No abstract available.
Mass Screening* ; Tomography, X-Ray Computed*

PURPOSE: To evaluate the ability of percutaneous ethanol ablation in the treatment of benign cysts of the liver and kidney, and to decide the need and the time of retreatment when the cysts remain on the follow-up ultrasonogram. MATERIALS AND METHODS: Twenty benign cysts(8 hepatic and 12 renal cysts) in 18 patients diagnosed or confirmed either by ultrasound, CT or cytology were treated with percutaneous ethanol injection(PEI). After evacuation of cystic fluid, 15-900ml(amount corresponding to 40-50% of the volume of aspirated fluid) of absolute ethanol(99.9%) was injected into the cysts through the aspiration catheter. rln large cysts, two or more PEIs were done in one session. Follow-up ultrasonographic studies during the period of 12 months with 1-2 months interval after PEI were performed for evaluation of the therapeutic effect. RESULTS: Nine cysts(45%) disappeared completely within 2 months after initial PEI. Although 11 cysts(55.5%) recurred 2 months after initial PEI, 8 of them disappeared within 6 months and one within 8 months after inital PEI without additional PEI. As a result, 18 of 20 cysts(90%) disappeared within 8 months after initial PEI and most of the recurrent cysts disappeared within 6 months without additional PEI. No major complications were encountered concerning PEI, although transient abdominal pain, elevation of body temperature, and drowsiness were noted in 8 patients. CONCLUSION: PEI is an effective and safe modality for the treatment of benign hepatic or renal cysts and the apparent recurrence within 6 months after initial PEI might be mostly a transient, reactive or inflammatory fluid collection rather than real recurrence.
Abdominal Pain ; Ameloblastoma* ; Ameloblasts ; Body Temperature ; Catheters ; Dentigerous Cyst ; Ethanol* ; Follow-Up Studies* ; Humans ; Kidney ; Liver ; Lung ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Recurrence ; Retreatment ; Retrospective Studies ; Sleep Stages ; Tooth, Unerupted ; Ultrasonography

Purpose: Nrf2 regulates antioxidant protein expression and protects against drug toxicity and oxidative stress, whereas Keap1 controls Nrf2 activity. The Keap1-Nrf2 pathway affects the prognosis of various cancers, however, its effect on cholangiocarcinoma chemoresistance and prognosis remains unclear. This study aimed to determine whether the Keap1-Nrf2 pathway affects chemoresistance and prognosis of distal cholangiocarcinoma. Methods: We investigated the correlation between Nrf2 and Keap1 expression and clinical characteristics and prognosis in 91 patients with distal cholangiocarcinoma who underwent curative surgery. Immunohistochemical staining was performed on paraffin blocks using primary antibodies against Nrf2 and Keap1. The relationship between Keap1 and Nrf2 protein expression levels, and clinical characteristics and prognosis was examined. Results: Nrf2 expression was not associated with overall survival in patients who did not receive adjuvant chemotherapy (P=0.994). Among patients receiving adjuvant chemotherapy, the Nrf2 low expression group had a significantly longer median overall survival than the Nrf2 high expression group in Kaplan-Meier survival analysis (P=0.019). In multivariate analysis, high expression of Nrf2 was confirmed as an independent poor prognostic factor in the group receiving adjuvant chemotherapy (P=0.041). Conclusion This study suggests that Nrf2 overexpression reduces the efficacy of adjuvant chemotherapy in distal cholangiocarcinoma.

Until now, there have been few reports of laparoscopic spleen preserving distal pancreatectomies with the conservation of the splenic vessels. We experienced two cases of a laparoscopic spleen preserving distal pancreatectomy, with the conservation of the splenic artery, vein and short gastric vessels. One case was in a 52 years old woman. The patient was preoperatively diagnosed with a nonsymptomatic cystadenoma, which measured 7 cm in diameter at the tail of pancreas. The procedure used was a 70% distal pancreatectomy, with preservation of the spleen, including the splenic vessels. Three 10 mm ports, one 15mm port and one linear stapler (EndoGIA60(R)) were used for the procedure. A 3 cm incision, extending 15 mm to the trocar site, was used for the extraction of the specimen. The total operative time was 435 minutes. The patient was discharged on the 8th postoperative day with no problems. The other case was in a 61 years old woman. The patient was preoperatively diagnosed with a symptomatic cystadenoma, which measured 3 cm in size at the body of the pancreas. The procedure used was an 85% distal pancreatectomy, employed the same method as the previous case, with the exception that an EndoGIA30(R) was used for the resection of pancreas in place of the EndoGIA60(R). The total operative time was 400 minutes. The patient was discharged on 9th postoperatvie day, with no problems. There was no morbidity and mortality during hospitalization. A laparoscopic spleen splenic vessels, could be an alternative treatment in selective preserving distal pancreatectomy with the conservation of the patients with benign pancreatic neoplasms.
Cystadenoma ; Female ; Hospitalization ; Humans ; Laparoscopy ; Middle Aged ; Mortality ; Operative Time ; Pancreas ; Pancreatectomy* ; Pancreatic Neoplasms ; Spleen* ; Splenic Artery* ; Surgical Instruments ; Veins*

