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: There is no definite criteria for treatment of polypoid lesions of the gallbladders although they may have malignant potentials. METHODS: Surgically resected polypoid lesions of the gallbladders of 68 patients who were treated at the Department of Surgery, Pusan National University Hospital, from Jan. 1986 to Dec. 1996 were evaluated based on the patients' sex and age, histologic results, and operative methods. RESULTS: The numbers of each type of polypoid lesion of the gallbladder were 28 cases (41.2%) of cholesterol polyps, 6 cases (8.8%) of inflammatory polyps, 8 cases (11.8%) of gallbladder adenomas, and 26 cases (38.2%) of gallbladder cancers. Two histologic characteristics of an adenoma and a carcinoma in situ coexisted in two cases of gallbladder cancers, in another two cases, there were adenomatous residue in their tissues, and in four cases of gallbladder adenomas, the authors could identify intestinal metaplasia in the tissues. Thus, the probablility of the adenoma-carcinoma sequence was suspected because of these results. The cancer risk of gallbladder polyps increased propotionally with their sizes and was related with their shapes. In the sessile group, the mean maximal diameter was 8.2+/-3.4 mm in benign polyps and 31.8+/-11.9 mm in malignant polyps (p<0.005). In the pedunculated group, the mean maximal diameter was 9.8+/-6.3 mm in benign polyps and 34.8+/-13.9 mm in malignant polyps (p<0.005). The sizes of the gallbladder cancers were evenly distributed in the sessile group but in the pedunculated group there was only one case with a maximal diameter of 13.8 mm, all others were over 20 mm. In the age and the sex distributions, benign polyps were distributed mainly below 50 in both genders, but malignant polyps were distributed above an age of 50 in men and were evenly distributed in women of all ages. CONCLUSIONS: The authors would recommend operations in case of the following: 1) age: above 50 in men, and all ages in women; and 2) size: above 10 mm the in pedunculated group, and above 5 mm in the sessile group.
Adenoma ; Busan ; Carcinoma in Situ ; Cholesterol ; Female ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Male ; Metaplasia ; Polyps ; Sex Distribution

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

PURPOSE: Postoperative serial serum thyroglobulin (Tg) measurements on levothyroxine (L-T4) therapy in patients with differentiated thyroid carcinoma (DTC) is known to be useful in monitoring tumor progression or regression. The objective of this study was to evaluate the significance of serum Tg levels on L-T4 therapy after surgery. METHODS: To determine the basal serum Tg levels on L-T4 therapy after surgery in patients with DTC, Tg levels during the initial 2 year-period after surgery were analyzed retrospectively in 37 patients who had undergone a total thyroidectomy for papillary thyroid carcinoma with (Group 2) or without (Group 1) palpable cervical lymph node metastasis. The Tg levels had been measured 1 to 4 times for each patient with total of 53 and 35 times in Group 1 and Group 2 respectively. RESULTS: The basal Tg levels in Group 1 were all less than 4 ng/mL with 79.3% less than 2 ng/mL, and those in Group 2 were all less than 9 ng/mL with 71.4% less than 2 ng/mL. CONCLUSION: The data suggests that the postoperative serum Tg level of 10 ng/mL can be a useful reference value in long-term follow-up after total thyroidectomy for patients with DTC.
Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Reference Values ; Retrospective Studies ; Thyroglobulin* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyroxine

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

BACKGROUND/AIMS: Intrahepatic duct stone (IHDS) present serious health problem in East Asian countries including Korea because of recurrent or residual stones and stones induced hepatic damage. Hepatic resection is known as most definitive procedure especially in patients with ductal stricture, but postoperative morbidity and residual or recurrent stones are still high. METHODS: We analyzed early and late complication according to type of hepatic resection in IHDs (38 cases) and also determined the predisposing factors related to complication. RESULTS: Location of IHDs was left in 30 cases (78.9%), right in 1 case (2.7%), both in 7 cases (18.4%), and 28 cases (73.7%) had concomitant extrahepatic duct stone. The type of hepatic resection was left lateral segmentectomy in 24 cases (63.2%), left lobectomy in 11 cases (28.9%) and right lobectomy in 3 cases (7.9%). Overall complication rate was 44.7% and it was increased by extension of resection (p<0.05). Overall incidence of residual or recurrent stone was 36.8% and it was higher in patients with left lateral segmentectomy and without biliary drainage procedure although statistically not significant. The postoperative mortality was 11.8% (2 cases). CONCLUSIONS: Hepatic resection can be a curative therapy in IHDS and routine use of intraoperative choledochoscopy and additional drainage procedures are recommended to minimize the incidence of residual or recurrent stones.
Asian Continental Ancestry Group ; Causality ; Constriction, Pathologic ; Drainage ; Humans ; Incidence ; Korea ; Mastectomy, Segmental ; Mortality

