The Feasibility of Recovered Warm Ischemic Injury on Non-heart-beating Donor Liver by Hepatocyte Growth Factor in Animal Model / 대한이식학회지

PURPOSE: Liver transplantation is the therapy of choice for patients with acute and acute-on-chronic severe liver failure or hepatocellular carcinoma. But a suitable liver is not always available for transplantation due to limited donor numbers. To increase the number of available liver for transplantation, a non-heart-beating donor (NHBD) liver transplant program is started. In NHBD liver transplantation, warm ischemic injury of liver occurs. The duration of warm ischemia is thought to be the most important risk factor for postoperative complications such as primary nonfunction or severe hepatic dysfunction. Recent evidence indicates that hepatocyte growth factor (HGF) plays an important role as a cytoprotector against hepatic injury by anti-apoptotic effect and mitogen in liver regeneration. Therefore studies also were performed to examine whether HGF influenced the viability and regeneration of hepatocytes from rats, subjected to prolonged warm ischemic injury. METHODS: Male Sprague- Dawley rats were subjected to non-heart-beating death by cervical spine fracture. Rats left in room temperature directly after, 30-minutes, 1-hours before surgery and perfusion was performed for isolating hepatocyte. Among three groups, hepatocyte viability was compared by trypan blue stain. And isolated hepatocytes from 30-minutes warm ischemic group were cultured for 24-hours, which were treated with no HGF and addition of various doses (5 ng/mL, 10 ng/mL, 20 ng/ mL, 40 ng/mL, 100 ng/mL) of HGF. Anti-apoptosis and regeneration of hepatocyte were compared by LDH assay, MTS assay, western blot, and immunocyto-chemistry after a 24-hours culture. RESULTS: The results of hepatocyte viability along the prolonged warm ischemic groups in isolated hepatocytes decreased sequentially 74.8+/-12.6%, 45.0+/-5.4%, 37.8+/-10.4% along directly after, 30-minutes, 1-hours in trypan blue stain (P<0.01). And 24-hour-cultured hepatocytes from 30-minutes warm ischemic group were treated with HGF. The results of LDH assay, MTS assay did not have relation with HGF addition. But the results of western blot and immunocytochemistry shown that HGF doses dependent anti-apoptosis and regeneration of hepatocyte increased. That indicates HGF presumably inhibites apoptotic pathway by phosphorylation. And HGF also makes hepatocyte hypertrophy and albumin synthesis. CONCLUSION: HGF was a potent cytoprotector against hepatic injury by anti- apoptotic effect and mitogen of liver regeneration in NHBD liver animal model. HGF facilitates recovery of the liver from prolong warm ischemic injury. If the more clinical studies and large animal studies are performed, NHBD using liver transplantation will be available with more chances by HGF.

Duodenal Perforation in a Child with Henoch- Schoenlein Purpura

Henoch-Schoenlein purpura is predominantly a childhood disease with good prognosis. It is characterized by nonthrombocytopenic purpura, arthritis, arthralgia, gastrointestinal symptoms and glomerulonephritis. Abdominal pain is the most common gastrointestinal symptom, however, some patient with Henoch-Schoenlein purpura have gastrointestinal major surgical complication such as intussusception, bowel infarction, necrosis, stricture and perforation. We report a case of duodenal perforation in a 6-year-old boy with Henoch-Schoenlein purpura, being treated with corticosteroids.

A Clinical Analysis of Abdominal Stab Injuries

PURPOSE: This study was done to evaluate the incidence, type of injury, medical consequences, mortality, and prognostic factors associated with stab wounds in patients who visited Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea. METHODS: A retrospective analysis of the clinical data of 40 patients with abdominal stab wounds who visited Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea from January 1, 2000 to December 31, 2004. RESULTS: 1) The most prevalent age group was patients in their the twenties to fourties (77.5% of all patients), and average age of the patients was 39.3 years. The male-to-female ratio was 2.07:1. 2) The external site of stab wounds was most commonly the periumbilcal area of the abdomen (14 cases, 33.3%). 3) The most commonly injured organs were the liver and the stomach (10 cases each, 16.9%). 4) Operations were performed on all 40 patients, with 9 (22.5%) negative operation findings. 5) Death occurred in 5 cases (12.5%). 6) The trauma indices of the death group were TRISS 51.9%, RTS 3.6 points, and APACHE II 23.0 points. 7) The average transfusion amount of the death group was 13.8 pints CONCLUSION: These data suggest that the transfusion amount and the trauma index of abdominal stab injuries may be statistically significant factors for predicting mortality.

