PURPOSE: Acupuncture has recently been accepted as a treatment option for managing postoperative ileus (POI) and various functional gastrointestinal disorders. Therefore, we conducted a prospective randomized study to evaluate the effect of acupuncture on POI and other surgical outcomes in patients who underwent gastric surgery. MATERIALS AND METHODS: Thirty-six patients who underwent distal gastrectomy for gastric cancer from March to December 2015 were randomly assigned to acupuncture or non-acupuncture (NA) groups at 1:1 ratio. The acupuncture treatment was administered treatment once daily for 5 consecutive days starting at postoperative day 1. The primary outcome measure was the number of remnant sitz markers in the small intestine on abdominal radiograph. The secondary outcome measure was the surgical outcome, including the times to first flatus, first defecation, start of water intake, and start of soft diet, as well as length of hospital stay and laboratory findings. RESULTS: The acupuncture group had significantly fewer remnant sitz markers in the small intestine on postoperative days 3 and 5 compared to those in the NA group. A significant difference was observed in the numbers of remnant sitz markers in the small intestine with respect to group differences by time (P<0.0001). The acupuncture group showed relatively better surgical outcomes than those in the NA group, but the differences were not statistically significant. CONCLUSIONS: In this clinical trial, acupuncture promoted the passage of sitz markers, which may reflect the possibility of reducing POI after distal gastrectomy.
Acupuncture* ; Defecation ; Diet ; Drinking ; Flatulence ; Gastrectomy* ; Gastrointestinal Diseases ; Humans ; Ileus* ; Intestinal Pseudo-Obstruction ; Intestine, Small ; Length of Stay ; Outcome Assessment (Health Care) ; Prospective Studies ; Stomach Neoplasms*

Secondary esophageal carcinoma usually originates from a primary site in either the lung or breast. Only one case of metastatic esophageal cancer with a radiologic evidence that it was originated from the rectal cancer had been reported. We report an unusual case of a 80-year-old man with secondary esophageal carcinoma originated from the rectal cancer. It was diagnosed by histopathologic confirmation using immunohistochemical staining including CK20 and CK7 by comparing the histopathologic findings of surgical specimen of rectal cancer and endoscopic biopsy tissue from the esophagus. To the best of our knowledge, this is the first case of secondary esophageal cancer arising from rectum in Korea.
Aged, 80 and over ; Biopsy ; Breast ; Esophageal Neoplasms* ; Esophagus ; Humans ; Korea ; Lung ; Rectal Neoplasms* ; Rectum

BACKGROUND AND OBJECTIVES: An awareness of the surgical anatomy and the possible dispositions of the superior, recurrent laryngeal nerve and the thyroid arteries are very helpful in avoiding injury during thyroidectomy. MATERIALS AND METHODS: The relationship of the superior and recurrent laryngeal nerve to the superior and inferior thyroid artery and the incidence of the thyroid ima artery were studied in 43 adult cadavers. RESULTS: The superior thyroid artery (STA) arose commonly from the external carotid artery (59.3%). And the superior laryngeal nerve (SLN) was closely related to the STA. The inferior thyroid artery (ITA) arose commonly from the thyrocervical artery (81.4%) and eight different types of relationship between the ITA and the recurrent laryngeal nerve (RLN) were found. Among them, the most common type was the RLN which passed in front of the ITA (39.5%). And the incidence of the thyroid ima artery was 9.3%. CONCLUSION: The course and anatomic relationship of laryngeal nerve to the thyroid arteries is not constant, therefore careful identification of these structures should be performed during operation to decrease the surgical complications, such as vocal cord paralysis or hemorrhage.
Adult ; Arteries* ; Cadaver ; Carotid Artery, External ; Hemorrhage ; Humans ; Incidence ; Laryngeal Nerves ; Recurrent Laryngeal Nerve ; Thyroid Gland* ; Thyroidectomy ; Vocal Cord Paralysis

The anomalous origin of the right coronary artery (RCA) is a rare condition. Most RCA anomalies are usually found incidentally, but these findings have clinical significance because many patients, particularly young ones, present with sudden death, myocardial ischemia and syncope without other symptoms. We describe a case of a 39-year-old male patient that presented with effort chest pain and was diagnosed with anomalous RCA that originated from the ascending aorta with prior history of repairing ruptured sinus valsalva and ventricular septal defect. The anomalous origin of RCA was identified by multidetector computed tomography (MDCT). Successful percutaneous coronary intervention was performed guided by MDCT coronary images and intravascular ultrasound.
Adult ; Angioplasty ; Aorta ; Chest Pain ; Coronary Vessel Anomalies ; Coronary Vessels ; Death, Sudden ; Heart Septal Defects, Ventricular ; Humans ; Male ; Multidetector Computed Tomography ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Syncope

