The learning curve for laparoscopic totally extraperitoneal herniorrhaphy by moving average / 대한외과학회지

PURPOSE: Laparoscopic totally extraperitoneal (TEP) herniorrhaphy has been recognized as a treatment option for inguinal hernia. The objective of this study was to clarify the learning curve for laparoscopic TEP herniorrhaphy using the moving average method. METHODS: A total of 90 patients underwent laparoscopic TEP herniorrhaphy by a single surgeon between March 2009 and March 2011. We analyzed medical records including the demographic data, operating time, hospital stay, and postoperative complications. RESULTS: The mean operating time of the initial 30 cases (learning period group) was 66.3 minutes. After the initial 30 cases were performed, the time decreased to 52.8 minutes in the later 60 cases (experienced period group, P = 0.015). This represents the operating time becoming stabilized and then decreasing as the number of performed cases accumulates. Hospital stay was shorter and frequency of pain control, and complication rate were lower in the experienced period, however, there was no statistical significance. CONCLUSION: We suggest that number of patients needed for the learning curve for laparoscopic TEP herniorrhaphy should be 30 cases. The operating time for laparoscopic TEP herniorrhaphy stabilizes after 40 cases in moving average analysis.

Mesenteric Pseudocyst of the Small Bowel in Gastric Cancer Patient: A Case Report

Mesenteric pseudocyst is rare. This term is used to describe the abdominal cystic mass, without the origin of abdominal organ. We presented a case of mesenteric pseudocyst of the small bowel in a 70-year-old man. Esophago-gastro-duodenoscopy showed a 3.5 cm sized excavated lesion on the posterior wall of angle. Endocopic biopsy confirmed a histologic diagnosis of the poorly differentiated adenocarcinoma, which includes the signet ring cell component. Abdominal computed tomography scan showed a focal mucosal enhancement in the posterior wall of angle of the stomach, a 2.4 cm sized enhancing mass on the distal small bowel loop, without distant metastases or ascites in rectal shelf, and multiple gallbladder stones. The patient underwent subtotal gastrectomy with gastroduodenostomy, segmental resection of the small bowel, and cholecystectomy. The final pathological diagnosis was mesenteric pseudocyst. This is the first case report describing incidentally detected mesenteric pseudocyst of the small bowel in gastric cancer patients.

Extensive Visceral Vein Thrombosis Associated with Deep Vein Thrombosis

Extensive visceral vein thrombosis, including the femoral vein, iliac vein, superior mesenteric vein, splenic vein and portal vein, is an uncommon type of thrombosis that is associated with significant mortality and morbidity. Making an early diagnosis and adequate management are very important. We present here the case of a 39-year-old woman with extensive visceral vein thrombosis and complicated small bowel necrosis and perforation. She had no known prothrombotic conditions, but the laboratory findings showed an elevated level of factor VIII. The patient's condition improved without complication after resection of the infarcted and perforated small bowel along with immediate postoperative anticoagulant therapy. On the follow up, the size of the thrombosis was decreased and there was no complication.

Torsion of Appendix Misdiagnosed as Ovarian Tumor / 대한내시경복강경외과학회지

Acute appendicitis is the most common cause of an acute abdomen. But torsion of the appendix is a rare disorder that causes abdominal symptoms that are indistinguishable from acute appendicitis. So, making the preoperative diagnosis of torsion of the appendix is difficult. In 1918, Payne et al. reported the first case of torsion of the appendix in a 37 years old woman. Since then, more than thirty cases have been reported. Torsion of the appendix can occur at any age & gender. Here, we report on a case of secondary torsion of appendix with mucinous cystadenoma in a 52 year-old woman, which was initially thought to be a right adnexal mass. Abdomen CT showed an 11x5 cm sized intra-abdominal mass growing along the right fallopian tube. On the small bowel series, an extra-luminal mass was found and this was pushing aside the small intestine. We performed diagnostic laparoscopic exploration and found inflammation of appendix with torsion. It was twisted 720degrees in a clockwise direction with ischemic change. The histological result was mucinous cystadenoma.

