Twenty patients with symptomatic congenital cysts in the liver, kidney, thyroid, and lower neck underwent, ultrasound guided percutaneous aspiration through a drainage catheter with temporary instillation of 95% ethanol into the cyst. Our procedure was based on the method as described by Bean and Rodan(16) in 1985. Additionaly, two othe steps were odded to prevent the dilutional effect of residual cyst fluid. One was the preliminary washing of the cyst with alcohol. The other was to treat with 30% replacement of alcohol every 10 minutes during the treatment secession. Minot complications of transient temperature elevation and hziness occurred, butj no major complications were encountered. After the alcohol treatment follow up examinations were performed with computed tomography or ultrasonography at 6 weeks. 6 months. 9 months and 15 months. Although there was diminished size, recurrence was noted in 6 of twenty patients(30%) at 6 weeks and one of twenty patients(5%) at 6 months. There was no recurrence at 9 months and 15 months. The results indicated that percutaneous aspiration and alcohol sclerotherapy are safe and effective therapy for symptomatic congenital cysts.
Catheters ; Cyst Fluid ; Drainage ; Ethanol ; Follow-Up Studies ; Humans ; Kidney ; Liver ; Methods ; Neck ; Recurrence ; Sclerotherapy* ; Thyroid Gland ; Ultrasonography

To evaluate a new reliable sclerosant of the gallbladder, we attempted gallbladder ablation with 10% phenol, and the results compared with those from using 95% ethanol which had been used previousy as gallbladder sclerosing agent in laboratory animals in other reports. After laparotomy, ligation of the cystic dusts with silk and cannulation of gallbladder with 18 gauge angiocatheter were done. Then, transcatheter administration of two different scleroing agents was performed in 8 rabbits respectively and normal saline in four rabbits as a control. Additionally, preliminary washing with each agent were implemented to prevent the dilutional effect of residual bile and bleeding. All animals survived without complication. Eight animals were used for each agent, four each being sacrified two weeks and six weeks after adminstration of sclerosing agents respectively. In our results, 10% phenol was more effective than 95% ethanol in denuding the gallbladder epithelium and promoting fibrosis of gallbladder wall, And it was relatively safe in regard to the dilutional effect of residual fluid and bleeding during procedure. Toxic effects on the liver evaluated by examination of histologic specimen were non-specific except for edematous swelling on some cases, which had also been observed on others including control group. 10% phenol can be considered to be a promosing sclerosant for gallbladder ablation, but further study of its toxicity is needed before its application on human gallbladder.
Animals ; Animals, Laboratory ; Bile ; Catheterization ; Dust ; Epithelium ; Ethanol ; Fibrosis ; Gallbladder* ; Hemorrhage ; Humans ; Laparotomy ; Ligation ; Liver ; Phenol* ; Rabbits* ; Sclerosing Solutions ; Sclerosis* ; Silk

No abstract available.
Hepatitis* ; Myocarditis* ; Pancytopenia* ; Q Fever*

PURPOSE: Laparoscopic total extraperitoneal (TEP) repair of inguinal hernia is technically challenging enough to build high barrier to entry. The purpose of this study was to identify clinical factors influencing technical difficulty with laparoscopic TEP according to learning period. METHODS: We conducted a retrospective study of 112 adult patients who underwent laparoscopic TEP for unilateral inguinal hernia from January 2009 to September 2013. A technically difficult case was defined as the 70th percentiles or more in the distribution curve of operative time, major complication, or open conversion. RESULTS: The rate of body mass index (BMI) above 25 kg/m2 was significantly higher in the difficult group than the nondifficult group in the learning period of laparoscopic TEP (57.9% vs. 26.8%, respectively, P = 0.020). However, in the experience period, it revealed no statistical difference with technical difficulty (31.3% vs. 33.3%, respectively, P = 0.882). In multivariate analysis, BMI (> or =25 kg/m2) was identified as a significant independent factor for technical difficulty with laparoscopic TEP in the learning period (odds ratio, 4.572; P = 0.015). CONCLUSION: Patient's BMI (> or =25 kg/m2) can create technical difficulty with laparoscopic TEP only in the learning period, but not in the experience period. Therefore BMI could be applied as one of the guidelines for patient selection, especially for surgeons in the learning curve of laparoscopic TEP.
Adult ; Body Mass Index ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Laparoscopy ; Learning Curve ; Learning* ; Multivariate Analysis ; Operative Time ; Patient Selection ; Retrospective Studies

