Retrospective study on prevalence of recurrent inguinal hernia: a large-scale multi-institutional study

PURPOSE: We conducted a multi-institutional analysis to establish the epidemiological characteristics of recurrent inguinal hernia following hernia repair in patients across 4 institutions in Korea.METHODS: The retrospectively reviewed data included patient characteristics, hernia location, year of primary operation, type of hernia, timing of recurrence, primary operation type, and whether a mesh was used.RESULTS: Among 4,604 patients who underwent hernia repair surgery, 255 patients (5.5%; 13 females and 242 males; mean age, 63 years) were found to have recurrent hernia from January 2010 to April 2017. Recurrent indirect inguinal and direct hernias were observed in 47.1% and 49.4% of the patients, respectively. The recurrence of hernias within 1 year of surgery was the highest at 17.25%. Early and late recurrences was observed in 23.5% and 66.5% of the patients, respectively. Among the patients, 81.6% underwent open hernia repair at the time of initial surgery.CONCLUSION: Recurrence of hernia is most common in the first year after the initial surgery, and 23.5% of recurrent inguinal hernia was developed within 2 years. Patients underwent surgery after an average of 116 months (median value, 64 months) following the first operation. In patients with recurrent hernia, direct hernia was seen more frequent than indirect hernia whereas indirect hernia occurred more in patients with primary hernia.

Everolimus Plus Ku0063794 Regimen Promotes Anticancer Effects against Hepatocellular Carcinoma Cells through the Paradoxical Inhibition of Autophagy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Everolimus only inhibits mammalian target of rapamycin complex 1 (mTORC1), whereas Ku0063794 inhibits both mTORC1 and mTORC2. Although they have similar anticancer effects, their combination has a synergistic effect against hepatocellular carcinoma (HCC) cells. We aimed to determine the mechanism underlying the synergistic effects of everolimus and Ku0063794 associated with autophagy in HCC cells. MATERIALS AND METHODS: We compared the effects of everolimus and Ku0063794, individually or in combination, on both the in vitro and in vivo models of HCCs. RESULTS: HepG2 cells treated with both agents had significantly lower rates of cell proliferation and higher apoptosis than the individual monotherapies (p < 0.05). Autophagic studies consistently indicated that, unlike the monotherapies, the combination therapy significantly reduced autophagy (p < 0.05). Autophagic blockage directly promoted the pro-apoptotic effects of combination therapy, suggesting autophagy as the survival mechanism of HCC cells. Unlike the monotherapies, combination therapy showed the potential to inhibit sirtuin 1 (SIRT1), the positive regulator of autophagy. SIRT1 overexpression abrogated the autophagy-inhibiting and pro-apoptotic effects of combination therapy. In a nude mouse xenograft model, the shrinkage of tumors was more prominent in mice treated with combination therapy than in mice treated with the respective monotherapies (p < 0.05). The immunohistochemical and immunofluorescence stains of the tumor obtained from the xenograft model showed that combination therapy had the potential of reducing autophagy and promoting apoptosis. CONCLUSION: The combination of everolimus and Ku0063794 potentiates anticancer effects on HCCs through a decrease in autophagy, which is prompted by SIRT1 downregulation.

The feasibility of single-port laparoscopic appendectomy using a solo approach: a comparative study

PURPOSE: To investigate the feasibility and safety of solo surgery with single-port laparoscopic appendectomy, which is termed herein solo-SPLA (solo-single-port laparoscopic appendectomy). METHODS: This study prospectively collected and retrospectively analyzed data from patients who had undergone either non-solo-SPLA (n = 150) or solo-SPLA (n = 150). Several devices were utilized for complete, skin-to-skin solo-SPSA, including a Lone Star Retractor System and an adjustable mechanical camera holder. RESULTS: Operating times were not significantly different between solo- and non-solo-SPLA (45.0 +/- 21.0 minutes vs. 46.7 +/- 26.1 minutes, P = 0.646). Most postoperative variables were also comparable between groups, including the necessity for intravenous analgesics (0.7 +/- 1.2 ampules [solo-SPLA] vs. 0.9 +/- 1.5 ampules [non-solo-SPLA], P = 0.092), time interval to gas passing (1.3 +/- 1.0 days vs. 1.4 +/- 1.0 days, P = 0.182), and the incidence of postoperative complications (4.0% vs. 8.7%, P = 0.153). Moreover, solo-SPLA effectively lowered the operating cost by reducing surgical personnel expenses. CONCLUSION: Solo-SPLA economized staff numbers and thus lowered hospital costs without lengthening of operating time. Therefore, solo-SPLA could be considered a safe and feasible alternative to non-solo-SPLA.

