Clinical Utility of Shear Wave Elastography Patterns for Differentiating between Benign and Malignant Breast Lesions

PURPOSE: This retrospective study evaluated the utility of shear wave elastography (SWE), Tozaki's visual pattern classification, and conventional Breast Imaging Reporting and Data System (BI-RADS) classification for differentiating between benign and malignant lesions. METHODS: Between May 2015 and July 2016, 388 patients underwent SWE and B-mode ultrasonography. The BI-RADS system was used to exclude cases with category 1–2 lesions or unbiopsied category 3 lesions. A total of 100 patients with 100 solid breast masses underwent tissue sampling (ultrasonography-guided core biopsy or vacuum-assisted biopsy) or surgical excision. The quantitative elasticity was measured for each lesion, and the imaging and histological findings were compared. RESULTS: The mean age of the patients was 51 years (range, 18–79 years). Histological examination identified 50 malignant lesions and 50 benign lesions. According to the BI-RADS classification, 20 lesions were classified as category 3, 56 as category 4, and 24 as category 5. Based on the Tozaki classification, 39 lesions were classified as pattern 1, seven as pattern 2, 23 as pattern 3, and 31 as pattern 4. If patterns 1 and 2 were assumed to be benign, and patterns 3 and 4 were assumed to be malignant, the combination of BI-RADS and SWE provided a sensitivity of 100% (50/50), a specificity of 92.0% (46/50), a positive predictive value of 92.5% (50/54), and a negative predictive value of 100% (50/50). CONCLUSION: The combination of SWE and BI-RADS was useful for evaluating breast lesions, improved the specificity of ultrasonography and may help facilitate appropriate treatment planning.

Necrotizing soft tissue infection: analysis of the factors related to mortality in 30 cases of a single institution for 5 years

PURPOSE: Necrotizing soft tissue infection is the infection of the soft tissue with necrotic changes. It is rare, but results in high mortality. We analyzed the characteristics of patients, prognosis, and mortality factors after reviewing 30 cases of a single hospital for 5 years. METHODS: From January 2009 to December 2013, 30 patients diagnosed with necrotizing fasciitis or Fournier's gangrene in Pusan National University Hospital were enrolled for this study. The following parameters were analyzed retrospectively: demographics, infection site, initial laboratory finding, initial antibiotics, isolated microorganisms, number of surgeries, time to first operation, length of intensive care unit, and total hospital stays. RESULTS: The overall mortality rate was 23.3%. Mean body mass index (BMI) of the survival group (24.7 ± 5.0 kg/m2) was significantly higher than the nonsurvival group (22.0 ± 1.4 kg/m2, P = 0.029). When BMI was less than 23 kg/m2, the mortality rate was significantly higher (P = 0.025). Two patients (6.7%) with chronic kidney disease requiring hemodialysis died (P = 0.048). Initial WBC count (>13×103/µL), CRP (>26.5 mg/dL), and platelet (PLT) count (27.6 mg/dL), serum creatinine (>1.2 mg/dL) that reflected kidney function were significant mortality factors. CONCLUSION: Patients with low BMI or abnormal values of WBC count, CRP, and PLT count reflecting the degree of infection or abnormal renal function will need more intensive care.

Necrotizing soft tissue infection: analysis of the factors related to mortality in 30 cases of a single institution for 5 years

PURPOSE: Necrotizing soft tissue infection is the infection of the soft tissue with necrotic changes. It is rare, but results in high mortality. We analyzed the characteristics of patients, prognosis, and mortality factors after reviewing 30 cases of a single hospital for 5 years. METHODS: From January 2009 to December 2013, 30 patients diagnosed with necrotizing fasciitis or Fournier's gangrene in Pusan National University Hospital were enrolled for this study. The following parameters were analyzed retrospectively: demographics, infection site, initial laboratory finding, initial antibiotics, isolated microorganisms, number of surgeries, time to first operation, length of intensive care unit, and total hospital stays. RESULTS: The overall mortality rate was 23.3%. Mean body mass index (BMI) of the survival group (24.7 ± 5.0 kg/m2) was significantly higher than the nonsurvival group (22.0 ± 1.4 kg/m2, P = 0.029). When BMI was less than 23 kg/m2, the mortality rate was significantly higher (P = 0.025). Two patients (6.7%) with chronic kidney disease requiring hemodialysis died (P = 0.048). Initial WBC count (>13×103/µL), CRP (>26.5 mg/dL), and platelet (PLT) count (27.6 mg/dL), serum creatinine (>1.2 mg/dL) that reflected kidney function were significant mortality factors. CONCLUSION: Patients with low BMI or abnormal values of WBC count, CRP, and PLT count reflecting the degree of infection or abnormal renal function will need more intensive care.

