PURPOSE: To compare standard laparoscopy-assisted Billroth I gastrectomies including standard lymph node dissection (LABIG) with hand-assisted laparoscopic surgery with the HandPort system (HALS) for the removal of early gastric cancers (EGC). METHODS: A prospective study was performed on 26 patients of EGC at Ewha Womans University Mok-Dong Hospital from July 1999 to August 2001. Seventeen patients (Group L) received LABIG using conventional laparoscopy-assisted methods and 9 patients received LABIG using HALS (Group H). We used staplers for the anastomosis, and a standard D2 lymph node dissection was done with ultrasonic shears or electrocautery. RESULTS: In group L, pathologic reports revealed 14 EGC (stage IA 14 cases), and 3 pm cancers (stage IB 1 case, II 2 cases). In group H, there were 9 early gastric cancers (stage IA 8 cases, IB 1 case). Significant differences (P<0.05) were present between group L and H in regards to the number of harvested lymph nodes (30.8 vs 18.9), estimated blood loss (462.1 vs 286.7 ml) and postoperative transfusion amounts (0.59 vs 0 unit). There were no differences in the mean operating time, distance from the lesion to the resection margin, postoperative leukocyte count, frequencies for pain control, wound size, time to diet, weight loss, serum protein, and postoperative hospital stay. Complications were present in 1 case in group L (enterocutaneous fistula) and 1 case in group H (gastric atony). There was one conversion to open surgery in group H. CONCLUSION: LABIG including standard lymph node dissections with both standard laparoscopic surgery and HALS were performed with equal outcome. The choice of surgical method depends on the characteristics of the lesion and the patient's physical factors.
Conversion to Open Surgery ; Diet, Reducing ; Electrocoagulation ; Female ; Gastrectomy* ; Gastroenterostomy* ; Hand-Assisted Laparoscopy* ; Humans ; Laparoscopy ; Length of Stay ; Leukocyte Count ; Lymph Node Excision ; Lymph Nodes ; Prospective Studies* ; Stomach Neoplasms* ; Ultrasonics ; Wounds and Injuries

PURPOSE: This descriptive study was conducted to identify the level of knowledge of stroke symptoms and risk factors among older adults. METHODS: A total of 200 older adults over 65 years of age were conveniently recruited from out patient departments of two hospitals and a health care center from October to November 2008. The level of knowledge was assessed using both open-ended questions and a structured questionnaire based on semi-structured interviews. Data were analyzed by t-tests and ANOVA using the SPSS program. RESULTS: 52.5% of the sample had hypertension and 30% had diabetes. The mean knowledge scores for symptoms and risk factors were 8.4 +/- 3.1(out of 15) and 9.5 +/- 3.9 (out of 16), respectively. The older adults who had lower education, lower family income, and who lived in rural areas were more likely to have less knowledge of stroke symptom and risk factors(p < .05). There was no significant knowledge difference between the older adults who had at least one risk factor and those who had no risk factor for stroke. CONCLUSIONS: Educational intervention should be focused on informing older adults who are at risk for stroke about the early symptoms and management of risk factors, especially those who have low education and low social status.
Adult ; Delivery of Health Care ; Humans ; Hypertension ; Risk Factors ; Stroke ; Surveys and Questionnaires

Simple or unicameral bone cysts are metaphyseal lesions of long bones. They usually move away from the physiswith growth to become diaphyseal in location. Involvement of the physis and epiphysis by these cystic lesions isvery rare. This paper reports a case of simple bone cyst of the proximal humerus in a 11- year -old girl which wasshown by MR imaging to extend through the physis into the epiphysis.
Bone Cysts* ; Epiphyses* ; Female ; Humans ; Humerus* ; Magnetic Resonance Imaging

PURPOSE: Nonsteroidal anti-inflammatory drugs (NSAID) are well known to be associated with gastroduodenal ulcers. Also, small bowel ulceration sometimes develops. The authors reviewed their experiences to emphasize clinical importance of this disease entity. METHODS: A retrospective study was performed for patients who had undergone surgical intervention for lower gastrointestinal bleeding, small bowel perforation, or obstruction at Ewha Womans University Mok-Dong Hospital during a 5-year period. The cases related to acute trauma, postoperative obstruction, malignant ulceration, specific inflammatory bowel disease and other definite gastrointestinal lesions were excluded. The medical records were reviewed and the patients were interviewed. RESULTS: Out of total 110 cases, 4 patients had histories of NSAID use. They showed emergent presentations of acute abdomen, who were in debilitated or malnutrition states with underlying disease, without protective management for NSAID-use. They had all undergone surgical interventions because of small bowel ulcerations and its complications. CONCLUSION: NSAID induced small bowel ulcers should be a differential diagnosis of an acute abdomen or lower gastrointestinal bleeding of uncertain origin, especially for older age, and for patient with debilitating disease. Misuse or overuse of NSAID should be avoided to prevent ulcer complications, especially in high-risk patients.
Abdomen, Acute ; Diagnosis, Differential ; Female ; Hemorrhage* ; Humans ; Inflammatory Bowel Diseases ; Malnutrition ; Medical Records ; Peptic Ulcer ; Retrospective Studies ; Ulcer*

