PURPOSE: We report the results of a policy of primary surgical closure of large ventricular septal defects(VSDs) applied over the past 3 years to all symptomatic infants regardless of patient weight, location or number of VSDs. To analyze the early postoperative mortality and other surgical complications in young infants, comparison of preoperative and outcome variables were made between infants weighing 6 kg or less and those weighing mort than 6 kg at the time of operation. METHODS: Forty-eight infants met criteria for inclusion in the study, and were divided into two groups based on body weight: group 1 infants weighed 6 kg or less(n=24), and group 2 infants weighed more then 6 kg(n=24). Both groups had similar variation in ventricular septal defect location and the ratio of the flow. resistance. RESULTS: The major associated cardiac defects were more in group 1. The overall mortality rate of this study was 4%(2/48): Two early deaths occurred in only group 1(8%). Both infants had a doubly committed subarterial defect and mild degree of coarctation of aorta (one was a preductal type). One received a coatctation-repari. There was o only one patch dehiscence(in group 1). No surviving patients required a second ventricular septal defect opetation, and the majority no longer received anticongestive therapies. CONCLUSIONS: These results indicate that primary surgical closure of large ventricular septal defects can be performed in small infants with no difference in mortality or serious complication rates compared with larger infants. Protracted medical efforts to achieve larger size before primary repair and palliative pulmonary artery banding are not necessary.
Aortic Coarctation ; Body Weight ; Heart Septal Defects, Ventricular* ; Humans ; Infant* ; Mortality ; Pulmonary Artery

PURPOSE: Our study was an experimental model for the mechanism of cortical dysplasia. We examined the changes of neuronal cells and glial cells by intrauterine irradiation. This paper will elucidate the effect of these changes on the development of cortical dysplasia. METHODS: The cytotoxic effect of irradiation was examined by viability and numbers in cerebral cortical neurons and glial cells, which were derived from a mouse exposed to 225 cGy of gamma-irradiation on embryonic day 17. In addition, the protective effect of an inhibitor of intracellular calcium release, dantrolene sodium(DS), on irradiation-induced neurotoxicity was examined after DS(10 mg/kg) was administrated via intraperitoneal injection after intrauterine irradiation. RESULTS: 1) Irradiation induced the decrement of the cell number and cell viability of cerebral cortical neurons in the developing stages. 2) The number of glial cells in the mouse treated with intrauterine irradiation was increased in E20-P4 stages compared with the control group, but there was no difference in cell viability. 3) The glial fibrillary acidic protein(GFAP)-positive cells were seen in developing stages (E20-P4). 4) In the protective effect from neuronal cell death by intrauterine irradiation, DS attenuated cell death by an increase of neuronal cells. CONCLUSION: From these results, it is suggested that intrauterine irradiation has the neurotoxic effect as neuronal cell death and induced glial cell proliferation. A selective inhibitor of intracellular calcium release such as DS is effective in protecting neuronal cell death induced by irradiation of the intrauterine period. Cortical dysplasia induced by intrauterine irradiation may be involved in neuronal cell death and the hyperproliferation of glial cells. Intracellular calcium influx may contribute to the pathogenesis of irradiation-induced neuronal cell death.
Animals ; Calcium ; Cell Count ; Cell Death ; Cell Survival ; Dantrolene ; Injections, Intraperitoneal ; Malformations of Cortical Development ; Mice ; Models, Theoretical ; Neuroglia* ; Neurons*

Crohn's disease is a chronic and insidious condition characterized by an inflammatory process that may extend across all layers of the entire gastrointestinal tract. The common sites involved by Crohn's disease are the terminal ileum and ascending colon. Crohn's disease limited to the appendix is uncommon. Since its first report in 1953 by Meyerding and Bertram, 156 cases of appendiceal Crohn's disease have been documented in the world literature. We experienced a case of Crohn's disease limited to the appendix in a-35year-old female who were performed an ileocecectomy.
Appendix* ; Colon, Ascending ; Crohn Disease* ; Female ; Gastrointestinal Tract ; Humans ; Ileum

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld lifesustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold lifesustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient’s wishes. When the patient decided to stop lifesustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P＜0.001). Conclusion In many cases, the decision to discontinue lifesustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients’ self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.

