The Current Concepts in the Management of Open Fractures / 대한정형외과학회잡지

Open fractures require infection prevention, injured soft tissue management, and fracture fixation. Moreover, it should be treated according to the emergency surgery. The main goals of treatment are life preservation, limb preservation, infection prevention, and functional restoration. Treatment procedure is carried out in the following order. Early diagnosis and management in the emergency room, appropriate antibiotic treatment, adequate irrigation and thorough debridement, fracture fixation and wound restoration (temporary stabilization of the fracture and covering of the wound, definite fixation of the fracture and soft tissue coverage). Herein, we discuss the current trends in each treatment phase to be helpful to other clinicians regarding the applicability of these steps in clinical practice.

Osteotomy Selection: Advantages, Disadvantages, and Indication

Malunion causes not only cosmetic problems, but also degenerative osteoarthritis due to changes in the anatomical and mechanical axes. Corrective osteotomy may be required in some cases to prevent these complications. The corrective osteotomy is divided into two types: Straight and dome. The straight type is divided into open and closed wedge, in accordance with the correction method. Surgeons should understand the indication, surgical procedure, as well as the advantages and disadvantages of each osteotomy method. Deciding on the method of corrective osteotomy depends on the degree of angulation, soft tissue condition, approximate with joint, implant type, and the experience of the surgeon.

The Significance of Micrometastases in Axillary Lymph Node Negative Breast Cancer

BACKGROUND: Once the diagnosis of operable breast cancer has been made, the single most predictive factor is lymph node status. Although patients with lymph node initially reported as histologically negative have a relatively good prognosis, the relapse rate is still considerable. In an effort to detect micrometastases in the axillary nodes, various antibodies have been used that recognize membrane and cytokeratin antigens. Cytokeratin antigens are expressed by epithelial tumors and are not expressed by normal lymphoid tissues. This study uses an immunohistochemical method to examine the incidence and the prognostic significance of such micrometastases in a series of patients with "node-negative" breast cancer. METHODS: The study population consisted of a retrospective series of 150 patient who were treated at Soonchunhyang University Hospital for breast cancer between March 1992 and February 1998. Based on the original pathologic examination, patients had negative axillary nodes. Pan-cytokeratin, a cocktail of monoclonal antibodies to cytokeratin (58 kd, 56 kd, 52 kd, 45 kd), and the avidin-biotin-peroxidase- complex technique were used to detect micrometastases in paraffin embedded lymph nodes. RESULTS: Micrometastases were detected in 16 (10.7%) patients. The recurrence rate for patients with micrometastases was 6.3% (1/16), and the recurrence rate for patients without micrometastases was 1.5% (2/134). Micrometastases correlated with the histological type (P=0.026) and were seen more frequently with larger tumor size, higher anaplastic nuclear grade, and overexpression of p53.

Using the Color Doppler Signal for Diagnosis of Breast Cancer

Breast ultrasound and mammography are established procedures for the diagnosis of breast masses while new technology is opening the door for early cancer diagnosis. The limitation of ultrasound and mammography is that they are only based on physical properties. Recently, using a color doppler system, detection of color flow signal and a resistance index that depend on the blood flow and the blood velocity was applied for diagnosis of breast malignancy. Sixty-five patients admitted for breast surgery were studied. The final diagnosis was made by pathology for thirty malignancies and thirty-five benign lesions. The color doppler measurements on the breast lesions were made preoperatively. The following parameter were assessed :flow velocity, color signal grade and resistance index. The results are as follows: 1) Color signals were detected in twenty-four of the thirty malignancies and in seven of thirty-five benign lesions. 2) Malignant lesions showed a significantly higher maximum velocity (mean=12.52 cm/sec vs 6.34 cm/sec). 3) The resistance index values in the malignancies was higher compared to that in the benign lesions (P 0.05). Color doppler flow examination is a useful method for evaluation of benign and malignant breast lesions.

