To a better understanding for molecular mechanism of oncogenesis in hepatoma, primary hepatocellular carcinoma and hepatoma cell lines (Hep 3B, PLC/PRP/5, Hep G2) were subjected to detailed cytogenetic analysis with G-banding method after cell cultures. No cloned chromosomal abnormalities were found in the primary hepatoma (below 100%). On the other hand, all hepatoma cell lines were cloned, the specific chromosomal abnormalities in Hep 3B were del(1p21), del(6q14) and t(1 ; 11)(pll ; q13). Genes of AMY1A, CGA, SEA and HSTF1 were located on 1p21 and 6q14 respectively. SEA and HSTF1 were located on 11q13. Regions of chromosome abnormalities in PLC/PRF/5 were the same found in Hep 3B. Besides, del(1q32) and del(1p32) were also cloned. Gene of CR1 and MYCL1 were located on 1q32 and 1p32 respectively. The characteristic findings of chromosome abnormalities in Hep G2 were del(1p31) and del(1q22). And GST1 and DAF were located on these regions each other Del(6q11) and del(1p22) were also found in Hep G2. From the above results, it is presumed that HBV may integrate to AMY1A gene or near this gene and leads to loss of functions to this gene. And impaired regulation of CGA occurs in next step. SEA, HSTF1 and MYCL1 oncogenes may act as a progressing factor of tumourgenesis in HBsAg(+) hepatoma. Some factors like chemical agents may cause functional loss of GST1 and DAF at first and functional loss of cell regulation of CGA occurs in next step. SKI oncogene may promote the progression of carcinogenesis in this cell line. Whether any causative agents are involved in carcinogenesis of hepatoma, functional loss of CGA gene is the most important factor in tumour-genesis in hepatoma.
Carcinogenesis ; Carcinoma, Hepatocellular* ; Cell Culture Techniques ; Cell Line ; Chromosome Aberrations* ; Clone Cells ; Cytogenetic Analysis ; Hand ; Humans* ; Methods ; Oncogenes

PURPOSE: Laparoscopic cholecystectomy has become the standard modality of acute and chronic gallbladder disease. This study was performed to evaluate a change in the indication for laparoscopic cholecystectomy according to period by analyzing our experiences. METHODS: We retrospectively analyzed 2,096 cases of laparoscopic cholecystectomy that were treated at the Department of Surgery, Dong-A University. They were divided into 3 groups from October 1992 to December 1996 (Group 1), from January 1997 to December 2001 (Group 2) and from January 2002 to March 2007 (Group 3). RESULTS: The mean age was 50.14+/-13.89 years and the male-to-female ratio was 1 : 1.23. Previous abdominal surgery was noted in 12.24% from Group 1, 14.96% from Group 2 and 21.48% from Group 3. Chronic cholecystitis was the most common pathologic diagnosis in all cases. However, while the incidence of acute cholecystitis and gallbladder empyema in Group 1 was 3.36% and 0%, that of Group 2 was 12.52% and 3.88% and that of Group 3 was 31.79% and 7.59%, which was increased. The mean operation time of each group was 101.00+/-51.00, 69.86+/-40.55, 78.01+/-45.55 minutes (P<0.05). The conversion rate of each group was nine cases (6.04%), 21 cases (3.02%), and 51 cases (4.07%). The surgical complication rate was 7.38%, 3.88% and 4.71%, respectively. The length of hospital stay was 6.08+/-3.65, 3.16+/-2.99 and 2.91+/-3.34 days, which was significantly decreased (P<0.05). CONCLUSION: As surgical experience increased and laparoscopic surgical skills developed, the indication for laparoscopic cholecystectomy changed. The results of this study showed that laparoscopic cholecystectomy was feasible for the treatment of complicated gallbladder lesion.
Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Gallbladder ; Gallbladder Diseases ; Incidence ; Length of Stay ; Retrospective Studies

