No abstract available.
Humans ; Lymphocytes* ; Stomach Neoplasms* ; Stomach*

No abstract available.

Pyoderma gangrenosum is an uncommon, chronic, recurrent cutaneous ulcerative disease. It is difficult to diagnosis and is frequently associated with systemic diseases. There is no specific therapy, nor effective uniform therapy. Systemic treatment with corticosteroids or cyclosporine, alone or together, appeared to be effective in many cases. However, prolonged therapy is associated with significant side effects, and in refractory cases, immunomodulatory therapy is needed. We report a case of pyoderma gangrenosum, which developed in a 41-years-old woman, who showed no symptoms of having an underlying systemic disease. The conduction was successfully treated with prednisolone, cyclosporine and dapsone.
Adrenal Cortex Hormones ; Cyclosporine* ; Dapsone* ; Diagnosis ; Female ; Humans ; Immunomodulation ; Prednisolone* ; Pyoderma Gangrenosum* ; Pyoderma* ; Ulcer

Pyoderma gangrenosum is an uncommon, chronic, recurrent cutaneous ulcerative disease. It is difficult to diagnosis and is frequently associated with systemic diseases. There is no specific therapy, nor effective uniform therapy. Systemic treatment with corticosteroids or cyclosporine, alone or together, appeared to be effective in many cases. However, prolonged therapy is associated with significant side effects, and in refractory cases, immunomodulatory therapy is needed. We report a case of pyoderma gangrenosum, which developed in a 41-years-old woman, who showed no symptoms of having an underlying systemic disease. The conduction was successfully treated with prednisolone, cyclosporine and dapsone.
Adrenal Cortex Hormones ; Cyclosporine* ; Dapsone* ; Diagnosis ; Female ; Humans ; Immunomodulation ; Prednisolone* ; Pyoderma Gangrenosum* ; Pyoderma* ; Ulcer

An adenocarcinoma of the appendix is a rare tumor, and so far only 130 cases have been reported worldwide. We report one patient with peritoneal seeding of an adenocarcinoma. A 51-year-old man was admitted to our hospital with the impression of intestinal obstruction. He had undergone an appendectomy 5 years ago due to acute appendicitis. At that time, postoperative histopathological analysis had revealed an adenocarcinoid tumor in the appendix. The patient had been told to visit our hospital for follow-up but he hadn't visited. When he finally visited our hospital diagnostic laparoscopy revealed the peritoneal seeding of a recurrent adenocarcinoma. A palliative right hemicolectomy was done to relieve the bowel obstruction. After recovering from operation, the patient was treated with the 5-fluoruracil, leucovorin, and oxaloplatin (FOLFOX). The patient was discharged in improved general condition with a future plan for regular cyclic chemotherapy.
Adenocarcinoma ; Appendectomy ; Appendicitis ; Appendix* ; Carcinoid Tumor ; Drug Therapy ; Follow-Up Studies ; Humans ; Intestinal Obstruction ; Laparoscopy ; Leucovorin ; Middle Aged ; Neoplasm Metastasis*

For many years it had been universally taught that administration of the commonly used analgesic agents retards the progress of labor. It was therefore advised that these agents should not be administered until the labor was active and progress was rapid. In recent years, more scientific analysis of the progress of labor and accurate recording of uterine contractility revealed that this classical teaching was inaccurate. Despite the increasing use of regional analgesia during labor, systemic medications are still widely used to relieve pain and anxiety. There is no ideal, generally applicable analgesic agent for use during childbirth. All systemic medications used for pain relief in labor cross the placenta and may have a depressant effect on the fetus and injudicious administration of an overdose can cause some depression of uterine activity. It is suggested that elimination of pain or anxiety will decrease adrenal medullary release of epinephrine. Since epinephrine is a known inhibitor of uterine activity, a decrease in its serum level should lead to increased uterine activity. Thus it was decided to make an objective estimation of the effects of morphine, meperidine, diazepam and ketamine upon uterine contractility of pregnant rat uteri, in vitro. The results are as follows: 1) Morphine caused a significant concentration dependent decrease in the contractility of pregnant rat uteri. 2) Meperidene did not cause any significant change in the contractility of pregnant rat uteri. 3) Diazempam caused a concentration dependent decrease in the contractility and the contraction disappeared at a concentration of 80 ug/100ml. 4) Ketamine caused a significant concentration dependent decrease in the contractility of pregnant rat uteri. 5) Addition of CaCl2 to the K-H solution did not cause any significant change in the result.
Analgesia ; Analgesics ; Animals ; Anxiety ; Depression ; Diazepam* ; Epinephrine ; Fetus ; Ketamine* ; Meperidine* ; Morphine* ; Parturition ; Placenta ; Rats* ; Uterus*

The role of surgical intervention in patients with diabetic gastroparesis is unclear. We report a case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standing type 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of reflux esophagitis or obstructive lesions. A gastric emptying time scan showed prolonged gastric emptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory tests revealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) and normal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction after subtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patient showed complete resolution of gastrointestinal symptoms postoperatively. Barium swallow test and gastric emptying time scan performed at follow-up revealed regular progression of barium and normal gastric emptying. Three months postoperatively, his fasting serum glucose level was within normal limits without the administration of insulin or oral antidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstruction after subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improving gastric emptying and glycemic control.
Adult ; Barium ; Blood Glucose ; C-Peptide ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Endoscopy, Digestive System ; Esophagitis, Peptic ; Fasting ; Follow-Up Studies ; Gastrectomy ; Gastric Emptying ; Gastroparesis ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemic Agents ; Insulin ; Vomiting

