Tuberculosis of the Breast

Tuberculosis of the breast is an extremely rare disease. That needs to be differentiated from inflammatory breast cancer, acute or subacute breast abscess and actinomycosis of the breast in order for it to be treated effectively. However, tuberculosis of the breast is difficult to diagnose because of the diagnostic methods used. In addition, significant time is needed to identify tuberculosis by culture. We experienced a case of tuberculosis of the breast that developed during the anti-tuberculous medication. The patient was diagnosed quickly using tuberculosis PCR and treated with a combination of a surgical excision and anti-tuberculous medication.

Clinicopathologic Features and Clinical Significance of Small and Diminutive Colorectal Polyps

PURPOSE: Small (6 to 10 mm) and diminutive colon polyps (below 5 mm) are routinely removed at the time of colonoscopy for the prevention of colon cancer. Our aims in this study were to determine clinicopathologic features and frequency of significant synchronous neoplastic lesions of small colon polyps and diminutive colon polyps and to investigate development of colorectal carcinoma via surveillance colonoscopy. METHODS: We evaluated medical reports of all patients undergoing total colonoscopic examination over a 12-month period. Three hundred thirty nine small colorectal polyps, removed during colonoscopy, have been analyzed. We investigated the result of surveillance colonoscopy, also. Using this database, all adenomas were categorized into two groups: Group I, < or =5 mm diameter (diminutive polyp), Group 2, 6 to 10 mm diameter (small polyp). Significant synchronous adenomas were defined as adenoma over 6 mm diameter, dysplasia or cancer. RESULTS: The most common age group was the sixth decade. The male-to-female ratio was 2.1 : 1. Of the small colorectal polyps, 180 (53.1%) were adenomatous, 32 (10.0%) were hyperplastic, 119 (34.9%) were chronic nonspecific inflammation, 3 (0.9 %) were lymphoid hyperplasia, and 4 (1.1%) were cancerous. The most frequent sites of these lesions were rectum and sigmoid (60.2%). Recognizable endoscopic features of polyps were redness (35.8%) and nodule (26.3%). The prevalence of advanced proximal synchronous polyps was 20.7% among patients with distal small lesions. And we detected 2 cases (25%) had new small polyps in follow up colonoscopic examination. CONCLUSIONS: All polyps should be removed when encountered during colonoscopy due to the higher prevalence of adenoma among these lesions. Effort to find new polyps via surveillance colonoscopy is needed.

Analyses of Cervical Lymph Node Metastases from Papillary Thyroid Cancer

PURPOSE: The management of cervical lymph node metastases from papillary thyroid cancer ranges from selective removal to a radical neck dissection. A clear understanding of the metastases of nodes at potential risk improves the quality of life (QOL) of patients, and through correct surgical methods, based on previous studies; it has been found that lymph node metastasis correlated with a high risk of recurrence. The purpose of our study was to improve the QOL of patients through an appropriate surgical method at the time of the initial operation, which decreases the risk and incidence of reoperation, by reviewing the relationship of multiple variables with cervical lymph node metastases. METHODS: We retrospectively reviewed 123 consecutive patients with papillary thyroid cancer, who underwent a total thyroidectomy with modified radical neck dissection between January 2000 and December 2001. We analysed the relationship between the metastatic pattern, age, sex, tumor location and tumor size, degree of invasion, multicentricity, duration and postoperative complications, in the patients with cervical lymph node metastases. RESULTS: Of the multiple variables, age, sex and capsular invasion were found to significantly correlate with lymph node metastases. CONCLUSION: In patients presenting with capsular invasion, modified radical neck dissections are recommended for palpable cervical lymph nodes, for the prevention of recurrence and reoperation, even when the statistics indicate significance in male patients, or those of a young age, although, further studies with a larger population are required.

