No abstract available.
Pancreatic Pseudocyst*

No abstract available.
Colorectal Neoplasms*

A cholecystectomy is one of the most frequent operations in the field of surgery. Recently, a laparoscopic cholecystectomy (LC) has become a commonly performed procedure for treatment of gallbadder disease, mainly gallstone disease. It has the advantages of less postoperative pain, fewer complications, and more rapid recovery. There is no doubt that LC will be the first choice for the treatment of gallbladder disease. We performed this study to research problem and to improve the successbility of this operation. We analyzed 300 patients who underwent a laparoscopic cholecystectomy from January 1, 1993 to December 31, 1996, at the Department of Surgery, College of Medicine, Pusan National University. The main results are as follows:1) The age range of the patients was from 17 to 72 years. There were 104 males and 196 females. 2) The most common previous operation was an appendectomy; the second most common was pelvic surgery. 3) The common chief complaints were right upper guadrant pain and indigestion. 4) Radiologic finding showed, gallstones in 212 cases and polyps in 30 cases. 5) The removed stones varied in size and number. 6) Postopertive complications were puncture site infection, bile leakage, pulmonary complications, etc. 7) The mean postopertive hospital stay was 4.2 days. 8) Intraoperative conversion to an open cholecystectomy was due to severe inflammation, adhesion, bleeding, etc. In conclusion, resolution of technical difficulties, meticulous training and experience, proper patient selection, and more developed tools are required.
Appendectomy ; Bile ; Busan ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Dyspepsia ; Female ; Gallbladder Diseases ; Gallstones ; Hemorrhage ; Humans ; Inflammation ; Length of Stay ; Male ; Pain, Postoperative ; Patient Selection ; Polyps ; Punctures

BACKGROUND: Papillary cystic and solid neoplasm of the pancreas is a relatively rare tumor that usually occurs in young adult women. This tumor is distinct from the usual ductal adenocarcinoma in clinical and histologic features. It has a much more favorable prognosis than other tumors of the pancreas due to a low incidence of metastasis and good resectability. METHODS: We reviewed eight patients who were treated at the Department of Surgery of PNUH (Pusan National University Hospital) from Jan. 1985 to Dec. 1996. RESULTS: Seven patients were women, and one patient was a man; the mean age of the patients was 26.8 years (range: 14 years to 39 years). Their chief complaints were epigastric pain (75%), palpable mass (37.5%), left upper quadrant pain (25%), nausea, and dyspepsia. The results of laboratory studies, including tumor markers (CEA, CA-19-9), were all negative and nonspecific. Although these tumors can occur in any portion of the pancreas, they are usually located in the tail and the body. We also identified these tumors in the tail and the body of the pancreas. In our cases, we treated these tumor by a distal pancreatectomy, a distal pancreatectomy with splenectomy, a Roux-en-Y cystojejunostomy, and enucleation; we didn't observe any morbidity or mortality. After discharge, there was no recurrence. CONCLUSIONS: There is no specifically known orgin or pathogenesis of this tumor, but it is well controlled by surgical removal. At the same time, it is important to do a more aggressive diagnostic work up and to make greater effort, with attention given to papillary cystic and solid tumors, when we meet any cystic tumors of the pancreas.
Adenocarcinoma ; Biomarkers, Tumor ; Dyspepsia ; Female ; Humans ; Incidence ; Mortality ; Nausea ; Neoplasm Metastasis ; Pancreas* ; Pancreatectomy ; Prognosis ; Recurrence ; Splenectomy ; Young Adult

