Radical antegrade modular pancreatosplenectomy (RAMPS) is regarded as a reasonable approach for margin-negative and systemic lymph node clearance in left-sided pancreatic cancer. We present a patient with more than 5 years disease-free survival after robotic anterior RAMPS for pancreatic ductal adenocarcinoma in the body of the pancreas. The distal part of pancreas, soft tissue around the celiac trunk, and the origin of splenic vessels was dissected with the underlying fascia between the pancreas and adrenal gland. Resected specimen was removed through small vertical abdominal incision. Robot working time was about 8 hours, and blood loss was about 700 mL without blood transfusion. He returned to an oral diet on the postoperative first day and recovered without any clinically relevant complications. There was no lymph node metastasis, perineural or lymphovascular invasion. Both the pancreatic resection margin and the tangential posterior margin were free of carcinoma. The patient received only postoperative adjuvant radiotherapy around the tumor bed. The patient has survived for more than 5 years without evidence of cancer recurrence. Minimally invasive radical left-sided pancreatectomy with splenectomy may be oncologically feasible in well-selected pancreatic cancer.
Aged ; Disease-Free Survival ; Humans ; Male ; Pancreatectomy ; Pancreatic Neoplasms/*surgery ; Splenectomy

BACKGROUND: As the necessity of adult living donor liver transplantation continues to increase, morbidity and mortality of donors has been considered vital. Thus, we performed a sequential analysis of our surgical experience in order to find ways to improve surgical outcomes in right liver donors. METHODS: We performed a retrospective sequential analysis of surgical outcomes of consecutive 245 right liver donors by 50 cases between October 2002 and November 2012. RESULTS: Hospital stay (13.78 to 10.98 days), operation time (432.76 to 389.98 minutes), amount of intra operative bleeding (577.70 to 502.56 mL), and perioperative transfusion rates decreased from the initial 50 cases to the last 45 cases. A total of 96 grade I complications by Clavien-Dindo classification decreased from 26 to 17. Ten and three cases had grade IIIa and IIIb complications, respectively. There were three cases of wound infection, two cases of duodenal ulcer bleeding, one case of pleural effusion, and four cases of bile leakage of grade IIIa complications, and one case of postoperative intestinal obstruction, one case of generalized peritonitis by small bowel perforation, and one case of bile leakage of grade IIIb complications. There was no mortality during the follow-up period. CONCLUSIONS: Although most complications with low-grade severity might be corrected by surgical refinement, efforts to reduce possible moderate to severe complications should be sustained.
Adult* ; Bile ; Classification ; Duodenal Ulcer ; Follow-Up Studies ; Hemorrhage ; Hepatectomy* ; Humans ; Intestinal Obstruction ; Length of Stay ; Liver Transplantation* ; Liver* ; Living Donors ; Mortality ; Peritonitis ; Pleural Effusion ; Retrospective Studies ; Tissue Donors ; Wound Infection

A neonate was dead 2 days after birth. He seemed to be healthy at birth. In autopsy we revealed severe aortic valve hypoplasia, hypoplasia of the ascending aorta, stenosis of the mitral valve and hypoplasia of the left ventricle. Multiple obstructions in the left heart-aorta complex have been associated with poor survival. We diagnosed this case as hypoplastic left heart syndrome(HLHS). Prenatal diagnosis using echocardiography can identify the fetus that has complex congenital heart disease and may improve early management and surgical outcome such as HLHS. Though HLHS can be frequently diagnosed prenatally, this has not been shown to improve surgical outcome. In forensic medicine field, we propose clinicians to use prenatal diagnostic instrument such as echocardiography to detect HLHS and the forensic pathologists should know HLHS as a primary cause of death of neonate who had normal appearances at birth. Here we report a case of HLHS and review articles.
Aorta ; Aortic Valve ; Autopsy ; Cause of Death ; Constriction, Pathologic ; Echocardiography ; Fetus ; Forensic Medicine ; Heart ; Heart Defects, Congenital ; Heart Ventricles ; Humans ; Hypoplastic Left Heart Syndrome* ; Infant, Newborn ; Mitral Valve ; Parturition ; Prenatal Diagnosis