A Clinical Review on Acute Appendicitis in Children

PURPOSE: Acute appendicitis still remains one of the most common causes of childhood abdominal surgery. Despite of the development of modern diagnostic tools, it presents more serious problems than in adults due to the higher perforation rate. METHODS: In our hospital, 5-year term clinical reviews have been performed, over the last 2 decades to see if there were any changing tendencies of this disease entity. We reviewed 186 cases of child acute appendicitis between January 1997 and December 2001. RESULTS: The results were as follows: 1) The male to female ratio was 1.35: 1. 2) The peak incidence occurred in the 11 to 15 years old age group. 3) The overall perforation rate was 24.7%, which was decreased compared with 34.7% of our previous study (P<0.05, Odd ratio=0.60). 4) The negative exploration rate was 8.06%. 5) The overall complication rate were 2.85% and 32.6% in non-perforated and perforated cases, respectively. CONCLUSION: In conclusion, the incidence of acute appendicitis were shown to be almost the same as for the previous decade, but the perforation rate had dropped, maybe due to the early intervention, and advances in the diagnostic tools.

Risk Factors of Bowel Resection on Intussusception

PURPOSE: Intussusception is one of the most common causes of childhood intestinal obstructions. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. In this study, authors have tried to analyze the risk factors associated with intussusception in infants and children to establish an early diagnosis to prevent unwanted outcomes. METHODS: We reviewed 44 cases involving operations for childhood intussusception from 1997 to 2001. These were divided into two groups and compared retrospectively using medical records. Group I included 34 cases of manual reduction (77.3%), and group II consisted of 10 cases of bowel resection (22.7%). RESULTS: There were no significant differences in age, sex, and clinical symptoms between the 2 groups. The anatomic location of the intussusceptum, and fever seemed to vary, but this was of no statistical significance. Factors significantly contributing to increase in the rate of bowel resection were the duration of the symptoms (more than 48 hours), and the leukocyte count (more than 15,000/mm3). CONCLUSION: This study revealed that only the duration of symptom and the leukocyte count contributed to an increase in the rate of bowel resection. Further prospective studies would be needed to reveal more risk factors to accurately predict the prognosis of the disease.

Bile Duct Injury during Laparoscopic Cholecystectomy

PURPOSE: Laparoscopic cholecystectomy has replaced open surgery as the standard treatment for symptomatic cholelithiais. The combined use of ERCP and endoscopic sphincterotomy makes it possible for the diagnosis and management of common bile duct stones also. The authors reviewed cases for complications and clinical results in order to elucidate the efficacy of laparoscopic cholecystectomy in our hospital. METHODS: Of the 996 subjects who underwent laparoscopic cholecystectomy in our hospital between 1994 to 2000, only subjects of bile duct injury during or after the surgery were chosen for study. The clinical signs, symptoms, laboratory data, treatment method and complications were reviewed retrospectively. RESULTS: 8 patients developed bile peritonitis (0.81%), and 2 of these died of complications. Abdominal pain was noted in all patients. Intraabdominal bile collection was detected with ultrasonography (6 cases), endoscopic retrograde cholangiopancreatography (6 cases), percutaneous transhepatic cholangiography (3 cases) and computerized tomography (1 case). Management of bile peritonitis was done with Roux-en-Y hepaticojejunostomy (3 cases), naso-biliary tube drainage (2 case), sono-guided bile drainage (1 case) and primary closure of the common bile duct (2 case). CONCLUSION: This study demonstrated that laparoscopic cholecystectomy is a relatively safe and effective approach for the management of gallstones. And though vague and nonspecific, there were clinical signs and symptoms revealing bile leakage such as abdominal pain, tenderness, fever, jaundice and so on. Therefore, prompt and proper management for bile leakage should be accomplished to prevent lethal outcome.

