We report our case of laparoscopy-assisted distal gastrectomy with D1 + beta lymph node dissection for a patient with early gastric cancer and laparoscopic cholecystectomy for gallstone with situs inversus totalis. A superficial elevated lesion was found on the lesser curvature of the antrum. The preoperative diagnosis was cStage IA (cT1, cN0, cH0, cP0, cM0). A 1 cm-sized gallstone was found in the fundus through upper abdominal ultrasound. A laparoscopy-assisted distal gastrectomy with standard D2 lymph node dissection for early gastric cancer and laparoscopic cholecystectomy was successfully performed by not shifting the monitor to the left and right and not changing operator's position without additional blood loss and time. The number of retrieved lymph nodes was 36. We have not found any abnormal course of blood vessels except for the right/left inversion. Billroth I reconstruction was performed through end-to-side anastomosis. Based on a histopathological examination, a 1.5 x 1.5 cm, submucosal (sm3), moderately differentiated adenocarcinoma (pT1, pN0, sH0, sP0, sM0, stage IA) was diagnosed. The postoperative course was favorable and the patient was discharged on postoperative day 7.
Adenocarcinoma ; Blood Vessels ; Cholecystectomy, Laparoscopic ; Gallstones ; Gastrectomy ; Gastroenterostomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Organothiophosphorus Compounds ; Situs Inversus ; Stomach Neoplasms

The glandular lesions of the uterine cervix can be classified into endocervical glandular dysplasia (EGD), adenocarcinoma in situ (AIS) and adenocarcinoma, but the diagnostic criteria and the continuity of endocervical glandular lesions are still controversial. The aim of this study was to evaluate the significance of immunohistochemical findings of p53 and MIB-1 in the discrimination and the continuity of EGD, AIS and adenocarcinoma. The materials for the study included 11 cases of adenocarcinoma, 7 cases of AIS, 12 cases of high grade EGD, and 19 cases of low grade EGD. Also included were eleven benign glandular lesions (5 cases of tuboendometrial metaplasia, 3 cases of mesonephric remnant, 3 cases of microglandular hyperplasia). A strong reaction of more than 5% of the glandular epithelial nuclei was interpreted as positive for p53 protein. MIB-1 expression was analyzed semiquantitatively as negative, 1 , 2 , 3 , depending on the percentage of positive nuclei (less than 1%, 1~9%, 10~39%, > or = 40%, respectively). p53 protein expression was found in 3 (27.3%) out of 11 cases of adenocarcinoma, and 2 (28.6%) out of 7 cases of AIS. But all of high and low grade EGD cases were negative. High MIB-1 labelling index (> or =10%) was found in all adenocarcinoma cases and in 3 (42.9%) out of 7 cases of AIS. But only 2 (17.7%) out of 12 cases of high grade EGD showed high MIB-1 labelling index, and all of low grade EGD and benign lesions showed negligible MIB-1 positivities. In summary, MIB-1 labelling index might be valuable in the discrimination of malignant glandular lesions and endocervical glandular dysplasia from benign lesions, but p53 expression could be a useful parameter in the discrimination of malignant glandular lesions from endocervical glandular dysplasia and benign lesions.
Adenocarcinoma ; Cervix Uteri* ; Discrimination (Psychology) ; Female ; Metaplasia

