Rapid Staining Using the Shorr Method for Intraoperative Peritoneal Washing Cytology in Advanced Gastric Cancer: a Pilot Study from a Single Institution

PURPOSE: Intraoperative peritoneal washing cytology (PWC) is used to determine treatment strategies for gastric cancer with suspected serosal invasion. However, a standard staining method for intraoperative PWC remains to be established. We evaluated the feasibility of a rapid and simple staining method using Shorr's stain for intraoperative PWC in advanced gastric cancer. MATERIALS AND METHODS: Between November 2012 and December 2014, 77 patients with clinical T3 or higher gastric cancer were enrolled. The sensitivity, specificity, and concordance between the Shorr staining method and conventional Papanicolaou (Pap) staining with carcinoembryonic antigen (CEA) immunohistochemistry (IHC) were analyzed. RESULTS: Intraoperative PWC was performed laparoscopically in 69 patients (89.6%). The average time of the procedure was 8.3 minutes, and the average amount of aspirated fluids was 83.3 mL. The average time for Shorr staining and pathologic review was 21.0 minutes. Of the 77 patients, 16 (20.7%) had positive cytology and 7 (9.1%) showed atypical findings; sensitivity and specificity were 73.6% and 98.2% for the Shorr method, and 78.9% and 98.2% for the Pap method with CEA IHC, respectively. Concordance of diagnosis between the 2 methods was observed in 90.9% of cases (weighted κ statistic=0.875) and most disagreements in diagnoses occurred in atypical findings (6/7). In overall survival, there was no significant difference in C-index between the 2 methods (0.459 in Shorr method vs. 0.458 in Pap with CEA IHC method, P=0.987). CONCLUSIONS: Shorr staining could be a rapid and reliable method for intraoperative PWC in advanced gastric cancer.

Solo Intracorporeal Esophagojejunostomy Reconstruction Using a Laparoscopic Scope Holder in Single-Port Laparoscopic Total Gastrectomy for Early Gastric Cancer

Single-incision laparoscopic total gastrectomy for gastric cancer has recently been reported by Seoul National University Bundang Hospital. However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy. At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy. In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer.

Neurotization of Brachial Plexus Injury / 대한정형외과학회잡지

PURPOSE: The aim of this study was to determine the result of neurotization on brachial plexus injury. MATERIALS AND METHODS: 51 patients (87 procedures) who were observed for more than 18 months after neurotization were chosen as subjects. The average follow-up period was 62.8 months, the mean age of patients was 27.8 years, and the average time between the injury and operation was 6.1 months. We performed 60 procedures of the whole arm type, 26 procedures of the upper arm type and 1 procedure of the lower arm type. The intercostal nerve, spinal accessory nerve, the contralateral 7th cervical (C7) nerve, and the phrenic nerve were used as donor nerves. The British Research Council System was used to evaluate the extent of recovery of upper limb function, and the time to first recovery of the muscle was noted. We also analysed results according to the type of injury, time between injury and surgery, and age. RESULTS: 30 procedures showed excellent results, 34 procedures good, 9 procedures fair and 14 procedures poor. In 64 procedures (73.6%) recovery of muscle strength was good or better, and in 73 procedures (83.9%) a recovery of muscle contraction was observed. The earliest evidence of recovery of muscle contraction was observed 6.4 months after using the intercostal nerve. When the contralateral C7 nerve was used, muscle contraction was most delayed. Surgery performed soon after injury and in younger patients produced the best clinical outcomes. CONCLUSION: We report that more than 2/3rds of the patients who received neurotization achieved at least a good result, which allowed a certain level of daily activity.

Immunohistochemical study of p21 and p53 expression in ameloblastoma

The p53 protein was discovered in 1979 as cellular 53-kD nuclear phosphoprotein bound to the large transforming antigen of SV40 virus. P21WAF1/CIP1, which has been described as the critical downstream mediator of p53, is known to suppress DNA replication and arrest the G1 cell cycle by quaternary complex with cyclin D, cyclin-dependent kinase(CDK) and proliferating cell nuclear antigen(PCNA). In these days, some studies shows that the p21 can be induced by independent pathways. There are various reports about the expression of p21 (67%.82.4%) in oral squamous cell carcinoma. But these studies are mostly done in malignant tumor not in benign tumor. So we decided to study the expression of p21 in ameloblastoma and the relationship between p53 and p21 as a downstream mediator of p53 in ameloblastoma. We investigated the expression of p21 and p53 with the method of immunohistochemistry. We selected 30 cases of ameloblastoma tissue blocks (acanthomatous type: 5 cases, follicular type: 8 cases, plexiform type: 17 cases) imbedded in paraffin. We used 30 cases of normal gingival tissues and 30 cases of squamous cell carcinoma tissues (SCC) respectively and compared their results with those of ameloblastoma. We made slides with the streptavidin-biotin methods and used monoclonal antibody DO-7 (Novocastra, Newcastle, United Kingdom) as p53 antibody and monoclonal antibody M7202 (DAKO, California, U.S.A.) as p21 antibody. We used Pearson's correlation coefficient to analyse the relationship. The results were as follows: 1. p21 was expressed in ameloblastoma about 30% and this is lower than that of normal gingiva and SCC. 2. In normal gingiva and ameloblastoma, p21 expression was correlated with p53 expression. 3. In SCC, p21 were expressed about 83.3% and this is more than that of p53. But there was no correlation between p21 and p53 expression. We confirmed p21 expression and relation with p53 in ameloblastoma. But, to confirm the function of p21, more studies about p21 expression in malignant ameloblastoma and ameloblastic carcinoma are needed.

Step osteotomy technique through intraoral approach for mandibular distraction

Spontaneous Rupture of the Esophagus (Boerhaave's Syndrome): A review of 10 cases

BACKGROUND: Boerhaave's syndrome is a spontaneous rupture of the esophagus. The classic symptom triad, vomiting, chest pain, and subcutaneous emphysema, rarely develop together. It is diagnosed by using plain chest film, an esophagogram with a water soluble contrast media, and computerized tomography, but it is somewhat difficult to make an early diagnosis. It is generally treated with a surgical procedure, but the most frequent complication is suture line leakage, which leads to a pyothorax, pneumonia, mediastinitis, and eventually an irreversible septic condition. METHODS: We retrospectively reviewed 10 cases of patients with spontaneous esophageal rupture treated by various surgical methods during the recent 6 years at the Department of Surgery and Internal Medicine, the Catholic University of Korea. RESULTS: The results of the clinical reviews are as follows: There were 9 males and 1 female, and the mean age was 53 years old. The main symptom was chest pain (70%), and that developed after severe vomiting in 6 cases (60%). Abnormal findings were revealed on the chest PA films of 6 cases. Esophagogram were used in 8 cases, and a combined chest CT in 5 cases. Seven (70%) received an operation in less than 24 hours after the attack and 3 cases after 72 hours. The lower one-third of the esophagus was perforated in 9 cases (90%), and the left side of the esophagus was perforated in 8 cases (80%). The methods of operation were primary repair (6 cases), an esophagectomy and esophagogastrostomy (3 cases), and a cardial ligation, proximal esophagostomy, gastrostomy, and feeding jejunostomy (1 case). Anastomosis leakage and empyema developed in each of 4 cases. The overall mortality rate was 20%; only two patients died due to a delayed hospital visit (surgery 72 hours after first attack of symptoms). CONCLUSIONS: We recommand that the most important factor affecting the prognosis for spontaneous rupture of the esophagus is early diagnosis and immediate surgical intervention.

Superior Lumbar Hernia: A case report

A lumbar hernia is a rare clinical disease entity which arises from the superior or the inferior lumbar triangle. The causes are congenital, traumatic, previous operation, and so on, but spontaneous occurrence is also encountered. We had a occasion to treat a 34-year-old female patient with a left superior lumbar hernia filled with retroperitoneal fats in a sac. The relatively large defect of the transversalis fascia was repaired with a PTFE (polytetrafluoroethylene) graft and an overlying approximation of external oblique and latissimus dorsi muscle. We report on this case with a brief review of the literature.

Superior Lumbar Hernia: A case report

A lumbar hernia is a rare clinical disease entity which arises from the superior or the inferior lumbar triangle. The causes are congenital, traumatic, previous operation, and so on, but spontaneous occurrence is also encountered. We had a occasion to treat a 34-year-old female patient with a left superior lumbar hernia filled with retroperitoneal fats in a sac. The relatively large defect of the transversalis fascia was repaired with a PTFE (polytetrafluoroethylene) graft and an overlying approximation of external oblique and latissimus dorsi muscle. We report on this case with a brief review of the literature.