BACKGROUND/AIMS: Pancreaticoduodenectomy( PD ) is a complicated procedure that carried a very high postoperative mortality and mobidity until 1970s. Since early 1980, motality has been decreased but morbidity is still high now. So this study was conducted to analyze the motality and morbidity as well as survival rates after PD for valiable disease. METHODS: From January 1988 to January 2000, 164 patients underwent PD in the Korea Cancer Center Hospital. Standard pancreaticoduodenectomy was performed in terms of lymph node dissection and main method of pancreaticoenterostomy was end-to-side pancreaticojejunostomy, among which ductto- mucosa anastomosis comprised of about half of cases. Survival rates and the differences were estimated by Kaplan-Meier method and Log-Lank test respectively, and multivariate analysis was done with Cox Regression hazard model using SPSS program for Windows. RESULTS: Median age of all patients was 57 years with slight male predominance(54.8%). Classical Whipple's operation was performed in 113 cases(68.9%), and PPPD in 40 cases(24.3%), hepatopancreaticoduodenectomy in 10 cases(6.1%). Operative mortality was 1.8%( 3/164 ), however no additional in-hospital death occurred. Nine patients underwent reoperation. Postoperative complication occurred in 56 cases(34.2%). The most common complication was pneumonia(11.5%), and delayed gastric emptying( 7.3%), pancreatic fistula(4.8%), intra-abdominal bleeding(4.8%) in orders. No pancreatic leakage occured in duct-to-mucosa anastomosis group. Median survival of 123 periampullary carcinoma was 25 months and better survival was shown in ampulla of Vater cancer. Factors influencing on survival for periampullary carcinoma were origin of tumor, cellular differentiation, lymph node invasion. CONCLUSION: Pancreaticoduodenectomy can be performed safely in the terms of mortality. Bleeding is the most common cause of reoperation and motality, so meticulous bleeding control is very important. And duct-to-mucosa anastomosis is very safe method of pancreaticoenterostomy.
Ampulla of Vater ; Hemorrhage ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes ; Male ; Mortality ; Mucous Membrane ; Multivariate Analysis ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Postoperative Complications ; Proportional Hazards Models ; Reoperation ; Survival Rate

No abstract available.
Female ; Pregnancy ; Pregnancy, Tubal*

There is controversy regarding the survival benefits of eliminating primary tumors via cytoreductive radical prostatectomy (CRP) in patients with metastatic prostate cancer (mPCa). The purpose of this article is to review the theoretical background of and rationale for CRP, and the current knowledge base. The Scopus and PubMed databases were searched for studies investigating CRP published between January 2000 and October 2019. The retrieved articles were nonsystematically reviewed. Based on preclinical data, retrospective patient case studies, retrospective population-based studies, and prospective studies, CRP has been reported to afford benefits for the treatment and prevention of local symptoms through the removal of primary tumors, and the management of neo-metastatic disease and overall survival. However, despite the results from these studies, the current review mostly addresses small case studies and uncontrolled population-based studies with weak evidence. Based on this weak evidence, therefore, clinical use has not yet been recommended. Further research investigating the role and timing of CRP in patients with mPCa is needed, in addition to studies screening the most suitable populations for CRP.

There is controversy regarding the survival benefits of eliminating primary tumors via cytoreductive radical prostatectomy (CRP) in patients with metastatic prostate cancer (mPCa). The purpose of this article is to review the theoretical background of and rationale for CRP, and the current knowledge base. The Scopus and PubMed databases were searched for studies investigating CRP published between January 2000 and October 2019. The retrieved articles were nonsystematically reviewed. Based on preclinical data, retrospective patient case studies, retrospective population-based studies, and prospective studies, CRP has been reported to afford benefits for the treatment and prevention of local symptoms through the removal of primary tumors, and the management of neo-metastatic disease and overall survival. However, despite the results from these studies, the current review mostly addresses small case studies and uncontrolled population-based studies with weak evidence. Based on this weak evidence, therefore, clinical use has not yet been recommended. Further research investigating the role and timing of CRP in patients with mPCa is needed, in addition to studies screening the most suitable populations for CRP.