Clinical Evaluation of Gastrointestinal Stromal Tumor of the Stomach

PURPOSE: Despite modern pathologic techniques, GISTs pose a dilemma in nomenclature, cellular origin, diagnosis, classification, and prognostication. The authors attempted to elucidate the clinical applications of known prognostic factors at our hospital on the basis of CD34 or CD117 positivity. METHODS: Immunostaining was done on 24 cases of GI tract tumor including leiomyoma, leiomyosarcoma, and GISTs treated in our hospital between 1991 and 2000. 20 cases that showed positive reactivity to either CD34 or CD117 were chosen, and a retrograde evaluation of the clinical characteristics and pathological characteristics was done. RESULTS: 16 of 24 cases (66.7%) showed a positive reactivity to CD34, 18 cases (75%) to CD117, and 20 cases (83.3%) to both CD34 and CD117. Complete resection was performed on all, with exception of one in which intraperitoneal metastasis was detected. The mean age of the patients was 58.9 (19~74) years, the mean tumor size was 8.1 cm (3~20) and there was no significant difference between the sexes. The overall survival rate was 80%. The difference of cumulative survival rate was significant when tumor size was 10 cm or greater (p=0.0021), mitotic count was 5/50 HPF or over (p<0.0001), or severe cellularity (p=0.0001), invasion (p<0.0001), necrosis (p=0.0185) or atypism (p<0.0001) were accompanied. CONCLUSION: Authors defined GIST as those case that were immunohistochemically positive to either CD34 or CD117. The prognostic factors those affected 5-year survival rate were tumor size, mitotic count, intratumoral necrosis, severecellularity, atypism and invasion. Additionally, the surgical treatment for this condition should be a complete resection of macroscopically identified tumor with adequate margin secured. Finally, a long term follow-up for the recurrence should be carried out.

Operation Method for Well-Differentiated Thyroid Cancer

PURPOSE: The treatment of choice for well-differentiated thyroid cancer is surgical excision. However, the operation method is still controversial. Also, the operation method has been changing gradually. Thus, we reviewed the records of patients with well-differentiated thyroid cancer who had received operations in our hospital to assess the trend in surgical procedure, and to determine the proper procedure, method, considering both recurrence and complications. METHODS: We retrospectively analyzed the cases of 452 patients with differentiated thyroid cancer who had received operations from January 1989 to December 1998. We divided the 10 years into two periods; period I was from 1989 to 1993 (254 patients) and period II was from 1994 to 1998 (198 patients). We analyzed recurrences and complications according to the operation method, including neck lymph-node dissection. The incidences and locations of lymph- node metastasis were taken into account, too. The statistical analysis was done by using the Fisher's exact test. RESULTS: In period I, 147 patients (58%) received a total thyroidectomy, and in period II, all patients received total thyroidectomy. In period I, 24 patients (9.4%) had a recurrence, and in period II, 13 patients (6.6%) had a recurrence. In period I, 55 patients (21.7%) had postoperative hypoparathyr oidism, and in period II, 38 patients (19.2%) had postoperative hypoparathyroidism. In period I, 15 patients (5.9%) had postoperative hoarseness, and in period II, 7 patients (3.5%) had postoperative hoarseness. Two hundred eighty-one patients (62.2%) had lymph-node metastasis, and the anterior neck region was the most common site of metastasis (60.2%). CONCLUSION: In the operation method for differentiated thyroid cancer, the trend is toward a total thyroidectomy away from a lobectomy. Also, a skillful and experienced surgeon can reduce the incidence of postoperative complications. Thus the best operation method for differentiated thyroid cancer is a total thyroidectomy, including a preventive anterior-neck lymph-node dissection, which is done by a skillful and experienced surgeon.

A Clinical Review of Lymph Node Metastases for Papillary Thyroid Cancer

BACKGROUND: Papillary thyroid cancer has a high frequency of lymph-node metastasis, but the methods for detecting and treating of lymph-node metastases remains controversial. We reviewed clinical analyses for lymph-node metastases. METHODS: Were retrospectively reviewed charts of 120 patients with papillary thyroid cancer who were treated from July 1994 to February 1997. Clinical aspects and the relationship between age, sex, tumor size, extracapsular invasion, multicentricity of the tumor and lymphadenopathy and the rate of lymph-node metastasis were investigated. RESULTS: Modified neck dissection was done in 97 patients, and lymph node metastases were detected in 72 patients (74.2%). Lymph-node meatastases were detected in 3 patients during routine central compartment neck dissection. The overall lymph-node metastasis was 62.5% (75 of 120). The mean number of metastastic nodes was 5.67, and the most frequent site was level VI. Lymph-node metastases were more frequent at a young age and for large sized tumors, extracapsular invasion and preoperatively palpable lymphadenopathy. CONCLUSIONS: The lymph-node metastatic rate is high for preoperatively palpable lymph node, tumor sizes over 4 cm, and extracapsular invasion (p<0.05). To reduce the recurrence rate, the surgeon shoud do a modified neck dissection on such above patients.

