Journal Detail Information

1

Cite

Share

The Role of Laparoscopy for Intussusceptions.

Hyoung Ran KIM ; Tae Ho HONG ; Yoon Suk LEE ; Jin Jo KIM ; Keun Ho LEE ; Se Jeong OH ; Seung Man PARK ; Young Ha KIM

Journal of the Korean Surgical Society.2008;74(2):126-128.

PURPOSE: In general, laparoscopic surgery has many advantages such as the improved cosmesis and the reduced pain, postoperative recovery and hospital stay. We evaluated the minimal invasive technique for the treatment of radiologically irreducible intussusceptions. METHODS: From January 1997 to April of 2007, the medical records of patients who underwent operation due to radiologically irreducible intussusceptions were reviewed. Age, gender, body weight, clinical symptoms, duration of symptoms, operation time, time to pass flatus, day of starting an oral diet, length of the hospital stay and complications were compared between the conventional surgery group and the laparoscopic group. RESULTS: 86 cases were enrolled in this study. 9 patients (10.5%) underwent laparoscopic surgery and 86 patients (89.5%) underwent conventional surgery. There were no differences between the two groups in terms of age, gender, body weight, duration of symptoms, clinical symptoms, operative time and the surgical morbidity. Postoperative flatus passing, starting the postoperative diet and the length of the hospital stay were significantly reduced in the laparoscopic group. CONCLUSION: The laparoscopic approach is one of the effective treatments for radiologically irreducible intussusceptions.
Body Weight ; Diet ; Flatulence ; Humans ; Intussusception ; Laparoscopy ; Length of Stay ; Medical Records ; Operative Time ; Pain, Postoperative

2

Cite

Share

The Usefulness of Endotoxin for Detection of Mucosal Injury in Intestinal Obstruction.

Jeong Eun LEE ; Cha Kyong YOM ; Jae Jung PARK ; Ki Hwan HAN ; Jung Won HUH ; Sun Hee SUNG ; Ku Yong CHUNG

Journal of the Korean Surgical Society.2008;74(2):121-125.

PURPOSE: The treatment outcome of an intestinal obstruction depends on the early recognition and emergent operation of a strangulated intestinal obstruction. Endotoxin is a lipopolysaccharide component of the cell wall of gram negative bacteria that normally exist in the intestinal lumen. When a strangulated obstruction occurs, the endotoxin passes transluminally into the peritoneal cavity and blood stream. A disruption of the mucosal barrier is an important putative cause in this pathogenesis. This study investigated the relationship between the endotoxin level and progress of an intestinal obstruction to a strangulated obstruction. METHODS: 25 adult male Sprague-Dawley rats (200~250 g) were divided into 3 groups, the control group, simple obstruction group, and closed loop obstruction group. An intestinal obstruction was induced using a silk tie. Blood samples and obstructed bowel wall specimens were obtained at 24, 48 and 72 hours after surgery. The endotoxin and IL-6 levels were examined, and all specimens were reviewed by a pathologist for mucosal damage after H-E staining. RESULTS: In the obstruction groups, dilated bowel loops at the proximal end of the obstruction site was identified but there were no ischemic changes. The endotoxin and IL-6 levels were similar regardless of the obstruction types and times. There were no differences between the three groups in the degree of mucosal damage. However, according to the endotoxin level, the groups with an endotoxin level < 0.2 EU/ml showed mild mucosal damage. The severity of mucosal damage increased with increasing endotoxin level. CONCLUSION: There is a positive relationship (r(2)=0.673, P-value=0.002) between the endotoxin level and mucosal damage. This suggests the possibility of using endotoxin as a predictive factor for the detection of mucosal injury in an intestinal obstruction. However, a larger scale will be needed to confirm the statistical significance.
Adult ; Cell Wall ; Gram-Negative Bacteria ; Humans ; Interleukin-6 ; Intestinal Obstruction ; Male ; Peritoneal Cavity ; Rats, Sprague-Dawley ; Rivers ; Silk ; Treatment Outcome

3

Cite

Share

The Impact of Obesity on Operative Results and Postoperative Courses in Laparoscopic-assisted Distal Gastrectomy (LADG).