The aim of this study is to appraise the efficacy of both recent therapeutic modalities and the prognosis after the biliary drainage procedure of various biliary diseases. A retrospective review of biliary drainage procedures for biliary disease was done from January 1986 to June 1996. We have experienced 252 cases at Pusan National University Hospital. The results were obtained as follows: 1) The most common age group was the 6th decade, and the ratio of male to female was 1:1.3. 2) Operative procedures consisted of sphincteroplasty in 62 cases(24.6%), choledochoduodenostomy in 63 cases(25%), choledochojejunostomy in 72 cases(28.6%), and choledochojejunostomy with defunctionalized jejunal limb in 55 cases(21.7%). 3) The indications for operative procedures of biliary drainage were as follows: intrahepatic stone in 67 cases(26.6%), dilated CBD with muddy stones in 57 cases(22.6%), CBD stone with stenosis of sphincter in 15 cases(5.9%), recurrent or residual stones in 89 cases(35.3%), and malignant disease in 24 cases(9.6%). 4) The preoperative diagnostic procedures were operative cholangiography, T-tube cholangiogram, ultrasound, ERCP, PTC, and abdominal CT. 5) The postoperative procedures for remaining stones after operation were choledochoscopic extraction, saline irrigation and reoperation. 6) The postoperative complications included wound infection (18 cases, 7.1%), respiratory infection (4 cases, 1.6%), GI trouble (19 cases, 7.5%), cholangitis ( 2 cases, 0.8%), residual stone (25 cases, 11%), pancreatitis ( 1 case, 0.4%), and biliary fistula (5 cases, 1.9%). Recently many therapeutic techniques have contributed to improving biliary drainage. We suggest that an apprapriate operation be selected according to the situation when performing biliary drainage for biliary diseases.
Biliary Fistula ; Busan ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledochostomy ; Constriction, Pathologic ; Drainage* ; Extremities ; Female ; Humans ; Male ; Pancreatitis ; Postoperative Care ; Postoperative Complications ; Prognosis ; Reoperation ; Retrospective Studies ; Surgical Procedures, Operative ; Tomography, X-Ray Computed ; Ultrasonography ; Wound Infection

Choledochal cyst is a relatively rare disease entity considered to be a congenital cyatic dilatation of the common bile duct. Since occurrence of malignant tumor in choledochal cyet was first reported by Irwin and Morrison in 1944, approximately 100 more cases of malignant tumors arising in congenital choledocal cyst have been reported in the world, and the risk of malignant tumor related to choledochal cyst have been reported 2.4-14%. Recently, we experienced a case of adenocarcinoma arising in choledochal cyst in 39 year-old woman who was diagnosed by ERCP and cholangioscopy with forceps biopsy, and was treated with en bloc resection of the choledochal cyst along with the pancreatic head and duodenum.
Adenocarcinoma ; Adult ; Bile Duct Neoplasms ; Biopsy ; Cholangiocarcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst ; Common Bile Duct ; Dilatation ; Duodenum ; Female ; Head ; Humans ; Rare Diseases ; Surgical Instruments

Choledochal cyst is a relatively rare disease entity considered to be a congenital cyatic dilatation of the common bile duct. Since occurrence of malignant tumor in choledochal cyet was first reported by Irwin and Morrison in 1944, approximately 100 more cases of malignant tumors arising in congenital choledocal cyst have been reported in the world, and the risk of malignant tumor related to choledochal cyst have been reported 2.4-14%. Recently, we experienced a case of adenocarcinoma arising in choledochal cyst in 39 year-old woman who was diagnosed by ERCP and cholangioscopy with forceps biopsy, and was treated with en bloc resection of the choledochal cyst along with the pancreatic head and duodenum.
Adenocarcinoma ; Adult ; Bile Duct Neoplasms ; Biopsy ; Cholangiocarcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst ; Common Bile Duct ; Dilatation ; Duodenum ; Female ; Head ; Humans ; Rare Diseases ; Surgical Instruments

