• Asian Pacific Journal of Cancer Prevention
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• 제15권17호
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• pp.7069-7077
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• 2014

Background: This retrospective study aimed to validate the safety and effectiveness of hepatectomy for huge hepatocellular carcinoma (HCC). Materials and Methods: Data of patients who underwent hepatectomy for HCC between January 2006 and December 2012 were reviewed. The patients were divided into three groups: huge HCC(${\geq}10cm$ in diameter), large HCC(${\geq}5$ but<10 cm in diameter) and small HCC(<5cm in diameter). Results: Characteristics of pre-operative patients in all three groups were homogeneously distributed except for alpha fetal protein (AFP)(p<0.001).The 30, 60, 90-day post-operative mortality rates were not different among the three groups (p=0.785, p=0.560, and p=0.549). Laboratory data at 1, 3, and 7 days after surgery also did not vary. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) rates in the huge and large HCC groups were lower than that of the small HCC group (OS: 32.5% vs 36.3% vs 71.2%, p=0.000; DFS: 20.0% vs 24.8% vs 40.7%, p=0.039), but there was no difference between the huge and large HCC groups (OS: 32.5% vs 36.3%, p=0.667; DFS: 20.0% vs 24.8%, p=0.540). In multivariate analysis, five independent poor prognostic factors that affected OS were significantly associated with worse survival (p<0.05), namely, AFP level, macrovascular invasion, Edmondsone Steiner grade, surgical margin and Ishak score. AFP level, macrovascular invasion, microvascular invasion, and surgical margin influenced disease-free survival independently (p<0.05). Conclusions: The safety of hepatectomy for huge HCC is similar to that for large and small HCC; and this approach for huge HCC may achieve similar long-term survival and disease-free survival as for large HCC.

• Korean Journal of Head & Neck Oncology
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• 제18권1호
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• pp.36-40
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• 2002

Background and Objectives: To determine if laser endoscopic microsurgery is a reliable and appropriate approach in the treatment of laryngeal carcinomas. Materials and Methods: Retrospective study of 62 patients treated with CO2 laser from June 1988 to November 2000 at Seoul National University Hospital for laryngeal squamous cell carcinoma. All patients were treated with curative intention. Fifty three untreated patients with laryngeal carcinoma (39 glottic and 14 supraglottic carcinoma patients) had primary carbon dioxide laser microsurgery. Nine radiation failure patients were treated. Postoperative radiotheray was done for 17 patients. Neck dissection was performed simultaneously for 4 supraglottic cases with cervical nodal metastasis. Mean follow-up duration was 40 months. Results: In primary laser surgery group, distribution of tumors (American Joint Committee on Cancer, 1997) were 38 cases with Tl, 13 cases with T2, 2 cases with T3. Cure rate was 88.7%(47/53) and local control rate was 92.5%(49/53). Larynx was preserved in 94%(50/53) of patients. The overall 5-year survival rate(Kaplan-Meier) was 81.5%. In radiation failure group, 56% of patients were recurred after laser surgery. Conclusion: Laser surgery could be a better treatment modality for early laryngeal cancers and selected advanced cases. Additional radiation therapy should be considered if resection margin is not satisfactory.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• 제14권
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• pp.103-152
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• 2000