Oh CHEONG ; Byung Sik KIM ; Sung Tae OH ; Jeong Hwan YOOK ; Jung Taek LIM ; Gun Chun PARK ; Ji Eun CHOI ; Kap Jung KIM

Journal of the Korean Surgical Society.2008;74(2):115-120.

PURPOSE: Despite known advantages of laparoscopy-assisted distal gastrectomy (LADG) over open surgery, including less blood loss, less pain, faster recovery, and shorter hospital stays, many surgeons still hesitate to perform LADG in overweight patients due to concerns about increased perioperative morbidity. We investigated whether surgical outcomes in LADG differ in overweight patients and normal patients, as well as the influence of surgical experience. METHODS: Between April 2004 and December 2006, 331 consecutive patients underwent LADG for preoperatively diagnosed early gastric cancer. Using the definition of overweight by western criteria, patients were classified into a low (n = 187, BMI < 25 kg/m(2)) and a high (n=144, BMI > 25 kg/m(2)) group. We retrospectively analyzed surgical outcomes, including operation time, retrieved lymph nodes, hospital courses, and postoperative complications. RESULTS: The only differences in overweight and normal patients were longer operation time, incision length, and fewer retrieved lymph nodes. As our surgical team accumulated experience (after 250 cases in our study), there were no differences at all between the two groups. CONCLUSION: Technical difficulty in overweight patients could hamper some surgical outcomes but didn't worsen the post- operative courses or complications. Moreover, those difficulties can be overcome as the surgical team accumulates experience.
Body Mass Index ; Gastrectomy ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Obesity ; Overweight ; Retrospective Studies ; Stomach Neoplasms

4

Cite

Share

Clinicopathologic Analysis of Gastric Carcinoma Patients with Outlet Obstruction.

Young Woong JEON ; Je Hee LEE ; Jong Heung KIM ; Jong Min PARK

Journal of the Korean Surgical Society.2008;74(2):110-114.

PURPOSE: This study was conducted to analyze the clinical course of patients of gastric cancer with outlet obstruction by comparing them with the gastric cancer patients without outlet obstruction. METHODS: The records of gastric cancer patients with outlet obstruction and who underwent radical gastrectomy from January 1996 to December 2005 were retrospectively reviewed and compared with those patients with gastric cancer and who were without outlet obstruction. RESULTS: The number of the patients who underwent radical gastrectomy was 461. Out of 461 patients, the number of gastric cancer patients with outlet obstruction was 42 (9.1%), and they had nasogastric tube insertion for an average of 4.4 days before operation. These patients showed several significant features such as large tumor size, advanced stage, an increased the number of involved LNs, a low serum albumin level, a frequent antral tumor location and duodenal invasion. There was no difference in complication rates between the two groups, but a higher mortality rate was noted in the gastric cancer patients with outlet obstruction than that in the other patients (P=0.038). The survival rate after the operation was significantly lower among the gastric cancer patients with outlet obstruction (P=0.0008), whereas no difference was found in the survival rate between the above two groups at the same stage (P=0.1951). CONCLUSION: The gastric cancer patients with outlet obstruction showed a comparatively poorer prognosis than those gastric cancer patients without outlet obstruction. However, there was no significant difference in the complication rate and the survival rate for both types of patients who were at the same stage. These results suggest that the patients with outlet obstruction can show the same result as the patients without outlet obstruction by undergoing radical gastrectomy.
Carbamates ; Gastrectomy ; Humans ; Organometallic Compounds ; Prognosis ; Retrospective Studies ; Serum Albumin ; Stomach Neoplasms ; Survival Rate

5

Cite

Share

Clinical Features of Gastric Cancer Patients with a Second Primary Cancer.

Jin Ho LIM ; Kwan Su SUNG ; Taeg Hyun KIM ; Kyo Young SONG ; Han Chol KANG ; Seung Nam KIM ; Cho Hyun PARK

Journal of the Korean Surgical Society.2008;74(2):105-109.