Novel method of laparoendoscopic single-site and natural orifice specimen extraction for live donor nephrectomy: single-port laparoscopic donor nephrectomy and transvaginal graft extraction

Laparoscopic live donor nephrectomy (DN) has been established as a useful alternative to the traditional open methods of procuring kidneys. To maximize the advantages of the laparoendoscopic single-site (LESS) method, we applied natural orifice specimen extraction to LESS-DN. A 46-year-old woman with no previous abdominal surgery history volunteered to donate her left kidney to her husband and underwent single-port laparoscopic DN with transvaginal extraction. The procedure was completed without intraoperative complications. The kidney functioned well immediately after transplantation, and the donor and recipient were respectively discharged 2 days and 2 weeks postoperatively. Single-port laparoscopic DN and transvaginal graft extraction is feasible and safe.

Does Korea's current diagnosis-related group-based reimbursement system appropriately classify appendectomy patients?

PURPOSE: As several years have passed since the implementation of the Korean diagnosis-related group (DRG) payment system for appendicitis, its early outcomes should be assessed to determine if further improvements are warranted. METHODS: We retrospectively analyzed clinical data from Korean patients who underwent appendectomy, dividing the sample into 2 groups of those who received services before and after implementation of the DRG system. Based on the DRG code classification, patient data were collected including the amount of DRG reimbursement and the total in-patient costs. We subsequently performed univariate and multivariate analyses to identify independent factors contributing to higher total in-patient cost. RESULTS: Although implementation of the DRG system for appendicitis significantly reduced postoperative length of stay (2.8 ± 1.0 days vs. 3.4 ± 1.9 days, P 70 years) have greater comorbidities, which contribute to higher inpatient costs. Thus, our study suggests that patient age be considered as a DRG classification variable.

Transumbilical pure single-port laparoscopic donor nephrectomy

Transumbilical single-port laparoscopic donor nephrectomy (SPLDN) is a novel, rapidly evolving, minimally invasive treatment modality for kidney transplantation. This method causes minimal parietal injury, has cosmetic advantages, and allows rapid recovery because of low postoperative pain and short hospital stay. Like other abdominal surgeries, when conducted by experienced laparoscopic surgeons, it can meet the same graft requirements as conventional laparoscopic surgery. Here, we report the first two cases of transumbilical SPLDN at Daejeon St. Mary's Hospital, The Catholic University of Korea. We used the umbilicus as a common path for laparoscopic procedures and as a route for specimen retrieval. The operating times were 230 and 265 minutes in cases 1 and 2, respectively. No intra- or postoperative complications were noted. In case 1, the wound length was 4 cm and duration of hospitalization was 2 days. In case 2, the wound length was only 2.5 cm, and the duration of hospitalization was only 1 day.