PURPOSE: Brain metastasis is infrequent in colorectal cancer patients. The purpose of this study was to analyze the clinical characteristics including the survival, type of treatment, and metastatic patterns of brain metastasis in colorectal cancer. METHODS: Between January 1993 and September 2002, we analyzed 2,019 surgical patients with colorectal carcinoma operated at Korea Cancer Center Hospital. Among these patients, 13 patients were identified with metastatic colorectal cancer to the brain. The medical records of these patients were reviewed retrospectively and survival analysis was performed. RESULTS: During the study period, the incidence of brain metastasis of colorectal cancer was 0.6%. Male-to-female ratio was 1:1.6. Mean age was 55.2+/-9.7 years and median age was 56 years (34~67years). The most frequent primary tumor site was the rectum (11 cases, 84.6%). and the most frequent symptom of brain metastasis was headache. According to the TNM staging system, there were 1 case in stage II, 8 cases in stage III, and 4 cases in stage IV at the time of initial diagnosis of colorectal cancer. Brain metastases were often occurred concurrently with lung metastases (9 cases, 69.2%), otherwise solitary brain metastasis was found in 4 cases. Between the diagnosis of primary cancer and the diagnosis of brain metastasis, the mean interval was 25.9+/-6.9 months and the median interval was 16 months (5~97) in stage II and III patients. The mean survival time after the diagnosis of brain metastasis was 18.5 months for patients who underwent surgery and 3.3 months for patients who received non-surgical therapy. CONCLUSIONS: Brain metastasis of colorectal cancer is relatively uncommon and the incidence is significantly low, commonly more or less than 1%. It is often accompanied by pulmonary metastasis. The results of this study show that surgical resection may increase the survival of these patients. Though inability to the awareness of the possibility and early diagnosis of brain metastasis in colorectal cancer could affect the poor prognosis, aggressive treatment in suitable cases might enhance the survival for this group of patients.
Brain* ; Colorectal Neoplasms* ; Diagnosis ; Early Diagnosis ; Headache ; Humans ; Incidence ; Korea ; Lung ; Medical Records ; Neoplasm Metastasis* ; Neoplasm Staging ; Prognosis ; Rectum ; Retrospective Studies ; Survival Rate

PURPOSE: Congenital chylothorax is an accumulation of lymphatic fluid within the pleural space. It is a common cause of unidentified hydrops fetalis. We examined the perinatal history, clinical manifestation, diagnosis, treatment, and outcome in 6 newborns diagnosed to have congenital chylothorax with hydrops fetalis. We also studied the effect of octreotide therapy for congenital chylothorax in relation to conservative treatment. METHODS: We retrospectively reviewed the medical records of 6 patients diagnosed to have congenital chylothorax with hydrops fetalis among 27,907 newborns who were born at the Cheil General Hospital and Womens Healthcare Center between January 2004 and July 2007 . The diagnosis of chylothorax is based on the analysis of pleural fluid before and after milk feeding. RESULTS: Incidence of congenital chylothorax in this study was 0.021%. All 6 cases were noted in over the 92% lymphocyte in pleural analysis. Transudate was changed into chyle with increasing triglyceride levels above 200 mg/dL after milk feeding. Three of 6 infants improved with conservative treatment, including thoracostomy and assisted ventilation. The others had persistent symptoms despite conservative treatment and responded to octreotide therapy. A complication, specifically vomiting was noted in 1 case during octreotide therapy. CONCLUSION: In this study, octreotide therapy resulted in a safe and excellent outcome. Therefore, octreotide therapy is considered in severe refractory congenital chylothorax in conservative treatment. Further studies are required to determine appropriate guidelines for octreotide therapy.
Chyle ; Chylothorax ; Delivery of Health Care ; Exudates and Transudates ; Female ; Hospitals, General ; Humans ; Hydrops Fetalis ; Incidence ; Infant ; Infant, Newborn ; Lymphocytes ; Medical Records ; Milk ; Octreotide ; Retrospective Studies ; Thoracostomy ; Ventilation ; Vomiting