BACKGROUND: Epidermal growth factor (EGF) , a potent stimulant of epithelialization, has been noted to increase the tickness of the epidermis, increase the epithelial cell proliferartion and keratinization, and accelerate wound contraction. OBJECTIVE: Our purpose was to evaluate the efficacy of topical application of recombinant human epidermal growth factor (rhEGF) in the healing of full-thickness excision and burn wound. METHODS: Full-thickness excision and burn wound were made on the back of the male Wistar rat. Recombinant human epidermal growth factor was applied twice a day and the size of the wound was measured with planimetry every other day for 21 days. The keratinocytes of the circumcised foreskin were cultured in different concentrations of recombinant human epidermal growth factor and proliferation of the keratinocytes was evaluated. RESULTS: 1. Regardless of wound types or base types, wound healing in the experimental groups (rhEGF 10, 30, 50g/g) was generally better than that in the control or vehicle group. 2. The duration of wound healing was decreased as follows in order; in full-thickness excision wound, rhEGF 50 g/g group, rhEGF 30 g/g group, rhEGF 10 g/g group, vehicle group, and control group and in full-thickness burn wound, rhEGF 30 g/g group, rhEGF 50g/g group, rhEGF 10g/g group, vehicle group, and control group. 3. In the biopsy specimen taken from the wound at 9th and 13th day, neodermis, neovascularization, the thickness and maturation of the collagen bundles, and reepithelithelialization were more increased in the experimental groups than in the control or vehicle group. 4. In vitro culture of epidermal cells showed similar proliferation in the concentration of rhEGF higher than 10 ng/ml. CONCLUSION: these findings suggest that topical application of recombinant human epidermal growth factor in the healing of full-thickness excision and urn wound.
Animals ; Biopsy ; Burns ; Collagen ; Epidermal Growth Factor* ; Epidermis ; Epithelial Cells ; Foreskin ; Humans ; Keratinocytes ; Male ; Rats ; Ticks ; Wound Healing* ; Wounds and Injuries*

Two patients with cutaneous leishmaniasis were treated with itraconazole. One patient was a 24-year-old man who had several erythematous papulonodules on the extremities for 1 month, which revealed cutaneous leishmaniasis, histopathologically. He was treated with itraconazole (200 mg/day) for 2 months. After treatment he showed clinical healing and the biopsy specimens no longer showed leishmania organisms. The other patient was a 27-year-old female who had several erythematous papulonodules on the face and neck for 3 months. The skin lesions revealed leishmania organisms in the tissue sections and culture media. She was also treated with itraconazole (200 mg/day) for 2 months. After treatment she also showed satisfying clinical healing and the biopsy specimens revealed no leishmania organisms. No specific side effects were encountered in both patients during the treatment. From these results, itraconazole is considered to be one of the promising anti-leishmanial drugs.
Adult ; Biopsy ; Culture Media ; Extremities ; Female ; Humans ; Itraconazole* ; Leishmania ; Leishmaniasis, Cutaneous* ; Neck ; Skin ; Young Adult

PURPOSE: The aim of this study was to determine the feasibility and safety of laparoscopy-assisted gastrectomy (LAG) with lymph node dissection for gastric cancer according to the analysis of postoperative complications. METHODS: The authors attempted LAG with lymph node dissection in 117 consecutive patients with gastric cancer. The clinicopathologic characteristics of the patients, operative outcomes, preoperative comorbidities and postoperative morbidities and mortalities were evaluated using the stomach cancer database of Dong-A university hospital and medical charts. RESULTS: Among the 114 successful patients, 100 had early gastric cancer and 14 had advanced gastric cancer. The mean operation time was 259.2 minutes (range 150~415). The mean number of retrieved lymph nodes was 23.4 (range 6~66). The mean time to the first flatus and postoperative hospital stay were 3.7 and 10.0 days, respectively. The overall operative mortality rate, hospital death rate and the overall rate of postoperative complications were 0, 1.7 and 14.7%, respectively. The major and minor complication rate were 4.3 and 10.4%, respectively. CONCLUSION: LAG with lymph node dissection is technically feasible and receptive as surgical treatment for patients with gastric cancer, although various postoperative complications can arise in LAG as they do in open gastrectomy.
Comorbidity ; Flatulence ; Gastrectomy* ; Humans ; Length of Stay ; Lymph Node Excision* ; Lymph Nodes* ; Mortality ; Postoperative Complications ; Stomach Neoplasms*

