Antiphospholipid syndrome is characterized by arterial or venous thrombosis and the production of antiphospholipid antibodies. Antiphospholipid syndrome may present primarily or secondary to systemic lupus erythematosus. The clinical features include multiple thrombosis, cerebral diseases, abortion in female, thrombocytopenia and so on. The treatment is based on anticoagulants, steroids, immunosuppressive agents and antiplatelet drugs. We report a case of a 29- year-old man who was admitted to Ewha Womans University Mok-dong Hospital with a generalized peritonitis. On emergency exploratory laparotomy, segmental infarction of the terminal ileum and the right colon was revealed and a right colon and ileal resection was performed. During the postoperative period, the patient was finally diagnosed having antiphospholipid syndrome with systemic lupus erythematosus. He also had ischemic heart disease due to coronary artery thrombosis and pulmonary embolism due to deep vein thrombosis of the lower extremities. He eventually expired following a restorative ileocolostomy owing to anastomotic leakage and sepsis.
Anastomotic Leak ; Antibodies, Antiphospholipid ; Anticoagulants ; Antiphospholipid Syndrome* ; Colon ; Coronary Vessels ; Emergencies ; Female ; Humans ; Ileum ; Immunosuppressive Agents ; Infarction* ; Intracranial Thrombosis ; Laparotomy ; Lower Extremity ; Lupus Erythematosus, Systemic* ; Myocardial Ischemia ; Peritonitis ; Platelet Aggregation Inhibitors ; Postoperative Period ; Pulmonary Embolism ; Sepsis ; Steroids ; Thrombocytopenia ; Thrombosis ; Venous Thrombosis

PURPOSE: Tension-free hernioplasty has become the most popular procedure for the repair of groin hernias in the United States and United Kingdom. The purpose of this study is to describe a 7-year personal experience with Lichtenstein's tension-free groin hernia repair under local anesthesia. METHODS: We retrospectively studied the clinical outcome of 321 cases of Lichtenstein repairs, performed consecutively by an experienced surgeon between Jan. 1994 and Dec. 2000. RESULTS: Of the 321 cases, 242 (75.4%) were indirect, 34 (10.6%) were direct, 8 (2.5%) were femoral, 7 (2.2%) were pantaloon, and 30 (9.3%) were recurred hernias. The mean age was 55 years; 91% were male. The mean number of injections of analgesics required in the postoperative period was 3.2. The mean hospital stay following repair was 2.7 days. Complications occurred in 23 cases (7.1%). Most of these were minor, consisting of five cases of bruising or hematomas (1.6%), four superficial infections (1.3%), three seromas (0.9%), two hydroceles (0.6%), six patients with persisting groin pain for more than a month (1.8%), one foreign body granuloma, one urinary retention, and one testicular atrophy. There were no recurrences or operative deaths. CONCLUSION: Lichtenstein's tension-free hernioplasty is an easy and simple technique with less pain, minor complications and only rare instances of recurrence. This procedure can be performed on a same-day basis under local anesthesia. Lichtenstein repair may be the most promising technique for the repair of groin hernias.
Analgesics ; Anesthesia, Local ; Atrophy ; Granuloma, Foreign-Body ; Great Britain ; Groin* ; Hematoma ; Hernia* ; Herniorrhaphy ; Humans ; Length of Stay ; Male ; Postoperative Period ; Recurrence ; Retrospective Studies ; Seroma ; United States ; Urinary Retention

PURPOSE: Laparoscopic surgery has became or is being tried as a standard procedure in most of abdominal surgeries due to the advantages of little postoperative pain, shortened of hospital stay, early return to daily life, the cosmetic effect etc. In this article, we examine the availability of laparoscopic herniorrhaphy through a clinical review of patients who had undergone by laparoscopic or conventional herniorrhaphy. METHODS: The records and data of 137 inguinal hernia patients who underwent laparoscopic herniorrhaphy (n=57) or conventional herniorrhaphy (n=80), with similar sex and age distribution, were retrospectively analyzed. Laparoscopic herniorrhaphy equated to transabdominal preperitoneal repair and conventional herniorrhaphy to Bassini's or Ferguson's repair. As statistical method, the Chi-square and T-test was used. RESULTS: There was no significant difference noted between the groups in relation to sex, age, site and type of hernia, complication rate, or recurrence rate in both group. The laparoscopic group had a longer mean operative time (87.3 vs 68.6 min) and less frequent postoperative analgesic use (49.1 vs 72.6%) as compared to the conventional group. However there was no statistical significance. The laparoscopic group had a significantly shorter mean postoperative hospital day (3.6 vs 7.8 days) and the mean period of return to work (6.2 vs 15.2 days) as compared to the conventional group. CONCLUSION: Laparoscopic herniorrhaphy is thought to be becoming the preferred operative procedure for young patients with a flourishing social activity particularly due to its shortening of the postoperative hospital stay and facilitating the early return to work. There is a need for the complication and recurrence rate to be reestimated following a sufficient and strict follow up. After studying more cases, a reevaluation must be done concerning the advantage of laparoscopic herniorrhaphy.
Age Distribution ; Follow-Up Studies ; Hernia ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Pain, Postoperative ; Recurrence ; Retrospective Studies ; Return to Work ; Surgical Procedures, Operative

