BACKGROUND/AIMS: Pancreaticoduodenectomy( PD ) is a complicated procedure that carried a very high postoperative mortality and mobidity until 1970s. Since early 1980, motality has been decreased but morbidity is still high now. So this study was conducted to analyze the motality and morbidity as well as survival rates after PD for valiable disease. METHODS: From January 1988 to January 2000, 164 patients underwent PD in the Korea Cancer Center Hospital. Standard pancreaticoduodenectomy was performed in terms of lymph node dissection and main method of pancreaticoenterostomy was end-to-side pancreaticojejunostomy, among which ductto- mucosa anastomosis comprised of about half of cases. Survival rates and the differences were estimated by Kaplan-Meier method and Log-Lank test respectively, and multivariate analysis was done with Cox Regression hazard model using SPSS program for Windows. RESULTS: Median age of all patients was 57 years with slight male predominance(54.8%). Classical Whipple's operation was performed in 113 cases(68.9%), and PPPD in 40 cases(24.3%), hepatopancreaticoduodenectomy in 10 cases(6.1%). Operative mortality was 1.8%( 3/164 ), however no additional in-hospital death occurred. Nine patients underwent reoperation. Postoperative complication occurred in 56 cases(34.2%). The most common complication was pneumonia(11.5%), and delayed gastric emptying( 7.3%), pancreatic fistula(4.8%), intra-abdominal bleeding(4.8%) in orders. No pancreatic leakage occured in duct-to-mucosa anastomosis group. Median survival of 123 periampullary carcinoma was 25 months and better survival was shown in ampulla of Vater cancer. Factors influencing on survival for periampullary carcinoma were origin of tumor, cellular differentiation, lymph node invasion. CONCLUSION: Pancreaticoduodenectomy can be performed safely in the terms of mortality. Bleeding is the most common cause of reoperation and motality, so meticulous bleeding control is very important. And duct-to-mucosa anastomosis is very safe method of pancreaticoenterostomy.
Ampulla of Vater ; Hemorrhage ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes ; Male ; Mortality ; Mucous Membrane ; Multivariate Analysis ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Postoperative Complications ; Proportional Hazards Models ; Reoperation ; Survival Rate

No abstract available.
MELAS Syndrome*

Laminin-1 is biologically active and can effect cellular proliferation, differentiation, migration, and apoptosis. In the central nervous system, neuronal cells are rarely reported to give positive reaction by laminin antibody staining. However, the original cell type which can produce the laminin molecule has not been well established. Since the neuronal cells of brain are derived from neuroectoderm, we thought that the neuronal cells should be able to produce the laminin molecules as other epithelial cells. In this study we aimed to explore whether the neuronal cells express the laminin chain mRNAs, and further to identify which types of laminin isoform are expressed at the specific sites of the brain structure. We found that neuronal cell was the important cell type in mouse brain, which could produce laminin isoforms. Although immunostainings disclosed reactivity of laminins in the basement membrane of capillaries as well as neuronal cells, mRNA expressions of laminins were intense only in the neuronal cells. It was relatively weak in the endothelial cells. Among neuronal cells the cortical cells of cerebrum, pyramidal cells of hippocampus, and Purkinje cells of cerebellum showed pronounced expression of laminin chain mRNA. Glial cells, especially astrocytes, were negative for laminin subtypes both in immunohistochemistry and in situ hybridization. Taken together, our data indicate that the neuronal cells of mouse brain actively produce laminin isoforms, and the resultant polymerized laminins are accumulated mainly in the basement membrane of capillaries. In conclusion, the results indicate that neuronal cells produce and utilize the different laminin chains to maintain the neurovascular environment of brain.
Animals ; Apoptosis ; Astrocytes ; Basement Membrane ; Brain* ; Capillaries ; Cell Proliferation ; Central Nervous System ; Cerebellum ; Cerebrum ; Endothelial Cells ; Epithelial Cells ; Hippocampus ; Immunohistochemistry ; In Situ Hybridization ; Laminin* ; Mice* ; Neural Plate ; Neuroglia ; Neurons* ; Polymers ; Protein Isoforms ; Purkinje Cells ; Pyramidal Cells ; RNA, Messenger

A relationship between preceding acute paralytic poliomyelitis and the later development of motor neuron disease has only occasionally been suggested since it was first postulated by Charcot in 1875. The authors recently experienced a 20-year-old male who was considered to have postpoliomyelitis muscular atrophy. We report this case in view of its rarity and necessity of differential diagnosis from other neuromuscular disorders. Clinical presentation included slowly progressive muscle wasting of left thigh for 4 years, mild weakness of left arm and both thigh, intermittent fasciculation, and previous history of acute paralytic poliomyelitis. Electromyographic findings showed fibrillation potentials, positive sharp waves, fasciculations, giant motor unit potentials and reduced interference patterns. Muscle biopsy revealed scattered small angulated fibers, individual myofiber degeneration and mild inflammatory cell infiltration.
Arm ; Biopsy ; Diagnosis, Differential ; Fasciculation ; Humans ; Male ; Motor Neuron Disease ; Poliomyelitis ; Postpoliomyelitis Syndrome* ; Thigh ; Young Adult