Comparison of Bile Drainage Methods after Laparoscopic CBD Exploration

PURPOSE: T-tube is a major procedure that prevents complication by biliary decompression, but which is accompanied by complications. Therefore, several procedures such as ENBD, PTBD, and antegrade biliary stent have been attempted, but with controversies as to which procedure is superior. Also, there are no standard procedures after laparoscopic CBD exploration. We performed this study to ascertain the most appropriate biliary drainage procedure after laparoscopic CBD exploration. METHODS: From March 2001 to December 2009, 121 patients who underwent Laparoscopic CBD exploration in Gunyang University were included for retrospective analysis. The patients were divided to 4 groups according to type of procedure, and we compared clinical parameters including age and gender, operation time, hospital stay, start of post-operative diet, and complications. RESULTS: There was no difference in age, gender, mean operation time, postoperative diet between the 4 groups. Hospital stay in the Stent group was shorter than T-tube group. There were 10 (7%) complications that occurred. Two 2 occurred in the T-tube, 3 in PTBD, and 5 in the Antegrade stent group. There were more complications in Stent group but no significant statistical difference. In 5 cases with remnant CBD stone, a total of 4 (3 PTBD, 1 Stent) was performed by endoscopic CBD stone removal. One T-tube case was removed easily by choledochoscopy through the T-tube. Three migrated and the impacted stents were removed by additional endoscopy. Perioperative biliary leakage (1) and peritonitis (1) post t-tube removal were resolved by conservative treatment. CONCLUSION: T-tube appears to be an appropriate method to patients who are suspected to have remnant CBD stones. Multiple procedures may be performed on a case by case basis such as performing PTBD first in a suspected cholangitis patient.

The Outcome of Laparoscopic Common Bile Duct Exploration (LCBDE) with Stone Removal in Common Bile Duct Stone / 대한내시경복강경외과학회지

PURPOSE: ERCP (Endoscopic retrograde cholangiopancreatigraphy) and ES (endoscopic sphicterotomy) have become the main treatments for common bile duct (CBD) stone. However, when ERCP with ES fails to remove CBD stone, an operation is needed for stone removal. The aim of this study was to investigate the outcomes of laparoscopic CBD exploration (LCBDE) for the management of difficult choledocholothoasis. METHODS: This study was a retrospective analysis of 106 LCBDE cases that were performed from March 2001 to December, 2009. RESULTS: Of the 106 patients who underwent laparoscopic procedures, 74 were combined with gallstone and 105 underwent the choledochotomy approach. The mean operation time and mean hospital stay were 146.9+/-74.5 minutes and 11.0+/-6.4 days, respectively. The open conversion and stone clearance rates were 3.8% (4 cases) and 96% (102/106 cases). There were 10 complications with 3 cases of bile leakage, 2 cases of pulmonary complications, 4 cases of remnant stone and 1 case of subhepatic seroma. CONCLUSION: The LCBDE is a safe and feasible procedure. If ERCP is difficult or stone retrieval is incomplete, then LCBDE could be an alternative treatment for difficult CBD stone.

Hepatic Resection for Large Hepatic Metastasis of Adrenocortical Carcinoma after Cyberknife Treatment

Surgical resection is the best treatment for operable metastatic liver cancer. Large metastatic cancer usually has low operability, so a debulking modality of mass is needed to increase operability. Chemotherapy and radiotherapy were commonly used as neoadjuvant treatments. Cyberknife stereotactic radiosurgery systems were only considered as one of the palliative treatment modalities for inoperable or surgically complex tumors. But, in this case, we applied Cyberknife as the preoperative debulking modality for large hepatic metastasis of adrenocortical carcinoma. After Cyberknife treatment 3 cyclex2,700 cGY, tumor size decreased (metastatic liver mass decreased to 15x9 cm from 19x12.5 cm, adrenal mass decreased to 5x3 cm from 7.4x4.5 cm). We could then resect the tumor completely by extended right hemihepatectomy & right adrenalectomy. A preoperative multidisciplinary approach, including chemotherapy and radiation therapy can be considered to increase operability. So, cyberknife can be considered an additional modality as a neoadjuvant radiotherapy.

A Case of Thyroid Hematoma Complicated with Unexpected Airway Obstruction by Blunt Cervical Trauma / 대한내분비외과학회지

Traumatic thyroid hematoma is a rare problem in cases of blunt trauma, but it can be a life-threatening condition. We report here on a case of thyroid hematoma that was complicated with unexpected airway obstruction due to blunt trauma on the anterior neck. A 23-year-old man who developed neck painful swelling and dyspnea was admitted to the emergency room with a blunt neck injury after motor-bicycle accident, and he hit his anterior neck against the handle-bar. He had no previous thyroid pathology and other medical problems. On the initial examination, his vital signs were stable and the oxygen saturation was 97.8%. A computed tomography (CT) scan of the neck showed fragmentation and extensive hematoma within the right thyroid gland and dislocation of the trachea. No definite bleeding focus was identified on the angiography that was done through the carotid artery. Two hours later, the patient experienced sudden respiratory distress and the oxygen saturation dropped rapidly. The patient needed emerg encyendotracheal intubation and surgical intervention. He successfully underwent right lobectomy of the thyroid gland, and was discharged on the 6th hospital day without any complications. The thyroid function was normal after 3 months.

