caused by fisticuffs, and 54 cases (22.3%) resulted from traffic accidents. Orbital fractures were the most common injury, comprising 156 cases (64.5%). The average injury severity score (ISS) of the patients was 6.5+/-4.0. As determined by multiple logistic regression analysis based on controlled physical examination and neurologic examination, significant risk factors related to facial fracture are abrasion, swelling, bruise, laceration, conjunctival hemorrhage, epistaxis, enophthalmos, extraoccular muscle limitation, temporo-mandible malocclusion and paresthesia. CONCLUSIONS: Facial bone fractures mostly occurred among active males between the ages of 20 to 40, and the most common causes are fisticuffs and traffic accidents. When facial injuries are associated with physical symptoms, such as swelling, laceration, conjunctival hemorrhage, epistaxis, enophthalmos, extraoccular muscle limitaion, temporo-mandible malocclusion and paresthesia, facial bone computed tomography is essential to proper diagnosis.

The Clinical Usefulness of Halo Sign on CT Image of Trauma Patients

PURPOSE: This research was performed to determine which clinical signs and symptoms of brain injury are sensitive indicators of skull fracture (SF) and intracranial injury (ICI) in head injured children. METHODS: We conducted a prospective study of minor head trauma in children younger than 2 years of age for a 1-year period. Skull radiographs, brain computed tomography (CT), and data forms, including mechanism of injury, symptoms, physical findings, and hospital course, were completed for each child. RESULTS: Of 137 study subjects, 17 (12.4%) had SF/ICI. Falls were the most common mechanism of injury, and heights of fall above 1 meter were associated with incidence of SF/ICI (p<0.05). Scalp abnormalities were not associated with incidence of SF/ICI. As for clinical symptoms, lethargy and a grouping of features (irritability & vomiting) were associated with incidence of SF/ICI (p<0.05). The incidence of seizure, loss of consciousness, vomiting, irritability, and scalp abnormality did not differ significantly between those with normal radiologic findings and those with SF/ICI. Among asymptomatic patients, 11 (14.5%) patients had SF/ICI, and among patients with normal scalp findings, 9 (12.7%) patients had SF/ICI. CONCLUSION: Clinical signs and symptoms, except for lethargy and a grouping of features (irritability & vomiting), were not sensitive predictors of SF/ICI. Nevertheless, SF/ICI occurred among normal children. In such a case, a liberal policy of CT scanning is warranted.

Prognostic Significance of p27(kip1) Expression in Node Negative Colorectal Carcinoma

PURPOSE: Dukes' A & B colorectal cancer patients are often excluded from adjuvant chemotherapy following potentially curative surgery because they are expected to have good long-term survival. However, actually 20 ~ 30% of these patients suffer from recurrent disease, so it would be helpful for these patients of recurrent disease to be able to select a high risk group. METHODS: In 78 Dukes' A & B colorectal cancers, we investigated by immunohistochemistry the role of molecular markers, such as p27(kip1), p53, Ki-67, and Skp2, in identifying high-risk patients. RESULTS: Patients with low p27(kip1) expression showed poor overall survival compared to those with high p27(kip1) expressions (55.3 versus 66.7 months, P=0.018). The only significant factor associated with p27(kip1) expression was p53 expression. The low p27(kip1) expression and positive p53 expression group had poor overall survival (54.3 months, P=0.036). CONCLISIONS: In a node-negative colorectal carcinoma, the molecular marker p27(kip1) does not play an independent prognostic role, but it may have prognostic significance in correlation with other markers such as p53, Ki-67, and Skp2. The assessment of molecular alterations may be useful to node-negative colorectal patients in identifying the high risk group that may benefit from adjuvant chemotherapy.

Malignant Pheochromocytoma that Recurred in the Contralateral Adrenal Gland and Metastasized to the Bladder / 대한비뇨기과학회지

Pheochromocytoma is an uncommon neoplasm and it is derived from the neural crest. It is one of the surgically curable hypertensive syndromes. The sequela of this disease can be serious if definite treatment is not promptly performed. We report here on a case of malignant pheochromocytoma that recurred in the contralateral adrenal gland and it subsequently metastasized to the bladder after the patient refused treatment of the contralateral adrenal tumor.

