PURPOSE: In this retrospective study, we aimed to compare the clinical characteristics of inguinal hernia developed after radical retropubic surgery for prostate cancer to the hernia without previous radical prostatectomy. METHODS: Twenty-three patients (group A) who had radical retropubic surgery for prostate cancer underwent laparoscopic or open tension-free inguinal hernia repair from March 2007 to February 2011. Nine hundred and forty patients (group B) without previous radical retropubic surgery received laparoscopic or tension-free open hernia operation. RESULTS: Group A was older than group B (mean +/- standard deviation, 69.6 +/- 7.2 vs. 54.1 +/- 16.1; P < 0.001). Right side (73.9%) and indirect type (91.3%) in group A were more prevalent than in group B (51.5% and 69.4%, respectively) with statistic significance (P = 0.020 and P = 0.023). The rate of laparoscopic surgery in group B (n = 862, 91.7%) was higher than in group A (n = 14, 64.3%, P < 0.001). In comparing perioperative variables between the two groups, operative time (49.4 +/- 23.5 minutes) and hospital stay (1.9 +/- 0.7 days) in group A were longer than in group B (38.9 +/- 16.9, 1.1 +/- 0.2; P = 0.046 and P < 0.001, respectively) and pain score at 7 days in group A was higher than in group B (3.1 +/- 0.7 vs. 2.3 +/- 1.0, P < 0.001). Postoperative recurrence rate was not significantly different between the two groups. CONCLUSION: Inguinal hernia following radical retropubic surgery for prostate cancer was predominantly right side and indirect type with statistic significance compared to hernias without previous radical prostatectomy.
Hernia ; Hernia, Inguinal ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Recurrence ; Retrospective Studies

PURPOSE: Diallyl disulfide (DADS) is a major organosulfur compound derived from garlic. It has been reported that DADS is able to inhibit the proliferation of several tumor cells. In this study, the effect of DADS was investigated in terms of the proliferation of AGS, gastric adenocarcinoma cell line at various concentrations. METHODS: The viability of cultured cells was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide assay. To detect the induction of apoptosis, Annexin V-FITC/propodium iodide (PI) staining assay was performed. Analysis of reactive oxygen species (ROS) and the distribution of cells in the cell cycle were measured by a flow cytometer. And using the Western blot analysis, the change of Fas, caspase-3, Bax, Bcl-2 activity was measured. RESULTS: The percentage of live AGS cells was decreased to 23% of that in the control group after 400 microM DADS treatment for 48 hours. The Annexin V positive/PI negative (apoptosis portion) area increased from low concentration of DADS to high concentration. When comparing among the DADS treatment groups, the amount of ROS production increased in a dose dependent manner. The percentage of sub-diploid DNA content increased from 8.71% at 50 microM to 25.74% at 400 microM DADS treatment group. The expressions of Fas, caspase-3, Bax were increased and that of Bcl-2 was decreased in a dose dependent manner. CONCLUSION: DADS decreases the viability of AGS cell lines and induces apoptosis in a dose-dependent manner. But the relationship of the anti-proliferative effect of DADS and related molecular changes were not clearly proportional to the concentration of DADS.
4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid ; Adenocarcinoma ; Allyl Compounds ; Annexin A5 ; Apoptosis ; Blotting, Western ; Caspase 3 ; Cell Cycle ; Cell Line ; Cells, Cultured ; Disulfides ; DNA ; Garlic ; Reactive Oxygen Species ; Stomach Neoplasms

PURPOSE: Unlike males, inguinal hernia surgery in females is an uncommon surgical procedure. The efficacy of laparoscopic surgery for female hernia must be proven. This study compared the clinical characteristics of male and female hernia as well as the efficacy of laparoscopic surgery with that of open surgery in female hernia. METHODS: From March 2007 to February 2011, one surgeon (C.S.) at the authors' institution operated on 965 patients (male/female=884/81) who were each more than 19 years old. The female patients were divided into the laparoscopic (n=67, TEP/TAPP=66/1) and open surgery groups (n=14). RESULTS: The mean age of the female patients was lower than that of the male patients. The incidence of bilateral and direct hernia was higher in the male patients but the incidence of femoral hernia was higher in the female patients (0.6 vs. 8.6%, p<0.001). Among the 81 female patients, the mean age of the patients with femoral hernia was higher than that of the patients with other types of hernia (56.4+/-12.5/43.0+/-15.1, p<0.026). The operation times and pain scores of the two groups 7 days after surgery were comparable. CONCLUSION: The findings revealed a higher incidence of femoral hernia in the female patients than male patients. Patients with a femoral hernia were older than those with other types of hernia. Therefore, laparoscopic surgery must be considered for elderly female patients who have a high incidence of femoral hernia.
Aged ; Female ; Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Humans ; Incidence ; Laparoscopy ; Male