BACKGROUND AND OBJECTIVES: Hypercholesterolemia is a key factor in the development of atherosclerosis. We sought to evaluate the relation between hypercholesterolemia and plaque composition in patients with coronary artery disease. SUBJECTS AND METHODS: Study subjects consisted of 323 patients (mean 61.5 years, 226 males) who underwent coronary angiography and virtual histology-intravascular ultrasound examination. Patients were divided into two groups according to total cholesterol level: hypercholesterolemic group (> or =200 mg/dL, n=114) and normocholesterolemic group (<200 mg/dL, n=209). RESULTS: Hypercholesterolemic patients were younger (59.7+/-13.3 years vs. 62.6+/-11.5 years, p=0.036), than normocholesterolemic patients, whereas there were no significant differences in other demographics. Hypercholesterolemic patients had higher corrected necrotic core volume (1.23+/-0.85 mm3/mm vs. 1.02+/-0.80 mm3/mm, p=0.029) as well as percent necrotic core volume (20.5+/-8.5% vs. 18.0+/-9.2%, p=0.016) than normocholesterolemic patients. At the minimal lumen area site, percent necrotic core area (21.4+/-10.5% vs. 18.4+/-11.3%, p=0.019) and necrotic core area (1.63+/-1.09 mm2 vs. 1.40+/-1.20 mm2, p=0.088) were also higher than normocholesterolemic patients. Multivariate linear regression analysis showed that total cholesterol level was an independent factor of percent necrotic core volume in the culprit lesion after being adjusted with age, high density lipoprotein-cholesterol , hypertension, diabetes mellitus, smoking and acute coronary syndrome (beta 0.027, 95% confidence interval 0.02-0.053, p=0.037). CONCLUSION: Hypercholesterolemia was associated with increased necrotic core volume in coronary artery plaque. This study suggests that hypercholesterolemia plays a role in making plaque more complex, which is characterized by a large necrotic core, in coronary artery disease.
Acute Coronary Syndrome ; Atherosclerosis ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Demography ; Diabetes Mellitus ; Humans ; Hypercholesterolemia ; Hypertension ; Linear Models ; Smoking

PURPOSE: To assess outcomes from patients who underwent radical prostatectomy and had their indwelling urinary catheter removed on postoperative day (POD) 4 or 7. MATERIALS AND METHODS: The medical records of 107 consecutive patients receiving radical prostatectomy (RP), were retrospectively reviewed. Patients were categorized into two groups according to length of catheterization. Group 1 (n=40) had the urethral catheter removed on postoperative day (POD) 4, and group 2 (n=67) had the catheter removed on POD7. Group 1 had urethral catheter removal following no leakage on intraoperative leak testing and POD4 cystography, whilst group 2 exhibited leakage at POD4 and instead had routine POD7 urethral catheter removal if there was evidence of no leakage of POD7 cystography. Incontinence was checked according to the use of protective pad. RESULTS: The mean age of the study population was 67.0 years. acute urinary retension (AUR) following catheter removal occurred in 6 of the cohort (5.6%); 3 patients (7.5%) from group 1 and 3 (4.5%) from group 2 (p=0.669). The overall continence rate was 39.3%, 68.2%, 80.4%, and 91.6% at 1, 3, 6, and 12 months respectively. Importantly, the incontinence recovery pace of group 1 was notably higher than that of group 2 (p=0.001). Neither group exhibited bladder neck contracture. Intraoperative factors influencing the decision to remove catheter at POD4 following RP, are bladder neck reconstruction (OR=3.792, p=0.010) and nerve sparing (OR=6.646, p=0.008). CONCLUSIONS: Selective early urethral catheter removal may shorten the length of incontinence recovery, without increasing the risk of AUR and bladder neck contracture.
Catheterization ; Catheters ; Cohort Studies ; Contracture ; Humans ; Medical Records ; Neck ; Prostatectomy* ; Prostatic Neoplasms ; Retrospective Studies ; Urinary Bladder ; Urinary Catheters*

BACKGROUND: With progressive improvement in the fraction of long-term surviviors, chronic GVHD has emerged as a increasingly frequent complication of allogenic bone marrow transplantation. Except for a few case reports, there has been no clinical study of chronic cutaneous GVHD in Korea so far. OBJECTIVE: In the present study we planned to investigate the clinical characteristics of chronic cutaneous GVHD and to compare the clinical manifestation and incidence of chronic cutaneous GVHD in Korea with previous reports in U.S.A. and Europe. METHODS: On the basis of the patients' charts and the records of bone marrow transplantation, we investigated the incidence of chronic cutaneous GVHD in Korean leukemia patients and studied the clinical manifestations of chronic cutaneous GVHD ocurring in 16 patients whose diagnosis was confirmed by histopathologic findings of skin biopsy. We also analysed whether total body irrdiation before bone marrow transplantation, GVHD prophylaxis and presence of preceding acute GVHD affected chronic cutaneous GVHD. RESULTS: 1. The incidence in chronic cutaneous GVHD in Korea was lower than that in Caucasian countries. 2. The onset was milder than that in Caucasians. 3. The clinical manifestation was earlier than that in Caucasians. 4. The relationship between the GVHD prophylaxis and incidence chronic cutaneous GVHD was not significant. 5. The incidence of chronic cutaneous GVHD in the presence of preceding acute GVHD was higher than in cases with no preceding acute GVHD. CONCLUSION: We speculate that the low incidence of chronic cutaneous GVHD and clinical characteristics differing from the reports in the U.S.A. and Europe might be unassociated with irradiation, GVHD prophylaxis or the presence of preceding acute GVHD but maybe related to differences in genetic background.
Biopsy ; Bone Marrow Transplantation ; Diagnosis ; Europe ; Humans ; Incidence ; Korea ; Leukemia ; Skin