This study was performed to evaluate histopathologic and physical characteristics of anterior capsule during capsulorhexis with a new high-frequency diathermy.The authors investigated the histopathologic characteristics of anterior capsule according to coagulation time and anterior capsular diameter in diathermy capsulorhesxis(DC),comparing with those in continuous curvilinear capsulorhexis(CCC). Thermally induced histopathologic alter-ation was localized at anterior capsule with coagulation for 0.5 second, while it was extended into cortex with coagulation for 2 seconds.When capsulorhexis was performed with diameter of 6 mmand the margin was pulled with iris retractor,anterior capsular edge was fully extended both in CCC and DC.But with diameter of 3.5 mm,DC mostly led to tear of capsular edge on its extension,while CCC permitted full extension of anterior capsular edge.These results suggest that strength of anterior capsular edge in DC is inferior to that in CCC.However diathermy capsulorhexis is a useful alternative technique in cases,which CCC is difficult to perform,such ashypermature or congenital cataracts.
Capsulorhexis* ; Cataract ; Diathermy* ; Iris

No abstract available.
Laparoscopy ; Stomach Neoplasms

Gastritis cystica profunda (GCP) is an uncommom hyperplastic lesion, which is located within the submucosa. GCP may occur several years after previous gastric surgery. In some reported cases, it was a premalignant condition and may lead to carcinoma of the stomach. We report a case of a 54-year-old man with epigastric pain and dyspepsia. He had undergone peritoneal dialysis for end stage renal disease about 13 years prior. An Upper gastrointestinal endoscopy showed elevated lesion at the gastric antrum, looking like an advanced gastric cancer or gastrointestinal stromal tumor. Endoscopic biopsy results were tubular adenoma with low-grade dysplasia. When followed up 9 months later, the lesion had increased in size and symptoms remained. We therefore performed a subtotal gastrectomy. The final biopsy was adenocarcinoma arising in GCP.
Adenocarcinoma ; Adenoma ; Biopsy ; Dyspepsia ; Endoscopy, Gastrointestinal ; Gastrectomy ; Gastritis ; Gastrointestinal Stromal Tumors ; Humans ; Kidney Failure, Chronic ; Middle Aged ; Peritoneal Dialysis ; Pyloric Antrum ; Stomach ; Stomach Neoplasms

PURPOSE: The chemoembolization with Lipiodol and doxorubicin hydrochloride is used in patients with hepatocellular carcinoma. What condition is the ideal emulsion of Lipiodol and doxorubicin for excellent anticancer effect? METHOD AND MATERIALS: Microscopic evaluation was performed on the emulsions, which were varied with different specific gravities of doxorubicin solutions, degrees in mixing of the emulsion, and amount of Lipiodol. RESULT: 1. Maximal amount of doxorubicin solution was contained in Lipiodol droplets and the release of doxorubicin from the droplets were delayed, when specific gravity of doxorubicin was equal to that of Lipiodol (SG, 1.28). 2. The optimal therapertic ratio of Lipiodol and doxorubicin was 3:2 at least, as in the emulsion less than 3:2, unmixed free forms of doxorubicin solution were increased. 3. The emulsion mixed by pumping 50--100 times had smaller Lipiodol droplets and contained larger amount of doxorubicin solution in the droplets than by pumping 20 times. CONCLUSION: We recommend the emulsion with specific gravity of doxorubicin equal to Lipiodol (SG. 1.28), the ratio of Lipiodol and doxorubicin closo to 3:2, and the mixture prepased with puming 50--100 times.
Carcinoma, Hepatocellular* ; Doxorubicin ; Emulsions ; Ethiodized Oil ; Humans ; Specific Gravity

The purpose of this study was to evaluate the efficiency of the preparation of oval canals using hand and engine-driven instruments with SEM observation. Thirty single-rooted teeth with oval canal were used in this study. The teeth were divided into 3 groups. In group A, the teeth were instrumented up to a size 35 K-file using RC-prep and irrigated with 5% NaOCl between each file size. In group B, the teeth were instrumented with Profile according to the manufacture's instructions using RC-Prep and irrigated with 5% NaOCl between each file size. In group C, the teeth were instrumented with GT file according to the manufacture's instructions using RC-prep and irrigated with 5% NaOCl between each file size. Then, in all teeth, a final flush of 5ml of distilled water delivered for 30s. Canals were dried with sterile standardized paper points. After preparing the canals, the teeth were sectioned along their mesial and diatal surfaces by using low-speed diamond disc, chisel and mallet. Each root section was then dehydrated in graded concentration of alcohol (70, 80, 90, 100%), mounted on an aluminum stub, sputter-coated with gold-palladium and observed with scanning electron microscope (HITACHI S-4200) in middle and apical area. The results of this study were as follows: 1. In the middle area, group B and group C showed less smear layer than group A, and it was statistically significant (p < 0.05). 2. In the middle area, group B showed greater smear layer than group C, but it was not statistically significant (p > 0.05). 3. In the apical area, group C showed less smear layer than group A, and it was statistically significant (p < 0.05). 4. In the apical area, group A showed greater smear layer than group B, but it was not statistically significant (p > 0.05). 5. In the apical area, group B showed greater smear layer than group C, but it was not statistically significant (p > 0.05). 6. In all groups, the middle area was less smear layer than the apical area, and it was statistically significant (p < 0.05).
Aluminum ; Diamond ; Hand* ; Smear Layer ; Tooth ; Water

Laparoscopic surgery is rapidly evolving with technological advances, but there are several drawbacks. An articulating device, with freedom of a perfect 360°, is attractive as a solution to overcome the restriction of instrument movement caused by straight tools. Its usefulness or efficacy should be supported by relevant scientific evidence. However, it is sometimes difficult to prove it because the factors influencing the surgical outcomes are complex and closely related to each other.

