The Effect of Preoperative Oral Application of Bovine Colostrum on Endotoxemia and TNF-alpha in Abdominal Surgery

PURPOSE: We conducted this study to assess the effect of oral application of bovine colostrum on the plasma endotoxin and TNF-alpha following the abdominal surgery. METHODS: 46 patients who underwent the abdominal surgery were evenly enrolled in a prospective, randomized, double blind and placebo-controlled study. The patients were preoperatively managed by oral application of 20 g of a bovine colostrums or placebo (nonfat dried milk) per a day for 3 days. In both groups, endotoxin was sequentially determined pre-, intra- and postoperatively by a modified limulus amebocyte lysate test. TNF-alpha and CRP were also measured. The clinical course was followed and compared in both groups. RESULTS: The colostrum group showed significantly lower level of endotoxin and TNF-alpha compared to the placebo group. CRP did not differ in both groups. Clinical event did not occur in both group until the discharge. Colostrum group tends to have a lower incidence of fever and leukocytosis without statistic significance. CONCLUSION: Prophylactic preoperative oral application of bovine colostrum lower the plasma level of perioperative endotoxin and TNF-alpha. Further studies were needed for the relation of clinical effect and preoperative oral application of bovine colostrum.

Predictive Value of Preoperative Serum CEA, CA19-9 and CA125 Levels for Peritoneal Metastasis in Patients with Gastric Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Peritoneal metastasis is a crucial factor for the prognosis in gastric cancer, but its diagnosis is difficult before laparotomy. This study analyzed the usefulness of diagnostic imaging and various tumor markers in the detection of peritoneal metastasis in gastric cancer. MATERIALS AND METHODS: The sera from 768 patients with gastric cancer were measured for CEA, CA19-9 and CA125 levels using a commercial immunoradiometric assay. All the patients underwent diagnostic imaging with computed tomography (CT) and ultrasound (US) before laparotomy. RESULTS: Preoperative levels of CEA, CA19-9 and CA125 were above the cut-off levels in 15.4%, 8.7% and 5.7% of all cases, respectively. Eighty-eight patients were diagnosed with peritoneal metastasis by laparotomy. CT and US revealed peritoneal dissemination in 15 of 88 patients (17%). Among the three tumor markers, CA19-9 and CA125 showed similar detection rates of peritoneal metastasis (37.5% and 38.6%, respectively). In particular, the serum CA125 levels showed the best sensitivity (38.6%), specificity (98.4%), and diagnostic accuracy (91.5%), and the highest odd ratio (24.46, 95% CI: 11.17~53.57) for predicting peritoneal metastasis among the markers tested. CEA did not add significant predictive information (p=0.471). CONCLUSION: Preoperative serum CA19-9 and CA125 levels may provide a predictable value in determining peritoneal metastasis in patients with gastric cancer.

Long-term Results of Proximal and Total Gastrectomy for Adenocarcinoma of the Upper Third of the Stomach / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The choice of surgical strategy for patients with adenocarcinoma of the upper one third of the stomach is controversial. This study was performed to analyze the surgical results of a 11-year experience with these lesions. MATERIALS AND METHODS: From January 1990 to December 2000, 259 patients with upper third gastric cancer underwent proximal gastrectomy (n=74) or total gastrectomy (n=185) through an abdominal approach. Morbidity, mortality, recurrence patterns, and survival were compared between these two groups retrospectively. RESULTS: There were no significant differences in general complication and mortality rates between the two groups. However, the incidences of reflux esophagitis (16.2%) and anastomotic stricture (35.1%) were more common in the proximal gastrectomy group compared with the total gastrectomy group (0.5 and 8.1%). Regarding the main patterns of recurrence, local recurrence was dominant in the proximal gastrectomy group, whereas distant recurrence was dominant in the total gastrectomy group. Five-year overall survival (54.8 versus 47.8%) and survival according to tumor stage were no different between the groups. Multivariate analysis showed that the extent of resection was not an independent prognostic factor. CONCLUSION: The extent of resection for upper third gastric cancer did not appear to affect long-term outcome. However, proximal gastrectomy is associated with an increased risk of reflux esophagitis, anastomotic stricture, and local recurrence.

