PURPOSE: The purpose of this study was to evaluate the feasibility and potential benefits of Hand-Assisted Laparoscopic Surgery (HALS) with the HandPort system. The surgeon inserts the nondominant hand into the abdomen while the pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic surgery. This approach provides an excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. METHODS: A prospective study was performed in patients who had undergone surgical intervention with the HandPort system at Ewha Womans University Mok-Dong Hospital. The surgeon was free to test the device in any situation where they expected a potential advantage over conventional laparoscopy. The surgeon inserted the nondominant hand into the abdomen while the pneumoperitoneum was generally maintained at 13 mmHg. RESULTS: Thirteen patients were entered in the study. Operations included radical gastrectomy in 8 cases, subtotal gastrectomy in 1 case, hemicolecotmy in 2, distal pancreatectomy with splenectomy in 1, nephrectomy with splenectomy in 1. The mean incision size for the HandPort device was 7.5 cm for the nondominant hand. None of the patients required conversion to open surgery as a result of an unmanageable air leak. There were no postoperative problems and no cases of mortality. CONCLUSION: HALS with the HandPort system is helpful in complex laparoscopic surgery and appeared to be useful in minimally invasive procedures considered too complex for,a laparoscopic approach.
Abdomen ; Conversion to Open Surgery ; Female ; Gastrectomy ; Hand ; Hand-Assisted Laparoscopy* ; Hemostasis ; Humans ; Laparoscopy ; Mortality ; Nephrectomy ; Pancreatectomy ; Pneumoperitoneum ; Prospective Studies ; Splenectomy

Umbilical cord blood is an attractive source of hematopoietic stem cells in allogeneic hematopoietic stem cell transplantation. Umbilical cord blood transplantation has merits of rapid availability and low risk of severe acute graft versus host disease. Umbilical cord blood should be an important source of stem cell transplantation for patients who have no suitable human leukocyte antigen-matched bone marrow, or peripheral stem cell donor. Transplantation of umbilical cord blood is limited by insufficient cell doses. This had led to the alternative concept of attempting to increase the number of cell doses using two cord blood units from different donor. We report a case of double-unit cord blood transplantation for 55-year-old male with primary refractory acute myeloid leukemia.
Bone Marrow ; Fetal Blood* ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Leukemia, Myeloid, Acute* ; Leukocytes ; Male ; Middle Aged ; Stem Cell Transplantation ; Stem Cells ; Tissue Donors

PURPOSE: Acute cholecystitis has been a general contraindication of laparoscopic cholecystectomy, and complicated cholecystitis is a challenging disease even in open surgery. The purpose of this study is to evaluate the effectiveness and safety of laparoscopic cholecystectomy in acute and complicated cholecystitis. METHODS: We retrospectively reviewed the medical records of 233 cases treated with laparoscopic cholecystectomy for acute and complicated cholecystitis at Ewha Mokdong hospital from March 1997 to February 2001. Postoperative outcomes were compared between simple acute cholecystitis and complicated cases. The uncomplicated simple acute cholecystitis group (simple acute group) comprised 161 cases (69%) and the complicated cholecystitis group, which included hydrops, empyema, and pericholecystic abscess (complicated group), included 72 cases (31%). RESULTS: In the acute and complicated cholecystitis groups, the length of postoperative diet was 2.19 days and 2.46 days, the conversion rate was 8.07% and 8.3%, and the complication rate was 4.97% and 12.5%, respectively. There was no statistical difference for these three factors (p>0.05). The hospital stay was 6.19 days and 7.57 days, and the mean time of operation was 97.09 minute and 116.5 minute, respectively. These two factors were significantly different (p<0.05). CONCLUSION: Laparoscopic cholecystectomy was shown to be a safe and effective treatment for simple acute cholecystitis and complicated acute cholecystitis. Even in severecomplicated cholecystitis, laparoscopic cholecystectomy can be a primary treatment modality.
Abscess ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Diet ; Edema ; Empyema ; Length of Stay ; Medical Records ; Retrospective Studies

