No abstract available.
Pancreas*

BACKGROUND: Pancreatoduodenectomy is a standard operation for benign and malignant lesions of the periampullary area. Even though the complication and the mortality rates have markedly decreased owing to recent developments in surgical techniques and postoperative care, the complication rates still remain high. Especially, pancreatic leakage is the main cause of death today in a pancreatoduodenectomy, so surgical techniques dealing with this problem have emerged as a major issue. The usual techniques used have been the duct ligation method, the duct occlusion method, a pancreatojejunostomy, and a pancreatogastrostomy. However, a recent trend has been to maintain pancreato-enteric continuity. Thus, the authors used a pancreatojejunostomy with the duct-to-mucosa method to decrease the complications. METHODS: The authors retrospectively reviewed the medical records of 56 patients who had undergone a pancreatoduodenectomy between January 1987 and July 1997 by one surgeon. RESULTS: The male-to-female ratio was 1.4:1 and the mean age was 55.5 years (ranging from 25 to 77). A Whipple's operation was done in 44 cases, and a pylorus-preserving pancreatoduodenectomy was done in 12 cases. All the cases used a pancreatojejunostomy with the duct-to-mucosa method. No pancreatic leakage was observed in any of the 56 cases. The immediate postoperative complication rate was 28.6%, and there was one (1.8%) postoperative mortality due to adult respiratory distress syndrome. Six patients complained of minimal exocrine functional abnormality, but only one patient, who had suffered severe chronic pancreatitis preoperatively, routinely now takes a pancreatic enzyme. However, even after long-term follow up, no endocrine insufficiency has been detected. CONCLUSIONS: Through our experience, a pancreatojejunostomy with the duct-to-mucosa method is a secure and reasonable method and can be used for all patients undergoing a pancreatoduodenectomy.
Cause of Death ; Follow-Up Studies ; Humans ; Ligation ; Medical Records ; Mortality ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy* ; Pancreatitis, Chronic ; Postoperative Care ; Postoperative Complications ; Respiratory Distress Syndrome, Adult ; Retrospective Studies

No abstract available.
Tuberculosis*

No abstract available.
Gastrectomy*

No abstract available.
Crohn Disease*

No abstract available.
Duodenum*

No abstract available.
Colorectal Neoplasms* ; Neoplasm Metastasis*

The objective of this study is to present a new approaches of development systems of test items that will be applied to the National Medical Licensing Examinations. In order to relate all elements of the evaluation process in building a new system, we used the systems approach to problem-solving which involves the development of an overall plan incorporating the interrelated parts of an evaluation process in a sequential pattern. The method we have applied focuses on valid and relevant test items of each subject as an outcome. We have designed the six individual programs that would be a part of whole processes which consists of three different phases such as before-test, test and after-test. The six programs involves sequentially planning of test, requesting test item development, construc ting MCQ, managing test item bank, preparation of test sheets, and test item analysis. One of the characteristic feature of new system is running test item development committees which are made up of subject-matter specialists who together with the nation-wide specialists who are primarily responsible to construct test items, and also with education specialists to refine the structures of each test items.
Education ; Licensure* ; Running ; Specialization ; Tolnaftate

Pancreatoduodenectomy has been a standard procedure for periampullary cancer. Even when the benign lesion is limited to the pancreatic head, the same procedure has been applied if the lesion should be removed surgically. The duodenum has a key role in the digestive physiologic function. However, removal of the pancreatic head while preserving the duodenum has been considered a very risky procedure because of duodenal ischemia. Since the vascular anatomy of the peripancreatic area was thoroughly examined and a meticulous dissection technique was developed, duodenum-preserving procedure has been tried by several surgeons with success. In this paper we report our experience of duodenum-preserving pancreatic head resection. To our knowledge this is the first report in Korea. The lesions were insulinoma and two serous cystadenomas located at the pancreatic head. Total removal of the pancreatic head was performed trying to preserve pancreaticoduodenal vascular arcade without a Kocher maneuver. The common bile duct was totally preserved in all cases and cholecystectomy with T-tube choledochostomy was performed in one case. The pancreatic duct was ligated just distal to the ampullary portion and the distal pancreas was anastomosed to the posterior wall of the stomach. Operation time was 7 hours 30 minutes in one and 5 hours and 30 minutes in two cases. Transfusion was not required at all. Pancreatic leakage was developed in one case and cured with conservative management. Any complication related to the preservation of the duodenum(leakage or obstruction) had not developed. The patients were discharged on postoperative 46 day(due to pancreatic leakage), 18 days and 11 days respectively. In conclusion, duodenum-preserving pancreatic head resection is recommended for benign pancreatic head lesions, such as benign cystic tumor and localized chronic inflammation.
Cholecystectomy ; Choledochostomy ; Common Bile Duct ; Cystadenoma, Serous ; Duodenum ; Head* ; Humans ; Inflammation ; Insulinoma ; Ischemia ; Korea ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Stomach

PURPOSE: This study was designed to analyze the short-term clinical and functional outcomes of perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse. METHODS: The data were prospectively collected and consisted of the clinical data, the functional status before and after surgery, the operation record, and the postoperative course. The functional status was evaluated by using Wexner's constipation score (0-30), Wexner's incontinence score (0-20), anorectal manometry, and pudendal nerve terminal motor latency. Follow-up was performed at 3-6 months after the operation by using both a standardized questionnaire completed in the outpatient clinic or telephone interview (n=23) and an anorectal physiology test (n=7). RESULTS: During a one-year period, 23 patients (male=10) underwent perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse. The median duration of the operations was 88 minutes. The median length of postoperative hospital stay was 6 days. There was one urinary tract infection and no mortalities. The constipation score was significantly decreased after the operation (9.8 vs 3.8; P<0.001), and constipation was improved in 90 percent (19/21) of the cases. The incontinence score was significantly decreased after surgery (mean preop.=11.6, postop.=3.7; P<0.001) and incontinence was improved in 17 of 21 patients with impaired continence (81 percent). Anal sphincter function was not improved but rectal reservoir capacity was significantly decreased after surgery (rectal urgent volume (45.7 cc vs 37.1 cc; P=0.045), maximal tolerable volume (120 cc vs 85.7; P=0.011). Most patients (83 percent) felt that the operation had improved their symptoms. The major reasons for dissatisfaction after surgery were frequent defecation, fecal soiling, persistent or aggravated fecal incontinence, and recurrence. One patient had a complete recurrence (4.3 percent), and another patient had a mucosal prolapse which was treated. CONCLUSIONS: Perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse is a safe technique with acceptable short-term functional results; however, it is not recommended for rectal prolapse patients with diarrhea-predominant irritable bowel syndrome.
Ambulatory Care Facilities ; Anal Canal ; Constipation ; Defecation ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Interviews as Topic ; Irritable Bowel Syndrome ; Length of Stay ; Manometry ; Mortality ; Physiology ; Prolapse ; Prospective Studies ; Pudendal Nerve ; Surveys and Questionnaires ; Rectal Prolapse* ; Recurrence ; Soil ; Urinary Tract Infections