Comparison Curative Operation with Internal Drainage Procedure of Periampullary Ca

BACKGROUND: The optimal management of periampullary Ca. stage III remains controversial. METHODS: A total of 103 patients treated in a 5-ear period at Kwangju Christian Hospital, 54 patients with a curative operation and 49 patients with internal drainage, were retrospectively studied. RESULTS: There was no significant difference in the 30-ay mortality rate between patients with a curative operation and those with internal drainage, 4% versus 6% respectively. There was a difference between a curative operation and the internal drainage procedure in the early morbidity rate (16.7% versus 8%) and the late morbidity rate (9.3% versus 32.7%). The mean survival was more favorable for those with a curative operation than for those with the internal drainage procedure for periampullary Ca. stage III (pancreatic Ca.: 11.6 months versus 4.7 months, CBD Ca.: 12.6 month versus 5.4 months, and Ampulla of Vater Ca.: 16.5 months versus 5.6 months). The 6-onth and the 12-onth survival rates of the curative-operation group were 80% and 55% for pancreatic Ca., 100% and 80% for CBD Ca., and 90% and 80% for Ampulla of Vater Ca.. The 3-onth and the 6-onth survival rates of the internal drainage group were 70% and 30% for pancreatic Ca., 85% and 40% for CBD Ca., and 75% and 45% for Ampulla of Vater Ca. CONCLUSION: The mean survival duration was more favorable for those with a curative operation than for those with an internal drainage procedure for periampullary Ca. stage III. Therefore, if there is no evidence of distant metastasis, a radial resection is the treatment of choice for a patient with a carcinoma of the periampullary Ca.

Analysis of Arterial Blood Gas in Acute Cholecystitis Treated by a Percutaneous Cholecystostomy

The Cholecystectomy is the treatment of choice in patients with acute cholecystitis, but non-surgical gall stone therapies, such as a percutaneous cholecystostomy (PC) should be attempted in high risk critically ill patient with acute cholecystitis. Forty critically ill patients with complicated medical and surgical problems underwent an emergency PC at kwanju christran Hospital between 1993 and 1996. Diagnosis were made based on clinical and sonographic findings. The PCs were performed for patients with septic shock (9 cases), severe pain due to gall bladder empyema (9 cases), severe medical problems with acute cholecystitis (16 cases), a previous operation history (3 cases), and refusal of surgery (3 cases). The PCs were successfully performed under ultrasound guidance, and symptoms of patients were improved within several days after the PC. There were no immediate technical complications. We measured the arterial blood gas and analyzed of several factors influencing the acid-base change before and after the PC. The values of the pH and the PCO2 changed with an increasing WBC count, the presence of jaundice, a positive blood culture, a decreasing platelet count, and hypotension but returned to normal within several days after the PC. Although we can not attach statistical significance to the findings, we found that the acid-base balance changed with severe acute cholecystitis, as well as with septic shock and that the clinical symptoms and hemodynamics were improved by the PC. In conclusion, a PC as a nonsurgical management may be the procedure of choice for nonsurgical management of high-risk patients with acute cholecystitis, and as a definitive treatment, a laparoscopic or open cholecystectomy should be performed when symptoms are improved and the patients become stable.

Comparison of One Stage Operation with Staged Operation in Malignant Obstruction of the Left Colon and Rectum

BACKGROUND: The optimal management of malignant obstruction of the left colon and rectum is controversial. METHODS: A retrospective study was performed of 33 patients who underwent one-stage operation(n=11), staged operation(n=20), and palliative colostomy(n=2) at Kwangju Christian Hospital between January 1992 and December 1996. RESULTS: Eleven patients underwent one-stage operations(7 cases with anterior resection, 3 cases with left hemicolectomy, 1 case with Miles' operation). In this group, postoperative morbidity was 36.3% including 1 wound infection(9.0%), 1 anastomotic leakage (9.0%), 1 postoperative intestinal obstruction and 1 pulmonary complication, but there was no postoperative death. The average of hospital stay in this group was 18.1 days and the first day of normal diet was 6.0 days. Twenty patients underwent staged operations including 12 cases of Hartmann's procedure. In this group, postoperative morbidity was 35.0% including 3 wound infections(15.0%), 2 pulmonary complications(10.0%), 1 parastomal hernia and 1 fistula. There were two postoperative deaths as a result of sepsis. The average of hospital stay in this group was 34.9 days and the first day of normal diet was 6.8 days. CONCLUSION: We believe that one-stage operation was of value in management of malignant obstruction of the left colon and rectum in selected patients.

