No abstract available.
Scalp* ; Skin* ; Transplants*

No abstract available.
Cleft Lip* ; Congenital Abnormalities*

BACKGROUND: Because of increased number of traffic and industrial accidents, the incidence of blunt abdominal injury patients has increased. Recently, abdominal computed tomographic(CT) scans have been widely used in emergency departments for initial diagnostic workups on patients with blunt hepatic injuries. The purpose of this study is to analyze the correlation between abdominal CT scans and the clinical outcomes and to recommend a direction for the management of blunt hepatic injury. METHODS: A retrospective review was conducted of 66 patients with blunt hepatic injuries who underwent abdominal CT scans and were treated at the Department of Emergency Medicine of Dankook University Hospital during the period from January 1998 to December 2000. Statistical analysis was performed using the chi-square(x2) test, Spearman correlation test, Cochran-Mantel-Haenszel chi-square(x2) test and Fisher's exact test; a value of p<0.05 was considered significant. RESULTS: Based on CT scans, we graded the liver injuries by using the system of the Organ Injury Scaling Committee of American Association for the Surgery of Trauma. Grade II injuries(28 cases, 42.4%) were the most common in this study. Most patients with injuries above grade III were managed surgically, and CT grades correlated well with operative treatment and initial fluid resuscitation. Initial shock status correlated with the CT grade, but did not correlate with operative management. For nonoperative management, as the CT grade increased, the amount of blood transfusion also increased. Increasing liver enzyme did not correlate with CT grade. The mortality rate was 9.1%, and the most common cause of death were hypovolemic shock due to massive bleeding. CONCLUSION: Non-operative management is the first choice of treatment in low grade blunt hepatic injury(CT grade I, II, and III). For cases above grade IV hepatic injury, the key points of operative management were the hepatic injury itself and it's complication.
Abdominal Injuries ; Accidents, Occupational ; Blood Transfusion ; Cause of Death ; Decision Making* ; Emergency Medicine ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Incidence ; Liver ; Mortality ; Resuscitation ; Retrospective Studies ; Shock ; Tomography, X-Ray Computed

PURPOSE: The only curative treatment for gastric carcinoma is surgery and it is still under debate which reconstruction method is better after performing gastrectomy for gastric carcinoma. The typical reconstruction methods after distal gastrectomy are Billroth I, Billroth II and Roux-en Y reconstruction. Yet it is difficult to compare these methods and not so much is known about which reconstruction is better in terms of the physiologic and nutritional function. With this background, we compared two reconstruction methods after distal gastrectomy (Billroth I versus Roux-en Y reconstruction) in terms of the long term physiologic function and nutritional status to create a reference for selecting reconstruction methods after distal gastrectomy. MATERIALS AND METHODS: Between 1999 and 2002, 663 patients who underwent distal gastrectomy for early gastric carcinoma filled out questionnaires every six months after operation, and these questionnaires evaluated the physiologic function. To evaluate their nutritional status, blood tests were performed every six months to check their albumin, protein and hemoglobin levels, and we checked the body weight every 6 months as well. RESULTS: The total score of the 15 questions on the questionnaire concerned with the physiologic function showed no difference between the two groups at every evaluation time, and both groups showed very low total scores, indicating tolerable physiologic function after operation. When comparing each question between two the groups, only symptoms of regurgitation and food passage showed a difference between the two groups, showing that the Roux-en Y group had better function in terms of these two symptoms. The Billroth I group showed a better nutrition status, indicating that the level of albumin, protein and hemoglobin were higher in the Billroth I group, with statistical significance. Body weight loss was severe in the Roux-en Y group. CONCLUSION: The physiologic function is slightly better in the Roux-en Y group in terms of some symptoms such as regurgitation and food passage. However, the nutritional status is better in the Billroth I group. In conclusion, because we cannot definitely ascertain which reconstruction is better when we consider both the physiologic and nutritional functions, it is reasonable that surgeon should choose reconstruction methods according to their experience and preference.
Body Weight ; Gastrectomy* ; Gastric Bypass* ; Gastroenterostomy* ; Hematologic Tests ; Humans ; Nutritional Status* ; Surveys and Questionnaires