PURPOSE: This study was aimed to compare the results of a transanal repair with those of a transvaginal levatorplasty and to determine the long-term clinical outcomes according to the change in the depth of the rectocele after the procedure. METHODS: Of 50 women who underwent a rectocele repair from March 2005 to February 2007, 26 women (group A) received a transanal repair, and 24 (group B) received a transvaginal repair with or without levatorplasty. At 12 months after the procedures, 45 (group A/B, 22/23 women) among the 50 women completed physiologic studies, including anal manometry and defecography, and clinical-outcome measurements. The variations of the clinical outcomes with changes in the depth of the rectocele were also evaluated in 42 women (group A/B, 20/22) at the median follow-up of 50 months. RESULTS: On the defecographic findings, the postoperative depth of the rectocele decreased significantly in both groups (group A vs. B, 1.91 +/- 0.20 vs. 2.25 +/- 0.46, P = 0.040). At 12 months after surgery, 17 women in each group (group A/B, 77/75%) reported improvement of their symptoms. However, only 11 and 13 women (group A/B, 55/59%) of groups A and B, respectively, maintained their improvement at the median follow-up of 50 months. Better results were reported in patients with a greater change in the depth of their rectocele (> or =4 cm) after the procedure (P = 0.001) CONCLUSION: In both procedures, clinical outcomes might become progressively worse as the length of the follow-up is increased.
Defecography ; Female ; Follow-Up Studies ; Humans ; Manometry ; Rectocele

Collapsing glomerulopathy (CG) has become an important cause of end-stage renal disease (ESRD). First delineated from other proteinuric glomerular lesions in the 1980s, CG is now recognized as a common, distinct pattern of proliferative parenchymal injury that portends a rapid loss of renal function and poor responses to empirical therapy. The first cases in the literature trace back to human-immunodeficiency-virus (HIV)-negative patients who underwent biopsy in 1979. A 45-year-old male patient complained of hematuria and proteinuria eight years ago. He showed an abrupt serum creatinine increase from 1.75 to 2.65mg/dL in the last preceding months. Afterwards, his serum creatinine progressively increased up to 6.82mg/dL. Moreover, his 24 h urine protein level was determined to have reached 6,171 mg/day, as opposed to 670 mg/day a year earlier. Consequently, renal biopsy was performed, and its result showed collapsing glomerulopathy, compatible with the diagnosis. He has undergone continuous ambulatory peritoneal dialysis as renal replacement therapy. Thus, it is reported herein that a patient clinically diagnosed with chronic kidney disease eight years ago showed a sudden renal-function decrease and was clinicopathologically diagnosed with collapsing glomerulopathy based on the results of his renal biopsy.
Biopsy ; Creatinine ; Glomerulosclerosis, Focal Segmental ; Hematuria ; Humans ; Kidney Failure, Chronic ; Male ; Peritoneal Dialysis, Continuous Ambulatory ; Proteinuria ; Renal Insufficiency, Chronic ; Renal Replacement Therapy

