BACKGROUND: Hemorrhage itself has been shown to produce abnormalities in immunity, particularly depression of the lymphocyte function. In order to better examine the amount of hemorrhage required to suppress the lymphocyte function, we determined the effect of graded fixed-volume hemorrhage on splenocyte proliferation and the lymphocyte subpopulation. METHODS: Male Sprague-Dawley rats(weight, 350~400g) were anesthetized, subjected to hemorrhages of 7.5ml/kg, 15ml/kg, and 22.5ml/kg by percutaneous cardiac puncture with 26G needles. After 1, 2, 4, and 7 days, animals were killed to obtain the blood and spleen. The splenocyte proliferative capacity was measured by using the tritiated thymidine incorporation technique, and the peripheral lymphocyte subpopulation was determined using flow cytometry with the following monoclonal antibodies: T cell(CD3+), T helper cell(CD4+), T cytotoxic cell(CD8+), and B cell(CD45RA+). RESULTS: Hemorrhage of 7.5ml/kg did not induce depression of splenocyte proliferation. However, for hemorrhage greater than 15ml/kg, the splenocyte proliferative capacity was significantly depressed at 2 days after hemorrhage and recovered at 4 days. Hemorrhage induced no changes in the relative percentage of lymphocyte subpopulations and in the number of each cell in peripheral blood. CONCLUSION: This study suggests that cellular immunity is depressed at 48 hrs after a hemorrhage greater than 15ml/kg without any change in the peripheral lymphocyte subpopulation.
Animals ; Antibodies, Monoclonal ; Depression ; Flow Cytometry ; Hemorrhage* ; Humans ; Immunity, Cellular ; Lymphocyte Subsets ; Lymphocytes* ; Male ; Needles ; Punctures ; Rats* ; Rats, Sprague-Dawley ; Spleen ; Thymidine

No abstract available.
Carbon Dioxide* ; Carbon* ; Lasers, Gas*

The results of surgery on Klatskin tumors have improved during the era of the combined liver resection. However, some surgeons still have a negative point of view on liver resection because of the locally infiltrative characteristics of cancer and the high mortality and morbidity. We treated 98 patients with a Klatskin tumor between 1990 and 1996. The mean age was 57 year, and the sex ratio (M : F) was 2.2 : 1. Among them, 27 patients (27.6%) received a combined liver resection, 11 patients (11.2%) received a segmental resection of the extrahepatic bile duct, and the other 60 patients (61.2%) had non resective procedures (a bypass operation, an intubational operation, or a percutaneous drainage procedure). The mean survival of the combined liver resection group was 30.0 months-higher than those of the other groups (17.1 months for the segmental-resection group, 14.0 months for the non resective procedures group)(p<0.05). The cumulative 1-, 2-, and 3-year survival rates in patients undergoing a combined liver resection were 95.5%, 83.9%, and 55.9% respectively (significantly higher than the 72.7%, 11.4%, and 0% in the patients undergoing a resection and the 41.1%, 11.4%, and 5.7% in the patients undergoing a non resective procedures). There was no difference in the survival rates between the segmental-resection and non resective-procedure group. In the segmental-resection group, 5 patients had a negative resection margin, and 6 patients had a positive resection margin. The mean survivals were 18.4 and 16.0 months, respectively (p>0.05). The morbidity rate for the combined liver resection was 74%--higher than that for the segmental resection (45%) and for the non resective-procedure group (30%)(p<0.05). There was one operative mortality (1.0%), the patient died due to postoperative sepsis after a U-tube intubational operation. Based on a univariate analysis, significant prognostic factors after liver resection were lymph node involvement, and bilirubin (>5 mg/dl) at admission. A multivariate analysis showed no prognostic significance for either lymph node involvement or bilirubin at admission. These results indicate that segmental resection is not a curable treatment modality and that only aggressive radical surgery, including a hepatectomy, gives any chance of a cure for a Klatskin tumor. We conclude that combined radical liver resection is the treatment of choice for a Klatskin tumor and that accurate preoperative diagnosis and cautious perioperative care decrease the mortality and morbidity of a hepatectomy.
Bile Ducts, Extrahepatic ; Bilirubin ; Diagnosis ; Drainage ; Hepatectomy ; Humans ; Klatskin's Tumor* ; Liver ; Lymph Nodes ; Mortality ; Multivariate Analysis ; Perioperative Care ; Sepsis ; Sex Ratio ; Survival Rate