BACKGROUND: To prevent bile duct related complications, exact division of donor bile duct is essential, not only for the recipient, but also for the donor during living donor liver transplantation. Cholangiography has been used for bile duct division during living donor right hemihepatectomy. This study was conducted to determine if bile duct probe could be used to replace cholangiography for bile duct division during living donor right hemihepatectomy. METHODS: Surgical outcomes of 234 donors with right hemihepatectomy and duct to duct biliary anastomosis in living donor liver transplantation between January 2009 and December 2014 were retrospectively analyzed. A total of 85 donors used the bile duct probe for bile duct division during the right hemihepatectomy, whereas 149 donors used cholangiography. All donors underwent preoperative magnetic resonance cholangiopancreatography (MRCP). RESULTS: The expected number of bile duct orifices based on MRCP did not differ significantly from the observed number of bile duct orifices after bile duct division (10 donors and five donors in each group were mismatched, P=0.238). The operation time was 384.7 minutes in the probe group, which was significantly shorter than that of the cholangiography group (400.4 minutes, P=0.041). CONCLUSIONS: Bile duct probing without intraoperative cholangiography might be a feasible procedure for bile duct division during living donor hemihepatectomy.
Bile Ducts* ; Bile* ; Cholangiography ; Cholangiopancreatography, Magnetic Resonance ; Humans ; Liver Transplantation ; Living Donors ; Postoperative Complications ; Retrospective Studies ; Tissue Donors*

PURPOSE: The purpose of this study was to find out cognitive function of the patients with subjective memory complaint. MATERIAL AND METHODS: From March 1st 2005 to May 31st 2009, 155 normal individuals without any medical illness who visited Yeungnam University Hospital to undergo medical checkup with neurocognitive test was enrolled, and checked by using Cognitive Assessment & Reference Diagnostic System. RESULTS: 107 of the patients had normal cognitive function, 21 patients (about 15%) were diagnosed with dementia, and 10 patients (about 7%) were diagnosed with considerable psychiatric illness, such as depression, anxiety disorder, adjustment disorder. CONCLUSION: Because the patients with subjective memory complaint can be diagnosed as any psychiatric illness as well as dementia, sensitive screening test and early psychiatric approach is needed.
Adjustment Disorders ; Anxiety Disorders ; Dementia ; Depression ; Humans ; Mass Screening ; Memory

PURPOSE: Major liver resection and radical lymph node dissection has been accepted as a definite treatment of choice for hilar cholangiocarcinoma (HC). However, the perioperative and survival outcomes of right hemihepatectomy (RH) and left hemihepatectomy (LH) still remain controversial. Thus, this study aimed to compare the surgical and oncological outcomes of RH and LH in HC patients. METHODS: From January 2000 to January 2018, a total of 326 patients underwent surgical resection for HC at Yonsei University College of Medicine in Seoul, Korea. Among the 326 patients, we excluded 130 patients and selected 196 patients, who underwent hemihepatectomy with caudate lobectomy. Among these 196 patients, 114 patients underwent RH, and 82 patients underwent LH. We compared the clinicopathological features as well as the surgical and oncologic outcomes of the RH and LH groups. RESULTS: There were no significant differences in disease-free survival (P = 0.473) or overall survival (P = 0.946) in the RH and LH groups. The LH group had fewer complications compared with the RH group, including postoperative ascites (RH: 15 [13.2%] vs. LH: 3 [3.7%], P = 0.023); however, the LH group had more bile leakage complications (RH: 5 [4.4%] vs. LH: 12 [14.6%], P = 0.012). The average time lag from portal vein embolization to operation was 25.80 ± 12.06 days (n = 45). There was no difference in postoperative liver failure (P = 0.402), although there were significantly more frequent ascites after RH (P = 0.023). CONCLUSION LH might be a good alternative option for the surgical treatment of HC given appropriate tumor location and biliary anatomy indications.

BACKGROUND: Duct-to-duct anastomosis is the most common biliary reconstruction method in living donor liver transplantation. However, biliary complications can frequently occur. The objective of this study was to examine biliary complications and related risk factors of patients with living donor liver transplantation during the last 12 years in our institution. METHODS: Surgical outcomes of 252 consecutive patients with duct-to-duct anastomosis for biliary reconstruction in living donor liver transplantation between December 2000 and July 2012 were analyzed retrospectively. RESULTS: Among the 252 patients, there were 65 cases (25.8%) of biliary complications. Before 2010, the incidence of biliary complications was 30.4% (56 of 184 cases). After 2011, the incidence was significantly (P<0.05) decreased to 13.2% (nine out of 68 cases). The complication rate of anastomosis of two separated bile ducts of graft to recipient two separated bile ducts using cystic duct and common bile duct of recipient was 50% (10 out of 20), which was relatively higher compared to that of single to single duct anastomosis (47 out of 191, 24.6%) or multiple duct to single duct anastomosis (eight out of 41, 19.5%). CONCLUSIONS: Duct to duct anastomosis between two separated bile ducts of a graft to two separated bile ducts of a recipient, the most common biliary reconstruction method, was associated with higher rate of biliary complications. Complications related to biliary reconstruction of living donor liver transplantation was gradually decreased. Standardization of bile duct anastomosis might lead to sequential reduction of biliary complications in living donor liver transplantations.
Bile Ducts ; Common Bile Duct ; Cystic Duct ; Humans ; Incidence ; Liver Transplantation* ; Liver* ; Living Donors* ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Transplants

