Early experience of transilluminated cryosurgery for varicose vein with saphenofemoral reflux: review of 84 patients (131 limbs)

PURPOSE: Varicose veins with great saphenous vein (GSV) insufficiency is prevalent. Among various surgical treatments for varicose veins, cryosurgery of GSV is an alternative minimally invasive technique that could leave fewer scars and replace conventional stripping with ambulatory phlebectomy. This study sought to assess outcomes including efficacy and safety of cryosurgery for varicose veins. METHODS: One hundred thirty-one limbs in 84 patients (37 male, 47 female; mean age, 53.3 years) with varicose veins were treated with cryosurgery over a 2-year period. The patients were followed for postoperative complication with surveillance of recurrence. The analyzed variables included age, sex, symptom, operative time (from skin incision to the application of elastic bandages on the legs for compression purposes), and postoperative complications including bruising, hematoma, superficial thrombophlebitis, cellulitis, seroma, cutaneous nerve damage, and wound complication. RESULTS: The mean operative time was 64.7 minutes for both limbs and 44 minutes for single limbs. The median number of incisions was 2. For stripping of GSV, one incision at the groin was necessary. Postoperative complications included an episode of hematoma in 3 limbs (2.3%), cutaneous nerve damage in 3 limbs (2.3%), cellulitis in 2 patients (1.5%), and seroma in 1 limb (0.8%). No wound infection, thrombophlebitis or deep venous thrombosis was observed. During follow-up (mean follow-up period, 13.5 months; range, 3–28 months), there was no recurrence. CONCLUSION: Cryosurgery to treat varicose veins is an effective and safe treatment modality in terms of postoperative complication, cosmetic result, and recurrence.

Bowel Perforation Due to Immobilization after Resurfacing Thumb with Anterolateral Thigh Free Flap in an Elderly Diabetic Woman

Inevitable immobilization after surgery on lower extremities can induce chronic constipation. Elderly diabetic women usually express ambiguous gastrointestinal symptoms and signs. We present here a case of panperitonitis developed from severe fecal impaction in an elderly diabetic woman after hand reconstruction using material harvested from the lower extremities. A 68-year-old diabetic female underwent anterolateral thigh free flap and wound revision twice on the left thumb. Three weeks after surgery, she complained about mild abdominal pain though she had daily defecation. Despite encouraging ambulation, her compliance was low. Resection of the sigmoid colon and colostomy were performed after diagnosis with bowel perforation. However, the patient went into septic shock and died with multiorgan failure after the guardians issued a DNR (do not resuscitate) order. For preventing bowel perforation, increased uptake of dietary fiber and early ambulation postoperatively should be encouraged, after even hand surgeries.

The effect of long Roux-en-Y gastrojejunostomy in gastric cancer patients with type 2 diabetes and body mass index < 35 kg/m2: preliminary results

PURPOSE: We applied a long Roux-en-Y (RY) gastrojejunostomy (bypassed jejunum over 100 cm) as a reconstruction method for diabetes control to gastric cancer patients with type 2 diabetes and body mass index (BMI) < 35 kg/m2. The effect of this procedure on diabetes control was assessed. METHODS: We prospectively performed modified RY gastrojejunostmy after curative radical distal gastrectomy. Thirty patients had completed a 1-year follow-up. Patients were followed concerning their diabetic status. The factors included in the investigation were length of bypassed jejunum, BMI and its reduction ratio, glycated hemoglobin (HbA1c), fasting blood glucose, and duration of diabetes. Diabetic status after surgery was assessed in three categories: remission, improvement, and stationary. In evaluation of surgical effects on diabetes control, remission and improvement groups were regarded as effective groups, while stationary was regarded as an ineffective group. RESULTS: At postoperative one year, statistical significance was observed in the mean BMI and HbA1c. Diabetes control was achieved in 50% of the patients (remission, 30%; improvement, 20%). BMI reduction ratio, preoperative HbA1c, and duration of diabetes were correlated to the status of type 2 diabetes mellitus. The preoperative HbA1c was the most influential predictor in diabetic control. CONCLUSION: The effect of long RY gastrojejunostomy after gastrectomy for diabetes control could be contentious but an applicable reconstruction method for diabetes control in gastric cancer patients with type 2 diabetes and BMI < 35 kg/m2. Diabetes remission is expected to be higher in patients with greater BMI reduction, short duration of diabetes, and lower preoperative HbA1c.

Generalized peritonitis arising from small bowel metastasis in a lung cancer patient / 대한외과학회지

Symptomatic gastrointestinal metastasis from lung malignancy is rarely reported. In this report, we present a case of lung adenocarcinoma with acute abdominal pain from small bowel perforation. The patient underwent small bowel resection and the final diagnosis was metastatic adenocarcinoma originating from lung. Immunohistochemistry was positive for thyroid transcription factor-1 and cytokeratin 7 (CK7), and negative for CK20. We present this rare case and briefly review the literature.