OBJECTIVE: The interaction between MK-801, a model of psychosis and KCl-induced depolarization or electroconvulsive shock (ECS), a therapeutic model of electroconvulsive therapy (ECT), was investigated in SH-SY5Y cells and the rat frontal cortex. METHODS: SH-SY5Y cells were pretreated with 1 microM MK-801 for 15 min, followed by cotreatment with 100 mM KCl for 5 min. MK-801 was reintroduced after the KCl was washed out, and the samples were incubated before harvesting. For the experiments in rats, male Sprague-Dawley rats were treated with MK-801 followed by ECS. Immunoblot analyses of glycogen synthase kinase 3beta (GSK3beta) (Ser9), AKT (Ser473) and extracellular legulated kinase (ERK)1/2 in SH-SY5Y cells and the rat frontal cortex were performed. RESULTS: KCl-induced neuronal depolarization resulted in the transient dephosphorylation of AKT (Ser473) and GSK3beta (Ser9), followed by increased phosphorylation of the enzymes in SH-SY5Y cells. Cotreatment with MK-801 and KCl inhibited the initial dephosphorylation of AKT and GSK3beta produced by KCl-induced neuronal depolarization. Similarly, ECS resulted in the transient dephosphorylation of AKT (Ser473) and GSK3beta (Ser9), whereas cotreatment with MK-801 inhibited the initial dephosphorylation of AKT (Ser473) and GSK3beta (Ser9) produced by ECS in the rat frontal cortex. No significant interaction was observed between MK-801 and KCl in the dephosphorylation of ERK1/2. CONCLUSION: These results suggest that an antagonistic interplay between MK-801 and neuronal depolarization by KCl or ECS is involved the regulation of AKT (Ser473) and GSK3beta (Ser9) phosphorylation.
Animals ; Dizocilpine Maleate* ; Electroconvulsive Therapy ; Electroshock ; Glycogen Synthase Kinases ; Humans ; Male ; Neurons* ; Phosphorylation ; Phosphotransferases ; Psychotic Disorders ; Rats* ; Rats, Sprague-Dawley

Continuous ambulatory peritoneal dialysis (CAPD) is an effective renal replacement therapy for end- stage renal disease. Hydrothorax secondary to leakage of dialysate via pleuroperitoneal communication is a rare complication of CAPD. Earlier treatments of CAPD-induced hydrothorax have included pleurodesis with tetracycline, talc, fibrin, or autologous blood and surgical treatment. These procedure have made many patients switch to hemodialysis, because of the high relapse rate of the former and the invasiveness and morbidity of the latter. The talc pleurodesis with video-assisted thoracic surgery (VATS) allows not only direct visualization of potential diaphragmatic defect but also direct application of the talc to the visceral or parietal pleura. This procedure is less invasive than thoracotomy and can perform more accurate poudrage of talc than conventional methods. We have recently managed a patient CAPD-induced massive hydrothorax using thoracoscopic talc pleurodesis. This patient was successfully returned to CAPD.
Fibrin ; Humans ; Hydrothorax ; Peritoneal Dialysis, Continuous Ambulatory* ; Pleura ; Pleurodesis* ; Recurrence ; Renal Dialysis ; Renal Replacement Therapy ; Talc* ; Tetracycline ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy

Continuous ambulatory peritoneal dialysis (CAPD) is an effective renal replacement therapy for end- stage renal disease. Hydrothorax secondary to leakage of dialysate via pleuroperitoneal communication is a rare complication of CAPD. Earlier treatments of CAPD-induced hydrothorax have included pleurodesis with tetracycline, talc, fibrin, or autologous blood and surgical treatment. These procedure have made many patients switch to hemodialysis, because of the high relapse rate of the former and the invasiveness and morbidity of the latter. The talc pleurodesis with video-assisted thoracic surgery (VATS) allows not only direct visualization of potential diaphragmatic defect but also direct application of the talc to the visceral or parietal pleura. This procedure is less invasive than thoracotomy and can perform more accurate poudrage of talc than conventional methods. We have recently managed a patient CAPD-induced massive hydrothorax using thoracoscopic talc pleurodesis. This patient was successfully returned to CAPD.
Fibrin ; Humans ; Hydrothorax ; Peritoneal Dialysis, Continuous Ambulatory* ; Pleura ; Pleurodesis* ; Recurrence ; Renal Dialysis ; Renal Replacement Therapy ; Talc* ; Tetracycline ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy

The liver fluke, Clonorchis sinensis is an important human parasite and is endemic in Eastern Asia including Korea, China, and Japan. Patients acquire the infestation by eating raw or undercooked freshwater fish. Radiologic examinations usually reveal dilated peripheral intrahepatic bile ducts and normal extrahepatic bile duct. The diagnosis of clonorchiasis may sometimes be difficult and a presentation as an obstructive mass at the common hepatic duct is a rare event. Here we report a case of clonorchiasis of 54-year-old woman presented with epigastric pain. Endoscopic retrograde cholangiography revealed a mass at the common hepatic duct with dilatation of the intrahepatic ducts mimicking cholangiocarcinoma. Using an endoscopic basket, muddy, sludge-like materials were extracted through the papillary orifice. We report this case with a review of literatures.
Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; China ; Cholangiocarcinoma ; Cholangiography ; Cholestasis ; Clonorchiasis* ; Clonorchis sinensis ; Diagnosis ; Dilatation ; Eating ; Far East ; Fasciola hepatica ; Female ; Fresh Water ; Hepatic Duct, Common* ; Humans ; Japan ; Korea ; Middle Aged ; Parasites