From January 1993 to December 1995, 47 patients with rectal carcinomas underwent a rectal anastomosis using the double stapling technique at the Surgical Department of Kwang-ju Christian Hospital. The major advantages of the double stapling technique for lower rectal cancer over the single stapling technique or a hand-sewn operation are as follows:1) Insertion of a purse-string suture is eliminated, and application of a linear stapler to close the distal rectum may be performed with greater ease. 2) In addition, fecal contamination and spillage of tumor cells from the rectal segment are minimized. 3) Differences in the sizes of the colons and rectums are not a concern in constructing the anastomosis. 4) The operating time is shorter. The following results were obtained by a comparison with 24 patients with rectal carcinoma who had undergone a rectal anastomosis using the double stapling technique from January 1989 to December 1992 which was reported in a previous study:1) Anastomotic stenosis was decreased from 8.3% to 4.2% because of reduced ischemia due to the double row of staples and the reduced injury due to compression of tissue between the anvil and the cartridge with experience. In addition, it resulted from reduced tension of the anastomosis due to sufficients mobilization of the proximal colon and from selection of large cartridge (33 mm). 2) Anastomotic leakage, even though the same location as the tumor and in the advanced age group, was decreased from 4.2% to 0% because the blood circulation was maintained and unnecessary tension was reduced with experience. In addition, it resulted from reinforced suture of the anastomotic site which was performed after anastomosis. 3) Systemic recurrence was the same result as that of the previous study(4.2/4.3%). 4) Local recurrence, even though at the same distal distance from the margin of the cancer, was increased from 0% to 2.1% because of advancing the pathologic stage (B2, C1>B1, B2) and increasing the poorly differentiated pathologic type.
Anastomotic Leak ; Blood Circulation ; Colon ; Constriction, Pathologic ; Gwangju ; Humans ; Ischemia ; Postoperative Complications ; Rectal Neoplasms* ; Rectum ; Recurrence ; Sutures

From January 1993 to December 1995, 47 patients with rectal carcinomas underwent a rectal anastomosis using the double stapling technique at the Surgical Department of Kwang-ju Christian Hospital. The major advantages of the double stapling technique for lower rectal cancer over the single stapling technique or a hand-sewn operation are as follows:1) Insertion of a purse-string suture is eliminated, and application of a linear stapler to close the distal rectum may be performed with greater ease. 2) In addition, fecal contamination and spillage of tumor cells from the rectal segment are minimized. 3) Differences in the sizes of the colons and rectums are not a concern in constructing the anastomosis. 4) The operating time is shorter. The following results were obtained by a comparison with 24 patients with rectal carcinoma who had undergone a rectal anastomosis using the double stapling technique from January 1989 to December 1992 which was reported in a previous study:1) Anastomotic stenosis was decreased from 8.3% to 4.2% because of reduced ischemia due to the double row of staples and the reduced injury due to compression of tissue between the anvil and the cartridge with experience. In addition, it resulted from reduced tension of the anastomosis due to sufficients mobilization of the proximal colon and from selection of large cartridge (33 mm). 2) Anastomotic leakage, even though the same location as the tumor and in the advanced age group, was decreased from 4.2% to 0% because the blood circulation was maintained and unnecessary tension was reduced with experience. In addition, it resulted from reinforced suture of the anastomotic site which was performed after anastomosis. 3) Systemic recurrence was the same result as that of the previous study(4.2/4.3%). 4) Local recurrence, even though at the same distal distance from the margin of the cancer, was increased from 0% to 2.1% because of advancing the pathologic stage (B2, C1>B1, B2) and increasing the poorly differentiated pathologic type.
Anastomotic Leak ; Blood Circulation ; Colon ; Constriction, Pathologic ; Gwangju ; Humans ; Ischemia ; Postoperative Complications ; Rectal Neoplasms* ; Rectum ; Recurrence ; Sutures