Clinical Significance of Measuring Levels of CEA, CA19-9 in Peritoneal Washing Fluid in Patients with Gastric Cancer

PURPOSE: Free cancer cells exfoliated from cancer-invaded serosa contribute to peritoneal dissemination, the most frequent pattern of recurrence in patients with gastric cancer. To detect free cancer cells, CEA and CA19-9 were introduced as the markers of gastric cancer, and many methods, such as cytology, immunoassay, and reverse transcription polymerase chain reaction (RT-PCR), exist for detecting them. The aim of this study is to define the clinical significance of using immunoassay to measure the levels of CEA and CA19-9 in the peritoneal washings in patients with gastric cancer. MATERIALS AND METHODS: The peritoneal washing fluids were obtained from 130 patients with gastric cancer who received a curative gastrectomy, palliative gastrectomy or open and closure. The pCEA and pCA19-9 levels were measured by using immunoassay and cytology. The results were compared with the clinicopathological data. RESULTS: The pCEA and pCA19-9 levels were correlated with tumor invasion, lymph-node metastasis, and stage (P<0.05). CONCLUSION: A correlation was found between elevated pCEA and pCA19-9 levels measured by immunoassay and the TNM stage. Therefore, a combined pCEA and pCA19-9 assay could be a sensitive detector of peritoneal dissemination, as well as a predictor of postoperative prognosis. pCEA and pCA19-9 may also determine the adjuvant management strategy.

Giant Cavernous Hemangioma of the Liver / 한국간담췌외과학회지

Cavernous hemangioma is the most common benign tumor of the liver. This tumor is mostly small and asymptomatic, but giant cavernous hemangioma can produce symptoms and complications including abdominal pain, palpable mass and hemorrhage due to spontaneous or traumatic rupture. The authors encountered exceptionally large hemangioma with abdominal pain and anemia, and performed successful right hemihepatectomy, and present the case with the brief review of the literature.

Adenosquamous Carcinoma of the Pancreas / 한국간담췌외과학회지

Adenosquamous carcinoma of the pancreas is a rare tumor but demonstrated an aggressive biologic behavior. A 60-year- old man with huge cystic mass in epigastrium was admitted complaining of abdominal discomfort. Initially the cystic mass was diagnosed to pancreatic pseudocyst. An abdominal computed tomography on 1 month later demonstrated a more enlarged mass in the body of the pancreas with central necrosis, which was infiltrating posterior wall of the stomach. Near total pancreatectomy, splenectomy and total gastrectomy were done. The resection specimen composed of squamous cell carcinoma components with a small area of adenocarcinoma. The patient died of cachexia 4 months after the operation. We reported an unusual case of adenosquamous carcinoma of the pancreas which was a giant cystic mass with central degeneration and gastric infiltration.

Inhibition of Cyclooxygenase-2 (Cox-2) Expression by Genistein in Breast Cancer Cell-line / 한국유방암학회지

PURPOSE: The isoflavones in soy are likely to contribute to the historically low incidence of breast cancer among Asian women that consume traditional diets. A possible role of isoflavones in controlling the expression of cyclooxygenase-2 (Cox-2) has not previously been explored. In this study, the ability of the isoflavone, genistein, to regulate the expression of Cox-2 in breast cancer cells was evaluated. METHODS: The effects of genistein and NS-398, a Cox-2 inhibitor, were examined on the expression of Cox-2 at the mRNA level using the MDA-MB 231, and MCF-7 breast cancer cell-lines. RESULTS: In the MCF-7 cells, the Cox-2 mRNA could not be detected using RT-PCR. In the MDA-MB-231 cells, NS-398 and genistein were found to inhibit the Cox-2 mRNA expressions by 50 and 35~40%, respectively. CONCLUSION: These studies suggest that dietary isoflavonoids may contribute to the prevention or inhibition of breast cancer by inhibiting the Cox-2 expression.

Two Cases of Leiomyosarcoma in Stomach / 대한소화기내시경학회지

Leiomyosarcomas make up approximately 1 to 3% of all gastric neoplasms. The most prevalent age group was 6th and 7th decades. The main symptoms and signs were abdominal pain and bleeding. They most frequently involve gastric body and often ulcerate and bleed. Diagnosis can be established only by exploratory operation and histologic examination. Leiomyosarcomas rarely invade adjacent viscera and characteristically do not metastasize to lymph nodes, but they may spread to the liver and lungs. The treatment of choice is surgical resection. We report two cases of gastric leiomyosarcoma which was successfully treated surgically.