PURPOSE: To compare laparoscopy-assisted Billroth I gastrectomy (LABIG) including standard lymph node dissection for patients with early gastric cancer was compared with open gastrectomy as a treatment method. METHODS: A prospective nonrandomized study was performed of early gastric cancer patients at Ewha Womans University Mok-Dong hospital from July 1999 to May 2001. Twenty patients (Group L) underwent LABIG including standard lymph node dissection. The control group (Group O) comprised 14 patients with conventional open radical subtotal gastrectomy and Billroth I anastomosis. RESULTS: In group L, pathologic reports revealed 18 early gastric cancers (stage IA 17 cases, IB 1 case), and 2 pm cancers (stage IB 1 case, stage II 1 case). In group O, there were 13 early gastric cancers (stage IA 12 cases, IB 1 case), and 1 pm cancer (stage IB). Significant differences (p<0.05) were present between group L and O in regards to mean operation time (277.5 vs 215.0 minutes), proximal margin (4.8 vs 7.0 cm), distal margin (4.4 vs 3.9 cm), number of harvested lymph nodes (25.6 vs 37.9), frequencies for pain control (7.2 vs 11.0 times), wound size (7.6 vs 20.0 cm) and postoperative hospital stay (13.7 vs 21.9 days). There were no differences in blood loss, transfusion, leukocyte count, time to diet, serum protein, or weight loss. Complications were seen in 2 cases in group L (enterocutaneous fistula, gastric atony), and 2 cases in group O (gastric atony, marginal ulcer with bleeding). CONCLUSION: LABIG with standard lymph node dissections is a safe and useful technique for the treatment of early gastric cancer with improved postoperative recovery as compared to open conventional gastrectomy.
Diet ; Female ; Gastrectomy* ; Gastric Fistula ; Gastroenterostomy* ; Humans ; Length of Stay ; Leukocyte Transfusion ; Lymph Node Excision ; Lymph Nodes ; Peptic Ulcer ; Prospective Studies ; Stomach Neoplasms ; Weight Loss ; Wounds and Injuries

PURPOSE: Pancreatic cystic neoplasm is a rare disease. It should be resected regardless of the presence of symptoms due to the possibility of malignancy. Standard pancreatic resection such as PPPD or distal pancreatectomy accompanies the loss of a significant amount of normal pancreatic parenchyma and may cause an impairment of normal pancreatic functions. On the contrary, pancreatic enucleation is known to have risks of pancreactic fistula or abscess. The aim of this study is to elucidate whether segmental resection of the pancreas is a safe and effective treatment in cystic neoplasms in the head and neck of the pancreas. METHODS: We reviewed the medical records of seven patients treated with central segmental resection of the pancreas for cystadenoma at Ewha Womans University Mokdong Hospital from December 2000 to April 2001. All lesions were located at the head and neck of the pancreas. A cephalic stump was sutured for closure of minute pancreatic ductal leakage and hemostasis, and the distal stump was anastomosed with a Roux-en-Y jejunal loop. Postoperative pancreatic functions, complications, and follow up results were analysed. RESULTS: The mean age of the patients was 48.14 (+/-9.55) years old. The pathological diagnoses were 4 cases of serous cystadenoma and 3 cases of mucinous cystadenoma. The mean size was 2.03 (+/-0.7) cm. The average operating time was 299.3 (+/-44.2) minutes. There were two cases of minor complications that were mild pancreatic fistulas without symptoms. There was no operative mortality, impairment of pancreatic function, or recurrence. The mean postoperative hospital stay was 23.6 days. CONCLUSION: Segmental resection of the pancreas can be a rational therapeutic option for cystic neoplasms in the head and neck of the pancreas in terms of the potential benefit of preserving pancreatic function.
Abscess ; Cystadenoma ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diagnosis ; Female ; Fistula ; Follow-Up Studies ; Head* ; Hemostasis ; Humans ; Length of Stay ; Medical Records ; Mortality ; Neck* ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Pancreatic Ducts ; Pancreatic Fistula ; Rare Diseases ; Recurrence

INTRODUCTION: Diabetes mellitus, as a major health problem for the elderly has been shown to alter the properties of the bone and impair bone healing around a titanium implant in both humans and animals. The aim of this study was to examine the effect of adipose-derived stem cells on the healing process around a titanium implant in streptozotocin-induced diabetic rats. MATERIALS AND METHODS: Thirteen rats were divided into two groups: adipose-derived stem cells injected group and a control group. A titanium screw implant (diameter: 2.0 mm, length: 3.5 mm) was placed into both tibia of 13 rats: 13 right tibia as the control group and 13 left tibia as the experimental group. The rats were sacrificed at different intervals (1, 2, and 4 weeks) after implantation for histopathology observations and immunohistochemistric analysis. RESULTS: The histopathological findings revealed earlier new formed bone in the experimental group than the control group. In particular, at 1 week after implantation, the experimental group showed more newly formed bone and collagen around the implant than the control group. In immunohistochemistric analysis, osteoprotegerin (OPG) expression in the experimental group increased early compared to that of the control group until 2 weeks after implantation. However, after 2 weeks, OPG expression in the experimental group was similar to OPG expression in the control group. The receptor activator of nuclear factor kappaB ligand (RANKL) expression in the experimental group increased early compared to that of the control group, and then decreased at 2 weeks. After 2 weeks, the level of RANKL expression was similar in both groups. CONCLUSION: These results suggest that adipose-derived stem cells in implantation can promote bone healing around titanium, particularly in diabetes mellitus induced animals.
Aged ; Animals ; Collagen ; Dental Implants ; Diabetes Mellitus ; Humans ; Osteoprotegerin ; RANK Ligand ; Rats ; Stem Cells ; Tibia ; Titanium

