PURPOSE: Pylorus-preserving gastrectomy (PPG) is known to have both nutritional and functional advantages over distal gastrectomy for the treatment of early gastric cancer. Although laparoscopic surgery is a popular choice, intracorporeal anastomosis is a newly developed technique that is gaining popularity. This study aimed to determine any differences in the oncological, surgical, and functional outcomes of intracorporeal and extracorporeal anastomosis after PPG. METHODS: A retrospective analysis was performed on 90 patients for cT1N0 gastric cancer who underwent laparoscopic pylorus preserving gastrectomy from January 2015 to June 2017 at the OOO, Korea; 38 patients underwent intracorporeal (TLPPG) and 52 underwent extracorporeal (LAPPG) anastomosis. The postoperative oncological, surgical, and functional outcomes were compared between the two groups. In order to compare the outcomes in obese patients, the postoperative and functional outcomes in patients with a BMI of ≥25, and in those with abdominal wall thickness measuring ≥28 mm, were evaluated. RESULTS: The TLPPG group showed a significantly reduced wound size (4 cm (3~4) vs 5 cm (5~6), p<0.001) and had fewer wound complaints than the LAPPG group (0.0% vs 15.4%, p=0.01). Postoperative complications were not significantly different between the two groups. In the BMI ≥25 subgroup, the first flatus time after operation was shorter in the TLPPG group (2.9±0.5 vs 3.5±0.8 days, p=0.04). CONCLUSION: The study demonstrates that both TLPPG and LAPPG are safe and feasible, and that there is a potential benefit for obese patients.
Abdominal Wall ; Flatulence ; Gastrectomy ; Humans ; Korea ; Laparoscopy ; Postoperative Complications ; Pylorus ; Retrospective Studies ; Stomach Neoplasms ; Wounds and Injuries

Background: To analyze the outcomes of clipping and coiling for ruptured intracranial aneurysms (RIAs) based on data from the National Health Insurance Service in South Korea, with a focus on variations according to region and hospital size. Methods: This study analyzed the one-year mortality rates for patients with RIAs who underwent clipping or coiling in 2018. Coiling was further categorized into non-stent assisted coiling (NSAC) and stent assisted coiling (SAC). Hospitals were classified as tertiary referral general hospitals (TRGHs), general hospitals (GHs), or semi-general hospitals (sGHs) based on size. South Korea’s administrative districts were divided into 15 regions for analysis. Results: In 2018, there were 2,194 (33.1%) clipping procedures (TRGH, 985; GH, 827; sGH, 382) and 4,431 (66.9%) coiling procedures (TRGH, 1,642; GH, 2076; sGH, 713) performed for RIAs treatment. Among hospitals performing more than 20 treatments, the one-year mortality rates following clipping or coiling were 11.2% and 16.0%, respectively, with no significant difference observed. However, there was a significant difference in one-year mortality between NSAC and SAC (14.3% vs. 19.5%, P = 0.034), with clipping also showing significantly lower mortality compared to SAC (P = 0.019). No significant differences in other treatment modalities were observed according to hospital size, but clipping at TRGHs had significantly lower mortality than at GHs (P = 0.042). While no significant correlation was found between the number of treatments and outcomes at GHs, at TRGHs, a higher volume of clipping procedures was significantly associated with lower total mortality (P = 0.023) and mortality after clipping (P = 0.022). Conclusion Using Korea NHIS data, mortality rates for RIAs showed no significant variation by hospital size due to coiling’s prevalence. However, differences in clipping outcomes by hospital size and volume in TRGH highlight the need for national efforts to improve clipping skills and standardization. Additionally, the higher mortality rate with SAC emphasizes the importance of precise indications for its application.

Deformities of the auricular region that have been resulted from burns or other traumatic injuries emotionally devastate the patients and frustrate the surgeons. The surgical procedure for ear reconstruction varies depending upon the quality and quantity of available skin in the auricular region after burns and other facial trauma for the coverage of cartilage framework. Postauricular skin, postauricular fascia, temporoparietal fascia have been used for traumatized ear reconstruction according to the literature. But toral ear reconstruction in the cases of severe trauma like burn or traffic accident is one of the most difficult problems because of its paucity and poor quality of the available skin in the auricular region. The author reports two cases of traumatized ear reconstruction using a prefabricated radial forearm fasciocutaneous free flap made of an autogenous costal cartilage framework. This flap is valuable for the reconstruction of severely traumatized ear when local tissue or other free flaps are improper to select.
Accidents, Traffic ; Burns ; Cartilage ; Congenital Abnormalities ; Ear* ; Fascia ; Forearm* ; Free Tissue Flaps* ; Humans ; Skin