PURPOSE: Many recent studies have reported on the feasibility and usefulness of laparoscopy assisted distal gastrectomy (LADG) for treating early gastric cancer. On the other hand, there has been few reports about laparoscopy assisted total gastrectomy (LATG) because upper located gastric cancer is relatively rare and the surgical technique is more difficult than that for LADG, We now present our procedure and results of performingLATG for the gastric cancer located in the upper or middle portion of the stomach. MATERIALS AND METHODS: From Jan 2005 to Sep 2007, 96 patients underwent LATG by four surgeons at the Asan Medical Center, Seoul, Korea. Among them, 48 consecutive patients who were operated on by asingle surgeon were analyzed with respect to the clinicopathological features, the surgical results and the postoperative courses with using the prospectively collected laparoscopy surgery data. RESULTS: There was no conversion to open surgery during LATG. For all the reconstructions, Roux-en Y esophago- jejunostomy and D1+beta lymphadenectomy were the standard procedures. The mean operation time was 212+/-67 minutes. The mean total number of retrieved lymph nodes was 28.9+/-10.54 (range: 12~64) and all the patients had a clear proximal resection margin in their final pathologic reports. The mean time to passing gas, first oral feeding and discharge from the hospital was 2.98, 3.67 and 7.08 days, respectively. There were 5 surgical complications and 2 non-surgical complications for 5 (10.4%) patients, and there was no mortality. None of the patients needed operation because of complications and they recovered with conservative treatments. The mean operation time remained constant after 20 cases and so a learning curve was present. The morbidity rate was not different between the two periods, but the postoperative course was significantly better after the learning curve. Analysis of the factors contributing to the postoperative morbidity, with using logistic regression analysis, showed that the BMI is the only contributing factor forpostoperative complications (P=0.029, HR=2.513, 95% CI=1.097-5.755). Conclusions: LATG with regional lymph node dissection for upper and middle early gastric cancer is considered to be a safe, feasible method that showed an excellent postoperative course and acceptable morbidity. BMI should be considered in the patient selection at the beginning period because of the impact of the BMI on the postoperative morbidity.
Body Mass Index ; Conversion to Open Surgery ; Gastrectomy ; Hand ; Humans ; Jejunostomy ; Korea ; Laparoscopy ; Learning Curve ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Patient Selection ; Prospective Studies ; Stomach Neoplasms

PURPOSE: Recently, the use of laparoscopic assisted gastrectomy for early gastric cancer has been on the increase and the procedure has been quickly adopted by clincians. However, there are few reports regarding the safety and risk of this type of surgery. The aim of this study is to evaluate the morbidity and to verify the safety of laparoscopic assisted gastrectomy for early gastric cancer. MATERIALS AND METHODS: A total of 376 patients that had undergone laparoscopic assisted gastrectomy for early gastric cancer between April 2004 and December 2006 were reviewed retrospectively. The clinicopathological characteristics, operative complications, and factors related to complications were evaluated. RESULTS: The overall operative morbidity and mortality rates were 10.6% and 0%, intraoperative morbidity was 1.1% (4 of 376 patients) and post operative morbidity was 9.6% (36 of 376 patients). Most complications required no surgery except for an intestinal obstruction in two cases. Multivariate analysis of risk factors related to operative morbidity determined that age was an independent factor associated with morbidity (P=0.021). CONCLUSION: The complication rate of laparoscopic assisted gastrectomy is low and most complications can be managed by conservative methods rather than with surgery. There were no specific predicting factors for complications except old age. Laparoscopy is a technically feasible and acceptable surgical modality for early gastric cancer.
Gastrectomy* ; Humans ; Intestinal Obstruction ; Laparoscopy ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms*

