Clinical Analysis and Laparoscopic Surgical Experience for an Appendiceal Mucocele / 대한내시경복강경외과학회지

PURPOSE: A mucocele of the appendix is an infrequent entity of appendiceal pathology. A preoperative diagnosis is important to determine for appropriate treatment and to avoid unintended rupture of the mucocele during surgery. The purpose of our study was to identify the clinical features of an appendiceal mucocele (AM) and to describe the experience of the use of the laparoscopic approach for an AM. METHODS: Between July 1998 and July 2008, 32 cases of AM were diagnosed. We reviewed the clinicopathological characteristics and surgical experience for an AM. RESULTS: The incidence of an AM was 0.66% for 4825 performed appendectomies. Most cases manifested with symptoms of abdominal pain (84.4%), but two cases were determined based on CT incidental findings. A preoperative diagnosis of a mucocele was determined for 34.4% of the cases. The use of ultrasonography, CT and colonoscopy helped to achieve a correct diagnosis. Open surgery was performed in 15 cases and laparoscopic surgery was performed in 17 cases. For patients that underwent an appendectomy, the mean operation time and diet-start date were significantly shorter for patients that underwent laparoscopic surgery as compared to patients that underwent open surgery (p=0.030, p=0.007, respectively). Pathology identified mucosal hyperplasia (25%), mucinous cystadenoma (59.4%) and a simple mucocele (15.6%). The mean duration of follow-up was 46 months. Recurrence or development of pseudomyxoma peritonei and complications after laparoscopic surgery were not seen. CONCLUSION: Laparoscopic resection of an AM was feasible when there was no mucinous spillage. Close follow-up is recommended in all patients due to the risk of recurrence in the form of pseudomyxoma peritonei or a gastrointestinal neoplasm.

Clinical Analysis of Femoral Hernia in Adult

PURPOSE: Compared with other types of hernia, femoral hernias in adults are less common and we have had little literature about femoral hernia. The purpose of this study was to evaluate the incidence of femoral hernias in adults and to analyze the characteristics of femoral hernias. METHODS: This retrospective study was based on the medical records of 60 patients who underwent herniorrhaphies for treating femoral hernia in adults from January 2001 to December 2007. We analyzed the incidence of femora hernias, the symptoms, the operative techniques, the complications, the mortality and the postoperative recurrence rates. RESULTS: The incidence of femoral hernia was 4.6% in all cases of inguinal hernias. The incidence in females was about 4 times higher than in males (P<0.001). The most common symptom was bulging. The operative technique was changed from plug technique to bilayer technique. Seroma including swelling and pain were prominent complications. We experienced one case of mortality. CONCLUSION: Femoral hernia is a rare type of inguinal hernia in adult. Femoral hernia is more frequent in females and in the aged; it is an important surgical pathology with high rate of incarceration or strangulation. In consideration of the pathology of hernia and difficulty of the peri-operative diagnosis, the Prolene Hernia System herniorrhaphy is a superior method to other methods in femoral hernia.

Clinical Experience with a Circular Stapled Hemorrhoidopexy without Circular Anal Dilator (CAD)

PURPOSE: The circular stapled hemorrhoidopexy (SH) reduces mucosal prolapse and interrupts the end branches of the upper hemorrhoidal artery through a suitable instrument, Procedure for Prolapse and Hemorrhoids (PPH). However, there are some technical difficulties in routine use of the circular anal dilator (CAD). The goal of this study was to evaluate the efficacy and the safety of a CSH without use of a CAD. METHODS: Between April 2005 and November 2006, 250 patients with Grade III and IV prolapsed hemorrhoids who had undergone CSH with PPH without using a CAD were retrospectively analyzed. The sex and age, the operation time, the type of anesthesia, the number of excised hemorrhoid piles, the degree of hemorrhoids and postoperative pain (consumed analgesics), the hospital stay, the postoperative complications, and the number of follow-up examinations at the outpatient clinic were analyzed. RESULTS: The operation time was 17.76 minutes (10~35 minutes). Most patients (89%) experienced spinal anesthesia. The degrees of hemorrhoids were Grade III (45%) and Grade IV (55%). The numbers of excised piles were 3 (44%), 4 (43%), and more than 5 (13%). The number of consumed postoperative analgesics was 0.97 times (mean). The mean hospital stay was 2.83 days. The postoperative complications were pain, bleeding, and urinary retention. CONCLUSIONS: A CSH without use of a CAD was an effective and safe surgical modality compared with other procedures for treating hemorrhoids. This procedure is feasible and convenient. The procedure is a new alternative in the treatment of severe hemorrhoids.