Utility of Radiologic Imaging for Patients who underwent Appendectomy

PURPOSE: The primary aim of this study was to evaluate the rate of advanced radiographic imaging for patients who underwent appendectomy. The secondary aim was to investigate the effect of ultrasonography (US) and computed tomography (CT) on the outcome of an appendectomy. METHODS: We retrospectively reviewed the data of 585 patients who underwent an appendectomy as an emergency procedure in our hospital within a 2-year period. Cases were categorized by the presence or absence of advanced radiographic imaging. We evaluated the negative appendectomy rate, the occurrence of perforation, and the preoperative emergency department length of stay (ED LOS). RESULTS: Five hundred eighty-five (585) patients underwent operative exploration for presumed appendicitis. Of those 165 patients had no advanced imaging, 347 had a US, 49 had a CT scan, 24 had both US and a CT scan. Acute appendicitis was pathologically proven in 567 patients, corresponding to negative appendectomy rate of 3.1%. Ninetythree appendices (15.9%) were perforated. The mean preoperative ED LOS was 15.8 hours. CONCLUSION: Advanced radiographic imaging prior to operative exploration did not lower the negative appendectomy rate. Diagnostic imaging significantly increased the perforation rate and the preoperative ED LOS.

Clinical Features and Radiological Findings of Cystic Tumor of the Pancreas

PURPOSE: Most cystic tumors of the pancreas are composed of serous cystic tumor, mucinous cystic tumor, solid pseudo- papillary epithelial neoplasm (SPEN) and intraductal papillary mucinous tumor (IPMT). With advancements in diagnostic imaging, cystic lesions of the pancreas are being detected with increasing frequency; however, there is still difficulty determining the appropriate diagnostic and therapeutic plan. METHODS: A retrospective review was performed of 15 cases that underwent surgery for pancreatic cystic tumors in our department between July 1995 and August 2005. All 15 cases identified had their records and radiological images reviewed. Radiological findings were characterized and analyzed by one radiologist. RESULTS: The median age was 55.9 years. Six cases were male and nine were female. Common symptoms included: epigastirc pain 6/14 (43%) and palpable mass 2/14 (14%). The accuracy of the preop radiological diagnosis including abdominal CT and US was 12/15 (80%). One case of serous cystic tumor, one of chronic pancreatitis and one SPEN were misdiagnosed; the preoperative diagnosis for these cases was mucinous cystic tumor. Serous cystic tumors were seen with central calcification 2/3 (67%), external lobulation 3/3 (100%); however, the mucinous cystic tumors were seen with peripheral calcification 4/5 (80%), no external lobulation 5/5 (100%) by radiological evaluation. There was no calcification, but external lobulation was common in the IPMT. The SPEN had no specific radiological findings except for peripheral calcification. CONCLUSION: Future multicenter studies with endoscopic sonography and aspiration cytology is needed for improved accuracy of diagnosis.

Impact of the Level on the Resuscitation of Prehospital Cardiac Arrest Patients

PURPOSE: The purpose of this research is to compare between teams in the same hospital the results of cardiopulmonary resuscitation on prehospital cardiac arrest patients. METHODS: We studied retrospectively 21 victims of prehospital cardiac arrest from June 20 to November 30, 2000, (group 1) and 155 victims of prehospital cardiac arrest from December 2000 to December 2003 (group 2). The results of resuscitation were estimated by using the number of ROSCs (return of spontaneous circulation), the 24-hour survival rate, and the alive discharge rate. RESULTS: In group 1, 13 of 21 patients (61.9%) had no ROSC, 4 patients (19.0%) had a transient ROSC, and no one was discharged alive. In group 2, 84 of 155 patients (54.2%) had no ROSC, 37 (23.9%) had a transient ROSC, and 11 patients (7.1%) were discharged alive. There were no statistical differences in ROSC rates, 24-hour survival rates, and alive discharge rates between the two groups, but group 2 had relatively good ROSC and survival rates. Among those discharged, 9 had visited our emergency department for cardiac causes and 2 for non-cardiac causes. The initial EKG findings were VF in 8 and PEA and Bradycardia in 3. In all discharged survival cases, the cardiac arrest had been witnessed. CONCLUSION: We failed to find significant outcome differences based on ACLS team skill. The result might have been made due to the fact that 119 transport time exceeded the threshold time (>10minutes) for good prehospital cardiac resuscitation and the absence of early cardiopulmonary resuscitation.