A Case of Pleomorphic Liposarcoma Originating from Mesentery / 대한소화기학회지

Liposarcoma is one of the most common soft tissue sarcomas that occurs in adults and is currently divided into five main subgroups: well-differentiated, myxoid, round cell, pleomorphic, and dedifferentiated. Primary mesenteric liposarcoma is extremely rare, and the treatment strategy is surgical resection with a wide free margin, often followed by radiation and adjuvant chemotherapy if distant metastasis is not detected. A 73-year-old male patient presented with lower abdominal distension. Abdominal CT scan revealed a large homogeneously enhancing mass lesion abutting the sigmoid colon and urinary bladder. At laparotomy, the solid mass measured 28x26x12 cm in size, was well-demarcated, and originated from the mesentery of the middle ileum. It was removed along with some small intestine (ileocecal valve upper 50-150 cm) and ileal mesentery because of adhesion. Histologically, the tumor proved to be pleomorphic liposarcoma. The patient did not undergo any adjuvant treatment following surgery, but he remains disease free until 33 months after surgery. Herein, we report a case of pleomorphic liposarcoma arising from small bowel mesentery.

A Case of Traumatic Inferior Mesenteric Arteriovenous Fistula / 대한소화기학회지

Inferior mesenteric arteriovenous fistula is rare and may be congenital or acquired. Affected patients present with abdominal pain, mass, or manifestations of portal hypertension and bowel ischemia. Until now, inferior mesenteric arteriovenous fistula due to trauma has not been reported. Herein, we report a case of a 53-year-old woman who had inferior mesenteric arteriovenous fistula considered to have originated from remote blunt trauma that was successfully treated by surgical resection of only the arteriovenous fistula without colectomy. To our knowledge, this is the first case of traumatic inferior mesenteric arteriovenous fistula.

Comparative Analysis of Laparoscopic Versus Open Appendectomy for Perforated Appendicitis in Children Under 12 Years Old at a Single Institute

PURPOSE: The purpose of this study is to evaluate the outcome of laparoscopic (LA) vs. open appendectomy (OA) in children under 12 years old with perforated appendicitis. METHODS: We reviewed the medical files of 156 children who underwent LA (n=96), OA (n=59), and conversion (CO) (n=1), and compared duration of operation, length of hospital stay, incidence of wound infection, mechanical ileus, intra-abdominal abscess (IAA), and re-admission. RESULTS: Compared to OA, LA resulted in longer duration of operation (58.32+/-17.105 min vs. 44.27+/-18.735 min; p=0.001), but fewer wound infections (2.1% vs. 10.2%; p=0.054), and fewer cases of mechanical ileus (0% vs. 5.1%; p=0.053). No differences in the length of hospital stay (5.85+/-1.824 days vs. 6.10+/-3.027 days; p=0.526), IAA (2.1% vs. 1.7%; p=1.000), or re-admissions (2.1% vs. 5.1%; p=0.369) were observed. CONCLUSION: We report that although LA showed an association with longer duration of operation compared to OA, it is superior to OA with regard to incidence of wound infection and mechanical ileus.

Comparative Analysis Between Totally Extraperitoneal Repair and Prolene Hernia System at a Single Institute