PURPOSE: The aim of this study was to clarify the risk factors and clinicopathologic features of gastric cancer patients with a second primary cancer (SPC). METHODS: The data on 2455 patients with gastric cancer was analyzed retrospectively with respect to the clinicopathologic features of the pathologically proven SPC. RESULTS: Of the 2,455 patients, there were 90 (3.7%) gastric cancer patients with SPC. Among them, 31 patients had synchronous cancers and 59 had metachronous cancers. Of the 59 metachronous cancers, 21 were found before the gastric surgery and 38 were found after the gastric surgery. The most prevalent SPC was colorectal cancer (28 cases) and followed by cancer in the liver (13 cases) kidney and pancreas (6 cases each, respectively). Among the 61 patients with SPC found after gastric cancer surgery, 31 cases (50%) were diagnosed within 2 years. On comparison of the clinicopathologic features, the patients with SPC tended to be older, more prone to have early gastric carcinoma and to have multiple gastric lesions. The survival rate of the patients with SPC and gastric cancer alone was not different; however, there was a significantly difference for the patients with early gastric cancer (61.7% vs. 91.3%, respectively, P < 0.05). CONCLUSION: For the patients who were older, had multiple primary lesions or they had early gastric cancer, evaluation for SPC, and especially in the colon and liver, should be considered during routine follow up.
Colon ; Colorectal Neoplasms ; Humans ; Kidney ; Liver ; Neoplasms, Second Primary ; Pancreas ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; Survival Rate

6

Cite

Share

Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma: A 17-year Experience at a Single Institution.

Sohee LEE ; Yong Sang LEE ; Ji Sup YUN ; Jong Ju JEONG ; Kee Hyun NAM ; Woong Youn CHUNG ; Hang Seok CHANG ; Cheong Soo PARK

Journal of the Korean Surgical Society.2008;74(2):98-104.

PURPOSE: The diffuse sclerosing variant of papillary thyroid carcinoma (DSPTC) is a rare histological subtype characterized by unique morphological features and aggressive behavior. The aim of this study was to evaluate the clinocopathologic features and outcome of DSPTC over 17 years. METHODS: Twenty-six cases of DSPTC (0.5%) were identified among 5,527 patients with papillary thyroid carcinoma treated between July 1990 and June 2007 at the Department of Surgery, Yonsei University College of Medicine. The clinicopathological features and outcome of these patients with DSPTC were evaluated. The median follow-up period was 46 months (range, 1~202 months). RESULTS: Twenty patients were females and 6 were males, the age ranged from 5 to 70 years (median 30.5 years). Histologically, most of the patients demonstrated diffuse involvement of one or both lobes of the thyroid, variable degree of lymphocytic infiltration, squamous metaplasia, psammoma bodies, extensive sclerosis and extracapsular extension, along with a high incidence of lateral neck node metastases (17/26, 65.4%). Treatment was by complete surgical resection by means of a total thyroidectomy (24/26, 92.3%), modified radical neck dissection (17/26, 65.4%) and postoperative radioactive iodine therapy (22/26, 84.6%). Recurrences were noted in 6 cases (5 locoregional recurrence and 1 distant metastasis in bone). One patient died of an unrelated disease. The 10-year overall survival and disease specific survival rates were 83.8% and 100%, retrospectively, but disease free survival was 48.0%. CONCLUSION: DSPTC showed an unfavorable clinical course with a low overall disease free survival. An aggressive therapeutic approach and close follow-up are recommended.
Carcinoma ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Iodine ; Male ; Metaplasia ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Sclerosis ; Survival Rate ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

7

Cite

Share

Hurthle Cell Carcinoma of the Thyroid Gland: Clinicopathologic Features and Treatment Outcome Compared with Pure Follicular Thyroid Carcinoma.

Jandee LEE ; Seong Hwan LEE ; Su Yun CHOI ; Kee Hyun NAM ; Woong Youn CHUNG ; Eui Young SOH ; Cheong Soo PARK

Journal of the Korean Surgical Society.2008;74(2):91-97.