Distribution and Impact of the Visceral Fat Area in Patients With Colorectal Cancer

PURPOSE: The purposes of this study were to investigate the distribution of the visceral fat area (VFA) and general obesity and to compare visceral and general obesity as predictors of surgical outcomes of a colorectal cancer resection. METHODS: The prospectively collected data of 102 patients with preoperatively-diagnosed sigmoid colon or rectal cancer who had undergone a curative resection at Pusan National University Yangsan Hospital between April 2011 and September 2012 were reviewed retrospectively. Men with a VFA of >130 cm2 and women with a VFA of >90 cm2 were classified as obese (VFA-O, n = 22), and the remaining patients were classified as nonobese (VFA-NO, n = 80). RESULTS: No differences in morbidity, mortality, postoperative bowel recovery, and readmission rate after surgery were observed between the 2 groups. However, a significantly higher number of harvested lymph nodes was observed in the VFA-NO group compared with the VFA-O group (19.0 +/- 1.0 vs. 13.5 +/- 1.2, respectively, P = 0.001). CONCLUSION: Visceral obesity has no influence on intraoperative difficulties, postoperative complications, and postoperative recovery in patients with sigmoid colon or rectal cancer.

Long-term follow-up may be needed for pancreaticobiliary reflux in healthy adults / 대한외과학회지

PURPOSE: The reflux of pancreatic enzymes into the biliary tract is associated with chronic inflammation and increases cellular proliferation of the biliary epithelium, leading to biliary carcinoma. The aim of this study is to detect the incidence of occult pancreaticobiliary reflux (OPBR) in patients who underwent elective cholecystectomy. METHODS: Forty-seven patients with symptomatic gallstones who underwent cholecystectomy were recruited for this study. The gallbladder bile samples were obtained from the specimen of gallbladder and the amylase level was measured. The immunohistochemistry of p53, SMAD4 and Ki-67 were performed for the detection of metaplasia and dysplasia. RESULTS: Biliary amylase was higher than the serum amylase in 10 patients (group A, 15,402.66 +/- 33,592.43 IU/L; group B, 13.06 +/- 18.12 IU/L). The mean age was 67.2 years in group A and 51.2 in group B (P < 0.01). The ratio of male to female was 1:2.3 and 1:1.8 in group A and B, respectively (P = 0.297). Eight patients in group A and thirteen patients in group B had inflammation (P = 0.014). The positive results of the Ki-67 test were exhibited in five cases in each group (P = 0.024). CONCLUSION: Results from the study indicate that the age was older, degree of inflammation and positive rate of Ki-67 were higher when OPBR was suspected. In conclusion, the patients with OPBR would need long-term follow-up, because the OPBR can cause dysplasia and the reflux of pancreatic juice may be considered as a risk factor for extrahepatic bile duct carcinoma.

Clinical Outcomes of Splenic Injury

PURPOSE: The management of splenic injuries has shifted from a splenectomy to splenic preservation owing to immunity. The purpose of this study was to assess the kinds of management and outcomes through a review of our experience with splenic injuries. METHODS: We retrospectively reviewed 47 patients with traumatic splenic injuries using by electronic medical records from Jan. 2007 and Dec. 2011. Splenic injuries were classified according to the American Association for the Surgery of Trauma (AAST) grading system. RESULTS: There were 11 falls, 11 traffic accidents, 10 motorcylcle accidents, 10 pedestrian accidents and 5 abdominal blunt traumas. Low-grade injured patients ( or =Grade IV) were 18 of 43(38.3%). In 34 patients, non-surgical treatment was performed, and 14 patients underwent a splenectomy. There were relatively more high-grade in older patients, and the highgrade-injury group showed need for a transfusion (p=0.002), more need for a splenectomy (p<0.001), a longer mean hospital stay (p=0.036), a longer ICU stay (p=0.045) and more combined organ injury (p=0.036). CONCLUSION: Conservative treatment should be considered in low-grade-injury patients (< or =Grade III). A Splenectomy was performed on 56% of the patients with Grade IV injuries, so a splenectomy should be considered carefully in such patients. In patients with a grade V injury, we think surgical treatment may be needed.