A Clinical Analysis of Abdominal Stab Injuries

PURPOSE: This study was done to evaluate the incidence, type of injury, medical consequences, mortality, and prognostic factors associated with stab wounds in patients who visited Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea. METHODS: A retrospective analysis of the clinical data of 40 patients with abdominal stab wounds who visited Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea from January 1, 2000 to December 31, 2004. RESULTS: 1) The most prevalent age group was patients in their the twenties to fourties (77.5% of all patients), and average age of the patients was 39.3 years. The male-to-female ratio was 2.07:1. 2) The external site of stab wounds was most commonly the periumbilcal area of the abdomen (14 cases, 33.3%). 3) The most commonly injured organs were the liver and the stomach (10 cases each, 16.9%). 4) Operations were performed on all 40 patients, with 9 (22.5%) negative operation findings. 5) Death occurred in 5 cases (12.5%). 6) The trauma indices of the death group were TRISS 51.9%, RTS 3.6 points, and APACHE II 23.0 points. 7) The average transfusion amount of the death group was 13.8 pints CONCLUSION: These data suggest that the transfusion amount and the trauma index of abdominal stab injuries may be statistically significant factors for predicting mortality.

Usefulness of the recombinant liver stage antigen-3 for an early serodiagnosis of Plasmodium falciparum infection

In order to develop tools for an early serodiagnosis of Plasmodium falciparum infection, we evaluated the usefulness of P. falciparum liver stage antigen-3 (LSA-3) as a serodiagnostic antigen. A portion of LSA-3 gene was cloned, and its recombinant protein (rLSA-3) was expressed in Escherichia coli and purified by column chromatography. The purified rLSA-3 and 120 test blood/serum samples collected from inhabitants in malaria-endemic areas of Mandalay, Myanmar were used for this study. In microscopic examinations of blood samples, P. falciparum positive rate was 39.1% (47/120) in thin smear trials, and 33.3% (40/120) in thick smear trials. Although the positive rate associated with the rLSA-3 (30.8%) was lower than that of the blood stage antigens (70.8%), rLSA-3 based enzyme-linked immunosorbent assay could detect 12 seropositive cases (10.0%), in which blood stage antigens were not detected. These results indicate that the LSA-3 is a useful antigen for an early serodiagnosis of P. falciparum infection.

Early Results of Transilluminated Powered Phlebectomy for Primary Varicose Vein of the Lower Limbs

PURPOSE: To determine the efficacy and safety of endoscopic resection and ablation of superficial varicose vein using a powered vein resector and irrigated illuminator. METHODS: Forty-three limbs in 29 patients were involved in our hospital study. The clinical records between August 2002 and February 2004 were reviewed. All patients were treated with a minimally invasive, powered vein resecting device, using cutaneous transillumination and tumescent fluid under general or spinal anesthesia. RESULTS: The 29 varicose vein patients were composed, (19 men (65.5%) and 10 women (34.5%), with a mean age of 56.9 years. The most common symptom or sign of varicose vein was an unsightly vein (15 patients, 51.7%). Fifteen unilateral (5: right, 10: left) and 14 bilateral operation for varicose veins were performed. The mean operative time, number of skin incisions and length of hospital stay were 34.2 minutes, (ranging from 26 to 58, 3.2 sites, (ranging form 2 to 6) and 3.3 days, (ranging from 2 to 6). Postoperative complications occurred in 12 limbs (27.9%), including skin perforation (1 limb, 2.3%), wound abscess (1 limb, 2.3%), cellulitis (1 limb, 2.3%), lower limb pain (4 limbs, 9.3%), edema (2 limbs, 4.7%), hematoma (1 limb, 2.3%), remaining varicose vein (1 limb, 2.3%) and paresthesia (1 limb, 2.3%). CONCLUSION: This study showed that the TIPP (TriVexTM) technique for varicose vein removal was swift and efficacious. When performed by trained surgeons the complication rates of the technique were comparable with those of conventional surgery, with the advantages of a trend toward reduced operating times in extensive varicose vein, and significantly fewer incisions.

A Case of Gastrocolic Fistula by Primary Colon Cancer

A gastrocolic fistula is a fistulous communication between a segment of colon and the stomach. It is a rare complication and is caused most commonly by a carcinoma of the colon or the stomach. Among the less common causes of a gastrocolic fistula are a benign gastric ulcer, chronic ulcerative colitis, Crohn's disease, a carcinoid tumor, syphillis, an intraabdominal abscess, a lymphoma, trauma, intestinal tuberculosis, and iatrogenic factors. Recently, the incidence of gastrocolic fistulas has decreased due to earlier diagnosis and treatment of stomach and colon cancer. The classic triad of symptoms are lienteric diarrhea, feculent vomiting, and foul eructations, but all patients do not necessarily present with these symptoms. A gastrocolic fistula is usually diagnosed by using a barium enema, but occasionally can be detected by using an upper gastrointestinal series or endoscopy. Here, we report experience with a fistula between a cancerous transverse colon and the stomach and give a review of the literature.

