Preventive effect of biodegradable stents on biliary stricture and fibrosis after biliary anastomosis in a porcine model

Purpose@#The current drain tubes for preventing surgically biliary anastomotic stricture are not naturally and easily removed. If a drain tube using biodegradable material is easily available and the degradation time of the tube is well controlled, surgical anastomotic stricture and fibrosis could be prevented. The aim of this animal study was to evaluate the preventive effect of novel biodegradable stents (BS) on biliary stricture and fibrosis after duct-to-duct (DD) biliary anastomosis. @*Methods@#Ten mini-pigs were allocated to the control group (n = 5) and or the stent group (n = 5). The common bile duct was exposed through surgical laparotomy and then resected transversely. In the stent group, a 4-mm or 6-mm polydioxanone/ magnesium sheath-core BS was inserted according to the width of the bile duct, followed by DD biliary anastomosis. In the control group, DD biliary anastomosis was performed without BS insertion. @*Results@#In the stent group, stents were observed without deformity for up to 4 weeks in all animals. Eight weeks later, histopathologic examination revealed that the common bile duct of the anastomosis site was relatively narrower in circumference in the control group compared to the stent group. The degree of fibrosis in the control group was more marked than in the stent group (3.84 mm vs. 0.68 mm, respectively; P < 0.05). @*Conclusion@#Our study showed that novel BS maintained their original shape and radial force for an adequate time and then disappeared without adverse events. The BS could prevent postoperative complications and strictures after DD biliary anastomosis.

Performance of disposable endoscopic forceps according to the manufacturing techniques

BACKGROUND/AIMS@#Recently, to lower the production costs and risk of infection, new disposable biopsy forceps made using simple manufacturing techniques have been introduced. However, the effects of the manufacturing techniques are unclear. The aim of this study was to evaluate which types of biopsy forceps could obtain good-quality specimens according to the manufacturing techniques.@*METHODS@#By using an in vitro nitrile glove popping model, we compared the popping ability among eight different disposable biopsy forceps (one pair of biopsy forceps with cups made by a cutting method [cutting forceps], four pairs of biopsy forceps with cups made by a pressing method [pressing forceps], and three pairs of biopsy forceps with cups made using a injection molding method [molding forceps]). Using an in vivo swine model, we compared the penetration depth and quality of specimen among the biopsy forceps.@*RESULTS@#In the in vitro model, the molding forceps provided a significantly higher popping rate than the other forceps (cutting forceps, 25.0%; pressing forceps, 17.5%; and molding forceps, 41.7%; p = 0.006). In the in vivo model, the cutting and pressing forceps did not provide larger specimens, deeper biopsy specimen, and higher specimen adequacy than those obtained using the molding forceps (p = 0.2631, p = 0.5875, and p = 0.2147, respectively). However, the molding forceps showed significantly more common crush artifact than the others (cutting forceps, 0%; pressing forceps, 5.0%; and molding forceps, 43.3%; p = 0.0007).@*CONCLUSIONS@#The molding forceps provided lower performance than the cutting and pressing forceps in terms of crush artifact.

Very late stent thrombosis of DES implanted patient during noncardiac surgery: A case report / 대한마취과학회지

Very late stent thrombosis after implantation of drug eluting stent is rare, but its consequences are potentially fatal. Stent thrombosis may be occurred in perioperative period because of interruption of anticoagulation therapy and intraoperative hypercoagulability. We report a case of very late stent thrombosis in a 49-year-old male patient during total gastrectomy. ST-segment elevation in lead II occurred during the surgery and followed by cardiac arrest. After external cardiac massage and electrocardioversion, normal sinus rhythm was restored. Postoperative 12 lead ECG showed ST-segment elevation in leads II, III, aVF and serum cardiac enzymes such as CPK, CK-MB, and Troponin T were markedly elevated. Postoperative coronary angiography showed complete occlusion of the right coronary artery stent. Emergency percutaneous transluminal coronary angioplasty was performed and the patient recovered uneventfully.