Hemangioma is one of the most common tumor in the region of the head and neck. There are many methods were tried for the treatment of hemangioma, however no single satisfactory method was introduced. The hemangioma which arised from the external ear are rare. Authors report three cases of the hemangioma which involved the external ear. The hemangioma was aesthetically treated with surgical reduction and ligation
Ear, External* ; Head ; Hemangioma* ; Ligation* ; Neck

Low molecular weight heparin (LMWH) demonstrated the safety and efficacy in patients with valve prosthesis and successfully prevented or treated venous thromboembolic events in large series of pregnant women. Subcutaneous injection of LMWH at home was done for whole gestational period (39 weeks) in 29 year-old female patient with mechanical prosthetic valves in the aortic (St. Jude 21 mm) and mitral (St. Jude 29 mm) position. aPTT and echocardiography were regularly monitored once a month. Dosage of LMWH was used in a steady state. On delivery day, use of LMWH was stopped and full-term vaginal delivary of a healthy baby could be obtained without fetal loss, thromboembolic episodes. Warfarin was combined with LMWH for 3 days after delivery. One week later, left posterior tibial artery embolism developed.
Adult ; Echocardiography ; Embolism* ; Female ; Heparin, Low-Molecular-Weight* ; Humans ; Injections, Subcutaneous* ; Pregnancy* ; Pregnant Women ; Prostheses and Implants ; Tibial Arteries* ; Warfarin

Acute pericarditis may be caused by a variety of disorders. Most cases of acute pericarditis without any initial apparent cause are idiopathic, although presumably viral in origin. While staphylococcus aureus, streptococcus pneumonias and streptococcus pyogens were the predominant organisms recovered prior to 1950, gram negative bacilli, anaerobic bacteria and fungus were recovered after 1950. These changes of the etiologic diversity of acute pericarditis were related to the development and advances of cardiac surgery, antibiotics, chemotherapy for cancer and immunosuppressive treatments. It is important for the therapy of acute bacterial pericarditis to establish the proper regimen of antibiotics and to drain pericardial effusion, if needed. We report a case of acute pericarditis, caused by Klebsiella pneumoniae, an uncommon pathogen that caused purulent pericarditis with cardiac tamponade.
Anti-Bacterial Agents ; Bacteria, Anaerobic ; Cardiac Tamponade ; Drug Therapy ; Fungi ; Klebsiella pneumoniae* ; Klebsiella* ; Pericardial Effusion ; Pericarditis* ; Pneumonia ; Staphylococcus aureus ; Streptococcus ; Thoracic Surgery

Endoscopic techniques have revolutionized current surgical techniques and have now been introduced to plastic surgery including zygomatic fracture repair. The main advantages of endoscopic zygomatic fracture repair are the minimization of scars, avoidance of undesirable risks and sequelae of the traditional open method. In previous endoscopic techniques for repair of zygomatic fracture, some used various additional percutaneous incisions besides temporal scalp and intraoral incisions for approach of the infraorbital rim and the zygomaticofrontal region, and others who did not use those additional incisions skipped the infraorbital rim fixation. The authors performed 16 cases of the reconstructions of the zygomatic bone fractures with endoscopic approach between September 1999 and April 2002, and all the fracture sites showing fracture displacement were approached using temporal and intraoral incisions only. The fracture sites over the zygomaticofrontal area and arch were stabilized with plates and screws through temporal scalp incisions under endoscopic control. Also the fracture of the zygomaticomaxillary buttress and the infraorbital rim were restored through upper buccal sulcus incision. All the patients showed rapid recovery without visible scar, and obtained acceptable zygoma symmetry, which was confirmed on the postoperative CT scans. With the use of the endoscope, we could minimize morbidity, and obtained favorable functional and aesthetic results.
Cicatrix ; Endoscopes ; Fractures, Bone* ; Humans ; Scalp ; Surgery, Plastic ; Tomography, X-Ray Computed ; Zygoma ; Zygomatic Fractures