A Case of Biliary Mucinous Cystadenocarcinoma / 대한소화기내시경학회지

Biliary cystadenoma and cystadenocarcinoma are rare tumors which have a good prognosis after complete surgical removal. Correct pre-operative diagnosis depends on the imaging characteristics of the tumors. Computed tomography, Ultrasono-graphy, angiography and cholangiogram are useful diagnostic procedure in biliary cystic tumor but definite diagnosis cannot be made without histologic diagnosis. Before the surgery, cholangioscopy is necessary for deciding operation field. The prognosis of the biliary cystic tumor seems to be much better than that of other solid hepatic tumors. If there is no evidence of metastasis, complete resection of these tumors is, therefore, necessary for these possibly curable disease. Recently, we experienced a 60-year-old woman complained of jaundice and generalized itching sensation, which was diagnosed as biliary mucinous cystadenocarcinoma. We decided operation field by cholangioscopy, and performed left hepatic lobectomy and T-tube choledochojejunostomy. So, we report this case with a review of relevant literature.

A Case of Mirizzi Syndrome with Cholecystocholedochal Fistula / 대한소화기내시경학회지

Mirizzi syndrome is a so-called functional hepatic syndrome with obstruction of the common hepatic duct secondary to pressure from an impacted stone, either in the cystic duct or the neck of the gallbladder. Mirizzi syndrome is classified into two types based on endoscopic retrograde cholangio-pancreatographic findings. Type I involves external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch. In type II, a chole-cystocholedochal fistul is present, caused by a calculus which has eroded partly or completely into the common bile duct. Gallstone obstruction of the cystic duct with resulting repeated attacks of inflammation and pressure necrosis leads to the formation of cholecystocholedochal fistulas. We experienced a 70-year-old female patient with Mirizzi syndrome type II, who complained of abdominal discomfort. ERCP revealed multiple filling defects in contracted gallbladder, which compressed lateral wall of common hepatic duct. Peroral cholangioscopy revealed an impacted stone at the neck of the gallbladder with neighboring mucosal erosions. She was treated under the diagnosis of Mirzzi syndrome type II by endoscopic biliary drainage and surgical operation.

A Case of Mirizzi Syndrome with Cholecystocholedochal Fistula / 대한소화기내시경학회지

Mirizzi syndrome is a so-called functional hepatic syndrome with obstruction of the common hepatic duct secondary to pressure from an impacted stone, either in the cystic duct or the neck of the gallbladder. Mirizzi syndrome is classified into two types based on endoscopic retrograde cholangio-pancreatographic findings. Type I involves external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch. In type II, a chole-cystocholedochal fistul is present, caused by a calculus which has eroded partly or completely into the common bile duct. Gallstone obstruction of the cystic duct with resulting repeated attacks of inflammation and pressure necrosis leads to the formation of cholecystocholedochal fistulas. We experienced a 70-year-old female patient with Mirizzi syndrome type II, who complained of abdominal discomfort. ERCP revealed multiple filling defects in contracted gallbladder, which compressed lateral wall of common hepatic duct. Peroral cholangioscopy revealed an impacted stone at the neck of the gallbladder with neighboring mucosal erosions. She was treated under the diagnosis of Mirzzi syndrome type II by endoscopic biliary drainage and surgical operation.

Immune response tests by multitest@ CMI and T-cell counts before surgery in the patients with stomach cancer

No abstract available.

Primary Gasric Malignant Lymphoma / 대한소화기내시경학회지

This article is the case report of primary gastric malignant lymphoma which was diagnosed by laparatomy. A 24-year-old male was admitted because of epigastric pain and general weakness, He was taken by gastrofiberoscopy with biopsy, upper gastrointestinal series, ultrasonogram, and abdominal computerized tomogram. Endoseopic pieture demonstrated whitish to yellowish exudate in the ulcer base and the surround.ing mucosal elevation in the poterior wall of the antrum and lower body. In the X-ray and endoseapic findings, the lesion was considered as Borrmann III type carcinoma, but on the second endoscopic biopsy gastric lymphoma was suapected. Reaected stomach revealed an irregular ulceration with the surrounding mucosal elevation with a size of 5X7X10cm at the pasterior wall of the antrum. Bridging folds were observed on the surrounding elevated mucosa of the lesion. Histologically, the lesion was diagnosed as malignant lymphoma (poorly differentiated lymphocytic).