PURPOSE: The recurrence of a groin hernia presents few surgical options for repair. We investigated the safety and efficacy of herniorrhaphy using PerFix(R) plug for patients with recurrent groin hernias. METHODS: Between October 2000 and December 2004, 30 herniorrhaphies for recurrent groin hernia were performed and followed-up. The operation time, length of hospital stay, time of analgesic use, complication rates, and recurrence were investigated. RESULTS: Surgery had been initially performed in 26 patients with the non-mesh method, and with mesh in 4 patients; 12 patients had a direct recurrence at the medial side of the inguinal area near the pubic tubercle, 7 patients had a direct recurrence at other sites, and 11 patients had an indirect recurrence. Eight patients had urinary retention and 2 patients had minor wound complications. Hospital stays and analgesic use were comparable to non-recurrent groin hernia operations, although operation time was significantly longer in recurrent group, and there were no recurrences during the 70 months of followup. CONCLUSION: Comparing open or laparoscopic preperitoneal approach, the PerFix(R) plug method is simple and effective for recurrent groin hernia repair.
Follow-Up Studies ; Groin ; Hernia ; Herniorrhaphy ; Humans ; Length of Stay ; Recurrence ; Urinary Retention

PURPOSE: Many cancers, including pancreatic cancer, harbor defects in TGF beta signaling and are resistant to TGF beta mediated growth inhibition. In addition, the expression of the p53 gene and mutations in K-ras might play an important role in the multistep carcinogenesis of pancreatic cancer. This study examined the expression level of TGF beta 1, TGF beta receptorII (T beta RII), p53 protein and K-ras mutation in pancreatic cancer, along with their role and clinical significance. METHODS: The overexpression of TGF beta 1, T beta RII and p53 protein was evaluated using an immunohistochemical assay. The K-ras mutation was analyzed by PCR-RFLP in the surgical resected pancreatic tissue from 26 pancreatic ductal adenocarcinomas and 5 normal pancreases. RESULTS: Immunohistochemical analysis of TGF beta 1 and T beta RII revealed positive immunostaining in 73.1% and 76.9% of the tumors, respectively, which were significantly higher than the normal pancreas (P=0.008). The p53 protein was positive in none of the 5 normal ducts and 16 out of 26 (61.5%) pancreatic carcinoma specimens. The K-ras mutation was positive in none of the 5 normal ducts, and in 20 of the 26 pancreatic carcinoma specimens (76.9%). The presence of TGF beta1 and T beta RII in the cancer samples was significantly associated with node metastasis, advanced tumor stage (P<0.01), and a short survival time (P<0.05). The p53-positive pancreatic cancers showed a significantly lower survival rate than those with p53-negative tumors (P<0.05). There was no correlation between K-ras mutations and the survival rates. CONCLUSION: The detection of K-ras mutations and TGF beta 1, T beta RII and p53 protein overexpression can predict the prognosis of pancreatic carcinoma patients.
Adenocarcinoma ; Genes, p53 ; Neoplasm Metastasis ; Pancreas ; Pancreatic Ducts ; Pancreatic Neoplasms ; Point Mutation ; Prognosis ; Receptors, Transforming Growth Factor beta ; Survival Rate ; Transforming Growth Factor beta1 ; Transforming Growth Factors

PURPOSE: The indocyanine clearance rate has been identified as an independent prognostic factor in patients with hepatocellular carcinoma (HCC). However, in contrast to its well-documented value in measuring hepatic reserve function, the mechanism by which it exerts its prognostic effect is not precisely understood. METHODS: We analyzed the clinical and pathological data, including preoperative ICG-R 15 and survival, of 80 patients with resectable HCC. The correlation between ICG-R15 and the degree of inflammation and fibrosis in non-cancerous liver tissue were investigated. The prognostic significance of ICG- R15 was also investigated in 67 patients with unresectable HCC who received transarterial chemoembolization. RESULTS: In patients with resectable HCC, the low ICG group (ICG-R15<15%) showed an increased overall survival rate (P<0.001) and disease-free survival rate (P<0.01) compared to the high ICG group (ICG-R15> or =15%). ICG-R15 was also a significant prognostic factor in the multivariate analysis. ICG-R15 showed a significant correlation with the degree of necroinflammation (P<0.001) and the degree of fibrosis (P<0.001). In patients with unresectable HCC, the low ICG group (ICG-R15<30%) showed a significantly increased progression-free survival rate (P=0.037). CONCLUSION: The results of the present study demonstrate that the ICG clearance rate can predict the degree of inflammation and fibrosis of non-cancerous hepatic parenchyma, and this capacity may explain the prognostic value of the ICG clearance rate in HCC patients.
Carcinoma, Hepatocellular ; Disease-Free Survival ; Fibrosis ; Humans ; Indocyanine Green ; Inflammation ; Liver ; Multivariate Analysis ; Prognosis ; Survival Rate