PURPOSE: To analysis of the clinical aspects of axillofemoral (AXFBG) and aortofemoral bypass (AOFBG) for aortoiliac occlusive disease. METHODS: Between June 1996 and May 2001, 23 patients underwent AXFBG or AOFBG for lower extremity ischemia caused by aortoiliac occlusive disease at Samsung Medical Center. The decision to perform AXFBG or AOFBG was based on an assessment of surgical risk and the patient's preference. We retrospectively analyzed the preoperative clinical status, risk factors and distal runoff scores affecting the patency rate as well as the clinical outcome following surgery. RESULTS: We performed 10 AXFBGs and 13 AOFBGs. The mean age was 67.8 years in AXFBG patients and 57.4 years in AOFBG patients. Limb salvage as an indication for surgery included 8 (80%) cases with AXFBG, as compared to 13(100%) cases with AOFBG. The mean follow-up period was 20.7 months in AXFBG and 21.8 months in AOFBG. The clinical improvement following surgery was statistically higher with AOFBG. The one-year and 2-year primary patency rates in AXFBG were 100% and 82% retrospectively. All of the grafts of AOFBG were patent during this follow-up period. CONCLUSION: The clinical improvement was higher with AOFBG as compared to AXFBG. However AXFBG is a safe practice in high-risk patients.
Follow-Up Studies ; Humans ; Ischemia ; Limb Salvage ; Lower Extremity ; Retrospective Studies ; Risk Factors ; Transplants

PURPOSE: It is difficult to preoperatively determine the extent of surgery for extrahepatic cholangiocarcinoma due to its proximity to vital structures. Recently the tendency of combined resection of liver and pancreas for the treatment of this appears to be increasing, although, in spite of the expected survival benefit, this radical surgery cannot be applied to all extrahepatic cholangiocarconoma because of the high rate of operative complications. We reviewed patients who had undergone segmental resection of the bile duct vice radical surgery for extrahepatic cholangiocarconoma in order to study their clinical features and to analyze the prognostic factors for survival. METHODS: Thirty-four patients who underwent segmental resection for extrahepatic cholangiocarcinoma, excepting GB cancer, at our center between 1994 to 2000 were included in this study and their medical records were reviewed retrospectively. RESULTS: The mean age of the patients was 63 years and they underwent segmental resection of bile duct and skeletalization of the hepatoduodenal ligament with hepatico-jejunostomy. The mean length of hospital stay after operation was 17.2 days (8~44) and no operative mortality was encountered. Postoperative complications including 5 wound dehiscences, 1 intraperitoneal abscess, 1 pyloric obstruction and 1 case of gastric ulcer bleeding were all improved following conservative management. The mean size of tumors was 2.6 cm and 11 tumors (32%) involved the resection margin. The estimated 2 and 4 year survival rates of the 34 patients following resection was 64% and 22% respectively and the only significant predictive factor for survival following resection was the tumor involvement of resection margin (P=0.045). The 2-year survival rate of the positive margin group was 34%, although that of the free margin group was 74%. CONCLUSION: Segmental resection for extrahepatic cholangiocarconoma may be a reasonable option offering relatively low morbidity and mortality if the resection margin is tumor- free. Additionally, segmental resection may be more beneficial to patients with high operative risk in particular.
Abscess ; Bile Ducts ; Bile Ducts, Extrahepatic* ; Cholangiocarcinoma ; Hemorrhage ; Humans ; Length of Stay ; Ligaments ; Liver ; Medical Records ; Mortality ; Pancreas ; Postoperative Complications ; Retrospective Studies ; Stomach Ulcer ; Survival Rate ; Wounds and Injuries

