PURPOSE: Acute appendicitis is the most frequently encountering extrauterine surgical condition in pregnancy. Prompt diagnosis of acute appendicitis in pregnancy is not easy on the basis of clinlical findings, which may be obscured or altered by the presence of a gravid uterus. In most of cases, prompt diagnosis and early surgical intervention could result in optimal maternal and fetal outcomes. MATERIAL AND METHODS: We performed retrospective analysis of 20 cases, which were operated under the diagnosis of acute appendicitis in pregnancy from 1990 to 1995 at the department of surgery, Soonchunhyang University Hospital. RESULTS: 1) The incidence of the acute appendicitis in pregnancy was one per 742 deliveries and the diagnostic accuracy was 85%. 2) The majority of patiens was in the 3rd decade of age (76.5%). 3) Gestational stages at onset of symptom were first trimester in 6 patients (35.3%) and second trimester (52.9%) in most patients. 4) The majority of patients(82.4%) spent less than 24 hours preoperatively. 5) The symptoms in order of frequency were; abdominal pain (100%), nausea (70.5%), vomiting (41.1%), fever (23.5%), chill (11.8%), constipation (11.8%), diarrhea (5.9%). The maximal tenderness was noted on McBurney's point (29.4%) and above McBurney's point (58.8%) in most of patient. 6) The leukocyte counts were mostly in the range of 10,000 to 15,000 mm3 (47.1%) and 15,000 to 20,000 mm3 (35.3%). 7) Several types of incisions were employed: a McBurney incision was used in 8 cases (47.1%), a transverse incision in 8 cases (47.1%), and a low midline incision in 1 case (5.8%). A general anesthesia was done in 6 patients (35.3%), a spinal anesthesia done in 8 patients (47.1%), and an epidural anesthesia done in 3 patients (17.6%). A drain was placed intraabdominally in 2 cases. 8) Among 17 cases, three were reported as focal appendicitis (17.6%), ten as suppurative one (58.8%), one as ganagrenous one (5.9%) and three as perforated one (17.6%). 9) The postoperative complications included 1 wound infection and 4 artificial abortions. There was no maternal death, preterm labor, or spontaneous abortion. CONCLUSION: Despite of diagnostic obstacles due to pregnancy, acute appendicitis can be diagnosed without major difficulty. High index of suspicion is required during diagnostic procedures and prompt surgical intervention improves maternal and fetal outcomes...EABS:
Abdominal Pain ; Abortion, Spontaneous ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Appendicitis* ; Constipation ; Diagnosis ; Diarrhea ; Female ; Fever ; Humans ; Incidence ; Leukocyte Count ; Maternal Death ; Nausea ; Obstetric Labor, Premature ; Postoperative Complications ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy* ; Retrospective Studies ; Uterus ; Vomiting ; Wound Infection

No abstract available.
Colonoscopy* ; Constriction, Pathologic*

We report a case of xanthoma disseminatum in a 24 year old male paitient. Multiple yellow-brown papules developed on the flexor aurfaces, such as the neck, axillae, antecubital fossae, groin, and perianal regions. Some papules were detected arouns the eyes and uvulai. biopsy specimen revealed a dense infiltrate of histiocytes, foam cells, Touton giant cells, and other inflammatory cells. No Langerhans granules were seen in the electron microscopic analysis.
Axilla ; Biopsy ; Foam Cells ; Giant Cells ; Groin ; Histiocytes ; Histiocytosis, Non-Langerhans-Cell* ; Humans ; Male ; Neck ; Xanthomatosis* ; Young Adult

