No abstract available.

BACKGROUND: Nonobstertic surgery during pregnancy needs special considerations by the surgeon in relation to the maternal and the fetal outcomes. Although there are many studies about appendicitis in pregnant women, nonobstetric surgery, in general, during pregnancy has not been sufficiently analyzed. In this clinical study, we reviewed the incidences of nonobstetric surgical diseases during pregnancy and observed the maternal and the fetal outcomes of surgery, including the effects of anesthesia and antibiotics. METHODS: We retrospectively analyzed 80 patients who were pregnant at the time of operation and who had undergone operations during an 11-year period from March 1986 to April 1997 at Shinchon- and Inchon-Severance Hospital. The distributions of age, disease, and delivery history were analyzed, and the diagnostic characteristics, and the fetal and the maternal outcomes were observed with respect to anesthesia and antibiotic usage. RESULTS: The average age of the patients was 32, and 53% of the patients were over 30. The numbers of patients in the first, the second, and the third trimester were 24 (30%), 36 (45%) and 20 (25%), respectively. The most frequent surgical disease was appendicitis with 52 patients (65%). The average duration of hospitalization was 14.4 days. Twenty-two patients (27.5%) had postoperative preterm labor and were successfully managed with tocolytic agents except for one preterm delivery. The total number of preterm deliveries was 10 (12.5%), and still birth occurred in 3 cases (3.8%). The cases of still birth involved severe original diseases, such as rectal carcinomas, pancreatic carcinomas, and sepsis. Among the antibiotics that were used during surgical care, monotherapy with ampicillin was the most frequently used mode. The incidence frequencies of delivery complications according to the used antibiotics were not significantly different from each other. General endotracheal anesthesia was used in 40 cases, spinal and epidural anesthesia was inducted in 25 and 13 cases, respectively. The incidences of fetal complications according to the methods of was administering anesthesia were not significantly different. CONCLUSIONS: The maternal and the fetal risks of nonobstetric surgery during pregnancy depend on the risk of the original surgical disease of the patient. Modes of anesthesia or antibiotic usage do not increase the incidences of obstetric complications.
Ampicillin ; Anesthesia ; Anesthesia, Epidural ; Anti-Bacterial Agents ; Appendicitis ; Female ; Hospitalization ; Humans ; Incidence ; Obstetric Labor, Premature ; Parturition ; Pregnancy Trimester, Third ; Pregnancy* ; Pregnant Women ; Retrospective Studies ; Sepsis ; Tocolytic Agents

BACKGROUND: Epicardial fat tissue has unique endocrine and paracrine functions that affect the cardiac autonomic system. The head-up tilt test (HUTT) is a simple non-invasive measurement that assesses autonomic nervous system dysfunction. We investigated the association between epicardial fat thickness (EFT) and autonomic neural tone, such as vagal tone. METHODS: A total of 797 consecutive patients (mean age 46.5 years, male: 45.7%) who underwent HUTT and echocardiography between March 2006 and June 2015 were enrolled. EFT was measured during the diastolic phase of the parasternal long axis view. We excluded patients with prior percutaneous coronary intervention, old age (* 70 years old), valvular heart disease, symptomatic arrhythmias and diabetes. We divided patients into two groups based on the HUTT (positive vs. negative). RESULTS: There were 329 patients (41.3%) with a negative HUTT result and 468 patients (58.7%) with a positive result. The HUTT-positive patients showed a significantly lower waist circumference, body mass index and systolic and diastolic blood pressure, although a significantly higher EFT as compared to the HUTT-negative patients (HUTT-positive, 5.69 ± 1.76 mm vs. HUTT-negative, 5.24 ± 1.60 mm; p < 0.001). EFT > 5.4 mm was associated with a positive HUTT result with 51.7% sensitivity and 63.8% specificity (p < 0.001) on receiving operator characteristic analysis. Multivariate Cox regression analysis revealed that EFT (hazard ratio: 1.02, 95% confidence interval: 1.01–1.30, p = 0.004) was an independent predictor of HUTT-positivity. CONCLSION: EFT was significantly correlated with positive HUTT, which suggests an association between EFT and autonomic dysregulation.
Arrhythmias, Cardiac ; Autonomic Nervous System ; Blood Pressure ; Body Mass Index ; Echocardiography ; Heart Valve Diseases ; Humans ; Male ; Percutaneous Coronary Intervention ; Sensitivity and Specificity ; Syncope* ; Syncope, Vasovagal ; Waist Circumference