Clinical Analysis of the Dependence of the Survival Rate of Gastric Cancer Patients on Lymph Node Metastatic Patterns

In this retrospective study, 412 patients who had a curative resection with a lymph node dissection of higher level than D2 for gastric cancer at the Kwangju Christian Hospital from 1985 to 1991 were reviewed to analyze the dependence of their survival rate on lymph node metastasis results obtained by evaluating various metastatic patterns and on the spectrum of tumors(location, depth of invasion, size, and histologic type). The results are as follows: 1) Positive metastatic lymph nodes were found in 258(62.6%) of the 412 patients. When it came to the metastatic frequencies of each lymph node, No. 6 was involved in 40% of the cases(165 cases), No. 4 in 21.6%(87 cases), No. 3 in 20.1%(83 cases), No. 5 in 15%(62 cases), No. 8 in 14.3%(59 cases), No. 1 in 9.7%(40 cases), No. 7 in 8.9%(37 cases), and No. 9 in 8.2%(34 cases), which shows relatively higher metastatic frequencies for the perigastric lymph nodes than for the others. The 5-year survival rates for metastasis of various lymph nodes were 33.3% for No. 10, 20.4% for No. 3, 20% for No. 2, 20% for No. 13, 17.5% for No. 6, 16.6% for both No. 12 and 15, 15.7% for N0. 4, 12.9% for No. 5, 11.7% for N0. 9, 10.8% for No. 7, 8.4% for No. 8, 10% for both No. 1 and No. 11, 5.5% for No. 14 and 0% for No. 16. 2) When it came to the dependence of the metastatic frequencies of lymph nodes on the location of the gastric cancer, cancers in the lower third of the stomach showed the highest metastatic frequency in No. 6(39%), followed by No. 3(16.8%) and No. 4(16.2%) in that order. In the case of gastric cancer in the middle of the stomach, No. 6 showed the highest frequency at 48.6% followed by No. 3(26.3%), No. 4(23.6%), No. 5(17.1%), No. 8(17.1%), and No. 9(9.2%) in that order. In the case of gastric cancer in the upper third of the stomach, No. 3 showed the highest frequency at 47.6% followed by No. 1(47.6%), No. 4(38%), No. 6(23.8%), No. 5(19%), and No. 7(9.5%) in that order. This showed that in all lacations of gastric cancer, lymph node metastases were primarily observed among the perigastric N1 node group. 3) As the tumor invasion into the stomach wall grew deeper, metastases of the lymph nodes of N2 or higher groups increased. There was a significant difference in the metastatic frequencies of the lymph nodes between the proper muscle and the serosal layer. The survival rate dropped to a remarkable degree when the tumor invasion was deeper than the serosal layer. 4) Poorly differentiated adenocarcinomas were more frequently metastasized to the regional lymph nodes than well differentiated ones, and the metastasis extended to nonperigastric lymph nodes. The poorer the differentiation was, the lower the survival rate became. 5) The larger the size of the tumors was, the higher the lymph node metastatic frequency grew, reducing the survival rate. 6) When patients were in advanced stages of gastric cancer, the survival rate dropped considerably. 7) Based on the results mentioned above in which tumor invasion into the lymph nodes of N2 or higher groups were often observed and in which there were significant differences in the prognosis, we conclude that a gastrectomy with extensive lymphadenectomy at least up to the second node group(D2) might be the procedure of choice for advanced gastric cancer in order to improve the survival rate.