PURPOSE: The aim of this study was to evaluate the rate and pattern of recurrence of rectal cancer as well as analyze the risk factors affecting recurrence following resection with curative intent. METHODS: 460 patients underwent curative resection for adenocarcinoma of the rectum at our clinic from 1994 to 1998. Among these, 132 patients (29.1%) whose recurrence was confirmed by clinical and radiologic examination or reoperation were studied retrospectively. The risk factors that determined the recurrence patterns were analysed with univariate and multivariate analyses. RESULTS: The mean time to recurrence was 22.0 months. The locoregional recurrence rate was 5.7% (25/440). The systemic recurrence rate was 18.4% (81/440). 12 patients (2.7%) had two or more sites of recurrence at the time of diagnosis. The most common locoregional recurrence was a pelvic recurrence (2.3%; 10/440), followed by anastomosis (2.0%; 9/440) and presacral (0.9%; 4/440). The most common site of systemic recurrence was the liver (7.0%; 31/ 440), followed by the lung (5.9%; 26/440) and peritoneum (3.2%; 14/440). The mean time from recurrence to death was 16.0 months. Logistic regression analysis demonstrated that nodal metastasis (P=0.002), vascular invasion (P=0.027), elevated CEA level (P=0.011), and microscopic invasion to the lateral margin (P=0.008) were risk factors for postoperative recurrence. When the recurrence patterns were compared to stage, the systemic recurrence rate was 3.0% in stage I, 15.3% in stage II, and 28.9% in stage III. The locoregional recurrence rate was 3.0% in stage I, 6.0% in stage II, and 6.8% in stage III. CONCLUSION: Even though an excellent local control was obtained following curative resection of rectal cancer, the main cause of recurrence was a systemic failure in advanced rectal cancer. More effective systemic chemotherapy is required for the prevention of systemic recurrence.
Adenocarcinoma ; Diagnosis ; Drug Therapy ; Humans ; Liver ; Logistic Models ; Lung ; Multivariate Analysis ; Neoplasm Metastasis ; Peritoneum ; Rectal Neoplasms* ; Rectum ; Recurrence* ; Reoperation ; Retrospective Studies ; Risk Factors

PURPOSE: Hepatic resection for metastatic colorectal cancer has recently become a widely acceptable treatment modality due to its low surgical mortality and the significant improvement of 5 year survival rates seen after resection. However the use of this treatment modality remains controversial. The aim of study was to assess the survival benefits in patients who had undergone a hepatic resection for metastatic colorectal cancer as well as to determine the prognostic factors. METHODS: A retrospective study was conducted of 94 patients who had undergone curative hepatic resection for synchronous or metachronous metastatic colorectal cancer at Department of Surgery, Yonsei University College of Medicine, between June 1989 and June 2000. Cases demonstrating extrahepatic metastasis at the time of initial surgery were excluded. The survival rate was calculated using the Kaplan-Meier and Cox regression hazard model. The mean follow up period was 35 months. RESULTS: There were 58 (61.7%) and 36 (38.3%) cases of synchronous and metachronous metastasis, respectively. The 5 year survival rate was shown to be significantly lower in patients with more than 3 metastases (P=0.05), 4 or more regional lymph node metastases in primary colorectal cancer (P=0.02), bilobar metastasis (P=0.002), extra hepatic recurrence (P=0.03) and recurrence within 1 year after hepatic resection (P=0.001). Bilobar metastasis (P=0.004) and recurrence within I year (P=0.001) has been demonstrated independent factor for 5 year survival. The overall 5 year survival rate was 30.4%. CONCLUSION: Patients with multiple, bilobar hepatic metastasis demonstrated a poor survival rate. Extrahepatic recurrence within 1 year following hepatic resection was also related with a poor outcome. Therefore, in patients with poor prognostic factors, curative surgical resection accompanied by a multimodality treatment is necessary for the improvement of survival.
Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Survival Rate*

PURPOSE: Nasogastric (NG) decompression has traditionally been used following gastrectomy with extended lymph node dissection in patients with gastric cancer. A prospective randomized study of 133 patients undergoing gastric cancer surgery was performed in order to determine the necessity of routine NG decompression. METHODS: Between July 1999 and July 2000, 133 patients with gastric cancer were randomly assigned to one of two groups: NG group (n=69)-NG decompression was maintained postoperatively until a resumption of bowel function; No-NG group (n=64)-NG tube was not inserted at all, either pre- or postoperatively. RESULTS: The times to return of bowel sounds, passage of flatus and start of oral intake were all significantly (P<0.001) shortened in the No-NG group. The length of operating time and postoperative hospital stay were also decreased in the No-NG group (P<0.001). Two patients in each group (2.9% in NG and 3.1% in No-NG group) required subsequent NG decompression. There were no significant differences between the two groups concerning the presence of postoperative fever, nausea, vomiting, anastomotic leakage, pulmonary or wound complications between the two groups. There was no postoperative mortality in either group. CONCLUSION: We concluded that routine NG decompression is not necessary in elective gastric cancer surgery, even in the presence of gastric outlet obstruction.
Anastomotic Leak ; Decompression* ; Fever ; Flatulence ; Gastrectomy ; Gastric Outlet Obstruction ; Humans ; Length of Stay ; Lymph Node Excision ; Mortality ; Nausea ; Prospective Studies ; Stomach Neoplasms* ; Vomiting ; Wounds and Injuries

No abstract available.
Animals ; Heart* ; Rats*

No abstract available.
Pulmonary Artery*