PURPOSE: Laparoscopic hernioplasty is a standard procedure used for the repair of inguinal hernia. However, due to the technical and anatomical complexities associated with this treatment and the requirement for long surgery time as compared to other methods, the use of laparoscopic hernioplasty remains questionable. This study compared the results of two surgical repair methods: totally extraperitoneal (TEP) hernia repair and the Prolene hernia system (PHS). METHODS: A retrospective review was conducted of all patients who underwent TEP (154 cases) and PHS (126 cases) from January 2008 to December 2010 as performed by a surgeon at our hospital. Operating time, length of hospital stay, recurrence rate, surgical site infection rate, wound hematoma rate and scrotum swelling rate were all compared. RESULTS: For the TEP treatment cases the mean operating time was 59.5 min, mean hospital stay was 4.9 days, there were 2 cases (1.3%) of recurrence, one case (0.6%) of surgical site infection, 20 cases (12.9%) of wound hematoma and 8 cases (5.2%) of scrotum swelling. In the case including treatment by PHS the mean operating time was 39.6 min, mean hospital stay was 5.4 days, there were no cases of recurrence, there were 2 cases (1.7%) of surgical site infection, 11 cases (9.5%) of wound hematoma and 12 cases (10.3%) of scrotum swelling. There were no cases involving neurogenic pain or chronic pain. CONCLUSION: Both PHS and TEP are safe and effective procedures for repairing inguinal hernia. Thus, with consideration of variable patient conditions and other factors, either PHS or TEP are recommended as viable procedures for treating inguinal hernia.

Single-center Comparative Study of Laparoscopic Versus Open Colon Surgery

PURPOSE: To examine the change in practice from open to laparoscopic practice in our local trust and compare the benefits with those of an open surgery group. METHODS: This retrospective comprehensive review analyzed 225 patients who underwent resection of colon cancers at the Dae Jin Medical Center, including 182 who underwent laparoscopic surgery (LAC) and 43 who underwent conventional open surgery (OC), conducted by a single surgeon from August 2002 to August 2010. The LAC group was divided into two groups, 50 patients during the early period and 132 patients during the late period, and short-term and oncologic outcomes were recorded. Patients identified through clinical coding and data were analyzed using the Statistical Package for Social Sciences, version 18.0 (2009. SPSS Inc. USA). RESULTS: Comparisons of 43 open versus 50 early and 132 late laparoscopic colon surgeries for various indications and outcomes were made. The operative time was longer in the LAC group (early and late LAC group) than in the OC group. However, post operative recovery time (hospital stay, days to sips of water and days to soft diet) was significantly shorter in the early and late LAC group than in the OC group. There was no significant difference between the LAC groups and open group with respect to age, sex, American Society of Anesthesiologists, tumor-node stage, morbidity, mortality, overall survival rates, disease free survival rates and recurrence rates. CONCLUSION: In our experience, laparoscopic surgery resulted in acceptable short term outcomes and our results support those of other studies with respect to clinical outcomes of laparoscopic surgery.

Herpes Simplex Virus 2 Infection Rate and Necessity of Screening during Pregnancy: A Clinical and Seroepidemiologic Study

PURPOSE: This study determined the seroprevalence of herpes virus 2 in gravidas and the differences between herpes virus 2-infected and healthy gravidas. The need to screen gravidas for herpes virus 2 was also evaluated. MATERIALS AND METHODS: A retrospective analysis involving 500 gravidas who underwent herpes virus 2 serologic testing and delivery in our hospital between January 2009 and August 2010 was performed. All patients in the study group were classified as herpes simplex virus 2 (HSV2) positive, and all cases were analyzed with respect to the clinical course of the pregnancy, pregnancy outcome, obstetric complications, and neonatal outcomes. SPSS software (version 14.0) was used for statistical analysis. A chi-square test and Student's t-test were used for statistical analysis. RESULTS: In the current study, the herpes virus 2 seroprevalence rate in gravidas was 17%. There was no significant difference in the rates of preterm delivery, premature rupture of membranes, preterm labor, and intrauterine growth restriction between the herpes virus 2-infected gravidas and the healthy control group. The rates of spontaneous abortion and sexually transmitted disease were higher in the herpes virus 2 infection group than the healthy control group. CONCLUSION: After educating gravidas on genital herpes and, if gravidas thereafter consent to herpes virus 2 screening, the risk of neonatal herpes virus 2 infections can be reduced. In addition, examination of gravidas for sexually transmitted diseases would increase as would appropriate treatment.