Adult Intussusception due to Cecal Lymphangioma: A Case Report

We present a rare case of adult intussusception due to cecal lymphangioma. A 30-year-old female was admitted to our hospital with abdominal pain and a palpatable mass on the right lower quadrant. Preoperative radiologic studies by ultrasound and computed tomography showed ileocolic intussusception with a multiseptated cystic tumor as a leading point on the cecum. An ileocecectomy was performed, and the postoperative course was uneventful. Histopathology showed a cecal lymphangioma. Although endoscopic polypectomy or endoscopic mucosal resection is recommended for pedunculated or semi-pedunculated colonic lymphangiomas less than 2 cm in size, it is proper to treat large or symptomatic colonic lymphangiomas with limited a bowel resection or a tumor resection.

An Experimental Model of Partial Auto-liver Transplantation in Pig with Intrahepatic Inferior Vena Cava Reconstruction Using a GORE-TEX(R) Vascular Graft

PURPOSE: Experimental animal models are useful training methods for liver transplantation, despite of ethical issues. The aims of this study are to examine the technical feasibility of living donor liver transplantation in pigs and to address the ethical problems. METHODS: Eight pigs were used in this experiment. The pig liver was divided via a left hemi-hepatectomy without inflow occlusion. The GORE-TEX(R) Vascular Graft was used as a replacement for the inferior vena cava during the graft. After the bench technique, the remnant right lobe of the pig was removed. During the anhepatic phase, an abdominal aortic clamp in combination with general hypothermia was applied, instead of using a conventional bypass procedure. RESULTS: Anhepatic time was 41.3+/-7.0 min and cold ischemic time was 200.3+/-29.4 min. The 1(st), 4(th), and 8(th) pig died because of declamping shock and arrhythmia on releasing the abdominal aortic clamp. Three pigs had five postoperative complications: pneumonia, gastrointestinal bleeding, IVC thrombosis, portal vein thrombosis, and bile duct stricture. The 6th pig received a hepaticojejunostomy due to stricture of the anastomosis site at 37 days after transplantation. CONCLUSION: Pigs are economically and ethically more convenient compared to primate models. For auto-liver transplantation, no immunotherapy was needed. The pigs lived relatively long, allowing operative faults to be detected and studied. This experimental model will be useful training for living donor liver transplantation.

Intraluminal Filling Defects of the Bile Ducts: Differentiation of Stones from Tumors-the Value of Magnetic Resonance Cholangiography in Conjunction with a 3D Spoiled Gradient Echo Gadolinium Enhanced Dynamic Sequence

PURPOSE: We wanted to determinate the value of a dynamic volumetric interpolated breath-hold examination (VIBE) as a supplement to MR cholangiography for differentiating biliary stones from tumors when patient are suspected of having intraluminal filling defects on direct cholangiography. MATERIALS AND METHODS: A retrospective analysis was performed for 49 patients who underwent MRI among all the patients who showed intraluminal filling defects on direct cholangiography for evaluating the cause of their jaundice from June 2002 to June 2003. After dividing these patients into two groups, i.e., the group with stones and the group with tumors, we analyzed and compared each MR patterns of 1) signal intensity, 2) shape, and 3) enhancement. RESULTS: High signal intensity on T1-weighted images (p< 0.001, chi-square test), dark signal intensity on T2-weighted images (p< 0.01, Fisher's exact test) or smooth contour of intraluminal filling defects (p< 0.001, chi-square test) could be significantly suggestive findings of stone rather than a tumor mass. Dynamic VIBE is the most specific sequence for differentiating non-enhancing stone from an enhancing mass (p< 0.001, Fisher's exact test). CONCLUSION: We showed that MR cholangiography, when added to the dynamic VIBE sequences, could be an important imaging technique for patients who are suspected of having intraluminal filling defects on direct cholangiography to differentiate stones from tumors. Especially, the addition of dynamic VIBE images can provide the increased level of confidence in the diagnosis.