PURPOSE: Splenic flexure mobilization in an anterior resection is a subject of controversy, but a tension-free anastomosis is needed in case of a low anterior resection or a coloanal anastomosis. Classical splenic flexure mobilization by means of the lesser sac opening is technically difficult in the laparoscopic era. METHODS: This study retrospectively analyzed the medical records and operation videos of 16 patients who underwent laparoscopic splenic flexure mobilization in Our Lady of Mercy Hospital, The Catholic University of Korea by using a medial approach. The operation procedure is as follows: Under general anesthesia, the patient was placed in the Trendelenburg position, after making pneumoperitoneum, the inferior mesenteric artery (IMA) and the inferior mesenteric vein (IMV) were ligated and divided. A medial-to-lateral mesocolon dissection was done, and the pancreas was dissected from the mesocolon of the transverse colon; then, the greater omentum was dissected. RESULTS: The mean age was 60 years old, and the male- to-female sex ratio was 9:7. The mean operation time was 293 minutes. The mean distal margin was 5.3 cm, and the mean number of harvested lymph nodes was 15. An anterior resection was done in 2 cases, a low anterior resection is 10 cases, and a coloanal anastomosis in 4 cases. The mean time from ligation of the IMA to splenic flexure mobilization was 45 minutes. There was no mortality or morbidity. CONCLUSIONS: Laparoscopic medial splenic flexure mobilization is a technically feasible and safe method.
Anesthesia, General ; Colon, Transverse* ; Head-Down Tilt ; Humans ; Korea ; Laparoscopy ; Ligation ; Lymph Nodes ; Medical Records ; Mesenteric Artery, Inferior ; Mesenteric Veins ; Mesocolon ; Middle Aged ; Mortality ; Omentum ; Pancreas ; Peritoneal Cavity ; Pneumoperitoneum ; Retrospective Studies ; Sex Ratio

Diverticulosis of the vermiform appendix is an uncommon entity with incidence of 0.2~2.0% in surgical pathologic specimens. Inflammation, perforation, and hemorrhage will be complications of appendiceal diverticulum. Without these complications, appendiceal diverticulum is asymptomatic. Authors experienced intussusception combined with appendiceal diverticulum.
Adult* ; Appendix ; Diverticulum* ; Hemorrhage ; Humans ; Incidence ; Inflammation ; Intussusception*

Performing laparoscopic surgery for colorectal cancer and early gastric caner has recently been rapidally increasing. We report here on our experiences of 3 cases of laparoscopic combined resection for synchronous colorectal cancer with early gastric cancer. Case 1) An 87-year-old male had synchronous right colon cancer along with early gastric cancer, and he underwent laparoscopic right colectomy with laparoscopic assisted distal gastrectomy. Case 2) A 49-year-old male had synchronous rectal cancer with early gastric cancer, and he underwent laparoscopic abdominoperineal resection and totally laparoscopic distal gastrectomy with delta anastomosis. Case 3) A 76-year-old female had synchronous sigmoid colon cancer with early gastric cancer, and she underwent laparoscopic low anterior resection with laparoscopic assisted distal gastrectomy. The laparoscopic approach for synchronous cancer can be a treatment option for selected cases.
Aged ; Aged, 80 and over ; Colectomy ; Colonic Neoplasms ; Colorectal Neoplasms* ; Female ; Gastrectomy ; Humans ; Laparoscopy ; Male ; Middle Aged ; Rectal Neoplasms ; Sigmoid Neoplasms ; Stomach Neoplasms*

PURPOSE: To evaluate the effectiveness of iliosacral screw fixation with anterior plating in the management of an unstable pelvic ring injury. MATERIALS AND METHODS: Nineteen patients with an unstable pelvic ring injury were enrolled in this retrospective study. All patients were followed up for at least 1 year. The mean age of the patients was 43 years. According to the AO-OTA classification, there were five B2 injuries, 11 C1 injuries, and 3 C2 injuries. After anterior fixation by plating, ilio-sacral screw fixation was performed percutaneously under the C-arm guide. RESULTS: All cases united except for 1 case of nonunion at the pubic ramus. The radiology results showed 9, 7, 2 and 1 case of anatomic, nearly anatomic, moderate and poor reduction, respectively. Sixteen out of 19 patients had a good or excellent functional result. Two moderate and one poor result were from an unsatisfactory reduction in a type C injury with the residual neurological signs. Screw misplacement with neurological compromise occurred in one patient but there were no adverse sequelae after its removal. Regarding the complications, there were two cases of screw loosening, two cases of anterior metal failures, and 1 case of a deep infection. CONCLUSION: Percutaneous ilio-sacral screwing with anterior plating may be a useful method for treating unstable pelvic ring injuries, and the reduction quality and neurological signs are important.
Classification ; Humans ; Retrospective Studies