The Variation of Hepatic Duct Confluence and Asymptomatic Common Bile Duct Stone with Routine Intraoperative Cholangiogram during Laparoscopic Cholecystectomy / 대한소화기학회지

BACKGROUND/AIMS: Intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC) has been used to evaluate bile duct stone. But, the routine use of IOC remains controversial. With routine IOC during LC, we reviewed the variation of hepatic duct confluence and try to suggest the diagnostic criteria of asymptomatic common bile duct (CBD) stone. METHODS: We reviewed the medical record of 970 consecutive patients who underwent LC with IOC from January 1999 to December 2009, retrospectively. RESULTS: Nine hundered seventy patients were enrolled. IOC were successful in 957 (98.7%) and unsuccessful in 13 (1.3%). Eighty two of 957 patients (8.2%) were excluded because of no or poor radiologic image. According to Couinaud's classification, 492 patients (56.2%) had type A hepatic duct confluence, 227 patients (26.1%) type B, 15 patients (17%) type C1, 43 patients (4.9%) type C2, 72 patients (8.2%) type D1, 21 patients (2.4%) type D2, 1 patient (0.1%) type E1, 1 patient (0.1%) type E2, 2 patients (0.2%) type F, and 1 patient (0.1%) no classified type. The CBD stone was found in 116 of 970 (12.2%) patients. In 281 patients, preoperative serologic and radiologic tests did not show abnormality. When preoperative findings were not remarkable, there was no difference of clinical features between patients with or without CBD stones. CONCLUSIONS: Although IOC during LC has some demerits, it is a safe and accurate method for the detection of CBD stone and the anatomic variation of intrahepatic duct.

Comparsion of Laparoscopic Appendectomy vs Open Appendectomy in Non-Complicated Appendicitis and Complicated Appendicitis / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic appendectomy has many benefits compared to the open technique, such as easy localization of the appendix, less scarring for cosmetic reasons and less reported wound infection. However, for patients with complicated appendicitis, controversy exists as to whether laparoscopic appendectomy is a safe procedure. Some recent studies have reported no significant difference of the complication rate compared to that of the open procedure, suggesting that laparoscopic appendectomy could be used as an alternative procedure. This study was performed to evaluate the safety and benefits of laparoscopic appendectomy as compared to that of the open technique for treating complicated and uncomplicated appendicitis. METHODS: We studied the patients who underwent appendectomy by either the laparoscopic or open technique at Bundang Jaesaeang General Hospital between January 2005 and September 2008. Of the total 2,226 patients, there were 168 patients in the laparoscopic appendectomy (LA) group and 2,058 patients in the open appendectomy (OA) group. We compared the patient demographic data and perioperative outcomes of the two groups. RESULTS: Both patient groups were comparable in terms of age. The mean operative time was 91.8 minutes in the LA group and 47.2 minutes in the OA group (p<0.00). There were no significant differences between the two groups in terms of the mean hospital stay. The noncomplicated appendicitis LA group showed a quicker time to start an oral diet (p=0.03) & wound infection (p=0.032). For complicated appendicitis, there were no differences of wound infection & intestinal obstruction between the two groups. CONCLUSION: Although laparoscopic appendectomies requires a longer operation time, it did not lengthen the hospital stay nor delay the start of a soft oral diet. Appendiceal abscess in complicated appendicitis did not occur in the laparoscopic or open appendectomy groups. Therefore, laparoscopic appendectomy is a safe procedure for both complicated and uncomplicated appendicitis. To reach a final consensus on the scope of this study, a prospective randomized controlled study is needed in the near future.