Recently, a combination of a partial mastectomy, axillary dissection, and radiation has been accepted as therapy for early-stage breast cancer because various significant trials have demonstrated that the combination therapy and the radical mastectomy produce comparable actuarial survival rates. The authors reviewed the cases of 62 patients who were treated for stage I and II breast cancer, 22 with breast-preserving surgery (quadrantectomy, axillary dissection and latissimus dorsi myocutaneous flap) and 40 with a modified radical mastectomy at Pusan National University Hospital during the period of 2.5 years from January 1994 to June 1996. The results are as follows: 1) The mean age of the breast-preserving group was 44.8 years, and that of the modified radical mastectmy group was 51.2 years. 2) The mean size of tumor mass was 2.1 cm and 2.5 cm, respectively. The most frequent site was the upper outer quadrant in both groups. 3) According to TNM classification, 8 patients (36.4%) had stage I tumors and 12 patients (54.5%) had stage II tumors in the breast-preserving group. The respective numbers of patients were 8 (20.0%) and 31 (77.5%) in the modified radical mastectomy group. 4) In the breast-preserving group, the number of axillary lymph-node metastasis was 0 in 16 cases (72.7%), 1~3 in 5 cases (22.7%), and 4 in 1 case (4.6%). In the modified radical mastectomy group, the number was 0 in 23 cases (57.5%), 1~3 in 13 cases (32.5%), and 4 in 4 cases (10.0%). 5) In the breast-preserving group, a local recurrence developed in one case at 12 months after the operation, and a salvage mastectomy was done. In the modified radical mastectomy group, a local recurrence developed in two cases, one at 14 months and the other at 16 months after the operation, and a wide excision was done. 6) Complications associated with axillary dissection were impaired arm mobility, arm edema, seroma, and skin necrosis. However, complications were well treated with no difficulty. 7) The overall subjective cosmetic results in the breast-preserving group were excellent in 7 cases (31.8%), good in 12 cases (54.1%), fair in 3 cases (13.7%), and poor in 0 cases. Postoperative asymmetry of the nipple is a problem to be solved. 8) The fear of recurrence was observed in 10 cases (45.5%) in the breast-preserving group and in 18 cases (45.0%) in the modified radical mastectomy group. 9) The complications associated with radiotherapy in the breast-preserving group were transient radiation dermatitis, breast fibrosis, radiation pneumonitis, and limited motion of shoulder. Our review shows a high loco-regional control rate (95.5%) and a satisfactory cosmetic result (86.3%) in the breast-preserving group for early-stage breast cancer. Thus breast-preserving procedures seem to be acceptable alternatives to a modified radical mastectomy in highly selective group of patients with early-stage breast cancer.
Arm ; Breast Neoplasms* ; Breast* ; Busan ; Classification ; Dermatitis ; Edema ; Humans ; Mastectomy ; Mastectomy, Modified Radical* ; Mastectomy, Radical ; Mastectomy, Segmental ; Necrosis ; Neoplasm Metastasis ; Nipples ; Pneumonia ; Radiation Pneumonitis ; Radiotherapy ; Recurrence ; Seroma ; Shoulder ; Skin ; Superficial Back Muscles ; Survival Rate

Collagenous colitis is recognized as one of the causes of chronic diarrhea accompanied with autoimmune diseases. It is a disease associated with chronic watery diarrhea and typical histologic findings of a thick subepithelial collagenous deposit on biopsy. We experienced a 75-year-old man patient with chronic watery diarrhea and mild abdominal pain for 7 years. Physical examination, laboratory and radiologic studies were unremarkable except hypokalemia. Colonoscopy disclosed mucosal atrophy, loss of submucosal vessel and altered vascularity of terminal ileum, ascending colon. Colonoscopic biopsy revealed homogenous hyaline layered collagen deposition beneath the surface epithelium and Masson's trichrome stain showed collagen deposition. We report the case of collagenous colitis with a review of literature.
Abdominal Pain ; Aged ; Atrophy ; Autoimmune Diseases ; Biopsy ; Colitis, Collagenous* ; Collagen* ; Colon, Ascending ; Colonoscopy ; Diarrhea* ; Epithelium ; Humans ; Hyalin ; Hypokalemia* ; Ileum ; Physical Examination

OBJECTIVE: This study investigated the effects of the balanced incline shoes on the stabilized walking, fatigue reduction, improvement of blood circulation and prevention of foot related disease for the pregnant women. METHODS: The seven 7~9 month pregnant women and three maternities within 3 months after delivery without a history of disease performed the cycles for each of the two walking conditions: wearing balanced incline shoes and flat shoes. The differences between the two walking conditions were statistically investigated including three dimensional motion analysis, footprint pressures and blood flow. To find out any possible difference between these two kinds and among the subjects, the statistical tool was utilized with one-way layout design. RESULTS: Of 10 subjects, seven subjects showed the significantly decreased in distance of both knee with balanced incline shoes than flat shoes (P<0.05). Those with the balanced incline shoes had a walking pattern whose knee moved inward about 6 mm, compared to those with the flat regular ones. Over plantar pressure measurements for all ten, it also revealed statistically significant differences that the balanced incline shoes decreased its pressure 15% and that the pressure heavily on heel area was distributed outward along the arch (P<0.05). The blood stream velocity belonged to C (200~300 microm/sec) or D (100~200 microm/sec) for the nine before wearing the balanced incline shoes. However, it was found to be enhanced in A (>600 microm/sec) or B (400~600 microm/sec) after they put them on, indicating 1~2 part equivalent improvement. The blood stream velocity showed a incremental tendency after wearing balanced incline shoes. CONCLUSION: This result suggests that the balanced incline shoes corrected the postures, stabilized the gait pattern, decreased the excessive load on ankle plantar flexors, reduced the fatigue level and improved the blood circulation.
Animals ; Ankle ; Blood Circulation ; Fatigue ; Female ; Foot ; Gait ; Heel ; Humans ; Knee ; Posture ; Pregnant Women ; Rivers ; Shoes ; Walking