Volvulus of the colon is a twisting of a redundant segment of the colon about it's narrow mesentery and sigmoid volvulus is the most common type. In many developing counteries this disorder is a common cause of obstruction of the intestine and in the western hemisphere it occurs in elderly patients who often have significant coexisting disease. This disorder may spontaneously reduce and recur as a chronic problem, but more frequently it becomes acute by obstruction, which may lead to strangulation and gangrene with high mortality if not treated promptly. Recently We have experienced 5 cases of signmoid volvulus, which were all in their twenties and had surgical operation. They had the triad of abdominal pain, distention, and absolute constipation. Plain abdominal roentgenogram was diagnostic in all cases The first line of treatment was nonoperative decompression with rigid sigmoidoscopy and successful in four of five. One Patient had emergency Hartman operation and other four had elective sigmoid resection with primary anastomosis.
Abdominal Pain ; Aged ; Colon ; Colon, Sigmoid* ; Constipation ; Decompression ; Emergencies ; Gangrene ; Humans ; Intestinal Volvulus* ; Intestines ; Male* ; Mesentery ; Mortality ; Sigmoidoscopy

In consideration of the potential deleterious effects of blood transfusion, the effect of acute anemia on the healing of both small (SI) and large intestinal (LI) anastomoses was evaluated. Thirty-six white rabbits underwent resection of both the mid-ileum and the distal colon with primary anastomosis of each. One and two weeks post operation, all anastomoses were assessed by anastomotic bursting pressure (ABP) and histologic evaluation utilizing a modified Erhlich/Hunt scale with grading of the WBC influx, blood vessel ingrowth, fibroblast proliferation, and collagen deposition. Results were analyzed using oneway analysis of variance (ANOVA) and the Chi-Square approximation with p<0.05 being considered significant. The SI ABP, reported in mmHg SE, of the anemic rabbits was decreased at one week vs. the controls (234 mmHg 17 vs. 201 mmHg 16), reaching significance at two weeks (190 mmHg 6 vs. 257 mmHg 17). A decreased LI ABP was found at one week, though not quite reaching singnificance (p=0.06). Recovery to control values occurred by two weeks. Histologic assessment (anemia vs. control) demonstrated a uniform decrease in WBC infiltration, reaching significance in the LI group at two weeks. Blood vessel ingrowth was likewise depressed, but did not achieve significance. The collagen contents of both the SI and the LI groups at two weeks decreased, as were the SI fibroblast proliferation at one week (p<0.05). This study demonstrates that severe, acute anemia in rabbits undergoing intestinal anastomoses severely alters histologic parameters in both the SI and the LI anastomoses while decreasing the overall strength of the SI anastomoses.
Anemia* ; Blood Transfusion ; Blood Vessels ; Collagen ; Colon ; Fibroblasts ; Rabbits*

Although abdominal lymphangiomas are much less common than neck and axillary lymphangiomas, pancreatic lymphangiomas are very rare with few reports in the literature. Authors report a case of cystic lymphangioma of the pancreas. A 21-year-old man was transferred from other hospital for huge cystic mass around pancreaticoduodeneum after he had received laparotomy with diagnosis of periappendiceal abscess. Abdominal CT scan demonstrated huge mutliseptated cystic mass, which was originated from head of pancreas and occupied entire right abdominal cavity. The patient underwent pylorus-preserving pancreaticoduodenectomy, which was proven to be a cystic lymphangioma of the pancreas.
Abdominal Cavity ; Abscess ; Diagnosis ; Head ; Humans ; Laparotomy ; Lymphangioma ; Lymphangioma, Cystic* ; Neck ; Pancreas* ; Pancreaticoduodenectomy ; Tomography, X-Ray Computed ; Young Adult