Early Experience of Single-Port Laparoscopic Anterior Resection for Colon Cancer / 대한내시경복강경외과학회지

PURPOSE: Single-port laparoscopic surgery (SPLS) has recently emerged as a method to improve the morbidity and cosmetic benefit of conventional laparoscopic surgery. We describe our experience of SPLS for an anterior resection (AR). The results of a prospective series of single-port laparoscopic anterior resection procedures are presented. METHODS: Anterior resections were performed on 16 cases using a single-port laparoscopic technique between March 2009 and March 2010. The surgical and oncologic outcomes were recorded on a prospective database. RESULTS: Sixteen (8 women) unselected patients (eight males, eight females), aged 43~82 years (median 66.5 years), underwent a SPLS anterior resection for sigmoid colon cancers (median 16 cm above AV, range 13~27). All patients were alive at 30 days. The surgery time ranged from 150~415 min (median 242 min) and the median wound incision length was 2.4 cm (range 1.5~4.0 cm). The median hospital stay was 7.5 days. Pathological reports from the resected specimens revealed adenocarcinoma in 15 patients and mucinous carcinoma in one. There was one case of an anastomotic leak that required reanastomosis. The median number of lymph nodes harvested was 27.5 (range 10~56). CONCLUSION: SPLS is a possible approach to an anterior resection with the potential for minimal access. A SPLS anterior resection is feasible and safe when performed by an experienced laparoscopic surgeon and team. On the other hand, the technique and oncologic safety warrants further prospective randomized studies.

Ileal Mesenteric Castleman's Disease

Castleman's disease is a rare disorder characterized by tumorous masses that may develop in the lymph node tissue throughout the body. Most common location is mediastinum, but it can also affect retroperitoneum, neck, pelvis, and/or axilla. It may exceptionally affect extranodal sites like striated muscle, thoracic wall, lungs, skull, larynx, and/or vulva. The presentation is varied and diagnosis is difficult. There are two main types of Castleman's disease: hyaline-vascular type and plasma cell type. The hyaline vascular type accounts for approximately 90% of the cases. Most individuals exhibit no symptoms of this form of the disorder or they may develop non-cancerous growths in the lymph nodes. The plasma cell type is often associated with fever, weight loss, skin rash, early destruction of red blood cells, leading to unusually low levels of circulating red blood cells (hemolytic anemia), and/ or abnormally increased amounts of certain immune factors in the blood (hypergammaglobulinemia). We here report a case of Castleman's disease of ileal mesentery in 30-years old female patient. Abdominal mass, 4.7x3.6 cm in size, was completely removed from ileal mesentery without complication, and confirmed histologically mesenteric Castleman's disease of the mixed type.

A Case Report and Systemic Analysis of Articles for Morgagni Diaphragmatic Hernia

It was difficult to determine the clinical situations of Morgagni diaphragmatic hernias of adults on account of its rarity. The aim of this study was to propose diagnostic and therapeutic guidelines for adult Morgagni diaphragmatic hernias. A computerized `Korean study information co.' and `medical research information center' literature search of domestic articles published since 1950 was carried out. These 10 cases in addition to ours were analyzed. The average age at treatment was 68.7 years of age ranging from 51 to 83 years with 90.9% of patients being female. 18.2% of patients had symptoms immediately after trauma. 27.3% of patients were incorrectly diagnosed preoperatively. 90.9% of all treated Morgagni hernias were located on the right side just behind the sternum with hernia sacs. The most common contents of the hernias were the greater omentum and transverse colon. The preferred method of surgery was the trans-abdominal approach. The mortality rate of the hernias was 9.1%. Morgagni diaphragmatic hernias once diagnosed should be referred for surgical repair due to the risk of bowel perforation. The transabdominal approach or laparoscopic surgery is preferred in accurately diagnosed Morgagni diaphragmatic hernias prior to surgery.

