1.The Surgical Investigation of Hepatic Resection for Intrahepatic Duct Stone.
Youn Joo JUNG ; Dong Hun KIM ; Mun Sup SIM
Korean Journal of Hepato-Biliary-Pancreatic Surgery 2001;5(2):55-63
BACKGROUND/AIMS: Intrahepatic duct stone (IHDS) present serious health problem in East Asian countries including Korea because of recurrent or residual stones and stones induced hepatic damage. Hepatic resection is known as most definitive procedure especially in patients with ductal stricture, but postoperative morbidity and residual or recurrent stones are still high. METHODS: We analyzed early and late complication according to type of hepatic resection in IHDs (38 cases) and also determined the predisposing factors related to complication. RESULTS: Location of IHDs was left in 30 cases (78.9%), right in 1 case (2.7%), both in 7 cases (18.4%), and 28 cases (73.7%) had concomitant extrahepatic duct stone. The type of hepatic resection was left lateral segmentectomy in 24 cases (63.2%), left lobectomy in 11 cases (28.9%) and right lobectomy in 3 cases (7.9%). Overall complication rate was 44.7% and it was increased by extension of resection (p<0.05). Overall incidence of residual or recurrent stone was 36.8% and it was higher in patients with left lateral segmentectomy and without biliary drainage procedure although statistically not significant. The postoperative mortality was 11.8% (2 cases). CONCLUSIONS: Hepatic resection can be a curative therapy in IHDS and routine use of intraoperative choledochoscopy and additional drainage procedures are recommended to minimize the incidence of residual or recurrent stones.
Asian Continental Ancestry Group
;
Causality
;
Constriction, Pathologic
;
Drainage
;
Humans
;
Incidence
;
Korea
;
Mastectomy, Segmental
;
Mortality
2.A Case of Juvenile Huntington.
Mun Su LEE ; Choong Ho SHIN ; Dong Wu SON ; Kyeong Hee PARK ; Do Hyun KIM ; Kyu Young KIM ; Sung Sup PARK ; Ji Yeon KIM
Journal of the Korean Child Neurology Society 1999;7(1):113-118
Huntington's disease(HD) is an autosomal dominantly inherited neurodegenerative disease, which is characterized by choreic movement and progressive dementia. HD is a disease caused by CAG repeat expansion of huntintin gene and definitely diagnosed or is excluded by molecular genetic analysis. Juvenile HD, of which onset is in children or young adult, is the most severely disabled type and shows several distinct clinical and genetic features in contrast to usual late-onset type. We report a 10 year-old girl who presented with involuntary movement, seizure and moderate dysarthria confirmed by molecular genetic analysis.
Child
;
Chorea
;
Dementia
;
Dysarthria
;
Dyskinesias
;
Female
;
Humans
;
Molecular Biology
;
Neurodegenerative Diseases
;
Seizures
;
Young Adult
3.Histologic Study on Reperfusion Liver after the Revascularization through the Portal Vein or Hepatic Artery Following Heterotopic Partial Liver Transplantation in Rats.
