No abstract available.

No abstract available.
Aneurysm, Infected ; Aorta, Abdominal

In gastric cancer, the significance of lymphatic invasion as a prognostic factor is controversial. This study was performed to investigate the significance of lymphatic invasion as a prognostic factor in early results of gastric cancer after gastrectomy. We had been prospectively analyzed 362 consecutive patients resected from June 1994 to June 1996 in the Department of Surgery, Ajou University Hospital. Grading of the lymphatic invasion was determined by pathologists according to the JRSGC classification. The difference in the survival rate between the ly0 group and the ly1 group was statistically insignificant, so we only used ly2 and ly3 as the risk group. The prognostic values of lymphatic invasion as a single parameter for survival and early recurrence were determined by using univariate and multivariate analyses. Lymphatic invasion was observed in 90 (24.9%) of the 362 gastric cancer cases, and ly2 or ly3 were 66 (18.3%)cases. The incidence of ly> or =2 steadily increased with advancing TNM stage : stageI, 9/124 (7.3%); stageII, 5/50 (10.0%); stageIII, 24/111 (21.6%); stageIV, 28/78 (35.9%). The incidence of ly> or =2 was significantly correlated with other prognostic factors such as lymph node metastasis, the depth of the primary tumor, and the stage (p<0.05). The cummulative 2-year-survival rate determined by the Kaplan-Meirer method was 56.4% in patients with ly> or =2 and 90.9% in patients with ly<2. The log-rank test showed significant differences between the ly<2 group and the ly> or =2 group (p<0.05). Multivariate analysis of the survival function showed that the depth of the primary tumor had the highest prognostic value followed by lymphatic invasion (ly> or =2) as an independent prognostic factor (p=0.0008, Exp(B)=3.55). The cummulative recurrence free rate determined by the Kaplan-Meirer method was 78.7% in the ly> or =2 group and 90.54% in the ly<2 group. There was statistically significant difference (p<0.05). Univariate analysis for recurrence after radical resection showed that lymphatic invasion had a prognostic impact in the ly> or =2 group (p=0.0055). Therefore lymphatic invasion with ly2 or ly3 grade is an independent prognostic factor that is associated with poor prognosis for early results after gastrectomy. In grading of lymphatic invasion by gastric cancer, simple differentiation of whether lymphatic invasion is present or not was insignificant in the results of our study. In the future, the grade of lymphatic invasion in gastric cancer should be carefully classified by pathologists.
Classification ; Fibrinogen ; Gastrectomy ; Humans ; Incidence ; Lymph Nodes ; Lymphatic Vessels* ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Prospective Studies ; Recurrence ; Stomach Neoplasms* ; Survival Rate

PURPOSE: The role of graduate medical education(GME) has become more important at the flood of knowledge and technical development. The korean board system in general surgery has a short history and has been developed mostly by the executive authorities rather than by autonomous civil organizations which is the case in america and europe. The aim and curriculum of our residency education is not yet well established, so that there requires the need to evaluate and analyze the training system of other well-established countries. METHODS: The structures of residency education and their characteristics in U.S.A., England and Germany were reviewed from the literatures and internet sites in terms of aims and objects of learning during the training period. The korean system was compared to these characteristics. RESULTS: Comparing the residency training programmes of U.S.A., Germany and England to our system there found some characteristic points as following that would be recommendable to be adopted for the renewal of our training programme. 1) Autonomous civil organizations endeavor for the regulations of educational goal, requirements and their accreditation. 2) The understanding of basic sciences that provide the fundamental principles of surgery was emphasized during the education. 3) Modern surgical techniques as a part of minimal invasive surgery can be easily acquired during the training course. 4) Participation in emergency medicine and intensive medicine was almost mandatory. 5) Interdisciplinary training and effective rotation schedule were highly recommended. All these characteristics could be actively integrated into our education, if we elaborate more well-established educational goal and curriculum for the residentship.
Accreditation ; Americas ; Appointments and Schedules ; Curriculum ; Education* ; Emergency Medicine ; England ; Europe ; Germany ; Internet ; Internship and Residency* ; Learning ; Social Control, Formal