PURPOSE: The intracorporeal reconstruction after laparoscopic gastrectomy can minimize postoperative pain, and give better cosmetic effect, while it may have technical difficulties and require the learning curve. This study aimed to analyze the surgical outcome of intracorporeal reconstruction according to the surgeon's experience comparing with extracorporeal procedure. MATERIALS AND METHODS: From January 2009 to September 2011, intracorporeal reconstruction in laparoscopic surgery for gastric cancer was performed for 71 patients (Intra group). During same period, 231 patients underwent laparoscopy-assisted gastrectomy (Extra group). These patients were classified into initial (1st to 20th case of intra group), intermediate (21th to 46th case), and experienced (after 47th case) phases. RESULTS: Intracorporeal procedures included 35 cases of Billroth-I, 30 Billroth-II and 6 Roux en Y reconstructions. In the initial phase, operation time (P=0.022) were significantly longer for the patients of intra group than them of extra group. Although the difference was not significant, the length of hospital stay was longer and complication rate was higher in the intra group. In intermediate and experienced phases, there was no difference between two groups in operation time and hospital stay. In these phases, complication rate was lower in the intra group than the extra group (3.9% versus 9.7%). The pain scale was significantly lower post operation day 5 in the intra group. CONCLUSIONS: Intracorporeal reconstruction after laparoscopic distal gastrectomy was feasible and safe, and the technique was stabilized after 20th case if the surgeon has sufficient experiences when we compared it with extracorporeal reconstruction.
Cosmetics ; Gastrectomy ; Gastroenterostomy ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Pain, Postoperative ; Stomach Neoplasms

No abstract available.
Ductus Arteriosus, Patent* ; Imaging, Three-Dimensional*

PURPOSE: Identification of the infrapyloric artery (IPA) type is a key component of pylorus-preserving gastrectomy. As the indocyanine green (ICG) fluorescence technique is known to help visualize blood vessels and flow during reconstruction, we speculated that this emerging technique would be helpful in identifying the IPA type. MATERIALS AND METHODS: From August 2015 to February 2016, 20 patients who underwent robotic or laparoscopic gastrectomy were prospectively enrolled. After intravenous injection of approximately 3 mL of ICG (2.5 mg/mL), a near-infrared fluorescence apparatus was applied. The identified shape of the IPA was confirmed by examining the actual anatomy following infrapyloric dissection. RESULTS: The mean interval time between ICG injection and visualization of the artery was 22.2 seconds (range, 14–30 seconds), and the mean duration of the arterial phase was 16.1 seconds (range, 9–30 seconds). The overall positive predictive value (PPV) of ICG fluorescence in identifying the IPA type was 80% (16/20). The IPA type was incorrectly predicted in four patients, all of whom were obese with a body mass index (BMI) of more than 25 kg/m². CONCLUSIONS: Our preliminary results indicate that intraoperative vascular imaging using the ICG fluorescence technique may be helpful for robotic or laparoscopic pylorus-preserving gastrectomy.
Arteries ; Blood Vessels ; Body Mass Index ; Fluorescence* ; Gastrectomy* ; Humans ; Indocyanine Green* ; Injections, Intravenous ; Laparoscopy ; Prospective Studies ; Stomach Neoplasms*

PURPOSE: The aim of this study is to investigate the clinical factors affecting on the cure rate by invasive and open surgery for gastric cancer and to establish a subgroup of patients who can be applied by the early recovery after surgery program through this retrospective analysis. MATERIALS AND METHODS: In this retrospective study, we analyzed 425 patients who underwent gastric cancer surgery between January 2011 and December 2011 and were managed with conventional clinical therapies. This clinical algorithm was made when the patient was in minimally invasive surgery group and discharged from hospital one day faster than them in open surgery group. RESULTS: The completion rate of the clinical pathway was 62.4%. Despite the different applications of clinical pathway, completion rate in minimally invasive surgery group was significantly higher than that of open group (P<0.001). In multivariate analysis, the surgical procedure of minimally invasive surgery (odds ratio=4.281) was the most predictable factor to complete clinical pathway. Additionally, younger patients (odds ratio=1.933) who underwent distal gastrectomy (odds ratio=1.999) without combined resection (odds ratio=3.069) were predicted to accomplish the clinical pathway without any modifications. CONCLUSIONS: We concluded that high efficacy of the clinical pathway for gastric cancer surgery was expected to selected patients through retrospective analysis (expected completion rate=85.4%). In addition, these patients would become enrolled criteria for early recovery program in gastric cancer surgery.
Critical Pathways ; Gastrectomy ; Humans ; Multivariate Analysis ; Retrospective Studies ; Stomach Neoplasms