The Effects of Simultaneous Vaginal Hysterectomy on the Outcomes of a Tension-free Vaginal Tape Procedure for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Hysterectomy, regardless of the surgical technique, increases the risk of having to undergo stress urinary incontinence surgery later in life. Furthermore, transvaginal hysterectomy may cause some changes in the normal architecture and tension of the tissues surrounding the pelvic floor, and this may also cause some changes in the continence mechanisms of the bladder and urethra. We investigated if there are any adverse effects of concomitant vaginal hysterectomy on the outcomes of a tension-free vaginal tape procedure. MATERIALS AND METHODS: The outcomes of the tension-free vaginal tape (TVT)/transvaginal total hysterectomy(VTH) group were compared with that of the TVT group in terms of cure and improvement of incontinence, satisfaction with the procedure and the complications. The preoperative evaluation included history taking, physical examination and stress tests and determining the stress-related leakage, the emptying ability, the anatomy, the protection and the inhibition(SEAPI) scores. The outcomes were evaluated at over one year after operation. RESULTS: The cure and improvement rates were 77.5% and 15% in the TVT group, and 88.9% and 7.4% in the TVT/VTH group, respectively, without any statistical difference between the two groups. The rates of patient- satisfaction with the procedure were similar in two groups. There were no serious or long term complications related to the procedure except for a case of local hematoma in the hysterectomy site, which was controlled conservatively. CONCLUSIONS: Our findings suggest that a TVT operation can be done simultaneously with vaginal hysterectomy with similar results as those of TVT operation only. In addition, it is thought that the simultaneous TVT operation in a patient who is undergoing hysterectomy and has urinary stress incontinence deserves to be recommended in a positive light

The Clinicopathologic Factors Affecting the False Negativity of Fine Needle Aspiration Cytology (FNAC) in Breast Cancer

PURPOSE: The aim of this study was to understand the diagnostic false negative outcome of FNAC at the first clinic visit of patients in relation to various clinicopathological factors with the uni- and multivariate analysis. METHODS: From January 1993 to October 2001, the one hundred and twenty-one cases of primary palpable breast cancers which were diagnosed by FNAC were reviewed retrospectively. RESULTS: The ages of the patients varied from 24 to 84 (mean age was 51.3 years). Ten clinicopathological factors correlating with failure or success of FNAC were analyzed. In univariate analysis, statistical significances were observed in palpability (P<0.001), tumor size (P<0.001), histopathologic type (P<0.001), cellular distribution (P=0.002), TNM staging (P=0.042), mammographic findings (P<0.001). On the other hand, other factors such as age, ultrasound findings, extent of tumors, ER status, aspiratiors did not reveal any statistical significance. In multivariate analysis, palpability (P=0.002), histopathologic type (P=0.0457), mammographic findings (P=0.0161) were observed significantly. CONCLUSION: The most important factors for concerning diagnostic failure by FNAC seemed to be summarized into clinically palpability, histopathologic type, mammographic findings, inexperience and number of aspirator were also considered as a factor of diagnostic failure. In rare carcinomas such as lobular carcinoma and DCIS, high false negative rate was identified.

Analysis of Risk Factor for Major Complications after Pancreatoduodenectomy / 한국간담췌외과학회지

BACKGROUND/AIMS: The mortality after pancretoduodenenctomy is decreased to less than 5 % in centers with experience. The morbidity, however, still remains high although the decrease has also been demonstrated. The aim of this study was to identify risk factors responsible for major complications following pancreatoduodenectomy. METHODS: Various features of forty nine consecutive patients who underwent pancreatoduodenectomy from 1990 to 1999 were statistically analyzed to determine risk factors for major postoperative complications. Anastomotic leakages, intraabdominal hemorrhage and intraabdominal abcess were categorized as major postoperative complication. RESULTS: In our series, postoperative mortality and morbidy rate were 6.1% and 51.0%, respectively. Seventeen major complications were found in 14 patients(28.6%): 7 cases with pancreaticojejuostomy leakage, 4 cases with biliojejunostomy leakage, 3 cases with intraabdominal hemorrhage and 1 case with intraabdominal abcess. The statistical analysis revealed that episode of intraoperative hypotension was the only independent risk factor for major postoperative complication.(Odds ratio: 25.4849, p=0.0048) CONCLUSION: Careful intraoperative management for maintenance of adequate blood pressure in hemodynamically unstable patients is important to reduce major complications after pancreatoduodenectomy.