OBJECTIVES: A non-progressive and conductive hearing loss with normal eardrum, but no history of trauma and infection, is highly suggestive of a congenital ossicular malformation. Among ossicular anomalies, stapes anomaly is the most common. The purpose of this study is to describe patterns of stapes anomaly and to analyze its surgical outcome with special reference to its patterns. METHODS: We conducted a retrospective case review. The subjects comprised 66 patients (76 ears) who were decisively confirmed by the exploratory tympanotomy as congenital stapes anomalies without any anomalies of the tympanic membrane and external auditory canal. The preoperative and postoperative audiological findings, temporal bone computed tomography scan, and operative findings were analyzed. RESULTS: There were 16 anomalous patterns of stapes among which footplate fixation was the most common anomaly. These 16 patterns were classified into 4 types according to the status of stapes footplate. Successful hearing gain was achieved in 51 out of 76 ears (67.1%) after surgical treatment. CONCLUSION: Footplate fixation was usually bilateral, whereas stapes anomalies associated with other ossicular anomaly were usually unilateral. The success of the surgical treatment of stapes anomaly might depend on its developmental status of the footplate. Stapes anomalies were detected without any fixed patterns, therefore, it is quite possible to detect a large variety of patterns in future.
Ear ; Ear Canal ; Hearing ; Hearing Loss, Conductive ; Humans ; Ossicular Replacement ; Retrospective Studies ; Stapes ; Temporal Bone ; Tympanic Membrane

PURPOSE: Catastrophic bleeding of the gastric varices has been considered a life threatening emergency. Sclerotherapy cannot easily control the bleeding, and there is a high risk of rebleeding despite successful intervention. Surgery is often necessary to save the life. The purpose of this study was to elucidate the role of surgery and analyze the factors determining operative mortality in gastric variceal bleeding. METHODS: A retrospective study was performed of 30 patients who underwent operation for gastric variceal bleeding with portal hypertension at Ewha Womans University Mok-Dong Hospital from Jul. 1994 to Feb. 2001. Among them, 23 patients received perigastric devascularization with fundectomy and the remainder received perigastric devascularization alone. RESULTS: There was one case of recurrent bleeding from esophageal varix at 8 months postoperative. This was controlled with sclerotherapy. The overall operative mortality rate was 30.0%. Preoperative hepatic functional reserve was a significant factor. The mortality rate was 0% (0/5) in Child-Pugh group A, 27.8% (5/18) in group B, and 57.1% (4/7) in group C (p<0.05). The preoperative success of intervention influenced postoperative outcomes. There was no mortality in the successfully controlled group (0/5). In the failure group, 5 of 7 patients expired (p<0.05). Preoperative transfusion amount was also a significant factor in determining survival. There was 15.8% (3/19) mortality rate in patients trans fused less than 10 units, and a 54.5% (6/11)rate in those receiving more than 10 units (p<0.05). CONCLUSION: This operative approach was effective for saving lives from an otherwise uniformly fatal disease. The rebleeding rate at the follow-up period was low. Proper selection of patients and an early surgical decision could lower the operative mortality.
Emergencies ; Esophageal and Gastric Varices* ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal ; Mortality ; Retrospective Studies ; Sclerotherapy

Cardiovascular malformations, such as bicuspid aortic valve and coarctation of the aorta, are more prevalent in patients with Turner syndrome than in the general population. Here, we describe the case of a 35-year-old female with Turner syndrome who was admitted to our hospital with a fever caused by infective endocarditis. Aortic coarctation was diagnosed using computed tomography. The patient was treated with antibiotics and a stent was then implanted. Endovascular therapy using stents is a safe and effective treatment option for aortic coarctation in patients with Turner syndrome.
Adult ; Anti-Bacterial Agents ; Aortic Coarctation* ; Aortic Valve ; Bicuspid ; Endocarditis ; Female ; Fever ; Humans ; Stents* ; Turner Syndrome*