PURPOSE: This study aimed to provide immunohistochemical evidence of micrometastasis in patients with node-negative Dukes' B colorectal cancer and to evaluate the clinical implications, including prognostic significance, of lymphatic metastasis. METHODS: A retrospective study of 90 patients who underwent a curative operation due to colorectal neoplasms from 1996 to 2001 was performed. Two consecutive sections of lymph nodes were prepared: one for ordinary hematoxylin-eosin staining, and the other for immunohistochemistry with pancytokeratine antibody. All clinical factors, including survival rate, were compared between patients with and without lymph-node metastasis. The mean follow- up period was 36.1 months. RESULTS: Micrometastasis was confirmed in 115 nodes (7.9%) from 32 patients (35.6%). No correlations were observed between micrometastases and prognostic factors, including survival rate, except for lymphatic invasion and postoperative TNM staging. Twenty-six of the 32 (81.3%) patients with micrometastases belonged to stage T3N0M0 (P<0.003). CONCLUSIONS: The immunohistochemical assay may be a useful way to identify micrometastasis in patients with Dukes' B colorectal neoplasms, but we were not able to demonstrate the prognostic significance of micrometastasis.
Colorectal Neoplasms* ; Humans ; Immunohistochemistry ; Lymph Nodes* ; Lymphatic Metastasis ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Neoplasm Staging ; Retrospective Studies ; Survival Rate

PURPOSE: Surgical resection for the hepatocellular carcinoma (HCC) is the only proven curative treatment modality. Most of these patients have chronic hepatitis with or without cirrhosis; therefore, curative resection with enough of a safety margin is always challenging for hepatic surgeons. The aim of our retrospective study was to analyze the correlation of the complications with the patient factors, the tumor factors and the surgical factors. MATERIALS & METHOD: A total of 145 patients who had hepatocellular carcinoma were resected surgically during the five year and nine months period between September 2000 and June 2006. We collected the database prospectively and we analyzed the perioperative outcomes from the accumulated database. RESULT: Anatomical resection, standard hemihepatectomy or systematic segmentectomy after injection of methylene blue dye into the portal vein branch was performed in 89 patients, and nonanatomical resection was done in 56 patients. The number of major resections that was more than two sections was 72, and the number of minor resection less than two sections was 73. The mean operative time was 270 minutes, the amount of bleeding was 669ml and the mean time of performing the Pringle maneuver was 31.5 minutes. Perioperative complication were noted in 20.0% of the patients and there were five mortalities (3.4%). The only one significant factor that affected a higher complication rate was the ICG15 and the significant factor that affected the mortality rate was the duration of the Pringle maneuver. CONCLUSION: Type oriented hepatic resection that achieves an adequate surgical resection volume is dependent on the status of the tumor and the hepatic reservoir function with limited bleeding, and these factors will help selected patients obtain a very good outcome with an acceptable complication rate and low mortality.
Carcinoma, Hepatocellular* ; Fibrosis ; Hemorrhage ; Hepatectomy ; Hepatitis, Chronic ; Humans ; Mastectomy, Segmental ; Methylene Blue ; Mortality ; Operative Time ; Portal Vein ; Prospective Studies ; Retrospective Studies

PURPOSE: Good color match is a key element in facial reconstruction for good aesthetic result. To correct the wide facial soft tissue defect were usually used the tissue expanded cheek flap, deltopectoral flap or radial forearm free flap. This study is aimed to analyse the color difference after flap surgery by using chromameter. METHODS: From August 1995 to December 2006, 30 patients who underwent flap operations were chosen randomly and evaluated color differences between flap site and adjacent skin. Reconstructive procedures included tissue expanded cheek flap(n=10), deltopectoral flap(n= 10), and radial forearm free flap(n=10). The measured sites were flap center within a radius of 1cm and four points of adjacent skin along the flap margin. The colors were quantified in a three dimensional coordinate system composed of L* (brightness), a*(redness), b*(yellowness). RESULTS: There were no significant color differences between the pedicled flaps(tissue expanded cheek flap and deltopectoral flap) and adjacent skin area. On the other hand, color values of the radial forearm free flap were statistically different from those of adjacent skin area. Total color difference(delta E) of tissue expanded cheek flap and deltopectoral flap were 7.45+/-5.78 versus 9.41+/-7.09, and that of radial forearm free flap was 11.74+/-3.85. It suggests that pedicled flaps have a potential of better color match than radial forearm free flap. CONCLUSION: Thus, better esthetic results and satisfaction is more likely to be expected in pedicled flaps as long as it could be applied comparing radial forearm free flap.
Cheek ; Forearm ; Free Tissue Flaps ; Hand ; Humans ; Radius ; Skin ; Surgical Flaps