PURPOSE: A Krukenberg tumor is an ovarian tumor of a signet-ring cell type. This tumor arises more commonly in young women, and the prognosis is poor. The primary focus of this tumor is often found at gastrointestinal malignancy, especially gastric cancer. We tried to identify the clinical characteristics of this tumor, and in that regard, this report might be helpful. MATERIALS AND METHODS: We reviewed the 61 patients with Krukenberg tumors, who had been diagnosed at our hospital from 1994 to 2002, and retrospectively analyzed the clinical features. RESULTS: The age distribution ranged from 15 to 59 years, and the mean age was 41 years. The most common symptom was a lower abdominal mass (46%). Fourty-two cases (77%) showed bilateral ovarian involvement, and the size of this tumor was variable, but in 24 cases (44%) the size was 5~0 cm for the largest diameter. Among 54 cases, 40 cases had ascites, and the volume of ascites was variable. The median survival of the 61 patients was 10 months, and Krukenberg tumor developed 19.7 months after the primary operation. The median survival durations of recurrence patterns were 20 months for the Krukenberg tumor alone, and 7 months for the Krukenberg tumor with peritoneal seeding. CONCLUSION: In young women treated with a gastrectomy, especially one for an advanced tumor, closed observation with abdominal ultrasonography or computed tomography to detect a Krukenberg tumor is recommended. The patient with a Krukenberg tumor alone has a better prognosis than one with a Krukenberg tumor combined peritoneal seeding. We will have to consider more progressive treatment for the patient with a Krukenberg tumor alone.
Age Distribution ; Ascites ; Female ; Gastrectomy ; Humans ; Krukenberg Tumor* ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms ; Ultrasonography

Anthracyclines have been widely used in cancer therapy because of their efficacy in the treatment of various solid tumors and hem -atologic malignancy. Cumulative dose-related cardiotoxicity was a well-known toxicity of anthracyclines. Particularly, at total doses of more than 550 mg/m2, therapy with anthracyclines could produce irreversible cardiac injury. Anthracycline-induced cardiac toxicity was usually manifested by congestive heart failure or arrhythmia. In co- ntrast, acute myocardial infarction is a rare event of anthracycline-induced heart diseases. A 31-year-old man with non-Hodgkin lymphoma(NHL) and single cardiac risk factor, including smoking, was presented with chest pain after receiving 2nd CEOP-BLAM chemo-therapy. An electrocardiogram revealed ST segment elevation in inferior leads consistent with acute myocardial infarction. An echocardiogram revealed an ejection fraction of 60% and severe hypokinesia in inferior and anteroseptal wall. Three days later, coronary angiography revealed 50% of luminal stenosis of right coronary artery(RCA) and near total occlusion with large thrombi in m-RCA. After balloon angioplasty and stent insertion, the patient was transferred to coronary care unit and continuous intravenous heparin infusion was started. On the 10th days, the patient was discharged in good condition. Six months later, follow-up coronary angiography showed no significant lesion in right coronary artery. In a young man with NHL, we report an acute myocardial infarction after 2nd course of CEOP-BLAM chemotherapy with a review of relevant literatures.
Adult ; Angioplasty, Balloon ; Anthracyclines ; Arrhythmias, Cardiac ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Care Units ; Coronary Vessels ; Doxorubicin* ; Drug Therapy* ; Electrocardiography ; Follow-Up Studies ; Heart Diseases ; Heart Failure ; Heparin ; Humans ; Hypokinesia ; Lymphoma, Non-Hodgkin* ; Myocardial Infarction* ; Phenobarbital ; Risk Factors ; Smoke ; Smoking ; Stents