Myung Hee YOUN ; Chung Han LEE ; Koon Taek HAN ; Dong Hun KIM ; Mun Sup SIM
Journal of the Korean Surgical Society 2002;63(2):89-98
PURPOSE: The technique of partial liver transplantation from a living donor was developed to expand the donor pool. However such small grafts may not only be functionally inadequate for the recipient, but will also sustain injury characterized by cholestasis and histological features of ischemia after implantation. Damage to partial liver grafts after reperfusion is frequently observed but the mechanism of injury remains unclear. Injury to partial liver grafts may be related to changes in portal blood flow. In this study, we investigated the histologic changes of the reperfusion of livers after revascularization through the portal vein or hepatic artery following heterotopic partial liver transplantation in rats. METHODS: Inbred Lewis partial liver were transplanted to inbred Brown Norway rats heterotopically in three groups. The first group of transplants, Group I (Portal vein group, n=3) was reperfused firstly through the portal vein. The second group, Group II (Hepatic artery group, n=3) was firstly reperfused through the hepatic artery. The third group, Group III (Control, n=1) was sham-operated. After reperfusion, the liver grafts were procured and fixed in formalin. The reperfusion livers were studied using immunohistochemical staining and in-situ RT PCR. RESULTS: In the H&E staining of the reperfusion livers there were no differences between groups I and II. Using immunohistochemical staining of TNF,R, FAS L, caspase 8 and in-situ RT PCR (NOS mRNA, TNF,R mRNA, FAS mRNA), the hepatic artery first reperfusion liver showed more damage than the portal vein first reperfusion liver. TUNEL staing showed severe apoptosis in hepatic artery reperfusion liver. CONCLUSION: The expression of the apoptosis molecular markers was more prominent in the reperfused liver performed with initial revascularization using the hepatic artery, rather than portal vein. These findings may be due to fact that the high oxygen blood in the hepatic artery is stressful to the reperfusion liver. The routinely used portal vein first revascularization technique decrease reperfusion injury to the graft when compared to hepatic artery first revascularization.
Animals
;
Apoptosis
;
Arteries
;
Caspase 8
;
Cholestasis
;
Formaldehyde
;
Hepatic Artery*
;
Humans
;
In Situ Nick-End Labeling
;
Ischemia
;
Liver Transplantation*
;
Liver*
;
Living Donors
;
Norway
;
Oxygen
;
Polymerase Chain Reaction
;
Portal Vein*
;
Rats*
;
Reperfusion Injury
;
Reperfusion*
;
RNA, Messenger
;
Tissue Donors
;
Transplants
;
Veins
4.Clinical Features and Outcomes of Surgically Treated Pediatric Head Injuries.
Dong Sup MUN ; Jung Hoon CHOI ; Sang Bong LEE ; In Chang LEE ; Sang Do BAE
Journal of Korean Neurosurgical Society 1996;25(11):2271-2277
As the incidence of victims of traumatic craniocerebral injury in children has increased in modern times, we retrospectively analyzed 103 cases of surgically treated craniocerebral injuries among patients under the age of 15 who were admitted from January 1991 to December 1994. We classified the materials, i.e. 1) cause and incidence of craniocerebral injury, 2) clinical symptoms, 3) diagnosis and operation, 4) outcome and complication, and 5) period of hospitalization. The results were as follows: 1) The male to female ratio was 1.9:1(male patients 68, female patients 35). 2) The incidence peaked at the age of 6 and was mostly distributed from the age of 6 to 10. 3) As for time distribution most of the accidents occurred between 3 and 6 in the afternoon. 4) The main cause of craniocerebral injuries was attributed to traffic accidents (54 cases, 52.4%) and the second most common cause was falls from heights(30 cases, 29.1%). 5) In 85 cases, the Glasgow coma scale 13-15 before operation was observed. 6) Depression fractures were found to be the most common lesion in our cases. 7) In 48 cases(46.6%) a craniotomy was the operative procedure performed and in 40 cases(38.8%) an elevation of the depressed bone was performed. 8) In 93 cases, the Glasgow outcome scale 4-5 after operation was observed. 9) The many sequelae of operation were neurological deficit, cognitive impairent, and post-traumtic seizure. 10) The average period of hospitalization was 18.7 days(s.d=18.1). The cause and incidence of surgically treated pediatric head injuries were similar to those of total pediatric head injuries. A high GCS score at admission predicts a good outcome and fewer sequelae. However, papillary abnormalities and a neurological deficit at admission were poor prognostic factors. This study confirms that pediatric head injuries treated surgically provide better results than in adults.
