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* ; Mesencephalon* ; Periaqueductal Gray* ; Somatostatin*

No abstract available.
Goats* ; Skeleton*

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.

PURPOSE: A choledochoscopy is useful for treating stone disease in the biliary tract. In the era of laparoscopic surgery, this method is expected to be used more widely. Its use during surgery may not only aid disease treatment, but may also help in making a differential diagnosis and a decision on the appropriate operative method. The aim of this study was to determine the role of intraoperative choledochoscopy in biliary surgery. METHODS: This study was a prospective analysis for 119 cases of biliary surgery where a choledochoscopy was used at the Ewha Womans University Mokdong Hospital from June, 1999 to February, 2001. An attempt was made to determine if the use of choledochoscopy altered the preoperative diagnosis, added another diagnosis and influenced the surgical treatment. In addition, the frequency of the remnant stones in biliary stone disease, and the complications related with this procedure were evaluated. RESULTS: The male to female ratio was 1:1.53, and the mean age was 61.1 (+/-14.53) years. A choledochoscopy was used in 82 cases (69%) in open surgery, and 37 cases (31%) in laparoscopic surgery. In 31 cases (26.1%), the diagnosis was changed by the choledochoscopic findings. In 9 cases (7.5%), new finding that was not recognized in the preoperative state was added with the use of choledochoscopy. The surgical method was influenced by the use of a choledochoscopy in 39 cases (32.8%). The remnant stones in patients with an intrahepatic duct stone and common bile duct stone were detected in 8 cases and 3 cases, respectively. The respective clearance rate of the stones were 79.5% (31/39) and 94.5% (52/55). There was no complications and side effects associated with the use of choledochoscopy. The mean time for diagnostic use was 14.6 (+/-10.0) minutes and for therapeutic use was 47 (+/-60.4) minutes. CONCLUSION: Intraoperative choledochoscopy provided useful information for a precise diagnosis and assisted in determining the appropriate treatment for biliary disease. Furthermore, it is very important for making a differential diagnosis in patients with an undetermined malignancy.
Biliary Tract ; Common Bile Duct ; Diagnosis* ; Diagnosis, Differential ; Female ; Humans ; Laparoscopy ; Male ; Prospective Studies

OBJECTIVE: Bilateral C1-2 transarticular screw fixation (TAF) with interspinous wiring has been the best treatment for atlantoaxial instability (AAI). However, several factors may disturb satisfactory placement of bilateral screws. This study evaluates the usefulness of unilateral TAF when bilateral TAF is not available. METHODS: Between January 2003 and December 2007, TAF was performed in 54 patients with AAI. Preoperative studies including cervical x-ray, three dimensional computed tomogram, CT angiogram, and magnetic resonance image were checked. The atlanto-dental interval (ADI) was measured in preoperative period, immediate postoperatively, and postoperative 1, 3 and 6 months. RESULTS: Unilateral TAF was performed in 27 patients (50%). The causes of unilateral TAF were anomalous course of vertebral artery in 20 patients (74%), severe degenerative arthritis in 3 (11%), fracture of C1 in 2, hemangioblastoma in one, and screw malposition in one. The mean ADI in unilateral group was measured as 2.63 mm in immediate postoperatively, 2.61 mm in 1 month, 2.64 mm in 3 months and 2.61 mm in 6 months postoperatively. The mean ADI of bilateral group was also measured as following; 2.76 mm in immediate postoperative, 2.71 mm in 1 month, 2.73 mm in 3 months, 2.73 mm in 6 months postoperatively. Comparison of ADI measurement showed no significant difference in both groups, and moreover fusion rate was 100% in bilateral and 96.3% in unilateral group (p=0.317). CONCLUSION: Even though bilateral TAF is best option for AAI in biomechanical perspectives, unilateral screw fixation also can be a useful alternative in otherwise dangerous or infeasible cases through bilateral screw placement.
Hemangioblastoma ; Humans ; Magnetic Resonance Spectroscopy ; Osteoarthritis ; Preoperative Period ; Vertebral Artery

Doxazosin is an adrenergic alpha-1 receptor antagonist used to treat lower urinary tract symptoms that are common in prostatic hyperplasia. To our knowledge, few cases of gynecomastia and mastodynia, as a complication of adrenergic alpha-1 receptor antagonist, have been reported to date; no cases have been reported in Korea. We describe a case involving a 78-year-old man treated for prostatic hyperplasia with 13 months of doxazosin. He complained about unilateral gynecomstia and mastodynia. Five months after the discontinuation of doxazosin, the gynecomastia was significantly improved. This is the first reported case of gynecomastia and mastodynia associated with doxazosin use in Korea.
Aged ; Doxazosin* ; Gynecomastia* ; Humans ; Korea ; Lower Urinary Tract Symptoms ; Male ; Mastodynia ; Prostatic Hyperplasia

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