Proximal Gastrectomy Reconstructed by Jejunal Pouch Interposition: Surgical Technique and Evaluation of Postoperative Function

PURPOSE: Total gastrectomy has generally been performed for the treatment of upper third gastric cancer. However, the optimal extent of resection for the upper third gastric cancer is controversial until now. This article describes the surgical techniques and postoperative status for proximal gastrectomy reconstructed by jejunal pouch interposition. METHODS: We have used interposition of a double jejunal pouch between the esophagus and the remnant stomach after performing proximal gastrectomy in 22 patients to date. The postoperative courses were compared with those of 23 patients who underwent total gastrectomy during the same period. RESULTS: The age of the patients ranged from 28 to 72 years (mean 56.4 years); 18 were men and 4 were women. The lesions were mostly located along the lesser curvature or at the posterior wall. Histological examination showed that 13 patients had early gastric cancer, seven had advanced cancer, and two had malignant GISTs. Lymph node metastasis was observed in two patients. The comparative study revealed that there were no significant differences in the operation time and the length of hospital stay. There was no anastomotic leakage or intraabdominal abscess, and no operative deaths. Other complications were anastomotic stricture in 2 patients, pouch bleeding in one, pouch ulcer in one, and delayed emptying in two patients. No other symptoms, including dumping or reflux esophagitis, were recognized in any of the patients. CONCLUSION: Proximal gastrectomy reconstructed with jejunal pouch interposition was a safe procedure and led to a better quality of life, as judged from the functional studies in our patients. However, long term follow-up results of quality of life and survival will be necessary to confirm the superiority of this procedure.

Analysis of Local Recurrence Following Proximal Gastrectomy in Patients with Upper Third Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Little is known about local recurrence following proximal gastrectomy in patients with upper third gastric cancer. We performed this study to evaluate the long-term results of a proximal gastrectomy, and to analyze the risk factors of local recurrence affecting survival in these patients. MATERIALS AND METHODS: We undertook a retrospective study of 63 patients who underwent potentially curative proximal gastrectomy between 1990 and 1999, with special reference to local recurrence. RESULTS: During a median follow-up period of 37 months, 25 of the 63 patients (39.7%) developed a recurrence of cancer, with local recurrence in 15 patients (23.8%), the majority of these occurring at the remnant stomach or anastomosis. The median time to local recurrence was 38 months (8~78 months). Univariate analysis of risk factors for local recurrence revealed an infiltrative or diffuse gross type, with a tumor sizes>5 cm, a distal resection margin

A Clinical Review of the Advantages of Laparoscopic Inguinal Herniorrhaphy

PURPOSE: Laparoscopic surgery has became or is being tried as a standard procedure in most of abdominal surgeries due to the advantages of little postoperative pain, shortened of hospital stay, early return to daily life, the cosmetic effect etc. In this article, we examine the availability of laparoscopic herniorrhaphy through a clinical review of patients who had undergone by laparoscopic or conventional herniorrhaphy. METHODS: The records and data of 137 inguinal hernia patients who underwent laparoscopic herniorrhaphy (n=57) or conventional herniorrhaphy (n=80), with similar sex and age distribution, were retrospectively analyzed. Laparoscopic herniorrhaphy equated to transabdominal preperitoneal repair and conventional herniorrhaphy to Bassini's or Ferguson's repair. As statistical method, the Chi-square and T-test was used. RESULTS: There was no significant difference noted between the groups in relation to sex, age, site and type of hernia, complication rate, or recurrence rate in both group. The laparoscopic group had a longer mean operative time (87.3 vs 68.6 min) and less frequent postoperative analgesic use (49.1 vs 72.6%) as compared to the conventional group. However there was no statistical significance. The laparoscopic group had a significantly shorter mean postoperative hospital day (3.6 vs 7.8 days) and the mean period of return to work (6.2 vs 15.2 days) as compared to the conventional group. CONCLUSION: Laparoscopic herniorrhaphy is thought to be becoming the preferred operative procedure for young patients with a flourishing social activity particularly due to its shortening of the postoperative hospital stay and facilitating the early return to work. There is a need for the complication and recurrence rate to be reestimated following a sufficient and strict follow up. After studying more cases, a reevaluation must be done concerning the advantage of laparoscopic herniorrhaphy.

Patients Outcome Following Surgical Treatment of Upper Third Gastric Cancer

PURPOSE: Although there is an increasing incidence of upper third gastric cancers, the appropriate extent of resection for upper third gastric cancer is not known. This study was performed to analyze a 9-year experience with upper third gastric adenocarcinomas from one institution treated by either total gastrectomy (TG) or proximal gastrectomy (PG). METHODS: The records and survival data of 158 upper third gastric cancer patients who underwent curative TG (n=106) or PG (n=52) through an exclusively abdominal approach were retrospectively analyzed. RESULTS: There was no significant difference in age, sex, tumor gross type, tumor differentiation, and stage between the groups who underwent TG and those who underwent PG. In addition, there were no significant differences in hospital mortality, overall 5-year survival, and disease-free survival rates between PG and TG group. However, PG group showed higher rates of postoperative reflux esophagitis and anastomosis stricture than TG group. Regarding the main patterns of recurrence, local recurrence was dominant in PG group, whereas distant recurrence was dominant in TG group. CONCLUSION: The extent of resection for upper third gastric cancer does not affect long-term outcome, and both procedures can be accomplished safely. When the cancer is confined to upper third of the stomach without serosal invasion, PG combined with antireflux procedures can be indicated.