PURPOSE: The prognosis of advanced gastric cancer is still dismal despite of aggressive surgical treatment. Many investigational approaches such as the use of adjuvant chemotherapy and neoadjuvant chemotherapy with or without radiation therapy have been widely attempted for highly advanced gastric cancer. There are, however, few studies about the use of these types of treatment in Korea. METHODS: Between 2001 and 2004, 38 patients with highly advanced gastric cancer underwent preoperative chemotherapy using the DXP (Docetaxel, Xeloda, and Cisplatin) regimen before surgery. An retrospective analysis including clinicopathological features, recurrence, and survival was performed using patient medical records. RESULTS: Twenty-five patients had locally advanced gastric cancer without a distant metastasis, and 13 patients had a distant metastasis or peritoneal metastasis. Patients received the chemotherapy regimen an average of 4.2 times. A partial response and stable disease were found in 28 (73.7%) and 10 (26.3%) patients, respectively, according to the RECIST criteria. Twenty- one (84%) of 25 patients without a distant metastasis had a curative resection compared to 6 (46.2%) of 13 patients with a distant metastasis (P=0.024). Four patients (10.5%) had complications with 1 postoperative death. The overall 5 year survival rate was 34% and the median survival duration was 22 months (49%, 34 months for the locally advanced group vs. 0%, 10 months for the distant metastasis group; P<0.001). The only predictor of prognosis of patients as determined by multivariate analysis was the pathological TNM stage. CONCLUSION: Preoperative chemotherapy can be safely performed without increased postoperative morbidity and mortality. To define the actual benefits for patient survival after pre-operative chemotherapy, a large scale randomized prospective control study should be performed.
Capecitabine ; Chemotherapy, Adjuvant ; Drug Therapy* ; Humans ; Korea ; Medical Records ; Mortality ; Multivariate Analysis ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Laparoscopic surgery for gastric cancer was introduced in the past decade because it was considered less invasive than open surgery, and this results in less postoperative pain, faster recovery and an improved quality of life. Several studies have demonstrated the safety and feasibility of this procedure. We examined the outcome of performing laparoscopic surgery for gastric cancer over the last two year. MATERIALS AND METHODS: From April 2004 to December 2006, 329 patients with gastric adenocarcinoma underwent a laparoscopy-assisted distal gastrectomy with lymph node dissection. The data was retrospectively reviewed in terms of the clinicopathologic findings, the perioperative outcomes and the complications. RESULTS: The total patient group was comprised 196 men (59.6%) and 133 women (40.4%). The mean BMI was 23.6 and the mean tumor size was 2.7 cm. The mean number of harvested lymph node was 22.7, and this was 18.6 before 30 cases and 23.1 after 30 cases, and the difference was significant (P=0.02). The mean operation time was 180.9 min, and this was than 287.9 min before 30 cases and 170.2 min after 30 cases. After 30 cases, there was a significant improvement of the operation time (P<0.01). The mean incision length after 30 cases was shorter than that before 30 cases (P<0.01). Postoperative complications occurred in 24 (7.3%) of 329 patients and there was no conversion to open surgery. CONCLUSION: Even though the LADG was accompanied by a difficult learning curve, we successfully performed 329 LADG procedures over the past 2 years and we believe that LADG is a safe, feasible operation for treating most early gastric cancers (EGC).
Adenocarcinoma ; Female ; Gastrectomy ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Lymph Node Excision ; Lymph Nodes ; Male ; Pain, Postoperative ; Postoperative Complications ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: To evaluate and report the clinical results of the treatment of distal humerus intercondylar fractures treated with internal fixation through the modified posterior approach. MATERIALS AND METHODS: From January 1999 to October 2003, 20 patient who had intercondyle fracture of the distal humerus treated with internal fixation through the modified posterior approach. We evaluated bone union, complication, postoperative elbow function. RESULTS: The average follow up period was 12.8 months. Nearly all most cases united at 14 weeks in an average. There were two neuropraxia and two hardware failure. The range of the elbow joint motion was flexion contracture 8 degree (5~15 degree) to further flextion 120 degree (75~140 degree) in average. The functional result with Riseborough and Radin's functional scale were as follows; 13 good, 4 fair, 3 poor. CONCLUSION: Not with severe comminuted like type C3 fracture, but in cases with intercondylar distal humerus fracture the modified posterior approach provided satisfactory exposure for open reduction and rigid internal fixation with satisfactory bone union. There was satisfactory bone union and good clinical result in postoperative elbow function.
Adult* ; Contracture ; Elbow ; Elbow Joint ; Follow-Up Studies ; Humans ; Humerus* ; Postoperative Complications

The majority of flexible bronchoscopies are performed under topical anesthesia with lidocaine being the most commonly used agent. Anaphylaxis rarely occurs after local administration of lidocaine, but can be a fatal complication. We experienced a case of unexpected anaphylaxis. A 66-year-old woman was scheduled for flexible bronchoscopy to evaluate a tracheal mass and stenosis. The oral and nasal mucosa were pretreated with lidocaine. About 2~3 minutes later, the patient developed hypotension and we treated for anaphylaxis in the emergency room. Then, we decided to perform rigid bronchoscopy in this patient, under conditions of general anesthesia. A rigid bronchoscopy was performed in this patient, safely and successfully. The tracheal mass was determined to be squamous cell carcinoma.
Aged ; Anaphylaxis ; Anesthesia ; Anesthesia, General ; Bronchoscopy ; Carcinoma, Squamous Cell ; Constriction, Pathologic ; Emergencies ; Female ; Humans ; Hypotension ; Lidocaine ; Nasal Mucosa