Expression of HER-2/neu in Gastric Adenocarcinoma

PURPOSE: The HER-2 oncogene plays a role in cellular oncogenic transformation, and is related to the aggressive tumor behaviour. Several studies have addressed the prognostic and predictive roles of the HER-2 status in gastric cancer; however, the HER-2 gene has not been used as a therapeutic target, as the opinions relating to its prognostic role are controversial. METHODS: Between January 1994 and December 1997 (1995 group), 192 patients who underwent a curative resection for a gastric adenocarcinoma at St. Mary's Hospital, College of Medicine, The Catholic University of Korea, were retrospectively reviewed from their paraffin embedded tissues and medical records. One hundred and twenty-seven patients, with the same characteristics and operated on between January and December 2002 (2000 group) were compared. The expression of HER-2 was analyzed by means of immunohistochemistry, with regard to the clinicopathological features and survival rate. RESULTS: The average ages of patients in the 1995 and 2000 groups were 56.3 and 59.1 years, respectively. In the 1995 group, 40.1, 26.5, 24.0 and 9.4%, had stage I, II, III and IV diseases, Whereas, in the 2000 group, these figures were 57.5, 18.1, 19.7, and 4.7%, respectively. The expression of HER-2 was positive in 12/192 patients (6.3%) in the 1995 group, and in 7/127 (5.5%) in the 2000 group. There was no relation between the overexpression of HER-2 and the pathological findings. However, the 5-year survival rates of patients with negative and positive HER-2 expression were 91.7 and 75.0%, in stage I and II gastric cancers, respectively. There was a significant difference in the survival rates between the two groups (P=0.010). CONCLUSION: HER-2 overexpression is an early event in gastric cancers, appearing at all stages of the disease, and is related to the poor prognosis of stage I, and II diseases. This fact is thought to be the basis of monoclonal antibody treatment and chemotherapy following a surgical operation for early gastric cancer.

Comparative Study of Ondansetron versus Placebo to Prevent Postoperative Nausea and Vomiting in those Undergoing Abdominal Surgery / 대한마취과학회지

Postoperative emesis is still a troublesome problem in patients undergoing general anesthesia. We compared the efficacy and safety of ondansetron, a selective antagonist of serotonin 5HT3 receptors, within the 24hours postoperative period. Forty patients between the ages of 12 and 75 and ASA class I-III, having general anesthesia, undergoing elective abdominal surgery (except gynecologic surgery) were assigned to one of two treatment groups according to uncontrolled parallel comparative study design. A standard anesthetic technique consisting of thiopental-atracurium for induction and N2O-Enflurane for maintenance of anesthesia was used. The data showed that intravenous ondansetron 4mg i.v. before induction was significantly more effective in preventing emesis (n=20, 85%) than placebo (n=20, 60%). Nausea severity scores were also significantly decreased from 1.5+/-0.6 (mean+/-SE) in placebo group to 0.30.1 in ondansetron group (p<0.05). All patients receiving of ondansetron 4mg intravenously tolerated their treatment well, without any special adverse events. Conclusion; Ondansetron(4mg) given intravenously before induction to prevent postoperative nausea and vomiting in patients undergoing elective abdominal surgery was effective and safe.

Clinical Investigation of Hemodynamic Changes during Anesthesia for Cesarean Section in Patients with Kyphoscoliosis / 대한마취과학회지

Kyphoscoliosis is a disease manifested as lateral curvature of spine and accompanying rotation of the vertebrae, resulting in distortion of rib cage. A curve greater than 40 degrees in considerd to be severe and most likely to be associated with physiologic derangements in cardiac and pulmonary function. Restrictive lung disease and pulmonary hypertension progressing to cor pulmonale are the major causes of mortality in patients with kyphoscoliosis. However, pregnancy itself increases cardiac output and circulating blood volume, and decreases total lung capacity due to enlarged uterus. So tidal volume is increased in pregnant women to compensate. But in kyphoscoliosis patients pulmonary fucntion is already impaired and cardiovascular reserve is minimal. So there is increasing tendency in actue cor pulmonale. Recently we experienced a case of cesarean section in patient with kyphoscoliosis, and observed severe hemodynamic changes especially in pulmonary capillary wedge pressure and cardiac output. And we investigated 7 cases of cesarean section of patients with kyposcoliosis.

Scheduling and Auditing of Anesthetic Record using Personal Computer / 대한마취과학회지

Now, in the 1980s computer literacy is an integral part of education. This is a result of both normal cultural evolution and revolutionary technical advances which have greatly deereased the cost of computers and made them for far easier to use and understand. Accordingly, the possible application for the anesthetist are varied and range from educational game to sophiscated servo control of vital signs. The following is an experience of application program named AMS(Anesthetic Management System). The AMS is for scheduling and auditing of anesthetic record. The usage is simple and accurate but have some problems including lack of uniformity in data input especially type of anesthesia and anesthetic agent used. Authors expect the better programs which can be used in risk analysis in anesthsiology will be developed.