Statistics is the science of data. As the foundation of scientific knowledge, data refers to evidentiary facts from the nature of reality by human action, observation, or experiment. Clinicians should be aware of the conditions of good data to support the validity of clinical modalities in reading scientific articles, one of the resources to revise or update their clinical knowledge and skills. The cause-effect link between clinical modality and outcome is ascertained as pattern statistic. The uniformity of nature guarantees the recurrence of data as the basic scientific evidence. Variation statistics are examined for patterns of recurrence. This provides information on the probability of recurrence of the cause-effect phenomenon. Multiple causal factors of natural phenomenon need a counterproof of absence in terms of the control group. A pattern of relation between a causal factor and an effect becomes recognizable, and thus, should be estimated as relation statistic. The type and meaning of each relation statistic should be well-understood. A study regarding a sample from the population of wide variations require clinicians to be aware of error statistics due to random chance. Incomplete human sense, coarse measurement instrument, and preconceived idea as a hypothesis that tends to bias the research, which gives rise to the necessity of keen critical independent mind with regard to the reported data.
Aluminum Hydroxide ; Bias (Epidemiology) ; Carbonates ; Humans ; Recurrence

BACKGROUND: Increased frequency of comminuted clavicle mid-shaft fractures and importance of functional satisfaction through early joint exercise has resulted in higher emphasis on surgical treatments. This study aimed to evaluate the clinical radiological results of treatment of clavicle mid-shaft fractures by open reduction and internal fixation using a plate with a small incision. METHODS: The subjects of this study were 80 clavicle mid-shaft fracture cases treated with internal fixation using a plate from October 2010 to July 2014. Clavicle mid-shaft fractures were internally fixated using anatomical plates or locking compression plates. Achievement of bone union, union period, and clavicle length shortening were evaluated radiologically, and clinical assessment was done by using Constant and University of California at Los Angeles (UCLA) scores. RESULTS: All 80 cases were confirmed to have achieved bone union through radiographs with an average union period of 10.9 weeks (range: 7–18 weeks). The average clavicle length of shortening in the affected side was 1.8 mm (range: 0–17 mm). The average UCLA score and Constant score were 33.6 (range: 25–35) and 92.5 (range: 65–100), respectively. Regarding complications, four cases reported skin irritation by metal plates, and one case reported a screw insertion site fracture due to minor trauma history. CONCLUSIONS: We were able to induce successful bone union and obtain clinically satisfactory results in displaced mid-shaft fractures of the clavicle without major complications such as nonunion through treatment of internal fixation using a plate.
California ; Clavicle* ; Joints ; Skin

There is no single characteristic clinical or radiological feature to diagnose xanthogranulomatous pyelonephritis, so it makes accurate preoperative diagnosis difficult. In our case, the renal parenchyme of affected kidney was well preserved on excretory urogram. The abnormal finding was only a filling defect within the right upper pelvocalyceal system. Herein we report a case of xanthogranulomatous pyelonephritis in a 18 years old girl which was confused with renal pelvic tumor.
Adolescent ; Diagnosis ; Female ; Humans ; Kidney ; Pyelonephritis, Xanthogranulomatous*

No abstract available.

This is a retrospective clinical analysis of 156 patient with colorectal cancer who were surgically treated from January 1988 to June 1996 at the Department of Surgery, Seoul Adventist Hospital. The results are as follows: 1) The peak age incidence was in the 7th decade (31.4% of the cases), and the sex ratio of males to females was 1.03 : 1. 2) The most common location of the tumor was the rectum in 77 cases (49.4%); next were the sigmoid colon in 25 cases (16.0%) and the ascending colon in 25 cases (16.0%). 3) In the right colon, the most frequent symptoms and signs were abdominal pain, a palpable mass, weight loss; in the left colon and rectum, bloody tarry stool and bowel- habit change were the most common symptoms and signs. 4) The duration of the symptoms and signs prior to admission was most commonly less than 3 month (46.8% of the cases). 5) The diagnostic methods were digital rectal examination, sigmoidoscopy, colonofiberoscopy, barium enema, and abdominal CT. In two cases,an exploratory laparotomy was done. Also, 2.8 studies were done per patient. 6) The operations performed included an abdominoperineal resection in 36 cases (24.0%) and a right hemicolectomy (18.7%). The operability was 96.2%, and the total resectability was 79.5%. 7) The staging of the tumor was performed during the initial operation according to the Aster Coller classification and the TNM classification. Stages C2 (33.8%) and B2 (29.1%) and T3N0M0 were the most frequent stages in both classification. 8) The most common histologic type was an adenocarcinoma (96.8%). 9) The most common macroscopic finding was of the annular type (59.6%) 10) The most common distant metastasis sites were the pelvic organs and the liver. 11) The most frequent postoperative complication was wound infection (14.7%). The complication rate and perioperative mortality were 32.7% and 2%, respectively.
Abdominal Pain ; Adenocarcinoma ; Barium ; Classification ; Colon ; Colon, Ascending ; Colon, Sigmoid ; Colonic Neoplasms ; Colorectal Neoplasms* ; Digital Rectal Examination ; Enema ; Female ; Humans ; Incidence ; Laparotomy ; Liver ; Male ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Rectal Neoplasms ; Rectum ; Retrospective Studies ; Seoul ; Sex Ratio ; Sigmoidoscopy ; Tomography, X-Ray Computed ; Weight Loss ; Wound Infection

No abstract available.
Evidence-Based Practice ; Uncertainty ; Research Personnel ; Bias (Epidemiology) ; Research