No abstract available.
Humans ; Pericardial Effusion*

We report a case of free flap deterioration which may have been induced by pressure gradient resulting from cranial defect overlying a ventriculoperitoneal shunt (VP shunt). The patient, male and aged 78, had a VP shunt operation for progressive hydrocephalus. Afterwards, the scalp skin flap surrounding the VP shunt collapsed and showed signs of necrosis, exposing part of the shunt catheter. After covering the defect with a radial forearm free flap, the free flap site showed signs of gradual sinking while the vascularity of the flap remained unimpaired. An agreement was reached to remove the shunt device and observe the patient for any neurological symptoms, and after the shunt was removed and the previous cranial opening filled with fibrin glue by Neurosurgery, we debrided the deteriorated flap and provided coverage with 2 large opposing rotational flaps. During 2 months' outpatient follow-up no neurological symptoms appeared, and the new scalp flap displayed slight depression but remained intact. The patient has declined from any further follow-up since.
Catheters ; Decompressive Craniectomy ; Depression ; Fibrin Tissue Adhesive ; Follow-Up Studies ; Forearm ; Free Tissue Flaps* ; Humans ; Hydrocephalus ; Male ; Necrosis ; Neurosurgery ; Outpatients ; Scalp ; Skin ; Ventriculoperitoneal Shunt*

OBJECTIVE: To compare radiographic analysis on the sagittal lumbar curve when standing, sitting on a chair, and sitting on the floor. METHODS: Thirty asymptomatic volunteers without a history of spinal pathology were recruited. The study population comprised 11 women and 19 men with a mean age of 29.8 years. An independent observer assessed whole lumbar lordosis (WL) and segmental lordosis (SL) between L1 and S1 using the Cobb's angle on lateral radiographs of the lumbar spine obtained from normal individuals when standing, sitting on a chair, and sitting on the floor. WL and SL at each segment were compared for each position. RESULTS: WL when sitting on the floor was reduced by 72.9% than the average of that in the standing position. Of the total decrease in WL, 78% occurred between L4 to S1. There were significant decreases in SL at all lumbar spinal levels, except L1-2, when sitting on the floor as compared to when standing and sitting on a chair. Changes in WL between the positions when sitting on a chair and when sitting on the floor were mostly contributed by the loss of SL at the L4-5 and L5-S1 levels. CONCLUSION: When sitting on the floor, WL is relatively low; this is mostly because of decreasing lordosis at the L4-5 and L5-S1 levels. In the case of lower lumbar fusion, hyperflexion is expected at the adjacent segment when sitting on the floor. To avoid this, sitting with a lordotic lumbar curve is important. Surgeons should remember to create sufficient lordosis when performing lower lumbar fusion surgery in patients with an oriental life style.
Animals ; Female ; Floors and Floorcoverings ; Humans ; Life Style ; Lordosis ; Male ; Spine

OBJECTIVES: To evaluate the incidence rate and associated factors of dementia in the elderly of rural community. METHODS: This study was three and half year follow-up of Yonchon cohort, participated in a prevalence study of dementia and depression in 1996 (N=1,037). A two-phase study was conducted using the Korean version of Psychogeriatric Assessment Scale in phase I and the diagnostic interview according to DSM-IV criteria by two psychiatrists in stage II. RESULTS: Of the 968 elderly residents who had not dementia in 1996 prevalence study, 596 residents completed the incidence study. The annual incidence rate for total dementia, dementia of Alzheimer's type and vascular dementia were 1.88% (1.86% in men, 1.98% in women), 1.58% (1.39% in men, 1.80% in women) and 0.34% (0.45% in men, 0.25% in women), respectively. Increasing age was significantly associated with total dementia and dementia of Alzheimer's type (p<0.01, p<0.05, respectively). There was statistically significant difference of the three and half year mortality rate between the dementia patients who were diagnosed in prevalence study and the non-dementic elderly (chi2=28.89, df=1, p<0.001). Only the 2.8% of newly onset dementia patients sought psychiatric service in the previously year. CONCLUSIONS: The incidence of dementia among the Korean elderly in a rural community was relatively consistent with the epidemiological studies of other countries. Age was the only risk factor for total dementia and dementia of Alzheimer's type. Very few dementia patients were treated by psychiatrist.
Aged* ; Cohort Studies* ; Cross-Sectional Studies ; Dementia* ; Dementia, Vascular ; Depression ; Depressive Disorder* ; Diagnostic and Statistical Manual of Mental Disorders ; Epidemiologic Studies ; Follow-Up Studies* ; Humans ; Incidence* ; Male ; Mortality ; Prevalence* ; Psychiatry ; Risk Factors ; Rural Population