Effect of Lysodren(R) on the Ultrastructural Changes in the Rat Adrenal Corex: Immunohistochemical staining for anti-ACTH antibody on the adenohypophysis

The toxicity and adrenostatic effect of o,p'-DDD, a derivative of the insecticidal DDT, on the adrenal cortex were well known. It known that the toxicity was based on the blocking of steroid biopsynthesis when cholesterol was converted to pregnenolone. Lysodren(R) was also known to be capable of producing a regression of adrenocortical carcinoma and its metastases, and this drug became one of useful choice for the treatment of unoperable adrenocortical carcinomas. Recently, fine structural effect of o,p'-DDD on the adrenocortical carcinoma show that the mitochondria is the primary target organelle. o,p'-DDD was dissolved in corn oil and it was orally administered for 28 days to investigate the ultrastructural effects of zona fasciculata of rat adrenal cortex. The results obtained were as follow: 1) The body weight was decreased after feeding o,p'-DDD. 2) Light microscopic examination showed no remarkable change except increased fine lipid droplets of zona fasciculata in group I (o,p'-DDD 75 mg/kg feeding). Moderately increased intracytoplasmic lipid droplets and pyknotic nuclei bearing membrane indentations were seen in group II (o,p'-DDD 150 mg/kg feeding). Large sized lipid droplet aggregates, pyknotic nuclei with severe nuclear membrane indentations and karyorrhexis in focal area were evident in group III. 3) Immunohistochemical staining for ACTH in pituitary gland showed increasing number of ACTH secretory cell and increasing intensity of staining property according to the dosage of o,p'-DDD. 4) Ultrastructural examination showed increased intracytoplasmic lipid droplets and mild increased peroxisome. There was no remarkable ultrastructural changes in mitochondria in group I. Moderately increased lipid droplets and clusters formation, compressed mitochondria, partial disappearance of mitochondrial cristae, increased peroxisome and nuclear membrane indentations were seen in group II. In group III, nuclear membrane showed prominent indentation. Numberous cytoplasmic vacuolation, double membrane ring in mitochondria, disappearance of mitochondrial cristae, myelin figure formation in mitochondrial matrix, and fatty changes in mitochondrial matrix were seen. These findings showed that the primary target organelle of attack by o,p'-DDD on zona fasciculata of adrenal gland in rat is mitochondria and it was developed from double ring formation in mitochondrial matrix.

Distribution of medically important freshwater snails and larval trematodes from Parafossarulus manchouricus and Semisulcospira libertina around the Jinyang Lake in Kyongsang-Nam-Do, Korea

The Jinyang Lake is dammed up Nam River, and surrounded by Jinju city and four counties; Jinyang, Sanchong, Hadong, and Sachon in Kyongsang-Nam-Do, Korea. The area around this man-made lake have been known as an endemic focus of clonorchiasis in Korea. The present study was first aimed to know the distribution of freshwater mollusks including medically important snails, and larval trematodes shed from Parafossarulus manchouricus and Semisulcospira libertina. In addtion to above studies, water analyses in each snail habitat were carried out in order to figure out a part of their environmental factors. This malaco-ecological survey was done at the six areas around upper, middle and lower parts of the lake for 4 months, August-November, 1983. Total nine species of freshwater mollusks were collected throughout the study: 4 species of gastropods; Semisulcospira libertina, Cipangopaludina chinensis, Parafossarulus manchouricus and Radix auricularia, and 5 species of bivalves; Unio douglasiae, Anodonta woodiana, Lamprotula gottschei, Corbicula fluminea and Limnoperma lucustris. Out of nine species of freshwater mollusks, three species of gastropods; S. libertina, P. manchouricus and R. auricularia were medically important in terms of the transmission of digenetic trematodes to humans. P. manchouricus and R. auricularia were mainly collected from the shallow ponds and the irrigation channels with the muddy basin, but S. libertina and the bivalves were only collected from the stream of Nam river where the gravels and rocks were dominant. The levels of dissolved oxygen(D.O.) and biochemical oxygen demand (B.O.D.(5)) of the water specimens sampled from the study areas ranged from 6.0 to 9.6 ppm and from 0.4 to 1.6 ppm respectively. As a result, it is considered that water system around the Jinyang Lake might be relatively clean without any heavy pollution of aquatic microorganisms and organic materials during the period of this study. On the other hand, eight metalic constituents from the water samples were also assayed, and all metalic ions detected were remarkably low below the legal criteria. However, calcium ion in the water samples from the habitats of P. manchouricus was considerably higher than others. Infection rates of digenetic trematodes in the snails were 6.9 percent in P. manchouricus and 4.8 poercent in S. libertina, respectively. P. manchouricus snails harboring with the cercariae of Clonorchis sinensis were only 0.14 percent among the snails examined and other trematode cercariae except cercaria of C. sinensis were; furcocercus cercariae, cercaria of Loxogenes liberum type I and II. S. libertina snails parasitized with the cercariae of Metagonimus yokogawai were 1.5 percent out of the snails examined and no cercaria of Paragonimus westermani was found in S. libertina snails in the present study. Digenetic trematode cercariae other then M. yokogawai in S. libertina snails were: Cercaria yoshidae (B type), Cercaria cristata, Cercaria innominatum, Cercaria of Centrocestus formosanus and Cercaria nipponensis.