PURPOSE: Although laparoscopy-assisted gastrectomy (LAG) has become a popular treatment option for early gastric cancer, information about postoperative complications is limited in the literature and their risk factors vary among investigators. We analyzed the complications and their risk factors of LAG. METHODS: We performed LAGs in 92 gastric cancer patients from July 2006 to December 2009. LAG indication was gastric cancer preoperatively diagnosed as cT1N0. Clinical and operative data and perioperative complications were retrospectively reviewed. According to the surgical experience, cases were divided into early (1~40) and late (41~92) groups because operative times stabilized after the 40th case. RESULTS: There were no open conversion or mortality cases. Complications occurred in 11 patients. Two of them were non-surgical complications: postoperative delirium and cerebral infarction. Surgical complications were ischemic necrosis of transverse colon, duodenal stump leakage, anastomotic bleeding, leakage and stenosis. Univariate analysis proved that lymph node metastasis, and comorbidities were related to complication rate (P=0.000, P=0.032). Multivariate analysis proved that lymph node metastasis was the most important risk factor of complication (P=0.001). Surgical experience was not related to complication rate (12.5% in early period and 11.5% in late period, P=1.000). CONCLUSION: Complication rate of LAG was acceptable (11.9%). According to this study, unexpected lymph node metastasis is thought to be the most important risk factor for complications of LAG. Therefore, it is possible to accomplish lower complication rates in this procedure with careful patient selection through accurate preoperative evaluation.
Anastomotic Leak ; Cerebral Infarction ; Colon, Transverse ; Comorbidity ; Constriction, Pathologic ; Delirium ; Gastrectomy ; Hemorrhage ; Humans ; Lymph Nodes ; Multivariate Analysis ; Necrosis ; Neoplasm Metastasis ; Operative Time ; Patient Selection ; Postoperative Complications ; Research Personnel ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms

BACKGROUND: Residual stones after biliary tract surgery are a formidable task for the surgeon. Choledocholithiasis and hepatolithiasis are more common in East Asia, including Korea, compared with the West, and retained and recurrent stones remain a major problem after the surgical treatment of biliary tract stones; thus, various attempts to reduce the rate of retained and recurrent stones are important in the treatment of biliary tract stones. METHODS: A retrospective analysis was done on 815 cases of patients with biliary tract stones who had undergone an operation at the Department of Surgery, Chung-ng University Hospital, during the 13 years from January 1984 to December 1996. RESULTS: The male-to-female sex ratio was 1 : 2, and the most common age group was the 7th decade. The most common symptoms and physical findings were right upper quadrant pain in 620 cases (76.1%), and right upper quadrant tenderness in 511 cases (62.1%). The most common laboratory findings were elevated alkaline phosphatase (88.3%), followed by elevated sGPT and elevated sGOT. Bile cultures and sensitivity tests were done in 815 cases and were positive in 682 cases (83.7%). The most common bacteria were E.coli in 252 cases (37.0%). The locations of the stones were gallbladder (GB) and common bile duct (CBD) in 420 cases (51.5%), the CBD in 160 cases (19.6%), the CBD and intrahepatic duct (IHD) in 108 cases (13.3%). The most common operative procedure was a cholecystectomy with T-ube insertion, 525 cases (64.4%). Postoperative complications developed in 208 cases (25.6%), and the most common postoperative complication was wound infection, 72 cases (8.8%). The operative mortality was 2.9%, and most common cause of death was sepsis (10 cases). CONCLUSIONS: The authors conclude that interventional therapy, as an initial treatment for residual stones, is a satisfactory treatment where possible. If there are residual stones in spite of the interventional therapy, a reoperation or hepatectomy is required.
Alanine Transaminase ; Alkaline Phosphatase ; Aspartate Aminotransferases ; Bacteria ; Bile ; Biliary Tract* ; Cause of Death ; Cholecystectomy ; Choledocholithiasis ; Common Bile Duct ; Far East ; Gallbladder ; Hepatectomy ; Humans ; Korea ; Mortality ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Sepsis ; Sex Ratio ; Surgical Procedures, Operative ; Wound Infection

PURPOSE: Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) for the majority of patients. However, a minority of patients still require conversion to open cholecystectomy during the perioperative period. This study was designed to determine the contributing factors related to conversion to open cholecystectomy. METHODS: The data from 3,510 laparoscopic cholecystectomies, performed at Chung-Ang university hospital from September 1990 to June 2001, were reviewed retrospectively. Pre-operative laboratory data, post-operative pathologic findings, complications, and the reasons for conversion to open cholecystectomy were evaluated. RESULTS: Sixty six (1.88%) of 3,510 patients were converted to open surgery, due to bleeding (39%), adhesion (26%), bile duct injury (23%) and inflammation (6%). These conversion cases were more prevalent in males and needed longer hospital stay. Thickening of the gallbladder wall and gangrenous cholecystitis were frequent pathologic findings among the conversion cases. CONCLUSION: Thickening of the gallbladder wall, inflammation and anatomical variation of the gallbladder were important factors for conversion to open surgery. Thus, these predictive findings allow the surgeons to preoperatively discuss the higher risk of conversion and allow for an earlier judgement and decision on conversion if intraoperative difficulty is encountered.
Bile Ducts ; Cholecystectomy* ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Conversion to Open Surgery ; Gallbladder ; Hemorrhage ; Humans ; Inflammation ; Length of Stay ; Male ; Perioperative Period ; Retrospective Studies