PURPOSE: Currently, in treatment of symptomatic common bile duct (CBD) stone, the endoscopic retrograde cholagiopancreatography (ERCP) is usually carried out as an initial evaluation and removal of CBD stones. But, many cases necessitate surgical exploration of CBD and stone removal. Recently, laparoscopic CBD exploration (LCBDE) procedure is increasing due to the high success rate of stone clearance with the easy use of a choledochoscope and the advantage of less aggressive laparoscopic procedure properties. We reviewed the long-term results and efficacy of LCBDE in relation to traditional open CBDE results to demonstrate the superiority of LCBDE. METHODS: From July 1997 until July 2007, 189 consecutive patients with CBD stones were enrolled in a retrospective study. Those patients were divided into two-groups: Laparoscopic CBDE (group L) and Open CBDE (group O), and compared the patients' clinical characteristics, postoperative outcomes and follow up data. RESULTS: Of 189 patients who underwent successful CBD exploration, 66 (34.9%) were open group and 123 (65.1%) were laparoscopic group. Stone clearance rate was 100% in both groups. The mean operation time, incidence of postoperative complications and hospital days had no significant difference between the two groups (P>0.05). The cases of T-tube insertion and recurrence of CBD stone were significantly more in open group (P<0.05). CONCLUSION: On investigation of long-term follow up data of the two groups, CBD stone recurrence cases were significantly fewer in laparoscopic group. The lower incidence of complication and stone recurrence is evidence of the superiority of laparoscopic procedure in CBD exploration and removal of CBD stones.
Choledocholithiasis ; Common Bile Duct ; Follow-Up Studies ; Humans ; Imidazoles ; Incidence ; Nitro Compounds ; Postoperative Complications ; Recurrence ; Retrospective Studies

PURPOSE: The aim of this study is to assess the long-term results of laparoscopic common bile duct exploration (LCBDE) and validate its effectiveness as a primary treatment modality for CBD stone. METHODS: A retrospective review of the medical records of 157 patients who underwent LCBDE from 1997 to 2011 was conducted. All LCBDE were performed by choledochotomy. Clinical demographics, operative outcome, recurrence rate of CBD stones, and long-term bile duct complications were analyzed. The mean follow-up period was 51.9 months. RESULTS: LCBDE was completed in 152 patients (96.8%) and 5 patients (3.2%) had open conversion. The male/female ratio was 78/79 and mean age was 67.3 years. Stone clearance was successful in 149 of 152 patients (98.0%). Nonlethal complications were noted in 11 patients (7.2%), including bile leakage in 6 patients (3.9%). Recurrent CBD stones developed in 9 of 152 patients (5.9%). Preoperative endoscopic sphincterotomy (P = 0.492) and choledochotomy repair type (T-tube drainage vs. primary closure, P = 0.740) were not significantly related to stone recurrence. There were no signs of any type of biliary injury or stricture observed in any of the patients during the follow-up period. CONCLUSION: LCBDE can be performed without increased risk of long-term complications such as bile duct stricture and recurrent CBD stones. LCBDE is a safe and effective treatment option for choledocholithiasis in terms of long-term outcome as well as short-term outcome.
Bile ; Bile Ducts ; Choledocholithiasis* ; Common Bile Duct* ; Constriction, Pathologic ; Demography ; Drainage ; Follow-Up Studies ; Humans ; Laparoscopy ; Medical Records ; Recurrence ; Retrospective Studies ; Sphincterotomy, Endoscopic