PURPOSE: A multidisciplinary program for early recovery after colorectal surgery has been developed continuously since 2000. The purpose of this study was to evaluate the effects of the standardized postoperative enhanced recovery program (SPERP) after a colorectal resection. METHODS: The patients undergoing laparoscopic colorectal resection for colorectal cancer were cared for by using the SPERP after surgery. The comparison group consisted of patients who had undergone similar surgery before establishment of the SPERP. The two groups were compared with respect to the patients' characteristics, operation methods, operation time, blood loss, amounts of intravenous fluid and intravenous antibiotics, complications, postoperative hospital stay, readmission rate, and reoperation rate. RESULTS: The number of patients being treated with the standardized postoperative recovery program, the standardized group (SG), was 63, and that of the traditional group (TG) was 61. Even though the day of oral feeding (1.02 vs. 2.67 days) was faster in the SG, the day of flatus and defecation was not different between two groups. The postoperative hospital stay in the SG (6.76 days) was significantly shorter than that in the TG (10.43 days). The total amount of intravenous fluid after surgery in the SG was 8,574.75 mL, compared with 19,568.22 mL in the TG. The duration of intravenous antibiotics was 2.69 days in the SG and 7.38 days in the TG (P=0.0001). The rates of complication (27.0% in SG vs. 39.3% in TG), reoperation (3.17% vs. 9.84%), and readmission (7.94% vs. 6.56%) did not increase after implementation of this program. CONCLUSION: The standardized postoperative recovery program reduced the amounts of postoperative intravenous fluid and antibiotics and the postoperative hospital stay without increasing either complications or the readmission rate. A prospective multi-center study of this program is needed.
Anti-Bacterial Agents ; Colorectal Neoplasms ; Colorectal Surgery ; Defecation ; Flatulence ; Humans ; Length of Stay ; Postoperative Complications ; Reoperation

PURPOSE: Laparoscopic herniorrhaphy (LH) has an advantage for evaluating the viability of incarcerated bowel. In this retrospective study, we aimed to review the data for use of the TEP technique in treating incarcerated hernias in order to document the feasibility of the laparoscopic procedure. METHODS: During a 2-year period from January 2008 to December 2009, one surgeon (C.S) at our institution operated on 27 patients with acutely (n=3) or chronically (n=24) incarcerated hernia. Incarcerated hernias were divided into acute or chronic types arbitrarily, based on who had symptoms of acute abdominal pain and signs of intestinal obstruction. For acute cases, the TEP procedure was done following laparoscopic transperitoneal evaluation to assess viability of the incarcerated bowel. RESULTS: All patients except one having a femoral hernia were male. Mean age was 41 years old (range, 25~75). No case converted from a laparoscopic to an open procedure. Two acute incarcerated cases contained a segment of small bowel and the other contained small bowel and omentum. All acute cases were operated on successfully on an emergency basis by laparoscopic TEP repair. All chronic cases contained omentum without bowel. In one case of acute and seven cases of chronic type, a small inguinal incision was made to reduce hernia contents. No recurrence was noticed at a mean of 13 months of follow-up. CONCLUSION: If there is no entrapment of bowel in chronic incarcerated cases, the TEP procedure will be satisfactory. It may be reasonable, however, to evaluate viability of bowel transperitoneally before doing a TEP procedure in acute cases.
Abdominal Pain ; Emergencies ; Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Imidazoles ; Intestinal Obstruction ; Laparoscopy ; Male ; Nitro Compounds ; Omentum ; Pyrazines ; Recurrence ; Retrospective Studies

PURPOSE: Laparoscopic herniorrhaphy (LH) can be used to examine the asymptomatic contralateral side and repair occult contralateral hernias coincidentally with reduced morbidity. In this prospective study, we evaluated the results of diagnostic exploration of the right side during total extraperitoneal (TEP) laparoscopic repair of left side inguinal hernias. METHODS: A prospective study of 100 consecutive male patients undergoing TEP repair by a single surgeon (C.S) between January and June 2008 was conducted. Two cases that had transabdominal preperitoneal (TAPP) prosthetic repair and one intraperitoneal onlay mesh (IPOM) were excluded. We routinely explored the contralateral side to determine the incidence of right side occult hernia. RESULTS: The mean age was 52 (range; 18~82 years). Among the 100 patients, 17 had bilateral, 52 right and 31 left hernias on physical examination prior to surgery. Three of 31 diagnosed preoperatively as left inguinal hernia were confirmed to have occult right hernias (3/31, 9.7%). Among the three patients, two patients with a direct type had the same type of hernia as on the contralateral side (2/10, 20%). Another one patient with an indirect type had direct type of hernia on the contralateral side (1/21, 4.8%). CONCLUSION: Given the low incidence of contralateral side occult hernia with indirect types of hernias, routine exploration may not be indicated during TEP repair. However, it might be, reasonable to explore the contralateral side in patients with a direct type of hernia because of the higher incidence of contralateral occult hernias.
Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Incidence ; Inlays ; Male ; Physical Examination ; Prospective Studies ; Pyrazines