PURPOSE: The purpose of this study is to evaluate the safety and feasibility of a proximal gastrectomy with a double tract reconstruction using remnant antrum in patients with early upper gastric cancer. METHODS: Between July 2003 and June 2005, we analyzed 45 patients with early upper gastric cancer, with 19 patients receiving a proximal gastrectomy with double tract reconstruction using the remnant antrum (Group A) and 26 receiving a total gastrectomy with a Roux-en Y anastomosis(Group B). We retrospectively analyzed the clinical characteristics (age, sex, operation time, duration of postoperative hospital stay, duration of follow-up), pathologic characteristics, postoperative nutritional status, complications, and recurrence rates between the two groups. RESULTS: There were no significant differences in the clinical characteristics of the two groups. However, the operation time of group A was significantly longer than group B. The total protein and albumin levels at 3 months, the serum iron and calcium levels by 6 months, and BMI at 3 and 6 months were significantly higher in group A than group B. There were no significant differences of postoperative complications between the two groups. However, the rate and degree of reflux esophagitis in group A were significantly lower than group B. CONCLUSION: Proximal gastrectomy with double tract reconstruction using the remnant antrum is a safe, feasible, function-preserving surgery for early upper gastric cancer.
Calcium ; Esophagitis, Peptic ; Gastrectomy ; Humans ; Iron ; Length of Stay ; Nutritional Status ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: Tamoxifen has been prescribed as a very effective hormonal agent not only for the treatment of breast cancer, but also for the prevention of the disease. The development of resistance to tamoxifen is one of the most important obstacles to hormonal therapy of breast cancer. HER2 or EGFR expression has been reported to be associated with the development of tamoxifen resistance. This study was performed to evaluate the effect of HER2 and EGFR inhibition on tamoxifen resistance using tamoxifen-resistant breast cancer cells (T47D:A18/4-OHT cells). METHODS: Tamoxifen-resistant T47D:A18/4-OHT cells were established by long-term treatment of 1micrometer 4-hydroxytamoxifen on T47D:A18 human breast cancer cells. The effect of HER2 and EGFR inhibition was investigated by the use of a cell proliferation assay with treatment of trastuzumab, a monoclonal antibody to the extracellular domain of the human HER2 receptor, and ZD1839, an ERFR tyrosine kinase inhibitor. RESULTS: In contrast to T47D:A18 cells, T47D:A18/4-OHT cells showed estrogen-independent proliferation and partial regulation by treatment with tamoxifen. With a single treatment of trastuzumab or ZD1839, T47D:A18/4-OHT cell growth was reduced to 77.8% (P=0.15) or 74.4% (P=0.034) respectively, as compared to untreated cells. Combinational treatment with 1 nM estradiol resulted in a further reduction of T47D:A17 cell proliferation by 83.6% (P=0.002) for trastuzumab and 77.7% (P=0.047) for ZD1839, as compared to the single treatments. CONCLUSION: Tamoxifen resistance could be partially regulated by inhibition of HER2 or EGFR in T47D:A18/4-OHT cells, especially in combination with a low dose of estradiol. This effect may provide an important clue to overcome tamoxifen resistance in the treatment of breast cancer.
Antibodies, Monoclonal, Humanized ; Breast ; Breast Neoplasms ; Cell Proliferation ; Estradiol ; Humans ; Protein-Tyrosine Kinases ; Quinazolines ; Tamoxifen ; Trastuzumab

PURPOSE: Although cyclosporine (CsA) improves short-term renal graft outcomes, many paradigms reduce or withdraw this drug because of its nephrotoxicity. However, inadequate immunosuppression with azathioprine led to little success. We conducted a prospective study to define the prolonged effect of CsA reduction in stable renal transplant recipients with mycophenolate mofetil (MMF). METHODS: Thirty-nine primary renal transplant recipients were divided into two cohorts, the AZA (N=13) and the MMF cohort (N=26). Both cohorts were allowed to reduce the CsA dose up to 50% of baseline within 3 to 4 months of conversion to AZA or MMF. Graft function, clinical parameters, and adverse events were monitored for up to 3 years. RESULTS: Ccr gradually deteriorated in the AZA cohort, but was stable in the MMF cohort. There was no episode of acute rejection or graft loss observed in either cohort. CONCLUSION: The CsA dose can be reduced in combination with MMF treatment in stable renal transplant recipients after 2 years of transplantation, resulting in beneficial effects on Ccr, lipid profiles, and blood pressure.
Azathioprine ; Cohort Studies ; Cyclosporine ; Immunosuppression ; Kidney Transplantation ; Mycophenolic Acid ; Prospective Studies ; Rejection (Psychology) ; Transplants