Purpose: This study aimed to compare the clinical outcomes of laparoscopic appendectomy (LA) according to the method of appendiceal stump closure. Methods: Patients who underwent LA for appendicitis between 2010 and 2020 were retrospectively reviewed. Patients were classified into locking polymeric clip (LPC) and loop ligature (LL) groups. Clinical outcomes were compared between the groups. Results: LPC and LL were used in 188 (56.6%) and 144 patients (43.4%), respectively for appendiceal stump closure. No significant differences were observed in sex, age, comorbidities, and the severity of appendicitis between the groups. The median operative time was shorter in the LPC group than in the LL group (64.5 minutes vs. 71.5 minutes, P=0.027). The median hospital stay was longer in the LL group than in the LPC group (4 days vs. 3 days, P=0.020). Postoperative incidences of intraabdominal abscess and ileus were higher in the LL group than in the LPC group (4.2% vs. 1.1%, P=0.082 and 2.8% vs. 0%, P=0.035; respectively). The readmission rate was higher in the LL group than that in the LPC group (6.3% vs. 1.1%, P=0.012). Conclusion Using LPC for appendiceal stump closure during LA for appendicitis was associated with lower postoperative complication rate, shorter operative time, and shorter hospital stay compared to the use of LL. Operative time above 60 minutes and the use of LL were identified as independent risk factors for postoperative complications in LA. Therefore, LPC could be considered a more favorable closure method than LL during LA for appendicitis.

Purpose: This study was conducted to evaluate the effectiveness of primary tumor resection (PTR) in asymptomatic colorectal cancer (CRC) patients with unresectable metastases using the inverse probability of treatment weighting (IPTW) method to minimize selection bias. Methods: We selected 146 patients diagnosed with stage IV CRC with unresectable metastasis between 2001 and 2018 from our institutional database. In a multivariate logistic regression model using the patients’ baseline covariates associated with PTR, we applied the IPTW method based on a propensity score and performed a weighted Cox proportional regression analysis to estimate survival according to PTR. Results: Upfront PTR was performed in 98 patients, and no significant differences in baseline factors were detected. The upweighted median survival of the PTR group was 18 months and that of the non-PTR group was 15 months (P = 0.15). After applying the IPTW, the PTR was still insignificant in the univariate Cox regression (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.5–1.21). However, in the multivariate weighted Cox regression with adjustment for other covariates, the PTR showed a significantly decreased risk of cancer-related death (HR, 0.61; 95% CI, 0.40–0.94). Conclusion In this study, we showed that asymptomatic CRC patients with unresectable metastases could gain a survival benefit from upfront PTR by analysis with the IPTW method. However, randomized controlled trials are mandatory.

No abstract available.
Stomach Neoplasms*

The venous thrombosis is the most common vascular event in Behcet's disease. Among the thrombotic complications of Behcet's disease, thrombosis in superior vena cava is rare, but once it happens, it may be life-threatening. In this report, we describe a case of 45-year-old female with Behcet's disease complicated by the superior vena cava thrombosis, which was treated successfully with the operation and then endovascular stenting. This case shows that endovascular stent may be one of good strategies for the management of vascular complication in Behcet's disease.
Female ; Humans ; Middle Aged ; Stents* ; Superior Vena Cava Syndrome* ; Thrombosis ; Vena Cava, Superior* ; Venous Thrombosis

INTRODUCTION: Applying clinical conditions to on experimental animals forto verifverifyingy the mechanism of disease and drug effects is crucial. Cirrhotic livers induced by Hepatitis B virus are frequent, and eEspecially in Korea where a great deal of more liver-related diseases occurs, cirrhotic livers induced by Hepatitis B virus are frequent, and, such viral-induced cirrhosis, and this often impedes other medical treatments. Therefore, creating a proper elucidating properly deriveding cirrhosis method in animal model to simulate the actual pathophysiology of cirrhosis can benefit future researches. AIMS: We wanted toTe testing various hypotheticalsized methods of inducing cirrhosis in animal models, and we wanted the model to have a with higher rate of reproducibility. METHOD: To induce cirrhotic liver, thioacetamide (Sigma, St. Louis, USA) wasis given either freely via oral intaken or it wasand injected into the peritoneal space ofn Sprague-Dawley(SD) rats. The SD rats wereare divided into four groups: the oOral intake gGroup 1 ((N=10, 0.03%, 13 weeks), the oOral intake gGroup 2 (N=20, 0.04%, 30 weeks), the iIntraperitoneal Injected gGroup 1 (N=10, 300mg/kg, 12 weeks (3 times per week for first 2 weeks, 2 times per week for next 10 weeks) and the iIntraperitoneal Injected gGroup 2 (N=20, 300mg/kg, 2 times per week for 16 weeks). The mMortality rate of the tested subjects is recorded, and a visual test of the livers is performed at the end of the experiment, a visual test of the livers is performed. Also, the extracted liver cells that were dyed with Trichrome are compared to evaluate the extent of the liver cirrhosis. RESULT: For theIn oral intake group 1, no loss of occurred until wWeek 13, and 5 of the SD rats (50%) showed signs of liver cirrhosis by the Trichrome dye test. However, the extent of cirrhosis greatly differed betweenfrom each of the subjects. ForIn the oral intakae group 2, no loss occurred until wWeek 30. 20 of the SD rat (100%) in this group possessed a cirrhotic liver. However, the weight of the cirrhoscirrhotic liversis differed from a minimum of 231g to a maximum of 770g. For theIn Injected Group 1, 4 tested subjects (40%) died between wWeeks 3 and 4; however, the rest of them survived and they all revealed a signs of cirrhosis. ForIn the iInjected Group 2, only 3 tested subjects (15%) died, and after wWeek 16, 17 survivors (100%) showed a signs of cirrhosis. CONCLUSION: The short-term oral administration of thioacetamide only induced a minimal amount of cirrhosis;, thus, a longer period of consumption is suggested. Injection of thioacetamide into the peritoneum resulted in higher death rate when thoacetamide wasis injected frequently. Therefore, selecting a proper method to create a cirrhotic liver, with considering the reproducibility, on cirrhotic liver, the survival rate of the experimental animals, and the length of the experiment, isare strongly suggested for creating an animal model of cirrhotic liverfor further experiments.
Administration, Oral ; Animals ; Fibrosis ; Hepatitis B virus ; Humans ; Korea ; Liver ; Liver Cirrhosis* ; Models, Animal ; Mortality ; Peritoneum ; Rats* ; Survival Rate ; Survivors ; Thioacetamide