BACKGROUND: Fibronectins(FN) are large, dimeric glycoproteins present in the plasma, loose connective tissues, and some basal lamina in vivo and synthesized by a number of cells in vitro, including lung fibroblasts, and alveolar macrophages. FN can affect the migration, proliferation, differention, and even apoptosis of various cell types, all considered necessary for organogenesis. This study was undertaken to detect the changes of localization and activity of FN, a glycoprotein molecule, in stages of lung differentiation in rats. MATERIAL AND METHOD: The experimental animals(Sprague-Dawley strain) were divided into 8 groups, a control group(adult male rats), and experimental groups of 17th day fetus, 20th day fetus, first day newborn, second day newborn, 3rd day newborn, 5th day new born, 7th day newborn. We used the immunohistological stain method with gold particle to obtain the data for distribution of FN in the alveoli, blood vessels, terminal bronchioles, alveolar macrophages and type II pneumocytes. This study revealed the FN reactions at the light and electron microscopic levels. RESULT: At 17th day fetal stage, FN reactions in fetal lung were strong on the blood vessels and moderate on the stroma. At 20th day fetal stage, FN reactions were strong on the blood vessels. After birth, FN reactions in alveolar basement membrane were maximum in the 5th and 7th day newborns. FN reactions in the blood vessels were observed to be moderate in first and second day newborns, but decreased in third day newborns. FN reactions in alveolar macrophages increased after birth. FN reactions in terminal bronchioles gradually increased after birth. 6. In type II pneumocytes, FN reactions were observed to be moderate in 1st and 3rd day newborns. CONCLUSION: Immunohistochemical analysis of rat lungs at various developmental stages revealed increased deposition of FN during the pseudoglandular stage of lung development, coinciding with the period of branching morphogenesis. Also, FN is released from type II pneumocytes. This observation, together with the strategic location of FN, suggests a role in airway formation.
Animals ; Apoptosis ; Basement Membrane ; Blood Vessels ; Bronchioles ; Connective Tissue ; Fetus ; Fibroblasts ; Fibronectins* ; Glycoproteins ; Humans ; Infant, Newborn ; Lung* ; Macrophages, Alveolar ; Male ; Morphogenesis ; Organogenesis ; Parturition ; Plasma ; Pneumocytes ; Rats*

OBJECTIVE: Our purpose was to compare the pregnancy outcomes of nulliparous women aged 40 years and older with those of nulliparous women under 35 years of age. METHODS: From January 1989 to December 1998 total 57,563 deliveries were seen in Gachon Gil Medical Center. Among them we experienced 59 cases of nulliparas at 40 years and older. These women were compared with 188 young nulliparas under 35 years of age as the control group. The statistical analysis was performed using Chi-square tests, and statistical significance was defined as p<0.05. RESULTS: The incidence rate of elderly nulliparas aged 40 years and older was increased from 0.04% in 1989 to 0.30% in 1998. The age distribution was from 40 years to 45 years. The gravidity of eldery nulliparas was 2.2 in comparison with 1.6 in control group. The incidence of uterine myoma, gestational DM, IUGR and oligohydramnios was significantly high rate in elderly nulliparas. There was significantly high rate of cesarean section in elderly nulliparas(88.1%) in comparison with control group(40.4%). The reasons of cesarean section were her demand(39.0%), CPD(15.3%) and breech presentation(13.6%) in decreasing order. The preterm delivery rate was 10.2% in elderly nulliparas in comparison with 4.3% in the control group. Placenta accreta and uterine atony were significantly high in elderly nulliparas and mean estimated blood loss was also high. There was no difference in 5-minute Apgar score between both group, but there were more cases of neonatal intensive care unit admission in neonates of elderly nulliparas(6.8% vs 0%). CONCLUSION: The incidence of elderly nulliparas is continuously increasing. The elderly nulliparas and their babies are at greater risk than young women. Therefore all elderly nulliparas aged 40 years and older can be regarded as high risk patients and they must be managed with careful attention.
Age Distribution ; Aged ; Apgar Score ; Cesarean Section ; Female ; Fetal Growth Retardation ; Gravidity ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Leiomyoma ; Oligohydramnios ; Placenta Accreta ; Pregnancy ; Pregnancy Outcome ; Uterine Inertia