PURPOSE: Hurthle cell carcinoma (HCC) of the thyroid gland is a rare disease that represents 3% of all thyroid carcinomas. HCC has been known as a more aggressive disease than the usual differentiated thyroid carcinoma. However, the biologic behavior and optimal treatment have come under considerable debate in recent years. This study was performed to evaluate the clinicopathologic features and treatment outcome of HCC. METHODS: From April 1986 to August 2006, 18 patients with HCC and 216 patients with pure follicular carcinoma (PFC) underwent thyroidectomy at our institutions with a mean follow-up of 114 (range: 6~253) months. The clinicopathologic characteristics and treatment outcome of each group were compared, and the prognostic factors for disease-free survival were analyzed. RESULTS: There were 14 women and 4 men with a mean age of 50 (range: 26~76) years. Compared with PFC patients, all of clinicopathologic features of HCC patients were different (gender, age, tumor size, multifocality, angioinvaion, invasion to adjacent structures, the subclassification and initial distant metastasis), but the high incidence of bilaterality was similar to the PFC patients (P<0.0001). The cause- specific survival (CSS) rates at 10 years were 83.4% in the HCC patients and 89.3% in the PFC patients (P=0.702). Older age (greater than 45) (P=0.0125) and initial distant metastasis (P<0.0001) in the HCC patients, and an older age (P<0.0001), male gender (P=0.0039), angioinvasion (P= 0.0122), invasion to adjacent structures (P<0.0001), a widely invasive type (P=0.004) and initial distant metastasis (P<0.0001) in the PCC patients were independent prognostic factors for survival. CONCLUSION: After accounting for important biologic behaviors, patients with HCC had similar clinicopathologic characteristics and prognosis compared with that of the PFC patients. Therefore, HCC should be managed using the same treatment strategy as PFC.
Accounting ; Adenocarcinoma, Follicular ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Neoplasm Metastasis ; Prognosis ; Rare Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Treatment Outcome

8

Cite

Share

Intraoperative Examination of Sentinel Lymph Nodes by Rapid Immunohistochemistry in Breast Cancer.

Hae Ran YUN ; Ki Eun YOO ; Young Jin CHOI ; Sang Uk WOO ; Yoon La CHOI ; Jeung Han KIM ; Seok Jin NAM ; Young Hyeh KO ; Jung Hyun YANG

Journal of the Korean Surgical Society.2006;70(4):275-280.

PURPOSE: The recently developed method of rapid immunohistochemistry (IHC) was applied to the intraoperative examination of sentinel lymph node (SLN) because as their routine frozen-section examination is liable to yield a false-negative results. This study is devoted to establish a reliable protocol for rapid IHC of SLN. METHODS: Between August 2004 and April 2005 a retrospective study was performed. SLNs from 50 breast cancer patients with clinically negative SLN were examined intraoperatively using hematoxylin-eosin (H&E) stain and immunostain for cytokeratin by rapid IHC assay. After examination of the frozen section, the SLNs were paraffin embedded and serially sectioned at 5 micrometer intervals. RESULTS: The median age and tumor size of the patients was 61.0 years and 1.4 cm (6% Tis, 70% T1, and 24% T2), respectively. The total number of dissected SLN was 112, with a mean of 2.2 (range, 1~4) SLNs per patient. Seven SLNs were found to be positive from metastasis in permanent pathological sections. Of these, 5 were stained by both intraoperative rapid IHC and H&E stain while one was not stained at all. The remaining SLN was initially stained with only the rapid IHC assay. The mean turn around time of the rapid IHC was less than 20 minutes, with sensitivity, true negative value, true positive values and accuracy of 85.7, 99.1, 100, and 99.1% respectively. CONCLUSIONS: The rapid IHC was a very sensitive and rapid technique for the intraoperative detection of metastatic involvement of SLNs, whitch may be helpful at increasing the accuracy of detecting the micro-metastasis of sentinel lymph nodes during an operation.
Breast Neoplasms* ; Breast* ; Frozen Sections ; Humans ; Immunohistochemistry* ; Keratins ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Paraffin ; Retrospective Studies

9

Cite

Share

Genomic DNA Aberration Profiles in Paraffin-Embedded Breast Tumor Using Array-CGH on c-erbB-2 Overexpression.

Tae Woo KANG ; Koon Taek HAN

Journal of the Korean Surgical Society.2006;70(4):265-274.