Accidents, Traffic
;
Adult
;
Child
;
Craniocerebral Trauma*
;
Craniotomy
;
Depression
;
Diagnosis
;
Female
;
Glasgow Coma Scale
;
Glasgow Outcome Scale
;
Head*
;
Hospitalization
;
Humans
;
Incidence
;
Male
;
Retrospective Studies
;
Seizures
;
Surgical Procedures, Operative
5.The Recurrence Pattern of Small Hepatocellular Carcinoma with Tumor-free Margin.
Jin Yong SIN ; Hyun Yul KIM ; Byuong Kook YEA ; Dong Heon KIM ; Mun Sup SIM
Korean Journal of Hepato-Biliary-Pancreatic Surgery 2003;7(1):49-54
BACKGROUND/AIMS: We studied the patterns of recurrence after resection of relatively small hepatocellular carcinoma, defined as less than 5 cm in diameter, with tumor-free margin, and risk factor for recurrence were re-evaluated for these group. METHODS: The subjects were 25 patients who had undergone tumor removal with tumor-free margin for hepatocellular carcinoma at our department from 1995 to 1998. Tumor-free survival rates of patients with various risk factors were calculated and differences between groups were evaluated. RESULTS: The tumors recurred in 17 patients (68.0%), with 11 patients (64.7% of recurrences) recurring within 1 year of surgery. Recurrent disease was nearly intrahepatic. Univariate retrospective analysis in this study showed the absence of tumor capsule to be significant risk factor. But there is no significant difference in survival rate between capsule (+) groups and capsule (-) groups. CONCLUSION: It was concluded that small hepatocellular carcinoma has no significant difference in clinicopathologic variables except tumor capsule.
Carcinoma, Hepatocellular*
;
Humans
;
Recurrence*
;
Retrospective Studies
;
Risk Factors
;
Survival Rate
6.Hepatic Angiosarcoma Mimicking Cavernous Hemangioma on Dynamic CT.
Gyung Mo SON ; Tae Yong JEONG ; Dong Heon KIM ; Mun Sup SIM ; Mong JO ; Jee Yeon KIM
Journal of the Korean Surgical Society 2003;65(1):79-84
A hepatic angiosarcoma is a rare primary malignant neoplasm, which accounts for only 2% of all primary hepatic tumors. The prognosis of a hepatic angiosarcoma is very poor, and most patients die within a year of the initial diagnosis. We report a case of a hepatic angiosarcoma in a 57-year-old man. Although a dynamic CT had suggested a carvenous hemangioma 12 months earlier, the tumor size increased and spontaneously ruptured, so surgical resection was mandatory. A pathological examination, including immunohistochemical studies, showed positive staining for CD34 and Factor VIII, which confirmed the diagnosis of an angiosarcoma. Although dynamic CT is an excellent modality for the diagnosis of a cavernous hemangioma of the liver, hepatic angiosarcomas should be ruled out in selected cases, because they may present with very similar CT findings to benign hemangioma.
Diagnosis
;
Factor VIII
;
Hemangioma
;
Hemangioma, Cavernous*
;
Hemangiosarcoma*
;
Humans
;
Liver
;
Middle Aged
;
Prognosis
;
Rupture, Spontaneous
7.A Case of Secretory Carcinoma of the Breast.
Young Tae BAE ; Hee Sook KWAK ; Dong Heun KIM ; Mun Sup SIM ; Mee Young SOL
Journal of the Korean Surgical Society 1999;56(3):449-452
Secretory carcinoma is an uncommon type of carcinoma and the only well-documented type that may arise in children and adults of both sexes. Secretory carcinomas do not occur with any particular frequency in any part of the breast. Usually, the primary symptom is a painless mass that may be present for years before biopsy. We encountered a case of a secretory carcinoma of the breast. The patient was a 34-year-old woman. She visited our hospital due to a painless mass located in the upper portion of the left breast in the direction of 11 o,clock and at a distance of 1 cm from the areola. On palpation, it showed a firm and fixed tumor mass. A secretory carcinoma was diagnosed based on excisional biopsy. The patient underwent an Auchincloss, modified radical mastectomy. Multistep cross sections showed an ill-defined brownish, white tumor mass with a gritty sensation and measuring 2.0 1.4 cm in size. Metastasis was found in 1 of 8 axillary lymph nodes. Compared with typical breast cancer, the prognosis is better, but a similar therapeutic strategy may be necessary.
