Clinical Review of Laparoscopic Cholecystectomy

BACKGROUND: Gallstones have been one of the most common gastrointestinal diseases to surgeons which open cholecystectomy has been the standard operation for the past one hundred years. Recently, operations with a laparoscope have become popular and are spreading worldwide. METHODS: A clinical analysis of 200 cases who had been treated by laparoscopic cholecystectomy for gallstone disease in Seoul Red Cross Hospital for 4 years from July 1993 to June 1997 was done according to age, sex, advantage, and complication. RESULTS: The results were as follows. 1) Among the 200 cases, there were 69 male patients and 131 female patients, with a female to male ratio of 1.9:1. The most prevalent age group was the 6th decade with 59 cases (29.5%) and the 7th decade with 43 cases (21.5%), the 5th decade with 41 cases (20.5%) and the 4th decade with 29 cases (14.5%) in order of frequency. 2) The associated diseases were hypertension with 25 cases (12.5%), diabetes mellitus with 12 cases (6.0%), cardiopulmonary disease with 11 cases (5.5%), and hepatitis with 10 cases (5.0%) in order of frequency. 3) The cases of previous abdominal operations were 75 cases (37.5%). The most frequent operations were appendectomy with 33 cases (16.5%), C-section with 12 cases (6.0%), laparoscopic tubal ligation with 11 cases (5.5%), salphingo- oophorectomy with 8 cases (4.0%) and T.A.H with 8 cases (4.0%) in order of frequency. 4) The most frequent pathologic diagnosis was chronic cholecystitis with 187 cases (93.5%). 5) The operation time ranged from 30-180 minutes with an average of 81 minutes. The operation time for the first 10 cases was 77 minutes, but it was been reduced to 58 minutes in the last 10 cases. 6) Conversion to an open cholecystectomy during the operation was done in 6 cases (3.0%), and the cause of conversion were uncontrolled bleeding with 2 cases (1.0%), severe adhesion with 2 cases (1.0%) and GB empyema with 2 cases (1.0%). 7) Postoperative analgesics were needed in 81 cases (40.5%) on the operative day, 71 cases (35.5%) on the 1st postoperative day, 26 cases (12.5%) on the 2nd postoperative day, 6 cases (3.0%) on the 3rd postoperative day, and 3 cases (1.5%) on the 4th postoperative day, and the use of analgesics was reduced as times went by. 8) The length of hospital stay ranged from 2 to 10 day with an average of 4.13 day, and 74 cases (37.0%) experienced a 3 to 6 day hospitalization, which was the most common hospital stay. 9) The total postoperative complication rate was 5.0% (n=10) with 2 cases (1.0%) of wound infection and 2 cases (1.0%) of ileus, and there was no postoperative mortality.

A Case of Atrichia with Papular Lesions / 대한피부과학회지

Artichia with papular lesions is a rare congenit,al disease characteriezed by the association of alopecia and papular lesions. We report a case of atrichia with papular lesions in 12-year-old. Alopecia of the scalp and eye brows were present at birth. Nurnerous papular lesions are presentation the trunk, buttock and inguinal area. The histopathologic iinding of a papular lesion showed ker till-filled cyst, and eruptive vellous hair cyst. The patient showed reticulat.ed hyperpigmentation on the hands and feet in addition to the characteristic feature of atriclia with papular lesions.

Immunohistochemical Study of TGFalpha , EGF and EGF Receptor on the Epithelial Tumors of the Skin / 대한피부과학회지

BACKGROUND: Several reports have demonstrated that TGFalpha and EGF are mitogenic for keratinocytes. Whenther its expression on epithelial tumors is a marker of malignancy or signifies an important step in the development of neoplasia is poorly understood. EGF receptors are also present in normal epidermis and epithelial tumors but their physiological roles are not yet understood. OBJECTIVE: Our purpose was to examine the staining patterns of TGFalpha, EGF and EGF receptors on the npithelial tumors of the skin, and to investigate kinetics of expression of EGF receptors. METHODS: We performed immunoperoxidase staining(ABC technique) with monoclonal anti-TGFalpha antibody, polyclonal anti-EGF antibody and polyclonal anti-EGF receptor antibody on the formalinfixed, paraffin-embedded tissue specimens of benign, premalignant and malignant skin tumors. RESULTS: The density of the expression of TGFalpha and EGF was not correlated with the degree of the malignancy of the epithelial tumors and is neither constant in any kind of the tumors. However the infiltrative type of basal cell carcinoma(BCC) is stronger that its solid type on the expression of TGFalpha and EGF. All benign tumors demonstrated a diffuse pattern within tumor lobules. pression of TGFalpha and EGF. All benign tumors demonstrated a diffuse pattern within tumor lobules. Focal TGFalpha immunostaining was seen in three of 10 squamous cell carcinomas(SCC) and four of 10 BCCs. TGFalpha immunostaining was absent from the outermost one to two layers of tumor lobules of all keratoacanthomas. The specimens which increased the expression of TGFalpha and EGF tended to decrease the expression of EGF receptor. CONCLUSION: These data suggest that the density of immunohistochemical expression of TGFalpha and EGF may be not dependent on the differentiation of tumor cells, and the pattern of immunohistochemical expression of TGFalpha can differentiate SCC from benign tumors such as keratoacanthoma. FGF receptor may be occupied by both of TGFalpha and EGF. With the receptors being occupied, a down regulation of the receptors may occur which results in decreased EGF receptor expression.