Cyclins are proteins that activate different cyclin-dependent kinases(CDKs) and promote the cell cycles. Their correlations with several human cancers have been identified. Cyclin E, as one of G1 cylins, produces DNA replication through the progression of cell cycle G1 --> S phase. In contrast, cyclin-dependent kinase inhibitors(CDKI) bound with cyclin E-cdk2 complex control the cell cycle and inhibit the cell proliferation. P21(WAF1) proteins, which are CDKIs, are transcripted by a p53 gene and participate in the cell cycle inhibition. Variant p53 proteins produced by a mutated p53 gene lose the ability to control of the cell cycle resulting in cell proliferation. This study is aimed to reveal the expressions of cyclin E, p21(WAF1) protein, p53 variant protein in colorectal adenomas and carcinomas, and also reveal their correlations in the process of carcinogenesis. Twenty-one colorectal adenomas or adenomatous polyps, and thirty colorectal carcinoma tissues were obtained by operative resections or endoscopic polypectomies. Immuno histochemical stains of the above-mentioned three proteins and a statistical analysis of their correlations were made. The results were as follows: 1. P21 proteins were expressed in the upper-one third layer of all normal colonic mucosa, but cyclin E and variant p53 protein were not identified. 2. Cyclin E was expressed in 23.8% of adenomas and 76.7% of carcinomas. Variant p53 protein was expressed in 71.4% of adenomas and 83.3% in carcinomas. The degree of positivity of variant p53 expression was correlated with cancer staging. P21 protein was expressed in all adenomas, similar to normal mucosa, but was not expressed in 43.3% of carcinomas. 3. Expression of cyclin E was increased as to the positivity of variant p53 proteins but the correlations of p21 proteins and cyclin E, and p21 proteins and variant p53 proteins were not identified. Cancer staging was not correlated with the expressions of the three proteins. In conclusion, it can be thought that the overexpression of cyclin E and variant p53 proteins, and the loss of p21 proteins are related with the colorectal carcinogenesis. We can also identify the relationship of cyclin E and variant p53 proteins.
Adenoma* ; Adenomatous Polyps ; Carcinogenesis ; Cell Cycle ; Cell Proliferation ; Colon ; Colorectal Neoplasms ; Coloring Agents ; Cyclin E* ; Cyclins* ; DNA Replication ; Genes, p53 ; Humans ; Mucous Membrane ; Neoplasm Staging ; Phosphotransferases ; S Phase

Intrathecal clonidine injection induces analgesia without significant respiratory depression, but decreases blood pressure and causes sedation. Injection of spinal cholinesterase inhibitor alone increases blood pressure in animals, and enhances clonidine induced analgesia. To evaluate the effect of pretreated pyridostigmine on the change of blood pressure and heart rate, clonidine was injected intrathecally in cats. We divided fifteen cats into three groups and administered saline(0.5 cc) to group 1, pyridostigmine(0.5 cc, 2.5 mg) to group 2, pyridostigmine(0.5 cc, 2.5 mg) and glycopyrrolate(0.5 cc, 0.1 mg) to group 3 before 20 minute of clonidine injection and measured mean arterial pressure, heart rate, P CO2 and central venous pressure. The results were as follows: 1)After clonidine injection, all mean arterial pressure values were significantly reduced in group 1, but in group 3, 20, 30 and 40 minutes values were significantly reduced, and 10, 40 minutes values after clonidine injection were not reduced significantly in group 2 compared to group 1. 2)After clonidine injection, heart rates were significantly reduced in all groups, but there was no significant difference between group 1, group 2 and group 3. 3)There was no significant difference of central venous pressure in any groups. 4)There was no significant difference for reversal of pyridostigmines effect by glycopyrrolate. Based on these results, these data suggest that pyridostigmine pretreatment counteracts clonidine induced hypotension, but further study of spinal az adrenergic-cholinergic combination for pain therapy is needed before clinical application.
Analgesia ; Animals ; Arterial Pressure ; Blood Pressure* ; Cats* ; Central Venous Pressure ; Cholinesterases ; Clonidine* ; Glycopyrrolate ; Heart Rate* ; Heart* ; Hypotension ; Pyridostigmine Bromide* ; Respiratory Insufficiency

PURPOSE: The significant drastic complications of performing laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients are gastric staple line leakage and bleeding. The aim of our study is to evaluate the efficacy of the clinical data for detecting postoperative complications after LSG. METHODS: The study enrolled 150 consecutive patients who underwent LSG from January 2003 to July 2006. When abnormal data (heart rate > or = 10/min, or temperature > or = 7.5degrees C) was detected on postoperative day 1, then laboratory tests (blood, urine, chest X-ray and abdominal sonogram) and water soluble gastrografin UGIS were performed to detect the postoperative complications after LSG (group A). The patients who had normal postoperative clinical data (group B) were compared with group A. RESULTS: Of the 150 patients who underwent LSG, 9 patients (6%) had postoperative complications. Two patients had major complications: 1 case of leakage (0.6%) and 1 case of delayed bleeding (0.6%), and 4 patients had minor complications in group A. But no major complications were detected in group B (P<0.01). The heart rate and body temperature in group A were significantly faster and higher than those in group B (P<0.01). Especially, 2 patients who had major complications had severe tachycardia over 120 beats per minute (bpm). However, when the body temperature of a patient was elevated, there was no high grade fever in all the cases ( > 39degrees C). CONCLUSION: Evidence of tachycardia or a high body temperature may be useful to detect major complications after LSG. We also recommend performing laboratory test and UGIS when clinically indicated.
Body Temperature ; Diatrizoate Meglumine ; Fever ; Gastrectomy ; Heart Rate ; Hemorrhage ; Humans ; Obesity, Morbid ; Postoperative Complications ; Tachycardia ; Thorax