Adult
;
Biopsy
;
Breast Neoplasms
;
Breast*
;
Child
;
Female
;
Humans
;
Lymph Nodes
;
Mastectomy, Modified Radical
;
Neoplasm Metastasis
;
Palpation
;
Prognosis
;
Sensation
8.The role of intermittent hepatic pedicle clamping on oxygen-derived free radical generation in the rat liver.
Mun Sup SIM ; Dong Heon KIM ; Seong Wan BAIK ; Sang Wook SHIN ; Hae Young KIM ; Tae Yong JEON ; Hong Jae JO
Korean Journal of Hepato-Biliary-Pancreatic Surgery 2001;5(1):9-18
BACKGROUND/AIMS: The tolerance of the liver to ischemia during intermittent hepatic pedicle clamping was compared with that during continuous hepatic pedicle clamping, and intermittent hepatic pedicle clamping was thought to more tolerable to ischemia/reperfusion injury. The mechanisms underlying this were unknown. We examined the relationship between ischemia/reperfusion injury and the production of oxygen-derived free radicals using spin resonance spectrometry. METHODS: Adult male Sprague-Dawley rats were subjected to either continuous or intermittent hepatic pedicle clamping. Alpha-(4-pyridyl 1-oxide)-N-tert-butylnitrone was administered to rats as a spin trap agent. Continuous clamping (15, 30, or 60 minutes) or intermittent clamping(four cycles of 15-minutes ischemia and 5 or 15 minutes of reperfusion) of hepatic pedicle was carried out. After reperfusion, blood samples were obtained and measuring liver enzyme to evaluate hepatic injury. Hepatic tissue blood flow was measured using a color Doppler blood flowmeter. RESULTS: When there was a longer period of hepatic pedicle occlusion, increased oxygen-derived free radical generation was detected after reperfusion. There was no significant increase in oxygen-derived free radical production or liver enzymes leakage when the duration of ischemia was 15 minutes. Oxygen-derived free radical generation and liver enzyme leakage were significantly less in intermittent pedicle clamping than in continuous clamping for 60 minutes. CONCLUSION: According this results, there is a oxygen-derived free radicals and liver damage in less in intermittent pedicle clamping than continuous clamping although many oxygen-derived free radicals are produced.
Adult
;
Animals
;
Constriction*
;
Flowmeters
;
Free Radicals
;
Humans
;
Ischemia
;
Liver*
;
Male
;
Rats*
;
Rats, Sprague-Dawley
;
Reperfusion
;
Spectrum Analysis
9.Plasma Ghrelin Level According to Extent of Gastric Resection.