Clinical Review of the Double Stapling Technique for Lower Rectal Cancer

From January 1993 to December 1995, 47 patients with rectal carcinomas underwent a rectal anastomosis using the double stapling technique at the Surgical Department of Kwang-ju Christian Hospital. The major advantages of the double stapling technique for lower rectal cancer over the single stapling technique or a hand-sewn operation are as follows:1) Insertion of a purse-string suture is eliminated, and application of a linear stapler to close the distal rectum may be performed with greater ease. 2) In addition, fecal contamination and spillage of tumor cells from the rectal segment are minimized. 3) Differences in the sizes of the colons and rectums are not a concern in constructing the anastomosis. 4) The operating time is shorter. The following results were obtained by a comparison with 24 patients with rectal carcinoma who had undergone a rectal anastomosis using the double stapling technique from January 1989 to December 1992 which was reported in a previous study:1) Anastomotic stenosis was decreased from 8.3% to 4.2% because of reduced ischemia due to the double row of staples and the reduced injury due to compression of tissue between the anvil and the cartridge with experience. In addition, it resulted from reduced tension of the anastomosis due to sufficients mobilization of the proximal colon and from selection of large cartridge (33 mm). 2) Anastomotic leakage, even though the same location as the tumor and in the advanced age group, was decreased from 4.2% to 0% because the blood circulation was maintained and unnecessary tension was reduced with experience. In addition, it resulted from reinforced suture of the anastomotic site which was performed after anastomosis. 3) Systemic recurrence was the same result as that of the previous study(4.2/4.3%). 4) Local recurrence, even though at the same distal distance from the margin of the cancer, was increased from 0% to 2.1% because of advancing the pathologic stage (B2, C1>B1, B2) and increasing the poorly differentiated pathologic type.

Clinical Analysis of the Dependence of the Survival Rate of Gastric Cancer Patients on Lymph Node Metastatic Patterns

In this retrospective study, 412 patients who had a curative resection with a lymph node dissection of higher level than D2 for gastric cancer at the Kwangju Christian Hospital from 1985 to 1991 were reviewed to analyze the dependence of their survival rate on lymph node metastasis results obtained by evaluating various metastatic patterns and on the spectrum of tumors(location, depth of invasion, size, and histologic type). The results are as follows: 1) Positive metastatic lymph nodes were found in 258(62.6%) of the 412 patients. When it came to the metastatic frequencies of each lymph node, No. 6 was involved in 40% of the cases(165 cases), No. 4 in 21.6%(87 cases), No. 3 in 20.1%(83 cases), No. 5 in 15%(62 cases), No. 8 in 14.3%(59 cases), No. 1 in 9.7%(40 cases), No. 7 in 8.9%(37 cases), and No. 9 in 8.2%(34 cases), which shows relatively higher metastatic frequencies for the perigastric lymph nodes than for the others. The 5-year survival rates for metastasis of various lymph nodes were 33.3% for No. 10, 20.4% for No. 3, 20% for No. 2, 20% for No. 13, 17.5% for No. 6, 16.6% for both No. 12 and 15, 15.7% for N0. 4, 12.9% for No. 5, 11.7% for N0. 9, 10.8% for No. 7, 8.4% for No. 8, 10% for both No. 1 and No. 11, 5.5% for No. 14 and 0% for No. 16. 2) When it came to the dependence of the metastatic frequencies of lymph nodes on the location of the gastric cancer, cancers in the lower third of the stomach showed the highest metastatic frequency in No. 6(39%), followed by No. 3(16.8%) and No. 4(16.2%) in that order. In the case of gastric cancer in the middle of the stomach, No. 6 showed the highest frequency at 48.6% followed by No. 3(26.3%), No. 4(23.6%), No. 5(17.1%), No. 8(17.1%), and No. 9(9.2%) in that order. In the case of gastric cancer in the upper third of the stomach, No. 3 showed the highest frequency at 47.6% followed by No. 1(47.6%), No. 4(38%), No. 6(23.8%), No. 5(19%), and No. 7(9.5%) in that order. This showed that in all lacations of gastric cancer, lymph node metastases were primarily observed among the perigastric N1 node group. 3) As the tumor invasion into the stomach wall grew deeper, metastases of the lymph nodes of N2 or higher groups increased. There was a significant difference in the metastatic frequencies of the lymph nodes between the proper muscle and the serosal layer. The survival rate dropped to a remarkable degree when the tumor invasion was deeper than the serosal layer. 4) Poorly differentiated adenocarcinomas were more frequently metastasized to the regional lymph nodes than well differentiated ones, and the metastasis extended to nonperigastric lymph nodes. The poorer the differentiation was, the lower the survival rate became. 5) The larger the size of the tumors was, the higher the lymph node metastatic frequency grew, reducing the survival rate. 6) When patients were in advanced stages of gastric cancer, the survival rate dropped considerably. 7) Based on the results mentioned above in which tumor invasion into the lymph nodes of N2 or higher groups were often observed and in which there were significant differences in the prognosis, we conclude that a gastrectomy with extensive lymphadenectomy at least up to the second node group(D2) might be the procedure of choice for advanced gastric cancer in order to improve the survival rate.