Clinical Factors Affecting Postoperative Mortality in Necrotizing Enterocolitis

PURPOSE: Necrotizing enterocolitis (NEC) is one of the most common surgical emergencies during the neonatal period. The aim of this study was to identify and assess the factors affecting the postoperative mortality in infants with NEC that require surgical treatment. METHODS: The authors retrospectively reviewed 37 infants surgically treated, at the Department of Surgery, Pusan National University Hospital, between Jan. 2000 and Dec. 2004. The patients were divided two groups according to the clinical outcomes; the survival and non-survival groups. Eight variables, i.e., sex, gestational age, weight at birth and at the time of the first operation, weight change between birth and the time of the first operation, degree of clinical manifestations (as a modified Bell's stage), interval between the onset of symptoms and the time of the first operation, the extent of necrotic intestine and associated anomalies, were analyzed. RESULTS: Among 37 infants, 6 expired (a mortality rate of 16.2%). The postoperative mortality was not affected by sex, gestational age, and the weight at birth and at the time of the first operation, weight change between birth and at the time of the first operation, degree of clinical manifestations and the interval between the onset of symptoms and the time of the first operation. However, the extent of necrotic intestine was associated with a significantly increased mortality (P=0.046). CONCLUSION: These data suggest that the extent of necrotic intestine is the only statistically significant factor affecting the postoperative mortality in infants with NEC that require surgical treatment.

Differentiation of Benign and Malignant Ulcers of the Stomach on Computed Tomography

PURPOSE: We wanted to determine the multidetector computed tomography (MDCT) findings for differentiating benign ulcers from malignant ones. MATERIALS AND METHODS: 18 clinicopathologically proven benign ulcers that had been detected by both endoscopy and MDCT were the focus of this study. 26 ulcerative advanced gastric cancers and 26 early gastric cancers with ulceration, all of which had been surgically proven, were selected as a control group. Five of the 26 early gastric cancers that were confined to the mucosa and that were not detected on CT were excluded in this study. The following CT findings were reviewed by two radiologists; ulcer size, the degree of enhancement and the thickness of inner enhancing layer in the ulcer base, the total thickness and the enhancing inner layer thickness in the largest part of the thickened ulcer mound, the presence of ulcer that projected beyond the healthy lumen, and the presence of perigastric fat infiltration and perigastric lymphadenopathy. RESULTS: An indiscernible thin-walled ulcer base (less than 1.5 mm) and suboptimal enhancement of the ulcer base for the discrimination of benign gastric ulcers from the malignant gastric ulcers showed sensitivities of 100% (18/18) and 78% (14/18), respectively, with specificities of 98% (46/47) and 92% (43/47), respectively. Ulcer projection was more significantly present in benign ulcer (13/18, 72%) than in the malignant gastric ulcers (7/47, 15%). The enhancing inner layer thickness in the ulcer mound was significantly greater in the AGC (mean: 7.4 mm) than in the benign gastric ulcers (mean, 2.2 mm). There were insignificant differences for ulcer size, total thickness of the ulcer mound, the perigastric fat infiltration and perigastric lymphadenopathy between the benign and malignant gastric ulcers. CONCLUSION: MDCT is an additional helpful diagnostic tool when benign gastric ulcers are histologically difficult to distinguish from malignant gastric ones.