Gastroduodenal Intussusception Secondary to a Gastric Carcinoma

Gastroduodenal intussusception is an extremely uncommon condition caused by the prolapse of a gastric tumor into the duodenum, with the subsequent invagination of a portion of the stomach wall. The lead point of the intussusception is usually a benign gastric tumor, with only a small number attributed to gastric carcinomas. Both gastroduodenal intussusception itself and a gastric carcinoma as the lead point are extremely rare. The authors present a case of gastroduodenal intussusception caused by a Borrmann type I gastric carcinoma. This case can be classified as a partial lateral invagination with a grade II internal mechanism.

Stercoral Perforation of the Colon

A stercoral perforation of the colon is a very rare condition, which results from stercoral ulcers due to severe, prolonged constipation, and has a very high mortality rate. Herein is presented four cases of stercoral perforation of the sigmoid colon. All the patients were female. They had long standing and severe constipation, with peritonitis, prior to admission. Plain chest or abdominal X-rays revealed the presence of abdominal free air in all cases, and so emergent operations were undertaken. Fecalomas were found in the colon or abdominal cavity, with round and spherical shaped perforated sites. Microscopically, the edges of the ulcers were compressed with the accumulation of lymphocytes. A resection of the perforated colon with a proximal colostomy was performed in one case, a primary closure of the perforated colon and a proximal colostomy in another and a Hartmann's colostomy in the remaining two cases.

Molecular Characterization and Sequence Analysis of Pneumococcal Surface Protein A ( PspA ) from Invasive Streptococcus pneumoniae Isolated in Korea

To investigate the genetic variation within pspA from 17 clinical isolates of Streptococcus pneumoniae representing 12 capsular serotypes, we used specific PCR primers LSM12 and LSM2 derived from the DNA sequence of pspA of S. pneumoniae Rxl (type 2). We have found that all 17 isolates of S. pneumoniae have a pspA gene whose size ranges from 1.8 to 2.3 kb. RFLP analysis of the PCR-amplified pspA genes of the isolates exhibited distinct restriction patterns. Even within the same capsular type, the individual isolates of S. pneumoniae generally differed in PspA molecular masses and showed variabilities in the pspA gene locus. The nucleotide sequence of the pspA gene of S. pneumonaie KNIH1156 (type 19F) isolated from a blood specimen was determined. The sequence revealed an open reading frame of 1,827 bp nucleotides. Predicted size of the mature PspA was approximately 63 kDa. Deduced amino acid sequence of PspA of S. pneumonaie KNIH1156 revealed 57.0% identity with that of S. pneumonaie Rxl. Comparison of the nucleotide and amino acid sequences of PspA S. pneumoniae KNIH1156 (type 19F) with those of Rxl (type 2) showed considerable differences in the a-helical coiled-coil region of the two PspAs. These results suggest that the PspA of S. pneumoniae KNIH1156 has antigenic variations distinguished from those of Rxl strains.

Tumor Angiogenesis Correlates with Prognosis in Patients with Stage 3 Gastric Cancer / 대한암학회지

PURPOSE: Several studies suggest that tumor angiogenesis is a significant prognostic factor in carcinoma of the breast, lung, prostate, oral cavity, and colon. We assessed whether intensity of tumor angiogenesis, as measured by microvessel counts in histologic sections, correlates with prognosis in patients with stage III gastric cancer. MATERIALS AND METHODS: Paraffin-embedded sections from 49 patients (23 stage IIla, 26 stage IIIb) with primary gastric cancer that had been completely removed were analyzed for angiogenesis. Vessels were stained with anti-factor VIII polyclonal antibody, and areas with the most discrete microvessels were counted in a 200X field. RESULTS: Patients with stage IIIa gastric cancer had fewer microvessels than those with stage IIIb gastric cancer (32.8+-14.5 vs. 40.3+-16.1, P=0.106). The mean microvessel count from patients who were alive were significantly lower than that from patients who had died at the time of follow-up (24.8+-10.0 vs. 42.9+- 14.5, P=O.OOO). The 5-year survival rate of patients with count less than 33 microvessels was higher than that of patients with count more than 33 microvessels (59.9% vs. 11.6%, P= 0.000). On multivariate analysis by Cox proportional hazards model, the microvessel count was a significant prognostic factor of stage III gastric cancer. CONCLUSION: Tumor angiogenesis assessed by microvessel count may be a significant prognostic factor of stage III gastric cancer and may prove valuable in selecting patients with stage III gastric cancer for aggressive adjuvant therapy and closer postoperative follow-up.

