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

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

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

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 role of peritoneal washing cytology in determining further treatment strategies after surgery for gastric cancer remains unclear. One reason for this is the fact that optimal procedures to increase the accuracy of predicting peritoneal metastasis have not been established. The aim of this study was to evaluate the efficacy of cytology using samples harvested from two different abdominal cavity sites during gastric cancer surgery. MATERIALS AND METHODS: We prospectively recruited 108 patients who were clinically diagnosed with locally advanced gastric cancer (higher than cT1 stage disease). Peritoneal washing fluids were collected from the pouch of Douglas and the subphrenic area. Patients were prospectively followed up for 2 years to determine the recurrence and survival rates. RESULTS: Thirty-three patients dropped out of the study for various reasons, so 75 patients were included in the final analysis. Seven patients (9.3%) showed positive cytology findings, of whom, three showed peritoneal recurrence. Tumor size was the only factor associated with positive cytology findings (P=0.037). The accuracy and specificity of cytology for predicting peritoneal recurrence were 90.1% and 94.2%, respectively, whereas the sensitivity was 50.0%. The survival rate did not differ between patients with positive cytology findings and those with negative cytology findings (P=0.081). CONCLUSIONS: Peritoneal washing cytology using samples harvested from two different sites in the abdominal cavity was not able to predict peritoneal recurrence or survival in gastric cancer patients. Further studies will be required to determine whether peritoneal washing cytology during gastric cancer surgery is a meaningful procedure.
Abdominal Cavity ; Humans ; Neoplasm Metastasis ; Peritoneum ; Prospective Studies* ; Recurrence* ; Sensitivity and Specificity ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Laparoscopic gastrectomy is a widely accepted surgical technique. Recently, robotic gastrectomy has been developed, as an alternative minimally invasive surgical technique. This study aimed to evaluate the question of whether robotic gastrectomy is feasible and safe for the treatment of gastric cancer, due to its learning curve. MATERIALS AND METHODS: We retrospectively reviewed the prospectively collected data of 100 consecutive robotic gastrectomy patients, from November 2008 to March 2011, and compared them to 282 conventional laparoscopy patients during the same period. The robotic gastrectomy patients were divided into 20 initial cases; and all subsequent cases; and we compared the clinicopathological features, operating times, and surgical outcomes between the three groups. RESULTS: The initial 20 robotic gastrectomy cases were defined as the initial group, due to the learning curve. The initial group had a longer average operating time (242.25+/-74.54 minutes vs. 192.56+/-39.56 minutes, P>0.001), and hospital stay (14.40+/-24.93 days vs. 8.66+/-5.39 days, P=0.001) than the experienced group. The length of hospital stay was no different between the experienced group, and the laproscopic gastrectomy group (8.66+/-5.39 days vs. 8.11+/-4.10 days, P=0.001). The average blood loss was significantly less for the robotic gastrectomy groups, than for the laparoscopic gastrectomy group (93.25+/-84.59 ml vs. 173.45+/-145.19 ml, P<0.001), but the complication rates were no different. CONCLUSIONS: Our study shows that robotic gastrectomy is a safe and feasible procedure, especially after the 20 initial cases, and provides a satisfactory postoperative outcome.
Gastrectomy ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Prospective Studies ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: The Roux en Y method has rarely been performed due to longer operation time and high risk of complication, despite several merits including prevention of bile reflux. We conducted a retrospective review of the result of Roux en Y reconstruction using two circular staplers after subtotal gastrectomy. MATERIALS AND METHODS: From December 2008 to May 2009, a total of 26 patients underwent Roux en Y reconstruction using two circular staplers after subtotal gastrectomy, and seventy-two patients underwent Billroth-I reconstruction. Roux en Y anastomosis was performed using two circular staplers without hand sewing anastomosis. We compared clinicopathologic features and surgical outcomes between the two groups. All patients underwent gastrofiberscopy between six and twelve months after surgery to compare the bile reflux. RESULTS: No significant differences in clinicopathologic findings were observed between the two groups, except for the rate of minimal invasive surgery (P=0.004) and cancer stage (P=0.002). No differences in the rate of morbidity (P=0.353) and admission duration (P=0.391) were observed between the two groups. Gastrofiberscopic findings showed a significant reduction of bile reflux in the remnant stomach in the Roux en Y group (P=0.019). CONCLUSIONS: When compared with Billroth-I reconstruction, Roux en Y reconstruction using the double stapler technique was found to reduce bile reflux in the remnant stomach without increasing postoperative morbidity. Based on these results, we planned to begin a randomized controlled clinical trial for comparison of Roux en Y reconstruction using this method with Billroth-I anastomosis.
Anastomosis, Roux-en-Y ; Bile ; Bile Reflux ; Gastrectomy ; Gastric Stump ; Hand ; Humans ; Pilot Projects ; Reconstructive Surgical Procedures ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: Composite neuroendocrine-exocrine carcinomas are malignancies that have two distinct components residing within the same tumor: an adenocarcinomatous portion and a neuroendocrine portion. This is rare in gastric cancers; however, poorly differentiated adenocarcinomas can sometimes reveal evidence of neuroendocrine features (NEF) or be 'mixed endocrine and exocrine carcinomas'. This study aimed to review NEF in gastric adenocarcinoma and to evaluate its prognostic significance. MATERIALS AND METHODS: We selected 29 patients who were diagnosed with gastric adenocarcinoma with NEF and received gastrectomies at the Department of Surgery, Ajou University Hospital between January 2001 and December 2009. We analyzed the clinicopathologic features of gastric cancer with NEF and the prognosis associated with such tumors. RESULTS: The pathologic result with respect to TNM staging of the gastric cancers with NEF were as follows: 5 cases of T1, 5 cases of T2, 10 cases of T3, and 9 cases of T4. There were 7 cases of N0, 7 cases of N1, 8 cases of N2 and 7 cases of N3. The staging of patients with NEF was higher than that of patients without NEF. Especially tumor lymphovascular invasion rate was 82.8%. The overall survival of patients with gastric cancer characterized by NEF was 73.8 months. CONCLUSIONS: Positive NEF status might be correlated with clinicopathologic parameters such as a high stage and high frequency of regional lymph node metastasis.
Adenocarcinoma ; Gastrectomy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms