The laparoscopic cholecystectomy, performed for the first time in France in 1987, has been accepted as in many countries the method of choice when performing a cholecystectomy. The trend toward minimally invasive surgery has prompted general surgeons to try it instead of open cholecystectomy. We performed 1000 laparoscopic cholecystectomies at the Department of General Surgery of Eulji Medical College Hospital from January 1992 to April 1997. The outcome data have been analyzed retrospectively. Moreover, we have compared the case histories of 13 patients who received cholecystostomy with those of 43 patient who did not. We also present preliminary results for an interval laparoscopic cholecystectomy which was a preceded by percutaneous cholecystostomy. The results are as follows: 1) The mean age was 54.3 years ranging from 17 to 86; there were 402 males and 598 females. 2) Of the 1000 patients, 123 patients (12.3%) had a history of abdominal surgery. 3) More than half of the patients(560 patients, 56.0%) underwent operations within 6 months of the onset of symptoms. 4) A preoperative endoscopic retrograde cholecystoscopy was performed on 220 patients (22.0%), and of these, 93 patients received endoscopic sphincterotomies because of bile duct stones. 5) The majority of patients(744 patients, 74.4%) had laparoscopic cholecystectomies which lasted 40 minutes or less. 6) More than half (54%) of the removed gallbladders showed grade II inflammation. 7) Drains were used in 142 patients (14.2%). 8) Postoperative complications were encountered in 48 patients (4.8%). 9) Postoperative oral intake was resumed within 24 hours in most patients. 10) Most patients(854 patients, 85.4%) were discharged within 3 days of the operation. 11) The pathologic diagnosis was chronic nonspecific inflammation in most cases (823 cases, 82.3%). 12) The most common microorganism in the bile was E. coli. 13) Patients who received a cholecystostomy had many benefits: a shorter operation time, a low rate of open cholecystectomy, early oral intake. 14) For the 1160 patients who underwent a cholecystectomy during the same period, the rate of open cholecystectomy was 13.8%.
Bile ; Bile Ducts ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystostomy* ; Diagnosis ; Female ; France ; Gallbladder ; Humans ; Inflammation ; Male ; Postoperative Complications ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Surgical Procedures, Minimally Invasive

PURPOSE: The rate of malignancy in the follicular neoplasm (FN) or Hürthle cell neoplasm (HCN) of the thyroid gland is estimated as approximately 20~30%. Fine-needle aspiration biopsy (FNAB) and frozen section examination are restricted in differentiating between benign and malignant. The aims of this study are to compare the differences of clinicopathologic features and to determine the risk factors for malignancy in patients with FN or HCN. METHODS: A retrospective study was conducted of patients with FN or HCN who were diagnosed by FNAB, and underwent surgery at our institution between Jan. 2005 to Jun. 2010. We analyzed the risk factors for malignancy and the differences of clinicopathologic features in patients with FN or HCN. RESULTS: A total of 290 patients were enrolledin this study; 160 (55.2%) patients underwent thyroidectomy, 97 (60.6%) patients had FN, and 63 (39.4%) had HCN. Forty one (25.6%) patients were diagnosed as malignancy of these, 22 (22.7%) patients were FN and 19 (30.2%) were HCN (P=0.29). Two (2.1%) patients with FN and 10 (15.9%) with HCN (P=0.002) comcomitant papillary thyroid carcinoma were indentified by FNAB. Classification of nodules according to ultrasonographic findings in both neoplasms (P<0.05) and galectin-3 in FN (P<0.05) were predictive factors for malignancy. In addition, galectin-3 was a predictive factor for malignancy in indeterminate nodules on ultrasonography (USG) (P=0.028). CONCLUSION: Classification of nodules according to ultrasonographic findings and galectin-3 expression is helpful in predicting carcinoma of patients with FN or HCN.
Biopsy, Fine-Needle ; Classification ; Frozen Sections ; Galectin 3 ; Humans ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Thyroidectomy ; Ultrasonography

No abstract available.
Genes, ras* ; Humans*

Gingival fibroblasts(GF) and periodontal ligament fibroblasts(PDLF) are the major cellular components of periodontal soft connective tissues, but the precise molecular biological differences between these cells are not yet known. In the present study, we investigated the expression of S100A4, S100A2 calcium-binding protein and osteoblast-specific factor 2(OSF-2, Periostin) mRNA in GF and PDLF in vitro through the process of reverse transcription-polymerase chain reaction(RT-PCR) and Northern blot analysis in each. Human GF and PDLF were isolated from the gingival connective tissue and the middle third of freshly extracted healthy third molars. They were cultured in Dulbecco's Modified Eagle Medium(DMEM) containing 10% fetal bovine serum and cells in the third passage were used in the experiments. After extracting total RNA from cultured cells, RT-PCR and Northern analysis were performed using S100A4-, S100A2- and Periostin-specific oligonucleotide primers and subcloned cDNA probes in each. In RT-PCR and Northern analysis, the expression of S100A4 and Periostin mRNA in GF was slightly detectable. Interestingly, the expression of S100A4 and Periostin mRNA in PDLF was much higher than that in GF. On the other hand, S100A2 mRNA was highly expressed in both GF and PDLF. Since there was a marked difference of S100A4 and Periostin expression between GF and PDLF in vitro, these data suggest that S100A4 and Periostin could be used as a useful marker for distinguishing cultured gingival fibroblasts and periodontal ligament cells.
Blotting, Northern ; Carrier Proteins* ; Cells, Cultured ; Connective Tissue ; DNA Primers ; DNA, Complementary ; Eagles ; Fibroblasts* ; Hand ; Humans* ; Molar, Third ; Periodontal Ligament* ; RNA ; RNA, Messenger*