PURPOSE: An ideal suturing material should be strong, easy to handle, should produce minimal tissue reaction and finally should disappear without a trace. Various micro-vascular suture materials have been produced in the past several decades in order to meet these demands. We have used nylon suturing material in experimental microsurgery because it is less expensive than polypropylene. After carotid artery end-to-end anstomosis, we found fusiform aneurysm incidentally. In this study 9-0 nylon (group I) and 9-0 polypropylene (group II) were compared to 10-0 nylon (group III), and 10-0 polypropylene (group IV) in order to survey the incidence of aneurysmal development in each material for use in microvascular surgery. METHOD: Forty Sprague-Dawley rats, 230 g to 350 g body weight, were used for this study. The carotid arteries were anastomosed end-to-end with 9-0 nylon, and 10-0 nylon, in addition to 9-0 polypropylene, and 10-0 polypropylene. The suture number of all arteries was 10 points except for two cases were 11 points due to uncontrolled bleeding. Specimens were harvested 1 week, 3 weeks, 6weeks and 10 weeks postoperatively. RESULT: The number of animals studied during the first week totaled 20 carotid arteries and they showed no interval change. After 3 weeks, we identified aneurysms in following cases: group I 3 cases, group II 2 cases, group III 1 case and group IV 1 case per five cases in each group. After 6 weeks, gross aneurysmal changes seen: group I, all (5) cases; Group II, 2 cases; group III, all (5) cases; Group IV, 3 cases. After 10 weeks, many aneurysms were observed: group I, all (5) cases; group II, all (5) cases; group III, 0 case; group IV, 2 cases. The aneurysms were measured and ranged in size from 1.3 mm to 8.1 mm. Histological analysis for inflammation, fibrosis and medial necrosis at the anastomosis site revealed no significant difference between same sized suture materials. If the experimental aneurysms were more than 5 times the diameter of the carotid artery, the aneurysms were considered to be experimental giant aneurysms. Seventy of our 34 experimental aneurysms were considered to be giant aneurysms. CONCLUSION: Our findings demonstrate that the development of aneurysms was related to size of the suture material and not the type of suturing material used. An ideal suture material for anastomosisof the carotid artery in the rat wasd a 10-0 monofilament suture material with suture numbers was above 10 points. We also made good aneurysm model. When we used 9-0 suture material and suture numbers were below 10 points multiple aneurysms developed. This model demonstrated the development mechanism of giant fusiform aneurysms.
Aneurysm* ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common* ; Fibrosis ; Hemorrhage ; Incidence ; Inflammation ; Microsurgery ; Necrosis ; Nylons ; Polypropylenes ; Rats* ; Rats, Sprague-Dawley ; Sutures

PURPOSE: An ideal suturing material should be strong, easy to handle, should produce minimal tissue reaction and finally should disappear without a trace. Various micro-vascular suture materials have been produced in the past several decades in order to meet these demands. We have used nylon suturing material in experimental microsurgery because it is less expensive than polypropylene. After carotid artery end-to-end anstomosis, we found fusiform aneurysm incidentally. In this study 9-0 nylon (group I) and 9-0 polypropylene (group II) were compared to 10-0 nylon (group III), and 10-0 polypropylene (group IV) in order to survey the incidence of aneurysmal development in each material for use in microvascular surgery. METHOD: Forty Sprague-Dawley rats, 230 g to 350 g body weight, were used for this study. The carotid arteries were anastomosed end-to-end with 9-0 nylon, and 10-0 nylon, in addition to 9-0 polypropylene, and 10-0 polypropylene. The suture number of all arteries was 10 points except for two cases were 11 points due to uncontrolled bleeding. Specimens were harvested 1 week, 3 weeks, 6weeks and 10 weeks postoperatively. RESULT: The number of animals studied during the first week totaled 20 carotid arteries and they showed no interval change. After 3 weeks, we identified aneurysms in following cases: group I 3 cases, group II 2 cases, group III 1 case and group IV 1 case per five cases in each group. After 6 weeks, gross aneurysmal changes seen: group I, all (5) cases; Group II, 2 cases; group III, all (5) cases; Group IV, 3 cases. After 10 weeks, many aneurysms were observed: group I, all (5) cases; group II, all (5) cases; group III, 0 case; group IV, 2 cases. The aneurysms were measured and ranged in size from 1.3 mm to 8.1 mm. Histological analysis for inflammation, fibrosis and medial necrosis at the anastomosis site revealed no significant difference between same sized suture materials. If the experimental aneurysms were more than 5 times the diameter of the carotid artery, the aneurysms were considered to be experimental giant aneurysms. Seventy of our 34 experimental aneurysms were considered to be giant aneurysms. CONCLUSION: Our findings demonstrate that the development of aneurysms was related to size of the suture material and not the type of suturing material used. An ideal suture material for anastomosisof the carotid artery in the rat wasd a 10-0 monofilament suture material with suture numbers was above 10 points. We also made good aneurysm model. When we used 9-0 suture material and suture numbers were below 10 points multiple aneurysms developed. This model demonstrated the development mechanism of giant fusiform aneurysms.
Aneurysm* ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common* ; Fibrosis ; Hemorrhage ; Incidence ; Inflammation ; Microsurgery ; Necrosis ; Nylons ; Polypropylenes ; Rats* ; Rats, Sprague-Dawley ; Sutures