The Learning Curve for Totally Extraperitoneal (TEP) Repair in Inguinal Hernia / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic totally extraperitoneal (TEP) repair has been increasingly used for the treatment of inguinal hernias. This procedure is a very difficult technically and it requires a great deal of experience. However, there are only few studies on the learning curve (LC) of this procedure in the Korea literature. The aim of this study is to determine the number of case that are needed to overcome the learning curve of TEP hernia repairs and to document the surgical and clinical differences before and after overcoming the LC. METHODS: This study retrospectively reviewed 96 TEP hernia repairs that were performed by a single surgeon. The time required to overcome the LC was determined by examining the operation time. The preoperative and postoperative clinical data, such as incidental intraoperative findings, the rate of operative morbidity, the rate of conversion to an open procedure and the length of the postoperative hospital stay, were compared between the before and after groups with overcoming the LC. RESULTS: The 40th case was determined to be the transition point of overcoming the LC according to the operation time. The time before overcoming the LC averaged 73.0 minutes compared to 55.6 minutes after overcoming the LC. The postoperative hospital stay and the conversion rate were all significant (p<0.05). However, the other postoperative outcomes did not show significant differences. CONCLUSION: Based on the plateau of the operative time, this study shows that the downward slope of LC for TEP repair is at the 40th operation.

Correlation between the cord blood concentarion of leptin and maternal, placental, fetal factors in uncomplicated singleton pregnancy / 대한산부인과학회지

OBJECTIVE: Umbilical leptin concentrations have been associated with whole-body mineral content, fetal bone growth stimulation, pulmonary development in utero, nutritional intake, energy metabolism, and adiposity in children and adults. In this study, we investigated the effect of maternal factor, placental factor and fetal factor on cord blood leptin concentrations. METHODS: We measured leptin concentration in umbilical cord blood using immunoradiometric assay in 50 women with uncomplicated singleton term pregnancies. we analyzed the correlation of leptin level with maternal age, sex, gestational age, smoking, placental weight, neonatal body mass index, maternal body mass index, head circumference, and chest circumference by simple linear regression. RESULTS: There were significant correlation between leptin and gestational age, fetal BMI, head circumference, and chest circumference with correlation coefficient 0.244 (P=0.010), 0.182 (P=0.030), 0.243 (P=0.011), and 0.228 (P=0.014), respectively in the male neonates. There were significant correlation between leptin and fetal BMI with correlation coefficient 0.341 (P=0.003) in the female neonates. No statistically significant correlation between the concentration of leptin and neonatal gender was observed, in spite of higher mean value of female leptin concentration level. Also no statistically significant correlation between the concentration of leptin and smoking and drinking of mother was observed. CONCLUSION: In this study, leptin is significantly correlated with maternal age, maternal BMI, gestational age, fetal BMI, and chest circumference. It was suggested that leptin level was more associated with maternal factor and fetal factor than placental factor.

Expression of p53 and bcl-2 in Gastric Adenocarcinoma Affects the Prognosis and Survival Rate

PURPOSE: p53 and bcl-2 are important markers of apoptosis. The expression of p53 and bcl-2 in gastric adenocarcinoma was examined in relation to prognosis and survival rate. MATERIALS AND METHODS: The clinicopathologic data from 238 patients who underwent gastrectomies for gastric adenocarcinoma between December 1999 and July 2007 were reviewed. Immunohistochemical staining of gastric adenocarcinoma tissues embedded in paraffin blocks was performed using an Envision kit (DAKO, Glostrup, Denmark). Statistical comparisons were made between age, gender, tumor invasion, lymph node metastasis, TNM stage, Lauren's classification, cell differentiation, and the relationship with p53 and bcl-2. RESULTS: The expression of p53 was related to cell differentiation (P=0.028) and UICC TNM stage (P<0.001). The expression of bcl-2 was related to UICC TNM stage (P=0.005). The co-expression of p53 and bcl-2 was related to UICC TNM stage (P=0.002). The co-expression group exhibited a greater reduction in the survival rate (P=0.001). CONCLUSION: The expression of p53 and bcl-2 nuclear proteins has significant relationships with other conventional prognostic factors and the survival rate. Bcl-2 will be characterized through analysis of a greater number of patients and comparison with survival data over a longer period of time.

