Purpose: The aim of this study was to compare the short-term outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) in elderly patients with hepatic tumors. Methods: From January 2013 to December 2019, a retrospective study was conducted for a total of 143 patients with over 70 years of age, who underwent liver resection for hepatic tumors. Forty-five patients who received biliary reconstruction at the same time were excluded. According to surgical approaches, 98 patients were classified into LLR and OLR groups. All postoperative complications were classified according to the Clavien-Dindo grading system and the Comprehensive Complication Index (CCI). Results: Incidence of the postoperative complications was not statistically different between LLR and OLR groups. The CCI was significantly lower in the LLR group, with a median of 8.556, and a median of 19.698 in the OLR group (p=0.042). The length of hospital stay in the LLR group was significantly shorter than in the OLR group (p=0.008). Conclusion LLR is safe and feasible as a treatment for hepatic tumor in elderly patients with potentially less postoperative complications compared to OLR.

No abstract available.

It has been suspected that the cannula of the ultrasonic generator became heated during liposuction, and that the heated cannula might possibly damage the soft tissues such as vessels, nerves and muscles. To confirm these suspicions, the actual temperature of the cannula was measured after being switched on, and the influence of the heated cannula on the soft tissues of 30 rabbits was studied macroscopically and microscopically. When the cooling system of ultrasonic generator was not operated, the temperature of a cannula tip increased to 100degrees C in 10 seconds, and the temperature of a cannula shaft did not increase over 40 degrees C. When the cooling system of the ultrasonic generator was operated, the temperature of the cannula tip increased to 70 degrees C in 20 seconds and to 100 degrees C in 1 minute. The stronger ultrasonic power was, the higher the temperature of the cannula tip was. When the heated cannnula tip touched the muscles, vesseles and nerves directly, the arterial and venous walls were perforated in about 20 seconds and 10 seconds, respectively. Gross changes of the muscles, such as color change and depression of the contacted area, were seen in about 30 seconds, and histological changes occurred in about 3 seconds. When adding the Klein solution, an infiltration solution for increasing the destructive effects of the ultrasound, the onset time of tissue damage was significantly shortened in vessels and nerves, but there was no significant difference in muscles. Although there was no finding of damage by the ultrasonic wave itself on the vessels, nerves, and muscles during ultrasonic liposuction, this study confirmed that the heated cannula could damage vessels, nerves, and muscles. Thus we must try to avoid placing the cannula at certain areas for more than 10 seconds douring the ultrasonic liposuction.
Catheters* ; Depression ; Hot Temperature ; Lipectomy* ; Muscles* ; Rabbits ; Ultrasonics* ; Ultrasonography

A case of diffuse malignant mesothelioma of peritoneum which was difficult to distinguish from metastatic anaplastic carcinoma or malignant melanoma was presented. The patient was a 50 year-old woman and complained of an abdominal pain and ascites for 20 days. Histologically, the tumor cells showed highly anaplastic appearance with sheet-like arrangement without any papillary or tubular structure. They stained Positive for cytokeratin and vimentin and negative for CEA, S-100 protein and melanoma associated antigen. A few cells within the tumor showed Positive reactivity to desmin. Ultrastructurally, the tumor cells had characteristic findings of mesothelioma such as long, exuberant, wavy microvilli with 10 to 12 of length/diameter ratio. The patient died 3 months after the diagnosis in spite of intraperitoneal chemotherapy.
Female ; Humans ; Neoplasm Metastasis

BACKGROUND: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. METHODS: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. RESULTS: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. CONCLUSIONS: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.
Acromion ; California ; Clavicle* ; Humans ; Osteolysis ; Periprosthetic Fractures ; Shoulder ; Skin