PURPOSE: Laparoscopic splenectomy (LS) is one method for treatment of various diseases of the spleen, especially hematological conditions. However, few recent long-term follow-up results have been reported. The purpose of this study is to evaluate the outcome of patients in a single institution who recently underwent LS and to analyze their long-term follow-up results. METHODS: Of 366 splenectomies, this study was conducted as a retrospective review of 52 patients who underwent LS for treatm ent of hematological or primary diseases of the spleen from January 1998 to October 2011. The data included age, sex, pathological diagnosis, operative time, postoperative hospital stay, rate to open conversion, perioperative transfusion, morbidity, mortality, and relapse. We analyzed outcomes of variable results through long-term follow-up. RESULTS: The mean follow-up period was 84 months (range, 4~147 months). The most common indication for LS was immune thrombocytopenic purpura (ITP). The median postoperative hospital stay was eight days (range, 3~28 days). Mean operative time was 203 minutes (range, 115~475 minutes). Two patients underwent open conversion. Thirty eight patients received perioperative transfusions. The mean spleen weight was 294.9 g (range, 31~2,564 g). The overall morbidity rate was 5.8% and one patient experienced relapse. Of the 28 patients with ITP, 89.3% responded to LS. CONCLUSION: LS should be one of the best treatment options regardless of splenomegaly and spleen-associated diseases. In particular, for patients with ITP, LS has shown very effective long-term follow-up results. Therefore, LS should be more actively considered as an early treatment option in surgical disease of the spleen, such as ITP.
Diagnosis ; Follow-Up Studies ; Hematologic Diseases ; Humans ; Length of Stay ; Methods ; Mortality ; Operative Time ; Purpura, Thrombocytopenic, Idiopathic ; Recurrence ; Retrospective Studies ; Spleen* ; Splenectomy* ; Splenomegaly

Purpose: The purpose of this study was to investigate the recurrence factors of choledocholithiasis after common bile duct (CBD) exploration. Methods: From January 2000 to December 2018, we retrospectively reviewed 253 patients who underwent CBD exploration surgery. We excluded 100 cases who had residual stone, combined major surgery, or follow-up loss after surgery. Total of 153 patients were included, and we investigated the recurrence factors of choledocholithiasis. Various variables such as patients’ demographics, gallstones, preoperative endoscopic treatment, and laboratory data were analyzed to find factors related to recurrent choledocholithiasis. Results: The median follow-up period was 20.6 months (range 4.7–219 months), and 27 patients (17.6%) had experienced recurrent choledocholithiasis. Univariate analysis showed that the following variables were associated with recurrence of choledocholithiasis; preoperative leukocytosis (white blood cell ≥ 11,000/µL), open procedure, T tube insertion, long hospital duration, and long operation time. Logistic regression multivariate analysis identified preoperative leukocytosis (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.21–9.73; p = 0.021), open procedure (OR, 5.54; 95% CI, 4.73–6.35; p = 0.037), and T-tube insertion (OR, 2.82; 95% CI, 1.04–7.65; p = 0.042) as independent predictors of recurrent choledocholithiasis. Conclusion Because of delayed recurrence of choledocholithiasis, it is recommended to continue follow-up of patients after CBD exploration surgery. Laparoscopic surgery was observed to be associated with a reduction in recurrence. The preoperative leukocytosis and clinical conditions in which open surgery is performed could be associated with recurrence of choledocholithiasis. However, further study is necessary to validate the result.

The presence of a bystander who can implement cardiopulmonary resuscitation would appear to increase chances of survival. However, there have been many reported complications associated with bystander CPR. Gastric rupture is a rare complication following cardiopulmonary resuscitation. An incidence of 0.1% has been reported in the literature. The majority of reported cases have been associated with inappropriate airway management or esophageal intubation. Gastric rupture can occur during chest compressions when the stomach is overinflated due to difficult airway management or esophageal intubation. Here we present the case of a patient with sudden cardiac arrest who experienced gastric rupture and pneumoperitoneum after bystander cardiopulmonary resuscitation.
Airway Management ; Cardiopulmonary Resuscitation ; Death, Sudden, Cardiac ; Humans ; Incidence ; Intubation ; Pneumoperitoneum ; Stomach ; Stomach Rupture ; Thorax

PURPOSE: Sulphomucin is secreted by immature foveolar cells of the stomach and is expressed in gastric adenocarcinomas. Carcinoembryonic antigen (CEA) is well known to be expressed in gastric adenocarci nomas and is correlated with the cellular differentiation of gastric adenocarcinomas. However, at the moment, there are no conclusions about the relationships between the expression of sulphomucin and pathological classifications. METHODS: This study was designed to determine the significance of expression of sulphomucin and CEA in advanced gastric adenocarcinomas. Also, these two factors were compared with established clinicopathological prognostic factors. Thirty-two paraffin-embedded surgical specimens of gastric adenocarcinomas were obtained from January 1993 to December 1995 and were selected for study. The expressions of sulphomucin and CEA were studied by using the Spicer method and immunohistochemical staining with CEA 2-7 monoclonal antibody. RESULTS: The expressions of sulphomucin and CEA were positive in 9 (28%) cases and 25 (78%) cases, respectively. There was a significant correlation between sulphomucin expression and histologic differentiation (p<0.05). However, the expression of CEA was correlated with neither clinopathological factors nor sulphomucin expression. CONCLUSION: These results suggest that expressions of sulphomucin are well correlated with cellular differentiations of advanced gastric adenocarcinomas.
Adenocarcinoma* ; Carcinoembryonic Antigen ; Classification ; Noma ; Stomach