No abstract available.
Cholecystectomy, Laparoscopic*

With advancement of endoscopical instruments and technique, gallstone diseases can be managed with laparoscopic cholecystectomy which has rapidly and radically changed the surgical treatment of gallstone diseases. The ideas of laparoscopic surgery was introduced by Germany gynecologist Semm, in 1967 and was first performed by French surgeon Mouret, Dubois in 1987. Although many reports of early laparoscopic cholecystectomy were excellent, many surgeons want to know the surgical results of laparoscopic cholecystectomy are enough good to perform comparing with the conventional cholecystectomy, especially in early complications and late complications. (continue...)
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Gallstones ; Germany ; Laparoscopy

OBJECTIVE: Parietal lobe epilepsy(PLE) is neither common nor easily diagnosed because of its variable clinical features. To elucidate its characteristics and surgical outcome, the authors review their surgical experiences. METHODS: Between September 1994 and August 2001, 38 patients with parietal lobe epilepsy received surgical treatment at our Hospital. All patients underwent resection, mainly involving the parietal lobe. In most patients, preoperative evaluation included interictal and ictal electroencephalography, magnetic resonance image, positron emission tomography, and interictal and ictal single photon emission computed tomography. The male to female ratio was 23: 15. Age at surgery ranged from 4 to 38 years (median, 25). RESULTS: Preoperatively over 60% were considered not to be PLE, even though PLE was the most common (15/38, 39.8 %). The most common seizure type was complex partial seizure (26/38, 68.4%) rather than simple partial seizure (3/38, 7.9%). Invasive study was performed in 37 of the 38 patients. Monitoring duration was from 4 to 18 days (median, 8 days). Awake operations under regional anesthesia were performed in 20 patients (52.6%). Follow-up periods ranged from 14 to 81 months (mean, 50.7). Seizure disappeared in 15 (Engel's classification I, 39.5%), and rare seizure remained in 5 (Engel II, 13.2%). Thirteen patients showed a worthwhile improvement (Engel III, 34.2%) and 5 no worthwhile improvement (Engel IV, 13.2%). Pathologies were diverse, the most common being cortical dysplasia (94.3%). CONCLUSION: Since PLE is difficult to diagnose preoperatively, an invasive study covering the parietal lobe is mandatory, if PLE is suspected. Cortical dysplasia was the most common etiology, thus awake operation under regional anesthesia and intraoperative brain mapping is helpful during extensive resection in order to spare the eloquent cortex. Using this protocol, PLE can be controlled surgically with a satisfactory result and a reasonably low level of complications.
Anesthesia, Conduction ; Brain Mapping ; Classification ; Electroencephalography ; Epilepsy* ; Female ; Follow-Up Studies ; Humans ; Male ; Malformations of Cortical Development ; Parietal Lobe* ; Pathology ; Positron-Emission Tomography ; Rabeprazole* ; Seizures ; Tomography, Emission-Computed, Single-Photon

Tracheobronchial injury is a rare but potentially fatal complication of blunt chest trauma. Delays in diagnosis may occur because the signs are nonspecific and these injuries are infrequent. This case report describes a patient who experienced blunt chest injury with a resulting left main bronchus rupture that was not initially diagnosed. The most challenging aspect of reconstruction surgery for tracheobronchial rupture is to design an effective ventilation method during operation that does not interfere with surgical exposure and allows adequate ventilation. Communication with the surgical team and careful planning of all surgical details are important. We review our experience, the ventilation technique and anesthetic problem encountered in the patient undergoing bronchial reconstruction.
Bronchi* ; Diagnosis ; Humans ; Rupture* ; Thoracic Injuries ; Thorax* ; Ventilation

No abstract available.
Korea*

Patients with Peutz-Jeghers syndrome often suffer from complications of polyps, such as intussusception, bowel obstruction, and bleeding. Another major problem of these patients is malignancy through the hamartoma-adenoma-carcinoma sequence. If the complications and the cancer risk of small intestinal polyps are to be reduced, early detection of these polyps and a polypectomy are important. Traditionally, a small bowel series, small bowel enteroclysis, and conventional endoscopy have been used for the proper evaluation, and management of polyps. Recently, several reports showed the advantages of enteroscopy and intraoperative endoscopy for achieving a more complete polypectomy of the small intestine. However, CT enteroclysis, which has been introduced as a reliable, less invasive, and tolerable diagnostic tool for small intestinal disease, may be useful for the evaluation of patients with gastrointestinal polyposis. We report the case of a patient with Peutz-Jeghers syndrome who had small-bowel polyposis and a rectal adenocarcinoma and who underwent preoperative CT enteroclysis and intraoperative endoscopy.
Adenocarcinoma ; Endoscopy ; Hemorrhage ; Humans ; Intestinal Diseases ; Intestinal Polyps ; Intestine, Small ; Intussusception ; Peutz-Jeghers Syndrome* ; Polyps