Clinical Review of the Double Stapling Technique for Lower Rectal Cancer

From January 1993 to December 1995, 47 patients with rectal carcinomas underwent a rectal anastomosis using the double stapling technique at the Surgical Department of Kwang-ju Christian Hospital. The major advantages of the double stapling technique for lower rectal cancer over the single stapling technique or a hand-sewn operation are as follows:1) Insertion of a purse-string suture is eliminated, and application of a linear stapler to close the distal rectum may be performed with greater ease. 2) In addition, fecal contamination and spillage of tumor cells from the rectal segment are minimized. 3) Differences in the sizes of the colons and rectums are not a concern in constructing the anastomosis. 4) The operating time is shorter. The following results were obtained by a comparison with 24 patients with rectal carcinoma who had undergone a rectal anastomosis using the double stapling technique from January 1989 to December 1992 which was reported in a previous study:1) Anastomotic stenosis was decreased from 8.3% to 4.2% because of reduced ischemia due to the double row of staples and the reduced injury due to compression of tissue between the anvil and the cartridge with experience. In addition, it resulted from reduced tension of the anastomosis due to sufficients mobilization of the proximal colon and from selection of large cartridge (33 mm). 2) Anastomotic leakage, even though the same location as the tumor and in the advanced age group, was decreased from 4.2% to 0% because the blood circulation was maintained and unnecessary tension was reduced with experience. In addition, it resulted from reinforced suture of the anastomotic site which was performed after anastomosis. 3) Systemic recurrence was the same result as that of the previous study(4.2/4.3%). 4) Local recurrence, even though at the same distal distance from the margin of the cancer, was increased from 0% to 2.1% because of advancing the pathologic stage (B2, C1>B1, B2) and increasing the poorly differentiated pathologic type.

Thiersch Operation for the Treatment of Old Patients with Rectal Prolapse

Although many kinds of operation for rectal prolapse exist, generally they could be divided into the transabdominal and transperineal approach. The former has low recurrence rate as compared with the latter, but needs laparotomy. Unfortunately, many patients with rectal prolapse are old and debilitated. So they are not suitable candidates for a major abdominal operation. For those patient, a transperineal method may be proper, but the recurrence rate may be high and continence is not always achieved. We reviewed 12 patients who were older than 70 years of age and treated by the Thiersch operation among the 52 cases of rectal prolapse from Feb. 1992 to Mar. 1997 at Kwangju Christian Hospital. The results were summarized as follows; 1) The male to female ratio was 1 : 1.4. 2) Durations of rectal prolapse were distributed from 6 months to 30 years. Seven cases had duration of longer than 10 years. 3) The preoperative incidence of incontience was 8 (67%) of 12 cases. Among the 8 patients with incontinence, the male was 3 (37.5%) and female was 5 (62.5%). 4) Postoperative review of incontinence revealed complete disappearance in 4 cases (50%), improvement in 3 cases (37.5%), and no improvement in 1 case (12.5%). 5) After the Thiersch operation, rectal prolapse recurred in only 1 of the 12 cases (8.3%), a wound infection developed in 1 case (8.3%), defecation difficulty due to the small Thiersch ring was present in 3 cases (25%). The results of this study show that the Thiersch operation may be an effective method in treating rectal prolapse, especially in patient who are old or have poor general condition and manifested incontinence.

Operation methods according to the location of intrahepatic duct stones

No abstract available.

Clinical review of surgical treatment for hyperthyroidism

No abstract available.

Survaval analysis of gastric cancer using personal computer

No abstract available.