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

No abstract available.
Goats* ; Skeleton*

No abstract available.
Goats* ; Mesencephalon* ; Periaqueductal Gray* ; Somatostatin*

Polymerase chain reaction (PCR) provides a powerful technique for identifying viruses and studying the homology between viral nucleic acids. However, PCR assay has limitations in its susceptibility to contamination or to enzymatic inhibitors. In order to avoid problems related to nucleic acid amplification, efforts have been made to obtain specific hybridization assays, such as dot blot hybridization (DBH). DBH has higher specificity and lower sensitivity than PCR. The aims of the present study were to develop a sensitive and specific assay for the detection of ovine herpesvirus 2 (OvHV-2), a gamma herpesvirus. PCR/DBH assay for detecting OvHV-2 DNA was developed and evaluated for its sensitivity and specificity. OvHV-2 specific primer pairs, 755/556, were used for the amplification of target DNA. When PCR product was visually detected, the limit of detection of the PCR test was 102 viral copies. For DBH, the amplified DNA with OvHV-2 specific primer pairs, 556/555, was labeled by the incorporation of digoxigenin (DIG). This DIGlabeled probe was capable of detecting 104 viral copies of purified OvHV-2 DNA by DBH. On the other hand, PCR/ DBH was more sensitive than either PCR or DBH and also very specific. The results showed that the sensitivity of PCR/DBH was higher and stronger than that of PCR and DBH alone. This PCR/DBH assay can be applied efficiently to confirm the presence of OvHV-2 virus on clinical samples and to differentiate specifically between OvHV-2 infection and other viral infections.
Digoxigenin ; DNA ; Hand ; Limit of Detection ; Nucleic Acids ; Polymerase Chain Reaction ; Sensitivity and Specificity

Purpose: Early recurrence of hepatocellular carcinoma (HCC) remains a challenging issue after hepatic resection (HR) because of the associated poor prognosis. Models for tumor recurrence after liver transplantation (MoRAL) have been designed to predict tumor recurrence in HCC patients in the liver transplantation setting. This study aimed to validate the predictability of MoRAL for HCC recurrence or patient death and to evaluate the predictors of early HCC recurrence in hepatectomy patients with treatment-naïve solitary HCC. Methods: This study included 443 patients with HCC recurrence after HR from January 2005 to December 2011. Patients were stratified into early recurrence (n = 312) and late recurrence (n = 131) groups according to the development of recurrence either within or more than 2 years after hepatectomy. Results: The median levels of alpha-fetoprotein and protein induced by vitamin K absence-II and the median MoRAL score were significantly higher in the early recurrence group than in the late recurrence group. Regarding pathologic characteristics, the median tumor size, prevalence of tumor grade 3 or 4, microvascular invasion, presence of tumor necrosis, and macrovascular invasion in the early recurrence group were greater than those in the late recurrence group.Multivariate analysis showed that tumor grade 3 or 4, microvascular invasion, and high preoperative MoRAL score were predisposing factors for early HCC recurrence after HR. Conclusion The MoRAL score can be used to predict early recurrence in patients with HCC who undergo curative HR.Using this model, other treatments could be considered for patients with early recurrence predicted after HR.

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We will discuss clinical outcomes of adult traumatic atlantoaxial rotatory subluxation (Fielding type I) and verify the correlation between the clinical outcomes and radiological reduction rate. SUMMARY OF LITERATURE REVIEW: Atlantoaxial rotatory subluxation which usually occur in children by non-traumatic sources or minor trauma has been discussed persistently. However, studies of atlantoaxial rotatory subluxation which occur in adults over 20 years old, especially by traumatic injury is rare. MATERIALS AND METHODS: From October 2004 to April 2011, thirty patients diagnosed of traumatic atlantoaxial rotatory subluxation with 6 months follow-up period were enrolled in the study. After diagnosis, we started treating Halter traction with 5 lbs. We discontinued traction when the patient recovered over 90% of ROM and applied Philadelphia collar to the patient. We measured visual analogue scale (VAS) for cervical pain and ROM. We measured atlanto-dens interval (ADI) and lateral mass-dens interval (LDI) difference using three-dimensional computed tomography (3D-CT) to validate radiological reduction rate. RESULTS: At the end of follow-up, none of the patients complained over pain and all recovered to full ROM. ADI was in normal range during the whole treatment period. LDI difference gradually decreased during treatment period, however, only 8 cases (26.7%) came back to normal range. CONCLUSIONS: In traumatic atlantoaxial rotatory subluxation (Fielding type I), satisfactory clinical outcomes such as pain relief or ROM improvement using traction and the radiological reduction rate was also improved but it failed to achieve a complete reduction of LDI difference in radiography.
Adult ; Child ; Follow-Up Studies ; Humans ; Neck Pain ; Philadelphia ; Porphyrins ; Reference Values ; Retrospective Studies ; Traction

OBJECTIVE: N-(3-iodopropene-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl)tropane(IPT) is a cocaine analogue which allows the presynaptic dopamine transporters. The aim of this study is to assess the imaging of dopamine transporters using 123I-IPT SPECT and its correlation with several clinical features of Parkinson's disease and Parkinson Plus syndrome. METHODS: Forty-two patients with Parkinson's disease(14 bilateral, 28 unilateral clinical features), three Parkinson Plus syndrome and five normal controls were studied. All patients with Parkinson's disease were evaluated with Hoehn-Yahr scale, UPDRS(on/off stage), duration, main symptoms(rigidity, tremor, bradykinesia), unilaterality and operation. The two statistical parameters were assessed with 123I-IPT SPECT. One is uptake ratio of basal ganglia and occipital cortex, basal ganglia and cerebellum. The other is three graded visual assessment. RESULTS: The uptake ratio of 123I-IPT SPECT in patients with Parkinson's disease were decreased with higher grade of Hoehn-Yahr scale, and more decreased in 2 hours than in 1 hour. But there was no statistical significance. The visual assessment was significantly correlated with Hoehn-Yahr scale(p<0.045). The early differential diagnosis between Parkinson's disease and Parkinson Plus syndrome could be allowed with visual assessment. But other clinical features of Parkinson's disease was not correlated with finding of 123I-IPT SPECT. CONCLUSION: The visual assessment of 123I-IPT SPECT imaging is useful in the early differential diagnosis and in confirming a clinical severity of Parkinson's disease.
Basal Ganglia ; Cerebellum ; Cocaine ; Diagnosis* ; Diagnosis, Differential ; Dopamine ; Humans ; Parkinson Disease* ; Tomography, Emission-Computed, Single-Photon* ; Tremor

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: 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*

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