Diaphragnatic hernia is one of the surgical emergencies of the childhood because of the life-threatening cardiorespiratory embarrassment frequently associated with it. This congenital condition is characterized by varying degrees of protrusion of the abdominal viscera into the thoracic cavity through an abnormal opening in the diaphragm this opening results from a defect in the complex embryologic developement of the diaphragm between the thoracic and abdominal cavities. We expenienced 16 cases of congenital diaphragmatic hernia which were diagnosed at Severance Hospital from May 1964 to April 1977, and obtained the following results. 1) In 16 cases, male were ten and female were six. They were eleven cases of bochdalek hernia, two cases of diaphragmntic eventration, one case of hiatal and two undetermined. 2) Onset of symptoms were within 24 hours in 7 cases and in the rest cases symptoms were occured up to 24 months. 3) Most common symptoms were dyspnea and cynosis. 4) Most common signs were decreased breathing sound on affected lung, PMI shifting, scaphoid abdomen and subcostal retraction. 5) Combined anomalies were band adhesion of intestinal loop, hypoplasia of left lung etc. 6) Small intestine were more frequently herniated as well as large intestine. 7) mortality rate between abdominal procedure and thoracic procedure was equal. 8) Cases whose symptoms were occured within 24 hours were 7, 5 of these 7 were expired, Expired cases were associated with marked respiratory difficulties and pulmonary hypoplasia.
Abdomen ; Abdominal Cavity ; Diaphragm ; Dyspnea ; Emergencies ; Female ; Hernia ; Hernia, Diaphragmatic* ; Humans ; Intestine, Large ; Intestine, Small ; Lung ; Male ; Mortality ; Respiratory Sounds ; Thoracic Cavity ; Viscera

No abstract available.
Heart Septal Defects, Atrial*

Septo-optic dysplasia is an uncommon developmental disorder consisting of septum pellucidum angenesis, optic nerve hypoplasia, congenital nystagmus, seizure and multiple endocrine dysfunction. Clinically mild forms of septo-optic dysplasia and syndrome of absent septum pellucidum are now easily detected by computed tomography. We report two cases of septo-optic dysplasia with consistent radiographic findings with the anomaly.
Nystagmus, Congenital ; Optic Nerve ; Seizures ; Septo-Optic Dysplasia* ; Septum Pellucidum

PURPOSE: There is a long-standing debate about whether postoperative adhesive small bowel obstruction (SBO) is best managed operatively or nonoperatively. The aim of this study is to define predictive factors for surgical indication in the treatment of an adhesive SBO. METHODS: Medical records and laboratory data of 211 patients who had a SBO after a laparotomy from January 2000 to December 2008 were reviewed retrospectively. The patients were divided into two groups according to the modality of SBO treatment: operatively and nonoperatively. The laboratory data and clinical parameters were compared between the two groups and a statistical analysis was performed. RESULTS: A Mann-Whitney analysis revealed previous SBO history, amylase, erythrocyte sedimentation rate (ESR), creatine phosphokinase, drainage amount via a Levin tube to be significant factors associated with surgical management. A multivariate analysis showed drainage amount via a Levin tube of 500 mL/day or greater (P=0.007), amylase of 90 IU/L or greater (P=0.04), and ESR of 11 mm/hr or greater (P=0.03) to be independent predictive factors for surgery. CONCLUSION: Surgical management should be considered among adhesive SBO patients with elevated amylase (> or =90 IU/L) and ESR (> or =11 mm/hr) and with large drainage amount through the Levin tube (> or =500 mL/day).
Adhesives ; Amylases ; Blood Sedimentation ; Creatine Kinase ; Drainage ; Humans ; Laparotomy ; Medical Records ; Multivariate Analysis ; Retrospective Studies