The mode of death was investigated according to 14 easily accessible clinical symptoms in terminal patients with stomach cancer. The purpose of this study was to understand the mode of death during the terminal period in patients with stomach cancer and to identify possible ways in which to improve patient care. Data were collected on all 65 patients with terminal stomach cancer admitted Department of Surgery, Korean Veterans' Hospital between April 1984 and April 1996. Pain was the most common main symptom on admission, occurring in 34 (52.3%) of the 65 patients. Fourteen patients (21.5%) had weakness, 12 patients (18.5%) had anorexia, 10 patients (15.4%) had edema or ascites, and 5 patients (7.7%) had dyspnea. Statistically significant clinical symptoms were as follows: anorexia, pain, weakness, dyspnea, and ascites or edema. Although the ranges of symptoms were similar on admission and at 1 week before death, there was a shift in prevalence of different types (dyspnea 7.7%-->98.5% and weakness 21.5%-->100%). In the last week of care (the week of death), weakness and dyspnea were the most common symptoms. Anorexia together with weakness and dyspnea was also a common problem. Near death, 65 patients (100%) had weakness, and 64 patients (98.5%) developed dyspnea as their main symptoms. Dyspnea became the most severe symptoms at death and appeared to be the most common uncontrollable problem, especially as death approached.
Anorexia ; Ascites ; Dyspnea ; Edema ; Humans ; Patient Care ; Prevalence ; Stomach Neoplasms* ; Stomach*

BACKGROUND: In recent years, knowledge of bacterial resistance to antimicobials has expanded in important ways. Availability of an increasing number of antibiotics allows more precise individualization of resistance phenotypes and recording susceptibility results as patterns or phenotypes is valuable for both surveillance and patient care. If the patterns of resistance to panels of related antimicrobials are considered the underlying mechanisms can often be inferred. And the inferred mechanisms make the clinician to be advised to use alternative treatment. Interpretation of resistance phenotypes is based on the comparison of clinical isolates with prototype susceptible bacteria belonging to the same species. But interpretative reading of antimicrobial susceptibility tests requires an immense knowledge of antibiotics. Such interpretative reading is best achieved by computerized expert systems. METHODS: The authors attempt to determine phenotypes for the clinically isolated strains for each class of drugs tested by the Vitek 2 systemTM(bioMerieux, Marcy I'Etoile, France) using the Advanced Expert SystemTM(AES, bioMerieux, Marcy I'Etoile, France). A total of 91, 107, 89, 65, 251, 113, 47, 33, 23, 122 and 110 isolates of Staphylococcus aureus, coagulase negative staphylococci, Enterococcus faecalis, Enterococcus facium, Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, Enterobacter cloacae, Enterobacter aerogenes, Pseudomonas aeruginosae and Acinetobacter baumannii, were examined respectively. RESULTS: Biological correction based on the phenotype was recommended from 2.2% of E. faecalis to 46.8% of S. marcescens and therapeutic correction, from 7.3% of A. baumannii to 60.9% of E. aerogenes. A total of 25, 26, 18, 19, 22, 22, 15, 15, 17, 19, 19 phenotypes of S. aureus, coagulase negative staphylococci, E. faecalis, E. facium, E. coli, K. pneumoniae, S. marcescens, E. cloacae, E. aerogenes, P. aeruginosa and A. baumannii, were detected respectively. Association of resistance mechanism from S. aureus, coagulase negative staphylococci, E. coli, K. pneumoniae, S. marcescens, show 10, 11, 6, 4 and 3 pairs from resistant phenotypes, respectively. CONCLUSION: Vitek AES potentially provides a tool to assist the development of antimicrobial susceptibility interpretation in the clinical microbiology laboratory. The inferred mechanisms make the clinician to be advised to use alternative treatment.
Acinetobacter baumannii ; Anti-Bacterial Agents ; Bacteria ; Cloaca ; Coagulase ; Enterobacter aerogenes ; Enterobacter cloacae ; Enterococcus ; Enterococcus faecalis ; Escherichia coli ; Expert Systems ; Klebsiella pneumoniae ; Patient Care ; Phenotype* ; Pneumonia ; Pseudomonas aeruginosa ; Serratia marcescens ; Staphylococcus aureus