Hair Casts : A Clinical and Morphologic Study in School Children / 대한피부과학회지

BACKGROUND: Hair casts(HGs) is a disorder of asymptomatic, firm yellowish white, freely movable accretions which encircles but is not attatched to the hairs. There are two types of HC:The first type, parakeratotic HC, is frequently associated with parakeratotic scalp disorders;the second type, the peripilar keratin casts, in an uncommon type not usually associated with diseases of the scalp and has only been reported in female children. The pathophysiology and origin of HC is poorly understood with only 37 cases reported in the literature. @ ES OBJECTIVE: our pupose was to establish the prevalence of hair cast in schoold children and to determine the predisposing factors of hair casts in Korea. METHODS: Five hundred and thirty-seven students of elementary schools(274male, 263female) were examined. Samples of plucked hair were stained with 4-dimethylaminocinnamaldehyde and examined under light microscopes. RESULTS: There were 182 patients with HC;Peripilar keratin casts:174(CRSC 165, ERSC 7, IRSC 2); paakeratotic HC:8. In a total of 182 patients with HC, 181 were girls and the incidence of HC in female children was 68.8%(181/263). In girls who tie up or weave their hair, the incidence of peripilar keratin casts was as high as 81.8%(171/209). CONCLUSIONS: These data suggest that the traction to the hair follicle may play a role in the generation of HC, and that peripilar keratin casts are not rare in Korea.

A case of idiopathic progressive atrophoderma of pasini and pierini / 대한피부과학회지

Idiopathic progressive atrophoderma of Pasini and Pierini(IPAPP) is charcterized by sharply dermatcated, atrophic and slate-gray to brownish patches. We report a 17-year-old female with well-defined, atrophic, and brown colored patched on the abdomen, flank, and back. Histologic finding showed marked thining of dermis with thichening of collagen fibers and fragmentation of elastic fibers.

Two cases of dyschromatosis universalis / 대한피부과학회지

Dyschromatosis universalis hereditaria was reported in 1933 by Ichikawa and Hiraga in Japan. This disease is characterized by small pigmented and depigmented mottled macules on the trunk and extremities. We report two cases of dyschromatosis universalis. Case one is a 47-year-old man presented with hypoand hyperpigmented spots on the trunk and extrexities. At about 30 years of age, he started to show pigmentary changes on the back, which became progressively spread to the other parts of the trunk and extremities. Case two is a 27-year-old man with numerous mottled hypo-and hyperpigmented spots on the trunk and extremities. He started to show pigmentary changes on the back about 12 years ago. This pigmentary changes also became progressively spread to the other part of the trunk and extrimities. There were no family history of similar disease. On physical exminations, both patients had hrown rice-grain sized pigmented and depigmented macules without scales and atropy on the trunk and extremites. Fontana-Masson stains revealed decreased and increased melar in granules in the basal cell layers in the hypopigrnented and hyperpigmented lesions respectively.

Histochemical Study on Herniated Lumbar Disc / 대한정형외과학회잡지

The etiology and pathogenesis of lumbar disc herniation is not clearly proved although biochemical change, physical stress, genetic factor, autoimmune phenomenon and psychophysiologic phenomenon have been considered by many investigators. The most important one is a result of pathologic acceleration of normal aging of the tissue. The present study is aimed to investigate the changes of mucosubstances in normal aging and herniated disc which might have possible role on the disc herniation. The materials used in this study consisted of 123 cases of surgically removed herniated disc and 7 cases of normal control disc obtained from autopsy. Sections were cut and stained with periodic acid-schiff (P.A.S.)-alcian blue (pH 2.5) for the detection of neutral mucosubstances, alcian blue at pH 2.5 for nonsulfated acid mucosubstances, and alcian blue at pH 1.0 and Spicers diamine method (HID) for sulfated mucosubstances. The results were as follows. l. Of the 123 cases of lumbar disc herniation, there was a slight male preponderance over female with a ratio of 1.5:1.0. The most commonly affected level was L4-5 comprising 69 cases (56.1%), and up to three quarters of the patients the age was from 3rd to 5th decades in which it was rather evenly distributed. 2. The time interval between the appearance of symptoms and operation was less than 1 year in 77 cases (62.6%), in 32 cases (26.0%) being within 3 months. 3. Histochemical studies of the normal discs showed increase of neutral mucopolysaccharides with reduction of acid and sulfated mucopolysaccharides in the nucleus pulposus, and increase of all the mucosubstances in the annulus fibrosus by aging. 4. Histochemical studies of herniated disc showed an acceleration of the changes seen in normal changes. 5. Cartilaginous end plate formation was noted in 46,3% of herniated discs. The results obtained by the present investigation suggest that herniation of lumbar diosc is closely associated with accelerated or premature degeneration of the disc.

Reconstruction of Posterior Cruciate Ligament Using Semitendinosus Tendon (3 cases) / 대한정형외과학회잡지

It is generally accepted that the integrity of posterior cruciate ligament plays a major role in knee stability. The rotatory movement is around a point to the back of center of joint where the posterior cruciate ligament lies, and it is a structure which is just as important as the other ligaments. Methods of reconstruction have been described, using semitendinosus tendon, gracilis tendon, popliteus tendon, patellar tendon, iliotibial band, and medial meniscus. We have successfully used the semitendinosus tendon in two patients who sustained neglected rupture of posterior cruciate ligament.