English contract law has traditionally taken the view that it is not the duty of the parties to a contract to give information voluntarily to each other. In English law, one of the principal distinctions between insurance contract law and general contract law is the existence of the doctrine of utmost good faith in insurance law. The doctrine gives rise to a variety of duties, some of which apply before formation of the contract while others apply post-formation. This article is, therefore, designed to analyse the overall structure and problems of the doctrine of utmost good faith in English marine insurance law. The results of analysis are as following : First, the requirement of utmost good faith in marine insurance law arises from the fact that many of the relevant circumstances are within the exclusive knowledge of the assured and it is impossible for the insurer to obtain the facts to make a appropriate calculation of the risk that he is asked to assume without this information. Secondly, the duty of utmost good faith provided in MIA 1906, s. 17 has the nature as a bilateral or reciprocal, overriding and absolute duty. Thirdly, the Court of Appeal in Skandia held that breach of the pre-formation duty of utmost good faith did not sound in damages since the duty did not arise out of an implied contractual term and the breach did not constitute a tort. Instead, the Court of Appeal held that the duty was an extra-contractual duty imposed by law in the form of a contingent condition precedent to the enforceability of the contract. Fourthly, the scope of the duty of utmost good faith is closely related to the test of materiality and the assured is required to disclose only material circumstances subject to MIA 1906, s. 18(1) and 20(1). The test of materiality, which had caused a great deal of debate in English courts over 30 years, was finally settled by the House of Lords in Pan Atlantic and the House of Lords rejected the 'decisive influence' test and the 'increased risk' test, and the decision of the House of Lords is thought to accept the 'mere influence' test in subsequent case by the Court of Appeal. Fifthly, the insurer is, in order to avoid contract, required to provide proof that he is induced to enter into the contract by reason of the non-disclosure or misrepresentation of the assured. Sixthly, the duty of utmost good faith is, in principle, terminated before contract is concluded, but it is undoubtful that the provision under MIA 1906, s. 17 is wide enough to include the post-formation duty. The post-formation duty is, however, based upon the terms of marine insurance contract, and the duty lies entirely outside s. 17. Finally, MIA 1906, s. 17 provides expressly for the remedy of avoidance of the contract for breach of the duty. This means rescission or retrospective avoidance of the entire contract, and the remedy is based upon a fairly crude 'all-or-nothing' approach. What is needed in English marine insurance law is to introduce a more sophiscated or proportionate remedy.

• Archives of Plastic Surgery
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• 제42권5호
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• pp.552-558
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• 2015

Background The Klippel-Trenaunay syndrome (KTS) is characterized by three clinical features, namely cutaneous capillary malformations, venous malformations, and soft tissue and/or bony hypertrophy of the extremities. The varied manifestations are attributed to the unpredictable clinical nature and prognosis of the syndrome. To elucidate the clinical characteristics of this disease, we reviewed a relatively large number of KTS patients who presented to our vascular anomalies center. Methods We conducted a retrospective study with 19 patients who were diagnosed with KTS and treated in our vascular anomalies clinic between 2003 and 2014, and examined their demographic characteristics, their clinical features, and the treatments administered. Results The sex distribution was balanced, with 9 (47%) males and 10 (53%) females. The mean follow-up period was 4.1 years (range, 7 months-9 years). Most of the patients received conservative treatments such as medication or physiotherapy. Compression therapies such as wearing of elastic garments/bandages were also administered, and surgical interventions were considered only when the patients became excessively symptomatic. Other treatments included laser therapy and sclerotherapy, and all the treatments were adjusted according to each case, tailored to the conditions of the individual patients. Conclusions KTS is an extremely rare, multifactorial disorder that induces widely varied symptoms. Because of this unique feature, plastic surgeons, when not careful, tend to attach a one-sided importance to typical symptoms such as limb hypertrophy or capillary malformation and thus overlook other symptoms and clinical features. KTS can be suspected in all infants who show capillary malformations or limb hypertrophy and require a multi-disciplinary approach for comprehensive management.

• Journal of Veterinary Clinics
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• 제29권1호
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• pp.8-11
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• 2012

The results of surgical repair for pelvic factures in 31 dogs were reviewed. Lameness and weight bearing scores were used to evaluate functional recovery of the hind limbs. Simple fracture occurred in sacroiliac joint (n = 5) and ilium (n = 3). Pelvic fractures had acetabular (n = 7) and non-acetabular fractures (n = 23). Acetabular fracture cases were composed of additional surgical treatments with femoral head and neck ostectomy (FHNO) (n = 4) and only acetabular rim fixation (n = 3). Simple fractures had more rapid initial and complete recovery times than multiple fractures. Non-acetabular fracture cases (initial recovery time: 2.7 weeks, complete recovery time: 9.1 weeks) had more rapid initial and complete recovery times than acetabular fracture cases (8.4, 12.5 weeks) (p < 0.05). In addition, the cases of additional surgical treatment with FHNO (5.3, 7 weeks) had more rapid mean recovery times than surgical treatment without FHNO (11.1, 16.3 weeks). Surgical approach with FHNO in acetabular fracture was an alternative method to treat pelvic fractures in small breed dogs.