BACKGROUND/AIMS: Solid and papillary epithelial neoplasm (SPEN) of the pancreas is a rare malignant tumor with a characteristic female predominance. This tumor has a low- grade malignant potential biologically, and shows favorable prognosis with surgical treatment clinically. METHODS: Nine patients with SPEN of the pancreas who were pathologically confirmed at the Dong-A University Medical Center were analyzed retrospectively. Clinical data, including clinical manifestation, diagnostic maneuvers, surgical treatment modality, and prognosis were evaluated. RESULTS: Six out of nine patients were females with a mean age of 28 (range, 15~52) years. Except in 2 cases, all patients presented with either a palpable abdominal mass (5 cases) or abdominal pain (2 cases). The tumors ranged in size from 3.8 to 18 (average size, 11.4) cm. Five were located in the body, 3 in the tail, and 1 in the head. SPEN was diagnosed preoperatively in 6 patients by abdominal ultrasonography and/or CT. All patients underwent surgical resection, which included subtotal pancreatectomies (4 cases), distal pancreatectomies (4 cases, 1 by laparoscopically) and local excision (1 case). All patiests are survived without evidence of recurrence with a mean follow up of 53.1 (range, 26~69) months. CONCLUSION: SPEN of the pancreas is low-malignant in character, and complete surgical excision is the treatment of choice which warrants a long-term survival.
Abdominal Pain ; Academic Medical Centers ; Female ; Follow-Up Studies ; Head ; Humans ; Neoplasms, Glandular and Epithelial* ; Pancreas* ; Pancreatectomy ; Prognosis ; Recurrence ; Retrospective Studies ; Ultrasonography

STUDY DESIGN: We analyzed the segmental mobility of the lumbar spine after anterior stabilization in the thoracolumbar spinal fractures, and the data were compared with those obtained from an asymptomatic control group. OBJECTIVE: To determine the effects of anterior stabilization on the unfused segments of the lumbar spine. SUMMARY OF LITERATURE REVIEW: Spinal fusions are commenly used to stabilize unstable motion segments and to help the maintenance of correction afforded by the instrumentation applied in surgery for spinal deformity or injuries. How the presence of the fusion effects upon the remaining infused spine is not well understood. MATERIALS AND METHODS: We measured the segmental deformations of the lumbar spine radiologically, from maximum flexion to maximum extension, right and left maximum lateral bending, in 20 asymptomatic volunteers( the control group ) and 30 patients who had the anterior stabilization of the thoracolumbar spinal fractures(the study group). We assessed the percentage of segmental deformations which were obtained by multipling one hundred after the segmental deformation value was divided by the total lumbar deformation value. We made the comparison between the White and Panjabi's results and the control group, between the control group and the study group, between the segmental deformations and the percentage of segmental deformations. RESULTS: In the control group , the segmental deformations were smaller than those of the corresponding segmenus in the White and Panjabi's results. In the flexion-extension rotation of the lumbarspine, the segmental deformations had a tendency to increase from cephalad to caudal in the controland study group. In the residual lumbar spinal mobility, the segmental deformations of the study group had decreased rather than those of the control group. Especially the segmental deformation below the juxtafused segment had increased more than those of the corresponding segment of the control group in the right lateral bending rotation. The residual lumbar spinal mobility tended to decrease from T12 vertebral stabilization to L2 vertebral stabilization. CONCLUSION: The unfused segments had accommodated a greater percentage of segmental deformations in spite of diminishing the segmental deformations in comparison with those of the corresponding control subjects. It suggests that the greater percentage of segmental deformations predisposes to early degeneration of unfused segments.
Congenital Abnormalities ; Humans ; Spinal Fractures* ; Spinal Fusion ; Spine