BACKGROUND: A retrospectiye study was done for understanding morbidity and mortality after major lung resection. MATERIAL AND METHOD: From June 1994 to August 1998, 203 patients received major lung resections for various causes. There were 142 males and 62 females with a mean age of 47.5 years. Initial complains were cough in 47.8%, sputum in 33.0%, hemoptysis or blood-tinged sputum in 23.2%, dyspnea in 18.2%, chest pain in 15.3%, weight loss in 10.8%, fever and chill in 4.9%. There were no complaints in 5.9% of the total patients. The underlying diseases were lung tumor(102 cases/50.2%), bronchectasis(28 cases/13.8%), aspergillosis(24 cases/1.8%), tuberculosis(20 cases/9.9%) and others (29 cases/66.5%) and pneumonectomy(68 cases/33.5%). The postoperative complications were classified as : empyema, BPF, respiratory problem, persistent air leakage over 7 days, arrhythmia, ventilator applied over 24 hours, bleeding, wound infection and chylothorax. The postlobectomy complications were revealed as follow: empyema(3.7%), BPF(2.2%), respiratory problem(5.2%), persistent air leakage over 7days(8.9%), arrhythmia(2.2%), ventilator applied over 24 hours(2.2%), bleeding(1.5%), wound infection(2.9%), chylothorax(0.7%). The postpneumonectomy complications were revealed as follow : empyema(5.9%), BPF (5.9%), respiratory problem(17.6%), persistent air leakage over 7days(0%), arrhythmia(5.4%), ventialtor apply over 24 hours(7.4%), bleeding (7.4%), wound infection(2.9%) and chylothorax(1.5%). Reoperation was done in 8 cases (4.0%). There were 5.8% operative mortalities in pneumonectomy and 0.7% in lobectomy.
Arrhythmias, Cardiac ; Chest Pain ; Chylothorax ; Cough ; Dyspnea ; Empyema ; Female ; Fever ; Hemoptysis ; Hemorrhage ; Humans ; Lung* ; Male ; Mortality* ; Pneumonectomy ; Postoperative Complications ; Reoperation ; Retrospective Studies* ; Sputum ; Ventilators, Mechanical ; Weight Loss ; Wound Infection ; Wounds and Injuries

BACKGROUND/AIMS: A stercoral perforation of the colon (SPC) is a rare, life-threatening disease. The aim of this study was to represent the definition of SPC and help the diagnosis and treatment of this condition. METHODS: We reviewed 92 medical records of patients who underwent operation due to colonic perforation from January 2000 to February 2009 retrospectively. Maurer's diagnostic criteria were used for the diagnosis of SPC. RESULTS: Eight patients (8.7%) were diagnosed as SPC. The age of the patients ranged from 59 to 85 years old. All of the patients were female and had a history of long-standing constipation. Only two patients (25%) were diagnosed as SPC preoperatively. The site of perforation of all patients was sigmoid colon. The methods of operation were Hartmann's procedure (7 cases), and primary repair with sigmoid loop colostomy (1 case). There were one recurrence and two deaths (25%) due to sepsis and multiple organ failure. CONCLUSIONS: SPC should be considered in chronically constipated, and bedridden patients who present with acute abdomen. Hartmann's procedure is the treatment of choice in most situations. Mortality is high but can be minimized with early definitive surgery.
Aged ; Aged, 80 and over ; Colon, Sigmoid/pathology ; Colonic Diseases/*diagnosis/radiography/surgery ; Female ; Humans ; Intestinal Perforation/*diagnosis/radiography/surgery ; Middle Aged ; Postoperative Complications ; Respiratory Distress Syndrome, Adult/etiology ; Retrospective Studies ; Sepsis/etiology ; Tomography, X-Ray Computed