PURPOSE: Experimental animal models are useful training methods for liver transplantation, despite of ethical issues. The aims of this study are to examine the technical feasibility of living donor liver transplantation in pigs and to address the ethical problems. METHODS: Eight pigs were used in this experiment. The pig liver was divided via a left hemi-hepatectomy without inflow occlusion. The GORE-TEX(R) Vascular Graft was used as a replacement for the inferior vena cava during the graft. After the bench technique, the remnant right lobe of the pig was removed. During the anhepatic phase, an abdominal aortic clamp in combination with general hypothermia was applied, instead of using a conventional bypass procedure. RESULTS: Anhepatic time was 41.3+/-7.0 min and cold ischemic time was 200.3+/-29.4 min. The 1(st), 4(th), and 8(th) pig died because of declamping shock and arrhythmia on releasing the abdominal aortic clamp. Three pigs had five postoperative complications: pneumonia, gastrointestinal bleeding, IVC thrombosis, portal vein thrombosis, and bile duct stricture. The 6th pig received a hepaticojejunostomy due to stricture of the anastomosis site at 37 days after transplantation. CONCLUSION: Pigs are economically and ethically more convenient compared to primate models. For auto-liver transplantation, no immunotherapy was needed. The pigs lived relatively long, allowing operative faults to be detected and studied. This experimental model will be useful training for living donor liver transplantation.
Arrhythmias, Cardiac ; Bile Ducts ; Cold Ischemia ; Constriction, Pathologic ; Hemorrhage ; Humans ; Hypothermia ; Immunotherapy ; Liver ; Liver Transplantation ; Living Donors ; Models, Animal ; Models, Theoretical ; Pneumonia ; Portal Vein ; Primates ; Shock ; Swine ; Thrombosis ; Transplants ; Vena Cava, Inferior

PURPOSE: Resection of the bowel or solid organs may be required for pelvic tumor surgery. The present study was performed to assess combined surgical procedures and determine the role of the general surgeon in gynecologic oncology surgery METHODS: We performed a retrospective study of 135 patients with gynecologic malignancy who underwent a combined operation with a general surgeon between January 2000 and December 2005 at Asan Medical Center. The purpose of the combined operation was categorized into 3 groups: a tumor debulking operation, a resolution of intraoperative complications by a gynecologic surgeon, or an intraoperative diagnostic change. RESULTS: The incidence of combined operations for debulking, resolution of intraoperative complications, and intraoperative diagnostic changes were 103 cases (76.3%), 22 cases (16.3%), and 10 cases (7.4%), respectively. Ovarian cancer was the most common gynecologic malignancy (74.1%) and the rate of a combined operation with a general surgeon in ovarian cancer was 18.5% during the time period. Colorectal resection was the most common procedure by a colorectal surgeon (61.5%). Twenty four patients (17.8%) experienced postoperative complications, including ileus, wound infection, pancreas leakage, and stomal necrosis, with no significant differences according to the purpose of combined operation, pathologic diagnosis, or bowel preparation. The rate of a preoperative consultation to a general surgeon by gynecologic surgeons in cases with colorectal or solid organ invasion preoperatively was 53.2%. CONCLUSION: A general surgeon is an important consultant in a debulking operation of gynecologic malignancies, especially ovarian cancer, or treatment of complications. Thorough preoperative evaluation, bowel preparation, and preoperative consultation to a general surgeon is important in gynecologic oncology surgery.
Consultants ; Humans ; Ileus ; Incidence ; Intraoperative Complications ; Necrosis ; Ovarian Neoplasms ; Pancreas ; Postoperative Complications ; Retrospective Studies ; Wound Infection

Parathyroid carcinoma is a rare disease in pediatric patients. We present a case of a 13-year-old girl who presented to the Thyroid Department for an asymptomatic palpable neck mass for 1 year. The high levels of calcium, ionized calcium, and parathyroid hormone level along with parathyroid scintigraphy studies suggested primary hyperparathyroidism. Parathyroid carcinoma was confirmed by biopsy and pathologic examination after resection. Six months postoperatively, persistent hypercalcemia and multiple lung metastases were found on computed tomography. Bilateral lung wedge resection was performed. En bloc resection for primary parathyroid carcinoma and aggressive resection of metastatic disease is the most effective treatment to control hypercalcemia.
Adolescent ; Biopsy ; Calcium ; Child ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary ; Lung ; Neck ; Neoplasm Metastasis ; Parathyroid Hormone ; Parathyroid Neoplasms ; Rare Diseases ; Thyroid Gland

Inflammatory myofibroblastic (IMF) tumor is a rare solid tumor that often affects children. IMF tumors occur primarily in the lung, but the tumor may affect any organ system with protean manifestations. A 22-year-old woman was evaluated for palpable low abdominal mass that had been increasing in size since two months prior. Abdominal computed tomography showed a lobulated, heterogeneous contrast enhancing soft tissue mass, 6.5 x 5.7 cm in size in the ileal mesentery. At surgery, the mass originated from the greater omentum laying in the pelvic cavity and was completely excised without tumor spillage. Histologically, the mass was a spindle cell lesion with severe atypism and some mitosis. Immunohistochemistry for anaplastic lymphoma kinase-1 revealed that the lesion was an IMF tumor. Because of its local invasiveness and its tendency to recur, this tumor can be confused with a soft tissue sarcoma. Increasing physician awareness of this entity should facilitate recognition of its clinical characteristics and laboratory findings.
Child ; Female ; Humans ; Immunohistochemistry ; Lung ; Lymphoma ; Mesentery ; Mitosis ; Myofibroblasts ; Omentum ; Sarcoma ; Young Adult