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 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

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

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