No abstract available.
Echocardiography, Transesophageal* ; Mitral Valve*

Colonoscopy is a safe procedure performed routinely worldwide. Splenic rupture is a rare complication of colonoscopy with several reported cases since 1974. We report the first case of a complication in the Republic of Korea. The literature on this rare complication is also reviewed here, with focus on the analysis of risk, diagnosis, and treatment. A 77-year-old patient receiving oral aspirin underwent colonoscopy with polypectomy. After 24 hours, the patient experienced dizziness and hypotension. Colonoscopy was performed to exclude intestinal bleeding, which could be diagnosed with hemoperitoneum. A computed tomography scan showed copious abdominal free blood and a splenic rupture. An urgent splenectomy was performed, which was the recognized procedure of choice. Physicians should have greater awareness of the possibility of splenic rupture following colonoscopy in order to avoid delay of diagnosis and treatment for this life-threatening complication.
Aged ; Colonoscopy/*adverse effects ; Hemoperitoneum/diagnosis ; Hemorrhage ; Humans ; Male ; Splenectomy ; Splenic Rupture/*diagnosis/etiology/surgery ; Tomography, X-Ray Computed

BACKGROUND: We understand that central parenteral nutrition has a wide range of technical, metabolic, and septic complications and that lipid-based parenteral nutrition, like Total Nutrients Admixture (TNA), is more physiologic than glucose-based parenteral nutrition. Peripheral parenteral nutrition has become more convenient sinse the introduction of the TNA system and the development of large-bored silicon venous catheters. We have administered peripheral TNA (p-TNA) selectively to patients in whom central vein access is difficult or in whom central vein access is not required in case of surgical observation with conservative therapy for a certain period. We investigated the convenience and effectiveness of p-TNA in this study. METHOD:We evaluated retrospectively 50 patients to whom p-TNA had been administered at the Department of Surgery, Wallace Memorial Baptist Hospital, sometime during the year from Dec. 1996 to Nov. 1997. RESULT:In the Subjective Global Assessment (SGA) designed by Detskey et al. as a method of nutritional status assessment before administration of p-TNA, Class A was 24%, Class B was 64%, and Class C was 12%. Common indications for p-TNA were recent GI anastomosis in 19 cases (38%), acute pancreatitis in 8 cases (16%), and prolonged ileus or delayed gastric emptying in 6 cases (12%). Most patients were administered 1.5~2 L daily, and the maximal daily administered volume was 2.5 L. The mean duration of administration was 9.5 day, and no patients was administered p-TNA for longer than 2 weeks. Nutritional status indices, like body weight, transferrin, 24h-UUN, and lymphocyte count, were checked serially after administration of p-TNA. Nutritional status indices improved in above 80% of the cases. Clinical progress was improved in 86% of patients. CONCLUSION:We believe p-TNA used under the proper indications to be efficacious and safe and to have fewer complications. The lipid, as the major calorie source is more physiologic, so p-TNA can supply patients with improved nutritional status easily.
Body Weight ; Catheters ; Gastric Emptying ; Humans ; Ileus ; Lymphocyte Count ; Nutritional Status ; Pancreatitis ; Parenteral Nutrition ; Protestantism ; Retrospective Studies ; Silicones ; Transferrin ; Veins

Heterotopic pancreas (HP) is defined as pancreatic tissue lacking anatomic and vascular continuity with the main body of the pancreas. Most are asymptomatic, but can cause ulcer, bleeding, intussusception, and mechanical obstruction. Herein, we presented one case of HP presented as duodenal tumor causing duodenal obstruction. A 7-year-old girl visited the emergency room for abdominal pain with vomiting for 24 hours. Computed tomography and upper gastrointestinal series revealed a polypoid mass with short stalk in the 2nd portion of duodenum. We attempted an endoscopic removal. However, the lumen was nearly obstructed by the mass and the stalk was too broad and hard to excise. The mass was surgically removed via duodenotomy. It was confirmed as a HP with ductal and acini components (type 2 by Heinrich classification). Postoperatively, the patient has been well without any complication and recurrence.
Abdominal Pain ; Child ; Duodenal Neoplasms ; Duodenal Obstruction ; Duodenum ; Emergency Service, Hospital ; Female ; Hemorrhage ; Humans ; Intussusception ; Pancreas* ; Recurrence ; Ulcer ; Vomiting

