A randomized controlled trial to evaluate the long-term outcomes of laparoscopic distal gastrectomy for gastric cancer is currently ongoing in Korea. Patients with cT1N0M0-cT2aN0M0 (American Joint Committee on Cancer, 6th edition) distal gastric cancer were randomized to receive either laparoscopic or open distal gastrectomy. For surgical quality control, the surgeons participating in this trial had to have performed at least 50 cases each of laparoscopy-assisted distal gastrectomy and open distal gastrectomy and their institutions should have performed more than 80 cases each of both procedures each year. Fifteen surgeons from 12 institutions recruited 1,415 patients. The primary endpoint is overall survival. The secondary endpoints are disease-free survival, morbidity, mortality, quality of life, inflammatory and immune responses, and cost-effectiveness (ClinicalTrials.gov ID: NCT00452751).
Adenocarcinoma ; Disease-Free Survival ; Gastrectomy ; Humans ; Joints ; Korea ; Prospective Studies ; Quality Control ; Quality of Life ; Stomach Neoplasms

Preduodenal portal vein, a rare anomaly, could be found in any age groups. In pediatrics it may present with a duodenal obstruction by itself or other coexisting anomalies; however it usually present with an asymptomatic or incidental findings during other surgery in adults. This anomaly has a clinical importance due to the possibility of accidental damage to portal vein. In addition to describing a series of 3 cases with different manifestation in infants, discuss about this anomaly with a review of relevant literature.
Adult ; Duodenal Obstruction ; Humans ; Incidental Findings ; Infant ; Pediatrics ; Portal Vein

Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic cholecystitis that is accompanied by xanthomatous histiocytes and chronic inflammation. A 2-month-old boy presented with a right upper abdominal palpable mass. Cholecystectomy with liver wedge resection was done, under the impression that the mass might be a hepatic tumor or liver abscess. Pathologic examination showed XGC with abscess formation. Most cases of XGC were observed in adult and only a few cases were reported in children. We describe a very rare case of XGC in infancy.
Abscess ; Adult ; Child ; Cholecystectomy ; Cholecystitis ; Granuloma ; Histiocytes ; Humans ; Infant ; Inflammation ; Liver ; Liver Abscess ; Xanthomatosis

PURPOSE: To evaluate the optimum timing of aspirin cessation before noncardiac surgeries. We have conducted a pilot study to minimize the aspirin cessation time before various surgeries. METHODS: Eighty patients who were taking regular aspirin for secondary prevention undergoing elective surgical operations were enrolled in the study. We separated the patients into two groups. The control group had 35 patients who stopped aspirin intake 10 days before surgery. The study group had 45 patients who stopped their aspirin intake and underwent surgery one day after arachidonic acid aggregation tests were within normal limits. Bleeding, blood loss, and transfusion requirements were assessed perioperatively. RESULTS: The mean time between aspirin cessation and aspirin nonresponsiveness were found to be 4.2 days with a median value of 4 days. In addition, the mean time between aspirin cessation and operation day were found to be 5.5 days with a median value of 5 days. No perioperative bleeding, thromboembolic or cardiovascular complications were encountered. CONCLUSION: Reducing time of aspirin cessation from 7-10 days to 4-5 days is a possibility for patients using aspirin for secondary prevention without increased perioperative complications.
Arachidonic Acid ; Aspirin ; Blood Platelets ; Hemorrhage ; Humans ; Perioperative Period ; Pilot Projects ; Secondary Prevention

PURPOSE: Since the 1990's, negative pressure wound therapy (NPWT) has been used to treat soft tissue defects, burn wounds, and to achieve skin graft fixation. In the field of abdominal surgery, the application of NPWT is increasing in cases with an open abdominal wound requiring temporary wound closure and a second look operation. In the present study, the authors analyzed patients that underwent NPWT for postoperative wound dehiscence. METHODS: The computerized records of patients that had undergone an abdominal operation from November 2009 to May 2012 were retrospectively analyzed. RESULTS: The number of total enrolled patients was 50, and 30 patients (60%) underwent an emergency operation. Diagnoses were as follows: panperitonitis or intra-abdominal abscess (24 cases, 48%), intestinal obstruction (10 cases, 20%), cancer (7 cases, 14%), mesentery ischemia (3 cases, 6%), and hemoperitoneum (1 case, 2%). NPWT was applied at a mean of 12.9 +/- 8.2 days after surgery and mean NPWT duration was 17.9 days (2 to 96 days). The 11 patients (22%) with unsuccessful wound closure had a deeper and more complex wound than the other 39 patients (78%) (90.9% vs. 38.5%, P = 0.005). There were two complication cases (4%) due to delayed wound healing. CONCLUSION: Most patients recovered well due to granulation formation and suturing. NPWT was found to be convenient and safe, but a prospective comparative study is needed to confirm the usefulness of NPWT in patients whose wounds are dehisced.
Abdomen ; Abdominal Abscess ; Burns ; Emergencies ; Hemoperitoneum ; Humans ; Intestinal Obstruction ; Ischemia ; Mesentery ; Negative-Pressure Wound Therapy ; Retrospective Studies ; Skin ; Surgical Wound Dehiscence ; Transplants