Hyun Yul KIM ; Tae Yong JEON ; Dong Heon KIM ; Mun Sup SIM ; Sang Yeoup LEE ; Yun Jin KIM ; Hyong Hoi KIM ; Han Chul SON
Journal of the Korean Surgical Society 2004;66(4):307-313
PURPOSE: Total gastrectomy is followed by weight loss in the majority of patients, but the reason for this is not clear. Ghrelin, a novely isolated gastric hormone, exerts orexigenic activity. If a circulating ghrelin participates in the adaptive response to weight loss, the weight loss induced by total gastrectomy may be accompanied by impaired ghrelin secretion. METHODS: The blood was collected from gastric cancer patients who have undergone gastric resection, preoperatively and immediately after resection, on the 1st, 3rd and 7th postoperative day. The correlation of the preoperative plasma ghrelin concentration with gender, age and BMI were analyzed. The concentration changes of plasma ghrelin were observed serially after dividing gastrectomized patients into the subtotal gastrectomy group, the total gastrectomy group, and the proximal gastrectomy group. RESULTS: Although statistically not significant, the plasma ghrelin concentration was negatively correlated with age and BMI. In the subtotal gastrectomy group, nadir ghrelin was 48.4 +/- 23.6% of the preoperative value after gastric resection and then gradually increased to 82.4 +/- 19.9% on the 7th postoperative day. In the total gastrectomy group, nadir ghrelin was 36.9 +/- 10.4% of the preoperative value after gastric resection and remained 20.9 +/- 10.9% on the 7th postoperative day. In the proximal gastrectomy group, nadir ghrelin was 29.4 +/- 4.6% after gastric resection, which was followed by a gradual recovery. However, the recovery rate was steadier than compare to the subtotal gastrectomy group, as the concentration was 41.8 +/- 23.1% even on 7th postoperative day. CONCLUSION: The principal site of the ghrelin synthesis is stomach which contributes 60~70% to the circulating concentration of ghrelin. In the case of subtotal gastrectomy, ghrelin production is compensated by the remnant stomach. For this reason total gastrectomy is associated with suppressed ghrelin levels and it possibly contribute to the weight loss.
Gastrectomy
;
Gastric Stump
;
Ghrelin*
;
Humans
;
Plasma*
;
Stomach
;
Stomach Neoplasms
;
Weight Loss
10.A Study for Porcine Liver Transplantation Using Nonheart Beating Donor.
Mun Sup SIM ; Dong Heun KIM ; Tae Yong JEON ; Hong Jae JOE ; Byung Kook YEA ; Jin Yong SIN ; Yong Hun JOE ; Seung Wan BAEK ; Jae Young KWEN
Korean Journal of Hepato-Biliary-Pancreatic Surgery 2003;7(1):19-25
BACKGROUND/AIMS: Experimental studies using porcine non- heart beating donors to ameliorate graft injuries in liver transplantation has been conducted. Recently, it has been reported that cellular calcium may have an important role in ischemic injury, which consists of damage during ischemia and impairment at the time of reperfusion. therefore, it is possible that calcium channel blocker might prevent warm ischemic injury of the graft in liver transplantation when administered to the donor before harvesting and to the recipient at reperfusion. the purpose of this study was to investigate the protective effect of a calcium channel blocker diltiazem (DTZ) on hepatic ischemic injury using a porcine model. METHODS: Twenty pigs weighing 20 to 30 kg were enrolled in this study. Cardiac death was induced by direct cardiac injection of potassium chloride. The perfusion of UW (University of Wisconsin) solution started after 30 min of cardiac arrest. Orthotopic liver transplantation was perforated. Group A (experimental group) was administrated of DTZ at a dose of 70microgram/kg bolus iv injection before hepatic ischemia, perfused of 70microgram/L in UW solution and thereafter infused continuously 70microgram/L in 5% dextrose solution. RESULTS: Two ones death occurred among the ten transplant pigs. 24 hour survival rates were 80%. DTZ administrated group showed the hepatic blood flow and arterial ketone body ratio better compared with untreated controls (p<0.05). In addition, the increase of plasma lactate level was suppressed after ischemia (p<0.05). CONCLUSION: Our results suggest that DTZ has a protective effect on ischemic induced hepatic damage and might be useful in the prevention of primary graft failure caused by warm ischemia in liver transplantation.
Calcium
;
Calcium Channels
;
Death
;
Diltiazem
;
Glucose
;
Heart
;
Heart Arrest
;
Humans
;
Ischemia
;
Lactic Acid
;
Liver Transplantation*
;
Liver*
;
Perfusion
;
Plasma
;
Potassium Chloride
;
Reperfusion
;
Survival Rate
;
Swine
;
Tissue Donors*
;
Transplants
;
Warm Ischemia