PURPOSE: Composite neuroendocrine-exocrine carcinomas are malignancies that have two distinct components residing within the same tumor: an adenocarcinomatous portion and a neuroendocrine portion. This is rare in gastric cancers; however, poorly differentiated adenocarcinomas can sometimes reveal evidence of neuroendocrine features (NEF) or be 'mixed endocrine and exocrine carcinomas'. This study aimed to review NEF in gastric adenocarcinoma and to evaluate its prognostic significance. MATERIALS AND METHODS: We selected 29 patients who were diagnosed with gastric adenocarcinoma with NEF and received gastrectomies at the Department of Surgery, Ajou University Hospital between January 2001 and December 2009. We analyzed the clinicopathologic features of gastric cancer with NEF and the prognosis associated with such tumors. RESULTS: The pathologic result with respect to TNM staging of the gastric cancers with NEF were as follows: 5 cases of T1, 5 cases of T2, 10 cases of T3, and 9 cases of T4. There were 7 cases of N0, 7 cases of N1, 8 cases of N2 and 7 cases of N3. The staging of patients with NEF was higher than that of patients without NEF. Especially tumor lymphovascular invasion rate was 82.8%. The overall survival of patients with gastric cancer characterized by NEF was 73.8 months. CONCLUSIONS: Positive NEF status might be correlated with clinicopathologic parameters such as a high stage and high frequency of regional lymph node metastasis.
Adenocarcinoma ; Gastrectomy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms

PURPOSE: The prognosis of a ductal adenocarcinoma of the body and tail of the pancreas is poor because it is usually diagnosed at an advanced stage and is rarely resectable. The aim of this study was to evaluate the clinical outcomes after a surgical resection of an adenocarcinoma of the distal pancreas. METHODS: A total of 311 patients with an adenocarcinoma of the distal pancreas were admitted between 1985 and 2001, and of these, 54 patients were surgically treated; 29 patients underwent a distal pancreatectomy (extended resection in 12 cases), 9 underwent a palliative bypass, and 16 underwent a open biopsy. The clinical outcome of the 29 patients who underwent a surgical resection for the adenocarcinoma of the distal pancreas was retrospectively analyzed. RESULTS: The resectability rate was 9.3% (29/311). In the resected cases, the cumulative 3-year survival rate was 14.9%, whereas it was 0% (p=0.013) in the non-resected cases. Moreover, a significant survival difference was found between the curatively resected cases (n=16, 28.1%) and the palliatively resected cases (n=13, 0%)(p=0.003). After the curative resection, 11 patients (68.8%) developed a recurrence. Three patients survived more than 3 years (46, 74, 56 months), of whom only one had no recurrent disease. The size of the tumor and the residual tumor were identified as independent significant prognostic factors by multivariate analysis. CONCLUSION: Only a curative resection can offer long-term survival as well as a survival benefit in patients with a ductal adenocarcinoma of the body and tail of the pancreas. Therefore, a surgical resection should be preferably performed and efforts for a curative resection should be made. However, adjuvant therapy, local and systemic, needs to be further developed because most patients develop a recurrence after the resection.
Adenocarcinoma* ; Biopsy ; Carcinoma, Pancreatic Ductal ; Humans ; Multivariate Analysis ; Neoplasm, Residual ; Pancreas* ; Pancreatectomy ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

The clinical usefulness of organ-preserving pancreatectomy is not well established due to technical difficulty and ambiguity of functional merit. The purpose of this study is to evaluate the clinical efficacy of organ-preserving pancreatectomy such as duodenum-preserving resection of the head of the pancreas (DPRHP), pancreatic head resection with segmental duodenectomy (PHRSD), central pancreatectomy (CP) and spleen-preserving distal pancreatectomy (SPDP). Between 1995 and 2007, the DPRHP were performed in 14 patients, the PHRSD in 16 patients, the CP in 13 patients, and the SPDP in 45 patients for preoperatively diagnosed benign lesions or tumors with low-grade malignant potential. The clinical outcomes including surgical details, postoperative complications and long-term functional outcomes were compared between organ-preserving pancreatectomy and conventional pancreatectomy group. Major postoperative complications constituted the following: bile duct stricture (7.1% [1/14]) in DPRHP, delayed gastric emptying (31.2% [5/16]) in PHRSD, pancreatic fistula (21.4% [3/14]) in CP. There were no significant differences in postoperative complications and long-term functional outcomes between two groups. Organ-preserving pancreatectomy is associated with tolerable postoperative complications, and good long-term outcome comparing to conventional pancreatectomy. Organ-preserving pancreatectomy could be alternative treatment for benign or low-grade malignant potential lesion of the pancreas or ampullary/parapapillary duodenum.
Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; *Pancreatectomy ; Pancreatic Neoplasms/diagnosis/*surgery ; Postoperative Complications ; Suture Techniques ; Treatment Outcome