Concurrent Malignant Carcinoid Tumor and Benign Carcinoid Tumor of the Rectum / 대한소화기내시경학회지

Neuroendocrine cells are distributed throughout the body and they are found in the gastrointestinal tract, pancreas, lung, thyroid, adrenal gland and many other organs, and especially the gastrointestinal tract. As a consequence, neuroendocrine tumors of the colon and rectum are common neoplasm. Several cases of the benign carcinoid tumor and a few cases of the malignant carcinoid tumor of the colon and rectum have been reported. Yet there have been no reports on concurrent malignant carcinoid tumor and benign carcinoid tumor at the same site of the colon. A 60-year-old man presented with an asymptomatic rectal mass. After the mass was evaluated and operated on, it was confirmed to be a concurrent malignant carcinoid tumor and benign carcinoid tumor of the rectum, and metastasis to the liver was also found.

An unusual foreign body in the bladder 5 years after a laparoscopic burch colposuspension / 대한산부인과학회지

Stress urinary incontinence is the predominant symptom in young and middle-aged women. Stress urinary incontinence is not a life-threatening disease but can lead to discomfort, which can also limit the social and sexual activities of women. Lately TOT operation is performed in most cases of stress urinary incontinence. But Burch colposuspension had been one of successful operations for genuine stress incontinence until TOT procedure was performed. Burch colposuspension has significant morbidity such as bleeding, infection and wound hematoma, and subsequent complications including voiding difficulty, de novo detrusor instability, recurrent urinary tract infection and uterovaginal prolapse. In this case, Delayed migration of the suture and bolster after an endoscopic Burch colposuspension across tissue planes, with subsequent erosion into the bladder, is uncommon. We report an unusual complication 5 years after Burch operation. It was an intravesical foreign body granuloma caused by suture material.

A case of one fetal demise of twin pregnancy by umbilical artery stricture / 대한주산의학회잡지

A death of one fetus in twin pregnancy is a rare obstetric complication. And the stenosis of umbilical cord artery is a very rare complication of cord abnormalities. The umbilical cord showed a false knot due to accentuation of a vascular spiral with a dilated vein and two arteries with incomplete patency of the lumen. This is the first report of single demise of twin pregnancy due to umbilical artery stenosis and umbilical vein varix.

Comparative Study of the Clinicopathologic Characteristics between Gastrointestinal Stromal Tumors Arising from the Stomach and Small Bowel

PURPOSE: The purpose of this study is to compare the clinicopathological characteristics of stomach and small bowel gastrointestinal stromal tumors and to determine the risk factors and treatment guidelines. MATERIALS AND METHODS: Among 38 patients who were diagnosed with a gastrointestinal stromal tumor from August 1998 to May 2006, 29 patients at the Pundang Jesaeng General Hospital, Daejin Medical Center were evaluated. The clinicopathological characteristics of gastrointestinal stromal tumors arising from stomach and small bowel were compared. Immunohistochemical staining for CD117, CD34, smooth muscle actin, desmin, and S-100 protein was performed and classified according to NIH criteria. Prognosis between groups was analyzed according to NIH criteria. RESULTS: There was no significant difference in the clinicopathological characteristics and prognosis between gastrointestinal stromal tumors arising from the stomach and small bowel. Recurrence of the disease occurred in four (13.8%) patients. Classification of gastrointestinal stromal tumors according to NIH criteria was predictive of recurrence (P=0.030). CONCLUSION: NIH criteria were predictive of recurrence, but the location of the primary site was not predictive of recurrence. A further study involving multi center data and a long-term follow-up will be needed for formulating diagnostic and therapeutic guidelines.

Comparison between Lichtenstein and Prolene Hernia System (PHS) in Anterior Tension-Free, Inguinal & Femoral Hernioplasty

PURPOSE: The aim of this study was to see if there are any differences in the post-surgical outcomes between 2 tension-free hernioplasty methods. METHODS: We selected those patients with unilateral, bilateral inguinal hernias and femoral hernias who had undergone Lichtenstein n=224) and PHS (n=62) mesh hernioplasty at the Pundang Jaesang Hospital, Department of Surgery, between January 2000 and February 2004, and compared the post-surgical results of each method. The factors analyzed for this comparative study included the patient's age, gender, operation time, length of hospital stay, use of analgesics, cost and recurrences. RESULTS: The results from the statistic showed significant differences between the 2 methods with respect to postoperative pain, cost, duration of hospital stay and recurrences. CONCLUSION: The PHS hernioplasty is a superior method to that of Lichtenstein's herni-oplasty in terms of hospital stay, operation time, postoperative pain & recurrences.

