Subclavian venous catheterization was once widely used for volume resuscitation, emergency venous access, chemotherapy, parenteral nutrition, and hemodialysis. However, its use has drastically reduced recently because of life-threatening complications such as hemothorax, pneumothorax. In this case, a patient admitted for a scheduled operation underwent right subclavian venous catheterization for preoperative, intraoperative, and postoperative volume resuscitation and parenteral nutrition. The procedure was performed by an experienced senior resident. Despite detecting slight resistance during the guidewire insertion, the resident continued the procedure to the point of being unable to advance or remove it, then attempted to forcefully remove the guidewire, but it broke and became entrapped within the thorax. We tried to remove the guidewire through infraclavicular skin incision but failed. So video-assisted thoracoscopic surgery was used to remove the broken guidewire. This incident demonstrates the risks of subclavian venous catheterization and the importance of using a proper and gentle technique.
Catheterization ; Catheterization, Central Venous ; Catheters ; Drug Therapy ; Emergencies ; Hemothorax ; Humans ; Parenteral Nutrition ; Pneumothorax ; Renal Dialysis ; Resuscitation ; Skin ; Thoracic Surgery, Video-Assisted* ; Thorax

Abdominal wall defect with large duodenal disruption after penetrating abdominal injury is a rare emergency situation that can result in life-threatening complications. We report on a 64-year-old man who had abdominal wall defect with large duodenal disruption after penetrating abdominal injury. The patient presented with intra-abdominal exsanguinating bleeding, duodenal disruption, and multiple small bowel perforation. The rarity of this complex injury and its initial presentation as a posttraumatic large duodenal disruption with abdominal wall defect warrant its description. The present case indicates that combining a free tissue flap with a covered expandable metallic stent can effectively and successfully repair an abdominal wall defect that is associated with a large duodenal disruption.
Abdominal Injuries ; Abdominal Wall* ; Duodenum ; Emergencies ; Free Tissue Flaps* ; Hemorrhage ; Humans ; Middle Aged ; Stents*

PURPOSE: The aim of this study was to compare two different treatment methods for pilonidal sinus with respect to complications, recurrence, and patient quality of life. METHODS: Five hundred forty-nine patients who underwent surgery for pilonidal sinus between January 2007 and August 2012 were included in this study. The patients were classified into group I (excision and primary closure) and group II (Limberg flap). RESULTS: There was no significant difference in the mean age and gender of the patients between groups I and II (P = 0.512 and P = 0.472). The duration of surgical operation was lower in group I (P < 0.001). There was no significant difference in hospitalization time after surgery, minor complications, and recurrence between the groups (P = 0.674, P = 1.000, and P = 1.000, respectively). The time required for pain-free walking, urinating, and returning to work was significantly lower in group II (P < 0.001, P < 0.001, and P < 0.001, respectively). The patients in group I stated that they were more satisfied in terms of aesthetics (P < 0.001). CONCLUSION: According to the results of this study, Limberg flap method has better outcomes compared with excision and primary closure. Therefore, we recommend Limberg flap for treatment of pilonidal sinus disease.
Esthetics ; Hospitalization ; Humans ; Oxalates ; Pilonidal Sinus* ; Quality of Life* ; Recurrence ; Surgical Procedures, Minor ; Walking

PURPOSE: This study aimed to assess the cytolytic activity and the phenotype of circulating blood immune cells in cancer patients by using a simple preparation of peripheral blood mononuclear cells (PBMCs). METHODS: Peripheral blood was obtained from 94 diagnosed colorectal cancer (CRC) patients and 112 healthy donors. PBMCs were cocultured with K562 cells for 2 hours and lactate dehydrogenase released from the dead K562 cells was measured by using a spectrophotometer. Meanwhile, PBMCs were stained with fluorescence conjugated monoclonal antibodies (mAbs) and analyzed by flow cytometry. RESULTS: The cytolytic activity of PBMCs were significantly different between CRC patient and healthy groups (8.82% +/- 3.84% vs. 17.51% +/- 8.57%; P < 0.001). However, no significant difference in the cytolytic activity was observed after surgery in the CRC patient group (before surgery, 8.82% +/- 3.84% vs. after surgery, 9.95% +/- 4.94%; P = 0.326). In addition, the percentage of peripheral blood natural killer cells was significantly higher in the preoperative patient group than in the healthy group (19.97% +/- 11.51% vs. 15.60% +/- 5.77%, P = 0.041). In contrast, the percentage of peripheral blood lymphocytes was lower in the preoperative patient group than in the healthy group (28.41% +/- 8.31% vs. 36.4% +/- 8.6%, P < 0.001). CONCLUSION: These results demonstrate that circulating blood immune cells of CRC patients are functionally impaired and undergo an immunophenotypic perturbation, and show that a simple preparation of PBMCs can be useful to evaluate cellular immunity in cancer.
Antibodies, Monoclonal ; Blood Cells ; Colorectal Neoplasms* ; Cytotoxicity, Immunologic ; Fluorescence ; Humans ; Immunity, Cellular ; K562 Cells ; Killer Cells, Natural ; L-Lactate Dehydrogenase ; Lymphocytes ; Phenotype ; Tissue Donors