PURPOSE: The present pilot study was conducted to detect putative cancer stem cell (CSC) from the hepatic portal system and peripheral blood in the colorectal cancer patients and to compare them to healthy donor and diverticulitis patients. METHODS: Laboratory study was performed to identify the expression of cell surface markers, epithelial cell adhesion molecule (EpCAM), cytokeratin (CK) 18, CK20, CD44, and CD133, on several colon cancer cell lines. Clinical pilot study was conducted to detect putative circulating CSC as EpCAM+CD133+ cell in colorectal cancer (n = 10), diverticulitis (n = 5), and four healthy donors, by using flow cytometry. Blood was drawn from the hepatic portal system and peripheral vein. RESULTS: On laboratory study, EpCAM was expressed in whole colon cancer cell lines, and CD44 and CD133 were simultaneously expressed in 50% of the cell lines with stemness phenotype, but CK18 and CK20 were not expressed in most of the cell lines. On clinical study, the mean EpCAM+CD133+ cell counts of 11.6/105 in the hepatic portal system were somewhat lower than 15.4/105 in peripheral vein (P = 0.241). As for diverticulitis patients, EpCAM+CD133+ cells were also detected to have steeper dropped to near zero, after the surgery. CONCLUSION: The numbers of putative CSC were not statistically different between the detection sites of the portal vein and peripheral vein in the colon cancer patients. Therefore, we may not have benefitted by getting the cells from the hepatic portal system. In addition, the CD133+EpCAM+ cells in the colon cancer patients might contain normal stem cells from cancer inflammation similar to diverticulitis.
Cell Count ; Cell Line ; Colonic Neoplasms ; Colorectal Neoplasms* ; Diverticulitis ; Epithelial Cells ; Flow Cytometry ; Humans ; Inflammation ; Keratins ; Neoplastic Stem Cells* ; Phenotype ; Pilot Projects ; Portal System* ; Portal Vein ; Stem Cells ; Tissue Donors ; Veins

PURPOSE: The aim of this study is to evaluate the safety and usefulness of indocyanine green (ICG) angiography in laparoscopic colorectal surgery and to explore its educational benefits in surgical beginners. METHODS: From July to October of 2015, a total of 21 patients with colorectal cancer underwent laparoscopic surgery using the fluorescence-guided imaging system, IMAGE1 S™ (Karl Storz, Germany). Real-time ICG fluorescence images and red inversion images were juxtaposed with standard white-light images for assessment of colonic perfusion. A surgical beginner group comprised of medical students (n=11) and surgical residents (n=11) were then questioned postoperatively about the colonic transection line and mesenteric vascular integrity across various image modes to determine the most proper view for surgical decision. RESULTS: A total of 21 patients underwent laparoscopic colorectal surgery using ICG angiography. Mean patient age was 69.7 years (52~77 years). Mean time-to-detection for the marginal arteries and colonic wall were 26.7 (range, 4~45) and 47.3 (range, 20~77) seconds, respectively. No injection-related adverse events were observed. Rate of change in the colonic transection line across modes was 59.9% (33.3~66.7%) in the surgical beginners. Decisions made by surgical beginners on the transection line were varied with the standard image, but converged to 81.8% in the ICG with red inversion mode. Surgical beginners preferred ICG with red inversion mode for assessment of mesenteric vascular integrity. CONCLUSION: ICG angiography seems to be safe and useful in evaluating colonic perfusion for transection decisions and could have educational benefits for surgical beginners in training to make surgical decisions.
Angiography* ; Arteries ; Colon ; Colorectal Neoplasms ; Colorectal Surgery* ; Fluorescence ; Humans ; Indocyanine Green* ; Laparoscopy ; Perfusion ; Students, Medical

