PURPOSE: The optimal surgical technique for inguinal hernia repair continues to be debated. This study was designed to investigate optimal surgical procedures in inguinal or femoral hernia. METHOD: We analyzed 153 cases of herniorrhaphy on inguinal or femoral hernias between August 1996 and November 2000. We divided patient into four groups according to the methods of hernia repair, i.e., 1) 78 cases of laparoscopic herniorrhaphy, 2) 42 cases of Lichtenstein herniorrhaphy, 3) 24 cases of Bassini herniorrhaphy and 4) 9 cases of McVay herniorrhaphy. RESULTS: The patient in the laparoscopic and Lichtenstein herniorrhaphy groups needed shorter hospital stays than those in the Bassini or McVay herniorrhaphy groups. The severity of pain was assessed by the total amount and duration of nonsteroidal anti-inflammatory drug injections, which was minimal in the laparoscopic group. There were no differences in complications between the groups. One patient in the laparoscopy group had a hernia recurrence and was reoperated with Lichtenstein herniorrhaphy. We compared two tension-free herniorrhaphies with each other. The numbers of patients not needing analgesic injections were more in the laparoscopic than the Lichtenstein herniorrhaphy group, reflecting less pain in the former group. Hospital stays were also shorter in the laparoscopic than the Lichtenstein herniorrhaphy group. CONCLUSION: We concluded that tension-free herniorrhaphy is superior to tension herniorrhaphy in terms of postoperative pain & recovery. Of the tension-free herniorrhaphies, laparoscopic herniorrhaphy is associated with less postoperative pain and shorter hospital stays than Lichtenstein herniorrhpahy.
Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Laparoscopy* ; Length of Stay ; Pain, Postoperative ; Recurrence

PURPOSE: There are a number of conditions that can lead to a hypercoagulable state, however, protein C and S deficiencies are frequently described as causes of the hypercoagulable states. The aim of this study was to evaluate the clinical features and prognosis of vascular diseases associated with protein C and/or S deficiencies and to determine an adequate treatment modality for such cases. METHODS: We prospectively evaluated 7 cases with vascular disease caused by protein C and/or S deficiencies confirmed with serologic tests. RESULTS: Four patients showed venous thrombosis, 1 peripheral arterial insufficiency, 1 cerebral venous thrombosis and peripheral arterial insufficiency, and 1 portal vein thrombosis. Surgical intervention was required in 5 patients. Full anticoagulation with heparin sodium followed by warfarin sodium was done in all patients. CONCLUSION: Protein C and S deficiencies may influence clinical management. Patients presenting with atypical vascular involvement without evidence of other risk factors should be evaluated for a hypercoagulable state. Once the diagnosis is made, patients should be treated with full anticoagulation.
Diagnosis ; Heparin ; Humans ; Prognosis ; Prospective Studies ; Protein C* ; Risk Factors ; Serologic Tests ; Vascular Diseases* ; Venous Thrombosis ; Warfarin

Hematocolpos is a congenital abnormality resulting from vaginal obstruction. This is relatively not rare condition but is rarely associated with obstructive uropathy such as acute urinary retention and hydronephrosis. We encountered a rare case of hematocolpos, secondary to imperforate hymen, which caused hydronephrosis and urinary retention.
Congenital Abnormalities ; Female ; Hematocolpos* ; Hydronephrosis ; Hymen* ; Urinary Retention*

Postoperative leakage is a serious complication in patients after gastric surgery. It can lead to a rapid deterioration in the patient's condition and quality of life. Treatment is guided by the type of anastomosis and the patient's clinical status. The role of interventional radiology in gastrointestinal tract is evolving. Metallic stent placement has shown encouraging results for the palliation of gastrointestinal tract obstruction and fistula in malignant patients. We encountered a case of the leakage of jejunal end of Roux limb after total gastrectomy. This patient required a drainage procedure with long-term parenteral nutrition. We performed peroral placement of a covered metallic stent to avoid surgery and long-term parenteral nutrition, and he resumed adequate oral intake immediately after stent placement. This minimally invasive procedure is very promising for the treatment of a gastrointestinal fistula to avoid surgery and long-term parenteral nutritional support in selected cases.
Aged ; Anastomosis, Roux-en-Y/*adverse effects ; Drainage ; Fistula/etiology/surgery ; Gastrectomy/*adverse effects ; Human ; Jejunal Diseases/*etiology/radiography/surgery ; Jejunum/radiography/*surgery ; Male ; Postoperative Complications ; *Stents

Hepatocellular carcinoma has a great tendency to invade blood vessels, particularly the portal vein. Invasion into the biliary lumen has been considered to be a rather rare event. Ultrasonogram and endoscopic retrograde cholangiopancreatography of the patient, a 65-year-old man presenting with obstructive jaundice, revealed an obstructing mass at the common hepatic duct and dilatation of the intrahepatic bile ducts. Abdominal computed tomography and hepatic angiogram showed no abnormal mass and abnormal staining in the liver. Obstructive jaundice due to Klatskin's tumor was suspected preoperatively. During operation, although no tumor was palpable in the liver, an intraductal tumor measuring 3.5X3.0 cm was found in the common hepatic duct. Bile duct resection was performed in a patient. Histologically, the tumor, a hepatocellular carcinoma showing abundant eosinophilic cytoplasm, was structurally arranged in a solid and trabecular pattern. We report a case of hepatocellular carcinoma mainly presenting as Klatskin tumor.
Aged ; Bile Ducts ; Bile Ducts, Intrahepatic ; Blood Vessels ; Carcinoma, Hepatocellular* ; Cholangiopancreatography, Endoscopic Retrograde ; Cytoplasm ; Dilatation ; Eosinophils ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive ; Klatskin's Tumor* ; Liver ; Portal Vein ; Ultrasonography