Air embolism during anesthesia in the beach chair position for shoulder surgery: A case report

A 60-year-old man was scheduled for elective right shoulder surgery. The patient was placed in the beach chair position. A venous air embolism was suspected because of a sudden decrease in the end-tidal carbon dioxide concentration, hypoxemia, tachycardia, and hypotension 5 mins after a stab incision in the surgical site. We inserted a central venous access catheter and provided hemodynamic support and cardiopulmonary resuscitation, but the patient died. We present this case to make surgeons and anesthesiologists aware of the possibility of air embolism during shoulder surgery in the beach chair position.

Pulsed radiofrequency lesioning for treatment of chronic breast neuropathic pain after breast reduction: A case report / 대한마취과학회지

Breast surgery is a common procedure performed in women. Many women who undergo breast surgery suffer from ill-defined pain syndromes. A nerve block is used in the treatment of the acute and chronic pain, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency lesioning (PRF) has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 52-year-old female patient complaining of chronic breast neuropathic pain after breast reduction, which was relieved after PRF lesioning of the 4th thoracic spinal nerve and its root.

Disseminated intravascular coagulation due to placenta accreta : A case report

Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality.It is usually discovered when removal of the placenta after delivery is difficult or there is substantial postpartum bleeding.Placenta accreta can be complicated by disseminated intravascular coagulation (DIC) and this increases maternal morbidity and mortality.DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessel.We report a 24-year-old woman with DIC, who developed severe pre- and intraoperative bleeding and massive transfusion during emergent cesarean section.

Disseminated intravascular coagulation due to placenta accreta : A case report

Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality.It is usually discovered when removal of the placenta after delivery is difficult or there is substantial postpartum bleeding.Placenta accreta can be complicated by disseminated intravascular coagulation (DIC) and this increases maternal morbidity and mortality.DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessel.We report a 24-year-old woman with DIC, who developed severe pre- and intraoperative bleeding and massive transfusion during emergent cesarean section.

The Feasibility of Recovered Warm Ischemic Injury on Non-heart-beating Donor Liver by Hepatocyte Growth Factor in Animal Model / 대한이식학회지

PURPOSE: Liver transplantation is the therapy of choice for patients with acute and acute-on-chronic severe liver failure or hepatocellular carcinoma. But a suitable liver is not always available for transplantation due to limited donor numbers. To increase the number of available liver for transplantation, a non-heart-beating donor (NHBD) liver transplant program is started. In NHBD liver transplantation, warm ischemic injury of liver occurs. The duration of warm ischemia is thought to be the most important risk factor for postoperative complications such as primary nonfunction or severe hepatic dysfunction. Recent evidence indicates that hepatocyte growth factor (HGF) plays an important role as a cytoprotector against hepatic injury by anti-apoptotic effect and mitogen in liver regeneration. Therefore studies also were performed to examine whether HGF influenced the viability and regeneration of hepatocytes from rats, subjected to prolonged warm ischemic injury. METHODS: Male Sprague- Dawley rats were subjected to non-heart-beating death by cervical spine fracture. Rats left in room temperature directly after, 30-minutes, 1-hours before surgery and perfusion was performed for isolating hepatocyte. Among three groups, hepatocyte viability was compared by trypan blue stain. And isolated hepatocytes from 30-minutes warm ischemic group were cultured for 24-hours, which were treated with no HGF and addition of various doses (5 ng/mL, 10 ng/mL, 20 ng/ mL, 40 ng/mL, 100 ng/mL) of HGF. Anti-apoptosis and regeneration of hepatocyte were compared by LDH assay, MTS assay, western blot, and immunocyto-chemistry after a 24-hours culture. RESULTS: The results of hepatocyte viability along the prolonged warm ischemic groups in isolated hepatocytes decreased sequentially 74.8+/-12.6%, 45.0+/-5.4%, 37.8+/-10.4% along directly after, 30-minutes, 1-hours in trypan blue stain (P<0.01). And 24-hour-cultured hepatocytes from 30-minutes warm ischemic group were treated with HGF. The results of LDH assay, MTS assay did not have relation with HGF addition. But the results of western blot and immunocytochemistry shown that HGF doses dependent anti-apoptosis and regeneration of hepatocyte increased. That indicates HGF presumably inhibites apoptotic pathway by phosphorylation. And HGF also makes hepatocyte hypertrophy and albumin synthesis. CONCLUSION: HGF was a potent cytoprotector against hepatic injury by anti- apoptotic effect and mitogen of liver regeneration in NHBD liver animal model. HGF facilitates recovery of the liver from prolong warm ischemic injury. If the more clinical studies and large animal studies are performed, NHBD using liver transplantation will be available with more chances by HGF.