Gastric variceal bleeding has relatively low incidence rate compared to esophageal variceal bleeding. However, gastric variceal bleeding tends to lead to a massive bleeding and rebleeding which in turn leads to high mortality rate. In cases where endoscopic approach is limited, Ballon-occluded retrograde transvenous obliteration (BRTO) could be considered as a next modality of seizing acute bleeding. Venous catheterization should be preceded to perform venous embolization, however, in cases of hypovolemic shock status, alternative approaches are required. We are reporting a case of 60-year old female with hypovolemic status due to a massive hematemesis, who went through a percutaneous transhepatic glue embolization to control gastric variceal bleeding.
Adhesives* ; Catheterization ; Catheters ; Esophageal and Gastric Varices* ; Female ; Hematemesis ; Hemorrhage ; Humans ; Hypovolemia ; Incidence ; Mortality ; Shock

The differential diagnosis of cardiac mass is important in determining the therapeutic plan and avoiding unnecessary surgical intervention. Non-invasive imaging methods would be useful in the diagnosis of suspected cardiac mass, because they may provide earlier diagnosis and more accurate assessment of cardiac mass. Native aortic valve thrombosis is a rare disorder and difficult to differentiate from a tumor, and in particular, a papillary fibroelastoma. Thus, the clinical decision making with imaging modalities should be performed cautiously. We recently met a female patient who had a aortic valve mass resembling papillary fibroelastoma in normal native valve. The patient underwent a surgical resection and the pathologic finding showed an organized thrombus with no evidence of papillary fibroelastoma.
Aortic Valve* ; Decision Making ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Pulmonary Embolism ; Thrombosis*

A lipoma is a benign tumor of matured adipose tissue that usually occurs at the shoulder, back, and abdomen. 13% of lipomas occur in the head and neck area. However, the incidence of lipoma in the parotid gland is very low, approximately 2.5%. A conservational surgical excision is recommended in cases of lipoma of the parotid gland, with only 1-2% of lipomas recurring. We report a case of a lipoma in the parotid gland that was removed by conservational surgical excision. The lesion was exposed by the pre-auricular approach and the tissue was detached. After the parotid gland envelop was exposed, a yellowish mass is observed that was easy to remove due to capsulation. Most authors recommend a surgical excision of the superficial lobe of the parotid gland as the treatment for a lipoma in the parotid gland. However, enucleation only may be a sufficient treatment when a lipoma occurs in the superficial lobe or around the parotid gland. A patidectomy is not needed when a lipoma is located at the superficial lobe of the parotid gland, and a conservational surgical excision is suitable. Therefore, a clinical diagnosis is important for reducing the damage to the facial nerve.
Abdomen ; Adipose Tissue ; Head ; Incidence ; Lipoma ; Neck ; Parotid Gland ; Shoulder

PURPOSE: To evaluate the usefulness of the West point view, we investigated the osseous pathology of the glenoid rim associated with shoulder instability and estimate the inter-observer reliability. MATERIALS AND METHODS: The West point views of sixty-seven patients with labral lesion confirmed by operation were mixed with those of thirty-three normal controls. Six observers independently reviewed the mixed radiographs and checked the lesion by identifying the glenoid erosion, bony defect, ectopic ossification and Hill-Sachs lesion. The incidence of osseous lesions suggesting instability was estimated. Sensitivity in the patient group, specificity in the normal control and inter-observer reliability were calculated to evaluate study susceptibility. RESULTS: The sensitivity of 67 patients group was 81.8% on average (73-94%), the specificity of 33 member control group was 85.2% (82-94%). The most frequent finding was glenoid erosion, with an average of 54.7%, which providing a sensitive clue of shoulder instability. Inter-observer reliability analyzed by using Kappa values showed significant agreement. (alpha=0.1 significant level). CONCLUSION: The West point view is considered to be a reliable diagnostic modality for shoulder instability. The additional sophisticated method is indicated only when a discrepancy between physical examination and radiologic findings exists.
Humans ; Incidence ; Ossification, Heterotopic ; Pathology ; Physical Examination ; Sensitivity and Specificity ; Shoulder*