Ulcer in buttock is mainly a pressure sore, which is frequently occurred at the sacral region in Korea and its surgical treatment is chiefly the operation using gluteus maximus myocutaneons flaps. For the treatment of ulcerated lesion in gluteal area, various methods using gluteus maximus muscle have been developed. We reviewed and analyzed the 100 cases using gluteus maximus myocutaneous flaps in our department since 1980. The results were summarized as follows ; 1) The ratio between male and female was 3:1. 2) The prevalent age groups were between third and fifth decades. 3) The main cause was the trauma. 4) The wound culture showed the pattern of mixed infections in most cases, consisting of Staphylociccus, Pseudomonas, Enterococcus, Streptococcus, and others. 5) The postoperative complications were noted in about thirty percent of the cases. The complications were flap tip necrosis, wound infection, wound disruption, and others. 6) For the treatment of small ulcers, a pure skin flap or myoplasty may be used, but for the treatment of large one, a kind of myocutaneous flap should be selected. 7) Gluteus maximus myocutaneous flaps can be used as variable methods, but of which the island flap is ideal in deep and large ulcerated lesion.
Buttocks ; Coinfection ; Enterococcus ; Female ; Humans ; Korea ; Male ; Myocutaneous Flap* ; Necrosis ; Postoperative Complications ; Pressure Ulcer ; Pseudomonas ; Sacrococcygeal Region ; Skin ; Streptococcus ; Ulcer ; Wound Infection ; Wounds and Injuries

No abstract available.
Antiemetics* ; Drug Therapy, Combination* ; Humans ; Ondansetron*

BACKGROUND: It is believed that stimulation of the P6 acupoint minimizes nausea and vomiting, and has been used to prevent and treat nausea and vomiting in various situations. The present study was undertaken to investigate whether the transcutaneous electrical stimulation of the P6 acupoint prevents postoperative nausea and vomiting (PONV) in female patients undergoing laparoscopic cholecystectomy. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, we investigated 59 ASA I or II female patients who underwent laparoscopic cholecystectomy under general anesthesia using isoflurane or enflurane. We used a ReliefBand(R) unit (NSTTM 600, Woodside Biomedical Inc, USA) for the transcutaneous electrical stimulation of the P6 acupoint. Patients were randomly divided into two groups; in the P6 group (n = 29) the activated ReliefBand(R) was placed at the P6 acupoint; and in the placebo group (n = 30) the inactivated ReliefBand(R) was placed at the P6 acupoint. The ReliefBand(R) was applied 10 min before the end of surgery and remained in place for 24 h. We evaluated the incidence and severity of PONV, and need for rescue antiemetics during the first 6 h and 24 h after surgery. RESULTS: No differences in age, weight, previous PONV history, or duration of anesthesia were present between groups. The incidence of PONV was significantly lower (34%) in the P6 group than in the placebo group (63%) during the first 24 h after surgery. The severity of nausea and vomiting was also significantly lower in the P6 group than in the placebo group. However, the need for rescue antiemetics was similar in the two groups. CONCLUSIONS: Transcutaneous electrical stimulation of the P6 acupoint significantly reduces the incidence and severity of PONV in female patients undergoing laparoscopic cholecystectomy during the first 24 h after surgery.
Acupuncture ; Acupuncture Points* ; Anesthesia ; Anesthesia, General ; Antiemetics ; Cholecystectomy, Laparoscopic* ; Enflurane ; Female ; Humans ; Incidence ; Isoflurane ; Nausea ; Postoperative Nausea and Vomiting* ; Prospective Studies ; Transcutaneous Electric Nerve Stimulation* ; Vomiting

No abstract available.
Etoposide* ; Fluorouracil* ; Stomach Neoplasms*