PURPOSE: In this retrospective study, we aimed to compare the clinical characteristics of inguinal hernia developed after radical retropubic surgery for prostate cancer to the hernia without previous radical prostatectomy. METHODS: Twenty-three patients (group A) who had radical retropubic surgery for prostate cancer underwent laparoscopic or open tension-free inguinal hernia repair from March 2007 to February 2011. Nine hundred and forty patients (group B) without previous radical retropubic surgery received laparoscopic or tension-free open hernia operation. RESULTS: Group A was older than group B (mean +/- standard deviation, 69.6 +/- 7.2 vs. 54.1 +/- 16.1; P < 0.001). Right side (73.9%) and indirect type (91.3%) in group A were more prevalent than in group B (51.5% and 69.4%, respectively) with statistic significance (P = 0.020 and P = 0.023). The rate of laparoscopic surgery in group B (n = 862, 91.7%) was higher than in group A (n = 14, 64.3%, P < 0.001). In comparing perioperative variables between the two groups, operative time (49.4 +/- 23.5 minutes) and hospital stay (1.9 +/- 0.7 days) in group A were longer than in group B (38.9 +/- 16.9, 1.1 +/- 0.2; P = 0.046 and P < 0.001, respectively) and pain score at 7 days in group A was higher than in group B (3.1 +/- 0.7 vs. 2.3 +/- 1.0, P < 0.001). Postoperative recurrence rate was not significantly different between the two groups. CONCLUSION: Inguinal hernia following radical retropubic surgery for prostate cancer was predominantly right side and indirect type with statistic significance compared to hernias without previous radical prostatectomy.
Hernia ; Hernia, Inguinal ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Recurrence ; Retrospective Studies

PURPOSE: Increased saphenous vein diameter is a common consequence of saphenous vein reflux. Until now, there have been no reports about the correlation between diameter and reflux of saphenous vein in Korea. The aim of this study was to investigate the correlation between saphenous vein reflux and diameter changes. METHODS: From April 2009 to August 2012, 777 patients were sent to the vascular laboratory for evaluation of venous reflux. The diameter of the saphenous vein was measured with B-mode imaging, and reflux was quantified based on valve closure time using Doppler spectral tracings. Receiver operating characteristics curve analysis was applied to determine the best saphenous vein diameter cutoff for predicting reflux. RESULTS: The mean diameters of normal great saphenous vein (GSV) and refluxed GSV were 5.0 +/- 2.4 mm and 6.4 +/- 2.0 mm, respectively. The mean diameters of normal small saphenous vein (SSV) and refluxed SSV were 3.1 +/- 1.3 mm and 5.2 +/- 2.7 mm, respectively. The diameter differences between the normal and refluxed GSV and SSV were 1.4 mm and 2.1 mm, respectively, and these differences were statistically significant (P < 0.0001). A GSV threshold diameter of 5.05 mm had the best positive predictive value for reflux. The sensitivity and specificity at 5.05 mm were 76% and 60%, respectively. The best SSV diameter for predicting reflux was 3.55 mm. The sensitivity and specificity at 3.55 mm were 87% and 71%, respectively. CONCLUSION: GSV diameter of > or =5.05 mm had the best positive predictive value for pathologic reflux. For pathologic reflux of SSV, the best cutoff diameter was 3.55 mm.
Humans ; Korea ; ROC Curve ; Saphenous Vein ; Sensitivity and Specificity ; Varicose Veins ; Veins ; Venous Insufficiency