PURPOSE: Array-CGH is the technique for detecting multiple chromosomal abnormalities in the genomic DNA with using a single procedure. Compared with conventional CGH, there are many advantages for array-CGH such as high resolution, simplified image analysis and high throughput, and its oligo-strategy allows a genome based design. We analyzed the gene aberrations in breast cancer patient to discover the other genomic aberrations that are associated with c-erbB-2 amplification. METHODS: 10 cases of breast cancer patients, considering its c-erbB-2 status of the paraffin embedded tissues, were analyzed with performing array-CGH. RESULTS: The repeated aberrations in whole cases were found in 78 loci, of which repeatedly gained in 1p36.33, 19p13.13, and lost in 14q32.33, 4q32.3, 10p15.3, 14q21.1. The unsupervised dendrogram couldn't show significant classifier for its limited case number. Each tissue from one bilateral breast cancer patient showed a different aberration pattern. There were no BRCA1, 2 aberrations in this study. The concordance was 100% between the IHC and the a-CGH. By the supervised clustering on the c-erbB-2 factor, 18 aberrations (gained in 17q12-21.1, 17q12, 17q21.1, 17q11.2 and lost in 22q11.1, 15q11.2) were found in c-erbB-2 (+) group with the permutation t-test. The repeated aberrations of c-erbB-2 (+) group were found in 170 loci, of which repeatedly gained in 17q12, 17q21.1 and lost in 14q32.33, 22q11.1. CONCLUSION: Although the number of cases was small, performing a-CGH with paraffin embedded breast cancer tissue was a useful technique for rapidly identifying DNA aberrations with high throughput, and this technique showed significant aberrations for some clinical variables.
Breast Neoplasms* ; Breast* ; Chromosome Aberrations ; DNA* ; Genome ; Humans ; Paraffin

10

Cite

Share

A Clinical Analysis of Methylation Status of Tumor Suppressor Genes in Breast Cancer.

Hun JUNG ; Chang Hyeok AN ; Kee Hwan KIM ; Ji Il KIM ; Woo Chan PARK ; Byung Joo SONG ; Sang Seol JUNG ; Keun Woo LIM ; Jeong Soo KIM

Journal of the Korean Surgical Society.2006;70(4):253-264.

PURPOSE: Aberrant methylation of CpG islands in gene promoters has been considered as a common mechanism for suppressing gene expression in cells. Hypermethylation of CpG islands in promoters is associated with silencing of transcription in various tumor suppressor genes and recent studies identified a CpG island methylator phenotype (CIMP) suggesting common methylation defect in cancer cells. For breast cancer, several genes were previously reported to be hypermethylated, but it is unclear whether the CIMP status is associated with any clinicopathological characteristics of breast cancer. In this study, we investigated the methylation patterns of several genes such as p16(INK4a), O(6)-methyguanine-DNA methyltransferase (MGMT), Death associated protein kinase (DAPK), E-cadherin, hMLH1, and four loci such as Methylation in tumor (MINT: MINT1, MINT2, MINT25, MINT31) and analyzed the correlation with clinical features. METHODS: 85 patients who underwent curative surgery for breast cancer were studied retrospectively using their paraffin-embedded tissues and medical records. Immunohistochemical staining were performed according to their hormone receptors. DNA extraction, sodium bisulfite modification and methylation specific PCR (MSP-PCR) were performed with some modifications. RESULTS: The rates of E-cadherin and MINT 31 methylation in cancer tissue were significantly higher than those of normal tissues (P<0.05). There was no statistical correlation between methylation status of each suppressor genes and hormone receptor except DAPK methylation with progesteron receptor. The rate of E-cadherin methylation was significantly high in stage II (P=0.010). For 5-year survival and disease-free survival rate, the group with methylated MINT1 and MINT25 had significantly better outcome than unmethylated group (P<0.05). There was no statistical significance between CIMP status and other prognostic factors such as hormone receptor and stage (P=0.885). But, CIMP-High group was significantly lower than CIMP-Low group in 5-year survival (P=0.001) and disease-free survival rate (P=0.024). CONCLUSION: The methylation of E-cadherin and some MINT loci seems closely related to tumorigenesis in breast cancer and CIMP status have some value as a prognostic indicator after surgery in breast cancer but more large scale study will be needed.
Breast Neoplasms* ; Breast* ; Cadherins ; Carcinogenesis ; CpG Islands ; Cyclin-Dependent Kinase Inhibitor p16 ; Disease-Free Survival ; DNA ; Gene Expression ; Genes, Suppressor ; Genes, Tumor Suppressor* ; Humans ; Medical Records ; Mentha ; Methylation* ; Phenotype ; Polymerase Chain Reaction ; Protein Kinases ; Retrospective Studies ; Sodium

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share