PURPOSE: Laparoscopic choledochal cyst excision with Roux-en-Y hepaticojejunostomy (LCE) in children is being attempted more frequently around the world, and although it has been performed in Korea, no publication has been published on it. However, cholangitis and/or pancreatitis are limitations that make open conversion more likely. The aims of this study, through a retrospective clinical analysis, were to prove the efficacy of LCE in children and to validate that preoperative management expands its indications. METHODS: From May 2011 to November 2012, 13 pediatric LCEs were performed. Demo graphics, preoperative findings, management, operative and postoperative outcomes were reviewed. RESULTS: The mean age at operation was 48.5 months and mean bodyweight 19.0 kg. Ultrasonography was conducted in all patients followed by either magnetic resonance cholangiopancreatography (8 cases) or computed tomography (5 cases). The mean diameter of the cysts was 30.2 mm. Eight patients with cholangitis and/or pancreatitis were given antibiotics preoperatively. Four had their condition resolved by administration of antibiotics, 3 underwent additional endoscopic retrograde biliary drainage or percutaneous transhepatic biliary drainage, and one, due to aggravating tenderness, underwent surgery after 4 days of administrating antibiotics without improvement of the inflammation. Two faced open conversions, one because of a very narrow bile duct, and the other because of remnant inflammation after inadequate preoperative management already mentioned above. Patients were discharged on the eighth postoperative day. There were no complications. CONCLUSION: Pediatric LCE is a feasible option for choledochal cyst. Proper preoperative management such as antibiotics and drainage procedures enhances its efficacy by broadening its indications, even with concomitant cholangitis and/or pancreatitis.
Anti-Bacterial Agents ; Bile Ducts ; Child* ; Cholangiopancreatography, Magnetic Resonance ; Cholangitis ; Choledochal Cyst* ; Drainage ; Humans ; Inflammation ; Korea ; Laparoscopy ; Pancreatitis ; Publications ; Retrospective Studies ; Ultrasonography

PURPOSE: Hepatopulmonary syndrome is an arterial oxygenation disorder brought about by advanced liver failure and pulmonary vascular dilatations. The reason why hypoxia develops in hepatopulmonary syndrome depends on the broadening of perialveolar capillary veins. Our study aims to investigate the effects of Flavanoid on hepatopulmonary syndrome through its inhibition of nitric oxide. METHODS: Three groups, each having 8 rats, were formed within the scope of our study. Group I (the control group) only received laparatomy, group II received choledoch ligation, and group III was administered Flavanoid (90% flavonoid diosmin, 10% flavonoid hesperidin) following choledoch ligation. The rats were administered Flavanoid at week two following choledoch ligation. The rats' livers and lungs were examined histopathologically following a five-week follow-up and the perialveolar vein diameters were measured. Arterial blood gases and biochemical parameters were evaluated. RESULTS: It was seen that fibrosis and oxidative damage in the liver with obstructive jaundice as well as hypoxia with pulmonary perialveolar vein sizes were significantly lower than the other group with cirrhosis formed through the administration of Flavanoid. CONCLUSION: We have concluded that Flavanoid administration might be useful in the treatment of hypoxia in hepatopulmonary syndrome and the delay of cirrhosis contraction.
Animals ; Anoxia ; Capillaries ; Contracts ; Dilatation ; Diosmin ; Fibrosis ; Follow-Up Studies ; Gases ; Hepatopulmonary Syndrome* ; Jaundice, Obstructive ; Ligation ; Liver ; Liver Failure ; Lung ; Oxygen ; Rats ; Veins