PURPOSE: Polypoid lesions of the gall bladder (PLG) have a variety of pathologies. Problems exist in the selection of patients for operation and in the operative approach used. We studied the accuracy of the preoperative radiologic diagnosis and suspected risk factors. METHODS: 121 polypoid lesions of gallbladder were sugically treated during 10 years. Preoperative radiologic diagnosis, age, gender, related symptoms, concurrent gallstone, size, shape, number and histologic diagnosis of the ployps were retrospectively reviewed. RESULTS: The average size of malignancy was 23.0 mm, and that of benign tumors was 7.1 mm (P=0.000). The mean age of patients with a malignancy was significant higher than that of those with benign tumor (P=0.000). The preoperative sensitivity of computed tomography for a malignancy was 67.7%. The patients with malignancy more frequently had related symptoms. CONCLUSION: A CT must be considered, for patients with risk factors, even if the ultrasonographic diagnosis was benign. An Age greater than 60 years, a tumor size greater than 10 mm, a solitary polyp, sessile shape, and related symptoms are predictive factors of a malignancy.
Diagnosis ; Gallbladder* ; Gallstones ; Humans ; Pathology ; Polyps ; Retrospective Studies ; Risk Factors ; Urinary Bladder

Between January 1986 and December 1995, 24 patients were treated surgically for thymoma. There were 17 males and 7 females, and their ages ranged from 23 to 69 years old and mean age was 49 years. Thymomas were associated with fourteen my asthenia gravis, and classified histologically as lymphocytic in 12 patients, mixed in 8, epithelial in 4, and classified clinically as stage I in 11, stage II in 4, stage III in 8 and stage VI in 1 patient. Eleven patients with non-invasive thymoma had received surgical resection, and 10 out of 13 patients with invasive thymoma were able to undergo complete resection. A partial resection or tissue biopsy followed by radiation or chemotherapy was done with the remaining three patients. Three died, four had improvement of symptom, two had relapse and fifteen had no symptom during follow up ranged from 25 days to 60 months. In fourteen cases of thymoma with myasthenia gravis, one died due to myasthenic crisis, two showed symptom aggravation, six had less medical treatment and five patients had medical treatment as same as dosage received preoperatively.
Aged ; Asthenia ; Biopsy ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Myasthenia Gravis ; Recurrence ; Thymoma*

According to the development of new diagnostic techniques and the extension of aging population, the diagnosis of multiple primary malignant neoplasm has increased. We report a 76 years old man who had prostate cancer, colon cancer and stomach cancer metachronously and review literatures about the history, criteria, incidence and causes of the multiple primary malignant neoplasm.
Aged ; Aging ; Colonic Neoplasms ; Diagnosis ; Humans ; Incidence ; Prostatic Neoplasms ; Stomach Neoplasms

OBJECTIVE: The purposes of this study are to estimate postoperative survival and ambulatory outcome and to identify prognostic factors thereafter of metastatic spinal tumors in a single institute. METHODS: We reviewed the medical records of 182 patients who underwent surgery for a metastatic spinal tumor from January 1987 to January 2009 retrospectively. Twelve potential prognostic factors (age, gender, primary tumor, extent and location of spinal metastases, interval between primary tumor diagnosis and metastatic spinal cord compression, preoperative treatment, surgical approach and extent, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, Nurick score, Tokuhashi and Tomita score) were investigated. RESULTS: The median survival of the entire patients was 8 months. Of the 182 patients, 80 (44%) died within 6 months after surgery, 113 (62%) died within 1 year after surgery, 138 (76%) died within 2 years after surgery. Postoperatively 47 (26%) patients had improvement in ambulatory function, 126 (69%) had no change, and 9 (5%) had deterioration. On multivariate analysis, better ambulatory outcome was associated with being ambulatory before surgery (p=0.026) and lower preoperative ECOG score (p=0.016). Survival rate was affected by preoperative ECOG performance status (p<0.001) and Tomita score (p<0.001). CONCLUSION: Survival after metastatic spinal tumor surgery was dependent on preoperative ECOG performance status and Tomita score. The ambulatory functional outcomes after surgery were dependent on preoperative ambulatory status and preoperative ECOG performance status. Thus, prompt decompressive surgery may be warranted to improve patient's survival and gait, before general condition and ambulatory function of patient become worse.
Diagnosis ; Factor Analysis, Statistical* ; Gait ; Humans ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Spinal Cord Compression ; Survival Rate