The Wound Healing Effect of a Silk Fibroin Film on Cutaneous Burn of Hairless Mice

PURPOSE: The aim of this study was to examine the effects of silk fibroin film on wound healing of cutaneous burn in hairless mice by using microscopic findings and stem cell markers (nestin, cytokeratin 15) and ki-67 proliferation marker. METHODS: Each mouse received two burns at the dorsal area by applying a metal rod heated with boiling water. Burn wound sites were dressed with Silk Fibroin Film and duoderm (SF group), Aquacel hydrofiber and duoderm (AC group) and duoderm only (Control group). All groups were covered externally with duodermas adhesive bands. Those mice were sacrificed at zero, two, seven, fourteen and twenty one days after burn. Histological findings and immunohistochemical staining for stem cell markers were observed. RESULTS: In SF group, inflammatory cell infiltration, formation of granulation tissue and inflammatory foci are greater than in AC and control group. Those factors appear to enhance mesenchymal stem cell markers such as nestin. Finally mesenchymal tissue regeneration was enhanced. In addition, the length of ki-67 expressed re-generating epithelium, which appeared to be associated with epithelial regeneration, was the longest in SF group. CONCLUSION: The results show that the wound healing effect of SF is the best among other treatment materials including AC in the experimental group and duoderm in the control group through mesenchymal regeneration and epithelial regeneration which are essential factors for wound healing.

A Tailored Approach for Recurrent Groin Hernias

PURPOSE: Recurrent groin hernias are a significant problem with high recurrence rates. There is a great deal of controversy regarding their management. This study examined the outcome of patients who had undergone a repair of recurrent groin hernias. METHODS: This study examined retrospectively the medical records of all patients who underwent repairs of recurrent groin hernias (a total 239 cases) between January 1998 and December 2006. The repair was tailored to the previous operation and the patients' medical condition. The types of previous operations, present operation, complications and re-recurrence rate were analyzed. RESULTS: Of the 2,542 groin hernias operated on, 239 cases (9.4%) were treated for recurrent groin hernias. The types of previous surgery were conventional open tissue repair in 199 cases (83.3%), Lichtenstein repair in 28 cases (11.7%), open mesh repair (PHS, Perfix plug) in 6 cases (2.5%) and laparoscopic repair in 6 cases (2.5%). The recurrent groin hernias were repaired using a laparoscopic method in 123 cases (51.4%), open mesh repair in 92 cases (38.4%), Lichtenstein repair in 18 cases (7.5%) and a conventional open tissue repair in 6 cases (2.5%). Postoperative complications occurred in 40 cases (16.7%), which included 10 seromas, 4 wound infections, 3 hematomas, 2 wound swellings, 8 scrotal swelling, 5 dysurias, 2 chronic neuralgias. There were 6 cases of re-recurrence in the 239 cases of recurrent groin hernias (2.5%). CONCLUSION: A tailored approach based on the previous repair and the medical condition of the patients with recurrent groin hernias is associated with a decrease in the incidence of major postoperative complications and a low recurrence rate (2.5%).

Pulmonary Resection for Invasive Pulmonary Aspergillosis in Hematological Malignancy Patients / 대한흉부외과학회지

BACKGROUND: Invasive pulmonary aspergillosis, a frequent fungal infection in immunocompromised patients, is known to have a poor prognosis despite the use of antifungal therapy in leukemic patients. We studied the outcome of surgical resection of invasive pulmonary aspergillosis where bleeding tendency, localized recurrence of infection, and incidence could be reduced. MATERIAL AND METHOD: We retrospectively reviewed 14 patients with a hematological malignancy where invasive pulmonary aspergillosis was diagnosed during the 10 years between 1998 and 2007. From the medical records, we reviewed the type and treatment of the hematological malignancy, including the diagnostic methods of invasive pulmonary aspergillosis, the preoperative hematological conditions and their management, and the surgical methods and records. We also analyzed the development of postoperative complications and patient mortality, the recurrence of postoperative invasive pulmonary aspergillosis, and if the patients had a bone marrow transplant. RESULT: Fourteen patients with invasive pulmonary aspergillosis and a hematological malignancy underwent a pulmonary lobectomy. One patient had a complication of bronchopleural fistula, but there were no other serious complications such as bleeding or wound infection, and none of the patients died postoperatively. CONCLUSION: We have shown that pulmonary lobectomy is a safe and effective therapy for invasive pulmonary aspergillosis in patients with hematological malignancies that allow further treatment of the hematological malignancy.