No abstract available.
Hemangioma* ; Liver*

PURPOSE: Despite radical lymph node dissection and combined resection, the operative results of treating advanced gastric cancer remains inadequate. The aim of this study was to determine the risk factors for recurrence of gastric cancer and the pattern of recurrence after curative resection for advanced gastric cancer. METHODS: Out of 220 patients who underwent curative resection for advanced gastric cancer from 1990 to 2000, 50 whose recurrence was confirmed by clinical, radiological, endoscopic or reoperative findings were studied retrospectively. We undertook a detailed analysis of the pattern of recurrence based on the morphologic and histopathologic characteristics of the initial tumor. RESULTS: The mean time to recurrence was 19.0 months. Early recurrence was found in 38 patients (76.0%), intermediate recurrence was found in 11 patients (22.0%), and late recurrence was found in 1 patient (2.0%). The patterns of recurrence were as follows: hepatic recurrence was found in 14 cases, peritoneal recurrence in 19 cases, local recurrence in 10 cases, extraperitoneal recurrence in 6 cases. In univariate analysis, the depth of invasion, extent of lymph node metastasis, TNM stage, and combined resection were important for recurrence. In multivariate analysis, depth of invasion and lymph node metastasis were important for recurrence. CONCLUSION: The peritoneal recurrence was the most frequently encountered pattern of recurrence. The two years following surgery was the most important period for recurrence. Depth of invasion and lymph node metastasis were related to recurrence with statistical significance. Since the results of treatment remain dismal, studies of perioperative adjuvant therapy in an attempt to reduce recurrence are warranted.
Humans ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence* ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms*

PURPOSE: The surgery clerkship, focusing on the clinical competency, including critical thinking, problem solving, self-directed learning, autonomy and professionalism, were revised. The purposes of this study were to evaluate the students' assessment of the revised surgery clerkship program in order to improve the quality of surgical education. METHODS: Clinical competency was classified into 6 dimensions: intelligence, skill, relationship, attitude, problem solving performance, and autonomy. Problem based learning (PBL), procedural skill training, surgical anatomy, case discussion, pre-diagnosis at outpatient clinics, quiz, clinical performance assessment (CPA) and modified essay question (MEQ) were performed. Forty-nine 3rd year medical students participated during 2002. All students were asked to rate how far they had progressed in the 6 dimensions, in order to evaluate the course, and each program, and to suggest improvements at the end of the rotation. RESULTS: The students responded extremely positively and became been more motivated. They evaluated that the new clerkship had helped them increase their abilities in clinical reasoning, self-directed learning, problem solving and clinical techology, and to develop professionalism and autonomy. Most of students revealed that the PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ programs were very helpful. They felt that procedural skill training and surgical anatomy programs required further improvements. CONCLUSION: The implementation of the new surgery clerkship was successful. The PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ were valuable learning tools. More tools should be developed for procedural skill training and surgical anatomy education.
Ambulatory Care Facilities ; Education ; Humans ; Intelligence ; Learning ; Problem Solving ; Problem-Based Learning ; Students, Medical ; Thinking

PURPOSE: The surgery clerkship, focusing on the clinical competency, including critical thinking, problem solving, self-directed learning, autonomy and professionalism, were revised. The purposes of this study were to evaluate the students' assessment of the revised surgery clerkship program in order to improve the quality of surgical education. METHODS: Clinical competency was classified into 6 dimensions: intelligence, skill, relationship, attitude, problem solving performance, and autonomy. Problem based learning (PBL), procedural skill training, surgical anatomy, case discussion, pre-diagnosis at outpatient clinics, quiz, clinical performance assessment (CPA) and modified essay question (MEQ) were performed. Forty-nine 3rd year medical students participated during 2002. All students were asked to rate how far they had progressed in the 6 dimensions, in order to evaluate the course, and each program, and to suggest improvements at the end of the rotation. RESULTS: The students responded extremely positively and became been more motivated. They evaluated that the new clerkship had helped them increase their abilities in clinical reasoning, self-directed learning, problem solving and clinical techology, and to develop professionalism and autonomy. Most of students revealed that the PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ programs were very helpful. They felt that procedural skill training and surgical anatomy programs required further improvements. CONCLUSION: The implementation of the new surgery clerkship was successful. The PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ were valuable learning tools. More tools should be developed for procedural skill training and surgical anatomy education.
Ambulatory Care Facilities ; Education ; Humans ; Intelligence ; Learning ; Problem Solving ; Problem-Based Learning ; Students, Medical ; Thinking