The effect of androgen in the development of the normal prostate and the evolution of benign prostatic hypertrophy (BPH), and prostatic adenocarcinoma has been proven. In addition to androgen, estrogen and progesterone are also thought to play a role in the pathogenesis of BPH and carcinoma. However, their exact roles are not yet known because there is no conclusive evidence. Thirty cases of prostatic adenocarcinoma and 16 cases of BPH were studied. Immunohistochemical staining for estrogen receptor (ER) and progesterone receptor (PR) in epithelial and stromal cells, respectively was performed and the results were assessed semiquantitatively based on the number of positive cells per 100 total cells. Slides were scored as negative; less than 5% of cells, 1 ; 6~15% of cells, 2 ; 16~25% of cells, and 3 ; more than 26% of cells. The relationship between ER and PR expression and the patient's age, histologic grade, and clinical stage was evaluated in prostatic adenocarcinomas. ER was negative in epithelial and in stromal cells for all prostatic adenocarcinomas and BPH cases. The PR expression in epithelial cells and in stromal cells of BPH was noted in 15 (93.8%) and 16 (100.0%) out of 16, respectively. The PR expression of carcinoma cells and stromal cells in prostatic adenocarcinoma was found in 28 (93.3%) and 23 out of 30 (76.7%), respectively. The PR immunoreactivities of stromal cells around carcinoma were 3 in 18 cases, 2 in one case, and 1 in 4 cases, but those of epithelial and stromal cells of BPH and carcinoma cells of prostatic carcinoma were similar to each other with a value of 3 in most cases. The PR expression rate of stromal cells around carcinoma was significantly correlated with the patient's age (p=0.044), but not with histologic grade and clinical stage. In summary, estrogen does not have a direct effect on the biological behavior of BPH and prostatic adenocarcinoma, but progesterone appears to play a role in the pathogenesis of BPH and prostatic adenocarcinoma. Further studies should clarify the biological role of progesterone in the human prostate.
Adenocarcinoma* ; Epithelial Cells ; Estrogens* ; Humans ; Progesterone* ; Prostate ; Prostatic Hyperplasia* ; Receptors, Progesterone* ; Stromal Cells

No abstract available.
Drug Therapy* ; Germ Cells* ; Neoplasms, Germ Cell and Embryonal*

Diastematomyelia is an uncommon congenital malformation of the vertebral axis characterized by a localized longitudinal separation of the spinal cord with an interposed septum. It may be found in association with congenital scoliosis. The Authors experienced a case of congenital scoliosis with diastematomyelia. Diastematomyelia was surgicallv resected and scoliosis was corrected by Dwyer operation 5 months later. The results of both operations were satisfactory in 10 months follow up.
Follow-Up Studies ; Neural Tube Defects ; Scoliosis ; Spinal Cord

Ten cases of unstable spine were treated with various surgical procedures under control of Halo apparatus and following results wen obtained. 1. Six cases of unstable cervical spine were treated with Halo apparatus and were able to obtain solid fusion for permanent stability. 2. Three cases of tuberculous kyphosis were corrected with halo-pelvic hoop on, and were able to obtain mean correction angle of 42 (65%) with little danger. 3. With halo on, staged operations such as anterior and posterior osteotomy, gradual distraction, anterior and posterior fusion of the spine for correcting deformity were carried out securely. 4. Average duration of halo application was eight weeks, no more twelve weeks, and there was no irreversible complication with halo apparatus per se.
Congenital Abnormalities ; Kyphosis ; Osteotomy ; Spine

A clinical study of the tibial fracture was made on patients, total 234 tibias, who were treated at the Department of Orthopedic Surgery, Paik Hospital, Inje Medical College from 1974 to 1979. The results were as follows: 1. The ratio between male and female was 5. 5: 1 and majority was found between 3rd decade and 5th decade. 2. In the shape of fracture, commiuted fracture, transverse fracrure were common in order. 3. The most common cause of these fractures was traffic accident and the ratio between open and closed fracture was 1:2. 4. The most common associated injury was the fibular fracture. 5. More complications ensued in open reduction and internal fixation than in closed reduction. of 50 cases, which were treated by open reduction and internal fixation, delayed union in 32 cases (64%) and infection in 11 cases (22%) resulted. 6. In the treatment of open comminuted tibial fractures with skin and soft tissue loss or marked displacement, Hoffmans external fixation method and pin and resin external fixation method bad good results, Early motion of adjacent joint, easy care of wound and rigid fixation were obtained by it.
Accidents, Traffic ; Clinical Study ; Female ; Fractures, Closed ; Humans ; Joints ; Male ; Methods ; Orthopedics ; Skin ; Tibia ; Tibial Fractures ; Wounds and Injuries