Effect of preoperative administration of celecoxib on postoperative pain after laparoscopic cholecystectomy / 대한마취과학회지

BACKGROUND: For laparoscopic cholecystectomy, pain is most frequent complaint and the most common cause of delayed discharge. The aim of this study was to determine the effect of preoperative administration of celecoxib on the level of postoperative pain in patient undergoing laparoscopic cholecystectomy. METHODS: We enrolled 60 patients ASA class I and II, scheduled for elective laparoscopic cholecystectomy. The patients were randomized to receive celecoxib 200 mg, celecoxib 400 mg or placebo two hour before the induction of anesthesia. The patients received the same anesthetics. The intensities of abdominal pain were assessed using VAS (visual analog scale) at 1, 2, 4, 12, 24 hours after surgery. RESULTS: In celecoxib 200 mg group, VAS score of somatic pain compared to control group decreased at 1, 2, and 4 hours after surgery. In celecoxib 400 mg group, VAS score of somatic pain compared to control group decreased at 1, 2, and 4 hours after surgery. There was no difference between celecoxib 200 mg and celecoxib 400 mg in pain scores of somatic pain. Dosage of meperidine in two celecoxib groups after surgery were each 31 mg and 26 mg and that of control group was 72 mg. There was no difference between celecoxib groups and placebo group in pain scores of visceral pain. CONCLUSIONS: The preoperative administration of celecoxib reduces the level of postoperative pain after laparoscopic cholecystectomy without adverse effects.

Preliminary Report on Efficacy of Speculoscopy for Increasing the Sensitivity of Cervical Cancer Screening Test / 대한산부인과학회잡지

OBJECTIVE: Since the accuracy of Pap smear for cervical neoplasm has been questioned, a number of adjunctive tests have been developed. The purpose of this study was to evaluate the accuracy of speculoscopy, a magnified chemiluminescent examination, as compared with that of the Pap smear in the screening of cervical neoplasm. METHODS: A total of 41 women were included in the study. We conducted Pap smear, speculoscopy, and punch biopsy to all subjects. Targeted biopsies were obtained from any suspicious lesions that were found with positive speculoscopy. Women with negative speculoscopy underwent random biopsies. The data were analysed using McNemar's test. RESULTS: Thirty-one out of 41 biopsy specimen were found to have cervical lesion that were worse than CIN I, including 8 cases of invasive cancer. The sensitivity and specificity of Pap smear were 74.2% and 70.0%, respectively. Those of speculoscopy were 93.5% and 60.0%, respectively. When these two tests were combined, the sensitivity was raised to 96.8%, but the specificity declined to 50.0%. Among 9 cases of ASCUS on Pap smear, 6 cases were found to have cervical pathology worse than CIN II, and these were positive on speculoscopy. CONCLUSION: Speculoscopy combined with a Pap smear can increase the detection of cervical lesions compared with the Pap smear alone. In the cases of ASCUS on Pap smear, speculoscopy may be more useful to detect significant pathology.

Peritoneo-Amniotic Shunting in Isolated Fetal Ascites of Unknown Origin / 대한산부인과학회잡지

Although sporadic cases of transient fetal ascites have been described, pulmonary hypoplasia or hydrops fetalis may occur as potentially lethal complications of isolated fetal ascites. Antenatal fetal paracentesis may be useful in improving neonatal pulmonary function, however rapid accumulation of fluid after paracentesis usually required repetitive invasive procedures. We successfully treated an isolated fetal ascites with peritoneo- amniotic shunt. Under the ultrasonographic guidence, we inserted a Double-Basket Catheter into the left lower quadrant of fetal abdominal wall at the end of second trimester. Shunt remained in place until the fetus was delivered at term. The peritoneo-amniotic shunt can improve fetal outcome and avoid repeated paracentesis before delivery.

A comparison of Clinical Efficacy of Intravaginal Misoprostol with Intravenous Sulprostone for Termination of Second-Trimester Pregnancy / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to compare the clinical efficacy of intravaginal misoprostol and that of intravenous sulprostone for termination of second-trimester pregnancy. METHODS: The patients were assigned to misoprostol and sulprostone group, and the misoprostol group was further divided into two groups according to gestational age. In the misoprostol group, the patients at or before 20 weeks of gestation received 400 microgram of intravaginal misoprostol every 4 hours until labor pain was established, 200 microgram every 6 hours after 20 weeks of gestation. In the sulprostone group, intravenous sulprostone was infused at the speed of 100 microgram/hr after cervical ripening with 3 mg of intravaginal dinoprostone. RESULTS: At or before 20 weeks of gestation, the median time from induction to completion of termination was longer, but the success rate within 24 hours was less in the misoprostol group than in the sulprostone group (18.75 vs. 7.15 hours, p=0.015; 50% vs 92%, p=0.014, respectively). After 20 weeks, there was no significant difference in median induction time or success rate within 24 hours (5.54 vs. 8.0 hours, p>0.05; 100% vs. 100%, p>0.05, respectively). There was no significant difference in the prevalence of complication or change of hemoglobin after termination between two groups. CONCLUSION: Sulprostone may be more effective for termination of pregnancy at or before 20 weeks of gestation and misoprostol may be as effective as sulprostone after 20 weeks of gestation. But considering less cost and complication, the efficacy of misoprostol should be further investigated for termination of second- trimester pregnancy.