Ultrasonography-guided Drainage of Tuberculous Abscess in the Retromammary Region: A Case Report

We report our recent experience of successful ultrasonography-guided catheter drainage of a huge retro-mammaryabscess in a 27-year-old female patient with pulmonary tuberculosis. For breast abscesses, the pro-cedure can beused instead of surgery. Its merits are that it is easy and cost-effective, there is less scar forma-tion,outpatient management may be possible, and in reported cases there has been no recurrence.

Clinical Effect of an Intraoperative Bile Culture and Antibiotic Prophylaxis in Biliary Tract Surgery

To assess prophylatic antibiotic usage and the value of an intraoperative bile culture in biliary tract surgery, intraoperative bile cultures were taken in 276 biliary surgical patients during the period from Jan. 1991 to Dec. 1995. The results of bile culture, the isolation of organisms, susceptibility of the microorganisms to antibiotics, and the relationship between a positive culture and postoperative complications were analyzed. The positive culture rate was 56.5%, and the highest culture rate(100%) was seen in patients with combined stones in the gallbladder, the common bile duct and the intrahepatic duct. The most common gram negative microorganism was E. coli(44%), and Enterococcus was the most common among the gram positive microorganisms. The effective antibiotics for gram negative organisms were Amikacin, Gentamicin, Tobramycin, and Chloramphenicol; for gram positive organisms, they were Amikacin, Tetracycline, Gentamicin, and Tobramycin in order of effectiveness. The frequency of wound infection was larger in positive cultures(11.5%) than in negative cultures (2.5%), and the risk factors for positive cultures were old age, obstructive jaundice, a high serum SGOT/SGPT level, and previous biliary tract surgery. In conclusion, we recommend that prophylactic antibiotic treatment be done during the perioperative period for old patients with leukocytosis, obstructive jaundice, cholangitis, or a history previous biliary tract surgery. Antibiotic prophylaxis in biliary tract surgery reduces postoperative infectious complications.

Tuberculosis of the Appendix Associated with as Acute Suppurative Inflammatory Reaction: A case report

Tuberculosis affecting only the appendix is exceedingly rare, and tuberculous involvement of the appendix in the presence of tuberculosis elsewhere in the body, e.g., the lung or the gastrointestinal tract, is not common. Tuberculosis of the appendix is not associated with any specific clinical features, and diagnosis is revealed only after histopathological examination. Recently, we clinically experienced a case of tubercular appendicitis on histopathologic examination after an appendectomy for acute appendicitis. This case of tubercular appendicitis is presented with a brief review of the literature.

Morphological Analysis of Intimal Hyperplasia in Allografted Aorta of Rat

Intimal hyperplasia, an abnormal migration and proliferation of vascular smooth muscle cells with associated deposition of extracellular connective tissue matrix, is a chronic structual changes occuring in denuded arteries, arterialized vein and prosthetic bypass graft. This is one of the most important cause of vascular graft failure within the first year after operation. Certain growth factors, particularly basic fibroblast growth factor, transforming growth factor- , and platelet-derived growth factor, are believed to be the cause of the smooth muscle cell proliferation and migration. This smooth muscle cell proliferation and collagen deposition eventually produce intimal thickening with subsequent stenosis or occlusion of the vascular lumen. In order to evaluate the serial changes of injured vessel wall, aortic patch allograft was done in rat, and studied the morphological finding at 1 day, 1, 2, 6, and 8 weeks after graft. The results were summerized as follows; (1) During the early phase after graft, no significant wall changes were seen in the region of the anastomotic site except the presence of acute inflammatory cells with platelet aggregation and thrombus formation. (2) The intimal thickening was apparent by 1 week and was predominantly composed of smooth muscle cells. At the 2 weeks after graft, endothelial cells were partially regenerated to cover the patch graft, and intimal hyperplasia was composed of a mixture of smooth muscle cells and extracellular matrix, mostly collagen. (3) Six weeks after graft, prominent features were production and deposition of collagen rather than proliferation of smooth muscle cells. Reendothelialization over the thickened intima was seen at 8 weeks and the propagation of intimal hyperplasia to adjacent intima of normal vessel was also noted. In conclusion, intimal hyperplasia after vascular injury seemed to be a progressive response of the proliferation and migration of smooth muscle cells and this result might be used for further study about the suppression of intimal hyperplasia.