Among 334 thoracolumbar spinal injury patients who were admitted to this hospital from June 1972 to June, 1982, 66 patients with fracture and fracture dislocation of thoraco-lumbar spine which were defined as unstable clinically and radiologically were treated with surgical measures. The ratio between male and female was 7.3:1, the majority was found in third and fourth decade (46 cases, 69%), and the most common cause of injury was falling from a height (38 cases, 58%). The most common site of the injury was lumbar spine (29 cases, 44%) and the most common mechanism of injury was flexion-rotation (29 cases, 44%). Our surgical measures were Harrington rod instrumentation with either anterior or posterior fusion (25 cases, 38%), posterior wiring and fusion (14 cases, 21%), anterior decompression and anterior fusion (14 cases, 21%), posterior fusion (4 cases, 6%), anterior fusion and posterior fusion (3 cases, 5%) and etc. The average correction of displacement was 65% and the average correction of kyphotic deformity was 50%. The most remarkable correction was found at the cases of Harrington rod instrumentation (71%, 74%). Neurological deficit had already developed in 43 cases(65%) prior to operation, and the recovery was observed in 18 cases(42%). Most excellent recovery of neural deficit was found also at the cases of Harrington rod instrumentation (11 cases, 52%). We have analysed the results of these treatment and obtained following conclusions. 1. For the unstable fracture and fracture-dislocation of thoraco-lumbar spine with or without neural involvement, immediate surgical treatments were valuable to expect restoration of anatomical reduction and promotion of every possible recovery of neural function with spinal stability and fewest complication. 2. Fixation with Harrington rod instrumentation appears to provide better reduction and stability with neural improvement than other methods, and therefore early undertaking of rehabilitation activities is possible. 3. For the patients who are seriously compromised or require anterior decompression, immediate posterior reduction and fixation with Harrington rod instrumentation followed anterior decompression and anterior fusion of the involved segments at the eariest feasible time, we feel, is the treatment of choice.
Accidental Falls ; Clinical Study ; Congenital Abnormalities ; Decompression ; Dislocations ; Female ; Humans ; Male ; Mortuary Practice ; Rehabilitation ; Spinal Injuries ; Spine

There was increasing tendency to stabilize unstable cervical spine injuries surgically with the benefit of good stability of the spine, easy nursing care, early mobilization and therefore early rehabilitation. A clinical study was performed on 47 patients with fractures and dislocations of the cervical spine treated at the department of orthopedic surgery, Inje Medical College, Paik Hospital from Jan. 1975 to Dec. 1981. Following is the summery of the our findings. 1. The prevalent age distribution was between 3rd and 6th decade and the ratio between males and females was 10:1. The most common cause of injuries was automobile accident (70%). 2. The most common site of the injuries was C5-6 (34%) and the most frequent mechanism of injury was flexion-rotation type (47%). 3. In overall patients, neurologic damage was found at first examination in 73% and among these, complete paralysis below the injured level in 26%, incomplete paralysis in 11% and nerve root injury in 35%. 4. Among 47 patients, conervative treatment was performed on 9 patients, anterior spinal fusion on 8 patients, anterior spinal fusion with Halo application on 4 patients, posterior wiring with posterior spinal fusion on 16 patients and posterior wiring with anterior spinal fusion on 8 patients. 5. In the several methods of treatment, the posterior wiring with anterior spinal fusion revealed the best results, the correction rate of displacement was 92%, the correction rate of angular deformity 98% and neural recovery rate 72%. 6. The posterior wiring with posterior spinal fusion revealed good results in correction of displacement and angular deformity but required rigid external support for a long time. The anterior spinal fusion revealed poor results in correction of displacement(67%) and angular deformity(38%) and required rigid external support for a long time and had increasing tendency of kyphotic angle after operation. 7. In the treatment of unstable cervical spine injury, we thoughy that early posterior reduction with posterior wiring and followed anterior spinal fusion was ideal for accurate reduction, rigid stability and early mobilization with simple external support.
Age Distribution ; Automobiles ; Clinical Study ; Congenital Abnormalities ; Dislocations ; Early Ambulation ; Female ; Humans ; Male ; Nursing Care ; Orthopedics ; Paralysis ; Rehabilitation ; Spinal Fusion ; Spine

No abstract available.
Cytogenetics*