BACKGROUND: Gastric cardia cancers are relatively rare neoplasms althougth it is reported that their relative incidence among gastric cancers is increasing. At the time of diagnosis, gastric cardia cancers in many cases are already in a more advanced stage in terms of depth of invasion or metastasis to lymph nodes. The purpose of this study was to evaluate the effect of the proximal resection margin on the survival rates for cardia cancer patients who underwent a total gastrectomy without a thoracotomy. METHODS: We retrospectively analyzed 87 patients who had undergone operations for gastric cardia cancers at Eulji College Hospital during the 8 years from Jan. 1988 to Dec. 1995. RESULTS: The most prevalent age group was in the 6th decade (34.5%) and the male-to-female ratio was 2.2:1.0. The TNM classification showed stage I (13.8%), II (10.3%), III (54%) and IV (21.8%). The overall 5-year survival rate was 35.6%, and the survival rates according to the stage were 83.3% in stage I, 87.5% in stage II, 27.1% in stage III, and 0% in stage IV. The 5-year survival rates according to the length of the proximal resection margin (PRM) for all patients were as follows: 22.0% for PRM< or =2 cm (N=34) and 44.0% for PRM>2 cm (N=52) 44.0% (p=0.0783). The 5-year survival rates according to the length of the PRM for stage III cancers were as follows: 19.7% for PRM< or =2 cm (N=18) and 31.7% for PRM>2 cm (N=28)(p=0.4090). CONCLUSIONS: These results suggest that the length of the proximal resection margin is not significant as a prognostic factor. We believe a total gastrectomy without a thoracotomy is a reasonable and safe alternative to a thoracotomy approach to the dissection of the mediastinal lymph node in cases of gastric cardia cancer.
Cardia* ; Classification ; Diagnosis ; Gastrectomy* ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate ; Thoracotomy

BACKGROUND: Among all gastric cancers, the most frequent malignant tumor in Korea, the proportion of early gastric cancer is increasing. This increase is bringing about controversy on the necessity of gastrectomy with extensive lymph node dissection for treatment. METHODS: Of 923 gastric cancer cases operated on at EulJi Medical Hospital from Jan. 1988 to Dec. 1996, we observed retrospectively 198 cases diagnosed as early gastric cancer on pathological biopsies. We performed this study in order to analyze the prognostic factors affecting recurrence and survival rate and to determine which characteristic of early gastric cancer influences lymph node metastasis. RESULTS: The rate of lymph node metastasis of early gastric cancer was 9.5% and it was revealed that depth of tumor invasion (p<0.0001) and tumor size (p=0.05) affected lymph node metastasis. This comprehensive study on the correlation between lymph node metastasis and such factors as gross type of tumor, depth of tumor invasion, tumor size, and histologic type of tumor indicated that the larger in size, a submucosal cancer in depth, the more depressed in gross type, the poorer in differentiation, the higher the rates of lymph node metastasis were. The 5-year recurrence rate was 4.9%, and the 10-year recurrence rate was 9.6%. Lymph node metastasis had the greatest effect on recurrence, compared with other factors influencing recurrence: depth of tumor invasion (p=0.0358), tumor size (p=0.0054) and lymph node metastasis (p=0.0003). The 5-year survival rate was 95.6% and 10-year survival rate was 91.9%. These survival rates didn't correlate with the depth of tumor invasion (p=0.099), the histologic type (p=0.963) or the gross type (p=0.1324) while the survival rates revealed significant differences (p=0.0337, 0.0032) based on tumor size (<1 100%, 1-2 100%, >2 89.6%) and lymph node metastasis (n 96.3%, n 88.9%). CONCLUSIONS: Lymph mode metastasis is the most influential factor in the survival rate and the recurrence rate of early gastric cancer. We conclude that limited surgery is a reasonable treatment for differentiated mucosal cancers less than 5 cm and selectively for submucosal cancers less than 2 cm with elevation, which have the least possibility of recurrence and lymph node metastasis. However, a gas-trectomy with extensive regional lymph node dissection is still considered to be essential for either submucosal cancer with a depression or the submucosal cancer measuring more than 2 cm in size with elevation since recurrence and lymph node metastasis were frequently seen with these variants.
Biopsy ; Depression ; Gastrectomy ; Korea ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis* ; Neoplasm Metastasis ; Recurrence* ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