A Clinical Study of Colorectal Cancer

This is a clinical study of 129 cases of colorectal cancer who were treated in the department of surgery, Inchon Christian Hospital from January 1989 to December 1996. The results were as follows; 1) The peak age incidence was 7th decade and the ratio between male and female was 1.87 : 1 2) The most frequent site of the tumor was the rectum(59.7%). 3) In the right and left colon cancer the most frequent symptom was abdominal pain and in the rectal cancer the most frequent symptom was bloody stool. 4) The duration of symptoms prior to admission was within 3months(58%). 5) The diagnostic methods were digital examination, sigmoidoscopy colonofiberscopy, barium enema and abdominal CT scanning. 6) The most frequently performed operation was Abdominoperineal resection(27%). 7) The staging of tumors was performed according to modified Dukes' classification and Dukes C was most frequent(55.1%). 8) The most common histopathologic type was adenocarcinoma(98%). 9) The most common macroscopic finding was ulcerative pattern. 10) The most common distant metastatic site was pelvic organ(12%). 11) The most common post-operative complication was wound infection(10.1%). 12) The 5year survival rate was analyzed by Kaplan-Meier's method : the overall 5year survival rate was 60.7%.

A Clinical Analysis of Open T-tube Choledochostomy

Traditionally, open choledochotomy with T-tube choledochostomy had been considered as the "gold standard" for choledocholithiasis. Recently, the frequency of performing the open choledochotomy with T-tube choledohostomy has decreased due to the progression of several less invasive procedures and laparoscopic technques, but until now open choledochotomy with T-tube choledochostomy is the most popular procedure in choledocholithiasis. Therefore we reviewed 126 cases who were treated with open choledochotomy with T-tube choledochostomy from January 1987 to June 1996 at our institution in order to inspect the several problematic points especially after T-tube removal. The results are summarized as follows, 1) The sex ratio of male to female was 1:1.29, and the average age was 59.6 years old. 2) 119 cases (94.4%) were biliary tract stone disease and 7 cases (5.6%) were non-calculous benign biliary tract disease. The most common etiologic disease was GB and CBD stone (37.3%). 3) Most of postoperative T-tube cholangiography was performed within 14 days (84.1%). 4) The number of patients containing some residual stone at postoperative T-tube cholangiography was 29 cases (23%). 14 of these patients were treated by Dormia-basket stone removal and its success rate was 85.7%. 5) The T-tube was removed within 2 months in 109 cases (86.5%). 6) The number of complications after T-tube removal were 8 cases (6.3%). All of them had bile peritonitis symptomes, and three of them were treated by reoperation. 7) The postoperative complications were noted in 27 cases (21.4%). and the most frequent complication is wound infection (25.8%). The postoperative mortality was noted in 1 case (0.8%).

Thyroid nodules

No abstract available.

Early secondary suture of wound infection after laparotomy

No abstract available.

Inguinal hernia in the adults

No abstract available.

Intestinal lipoma near the ileocecal calve Report of 3 cases and review of the literature / 영남의대학술지

Three cases of intestinal lipoma near the ileocecal valve are described. In patients of cecal and ileocecal valve lipoma, they had right lower quadrant abdominal pain secondary to partial intestinal obstruction. In rarely developed segmental lipomatosis of the ileum, the patient had right abdominal mass and pain to fecal impaction of the diverticula. Diagnosis may be made by an abnormal roentgenographic pattern and confirmed by colonoscopy. Surgical removal of the affected segment results in cure in symptomatic patients.

A study of mammographic appearance of the breast diseases

The history of the radiological examination of the breast has been long, and recently the methods forexamining the breast are variable: mammography, thermography, xeroradiography, ultrasonography, water-pathsonography, transillumination, mammary C.T., M.R. Imaging, infra-red scanning, nuclear medicine, andgalactography. Most of these methods were not proven or have not been satisfied on their clinical testing butconventional mammography has been the gold standard for diagnosis of the breast cancer and no other method hasreached its effectiveness. The authors performed mammography in 488 patiens with breast abnormalities who hadvisited to Yeung Nam University hospital form May, 1983 to Dec. 1984. And we analyzed the mammographic findingsand diagnostic accuracy in pathologically confirmed 53 cases by operations or biopsies. The results are asfollows: 1. Among 16 cases of breast malignancies, (1) the most prevalent age group is 6th decade(37.5%), followedby 5th decade(31.3%), (2) the most common pathologic type is ductal carcinoma(93.75%), (3) the masses are largerthan 2cm, in 8 cases, smaller than 2cm. in 5 cases, and no visible mass is observed in 3 cases. 2. Among 37 casesof benign breast diseases, (1) the most prevalent age group is 4th & 5th decades(each11 cases), and followed by3rd decade(8 cases), (2) the most common disease is benign tumor (17 casees), followed by fibrocystic dysplasia(13cases), and inflammating disease(7 cases). (3) radiologically visible masses are observed in 16 cases and themasses are smaller than 2cm. in 11 cases. 3. the diagnostic accuracy of mammography compared with that ofpathology, (1) in malignancy, the accuracy rate is 75%(12/16 cases), and 87%(32/37 cases) in benign diseases. (2)avearage accuracy rate is 81%(44/53 cases).