Fixation of Epidural Catheters using Blood Set - Report of 120 cases / 대한마취과학회지

Secure fixation is essential for continous epidural catheterization on a long-term-basis. Adhesive tape or surgical knots were commonly used for those patients, but the surgical knot method has a tendency to cause strangulation of catheter. Another invasive technique, subcutaneous tissue tunnelling is more safe than other methods but requires sophisticated technique and time. We employed a simple device using a blood transfusion set for patients who have epidural catheters placed safely on their backs. In 120 patients treated for postoperative and chronic pain by means of this technique, the results were as follows: 1) Five of 120 patients (4.2%) developed backache and pruritus, but there were no instances of respiratory depression, local infection and headache. 2) Nine of 120 patients (7.5%) failed booster-injections, but two cases were due to be non-technical errors. 3) The duration of fixation was 1-3 days in most cases (85%), the longest being for 21 days.

A Clinical Review of Geriatric Anesthesia - an Analysis of 601 Cases / 대한마취과학회지

A total of 601 anesthesias given to the patients over age 60 who were admitted to Han Gang Sung Shim Hospital during the period from Jan. 1976 to Dec. 1980, were subjected to this clinical review. 1) Of the total 15,609 cases, 601 cases(3.8%) were over 60 years of age consisting of 315 male(52.4%) and 286 female(47.6%). 2) Among the 601 geriatric patients, 453 cases were 60~69 years of age(75.4%), 128 cases were 70~79 years of age(21.3%) and 20 cases were over 80 years of age(3.3%). 3) In the surgical group, 358 cases(59.7%) were general surgery, 120 cases(20.0%) were orthopedic surgery, 34 cases(5.6%) were urology, 20 cases(3.3%) were gynecology respectively. 4) The techniques of anesthesia were 545 cases(90.7%) of general anesthesia, 22 cases(3.7%) of spinal anesthesia and 17 cases(2.8%) of axillary block. 5) Anesthetics were diethly-ether 24 cases(36.3%) and halothane 22 cases(33.3%) in 1976. But there were 5 diethly-ether cases(0.3%) and 120 halothane cases(91.6%) in 1980. 6) For the duration of anesthesia, 81 cases(13%) were within 1 hour, 238 cases(39.6%) within 2 hours, 156 cases(26.0%) within 3 hours and 21 cases over 5 hours. 7) In the classification of physical status of the geriatric patients, 42 cases(7.0%) were class l, 201 cases(33.2%) were class ll, 109 cases (18.1%) were class lll and 8 cases(1.3%) were class lV. 8) Emergency cases were 223 cases(37.1%) and 378 cases(62.9%) were elective. 9) The findings of preoperative chest X-rays revealed that 227 cases(48.8%) were within normal limits, 56 cases(12.0%) had hypertensive heart disease, 24 cases(5.1%) had senile fibrosis, 22 cases(5.1%) had unstabilized tuberculosis and 14 cases(3%) had pneumonis. 10) In the preoperative R.K.G., which covered 50% of the patients, 115 cases(38.3%) were within normal limit, 41 cases(13.6%) showed L.V.H., 30 cases(10.0%) had sinus bradycardia, 13 cases (4.3%) had myocardial lschemia and 7 cases(2.3%) had R.B.B.B. 11) Post-operative mortality rate was 5.8% in 1976, 4.0% in 1977, 3.6% in 1978 and 2.1% in 1980, and over all mortality rate was 3.1%.