PURPOSE: This study investigated the Jurkat T cell line expresses cytotoxicity when treated with different concentrations of FK506, and analyzed the expression pattern of microRNA when stimulated by FK506 using the microRNAs microarray, as well as the expression pattern of a gene that is related to the differentiation, activation and proliferation of T cells after being affected by the change of microRNAs. METHODS: To investigate the effects of FK506 on microRNA expression, we purified total RNA of Jurkat cells treated with 20 microM FK506 for 72 hours and used to analyze microRNA profiling by using Agilent's chip. RESULTS: These results demonstrated that treatment with FK506 markedly induced the down-regulation of 20 microRNAs as well as the up-regulation of 20 microRNAs in a time-dependent manner. The genes that down-regulated by FK506 include let-7a*, miR-20a*, and miR-487a. Otherwise miR-202, miR-485-5p, and miR-518c* are gradually up-regulated in expression. Sanger Institute and DAVIDs bioinformatics indicated that microRNAs regulated the several transcriptomes including nuclear factor of activated T cell-related, T cell receptor/interleukin-2 signaling, and Ca(2+)-calmodulin-dependent phosphatase calcineurin pathways. CONCLUSION: As a result of treating FK506 to a Jurkat cell line and running the microRNA microarray, it was found that FK506 not only took part in the suppression of T cell proliferation/activation by inhibiting calcineurin in Jurkat apoptosis, but also affected the microRNAs that are involved in the regulation of various signal transduction pathways.
Apoptosis ; Calcineurin ; Cell Line ; Computational Biology ; Down-Regulation ; Genes, vif ; Humans ; Jurkat Cells ; MicroRNAs ; RNA ; Running ; Signal Transduction ; T-Lymphocytes ; Tacrolimus ; Transcriptome ; Up-Regulation

PURPOSE: This study evaluated the efficacy of neoadjuvant chemotherapy combining 5-flurouracil/folinic acid with irinotecan (FOLFIRI) in colorectal multiple liver metastases regardless of resectability. METHODS: Forty-four patients with multiple (at least two) colorectal liver metastases were enrolled at seven tertiary referral hospitals between May 2007 and September 2010. All patients received the FOLFIRI chemotherapeutic regimen. Response to chemotherapy was assessed after three cycles (6 weeks) and once more after six cycles (12 weeks) of treatment. RESULTS: Objective response was noted in 27 patients (61.4%) and 4 patients (9.1%) had progressive disease. Of 44 patients, 10 patients (22.7%) underwent curative surgery (R0 resection) and 34 patients did not receive R0 resection. Grades 3 to 4 hematological toxicity was noted in 12 patients (27.3%) and grades 3 to 4 nonhematologic toxicity was identified in 5 patients (11.4%). CONCLUSION: FOLFIRI chemotherapy as a neoadjuvant chemotherapy for multiple colorectal liver metastases regardless of resectability demonstrated the possibility of R0 resection, high rate of objective response, and tolerable toxicities in this study.
Camptothecin ; Colorectal Neoplasms ; Humans ; Liver ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Prospective Studies ; Tertiary Care Centers

PURPOSE: Minimally invasive surgical technics have benefits such as decreased pain, reduced surgical trauma, and increased potential to perform as day case surgery, and cost benefit. The primary aim of this prospective, randomized, controlled study was to compare the effects of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) procedures regarding postoperative pain. METHODS: Ninety adult patients undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomized to either SILC or CLC. Patient characteristics, postoperative abdominal and shoulder pain scores, rescue analgesic use, and intraoperative and early postoperative complications were recorded. RESULTS: A total of 83 patients completed the study. Patient characteristics, postoperative abdominal and shoulder pain scores and rescue analgesic requirement were similar between each group except with the lower abdominal pain score in CLC group at 30th minute (P = 0.04). Wound infection was seen in 1 patient in each group. Nausea occurred in 13 of 43 patients (30%) in the SILC group and 8 of 40 patients (20%) in the CLC group (P > 0.05). Despite ondansetron treatment, 6 patients in SILC group and 7 patients in CLC group vomited (P > 0.05). CONCLUSION: In conclusion, in patients undergoing laparoscopic surgery, SILC or CLC techniques does not influence the postoperative pain and analgesic medication requirements. Our results also suggest that all laparoscopy patients suffer moderate and/or severe abdominal pain and nearly half of these patients also suffer from some form of shoulder pain.
Abdominal Pain ; Adult ; Cholecystectomy, Laparoscopic ; Cost-Benefit Analysis ; Humans ; Laparoscopy ; Nausea ; Ondansetron ; Pain, Postoperative ; Postoperative Complications ; Prospective Studies ; Shoulder Pain ; Wound Infection