No abstract available.
Hidrocystoma*

A 60-year-old woman has experienced of right upper quadrant abdominal discomfort. This partient took cholecytectomy due to gall stone 15 years ago. At that time microscopic finding the neck of gallbladder showed well differentiated papillary adenocarcinoma confined to superficial part of musele layer. 3 years before admission she took T-tube drainage due to obstructive jaundice. The microscopic finding af distal common bile duct showed well differentiated adenocarcinoma. Recently she complained of pain and discomfort on T-tube site and so we perforrned endoscopic retrograde biliary drainage after removal of T-tube. The computed tomogram showed no mass in liver or lymph node enlargement. 4 months after procedure of ERBD; we changed to the new catheter for the prevention of cloggiag of prosthesis. We report here a case of longterm survival over 15 years after the diagnosis of cancer of extrahepatic bile duct.
Adenocarcinoma ; Adenocarcinoma, Papillary ; Bile Ducts, Extrahepatic ; Catheters ; Common Bile Duct* ; Diagnosis ; Drainage ; Female ; Gallbladder* ; Gallstones ; Humans ; Jaundice, Obstructive ; Liver ; Lymph Nodes ; Middle Aged ; Neck ; Prostheses and Implants

PURPOSE: Doppler-guided hemorrhoidal artery ligation and recto-anal repair (DG-HAL & RAR) is known for low recurrence, high patient satisfaction, and less postoperative pain. The purpose of this study is to analyze the 1-year follow-up results in patients who underwent a DG-HAL & RAR and to establish the benefits of the procedure. METHODS: Among the hemorrhoid patients who were admitted to our hospital from March 2008 to May 2010 and who underwent a DG-HAL & RAR, 97 patients who were followed up for a year were investigated. Recurrence, complications, admission period, difference in preoperative and postoperative pain, operation time, and time to return to daily activities were investigated. RESULTS: The average admission period was 1.6 +/- 1.1 days. Pain at postoperative day 7 showed no significant difference from preoperative pain (P > 0.05). The operation time was 34.0 +/- 7.3 minutes on average, and return to daily activities was timed at 2.3 +/- 2.0 days postoperatively. At the one year follow-up, no serious complications were noted, and preoperative symptoms recurred only in 14 patients (14.4%). CONCLUSION: In most patients with hemorrhoids, excluding those with severe prolapsed hemorrhoids, less pain, no serious complications, and good long-term outcome can be expected from a DG-HAL & RAR.
Arteries ; Follow-Up Studies ; Hemorrhoids ; Humans ; Ligation ; Pain, Postoperative ; Patient Satisfaction ; Recurrence

BACKGROUND: Colloid solutions are used to treat hypovolemia and expanding plasma, but they may inhibit platelet function and reduce the level of coagulation factors during surgery. This study was conducted to compare the effects of hydroxyethyl starch (HES) on adenosine diphosphate (ADP)- and collagen-induced platelet aggregation in patients undergoing total intravenous anesthesia. METHODS: Patients undergoing endoscopic sinus surgery under total intravenous anesthesia with propofol and remifentanil were divided into a group that underwent fluid management with only crystalloid solution (n = 15) and a group that was managed with crystalloid solution that included 6% HES (130/0.4) (n = 15). ADP- and collagen-induced platelet aggregation were measured 5 minutes before induction, after the first intraoperative hour, and one hour postoperatively. RESULTS: Significantly diminished ADP- and collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the patients that were managed with colloid solution that included HES. In addition, significantly diminished collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the group that was managed with the solution that only contained the crystalloid. However, ADP- and collagen-induced platelet aggregation were recovered postoperatively in both groups. CONCLUSIONS: The results of this study indicated that fluid therapy with colloid solution that contained 6% HES (130/0.4) may diminish ADP-induced platelet aggregation intraoperatively in patients subjected to total intravenous anesthesia.
Adenosine Diphosphate ; Anesthesia, Intravenous ; Blood Coagulation Factors ; Blood Platelets ; Colloids ; Fluid Therapy ; Hetastarch ; Humans ; Hypovolemia ; Isotonic Solutions ; Piperidines ; Plasma ; Platelet Aggregation ; Propofol