The Outcome of Transanal One-stage Pull- through Procedure for Hirschsprung Disease

PURPOSE: In the management of Hirschsprung's disease (HD), conventional Duhamel's, Swenson's or Soave's procedures have generally been performed. The author tried a new procedure, a transanal one-stage pull-through procedure (TOP). The aim of this study is to compare functional outcome of TOP with the conventional procedures that are generally used in treating HD. METHODS: Thirty-one cases received TOP procedure from November 2000 to December 2003. The postoperative results were evaluated by performing a retrospective medical record review, and by using as questionnaire. These results were then compared with reports' on patients after using one of the conventional procedures. RESULTS: In this study, the mean age of patients was 73.4 days, the mean hospital stay was 5.7 days and the mean follow-up period was 20.1 months. Postoperative results were as follows: (1) 23 cases (74.2%) had 1~2 times of defecation per day. (2) 26 cases (83.9%) had no problematic soiling. (3) 22 cases (70.9%) had soft consistency of stool. (4) 24 cases (77.4%) had no straining during defecation. (5) 25 cases (80.7%) didn't need stool softner. (6) In 14 cases (45.2%), an anal dilator was necessary for transient postoperative anal stricture. (7) After 24 months of age, a diaper was not necessary in 12 cases (70.6%). (8) The parents felt satisfactory in 28 cases (90.3%) for their children, as compared with the children from other families, and the parents felt satisfactory in 18 cases (94.7%) for the HD children compared with the other children of their family.(9) 23 cases (74.2%) had not shown constipation findings on simple abdomen film. (10) At the first digital rectal examination, perianal rash was found in 13 cases (41.9%), anastomotic stricture had occurred in 12 cases (38.7%), and normal squeezing pressure was felt in 27 cases (87.1%). However, at the last examination during the follow-up period, perianal rash was found in 2 cases (6.5%), the anastomotic stricture had not persisted, and normal squeezing pressure was felt in all cases (100%). (11) On the barium study, 13 months after operation, no retention of contrast within 24 hours was shown in 21 cases (95.5%). (12) According to the SanFilippo system, there were 24 excellent cases (77.4%) and 7 good cases (22.6%), so all the cases showed a favorable functional outcome. (13) In comparison with other reports' results, there was no significant difference between the author's outcomes and other reports' outcomes (p=0.752). CONCLUSION: This transanal one-stage pull-through procedure (TOP) seems to be as effective as the traditional method for the management of HD.

Hepatic Ischemia-Reperfusion Injury according to Inflow Occlusion in Porcine Liver Surgery / 한국간담췌외과학회지

PURPOSE: There are some methods for preventing massive intraoperative blood loss during major hepatic resection such as temporary vascular occlusion, but this can consequently lead to ischemia and reperfusion injury in the remnant liver. The purpose of this study is to assess ischemia-reperfusion (I/R) injury in a porcine hepatectomy model with continuous or intermittent inflow occlusion of a prolonged duration. METHODS: We performed right hepatic lobectomy in a porcine model with a liver ischemia lasting 120 mins; there was continuous (n=4) or intermittent (8 subsequent periods of 12 min ischemia and 3 min recirculation; n=4) inflow occlusion, and this was followed by 6 hours of reperfusion. We assessed hepatocytic injury by the serum levels of liver enzymes (AST, ALT, LDH), and we assessed the hepatocellular functions by the indocyanine green clearance test, inflammatory reactions by the serum levels of IL-6, and injury to the SECs (sinusoidal endothelial cell) by hyaluronic acid uptake. We compared these parameters during a preischemic period, a ischemic period and reperfusion period between the two groups. RESULTS: There were significant differences in the serum AST levels, IL-6 levels and HA uptake between the continuous and intermittent occlusion groups. In the intermittent occlusion group, we observed 1) less severe hepatocytic injury (p= 0.041) ; 2) more preserved HA uptake meaning less I/R injury (p=0.031) ; and 3) less inflammatory responses in the reperfusion period (p=0.045). CONCLUSION: During prolonged hepatic ischemia in a porcine model, the intermittent inflow occlusion method seemed to cause less hepatocellular injury and less SEC injury when compared to the continuous occlusion method. This means that we can expect less reperfusion injury in the intermittent inflow occlusion during a major hepatic resection with a prolonged ischemia.