Selection of Surgical Procedure in the Elderly with Advanced Gastric Cancer / 대한암학회지

PURPOSE: The quality of life has become increasingly important as an outcome when assessing patients who have had surgery for advanced gastric cancer in the elderly. The purpose of this study was to study the validity of quality of postoperative life as a criterion in the decision-making process as well as the results of operation for advanced gastric cancer in the elderly. MATERIALS AND METHODS: Spitzer's quality of life index, postoperative mortality and survival were evaluated in 67 patients(over 65 years of age) with advanced gastric cancer who had undergone operation between 1988 and 1997 at the Department of Surgery, Kangnam Sacred Heart Hospital. RESULTS: The quality of life score and median survival correlated with TNM clinical stage(IIIa; 7.1+/-1.8, 36.0 months vs. IIIb: 5.8+/-2.8, 28.6 months vs. IV: 2.9+/-1.9, 4.5 months), resectability(reseetion: 5.9+/-2.7, 21.0 months vs. no resection: 3.0+/-2.0, 4.0 months), curability(curative operation: 6.5+/-2.4, 29.0 months vs. palliative operation: 3.3+/-2.4, 6.0 months), type of gastrectomy(subtotal gastrectomy: 6.4+/-2.7, 28.0 months vs. totai gastrectomy: 4.5+/-2.6, 9.0 months), but not with age or sex. There was a difference in operative mortality according to age group(65~70 years: 7.8% vs. >70 years: 18.8%), resectability(resection: 7.4% vs. no resection: 23.0%) and curability (curative operation: 2.3% vs. palliative operation: 25.0%). CONCLUSION: The results suggest that surgical resection offers the only chance for improved survival and qulaity of life. Gastric resection, even with total gastrectomy, can be undertaken to reduce tumor burden, decrease threats of obstruction, hemarrhage, or perforation and improve quality of life in the elderly if there is little coexisting impairment.

Complications of Colostomy

Although the creation of a colostomy is often regarded as a minor surgical procedure, complications and underlying diseases associated with colostomy creation alter the quality of life and the life-style of the patient significantly. One hundred forty-five patients underwent a colostomy at the Department of Surgery, Kangnam Sacred Heart Hospital, between 1987 and 1996. There were 83 males and 62 females, with a mean age of 52 years (range: 1 year to 89 years). Sigmoid-end colostomies were performed most commonly (60.7%). The colostomies were performed predominantly for colorectal cancer (110 cases). Complications arising from the colostomy formation occurred in 45 patients (31%), with wound infection being the most common problem observed (16 cases). Colostomy revision was required in 4 cases. Patients with cecostomies had a relatively higher incidence of stomal complications (75%) when compared to those with other types of colostomies. Postoperative complications were more common after emergency operations than after elective operations. The complication rate for patients with obstructive colorectal cancer was higher than that of patients with non-obstructive colorectal cancer. Complications occurred in 3 patients of the 29 patients underwent colostomy closure(10.3%). The incidence of surgical complications was not related to the time interval between colostomy formation and closure. The mortality rate for colostomy formation was 2.7%, and the most common cause of death was sepsis. These results suggest that careful attention to technical details and intraoperative care in the case of emergency colostomy formation for obstructive colorectal cancer are necessary to reduce the risk of postoperative complications.

Ileocolovesical Fistula Caused by Crohn's Disease: Report of a Case / 대한비뇨기과학회지

Enterovesical fistula is a relatively rare disease and usually caused by primary intestinal disease (diverticulitis, colon cancer and inflammatory bowel disease including Crohn's disease etc.). We experienced a rare case of ileocolovesical fistula caused by Crohn's disease. The 34 year old man had had chronic dysuria, lower abdominal pain and turbid urine for 3 years. Contrast studies including cystography, small bowel series, barium enema and abdominal Of showed ileocolovesical fistula. Small bowel segmental resection, Hartmann's colostomy and suprapubic cystostomy were performed. Histological examination of operative specimen showed a granulomatous inflammation caused by Crohn's disease. Our case suggests that Crohn's disease may be a rare cause of enterovesicalfistula in Korean.