Mesh Plug Hernia Repair

PURPOSE: A mesh plug hernia repair has revealed encouraging results in inguinal hernia repair. This article compares our results with both conventional hernia repair and the mesh plug hernia repair procedure. METHODS: From January 1999 to October 2000, we performed 171 herniorrhaphies. Among these cases, we analyzed 49 cases of mesh plug hernia repair and 47 cases of conventional hernia repair. We recorded incidents of recurrence, postoperative complications, surgical time, duration of hospital stay, and the use of narcotics and antibiotics. RESULTS: There were no significant differences observed concerning recurrence, postoperative complications, duration of hospital stay, or the use of antibiotics and analgesics, however the surgical time was significantly reduced in the mesh plug hernia repair procedure. (55.51+/-25.46 minutes versus 65.65+/-18.87 minutes, P<0.05) CONCLUSION: Compared with the conventional sutured surgical technique, a mesh plug hernia repair uses less overall dissection and ensures a tension free hernioplasty, resulting in a shortened surgical time, greater patient comfort, rapid rehabilitation, decreased recurrence and lower rates overall complications.

Small-Bowel Obstruction in Patients with a Previous History of Abdominal Surgery due to Cancer

PURPOSE: The purpose of this study was to analyze the clinical features and to assess the risk factors in the treatment of small-bowel obstructions. METHODS: This retrospective clinical report was based on the medical records of 67 patients who were treated between Jan. 1992 and Dec. 1999 and who had had a history of abdominal surgery due to cancer. RESULTS: The distribution of primary cancer was as follows: stomach cancer 36 (53.7%), colorectal cancer 25 (37.3%), uterine and ovarian cancer 4 (6.0%), and other cancers 2 (3.0%). The mean interval from the primary operation to the development of a small- bowel obstruction was 27 months. Conservative treatment produced a successful outcome in 36 patients (59.0%), but recurrences of obstruction were noted in 18 of those patients. There were 34 operations in 30 patients. The initial success rate of operative treatment was 80% (24/30), obstructions recurred in 6 patients. The causes of obstructions in the surgically treated patients were adhesion (53.3%) and recurrence of cancer (46.7%). The postoperative complication rate was 44.1%, and the mortality rate was 20.0%. The mean survival time of the patients with benign causes of obstruction was significantly longer than that of the patients with malignant causes of obstruction (46 months vs 11 months). CONCLUSION: In the treatment of such patients, conservative treatment should be considered first. However if conservative treatment fails, surgery should be done without hesitation, especially in patients with no definite evidence of recurrence.

A Case of Intrahepatic Cholangiocarcinoma in Polycystic Liver Disease / 대한간학회지

Cholangiocarcinoma has been associated with various fibrocystic diseases of liver and biliary tract, but cholangiocarcinoma in polycystic liver disease (PLD) was extremely rare. It was reported that the prognosis of cholangiocarcinoma associated PLD was very poor and distant metastases were common. We report a rare case of intrahepatic cholangiocarcinoma associated with PLD in 58- year- old female who presented vague abdominal pain. She had also polycystic kidneys with normal renal function. MRI showed well demonstrated tumor with central scar and a adjacent large cyst in the left lobe of the liver. She underwent extended left lobectomy. On microscopic examination, the tumor was moderately differentiated cholangiocarcinoma having abundant fibrous stroma and necrosis and the adjacent cyst showed focal in situ carcinomatous changes in the lining epithelium.

