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.

PURPOSE: To compare a laparoscopic common bile duct (CBD) exploration with the open method with regards to the clinical outcome in the treatment of a CBD stone. METHODS: A comparative study was performed on 88 patients who underwent surgical treatment for a CBD stone at Ewha Womans University Mokdong Hospital from February 1997 to December 2001. The patients were divided into three groups; a group treated by a laparoscopic CBD exploration (group L, n=59), a group treated by open surgery (group O, n=22), and a group converted to open surgery during laparoscopic treatment (group C, n=7). The medical records were reviewed, and the follow-ups study of the quality of life was assessed with a questionnaire on the symptoms associated with cholangitis. RESULTS: Among the 3 groups, there was no difference in the preoperative status of the patients (age, sex, preoperative comorbidity and previous abdominal operation history). The mean operating time were 230.7 minutes in group L, 182.0 minutes in group O, and 247.9 minutes in group C (P>0.05). The time to diet and hospital stay was longer in group C than the others (P<0.05). The postoperative complications were 10.5% in group L, 40.9% in group O and 14.3% in group C. The symptoms of cholangitis by the questionnaire during the follow-up period were 2.7% in group L, 33.3% in group O, and 66.7% in group C. CONCLUSION: Laparoscopic CBD exploration has acceptable operative difficulties, less morbidity, and good follow-up quality of life compared to the open method in treating CBD stones.
Cholangitis ; Common Bile Duct* ; Comorbidity ; Diet ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Medical Records ; Postoperative Complications ; Quality of Life ; Surveys and Questionnaires

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

OBJECTIVE: Lumbar lordotic curve on L4 to S1 level is important in maintaining spinal sagittal alignment. Although there has been no definite report in lordotic value, loss of lumbar lordotic curve may lead to pathologic change especially in degenerative lumbar disease. This study examines the changes of lumbar lordotic curve after posterior lumbar interbody fusion with wedge shape cage. METHODS: We studied 45patients who had undergone posterior lumbar interbody fusion with wedge shape cage and screw fixation due to degenerative lumbar disease. Preoperative and postoperative lateral radiographs were taken and one independent observer measured the change of lordotic curve and height of intervertebral space where cages were placed. Segmental lordotic curve angle was measured by Cobb method. Height of intervertebral space was measured by averaging the sum of anterior, posterior, and midpoint interbody distance. Clinical outcome was assessed on Prolo scale at 1month of postoperative period. RESULTS: Nineteen paired wedge shape cages were placed on L4-5 level and 6 paired same cages were inserted on L5-S1 level. Among them, 18patients showed increased segmental lordotic curve angle. Mean increased segmental lordotic curve angle after placing the wedge shape cages was 1.96? Mean increased disc height was 3.21mm. No cases showed retropulsion of cage. The clinical success rate on Prolo's scale was 92.0%. CONCLUSION: Posterior lumbar interbody fusion with wedge shape cage provides increased lordotic curve, increased height of intervertebral space, and satisfactory clinical outcome in a short-term period.
Postoperative Period

PURPOSE: To evaluate the safety of a laparoscopic cholecystectomy in acute, or complicated, cholecystitis in patients older than sixty. METHODS: A prospective study was performed, at the Ewha Womans University Mokdong Hospital, on a series of elderly patients (>60 years; n=137) who had undergone a laparoscopic cholecystectomy due to acute, or complicated, cholecystitis between March 1997 and December 2001. We divided the patients into 3 groups; ASA 1 (n=33, 24.1%), ASA 2 (n=79, 57.7%) and ASA 3 (n=25, 18.3%), according to their ASA (American Society of Anesthesiologist) classification. No patient was categorized as either ASA 4, 5 or 6. RESULTS: The mean age of the ASA 3 patients was 71.9+/-6.9 years, which was older than the 65.7+/-6.0 years of the ASA 1 patients (P<0.05). The preoperative hospital stay for the ASA 3 patients was 8.8+/-5.6 days, compared to 5.6+/-3.7 days for the ASA 1 patients (P<0.05). The incidences of complicated cholecystitis were lower in the ASA 1 (n=8, 24.2%) than in both the ASA 2 (n=40, 50.6%) and 3 patients (n=12, 66.7%) (P<0.05). The mean operating times for the ASA 2 and 3 patients were longer, at 111.0+/-58.2 and 114.0+/-62.7 minutes, retrospectively, than the 85.0+/-33.1 minutes for the ASA 1 patients (P<0.05). Drain insertions were more frequently performed in the ASA 2 (n=33, 44.4%) and 3 (n=15, 60.0%) than in the ASA 1 patients (n=10, 30.3%) (P<0.05). Postoperative morbidity was more frequent in the ASA 3 (n=5, 20.0%) than ASA 1 (n=3, 9.1%) patients. However, in terms of the postoperative recovery parameters (time to diet, hospital stay), there were no difference between the three groups (P>0.05). One death, due to acute myocardial infarction, occurred in one of the ASA 3 patients. CONCLUSION: A laparoscopic cholecystectomy in acute, or complicated, cholecystitis could be an option in elderly-high risk patients.
Aged ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Classification ; Diet ; Female ; Humans ; Incidence ; Length of Stay ; Myocardial Infarction ; Prospective Studies ; Retrospective Studies