A clinical study of colorectal cancer

No abstract available.

Clinical Evaluation of Hypobaric Spinal Anesthesia for Total Hip Replacement in Lateral Decubitus Position / 대한마취과학회지

Hypobaric spinal anesthesia for fifty patients(spinal group) undergoing total hip replacement were compared with general anesthesia(general group) in respect to intraoperative blood loss, changes of blood pressures, postoperative analgesics, etc. Furthermore, the technical aspects were evaluated for hypobaric spinal anesthesia in the lateral position when 1% tetracaine in distilled water (epinephrine 1: 200,000) was administered. The lowest blood pressure parameters were significantly lower in the spinal group(29%) than in the general group(22%). The amount of blood loss in the spinal group was less than that in the general group even though there was no difference in blood replacement between groups. The time period before analgesic use longer in the spinal group(4.1 hours)than the general group(2.7 hours). The most common complication in either group was urinary retention(50% in the spinal and 44% in the general) in which urinary catheterization was necessary. In the general group, thirty-six per cent of the patients had mild fever in the first or second postoperative day which were not consistently related to pulmonary complications. For spinal anesthesia, 5 or 6 mg of 1%-tetracaine in distilled water mixed to 1: 200,000 epinephrine was used. The spinal puncture was performed by a 22G needle on the L2-3 or L3-4 in- tervertebral space with lateral aproach in the position of the operation. Injection speed was controlled to 1 ml/sec in all patients. Sensory levels were reached to T7-8 and T9-10 in the non-dependent and dependent side, respectively. Motor funetion on knee and ankle was lost in the non-dependent side, but not in the dependent side. There were some intraoperative complaintments including positional discomfort on hip rest and shoulder bar. However, there was no remarkable problem in hypobaric spinal anesthesia intraoperatively. The results of our study indicate that hypobaric spinal anesthesia in lateral decubitus position is a recommendable anesthetic technique for total hip replacement surgery.

Interscalene Brachial Plexus Black for the Surgery of Shoulder , Clavicle, and upper Arm / 대한마취과학회지

A number of reports about interscalene brachial plexus block for the surgery of shoulder, clavicle, and upper arm have described the advantage, especially to patients with limited shoulder motion and lung disease. This method can be used for short procedures which are bone biopsy, arthroscopy, closed reduction and percutaneous pinning of shoulder. It can also free from pneumothorax and torniquet pain. But other studies have listed Horners syndrome, phrenic block, recurrent laryngeal block, bilateral anesthesia, and spinal or epidural blockade. Thesecomplications can be avoided by careful procedure. Patients receiving interscalene brachial plexus block were randomly assigned to one of two groups according to the suspected operation time and the extent of trauma site. Group 1 received lidocaine 1.33% and group 2, lidocaine 1.33% plus bupivacaine 0.4~0.5%. All local anesthetics were added adrenalin. The blocks were carried out in the method described by Winnie. The agents used were lidocaine 1.33% and lidocaine 1.33% plus bupivacaine 0.4~0.5%. 12 patients have sufficient analgesia of the shoulder, supraclavicular region, and the upper arm, but one patient required 25 ug fentanyl during operation. There are no other complications except Horneris sign of two patients.

A clinical analysis of stomach cancer

No abstract available.

Treatment and timing of operation in adhesive small bowel obstruction with the history of previous abdominal operation

No abstract available.

Complications of Artificial Airways / 대한마취과학회지

Artificial airways have been widely used to keep patency of airway and apply respiratiory care, however those airways may cause frequent and severe complications. Many etiologic factors have been implicated in the development of these problems with the exact reasons being as yet unknown. The purpose of this study was to assess the incidence, evolution and long-thrm effects of complications following artificial airways and to evaluate the effect of complications following artificial airways and to evaluate the effect of factors in the genesis of those complications. 332 consecutive patients admitted to Intensive Care Unit in Shinchon Severance Hospital over a 6-month period from March to August, 1990 were studied who had been intubated or tracheostomied. 1) Complications following artificial airways occurred in 58 patients among 332 patients and the rate of complication was 17.5% and the total number of complication was 63 cases. 2) There was no significant relationship between the rate of complications and patient's demographic factors, such as age and sex. 3) There was statistic significance between the rate of complications and factors such as frequencies of intubation and drugs used for intubation such as sedatives and muscle relaxants. 4) As frequency of intubation increased once, the rate of complication increased about twice. 5) The rate of complications in the patients without sedatives and muscle relaxants at intubation was 2.34 times greater than in those administered either medications.