Transanal Posterior Anorectoplasty of Rectal Prolapse

PURPOSE: Many different procedures for rectal prolapse have been described, but optional surgical treatment remains controversial. The aim of this report is to introduce an innovative and effective method of surgical treatment to restore anal continence and anatomic correction of rectal prolapse. METHODS: Data were retrospectively collected and analyzed on 11 patients (7 male and 4 female) who underwent transanal posterior anorectoplasty for complete rectal prolapse between Jan. 1995 to Dec. 2000. This procedure is summarized to five steps as follows: 1. Partial resection of posterior rectal ampulla. 2. Longitudinal plication with posterior fixation. 3. Posterior levatorplasty. 4. One layer suture as longitudinal fashion. 5. Gant-Miwa operation-like procedure on anterior rectum. RESULTS: There were no cases of postoperative infection and bleeding. There were no cases of recurrence of the rectal prolapse except 1 case of ant. mucosal prolapse which was successfully treated with one more Gant-Miwa operation-like procedure at postoperative 3 months. Fecal incontinence were in two cases at postoperative 12 months which were estimated as grade 2 by assessment of bowel function by Kirwan. CONCLUSIONS: Although, the best operation for rectal prolapse remains controversial subject, authors believe that transanal posterior anorectoplasty should be considered as effective new surgical procedure for the treatment of rectal prolapse.

Correlation of Ultrasonographic Findings and Pathologic Prognostic Predictions in Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Increased technologic capabilities have allowed for the expanded use of ultrasound beyond simple differentiation of a lesion as solid versus cystic nature, allowing us to classify lesions into various categories based on a number of descriptive features. The purpose of this study was to investigate whether to predict the preoperative prognosis of breast cancer through the correlation between ultrasonographic images and the grade of malignancy. MATERIALS AND METHODS: The patient population for this study consisted of 107 patients with infiltrative ductal carcinoma who were evaluated using ultrasound technology. Ultrasonographic findings were divided as follows: Type I, round or oval shape and regular border; Type II, partially round or oval shape and partially irregular border; and Type III, irregular shape and irregular border. RESULTS: 1. The frequency of grade 1 (G1) was significantly higher in the Type I group than the othergroups. 2. In the 2.0 cm sized mass, the lymph node metastasis rate was significantly lower in the Type I group than the other groups. 3. In all the groups, Estrogen receptor (ER) positivity was insignificant regardless of tumor size and type. 4. In the 2.0 cm sized mass, c-erbB-2 positivity was significantly lower in the Type I than the other groups. There was no clear difference among the three groups in tumors greater than 2.0 cm in size. CONCLUSION: These results show that our classification of ultrasonographic images reflect the grade of malignancy in terms of clinicopathological features in breast cancers less than 2.0 cm in size. Therefore, ultrasonographic findings may help predict the preoperative prognosis in T1 size breast cancer, although further study is required.

The role of intermittent hepatic pedicle clamping on oxygen-derived free radical generation in the rat liver / 한국간담췌외과학회지

BACKGROUND/AIMS: The tolerance of the liver to ischemia during intermittent hepatic pedicle clamping was compared with that during continuous hepatic pedicle clamping, and intermittent hepatic pedicle clamping was thought to more tolerable to ischemia/reperfusion injury. The mechanisms underlying this were unknown. We examined the relationship between ischemia/reperfusion injury and the production of oxygen-derived free radicals using spin resonance spectrometry. METHODS: Adult male Sprague-Dawley rats were subjected to either continuous or intermittent hepatic pedicle clamping. Alpha-(4-pyridyl 1-oxide)-N-tert-butylnitrone was administered to rats as a spin trap agent. Continuous clamping (15, 30, or 60 minutes) or intermittent clamping(four cycles of 15-minutes ischemia and 5 or 15 minutes of reperfusion) of hepatic pedicle was carried out. After reperfusion, blood samples were obtained and measuring liver enzyme to evaluate hepatic injury. Hepatic tissue blood flow was measured using a color Doppler blood flowmeter. RESULTS: When there was a longer period of hepatic pedicle occlusion, increased oxygen-derived free radical generation was detected after reperfusion. There was no significant increase in oxygen-derived free radical production or liver enzymes leakage when the duration of ischemia was 15 minutes. Oxygen-derived free radical generation and liver enzyme leakage were significantly less in intermittent pedicle clamping than in continuous clamping for 60 minutes. CONCLUSION: According this results, there is a oxygen-derived free radicals and liver damage in less in intermittent pedicle clamping than continuous clamping although many oxygen-derived free radicals are produced.