Cytotoxic Mechanism of FK506 on Human T Lymphocytes

PURPOSE: FK506 (Tacrolimus) has been widely used as an immunosuppressant. We examined the effects of FK506 on the activation, proliferation and expression of cytotoxic effector molecules of Jurkat human T-lymphocytes. METHODS: We investigated the effects of this compound on cell viability, the production of reactive oxygen species and mitochondrial dysfunction. The cells were cultured in the presence or absence of FK506. Flow cytometric analysis was performed after staining with PI. The viability of the Jurkat cells was decreased by the addition of FK506 in a dose-and time-dependent manners. RESULTS: FK506-induced cytotoxicity was characterized by G0/G1 phase cell-cycle arrest. FK506 induced cell death was confirmed by the caspase-3 protease activation. In addition, the pharmacologic scavenging study of reactive oxygen species (ROS), including H2O2, revealed that cytotoxicity was achieved by the generation of ROS, which might modulate the mitochondrial dysfunction. CONCLUSION: These results suggest that FK506 functions in CDK4-cyclin D1 mediated cell-cycle arrest of Jurkat cells via generation of ROS and mitochondrial dysfunction.

Reduced Th1 Response with Herpes Simplex Virus Type 1 in Behcet's Disease / 대한류마티스학회지

OBJECTIVE: To investigate the interaction of herpes simplex virus type 1 antigen and T cells in Behcet's disease. METHODS: Intracellular interferon-gamma response of T cells was measured before and after stimulation with herpes simplex virus type 1 in 17 patients with Behcet's disease and 20 healthy controls. The proliferation rate and the changes of CD4+/CD8+ T cell subsets were also measured. RESULTS: In the basal status, the proportions of interferon-gamma producing CD4+ or CD8+ T cells were higher in patients with Behcet's disease than healthy controls. The number of interferon-gamma producing CD4+ or CD8+ T cells in patients with Behcet's disease was significantly decreased after stimulation with herpes simplex virus (mean+/-SD, 14.6+/-6.4 % vs 10.0+/-4.7%, p=0.0052 for CD4+ T cells; 29.5+/-14.2% vs 21.2+/-11.8%, p=0.045 for CD8+ T cells), while it did not change in healthy controls (11.5+/-7.4% vs 11.2+/-6.3%, p=0.88 for CD4+ T cells; 19.8+/-15.2 vs 20.7+/-10.8, p=0.84 for CD8+ T cells). There was no difference in the proliferation rate or CD4+/CD8+ subset changes between patients with Behcet's disease and healthy controls. CONCLUSION: The stimulation of peripheral blood mononuclear cells with herpes simplex virus type 1 leads to the reduction of interferon-gamma producing T cells in patients with Behcet's disease. These findings suggest that the stimulation with herpes simplex virus type 1 antigen may reverse the interferon-gamma dominant status of the Behcet's disease.

Immunohistochemical Identification of Phosphorylated Extracellular Signal-Regulated Kinase1/2 in Rat Vestibular Nuclei by Unilateral Labyrinthectomy

This study evaluated the expression of phosphorylated signal-regulated kinase1/2 (pERK1/2), which is one of the main factors regulating transcription of the cfos oncogene in neurons, in the vestibular nuclei of Sprague-Dawley rats following unilateral labyrinthectomy (UL). Surgical UL was performed to eliminate afferent signals from the peripheral vestibular receptors in the inner ear, under a surgical microscope, 2 hours after anesthesia. Significant numbers of pERK1/2 immunoreactive neurons were seen in the superior, medial, and inferior vestibular nuclei. There were more pERK1/2 immunoreactive cells in the vestibular nuclei contralateral than in the vestibular nuclei ipsilateral to the injured labyrinth, which resulted in significant asymmetric expression of pERK1/2 immunoreactive cells. Subsequently, the pERK1/2 immunoreactivity decreased rapidly, disappearing 90 min after labyrinthectomy. No pERK1/2 labeling was seen in the lateral vestibular nucleus. These results suggest that intracellular signal pathways for the activation of extracellular signal-regulated kinase in the vestibular nuclei are involved in lesion-neural plasticity in the vestibular system

A Case of Pneumocystis carinii Pneumonia in a Patient with Relapsed Acute Myelogenous Leukemia / 감염

We experienced a 61-year old man with Pneumocystis carinii pneumonia who had been diagnosed as having relapsed acute myelogenous leukemia(AML). He developed severe dyspnea in the nadir state after reinduction chemotherapy. His chest X-ray showed bilateral interstitial pneumonia in both lung fields. We started ventilator therapy and obtained sputum through the endotracheal tube. Typical P. carinii cysts were found in the sputum by Giemsa stain. No other organisms were found in thelavage sediments. From clinical observation and the presence of typical P. carinii cysts, the patient was diagnosed as having P. carinii pneumonia and was treated with sulfamethoxazole/trimethoprim and glucocorticoid. This was the first reported case of P. carinii pneumonia in an AML patient undergoing chemotherapy in Korea.