Arteriovenous malformation(AVM) is an abnormal communication between an artery and a vein and often causes significant hemorrhage or cosmetic problems. Treatment of these vascular anomalies is hazardous and has high incidence of recurrence. A multidisciplinary team approach is required in the assessment and treatment of the lesion, and preoperative angiography with superselective embolization followed by resection is required. The authors performed nine cases of the wide resection of the congenital arteriovenous malformation(7 on the head and neck, 2 on the trunk) between April 1998 and January 2002. All patients underwent preoperative embolization with n-butyl 2-cyanoacrylate at 1 week before operation. Preoperative embolization resulted in significant devascularization of the AVM thus leading to minimal bleeding during operation. After resection, direct closure were performed in 6 cases, skin graft in 1 case, free transverse rectus abdominis musculocutaneous flap in 1 case, and tissue expansion using tissue expander in 1case. There was one complication related with embolization procedure in temple AVM patient. No recurrence has been recognized during the follow-up period, which ranges from 16 to 61 months. Preoperative embolization with n-butyl 2-cyanoacrylate and surgical resection of the AVM provided excellent long-term palliation in patients with congenital AVM.
Angiography ; Arteries ; Arteriovenous Malformations* ; Follow-Up Studies ; Head ; Hemorrhage ; Humans ; Incidence ; Myocutaneous Flap ; Neck ; Rectus Abdominis ; Recurrence ; Skin ; Tissue Expansion ; Tissue Expansion Devices ; Transplants ; Veins

BACKGROUND: Psoriasis is characterized by uncontrolled hyperproliferation, aberrant differentiation, and dermal infiltration of immune cells. Recent studies have reported that Wnt5a and Notch1 signaling are altered in psoriatic skin lesions. OBJECTIVE: We aimed to investigate the interaction of Wnt5a with Notch 1 with respect to inflammation-mediated epidermal hyperproliferation in psoriasis. METHODS: Expression of Wnt5a and Notch1 signaling-related proteins were examined in psoriatic skin biopsies. Wnt5a was upregulated in human keratinocytes by treating the cells with its recombinant form (rWnt5a). RESULTS: In psoriatic lesions, expression of Wnt5a increased while that of Notch1 decreased when compared to that in non-lesional and normal skin. Treatment with rWnt5a increased the proliferation of keratinocytes and increased their secretion of interleukin (IL)-23, IL-12, and tumor necrosis factor (TNF)-alpha. Further, exposure of keratinocytes to IL-1alpha, TNF-alpha, transforming growth factor-alpha, and interferon-gamma downregulated Notch1 as well as HES 1, which is downstream to Notch1, but increased the Wnt5a levels. The upregulated Wnt5a in keratinocytes downregulated both Notch1 and HES1. CONCLUSION: Our data suggest that Wnt5a and Notch1 signaling exert counteracting influences on each other and are involved, in part, in the pathomechanism of psoriasis.
Biopsy ; Humans ; Interferon-gamma ; Interleukin-12 ; Interleukins ; Keratinocytes ; Psoriasis* ; Skin ; Tumor Necrosis Factor-alpha

BACKGROUND: Isoflurane, a common anesthetic for cardiac surgery, reduced myocardial contractility in many experimental studies, few studies have determined isoflurane's direct impact on the left ventricular (LV) contractile function during cardiac surgery. We determined whether isoflurane dose-dependently reduces the peak systolic velocity of the lateral mitral annulus in tissue Doppler imaging (S′) in patients undergoing cardiac surgery. METHODS: During isoflurane-supplemented remifentanil-based anesthesia for patients undergoing cardiac surgery with preoperative LV ejection fraction greater than 50% (n = 20), we analyzed the changes of S′ at each isoflurane dose increment (1.0, 1.5, and 2.0 minimum alveolar concentration [MAC]: T1, T2, and T3, respectively) with a fixed remifentanil dosage (1.0 μg/min/kg) by using transesophageal echocardiography. RESULTS: Mean S′ values (95% confidence interval [CI]) at T1, T2, and T3 were 10.5 (8.8–12.2), 9.5 (8.3–10.8), and 8.4 (7.3–9.5) cm/s, respectively (P < 0.001 in multivariate analysis of variance test). Their mean differences at T1 vs. T2, T2 vs. T3, and T1 vs. T3 were −1.0 (−1.6, −0.3), −1.1 (−1.7, −0.6), and −2.1 (−3.1, −1.1) cm/s, respectively. Phenylephrine infusion rates were significantly increased (0.26, 0.22, and 0.47 μg/kg/min at T1, T2, and T3, respectively, P < 0.001). CONCLUSION: Isoflurane increments (1.0–2.0 MAC) dose-dependently reduced LV systolic long-axis performance during cardiac surgeries with a preserved preoperative systolic function.
Anesthesia ; Echocardiography ; Echocardiography, Transesophageal ; Heart Function Tests ; Heart Valves ; Humans ; Isoflurane ; Multivariate Analysis ; Phenylephrine ; Thoracic Surgery