Paraduodenal hernia is a rare congenital anomaly caused by abnormal rotation of the midgut in embryonic stage, with part of the small intestine becoming trapped posterior to the mesocolon. Right and left paraduodenal hernias are distinct and separate entities, varying not only in anatomical structure but also in embryological origin. Paraduodenal hernia is a rare cause of acute intestinal obstruction. Careful clinical evaluation is needed for prompt surgical treatment. Because it is difficult to diagnose before exploration, and since paraduodenal hernia may cause potentially lethal complications such as obstruction, gangrene or bowel perforation, the possibility of internal hernia should be considered in any patient with acute intestinal obstruction who has no previous abdominal operation or external hernia. If paraduodenal hernia is suspected to be the cause of acute intestinal obstruction, the recommended tool for diagnosis is abdominal computed tomography. We experienced three cases of paraduodenal hernia, one case was right paraduodenal hernia while the others were left paraduodenal hernia.
Diagnosis ; Gangrene ; Hernia* ; Humans ; Intestinal Obstruction ; Intestine, Small ; Mesocolon

Cephalosporins are commonly used antibiotics in treatment of clinical infection. They frequently cause a positive direct antiglobulin test, but rarely cause hemolysis. The authors report a case of immune hemolytic anemia due to a second-generation cephalosporin, cefuroxime, by the drug adsorption mechanism.
Adsorption ; Anemia, Hemolytic* ; Anti-Bacterial Agents ; Cefuroxime* ; Cephalosporins ; Coombs Test ; Hemolysis

PURPOSE: Protein C and S deficiencies are frequently described as causes of the hypercoagulable states. The aim of this study was to evaluate the clinical features and prognosis of deep venous thrombosis associated with protein C and/or S deficiencies and to determine an adequate treatment modality for such cases. METHOD: A total of consecutive 42 patients with deep venous thrombosis of the lower extremity were seen in our hospital between September 2000 and August 2002. Hypercoagulability studies were done before systemic anticoagulation therapy, and the diagnosis of protein C and/or S deficiencies was confirmed if antigenic protein C and/or S levels were less than 60%. RESULT: Seven patients (16.7%) were diagnosed with deep venous thrombosis associated with protein C and/or S deficiencies. Of these, 5 patients with acute iliofemoral deep venous thrombosis were treated with catheter-directed thrombolysis therapy, and 2 with systemic anticoagulation therapy. There were no major complications or clinically detectable pulmonary emboli. CONCLUSION: Protein C and/or S deficiencies are one of the common causes of deep venous thrombosis. Considering that patients with deep venous thrombosis and protein C and/or S deficiencies should be treated with life-long anticoagulation for the prevention of recurrence, patients presenting with deep venous thrombosis without evidence of other risk factors should be evaluated for hypercoagulable states.
Diagnosis ; Humans ; Lower Extremity* ; Prognosis ; Protein C* ; Protein S ; Recurrence ; Risk Factors ; Thrombophilia ; Thrombosis ; Veins ; Venous Thrombosis*

With acupuncture treatment becoming an increasingly popular analgesic, there have been increasing reports on its associated complications. Although pneumothorax is the most frequently reported injury caused by acupuncture needles, infectious complications may not be uncommon. Most infectious complications show less serious clinical manifestations than pneumothorax, but retroperitoneal or intraabdominal abscess caused by acupuncture may be much more serious conditions. We experienced a 56-yr-old male diabetic patient presenting with serious retroperitoneal abscess after acupuncture treatments. Emergency operative drainage with adequate antibiotic therapy was performed. Bacterial culture of blood and closed pus specimens recovered Klebsiella pneumoniae. In addition to application of better knowledge on anatomy, appropriate antiseptic practice by practitioners will reduce many serious complications associated with acupuncture.
Abdominal Abscess/radiography ; *Acupuncture ; Acupuncture Therapy/*adverse effects ; Anti-Bacterial Agents/*therapeutic use ; Diabetes Mellitus/complications ; Human ; Klebsiella Infections/*diagnosis/therapy ; Klebsiella pneumoniae/*metabolism ; Male ; Middle Aged ; Sepsis/diagnosis ; Tomography, X-Ray Computed

Sudden acute arterial occlusion can result from a multitude of pathological processes. Although the appearance and the secondary effects of an acute arterial occlusion are similar regardless of the underlying cause, the treatment and prognosis are different. Therefore, establishing a correct diagnosis is crucial. Acute arterial occlusion is most frequently a complication of ischemic cardiac disease, with an atrial fibrillation occurring in most patients. An identifiable noncardiac source of the acute arterial occlusion can be found in 5~10% of patients. Howerver, in these cases, the specific source of the occlusion cannot be determined clinically or even at autopsy. Possible hypercoagulable states should be suspected and appropriately evaluated, particularly in patients with no history of antecedent occlusive disease who present with sudden arterial occlusions, or in patients with malignant disease. Protein C and protein S deficiencies are frequently described as a cause of the hypercoagulable states. We reported 3 cases of acute arterial occlusion associated with protein C and S deficiencies.
Acute Disease ; Atrial Fibrillation ; Autopsy ; Diagnosis ; Heart Diseases ; Humans ; Pathologic Processes ; Prognosis ; Protein C* ; Protein S ; Protein S Deficiency