The Role of Surgery for the Treatment of Upper Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: In the past, radiotherapy was the gold standard for the treatment of upper esophageal cancer, but the long-term follow-up was disappointing. There is still ongoing debate on the surgical management of these patients. This study was undertaken to update our experience with upper esophageal carcinoma and to evaluate the effectiveness of surgery. MATERIAL AND METHOD: From May 1995 to December 2005, 147 patients with esophageal cancer underwent surgery at our hospital. They were divided into two groups: one group consisted of 23 patients with upper esophageal (cervical and upper thoracic) cancer and another group consisted of 124 patients with lower esophageal (middle thoracic, lower thoracic and abdominal) cancer. We evaluated the effectiveness of surgical treatment between the 2 groups by measuring the rate of complete surgical resection, the postoperative complications, the postoperative mortality, tumor recurrence, the average life expectancy and the long-term survival. RESULT: On comparing both groups, there was no significant difference in the distribution of the pathological stage and no significant difference in the percentage of performing complete surgical resection. The percentage of postoperative complications was 39.1% (9 out of 23 patients) in the upper esophageal cancer group, and this was significantly higher than 16.9% (21 out of 124 patients) in the lower esophageal cancer group (p<0.05). However, there was no significant statistical difference between the groups for the percentages of postoperative mortality, tumor recurrence or the postoperative average life expectancy. CONCLUSION: There was no significant difference in operative mortality or surgical effectiveness between the 2 groups. Therefore, we thought that surgical treatment is also effective for treating upper esophageal cancer, but further investigation with large patient populations will be required.

Modified Tracheostomy for Severe Tracheal Stenosis / 대한흉부외과학회지

When tracheal invasion of a malignant tumor or tracheal stenosis of a benign origin exists at the lower or anterior part of the trachea, tracheal intubation or conventional tracheostomy may be difficult, and in these cases a modified tracheostomy through the lower or lateral part of the trachea would be necessary. We present 6 cases of modified tracheostomy performed with satisfactory results in severe tracheal stenosis that developed in the lower or anterior part of the trachea.

A Clinical Analysis of One Hundred Cases of Endoscopic Thyroidectomy: Breast Approach

PURPOSE: Neck surgery is one of the newest fields of endoscopic surgical application. We have developed a technique for performing endoscopic thyroidectomy using a breast approach and low-pressure CO2. We report this surgical procedure and its results. METHODS: One hundred patients underwent endoscopic thyroidectomy using a breast approach. Preoperative fine needle aspiration cytology revealed 74 benign nodules, 21 follicular neoplasms, 4 in which there was difficulty in distinguishing between benign and malignant tumor and 1 not checked. We used 3 incisions on both upper circumareolar areas and one at about 3 cm below the clavicle on the tumor side. Three trocars, 5 mm, 10 mm, 15 mm were used. Subplatysmal and subcutaneous operative space was created with CO2 insufflation at 6 mmHg of pressure. The thyroidal vessels and the parenchyme of the gland were dissected and divided with an ultrasonically activated scalpel and commonly used laparoscopic instruments. RESULTS: The subjects were 93 women and 7 men with ages ranging from 7 to 63 years (mean 38.9 yerars). The operation time 136+/-9.85 minutes before year 2000 and 66.8+/-8.26 at year 2000. There were 6 cases of conversion to conventional thyroidectomy, 1 case of uncontrolled intraoperative bleeding, 1 case of invasive follicular carcinoma and 4 papillary carcinoma. Postoperative complications occurred in 5 cases; 1 case of permanent recurrent laryngeal nerve palsy, 3 cases of transient voice change and 1 case of severe chest discomfort for 3 months. There was no occurrence of subcutaneous emphysema. The average of postoperative hospitalization time was 4.5+/-0.35 days. Operative scars were completley concealed by clothes and the patients were satisfied with the cosmetic result. CONCLUSION: This approach completely avoided operative scars in the neck and resulted in satisfactory cosmetic result with minimal scars in the breast. We believe that endoscopic thyroidectomy using breast approach is feasible and safe for resection of thyroid tumors.

Small Bowel Infarction or Necrosis Due to Mesenteric Venous Thrombosis

Acute mesenteric infarction due to mesenteric venous thrombosis was first reported by Elliot in 1895. In 1925 Warren and Eberhard characterized mesenteric venous thrombosis as an unique disease. PURPOSE: Mesenteric venous thrombosis is responsible for 5~15% of causes in acute mesenteric infarction. There are idiopathic thrombosis that has no specific causative disease and secondary thrombosis due to intraabdominal infection, tumor, portal hypertension, hematologic disorders and trauma to portal venous system etc. A diagnosis is made by Duplex scan, CT, MRA and angiography. CT has a 90% sensitivity rate. Bowel wall thickening and ascites are observed in advanced state. Angiographay can be used when the diagnosis is uncertain. Mortality is reported as high as 13~50% and major complications include short bowel syndrome, wound infection and sepsis etc. METHOD: We exprienced two patients (male 36 year old, male 47 year old) presented with acute abdominal pain who proved to have small bowel infarction due to mesenteric thrombosis. RESULT: Both patients showed signs of panperitonitis. CT examination showed portal-superior mesenteric venous thrombosis, small bowel infarction and large amout of ascites in either case. Small bowel resection and thrombectomy in one case and only small bowel resection in the other case were carried. Progressive postoperative fever and abdominal pain developed in one patient and intraabdominal absecess showed on CT examination. We performed secondary operation in the 9th postoperative date. CONCLUSION: The diagnosis of mesenteric venous thrombosis is difficult and small bowel resection should be performed when necrotic small bowel was encountered on exploration. Postoperative anti-coagulation therapy is reported to reduce recurrence and mortalty rate.