The clinical and pathological features of warty dyskeratoma are presented. Warty dyskeratoma is a rarely encountered, solitary, benign cutaneous tumor occurring most often on the head and neck and to our knowledge, no cases associated with cutaneous horn have been published in western literature. We experienced a case of warty dyskeratoma with a cutaneous horn occurring in a 70-year-old male, who had a 1.3 cm-sized and slowly growing nodule on his neck. A brief review of the literature, was made especially in relation to the pathological findings and histogenesis of warty dyskeratoma.
Aged ; Animals ; Head ; Horns* ; Humans ; Male ; Neck

Pigmented squamous cell carcinoma is a very rare malignant, pigmented, epidermal tumor. The rarity of pigmented squamous cell carcinomas may reflect in part their misdiagnosis as other pigmented neoplasms, particularly malignant melanoma. To our knowledge, only five cases have been reported in literature. We recently experienced a case of pigmented squamous cell carcinoma arising from pigmented actinic keratosis in a 77 years old female. Physical examination showed a 0.8 0.6 cm, smooth, dark brown pigmented patch with irregular but sharply defined borders located on the upper left chest. The biopsy specimen showed histologic findings of pigmented actinic keratosis with abundant melanin pigments, which became pigmented squamous cell carcinoma. Most of pigments in the squamous cell carcinoma were contained within the melanocytes along with the neoplastic squamous cells.
Actins* ; Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Diagnostic Errors ; Female ; Humans ; Keratosis, Actinic* ; Melanins ; Melanocytes ; Melanoma ; Physical Examination ; Skin ; Thorax

PURPOSE: To evaluate the surgical result and complications of scleral fixation of foldable intraocular lenses. METHODS: We reviewed the medical records of 17 patients who had undergone scleral fixation of acrylic three-piece foldable intraocular lens. RESULTS: Uncorrected visual acuity were improved in all eyes with time. Postoperative best corrected visual acuity were better than preoperative best corrected visual acuity in 14 eyes from 1.18+/-0.84 to 0.26 +/-0.25 in logMAR visual acuity. Estimated refractive error were 0.01+/-0.34 diopter in spherical equivalent preoperatively and .0.59+/-1.00 diopter postoperatively (p=0.02, paired t-test). The corneal astigmatic changes (dK) of mild against-the-rule astigmatism decreased as time passed. There was no intraoperative bleeding. There were postoperative complications such as increased intraocular pressure in 2 eyes, corneal epithelial defect in 1 eye. CONCLUSIONS: In cases of scleral fixation, by using acrylic foldable intraocular lens through small incision, we were able to reduce corneal astigmatism and complications due to large incision and therefore, improve visual acuity instantly.
Astigmatism ; Hemorrhage ; Humans ; Intraocular Pressure ; Lenses, Intraocular* ; Medical Records ; Postoperative Complications ; Refractive Errors ; Visual Acuity

PURPOSES: A laparoscopic cholecystectomy has many clinical advantages and is now recognize as the choice of treatment for gallstones. However a laparoscopic cholecystectomy is often not feasible or is converted to the conventional open method in patients with acute cholecystitis because of inflammation around the gallbladder, surrounding adhesion, unclear anatomy, or intraoperative complications, such as excessive bleeding, bile duct and other organ injury, or other technical problems. Recent studies recommended that acute cholecystitis patients or gallbladder empyema patients with pain undergo a cholecystostomy first and a laparoscopic cholecystectomy later because a cholecystostomy can be very helpful for improving the patient's state: for example, gallbladder decompression, early control of acute inflammation, and alleviating gallbladder adhesion alleviation. METHODS: This study was carried out on 62 patients (Group I) who underwent a laparoscopic cholecystectomy after a percutaneous cholecystostomy at EulJi Medical College between January 1996 and March 2000. These cases were compared with a control group of 41 patients (Group II) who showed similar symptoms, ultrasonographic findings, operative findings, and pathologic results before January 1996 when a cholecystostomy was not yet used at this hospital. RESULTS: Among Group I, a successful laparoscopic cholecystectomy was possible in 40 patients (64.5%), the other 22 patients were converted to open cholecystectomy. In Group II, only 15 patients (36.6%) out of 41 underwent a successful laparoscopic cholecystectomy. This difference was statistically significant (p=0.005). In other words, the open conversion rates were 35.5% in Group I and 63.4% in Group II. There were no differences in the age and the sexdistributions, the symptom duration, Alk-phosphatase, total bilirubin, and leucocytosis. The degree of inflammation didn't have a singificant influence. Neither did the gallbladder wall thickness. CONCLUSION: We think that a laparoscopic cholecystectomy perfomed some time after a percutaneous cholecystostomy to improve the patient's condition by eliminating acute inflammation or decompressing the gallbladder may be recommended for management of acute cholecystitis patients with severe clinical symptoms and ultrasonographic findings of marked gallbladder dilatation or pericholecystic fluid collection.
Bile Ducts ; Bilirubin ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute ; Cholecystostomy* ; Decompression ; Dilatation ; Gallbladder ; Gallstones ; Hemorrhage ; Humans ; Inflammation ; Intraoperative Complications