PURPOSE: The aim of this study was to compare three types of hernioplasty using a mesh: Lichtenstein, Mesh-plug and Prolene Hernia System. METHODS: From February 2002 to April 2007, we retrospectively studied the clinical outcome of 138 cases of adult inguinal hernia patients who had operations performed with the use of mesh. Three types of mesh operations were composed of Lichtenstein repair group (LR group; N=18), Mesh plug repair group (MR group; N=38) and Prolene hernia system group (PHS group; N=82). The Clinical features and outcomes of the three groups were compared by age, sex, operation time, lengths of hospital stay, numbers of post-operative intravenous analgesics, complications, and recurrence. RESULTS: Mean age of three groups was 50.2+/-20.7, 51.0+/-18.4 and 61.5+/-15.9 years for LR. MR, PHS groups, respectively. The PHS group was significantly older than other two groups (P=0.002). The sex, operation time and lengths of hospital stay were not significantly different among the three groups. Numbers of intravenous analgesics used after the operations were 1.7+/-1.2, 2.7+/-2.2, 3.3+/-2.0 in the LR, MR, PHS groups, respectively. A lesser amount of IV analgesics was injected into the LR group than the PHS group. Although some complications occurred such as wound infection, hematoma, dehiscence, testicular edema in the three groups, there were no significant differences among the three groups. There were no recurrences in all three groups. CONCLUSION: We could not find any better outcome among the LR, MR and PHS groups.
Adult ; Analgesics ; Edema ; Hematoma ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Polypropylenes ; Recurrence ; Retrospective Studies ; Wound Infection

PURPOSE: The aim of this prospective study was to analyze anorectal physiologic and clinical outcomes of the colonic J-pouch-anal anastomosis compared with the traditional straight colorectal anastomosis after ultra-low anterior resection in patients with rectal cancer, thus to define if this method of modified reconstruction has a functional superiority. METHODS: After total mesorectal excision for mid or low rectal cancers, patients were randomized to either a straight (n=23) or a colonic J-pouch anastomosis (n=24) to the lowermost rectum or anal canal. Functional outcomes were compared between two groups using an anorectal manometry performed before and 1 year after surgery and a bowel function questionnaire administered 6 months and 1 year postoperatively. RESULTS: Except the arithmetic level of anastomosis which was significantly higher in straight group than in pouch group (5.1 +/- 1.2 cm vs. 3.8 +/- 0.9 cm; P=0.0001), the two groups were well matched for demographic distribution, pathologic stage, colonic segment used for neorectum and use of adjuvant therapies. Patients with colonic J-pouch anastomosis showed functional superiority in terms of frequency of bowel movements, degree of urgency at 6 months (P<0.0001 and =0.03, respectively) and 1 year postoperatively (P<0.0001 and <0.05, respectively). Functional parameters, including incontinence to liquid stool and impaired discrimination between gas and stool were more pronounced in straight group after 6 months (P=0.04, and <0.05, respectively), but the differences were not statistically significant after 1 year. Sensation of incomplete evacuation was not different statistically between groups at 6 months, but more common in J-pouch group at 1 year (39.1% vs. 8.3%; P=0.04). As well as the length of high pressure zone and presence of rectoanal inhibitory reflex, there was no difference in sphincter pressure parameters between groups either before or 1 year after surgery. Maximal tolerable volume of the neorectum in J-pouch group was 110.2 +/- 16.7 ml, which was significantly larger than that of 74.1 +/- 14.9 ml in straight group (P<0.0001), and the neorectum in J-pouch group was significantly more compliant than that in straight group (6.1 +/- 1.9 vs. 3.3 +/- 2.1; P<0.0001) in 1 year after surgery. CONCLUSIONS: Construction of a colonic J-pouch as a substitute for the rectum restores neorectal volume and compliance. Clinically it offers patients superior anorectal function compared with straight anastomosis. To minimize evacuation difficulty associated with the pouch, optimal size of the pouch should be defined, thus to achieve an ideal balance between stool frequency/urgency and evacuation problems through larger prospective studies.
Anal Canal ; Colon* ; Colonic Pouches* ; Compliance ; Discrimination (Psychology) ; Humans ; Manometry ; Prospective Studies* ; Surveys and Questionnaires ; Rectal Neoplasms* ; Rectum ; Reflex ; Sensation