PURPOSE: We evaluated the relationship of cancer-associated fibroblasts (CAFs) and desmoplastic reactions with cancer invasiveness and long-term outcomes in patients with colorectal cancer (CRC). METHODS: Histologic evaluation of mature CAFs and desmoplasia was performed by observing the collagen fiber structure and fibroblast cytomorphology in the intratumoral stroma and invasive front of CRC tissues. Cancer-cell invasiveness was evaluated using lymphatic invasion, vascular invasion, perineural invasion, tumor budding, and tumor growth patterns. Overall survival and systemic recurrence were analyzed. A network analysis was performed between CAF maturation, desmoplastic reaction, and cancer invasiveness. RESULTS: The proportions of mature CAFs in the intratumoral stroma and the invasive front were 57.6% and 60.3%, respectively. Epidermal growth factor receptor (EGFR) overexpression was significantly higher in the mature CAFs in the invasive front as compared to immature CAFs. Lymphatic invasion increased as the number of mature fibroblasts in the intratumoral stroma increased. Tumor budding was observed in almost half of both mature and immature stroma samples and occurred more frequently in infiltrating tumors. On network analysis, well-connected islands were identified that was associated with EGFR overexpression, CAF maturation, and infiltrating tumor growth patterns leading to tumor budding. CONCLUSION: The maturity of CAFs and desmoplastic reactions were associated with cancer invasion. However, the cytomorphologic characteristics of CAFs were insufficient as an independent prognostic factor for patients with CRC.
Collagen ; Colorectal Neoplasms ; Fibroblasts ; Humans ; Islands ; Receptor, Epidermal Growth Factor ; Recurrence ; Wound Healing

PURPOSE: Colon perfusion status is one of the most important factors for the determination of postoperative anastomotic complications. Colonic hypoperfusion can be induced by inferior mesenteric artery (IMA) ligation in some patients. This study aimed to evaluate atherosclerotic risk assessment and vascular parameters of CT angiography as predictors of colonic hypoperfusion. METHODS: This prospective study was conducted at a tertiary referral hospital and included 46 rectosigmoid colon cancer patients undergoing laparoscopic anterior resection between August 2013 to July 2014. Atherosclerotic risk scores were assessed using the Framingham cardiovascular risk score system. The IMA length, branching pattern, atherosclerotic calcification, and intermesenteric artery and mesenteric vascular diameters were evaluated using CT angiography. Mesenteric marginal artery pressures were measured before and after IMA clamping. The mean arterial pressure (MAP) index was calculated by dividing the mesenteric marginal MAP into the systemic MAP to determine the mesenteric hypoperfusion status after IMA clamping. A critically low MAP index was defined as <0.4. RESULTS: Critically low MAP index (<0.4) was observed in 6 cases (13.0%) after IMA clamping. Atherosclerotic calcification of the IMA and superior mesenteric artery occurred in 11 (23.9%) and 5 patients (10.9%), respectively. Low MAP index was associated with high atherosclerotic risk score and short IMA length, rather than atherosclerotic calcification and other vascular parameters of the major mesenteric arteries. Multivariate analysis indicated that high atherosclerotic risk and short IMA length were independent predictors of critically low MAP index. CONCLUSION: Atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery.
Angiography ; Arterial Pressure ; Arteries ; Atherosclerosis ; Colon ; Colonic Neoplasms ; Constriction ; Humans ; Ligation ; Mesenteric Arteries ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Multivariate Analysis ; Perfusion ; Prospective Studies ; Risk Assessment ; Tertiary Care Centers