BACKGROUND: The operating room should provide an optimum environment that is safe for the patient and the working personnel. In this point of view, we investigated 8 items of temperature, humidity, air flow, noise, brightness, dust, CO2 and NO2. METHODS: Operating rooms, corridors and recovery rooms were tied as region I, II and III depending on their characteristics. 29 points were measured using appropriate instruments. After that, averaged values were calculated. RESULTS: Indoor climate (temperature, humidity and air flow) in region I were averaged 24.7, 65, 0.18/II were 25.5, 68, 0.18/III were 22.3 (degrees C), 56 (%), 0.22 (m/sec). Physcial condition (noise, brightness and dust) in region I were averaged 63, 295, 63/II were 67, 138, 87/III were 63 (db), 139 (lux), 26 (microgram/m3). Harmful gas (CO2 and NO2) concentration in region I were averaged 1152, 0.008/II were 913, 0.009/III were 1367 (ppm), 0.013 (ppm). CONCLUSIONS: Temperatures were appropriate but humidities were high except partial points. Air flow showed low values in average. Values of noise, dust and CO2 were relatively high. NO2 was low but brightness was variable. These mean that adequate improvement for quiet condition and air ventilation should be considered.
Climate ; Dust ; Humans ; Humidity ; Noise ; Operating Rooms* ; Recovery Room ; Ventilation

PURPOSE: Combined resection of invaded organ in advanced gastric cancer has been performed for complete removal of tumor and clearance of regional lymph node. However, higher morbidity and mortality associated with this procedure have been reported in recent large series and the efficacy of the procedure in survival remains controversial. In this study, we analyzed the efficacy of gastrectomy combined with invaded organ resection. METHODS: The medical records of 153 patients with T4 gastric carcinoma who underwent operation at Department of Surgery, Kangnam St. Mary's Hospital, The Catholic University of Korea from 1990 to 1998 were evaluated retrospectively. The patients were divided into three groups. Thirty five patients with combined resection were included in group I, and 72 patients with gastrectomy alone were in group II and 46 patients with no resection were included in group III. RESULTS: Pancreas was the most frequently invaded organ (100 patients: 65.4%), followed by colon (57 patients: 37.3%). The patients of group III were older than that of group I, and the tumor size was bigger in group I than group II. Incidence of the lower one third of the gastric cancer was higher in group II and III than that of group I. Histologically, undifferentiated carcinomas were more frequent in all groups. Postoperative complications in group I occurred in 11 patients (31.5%): intraabdominal abscess (4 patients: 11.4%), duodenal stump leakage (2 patients: 5.7%), renal failure (2 patients: 5.7%), and followed by bleeding, pulmonary complication, pancreatitis. Operative mortality of group I was 2.9%. The 5-year survival rate of group I and II was 15.6% and 3.1%, respectively and 0% in group III. In patients without peritoneal or liver metastasis, the 5-year survival rate of group I and II was 27.0% and 5.5%, respectively. But in patients with incurable factors, there was no difference in survival between the two groups. Median survival of group I with incurable factors was only 7 months. CONCLUSION: Combined resection of invaded organ in patients with T4 gastric carcinoma is a relatively safe procedure. Combined resection should be considered in patients without incurable factors such as peritoneal or liver metastasis.
Abscess ; Carcinoma ; Colon ; Gastrectomy ; Hemorrhage ; Humans ; Incidence ; Korea ; Liver ; Lymph Nodes ; Medical Records ; Mortality ; Neoplasm Metastasis ; Pancreas ; Pancreatitis ; Postoperative Complications ; Renal Insufficiency ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

Neurofibroma is a benign tumor characterized by diffuse proliferation of the peripheral nerve elements. It mostly occurrs in the retroperitoneal region. Although neurofibroma may occurr as a solitary lesion, its common manifestation is in the syndrome of neurofibromatosis with a variable clinical course. Neurofibroma is a slowly growing neoplasm that presents symptoms only after a period of several years. Complete surgical removal is the treatment of choice, however this can be occasionally dangerous because of their tendency to adhere to adjacent structures. Herein we report a case of neurofibroma causing duodenal obstruction.
Duodenal Obstruction* ; Neurofibroma* ; Neurofibromatoses ; Peripheral Nerves

Gallbladder agenesis is a rare condition of hepatobiliary congenital anomaly. It is caused by failure of development of the caudal division of the primitive hepatic diverticulum or failure of vacuolization after the solid phase of embryonic development. It is divided into 2 groups: (1) those whose conditions are discovered clinically because of persistent symptoms and proven by abdominal exploration with operative cholangiography; and (2) those who are asymptomatic during life and whose conditions are discovered only at necropsy. If symptoms are present, they are unlikely to be related to gallbladder disease. It is impossible, at present, to make a preoperative diagnosis of gallbladder agenesis. Operative cholangiography is absolutely necessary to rule out an intrahepatic gall bladder. Confirmation at surgery and autopsy requires thorough dissection of the biliary tract and liver bed. Therefore, we presented this case with a brief review of the related literature.
Autopsy ; Biliary Tract ; Cholangiography ; Diagnosis ; Diverticulum ; Embryonic Development ; Female ; Gallbladder Diseases ; Gallbladder* ; Liver ; Pregnancy ; Urinary Bladder

A 16-year-old male patient was diagnosed as chondroid osteosarcoma of the left humeral shaft. He showed normal serum creatinine level and no complications following the first course of high-dose methotrexate (HD-MTX) chemotherapy with a total dose of 12g/m2. After the 2nd HD-MTX chemotherapy with the same dosage as in the 1st course, plasma MTX levels soared up to 72micromol/L and serum creatinine level increased to 1.39mg/dL. We failed to lower the plasma MTX levels and to recover the renal function by high-dose leucovorin rescue and plasmapheresis. Plasma MTX level was successfully lowered after three consecutive total plasma exchanges and the withdrawal of aceclofenac which was suspected as an aggravating agent. No rebound in plasma MTX level was observed. We report that total plasma exchanges were effective in a patient with renal failure and delayed MTX excretion which occurred after HD-MTX chemotherapy.
Acute Kidney Injury* ; Adolescent ; Creatinine ; Drug Therapy ; Humans ; Leucovorin ; Male ; Methotrexate ; Osteosarcoma ; Plasma Exchange* ; Plasma* ; Plasmapheresis ; Renal Insufficiency

Cavernous transformation of the portal vein is a rare condition probably arising secondary to extrahepatic portal vein thrombosis or obstruction with recannalization and/or collateral veins formation to bypass the obstruction. It is believed that cavernous transformation of the portal vein is caused by a variety of diseases associated with periportal collateral development and hepatopedal flow. It is known that portal vein occlusion, which is the actual cause of cavernous transformation, has a wide variety of etiologies, such as congenital abnormalities, omphalitis, pancreatitis, various carcinoma, and liver cirrhosis. In most cases, the revealing symptom is upper gastrointestinal bleeding. Rarely, however, diagnosis is made from obstructive jaundice. Extensive collateral veins due to portal vein occlusion may compress and narrow the biliary tract. A 39-year-old man was admitted due to jaundice and abdominal discomfort for 1 month. He was confirmed to have obstructive jaundice due to collateral vessels of cavernous transformation of the portal vein. We report a case of obstructive jaundice caused by cavernous transformation of the portal vein.
Adult ; Biliary Tract ; Congenital Abnormalities ; Diagnosis ; Hemorrhage ; Humans ; Jaundice ; Jaundice, Obstructive* ; Liver Cirrhosis ; Pancreatitis ; Portal Vein* ; Veins ; Venous Thrombosis