PURPOSE: The long-term results of a laparoscopic resection for colorectal cancer have been reported in several studies, but reports on the results of laparoscopic surgery for rectal cancer are limited. We investigated the long-term outcomes, including the five-year overall survival, disease-free survival and recurrence rate, after a laparoscopic resection for colorectal cancer. METHODS: Using prospectively collected data on 303 patients with colorectal cancer who underwent a laparoscopic resection between January 2001, and December 2003, we analyzed sex, age, stage, complications, hospital stay, mean operation time and blood loss. The overall survival rate, disease-free survival rate and recurrence rate were investigated for 271 patients who could be followed for more than three years. RESULTS: Tumor-node-metastasis (TNM) stage I cancer was present in 55 patients (18.1%), stage II in 116 patients (38.3%), stage III in 110 patients (36.3%), and stage IV in 22 patients (7.3%). The mean operative time was 200 minutes (range, 100 to 535 minutes), and the mean blood loss was 97 mL (range, 20 to 1,200 mL). The mean hospital stay was 11 days and the mean follow-up period was 54 months. The mean numbers of resected lymph nodes were 26 and 21 in the colon and the rectum, respectively, and the mean distal margins were 10 and 3 cm. The overall morbidity rate was 26.1%. The local recurrence rates were 2.2% and 4.4% in the colon and the rectum, respectively, and the distant recurrence rates were 7.8% and 22.5%. The five-year overall survival rates were 86.1% in the colon (stage I, 100%; stage II, 97.6%; stage III, 77.5%; stage IV, 16.7%) and 68.8% in the rectum (stage I, 90.2%; stage II, 84.0%; stage III, 57.6; stage IV, 13.3%). The five-year disease-free survival rates were 89.8% in the colon (stage I, 100%; stage II, 97.7%; stage III, 74.2%) and 74.5% in the rectum (stage I, 90.0%; stage II, 83.9%; stage III, 59.2%). CONCLUSION: Laparoscopic surgery for colorectal cancer is a good alternative method to open surgery with tolerable oncologic long-term results.
Colon ; Colorectal Neoplasms ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Prospective Studies ; Rectal Neoplasms ; Rectum ; Recurrence ; Survival Rate

BACKGROUND/OBJECTIVES: Elevation of postprandial lipemia characterized by a rise in triglyceride (TG)-rich lipoproteins can increase the risk of atherogenesis. The objective of this study was to investigate postprandial lipemia response to a single dietary fat/sugar load test and monitor beneficial changes induced by the consumption of Platycodi radix (AP) beverage in healthy subjects. SUBJECTS/METHODS: A total of 52 subjects were randomly assigned to either placebo or AP beverage group with a high-fat shake in a randomized controlled crossover trial. Postprandial blood was collected at 0, 1, 2, 4, and 6 h and analyzed for TG and lipoprotein lipase mass. Inhibition of pancreatic lipase was determined in vitro. RESULTS: AP inhibited pancreatic lipase activity in vitro (IC₅₀ = 5 mg/mL). Compared to placebo beverage, AP beverage consumption with a high-fat shake induced significant increase of plasma lipoprotein lipase mass (P = 0.0111, β estimate = 4.2948) with significant reduction in very low-density lipoprotein (VLDL) TG concentration (P = 0.038, β estimate = −52.69) at 6 h. Based on significant correlation between high-fat dietary scores MEDFICTS and postprandial TG responses in VLDL (P = 0.0395, r = 0.2127), subgroup analysis revealed that 6 h-postprandial VLDL TG response was significantly decreased by AP consumption in subjects with MEDFICTS ≥ 40 (P = 0.0291, β estimate = −7214). CONCLUSIONS: AP beverage might have potential to alleviate postprandial lipemia through inhibiting pancreatic lipase activity and elevating lipoprotein lipase mass. Subgroup analysis revealed that subjects with high-fat dietary pattern could be classified as responders to AP beverage among all subjects.
Atherosclerosis ; Beverages* ; Healthy Volunteers* ; Hyperlipidemias* ; In Vitro Techniques ; Lipase ; Lipoprotein Lipase ; Lipoproteins* ; Plasma ; Triglycerides