An Adult with Symptomatic Isolated Cecocolic Nonrotation

On the contrary to congenital anomalies of intestinal rotation in pediatric patients, those in adults are generally nonsymptomatic and of little consequence. Occasionally, however, an adult may have midgut nonrotation and complain of chronic or recurrent abdominal pain. Intestinal nonrotation can be divided into complete or partial failure of rotation and into abnormalities affecting the proximal segment, the distal segment or both. We report herein a 43-year old female patient with symptomatic partial, cecocolic nonrotation.

Fine Needle Aspiration Biopsy for Metastatic Cervical Lymphadenopathy / 대한암학회지

PURPOSE: This study was intended to evaluate the value of the FNAB in the diagnosis of the suspected metastatic cervical lymphadenopathy. MATERIALS AND METHODS: 221 patients diagnosed as metastatic cervical lymphadenopathy by FNAB from Jan., 1990 to Oct., 1994 were analyzed retrospectively. They represented 92.1% of metstatic cervical lymphadenopathy managed and 15.7% of 1,411 FNAB's performed during the same period. 33 cases with lymphoma were excluded in this study. RESULTS: In 107 patients with cervical lymphadenopathy who also received confirmatory node biopsy, the sensitivity, specificity, positive and negative predictive values of FNAB for the metastatic cervical lymphaenopathy were 79.3%, 100%, 100% and 44.1% respectively. In 76 (33.4%) patients the histopathologic types of the primary cancers were decided by information gained from FNAB alone. There were two kinds of tendency that GI cancers metastasized to left-sided cervical nodes (88.1%) and breast and lung cancers to ipsilateral supraclavicular nodes in high frequencies (94.1% and 86.8%, respectively). No complications were associated with FNAB. CONCLUSION: FNAB is a simple, rapid, inexpensive and highly specific diagnostic tool in the evaluation of suspected metastatic cervical lymphadenopathy. The sensitivity and negative predictive value, however, are relatively low. When the clinical findings strongly suggest metastatic lymphadenopathy, the negative FNAB should be followed by confirmatory biopsy. Information gained from it guides further diagnostic and therapeutic plans. Surrounding normal tissues are not damaged, and the theoretical hazards of local implantation of tumor cells and complication are negligible.

A Comparison between the 4 th and 5 th Editions of the UICC Stage Classification of the Gastric Cancer with Special Emphasis / 대한암학회지

PURPOSE: In the new 5th edition of the UICC-TNM stage classification for gastric cancer, there were substantial changes for the N classification by accepting the convenience of the quantitative system. This study is intended to evaluate the efficacy of the new edition. MATERIALS AND METHODS: The stages and nodal status were retrospectively reclassified according to the 5th edition in 399 patients with gastric cancer who were operated at the NMC and they were compared with the result classified by the 4th edition. RESULTS: Each stage system showed a significant difference in respect to the survival among subgroups of patients. Lymph nodes metastasis by both classification systems also showed a significant difference in respect to the survival among the subgroups. Five-year survival rate decreased significantly in relation to numbers of metastatic lymph nodes. Multivariate analysis revealed that new staging system was one of the highly significant prognostic factor. Patients with metastatic deposits in the regional lymph nodes in the hepatoduodenal ligament, classified as distant nodes in the 4th edition, had worse survival than those without. There was no significant survival difference between the patients with N3 and those with distant node metastasis in the 5th edition. CONCLUSION: Although the new UICC-TNM classification seemed to need further classification by comparative studies, it might be a more convenient staging system with an ability to identify subgroups with different survival. But, it still has some controversies.

Surgical management of intrahepatic stone(72 cases) and its results

No abstract available.

Postoperative bile duct strictures

No abstract available.

Bile culture in biliary tract disease

No abstract available.

Immunotherapy with "mesima EX" in the treatments of digestive cancers / 대한암학회지

No abstract available.