BACKGROUND: Changes in nitric oxide (NO) production in the dorsal root ganglia (DRG) may contribute to allodynia after nerve injury. It is known that the histochemistry of NADPH-diaphorase (NADPH-d) is known to be not always coincident with NOS. This study was conducted to investigate the relationship between nNOS and NADPH-d expression in the DRG in a spinal nerve injury model of neuropathic pain, and to elucidate role that NO plays in neuropathic pain. METHODS: nNOS immunohistochemistry and/or NADHP-d histochemistry were conducted in the DRG of a spinal nerve transection model of neuropathic pain, and the pain behavior was then measured by a von Frey filament test of the hindpaws of wild type and nNOS knock-out mice. RESULTS: nNOS immunoreactive neurons and NADPH-d stained neurons were not always identical. Additionally NADPH-d increased, but nNOS did not increase significantly in the DRG after spinal nerve transection. Neuropathic pain behavior increased in the hindpaw of nNOS(-/-) mice after spinal nerve transection, but was lower than that of wild type mice after spinal nerve transection. CONCLUSIONS: nNOS immunoreactive neurons and NADPH-d stained neurons were not always identical in the DRG, and a novel NADPH-d positive source may be involved in neuropathic pain after spinal nerve transection. Changes in nNOS expression in the DRG were not the primary cause of neuropathic pain behavior in a spinal nerve transection model of neuropathic pain.
Animals ; Diagnosis-Related Groups ; Ganglia, Spinal ; Hyperalgesia ; Immunohistochemistry ; Mice ; Mice, Knockout ; Neuralgia ; Neurons ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type I ; Spinal Nerve Roots ; Spinal Nerves

The correlation between facial pain and/or headache in patients with chronic sinusitis and localized findings on paranasal sinus omputed tomography (CT) are poorly understood. So we prospectively evaluated the relationship of paranasal sinus pain symptoms with CT imaging. Fifty eight patients with headache and/or facial pain rated their pain in 9 areas at the time of CT scanning and 2 months after endoscopic sinus surgery (ESS). We scored the degree of air-fluid level, mucosal thickening, and mucus retention cysts using a grade scale of severity. The ostiomeatal unit, middle meatus and nasofrontal duct were also evaluated for patency. Bivariate analysis was performed to evaluate the relationship between patients' pain, that was improved after ESS and CT findings. Among 58 patients who had facial pain and/or headache at the time of CT scan, the pain improved in 51 patients after ESS. Bivariate analysis failed to show any relationship between pain symptoms and CT findings in 51 patients. This study suggests that findings on CT do not routinely correlate with the patients' symptoms of facial pain or headache. CT should therefore be reserved for delineating the anatomy and degree of sinus disease before surgical intervention.
Facial Pain ; Headache ; Humans ; Korea* ; Mucus ; Prospective Studies ; Sinusitis ; Tomography, X-Ray Computed

In the era of government 3.0, the availability of open government-owned public data and data sharing with the private sector are important. We surveyed the status of public data openness in the healthcare domain and of compliance with the standard open data format based on the “5 stars of linked data” model. We examined healthcare data on the Open Data Portal (https://www.data.go.kr). We also surveyed data on the websites of the public institutions and state administrative agencies that provided healthcare data on the Portal. In terms of data on the Portal, all public institutions except the National Medical Center, the Korea Institute of Science and Technology Information, and the Korea Environment Corporation were found to have provided data in the 3-stars format corresponding to the Public Data Open Standard Maintenance Guide. All data provided by state administrative agencies met the 3-stars format. Only 2 institutions (the Health Insurance Review & Assessment Service and the Korea Health Industry Development Institute) released data in the 3-stars format on their websites. Among the major state administrative agencies providing data on the Portal, none released data in the 3-stars format on their websites. Government-owned data should be provided in a standard format both on the Open Data Portal and on data-holders' websites to facilitate communication and collaboration. Considering the huge potential of linked healthcare data from a single national health insurance system, providing open data in compliance with the standard open format will promote the opening and sharing of public data.
Compliance* ; Cooperative Behavior ; Delivery of Health Care* ; Information Dissemination ; Information Storage and Retrieval ; Insurance, Health ; Korea* ; National Health Programs ; Private Sector ; Public Sector ; Vital Statistics