Clinical Studies on Emergency Anesthesia for 4,436 Cases / 대한마취과학회지

The authors analyzed statistically 4436 cases of emergency anesthesia which were performed at the Department of Anesthesiology, Han-Gang Sung Shim Hospital from Dec. 1971 to Dec. 1976 according to sex, age, department, physical status, anesthetic method, anesthetic agent, anesthetic duration, and mortality. The results were as follows: 1) About forty-five percent of all anesthetic patients were emergency cases. 2) About sixty-three percent of all emergency patients were in the 21 40 age group. 3) The most common disease was appendicitis (996 cases). 4) Halothane was the most commonly used anesthetic agent. .5) Closed or semiclosed circuit absorption anesthesia with endotracheal intubation was mainly employed. 4) Hypotension developed in twelve percent of all emergency anesthesia cases and whole blood was transfused in 1128 cases. 7) Intraoperative and postoperative death occurred in 233 cases, mainly with neurosurgical operations.

Axillary Block of Brachial Plexus : A Review of 808 Cases / 대한마취과학회지

An evaluation of axillary block in 803 clinical cases, during the period from January 1974 to June 1979, was made. Satisfactory results were obtained in 756 out of 803 blocks (94. 2%) with the axillary perivascular technique. The authors feetl that the axillary perivascular technique in which a relatively large volume(40~50ml) of anesthetic solution was administered into the perivasculsr space of the axilla was simple, convenient and had no serious complications compared to the supra-or subclavian perivascular technique and interscalene block for a diagnosis and treatment of upper extremities.

Clinical Evaluation of Anesthetic Experiences with 10,000 Cases / 대한마취과학회지

To evaluate trends, if any, anesthetic experiences of 10,000 cases in the total performed at the department of Anesthesiology, Han Kang Sung Shim Hospital, Choong Ang University, School of Medicine from Dec. 197I through Nov. 1976 were analyzed statistically according to anesthetic method, age, sex, department, anesthetic agent, anesthetic duration, physical status and cause of death. The results are as follows; 1. About forty-five percent of all surgical patients were emergency cases. 2. The spinal and regional blocks tended to increase compared with inhalation anesthesia. 3. The patients under 1 year and over 60-years of age also tended to increase. 4. In almost all cases, post-operative and post-anesthetic cause of death was due to the severity of preexisting disease itself and overall death rate of surgical patients who received anesthesia was 0.16% 5. Through this statistical study, we can perform anesthesia with more safety and ease, and also eliminate post-operative and post-anesthetic complications, with further study of new agents and techniques.

Analgesic Effect of Methoxyflurane ( Penthrane ) in Burn Dressings / 대한마취과학회지

Methoxyflurane was used as the sole inhalational analgesic in the dressing of 76 burns performed on 10 patients. It was used in air by analgizer(method 1) or analgizer with mask(method 2), or used by the semiclosed circle absorber by Pentec vaporizer(Cyprane) in 100% oxygen with the concentration of mathoxyflurane set at 0.5%(method 3) or at 0.7%(method 4). Comparative study concerning the analgesic action gave the following results: 1. Methoxyflurane through on analgizer(method 1) produced poor to good annalgesic action in burned patients. 2. Analgizer with mask(method 2) produced better analgesic action than analgizer alone. 3. 0.5% setting(method 3) was similar to analgizer with mask(method 2). 4. 0.7% setting(method 4) was produced complete analgesia, amnesia and partial loss of consciousness.

Acute Pulmonar Edema during General Anesthesia / 대한마취과학회지

The authors have experienced, during general anesthesia with methoxyflurane-nitrous oxide- oxygen for explorative laparatomy to perform appendectomy, a case of acute pulmonary edema, which is rare and it's etiology is various. The patient had no specific past or family history and the only predisposing factor was myocardial ischemia caused by cardio-vascular collapse due to severe dehydration. In this case, the authors believed that pre-existing myocardial ischemia, rapid transfusion of 5% dextrose and myocardial depressants (methoxyflurane and d-tubocurarine) were the causative factors. For this reason at least, myocardial depressants should be avoided in severely dehydrated patients. There are many preventive measures and treatments for acute pulmonary edema during general anesthesia. As in this case, we believe that prompt recognition and attention by the anesthesiologists are the most important preventive and therapeutic measures.