• Journal of Chest Surgery
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• 제34권10호
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• pp.769-774
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• 2001

Background: Descending necrotizing mediastinitis(DNM) is a serious complication originating in odontogenic or oropharyngeal infection with previously reported mortality rates of 25% to 40%. We retrospectively reviewed the 4 years of our surgical drainage and debridement in DNM. Material and Method: We studied 7 cases diagnosed as DNM from 1997 through 2000. Primary oropharyngeal infection lead to DNM in four cases(57%) and odontogenic abscess in three cases(43%). All patients were received emergent cervicotomy and thoracotomy or sternotomy for debridement of necrotic tissue and mediastinal or pleural drainage. Result: Five cases were evolved well and were discharged after a mean of 42 days. Two patients(28.6%) died. Three patients required reoperation due to local surgical complication; empyema(two) and impending cardiac tamponade. One of these patients died on 12 post-reoperative day due to great vessel erosion, renal and respiratory insufficiency. The other patient died of broncho- esophageal fistula and asphyxia on 10 postoperative day without reoperation. Conclusion: On the basis of experience accrued in treating these patients, early diagnosis by cervicothoracic computed tomographic scan of neck and thorax aids in rapid indication of a surgical approach of DNM. We emphasize that performing early surgical drainage and debridement of necrotic tissues with intensive postoperative care can significantly reduce the mortality rate.

• Asian Pacific Journal of Cancer Prevention
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• 제17권6호
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• pp.2857-2860
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• 2016

Background: Chronic hepatitis B (CHB) infection is one of the important causes of hepatocellular carcinoma (HCC) in Thailand, involved in the pathogenesis and leading to a development of HCC with or without cirrhotic changes of the liver. This study was aimed to investigate the predictive factors for HCC among CHB patients in a tertiary care center in Thailand. Materials and Methods: We conducted a retrospective study of CHB patients with or without HCC during the period of January 2009 and December 2014 at Thammasat University Hospital, Pathumthani, Thailand. Data on clinical characteristics, biochemical tests and radiologic findings were collected from review of medical records. Results: A total of 266 patients were diagnosed with CHB in Thammasat university hospital during the study period. However, clinical information of only 164/266 CHB patients (98 males, 66 females with mean age of 49.4 years) could be completely retrieved in this study. The prevalence of HCC in CHB infection in this study was 38/164 (23.2%). CHB patients with HCC had a mean age older than those without HCC (59.5 vs 47 years, P-value = 0.01). Furthermore, history of upper GI bleeding, tattooing, blood transfusion, and chronic alcoholism were significantly more common in CHB patients with HCC than patients without HCC (13.2% vs 3.2% P-value 0.03, OR = 4.6, 95%CI = 1.2-18.1, 20% vs 3.9%, P-value = 0.01, OR= 6.1, 95% CI= 1.6-23.6, 20% vs 6.3%, P-value = 0.03, OR = 3.8, 95%CI =1.1-12.7, 62.2% vs 30.3%, P-value <0.0001, OR = 3.7, 95%CI= 1.7-8.1 respectively). Interestingly, more CHB patients with HCC had evidence of cirrhosis than those without HCC (78.9% vs 20.4%, P-value <0.0001, OR = 14.6, 95%CI = 5.8-36.7). In CHB patients with HCC, surgical therapy provided longer survival than radiofrequency ablation (RFA) (72 vs 46.5 months, P-value= 0.04). The mean survival time after HCC diagnosis was 17.2 months. Conclusions: HCC remains a major problem among patients with CHB infection in Thailand. Possible risk factors are male gender, history of upper GI bleeding, chronic alcoholism, tattooing, blood transfusion and evidence of cirrhosis. For early stage HCC patients, surgical treatment provided longer survival time than RFA. Most HCC patients presented with advanced disease and had a grave prognosis. Appropriate screening of CHB patients at risk for HCC might be an appropriate approach for early detection and improvement of long-term outcomes.