PURPOSE: Sarcomatoid hepatocellular carcinoma (HCC) is a rare neoplasm and it has been found in only 1.8% of the surgically resected HCC patients, and in only 3.4~9.4% of the autopsied HCC cases. The pathogenesis of this tumor has't yet been thoroughly clarified, and such a tumor has been variously referred to as spindle cell carcinoma, sarcomatoid carcinoma, pseudosarcoma, or carcinosarcoma. There is only a little difference between the clinical characteristics of the sarcomatoid HCC and those of ordinary HCC. The diagnosis of the sarcomatoid HCC is made by pathological and immunohistochemical techniques after surgical resection, biopsy, or autopsy. METHODS: We reviewed the 10 cases of pathologically confirmed sarcomatoid HCC that were registered at the Yonsei University Medical Center from 1992 to 2004. RESULTS: Surgical operation was performed in seven cases, and curative resection was done only in five. Three patients were treated with chemotherapy or transarterial chemoem-bolization (TACE) with or without concurrent radiotherapy after the diagnosis of sarcomatoid HCC by liver biopsy. Six patients expired within 4 months after the diagnosis. The 6 month and 12 month survival rates for sarcomatoid HCC were 40% and 20%, respectively. The 6 month survival rates for radical resection and non-radical resection were 60% and 0%, respectively. The difference in cumulative survival according to the treatment of sarcomatoid HCC was statistically significant. CONCLUSION: The prognosis of sarcomatoid HCC is very poor; therefore, curative resection, adjuvant chemoradiotherapy, and close follow-up are necessary for patients suffering with sarcomatoid HCC.
Academic Medical Centers ; Autopsy ; Biopsy ; Carcinoma, Hepatocellular ; Carcinosarcoma ; Chemoradiotherapy, Adjuvant ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Prognosis ; Radiotherapy ; Survival Rate

PURPOSE: The aim of this study was to evaluate the short- term outcome of a pylorus-preserving proximal gastrectomy by comparing it with a jejunal interposition after a total gastrectomy in proximal gastric adenocarcinoma. MATENRIALS AND METHODS: For 22 patients (12 men and 10 women) who underwent a pylorus-preserving proximal gastrectomy, several clinical parameters were obtained from the medical records retrospectively. In this study, the data were collected between September 1993 and December 1999 at Chungnam National University Hospital, and the results were compared with those of 25 patients (17 men and 8 women) who underwent an isoperistaltic simple jejunal interposition. RESULTS: The average operative time in the pylorus-preserving proximal gastrectomy group (220 minutes) was shorter than that in the jejunal interposition group (243 minutes) (P<0.05). The hemoglobin and hematocrit levels were significantly higher in the pylorus-preserving proximal gastrectomy group at 2 years after the operation. The body weight ratio (postoperative body weight/preoparative body weight) in patients who had a pylorus-preserving proximal gastrectomy was significantly higher than that in patients with a jejunal interposition at 2 years after the operation. The jejunal interposition procedure had better outcomes in anastomotic site stricture, duration of hospital stay, and number of removed lymph nodes (P<0.05). CONCLUSION: We think that from the viewpoint of quality of life, a pylorus-preserving proximal gastrectomy, as well as a jejunal interposition, is a useful reconstruction method for early adenocarcinomas of the proximal stomach. However, stricture of the esophagogastrostomy site in the pylorus- preserving proximal gastrectomy is a common problem to be solved in the future.
Adenocarcinoma* ; Body Weight ; Chungcheongnam-do ; Constriction, Pathologic ; Gastrectomy* ; Hematocrit ; Humans ; Length of Stay ; Lymph Nodes ; Male ; Medical Records ; Operative Time ; Quality of Life ; Retrospective Studies ; Stomach