For the improvement of denture fitness of changed residual ridge, denture liner can be used. Denture liner should be very stable physically in various environments of the mouth as well as be bonded strongly with denture resin. In this study, the specimens bonded with four kinds of soft denture liner and three kinds of hard denture liner were used to test the physical properties of the liners. All experimental groups were stored in 37+/-1degrees C distilled water for 24hours, followed by thermocycling between 15degrees C and 45degrees C with 15 second dwell time. 1000, 2000, 3000 cycles of thermocycling were excuted and physical properties were measured by Instron Universal Testing Machine. The obtained results were as follows: 1. In tensile bond test of soft liners, it was shown that both of Molloplast-B(R) specimens before and after thermocycling had the highest tensile strength, and in case of hard liners, Dura-liner II(R)speimen had the highest tensile strength before and after thermocycling. Depending on thermocycling, Soft-Relining(R), Denture-Relining(R),Molloplast-B(R), Coe-soft(R) and Kooliner(R) specimen showed significant difference(p<0.05). 2. In strain test of soft liners, it was shown that Molloplast-B(R) specimen before thermocycling and the Coe-soft(R) after thermocycling showed highest results, and in case of hard liners, the Dura-Liner II(R) speimen before and after thermocycling had the highest result. Depending on thermocycling. Denture-Relinig(R). Molloplast-B(R) and Dura-Lner II(R) specimen showed significant difference(p<0.05). 3. In Maximum distance test of soft liners, the Molloplast-B(R) specimen before thermocycling and the Coe-soft(R) after thermocycling showed highest results, and in case of hard liners, the Dura-Liner II(R) specimen before and after thermocycling showed highest results. Depending on thermocycling, Denture-Relining(R), Molloplast-B(R) specimens showed significant difference(p<0.05). 4.In elasticity test of soft liners , the Molloplast-B(R) specimen before and after thermocycling showed highest results, and in case of hard liners, the Dura-Liner II(R) specimen before thermocycling and the Tokuso-Rebase (R) after thermocycling showed highest results. Depending on thermocycling, Soft-Relining(R) , Molloplast-B(R) specimens showed significant difference(p<0.05).
Denture Liners* ; Dentures* ; Elasticity ; Mouth ; Tensile Strength ; Water

BACKGROUND AND OBJECTIVES: Persistent and recurrent otorrhea following open cavity tympano-mastoidectomy can be a serious problem for the patient and the otologic surgeon. Frequent post-operative otorrhea hallmarks surgical failure. Medical treatment may often yield resolution, but a significant number of patients would still require re-operation. So we applied CO2 laser cauterization to draining cavity. The objective of the present study was to introduce the CO2 laser cauterization on draining cavity, and to describe the clinical course of the laser treatment. MATERIALS AND METHOD: Twenty-one cases of post-operative persistent or recurrent otorrhea were diagnosed at our hospital from January 1999 to December 2000. Fifteen cases were selected in this study. The selection criteria included chronic ear patient, open cavity tympano-mastoidectomy, absent residual or recurrent cholesteatoma. The minimum duration of follow up was 6 months. All cases were locally anesthetized with 10% xylocaine. The CO2 laser was Shaplan 100 which was connected to a microscope. The interval of CO2 laser cauterization was one week. RESULTS: All of 15 cases were cured completely. There was no recurrence during the follow up period. The locations of granulation tissues were tegmen (10 cases), mastoid tip (6 cases), retro-facial or facial ridge (4 cases), and sino-dural angle (4 cases). The mechanical causes of retention of debris in open cavity procedures included insufficient meatoplasty (3 cases) and high facial ridge (2 cases). The times of CO2 laser coagulation ranged from 2 to 5. CONCLUSION: Based on our research on the effect of CO2 laser among patients with draining cavity, we concluded that : 1) CO2 laser cauterization was an efficient method for the management of draining cavity, 2) CO2 laser cauterization has benefits which reduced the frequency of OPD visits and 3) CO2 laser cauterization provided a delicate, selective removal of granulation tissues.
Cautery ; Cholesteatoma ; Ear ; Follow-Up Studies ; Granulation Tissue ; Humans ; Lasers, Gas ; Lidocaine ; Mastoid ; Patient Selection ; Recurrence