• Journal of Rhinology
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• 제25권2호
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• pp.75-79
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• 2018

Background and Objectives: To investigate the common site of recurrent epistaxis after initial intervention such as packing and cauterization had failed and to evaluate the efficacy of surgical endoscopic electrocautery. Subjects and Method: Retrospective review of 47 patients with recurrent and uncontrolled idiopathic epistaxis between October 1995 and March 2016. All patients underwent endoscopic examination in the operating room after hospitalization. We performed electrocautery when a bleeding site was found. Results: The most common sites of bleeding were the inferior meatus (28%), sphenoethmoid recess (23%), superior septum around the olfactory cleft (13%), and the posterior end of the middle turbinate (15%). There was no serious complication during the one week after surgery. In 46 (98%) patients, refractory epistaxis was successfully controlled. One patient had recurrent epistaxis after electrocautery and underwent endoscopic sphenopalatine artery ligation. Conclusion: In patients with refractory idiopathic epistaxis after failure of first-line treatment, endoscopic examination through a surgical approach and electrocautery for suspected bleeding are effective.

• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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• 제60권8호
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• pp.390-395
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• 2017

Background and Objectives With increasing frequency of car accidents, patients of dizziness caused by car accidents are also increasing. Various types of dizziness or vertigo can occur from car accidents depending on different injury mechanisms. Since accurate diagnosis is important for providing proper treatments, we evaluated clinical characteristics related to vestibular function of patients with dizziness caused car accidents. Subjects and Method In this retrospective case review study that runs from January 2011 to March 2013, a total of 82 patients with dizziness following car accident were enrolled consecutively. We analyzed the final diagnosis of dizziness according to different mechanisms of injury during car accident through clinical record review. Patients who developed dizziness within one month of car accident were included, excluding those who had temporal bone fracture and previous history of dizziness. Results Of the different types observed, 36.6% was head injury, 24.4% whiplash injury, 3.7% complex injury, 2.4% others and the rest was unknown. In the final diagnosis, the different types included 36.6% benign paroxysmal positional vertigo (BPPV), 23.2% unclassifiable dizziness, 18.3% cervical vertigo, 7.3% labyrinthine concussion, 3.7% BPPV with labyrinthine concussion and the rest was others. Of the different types of dizziness symptoms, 58.5% was headache, 45.1% was audiologic symptoms, and others included earfullness, tinnitus and hearing disturbance. Tinitogram and pure tone audiogram results show that 2.9% (27 people) of patients have tinnitus and 7.3% (6 people) have hearing disturbance. Conclusion An accurate diagnosis and timely management would be very important in forming a proper approach for post traumatic vertigo patients.

• Journal of Chest Surgery
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• 제55권1호
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• pp.49-54
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• 2022

Background: We compared the safety and effectiveness of robotic anatomical resection and video-assisted thoracoscopic surgery (VATS). Methods: A retrospective analysis was conducted of the records of 4,283 patients, in whom an attempt was made to perform minimally invasive anatomical resection for lung cancer at Seoul National University Hospital from January 2011 to July 2020. Of these patients, 138 underwent robotic surgery and 4,145 underwent VATS. Perioperative outcomes were compared after propensity score matching including age, sex, height, weight, pulmonary function, smoking status, performance status, comorbidities, type of resection, combined bronchoplasty/angioplasty, tumor size, clinical T/N category, histology, and neoadjuvant treatment. Results: In total, 137 well-balanced pairs were obtained. There were no cases of 30-day mortality in the entire cohort. Conversion to thoracotomy was required more frequently in the VATS group (VATS 6.6% vs. robotic 0.7%, p=0.008). The complete resection rate (VATS 97.8% vs. robotic 98.5%, p=1.000) and postoperative complication rate (VATS 17.5% vs. robotic 19.0%, p=0.874) were not significantly different between the 2 groups. The robotic group showed a slightly shorter hospital stay (VATS 5.8±3.9 days vs. robotic 5.0±3.6 days, p=0.052). N2 nodal upstaging (cN0/pN2) was more common in the robotic group than the VATS group, but without statistical significance (VATS 4% vs. robotic 12%, p=0.077). Conclusion: Robotic anatomical resection in lung cancer showed comparable early outcomes when compared to VATS. In particular, robotic resection presented a lower conversion-to-thoracotomy rate. Furthermore, a robotic approach might improve lymph node harvesting in the N2 station.