Clinical Review of Traumatic Pancreatic Injuries / 한국간담췌외과학회지

BACKGROUND: Due to its anatomical location and vague symptom, early diagnosis of traumatic pacreatic injury is difficult. Furthermore it is very difficult to carry out appropriate management for the injury, so morbidity and mortality rates of traumatic pancreatic injuries remain high. Patients and METHODS: We reviewed medical records of 35 cases of patients who had been diagnosed as pancreatic injury and operated at Department of Surgery, Busan National University College of Medicine between January 1995 and December 2000. RESULT: 1) The male to female ratio was 2.5:1 and the highest incidence occurred in the 4th decade(31.3%). 2) Thirty two cases(91.4%) were injured by blunt trauma and 3 cases(8.6%) were injured by penetrating trauma. 3) The most common clinical manifestation was abdominal pain. 4) Twenty two patients(62.9%) were operated within 24hours after injury, and the mean time interval between injury and operation was 26.4 hours. 5) The serum amylase levels higher than 150 somogi unit were recorded in 20 cases(57.1%) of the patients. 6) Twenty seven patients(77.1%) had another associated injury with an average of 2 associated intraabdominal injuries. The most frequently injured intraabdominal organ was mesentery. 7) Complications occurred in 20 of 35 patients(57.1%) and the most common complication was pancreas-related complications, such as fistula, pseudocyst, abscess, pancreatitis. 8) Six patients(17.1%) were died due to hypovolemic shock, sepsis, respiratory failure and renal failure. CONCLUSION: Early diagnosis and appropriate operative methods may reduce morbidity and mortality from traumatic pancreatic injury

Factors Influencing the Pancreatic Leakage after Pancreaticoduodenectomy / 한국간담췌외과학회지

BACKGROUND/AIMS: Pancreaticoduodenectomy is the procedure of choice in patients with periampullary cancers. Marked improvements in morbidity and mortality rates following pancreaticoduodenectomy have been reported in recent years. However, pancreatic leakage still occurs in 5% to 25% of patients and is a major cause of morbidity and mortality. METHODS: Between January 1990 to June 1999, eighty-two patients underwent pancreaticoduodenectomy. We compared preoperative, intraoperative characteristics as well as postoperative sandostatin usage in those patients who experienced (n=21) versus those who did not experience pancreatic leakage (n=61). Information was retrospectively collected from hospital record. RESULTS: The clinical leakage rate in this series was 25.6% (n=21). There were no significant differences in preoperative characteristics comparing those with versus those without pancreatic leakage. Among intraoperative characteristics, duct stenting and transfusions were significantly associated with the pancreatic leakage. Finally, postopeative sandostatin usage was able to reduce significantly the incidence of pancreatic leakage. CONCLUSION: Although consensus among surgeons does not exist as to opeative tenchnique and postoperative management, stenting and less bleeding as well as sandostatin usage had better results in this study.

The influence of fasting on preserved liver and transplantation outcome : an animal experiment / 한국간담췌외과학회지

During liver transplantation, as a rule, liver can be preserved for 24 hr or more. Livers can be successfully preserved with simple cold storage, but some transplanted livers may have poor or no(primary nonfunction) function. Several factors have been investigated to aid in the production of primary nonfunction. No single parameters has been established absolutely governing the acceptance of a donor for organ harvest. The quality of the liver may dependent upon many factors, such as the time of preservation and the condition of the donor may contribute, too. In this study, we have investigated the effects of fasting on the quality of liver preservation by simple cold storage. Mixed breed pigs(30-40kg) were fasted for 72hr, livers preserved for 12hr, and viability determined by orthotopic transplantation. The liver function(AST, LDH) was examined 1 hr, 6 hr, 24 hr after transplantation. Livers from fasted animals were less viable than livers from fed animals. Pigs receiving livers from fed animals preserved for 12 hr had better survived than livers from fasted animals. The results show that the nutritional status of the donor can affect the outcome of liver preservation and transplantation. Increased injury in livers from fasted animals may be due to the loss of glycogen that may be an essential source of energy in the initial posttransplantation period. In clinical setting, donor's nutritional status may be an important factor in the initial function of the transplanted liver, and methods to increase donor's nutritional status may be important in increasing the quality of liver.