No abstract available.
Colorectal Neoplasms*

No abstract available.
Pancreatic Pseudocyst*

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

BACKGROUND/AIMS: Intrahepatic cholangiocarcinoma, which has been defined as a primary adenocarcinoma from the intrahepatic bile ducts distal to the second-order branch of the main hepatic ducts, has a poor prognosis against various treatment modalities. We analyzed the clinical characteristics of intrahepatic cholangiocarcinomas and evaluated the outcomes of surgical treatment. METHODS: Forty five cases of microscopically-proven intrahepatic cholangiocarcinoma during 8 and a half year period from January 1993 to june 2001 were reviewed. RESULTS: They comprised 29 men and 16 women with an average age of 54.3 years (range: 34 to 76 years). The overall incidence of intrahepatic cholangiocarcinoma in association with hepatolithiasis was 4~% and in this sutdy 17 out of 45 cases (37.8%) of intrahepatic cholangiocarcinoma was combined with intrahepatic stones. The incidence of accurate preoperative diagnosis was 56% due to low index of suspicion. The growth pattern of intrahepatic cholangiocarcinoma was mass-forming type in 32 cases, periductal infiltrative type in 9 cases, and intraductal growth type in 4 cases. CONCLUSION: Careful preoperative evaluation using computed tomography, ultrasonography, and angiography and a study of tumor markers for the possibility of a intrahepatic cholangiocarcinoma is necessary in risk groups with hepatolithiasis or clonorchiasis. Hepatric resection should be used in hepatolithiasis patients to improve the chance of survival.
Adenocarcinoma ; Angiography ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma* ; Clonorchiasis ; Diagnosis ; Female ; Hepatic Duct, Common ; Humans ; Incidence ; Male ; Prognosis ; Biomarkers, Tumor ; Ultrasonography

BACKGROUND/AIMS: Pancreaticoduodenectomy is the procedure of choice in patients with periampullary cancers. Marked improvements in morbidity and mortality rates following pancreaticoduodenectomy have been reported in recent years. However, pancreatic leakage still occurs in 5% to 25% of patients and is a major cause of morbidity and mortality. METHODS: Between January 1990 to June 1999, eighty-two patients underwent pancreaticoduodenectomy. We compared preoperative, intraoperative characteristics as well as postoperative sandostatin usage in those patients who experienced (n=21) versus those who did not experience pancreatic leakage (n=61). Information was retrospectively collected from hospital record. RESULTS: The clinical leakage rate in this series was 25.6% (n=21). There were no significant differences in preoperative characteristics comparing those with versus those without pancreatic leakage. Among intraoperative characteristics, duct stenting and transfusions were significantly associated with the pancreatic leakage. Finally, postopeative sandostatin usage was able to reduce significantly the incidence of pancreatic leakage. CONCLUSION: Although consensus among surgeons does not exist as to opeative tenchnique and postoperative management, stenting and less bleeding as well as sandostatin usage had better results in this study.
Consensus ; Hemorrhage ; Hospital Records ; Humans ; Incidence ; Mortality ; Octreotide ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Retrospective Studies ; Stents

BACKGROUND: Due to its anatomical location and vague symptom, early diagnosis of traumatic pacreatic injury is difficult. Furthermore it is very difficult to carry out appropriate management for the injury, so morbidity and mortality rates of traumatic pancreatic injuries remain high. Patients and METHODS: We reviewed medical records of 35 cases of patients who had been diagnosed as pancreatic injury and operated at Department of Surgery, Busan National University College of Medicine between January 1995 and December 2000. RESULT: 1) The male to female ratio was 2.5:1 and the highest incidence occurred in the 4th decade(31.3%). 2) Thirty two cases(91.4%) were injured by blunt trauma and 3 cases(8.6%) were injured by penetrating trauma. 3) The most common clinical manifestation was abdominal pain. 4) Twenty two patients(62.9%) were operated within 24hours after injury, and the mean time interval between injury and operation was 26.4 hours. 5) The serum amylase levels higher than 150 somogi unit were recorded in 20 cases(57.1%) of the patients. 6) Twenty seven patients(77.1%) had another associated injury with an average of 2 associated intraabdominal injuries. The most frequently injured intraabdominal organ was mesentery. 7) Complications occurred in 20 of 35 patients(57.1%) and the most common complication was pancreas-related complications, such as fistula, pseudocyst, abscess, pancreatitis. 8) Six patients(17.1%) were died due to hypovolemic shock, sepsis, respiratory failure and renal failure. CONCLUSION: Early diagnosis and appropriate operative methods may reduce morbidity and mortality from traumatic pancreatic injury
Abdominal Pain ; Abscess ; Amylases ; Busan ; Early Diagnosis ; Female ; Fistula ; Humans ; Incidence ; Male ; Medical Records ; Mesentery ; Mortality ; Pancreatitis ; Renal Insufficiency ; Respiratory Insufficiency ; Sepsis ; Shock

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