BACKGROUND: A correct estimation of volume status and dry weight in dialysis patients remains a difficult clinical problem. Clinical status and chest X-ray are not sensitive enough, while invasively measured central venous pressures are not routinely available. Recently, the ultrasonographic determination of the diameter and collapse index of the inferior vena cava has been proposed as a noninvasive method for estimating intravascular volume. We tried to evaluate the clinical relevance of this method in dialysis patients by comparing it with alphahuman-atrial natriuretic peptide (alpha-h-ANP) and cyclic guanosine 3:5-monophosphate (cGMP) levels. METHODS: Using echocardiography, the diameter of the inferior vena cava (VCD) and its decrease on deep inspiration (collapse index : CI) were evaluated in 27 hemodialysis patients. Echocardiography of the inferior vena cava (IVC) was performed in the supine position after 10 minutes rest. The transducer was placed in the subxiphoid region and long and short axis views of the IVC were obtained just below the diaphragm in the hepatic segment. VCD was measured before the P-wave on the electrocardiogram to avoid interference with A-wave and V-wave on the venous pressure curve, and corrected for body surface area. Preand post-hemodialysis levels of the plasma alpha-h-ANP and cGMP were measured by radioimmunoassay. The relationship between VCD, CI determined by echocardiography, and alpha-h-ANP and cGMP concentrations were studied. RESULTS: The levels of alpha-h-ANP and cGMP were markedly elevated before hemodialysis and significantly lower values were found after hemodialysis (alpha-hANP : 162.7 102.6 pg/ml vs 90.6 61.0 pg/ml , cGMP : 35.3 8.8 pmol/ml vs 21.3 6.2 pmol/ml). A significant correlation was found between VCD and alpha-h-ANP before (r=0.81, p < 0.05) and after hemodialysis (r=0.65, p < 0.05). No such significant correlation was observed bet ween CI and alpha-h-ANP levels. Furthermore, a significant correlation was observed between VCD before hemodialysis and the change in alpha-h-ANP during hemodialysis (r=0.64, p < 0.05). The relationship between VCD and cGMP before hemodialysis was not significant (r=0.26, p> 0.05) and also no relation was observed between the decrease of cGMP during hemodialysis and VCD before hemodialysis (r=0.12, p > 0.05). A significant correlation between the percent change in body weight and the percent change in VCD during hemodialysis (r=0.91, p<0.05) and also significant relation was observed between the pecent change in body weight and the percent change in alpha-h-ANP levels (r=0.40, p , 0.05). CONCLUSION: Echocardiography of the inferior vena cava allow an estimation of changes of intravascular volume in ESRDpatients without cardiac filling impairment as shown by the correlation to other indices of intravascular volume, such as alpha-h-ANP. In this study, CI and cGMP levels were less informative. Inferior vena cava echocardiography is noninvasive and easily available and serial measurements of VCD and alphah-ANP levels allow an estimation of chages of intravascular volume in ESRD patients on maintenance hemodialysis.
Axis, Cervical Vertebra ; Body Surface Area ; Body Weight ; Central Venous Pressure ; Dialysis ; Diaphragm ; Echocardiography ; Electrocardiography ; Guanosine* ; Humans ; Kidney Failure, Chronic ; Plasma ; Radioimmunoassay ; Renal Dialysis* ; Supine Position ; Thorax ; Transducers ; Vena Cava, Inferior* ; Venous Pressure

No abstract available.
Pleural Effusion*

PURPOSE: Bypasses to the infra-inguinal arteries using autologous vein are now routinely used for limb salvage and as this technique has evolved, the distal limits of revascularization have been extended to near the ankle or in the foot. As the prevelances of chronic renal failure, diabetes and Buerger's disease increased, the more infrapopliteal arterial occlusions were detected. But the safety and effect of pedal bypass was not reported so much in our society. So we studied our cases of ankle bypass to find out its effect on preventing from primary amputation in infrapopliteal arterial occlusive diseases. METHOD: From July 2000 to December 2000, 12 cases of ankle bypasses were performed and followed most of them up to May 2001. The underlying diseases included 6 cases of atherosclerosis obliterance and 6 cases of Buerger's disease. Surgical indications were 9 minor toe gangrene, 2 major gangrene and 1 intractable resting pain. The surgical procedures were 3 popliteo-distal bypasses, 3 popliteo-distal bypasses after femoral thrombectomy, 2 above knee popliteo-below knee popliteo-distal sequential bypasses, 2 combined bypasses of femoro-above knee popliteal bypass and below knee popliteo-distal bypass, and 2 femoro-above knee popliteo-below knee popliteo-distal sequential bypasses. The distal bypass sites were 8 posterior tibial artery (PTA) near medial malleolous, 2 dorsalis pedis (DP) and 2 PTA-DP sequentially. RESULT: There were 2 cases of early occlusion from graft thrombosis and 1 case of late occlusion from inflow embolism. These 3 cases were revised and rebypassed. There was one case of amputation due to deep metatarsal infection. One patient with atherosclerosis died of acute myocardial infarction a month after bypass operation. One patient who underwent bilateral bypass was lost to follow up. The others showed patent graft unil may 2001. 3 patients underwent toe amputation but they didn't have any problem in bipedal ambulation. CONCLUSION: Ankle bypass is safe and promising procedure in infrainguinal arterial occlusive disease.
Amputation ; Ankle ; Arterial Occlusive Diseases ; Arteries ; Atherosclerosis ; Embolism ; Foot ; Gangrene ; Humans ; Kidney Failure, Chronic ; Knee ; Limb Salvage ; Lost to Follow-Up ; Metatarsal Bones ; Myocardial Infarction ; Thrombectomy ; Thromboangiitis Obliterans ; Thrombosis ; Tibial Arteries ; Toes ; Transplants ; Veins ; Walking