PURPOSE: The purpose of this study was to evaluate the feasibility and potential benefits of Hand-Assisted Laparoscopic Surgery (HALS) with the HandPort system. The surgeon inserts the nondominant hand into the abdomen while the pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic surgery. This approach provides an excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. METHODS: A prospective study was performed in patients who had undergone surgical intervention with the HandPort system at Ewha Womans University Mok-Dong Hospital. The surgeon was free to test the device in any situation where they expected a potential advantage over conventional laparoscopy. The surgeon inserted the nondominant hand into the abdomen while the pneumoperitoneum was generally maintained at 13 mmHg. RESULTS: Thirteen patients were entered in the study. Operations included radical gastrectomy in 8 cases, subtotal gastrectomy in 1 case, hemicolecotmy in 2, distal pancreatectomy with splenectomy in 1, nephrectomy with splenectomy in 1. The mean incision size for the HandPort device was 7.5 cm for the nondominant hand. None of the patients required conversion to open surgery as a result of an unmanageable air leak. There were no postoperative problems and no cases of mortality. CONCLUSION: HALS with the HandPort system is helpful in complex laparoscopic surgery and appeared to be useful in minimally invasive procedures considered too complex for,a laparoscopic approach.
Abdomen ; Conversion to Open Surgery ; Female ; Gastrectomy ; Hand ; Hand-Assisted Laparoscopy* ; Hemostasis ; Humans ; Laparoscopy ; Mortality ; Nephrectomy ; Pancreatectomy ; Pneumoperitoneum ; Prospective Studies ; Splenectomy

PURPOSE: Cefodizime is a new third-generation cephalosporin which has a structure and immunomodutation properties similar to cefotaxime. Various studies on cefodizime have demonstrated the direct eradication of bacteria in cooperation with the host defense mechanism, particularly with phagocytosis. We evaluated the effects of cefodizime on the phagocytosis of COS-1 cells transfected with FcgammaRI/gammagamma or FcgammaRIIA cDNA. METHODS: Phagocytosis was measured using the in vitro COS-1 cell modeling system according to Schreiber's method. COS-1 cells, which lack endogenoous Fcgammareceptors but have phagocytic potential, were transfected with either FcgammaRI/gammagammaor FcgammaRIIA cDNA. COS-1 cells, as target cells, were treated with antibiotics for 1 or 24 hours and incubated for 30 min with IgG coated sheep RBCs. Adhered IgG coated sheep RBCs were removed after brief exposure to hypotonic phosphate buffered saline. Phagocytosis index (PI) was calculated as the number of ingested RBCs per 100 phagocytic cells after wright-Giemsa staining. RESULTS: COS-1 cells tranfected with FcgammaR (either FcgammaRI/gammagamma or FcgammaRIIA cDNA) showed the phagocytic activity against IgG coated sheep RBC, while untransfected COS-1 cells did not. After treatment with cefodizime, phagocytic activity of FcgammaRI/gammagammacDNA transfected COS-1 cells was significantly increased, while that of FcgammaRIIA cDNA transfected COS-1 cells did not. Marked enhancement of phagocytosis of COS-1 cells was observed after treatment with cefodizime, but was not observed with ceftriaxone or moxalactam. CONCLUSION: Cefodizime showed marked enhancement of phagocytic activity of FcgammaR transfected COS-1 cells. FcgammaRI seems to play an important role in the enhancement of phagocytosis. Further studies will be required.
Animals ; Anti-Bacterial Agents ; Bacteria ; Cefotaxime ; Ceftriaxone ; COS Cells ; DNA, Complementary ; Immunoglobulin G ; Moxalactam ; Phagocytes ; Phagocytosis* ; Sheep

Although the standard treatment of gastric cancer is still radical subtotal or total gatrectomy, minimal invasive surgery is a primary issue in early gastric cancer, because quality of life is very important if the disease is curable. Laparoscopic total gastrectomy has not yet met widspread acceptance owing to the technical difficulties and has not been reported in Korea. The authors used the Handport system(TM), which enables introducing one of the surgeon's hands into the abdominal cavity while maintaining pneumoperitoneum. The patient was a 38-year old man. His chief complaint was hematemesis. Emergency esophagogatroscopy revealed cardiac ulcer with active bleeding. Sclerotherapy was successfully done and the patient was stabilized. Follow-up gastroscopic examination and biopsy demonstrated moderately differentiated adenocarcinoma in the ulcer area. The surgery was done electively. The operator's left hand was inserted into the abdomen through the right upper quadrant via the Handport system. An additional 10 mm working port was made in the left upper quadrant. Laparoscopy was inserted through the umbilical port. An Ultrashear(R) was used for dissection of omentum and perigastric vessels. D1 plus alpha lymph node dissection was performed completely. Roux-en-Y esophagojejunostomy was done for reconstruction through the Handport site. Opeation time was 6 hours and blood loss was 500 ml. No transfusion was required. The patient recovered uneventfully and was discharged at 16 postoperative days. In terms of recovery and quality of life laparoscopic total gastrectomy is a technically feasible and reasonable option for the treatment of early gastric cancer.
Abdomen ; Abdominal Cavity ; Adenocarcinoma ; Adult ; Biopsy ; Emergencies ; Follow-Up Studies ; Gastrectomy* ; Hand ; Hand-Assisted Laparoscopy ; Hematemesis ; Hemorrhage ; Humans ; Korea ; Laparoscopy ; Lymph Node Excision ; Omentum ; Pneumoperitoneum ; Quality of Life ; Sclerotherapy ; Stomach Neoplasms ; Ulcer