PURPOSE: This study was performed to evaluate the usefulness of abdominal computed tomography (CT) for patients with right lower quadrant (RLQ) pain. METHODS: Between January 2006 and July 2008, 191 consecutive patients with RLQ pain underwent abdominal CT (CT group). Forty-two patients who had undergone abdominal ultrasound (US group) and 52 patients without abdominal CT or abdominal ultrasound for RLQ pain (clinical Dx group) underwent emergent operations. Using the Alvarado scoring system, we scored all patients. The abdominal CT was performed in the abdominal and pelvic area with contrast. RESULTS: One hundred twenty-one (63.4%) of the 191 patients in the CT group were preoperatively diagnosed as having acute appendicitis and underwent surgery. There were three cases of negative appendectomy (1.6%). In the US group and the clinical Dx group, the negative appendectomy rates were 4.8% and 3.8%, respectively. The sensitivity of the abdominal CT was 96.7%. In the CT group, in addition to acute appendicitis, colitis, nonspecific enteritis, diverticulitis, urinary stone, ovary, uterine, and diseases were indentified. CONCLUSIONS: In this study, abdominal CT scans in patients with RLQ pain were useful for the diagnosis acute appendicitis and for the differential diagnosis of other diseases presenting with RLQ pain. The false positive rate was significantly lower in the CT group than in the other groups.
Appendectomy ; Appendicitis ; Colitis ; Diagnosis, Differential ; Diverticulitis ; Enteritis ; Female ; Humans ; Ovary ; Urinary Calculi

BACKGROUND: In contrast to childhood intussusception, the clinical features in adults are not typical, and the incidence of adult intussusception is low. This study was to evaluate the clinical features, diagnosis, and management of adult intussusception. METHODS: Thirty-seven cases of adult intussusception occurring between 1981 and 1996 in individuals older than 16 were investigated retrospectively. RESULTS: The most common age was in the 3rd decade (24.3%). Abdominal pain, nausea and vomiting, abdominal tenderness and palpable abdominal mass were common symptoms and physical findings in order of frequency. The duration of symptoms was less than 7 days in 54% of the cases. Correct preoperative diagnosis was made in 13.3% from 1981 to 1990 versus 72.7% from 1991 to 1996. This difference was caused by common use of abdominal ultrasound (US) and computed tomography (CT) during recent years. On exploration there were 27 cases of enteric (73%) and 10 cases of colonic (27%) intussusceptions and there were underlying lesions in 30 cases (81%). Two manual reductions only, 7 manual reductions and resections, including one reoperation after manual reduction only, 28 resections without manual reduction, and 1 ileocolostomy were performed. While only 2 cases (7.4%) of malignancy were identified among the enteric intussusceptions, there were 7 cases (70%) of malignancy among the colonic intussusceptions. CONCLUSIONS: With the advance of abdominal US and CT, preoperative diagnosis of adult intussusception was not so difficult. Because of high prevalence of underlying lesions in adult intussusception, operative management is mandatory. Resection without reduction is the most common method of operation and is recommended in edematous and ischemic enteric intussusceptions and in all colonic intussusceptions which have high malignant rate.
Abdominal Pain ; Adult* ; Colon ; Diagnosis* ; Humans ; Incidence ; Intussusception* ; Nausea ; Prevalence ; Reoperation ; Retrospective Studies ; Ultrasonography ; Vomiting

PURPOSE: Recent advances in the internet have enabled us to search for large amounts of medical information. In Korea there are many websites providing medical information, but the quality and quantity of these websites relating to surgery remains to be clarified. Therefore, through the analysis of the surgical websites in Korea, the characteristics and future directions are presented. METHODS: Two hundred and thirteen websites were retrieved using three search engines: Yahoo, Lycos and Naver. We reviewed these websites, and they were classified according to their administrator, subject and content. We also recorded the presence or absence of e-mail addresses, the section on medical counseling and internet reservation. RESULTS: One hundred and sixty-eight websites (78.9%) were administrated by the local clinics. In relation to the main subjects, 94.4% of websites targeted the general public. The main contents of the websites were colorectal and anal disease (83.1%). Of the 168 websites administrated by local clinics, online medical counseling was available in 142 (84.5%) and internet reservation was possible in 39 (23.2%). Most of the local clinics' websites were located in urban area. CONCLUSION: Our study showed surgical websites were led by local clinics, which specialized in colorectal and anal disease. It is emphasized that efforts to informationalization are needed by medical schools, affiliated hospitals and medical associations, and the guidelines enabling validity of medical counseling should be put in place.
Administrative Personnel ; Counseling ; Electronic Mail ; Humans ; Internet ; Korea* ; Schools, Medical ; Search Engine