Adult onset Still's disease (AOSD) is a rare systemic inflammatory disorder of an unknown etiology, and its major clinical manifestations include high spiking fever, polyarthralgia, salmon-colored evanescent rash and neutrophilic leukocytosis. We describe here a 41 year old woman with AOSD who presented with non-remitting high fever, polyarthralgia, sore throat, skin rash, splenomegaly, thrombocytopenia, neutrophilic leukocytosis, hyperferritinemia and coagulopathy with disseminated intravascular coagulation (DIC). The patient had a history of laparoscopic cholecystectomy due to acalculous cholecystitis prior to admission. We suspected sepsis due to bile peritonitis after the previous laparoscopic cholecystectomy. Yet we could not detect infectious organisms on the cultures or serologic studies. Finally, we suspected AOSD-associated hemophagocytic syndrome (HS). So, intravenous immunoglobulin and pulse methylprednisolone treatment brought about transient improvement of the fever and the neutrophilic leukocytosis, but the disease progressed and the patient expired due to acute renal failure. HS is a fatal cause of AOSD. If a patient has DIC and sepsis and these fail to respond to conservative treatment, then AOSD should be added to the differential diagnosis of sepsis and DIC.
Acalculous Cholecystitis ; Acute Kidney Injury ; Adult* ; Arthralgia ; Bile* ; Cholecystectomy, Laparoscopic ; Dacarbazine ; Diagnosis, Differential ; Disseminated Intravascular Coagulation ; Exanthema ; Female ; Fever ; Humans ; Immunoglobulins ; Leukocytosis ; Lymphohistiocytosis, Hemophagocytic ; Methylprednisolone ; Neutrophils ; Peritonitis* ; Pharyngitis ; Sepsis* ; Splenomegaly ; Still's Disease, Adult-Onset* ; Thrombocytopenia

PURPOSE: A fistula in ano is a granulating track between the anorectum and the perianal region or perineum. A typical fistula may consist of the track, the primary (internal) opening and secondary (external) opening. Its hallmark is frequent discharge through external opening. Sometimes this track become occluded and a sinus remains. Therefore abscence of an external opening should not be taken as evidence that there is no fistula, and then this study is aimed to make clear perianal sinus as another form of fistula in ano. METHODS: This study is a clinical analysis of 17 patients with perianal sinus, who were treated at the Department of General Surgery of Pundang-CHA hospital from June, 1995 to December, 1998. As comparative group, 91 patients of typical fistula in ano were also taken in same period. RESULTS: The ratio of male to female was 4.6:1 in sinus group, 4.1:1 in fistula group. The prevalent ages were in the third decade in both group. The main symptoms of sinus group were a palpable mass (94.1%), pain & discomfort (35.3%) but that of fistula group were purulent discharge (87.9%) and pain (28.6%). The most frequent duration of illness was 6 months~1 year (52.9%) in sinus group, within 6 months (40.7%) in fistula group. The distributions of sinus size were 7 cases (41.2%) in <1 cm, 8 cases (47.0%) in 1~2 cm and 2 cases (11.8%) in >2 cm. The most common type was intersphincteric in both group. The operative procedures included excision with fistulectomy in 4 cases (23.5%), lay open of sinus with fistulotomy in 11 cases (64.7%), seton procedure in 2 cases (11.8%). The mean hospital stay was 5.0 day in sinus group, 4.9 day in fistula group. CONCLUSIONS: There was no distinct difference in the clinical features or characteristics between the both groups, therefore perianal sinuscould be taken as fistula in ano and treated similar procedures.
Female ; Fistula* ; Humans ; Length of Stay ; Male ; Perineum ; Surgical Procedures, Operative

The purpose of this study was to describe the CT findings of focal organizing pneumonia and to compare the findings with pathology. CT findings of histologically proven focal organizing pneumonias in 26 consecutive patients were analyzed. In 17 patients who had undergone surgical resections, the findings were correlated with pathology. Focal organizing pneumonias appeared as a nodule (n= 13) or a mass (n=13), ranging from 9 mm to 66 mm in diameter. Ground-glass opacity was seen in 6/13 (46%) nodules and 6.5/13 (50%) masses (k=.48) with an extent ranging from 5% to 75% (mean, 16%). In 4/26 (15%) patients, the extent was more than 50% of the lesion. They showed smooth (n=4), lobulated (n=8), spiculated (n=1), or lobulated and spiculated margin (n=13). On correlative analysis, nodule or mass on CT consisted histologically of intraalveolar exudate or microabscess, chronic inflammatory cell infiltration, fibrotic nodules, and polypoid granulation tissue in the alveolar or bronchiolar spaces. Ground-glass opacity consisted of interstitial fibrosis and chronic inflammatory cell infiltration and intraalveolar polypoid granulation tissue. Focal organizing pneumonia may simulate a lung cancer with variable appearances on CT and the findings reflect underlying histopathology of the disease.
Adult ; Aged ; Aged, 80 and over ; Female ; Human ; Male ; Middle Age ; Pneumonia/pathology/*radiography ; *Tomography, X-Ray Computed