Locally advanced hepatocellular carcinoma (HCC) with portal vein thrombosis carries a 1-year survival rate <10%. Localized concurrent chemoradiotherapy (CCRT), followed by hepatic arterial infusion chemotherapy (HAIC), was recently introduced in this setting. Here, we report our early experience with living donor liver transplantation (LDLT) in such patients after successful down-staging of HCC through CCRT and HAIC. Between December 2011 and September 2012, eight patients with locally advanced HCC at initial diagnosis were given CCRT, followed by HAIC, and underwent LDLT at the Severance Hospital, Seoul, Korea. CCRT [45 Gy over 5 weeks with 5-fluorouracil (5-FU) as HAIC] was followed by HAIC (5-FU/cisplatin combination every 4 weeks for 3-12 months), adjusted for tumor response. Down-staging succeeded in all eight patients, leaving no viable tumor thrombi in major vessels, although three patients first underwent hepatic resections. Due to deteriorating liver function, transplantation was the sole therapeutic option and offered a chance for cure. The 1-year disease-free survival rate was 87.5%. There were three instances of post-transplantation tumor recurrence during follow-up monitoring (median, 17 months; range, 10-22 months), but no deaths occurred. Median survival time from initial diagnosis was 33 months. Four postoperative complications recorded in three patients (anastomotic strictures: portal vein, 2; bile duct, 2) were resolved through radiologic interventions. Using an intensive tumor down-staging protocol of CCRT followed by HAIC, LDLT may be a therapeutic option for selected patients with locally advanced HCC and portal vein tumor thrombosis.
Adult ; Carcinoma, Hepatocellular/complications/drug therapy/surgery/*therapy ; *Chemoradiotherapy ; Cisplatin/therapeutic use ; Disease-Free Survival ; Female ; Fluorouracil/therapeutic use ; Humans ; Liver Neoplasms/complications/drug therapy/surgery/*therapy ; *Liver Transplantation ; *Living Donors ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; *Portal Vein ; Venous Thrombosis/*complications

Positive identification of human body remains is one of the most important tasks in mass disaster management. In general, anthropometric studies of long bones help to take informations such as race, gender, age, and stature of an individual. The previous reports estimated the stature from the femur length or from its fragments. One hundred ninety five (male 120, female 75) human bodies were examined. We measured 11 items which related breadth and length of femur. The highest correlation coefficients showed in the distance from most proximal point of intercondylar fossa to midpoint of lesser trochanter (IFLM) and distance from most proximal point of intercondylar fossa to most proximal point of greater trochanter (IFGP). The regression formulae were obtained from the various measurement of the fragmentary femur. With known values, the expected maximum femoral length was as follows. When using IFLM, maximum femoral length (male) = 21.788+/-1.278*IFLM+/-9.714 maximum femoral length (female) = 33.892+/-1.224*IFLM+/-11.311 maximum femoral length (combined) = 10.201+/-1.310*IFLM+/-6.746 When using IFGP, maximum femoral length (male) = 1.162*IFGP-8.770+/-8.882 maximum femoral length (female) = 1.117*IFGP+/-7.265+/-13.604 maximum femoral length (combined) = 1.149*IFGP-3.860+/-5.827 Consequently, these formulae are useful to persume the maximal length of femur for the unidentified fragments of femur in Korean.
Continental Population Groups ; Disasters ; Female ; Femur* ; Human Body ; Humans

OBJECTIVE: To clarify the landmark for deciding the entry point for C1 lateral mass screws via the posterior arch by using 3-dimensional (3D) computed images. METHODS: Resnick insisted that the C1 posterior arch could be divided into pure posterior and lateral lamina (C1 pedicle). Authors studied where this transition point (TP) is located between the posterior lamina and the C1 pedicle and how it can be recognized. The 3D computed images of 86 cadaver C1s (M : F=45 : 41) were used in this study. RESULTS: The superior ridge of the C1 posterior arch had 2 types of orientation. One was in the vertical direction in the C1 posterior lamina and the other was in the horizontal direction in the C1 pedicle. The TP was located at the border between the 2 areas, the same site as the posterior end of the groove of the vertebral artery. On posterior-anterior projection, the posterior arch was sharpened abruptly at TP. We were unable to identify the TP in 6.4% of specimens due to complete or partial osseous bridges. A total of 93.8% of the TP were located between the most enlarged point of the spinal canal and the medial wall of the vertebral artery. CONCLUSION: The anatomic entry zone of C1 lateral laminar screws was clarified and identified based on the TP by using preoperative 3D computed images.
Cadaver ; Spinal Canal ; Vertebral Artery