Impact of PTGBD on Patients with Acute Complicated Cholecystitis: Consecutive 4,000 Cases of Laparoscopic Cholecystectomy / 대한내시경복강경외과학회지

PURPOSE: The aim of this study was to determine the advantage of adequate PTGBD in acute complicated cholecystitis patients. METHODS: We performed a retrospective review of a collected database from September 2001 to July 2008. Acute cholecystitis with gangrene or perforation was defined as acute complicated cholecystitis. A PTGBD was performed for these patients immediately after the diagnosis using US or CT and then a tubogram was performed after 5~7 days. After evaluating the gallbladder (GB) and common bile duct (CBD) with a tubogram, we removed the drainage tube and the patients underwent a LC after readmission. RESULTS: Three hundred seventy four of the 893 patients who were diagnosed with acute cholecystitis underwent PTGBD. While 19 (3.2%) of the total acute cholecystitis patients were converted to open cholecystectomy due to severe inflammation, 14 (3.7%) of the acute complicated patients were converted to open cholecystectomy. In 79 patients, the pre-operative tubogram showed the presence of CBD stone and so ERCP was performed. There were no post-operative deaths. CONCLUSION: PTBGD in acute complicated cholecystitis patients allows the early relief of acute cholecystitis symptoms. This allows sufficient evaluation and treatment for CBD during the PTGBD state. Furthermore, this decreases the mortality and morbidity in the high-risk patients due to sufficient evaluation and management of the underlying critical disease, which allows elective cholecystectomy when the patients is in better condition for surgery. Therefore, PTGBD can be useful for acute complicated cholecystitis.

Long Term Impact of Laparoscopic Assisted Distal Gastrectomy on Quality of Life

PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance for the treatment of early gastric cancer. However, firm evidence supporting the long-term outcome after LADG for gastric cancer is unknown. This study compared long-term quality of life after LADG versus an open distal gastrectomy (ODG) for early gastric cancer. METHODS: This study included 29 patients who underwent LADG and 57 patients who underwent ODG for the treatment of stage I gastric cancer. Quality of life was evaluated based on the Korean version of EORTC QLQ-C30 (version 3.0) and EORTC QLQ-STO22 one year after surgery. All patients underwent a Billroth II gastrectomy for stage I gastric cancer between January 2003 and December 2004. RESULTS: A total of 86 (58%) out of 154 patients responded to the questionnaire. Demographic features showed no difference between the two groups of patients for age, sex, depth of invasion, lymph node metastasis except for tumor size and the number of retrieved lymph nodes. The mean score for global health status was not statistically different (LADG, 60.3+/-20.4 vs ODG, 57+/-20.6; P=0.413). The total score of 21 items related to stomach cancer (EORTC QLQ-STO22) also was not statistically different (LADG, 68.9+/-64.9 vs ODG, 94.5+/-97.3; P=0.340). CONCLUSION: Based on the results of the Korean version of EORTC QLQ-C 30 (version 3.0) and EORTC QLQ-STO22, LADG does not seem to have any long-term benefit over ODG on 'quality of life'.

A Case of Juvenile Huntington / 대한소아신경학회지

Huntington's disease(HD) is an autosomal dominantly inherited neurodegenerative disease, which is characterized by choreic movement and progressive dementia. HD is a disease caused by CAG repeat expansion of huntintin gene and definitely diagnosed or is excluded by molecular genetic analysis. Juvenile HD, of which onset is in children or young adult, is the most severely disabled type and shows several distinct clinical and genetic features in contrast to usual late-onset type. We report a 10 year-old girl who presented with involuntary movement, seizure and moderate dysarthria confirmed by molecular genetic analysis.

A Case of TypeI Glanzmann's Thrombasthenia Diagnosed by Flow Cytometry

Glanzmann's thrombasthenia is a rare autosomal recessive hemorrhagic disorder of platelet function with missing or abnormal platelet plasma membrane glycoprotein IIb-IIIa, which functions as a receptor for fibrinogen. We have experienced a case of thrombasthenia in a 6-year-old female whose chief complaints were easy bruising, frequent epistaxis, arthralgia and swelling of the right ankle joint. Bleeding time was prolonged in the presence of normal platelet levels and the platelet aggregation test showed lack of aggregation after exposure to ADP, epinephrine and collagen, but showed an aggregation response to ristocetin. Platelet analysis by flow cytometry is a successful alternative rapid diagnostic technique for Glanzmann's thrombasthenia patients as well as for carriers of this disease. Flow cytometry technique provides an effective tool for investigating platelet function defects caused by altered expression or deficiency of platelet surface proteins.

A Case of TypeI Glanzmann's Thrombasthenia Diagnosed by Flow Cytometry

Glanzmann's thrombasthenia is a rare autosomal recessive hemorrhagic disorder of platelet function with missing or abnormal platelet plasma membrane glycoprotein IIb-IIIa, which functions as a receptor for fibrinogen. We have experienced a case of thrombasthenia in a 6-year-old female whose chief complaints were easy bruising, frequent epistaxis, arthralgia and swelling of the right ankle joint. Bleeding time was prolonged in the presence of normal platelet levels and the platelet aggregation test showed lack of aggregation after exposure to ADP, epinephrine and collagen, but showed an aggregation response to ristocetin. Platelet analysis by flow cytometry is a successful alternative rapid diagnostic technique for Glanzmann's thrombasthenia patients as well as for carriers of this disease. Flow cytometry technique provides an effective tool for investigating platelet function defects caused by altered expression or deficiency of platelet surface proteins.