Myasthenia gravis, an autoimmune disease with antibodies directed against the nicotinic acetylcholine receptor, is relatively common in young women and sometimes associated with pregnancy. Because pregnancy can influence myasthenia gravis and the drugs used for its treatment influence gestation, obstetrical management can be complicated. Regional anesthesia during vaginal delivery is the anesthesia treatment of choice, and cesarean delivery should avoid epidural or spinal anesthesia to reduce postoperative problems. We performed spinal anesthesia with bupivacaine in a 38-year-old multipara myasthenic with normal lung function, with specific perioperative complications.
Adult ; Anesthesia ; Anesthesia, Conduction ; Anesthesia, Spinal ; Antibodies ; Autoimmune Diseases ; Bupivacaine ; Cesarean Section ; Female ; Humans ; Lung ; Myasthenia Gravis ; Pregnancy ; Receptors, Nicotinic

The authors observed the histological and ultrastructural findings in a study of the fibrosis of the extraocular muscles following a posterior fixation suture in rabbits. the early findings demonstrated hyalinosis, clumping of the nuclei of muscle cells and collagenization of the muscle tissue. However, there was no evidence of collagen tissue in the degenerated muscle fiber, reserving cell membrane and basement membrane ultrastructurally. The late findings showed splitting and irregular stain of the muscle fibers, many nuclei of presumed muscle cell and filamentous structure at the collagen tissue in the extracellular space. Electron microscopic study showed atrophy and angulation with distortion of the myofibrillar matrix, along with other cytoplasmic degenerative phe nomena in the muscle fibers. Clumps of the well-arranged microfibrils(Mf) and irregularly arranged Mf with fine granular materials(FGM) were adjacent to the immature collagen fibrils. Many of the Mf and FGM were closely associated, and the number of the Mf and FGM decreased with the degree of maturity of the collagen fibrils. The anatomical structure of the myofibrill was identified as that of the Mf. From these findings, it would appear that formation of collagen fiber occurs in the extracellular space and that Mf and FGM are primarily responsible for the formation of the collagen fibils.
Atrophy ; Basement Membrane ; Cell Membrane ; Collagen ; Cytoplasm ; Extracellular Space ; Fibrosis* ; Microfibrils ; Muscle Cells ; Muscles ; Myofibrils ; Rabbits* ; Sutures*

PURPOSE: A pancreaticoduodenectomy is the procedure of choice for managing a periampullary malignancy. This is a complex procedure accompanied with some morbidity. In order to improve postoperative clinical results, we tried to apply a binding pancreaticojejunostomy and Endo GIA stapler during pancreaticoduodenectomy. According to the clinical outcomes, compare this trial with a conventional procedure. METHODS: We evaluated retrospectively clinical results of 30 patients who had received pancreaticoduodenectomy from Jan. 2003 to Dec. 2004 in the Pusan National University Hospital. These cases were divided into two groups; Group I comprised of 16 patients receiving this procedure and Group II comprised of 14 patients receiving conventional procedure. RESULTS: There were some differences in the mean operation time and the amount of blood loss between two groups, but significant difference only in an aspect of blood loss (P=0.042). Postoperative complications were as these: Group I, pancreatic fistula was in 12.5%, intraabdominal bleeding in 6.2%, wound infection in 12.5%; Group II, pancreatic fistula was in 35.7%, intraabdominal bleeding in 21.4%, wound infection & intraabdominal abscess in 7.1%. In Group I, there was a lower morbidity rate than in Group II, but there was a significant difference in the development of a pancrea-tic fistula as a pancreatic parenchymal texture (P=0.021). CONCLUSION: Although there was a small number of cases, it appears that a pancreaticoduodenectomy with the application of a binding pancreaticojejunostomy and Endo GIA stapler can produce good results, also need to get more clinical results.
Abscess ; Busan ; Fistula ; Hemorrhage ; Humans ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy* ; Postoperative Complications ; Retrospective Studies ; Wound Infection