PURPOSE: Prognostic factors for distal bile duct cancer are contentious. This study was conducted to analyze the prognostic factors of distal bile duct cancer after surgery with the aim of identifying those associated with diminished survival. METHODS: Two hundred forty-one patients who underwent pylorus-preserving pancreaticoduodenectomy (PPPD) or Whipple procedure in our tertiary hospital from February 1995 to June 2011 were retrospectively analyzed. All patients were pathologically proven to have distal bile duct adenocarcinoma. Postoperative complications, survival, and well-known prognostic factors after resection for distal bile duct cancer were investigated. RESULTS: Preoperative elevated carbohydrate antigen 19-9 (CA 19-9) level (P = 0.006), positive resection margin (P < 0.001), advanced T stage (P = 0.043), and lymph node metastasis (P = 0.002) were significantly independent worse prognostic indicators by multivariate analysis of resectable distal bile duct cancer. CONCLUSION: R0 resection is the most important so that frozen sections should be utilized aggressively during each operation. For the distal bile duct cancer with elevated preoperative CA 19-9 level or advanced stage, further study on postoperative adjuvant treatment may be warranted.
Adenocarcinoma ; Bile Duct Neoplasms* ; Bile Ducts* ; Bile* ; CA-19-9 Antigen ; Frozen Sections ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Pancreaticoduodenectomy ; Postoperative Complications ; Retrospective Studies ; Tertiary Care Centers

PURPOSE: Arthralgia is the most common side effect in breast cancer patients receiving aromatase inhibitor (AI) therapy. Few studies have evaluated the risk factors, onset, and incidence of musculoskeletal pain in these patients. This study identifies the risk factors of AI-related severe arthralgia and their prevalence. METHODS: All the clinical and pathological records of postmenopausal patients diagnosed with invasive breast cancer using AI at Samsung Medical Center from January 2005 to November 2007 were reviewed. Multivariate logistic regression analyses were performed to evaluate the risk factors of AI-associated musculoskeletal symptoms (AIMSS) and factors associated with AI discontinuance. RESULTS: Among 299 patients, 69 patients (23%) experienced musculoskeletal symptoms attributed to AI use. In multivariate logistic regression analysis, no statistically significant outcome was found to confirm the risk factors for the development of AIMSS. Among the 69 patients who experienced AI-associated musculoskeletal symptoms, 29 (39.7%) discontinued AI use. Multivariate logistic regression analyses revealed an association of prior tamoxifen use with discontinuance of AI (P < 0.01; odds ratio, 4.27; 95% confidence interval, 1.74 to 10.50). CONCLUSION: Prior use of tamoxifen is related to discontinuation of AI due to AI-associated severe arthralgia. Special monitoring and proper pain control for these patients should be considered during the treatment period.
Aromatase Inhibitors ; Aromatase* ; Arthralgia ; Breast Neoplasms ; Humans ; Incidence* ; Logistic Models ; Musculoskeletal Pain ; Odds Ratio ; Risk Factors ; Tamoxifen

PURPOSE: A number of researchers have suggested the use of sodium hyaluronate carboxymethyl cellulose (HA-CMC) membrane for preventing postoperative adhesion. This study evaluated the antiadhesive effect and safety of HA-CMC membrane in thyroidectomy for papillary thyroid cancer. METHODS: One hundred sixty-two patients who underwent thyroidectomy were prospectively randomized. In the study group of 80 patients, the 7.5 cm x 13 cm HA-CMC membrane was applied to the operative field after thyroidectomy. The subjects were asked about complications including adhesive symptoms using an 8-item questionnaire at 2 weeks, 3 months, and 6 months after surgery. In addition, items on the appearance of neck wrinkles and scars were evaluated by a physician who had no information about the patient's allocation. RESULTS: There were no significant differences in complications such as swallowing difficulty, and wrinkles between study and control groups. Both groups presented significantly decreased scores over time in swallowing difficulty, and wrinkles. There were no complications regarding the HA-CMC membrane. CONCLUSION: The antiadhesive effect of HA-CMC membrane in thyroid surgery is still uncertain, although it is biologically safe. Further investigation is needed to confirm the antiadhesive effect of HA-CMC membrane in thyroid surgery.
Adhesives ; Carboxymethylcellulose Sodium ; Cellulose* ; Cicatrix ; Deglutition ; Humans ; Hyaluronic Acid ; Membranes* ; Neck ; Prospective Studies ; Surveys and Questionnaires ; Sodium* ; Thyroid Gland* ; Thyroidectomy

Heterotopic pancreas in the gallbladder is extremely rare and usually incidentally discovered at the pathologic examination followed by cholecystectomy for symptomatic gallbladder disease. Up to the presents, only about 30 cases have been reported. We report the case of a 36-year-old female who presented with symptoms of cholecystitis. The histological analysis followed by cholecystectomy revealed heterotopic pancreas of the cystic duct.
Cholecystectomy ; Cholecystitis ; Cystic Duct ; Female ; Gallbladder ; Gallbladder Diseases ; Humans ; Pancreas