A Clinical and Statistical study of Pregnancy and Delivery in the Mid-teenager mothers / 대한산부인과학회지

OBJECTIVE: This study is designed to help pregnancy and delivery of mid-teenager mothers by analyzing the clinical features of pregnancy and delivery of mid-teenager mothers ranging from 13 to 16 years old. METHODS: This study includes 77 mothers aged 16 years and younger among the 3,863 mothers who delivered in our hospital from January 1998 to December 2005. We selected 100 mothers who aged between 17 and 19 years, 100 mothers who aged between 20 and 29 years as control groups respectively during the same period and statistical analysis is applied to compare the results. RESULTS: In this study, mid-teenagers constitutes 1.99% of all pregnant women. The number of antenatal care, the number of women experienced abortion, and age of menarche were significantly low in the mid-teenager mothers. Especially, the risks of anemia and meconium staining were significantly higher and the rate of cesarean section was significantly lower than those of the mothers in twenties. The risks of prematurity, low birth weight infant, preterm labor, and birth canal injury were higher than those of control groups, but there were no significant differences in three groups. CONCLUSION: Mid-teenager mothers were known to be high risk mothers in obstetrics due to immaturity in physics and low socioeconomic status. However, the risks can be decreased by adequate prenatal care, sufficient nourishment and maintenance of good habits based on medical and socioeconomic supports.

Two Cases of Cerebral Hemorrhage in the Antepartum and Postpartum / 대한산부인과학회지

Pregnancy and the puerperium are associated with an increased risk of stroke, and stroke is considered an important cause of maternal morbidity and mortality during this time. Pregnancy and delivery can lead to substantial alterations in systemic arterial and venous hemodynamics that may predispose to cerebrovascular disorders. We present one case of cerebral hemorrhage in puerperium after a normal pregnancy without any manifestation of preeclampsia or eclampsia and the other case with recurred cerebral hemorrhage in 16 gestational weeks pregnancy with previous cerebral hemorrhage history.

A case of solitary retroperitoneal recurrence of granulosa cell tumor / 대한산부인과학회지

Granulosa cell tumor is a rare ovarian neoplasm. It's indolent growth leads to large tumor at time of diagnosis. It is characterized by variable and long interval to recurrence in pelvic and peritoneal cavities, but solitary retroperitoneal recurrence is very rare. At laparotomy, a 52-years-old woman was found to have an oval shaped cystic tumor near left renal hilar region. Ten years ago, she had total hysterectomy with bilateral salpingo-oophorectomy due to left ovarian granulosa cell tumor. Histological features of the retroperitoneal tumor were granulosa cell tumor. We report a rare case of solitary retroperitoneal recurrence of granulosa cell tumor with a review of relevant literatures.

A Case of Pheochromocytoma Antenatally Diagnosed in the Mid Gestation / 대한주산의학회잡지

Pheochromocytoma during pregnancy is very rare tumor, and this condition is life threatening to both mother and fetus. We describe a case of pheochromocytoma antenatally diagnosed at the midtrimester in gestation. A patient was transferred to National Medical Center during gestational week 24 with severe hypertension, generalized edema. Pheochromocytoma caused by a left adrenal mass was diagnosed. The patient was treated with titrated dose of phenoxybenzamine, propranolol, and intravenous nicardipine, but, intermittent severe hypertension was developed. At 33 weeks gestation, fetal distress was developed, and emergent c-sec was done. Two weeks after delivery, she underwent a successful left adrenalectomy. Two months after surgery, all antihypertensive medications were discontinued and her blood pressure have remained normal range.