ABSTRACT
PURPOSE: Conventional intravenous nutrition has been given as a solution of amino acids combined with dextrose and a separate line delivering a lipid emulsion. This technique was unsatisfactory, however, because of difficulties in managing technical and metabolic complications. Since the first clinical use of a single solution containing all the necessary nutrients was introduced in 1976, the total nutrient admixture (TNA) system has been used. However, despite the numerous advantages of this TNA system, it has not been used worldwide because of an assumption about unstability of this admixture. This study was conducted to compare the physical stability of TNA systems using two different 2 commercially available amino acid solutions and fat emulsions. METHODS: Each group contained 600 ml of 20% dextrose, 250 ml of 10% amino acid solution, 250 ml of 10% fat emulsion, 0.2 ml of heparin, and 20 ml of electrolyte solution was investigated for 7 days while being stored 4oC and at ambient temperature. The stabilities of these admixtures were compared by noting changes in macroscopic appearance, pH, osmolarity, Zeta-potential, peroxide value, particle size and distribution, and fat composition. RESULTS: When an amino acid solution containing P 2 was used, a supernatant yellow band was observed from the 3rd day at ambient temperature. The pH and peroxide value also showed significant changes, but these changes did not exceed the product-specifications. When an amino acid solution without P 2 was used, no significant change was observed. CONCLUSION: TNA systems are physically stable at 4oC temperature for at least 7 days, but TNA systems prepared with amino acid solution containing P 2 are not stable at ambient temperature from the 3rd day. On the other hand, TNA systems prepared with an amino acid solution without P 2 are stable at ambient temperature for 7 days. Various commercially available fat emulsions containing 10% soybean oil did not affect the stability of TNA systems.
Subject(s)
Amino Acids , Emulsions , Glucose , Hand , Heparin , Hydrogen-Ion Concentration , Osmolar Concentration , Parenteral Nutrition , Particle Size , Soybean OilABSTRACT
BACKGROUND: The 5-year survival rate for early gastric cancer (EGC) now exceeds 90% and EGC is now recognized as a curable malignancy. The less extensive treatment has attracted interest. It is of vital importance to select a surgical method appropriate to each individual case. A retrospective study was undertaken to compare clinicopathologic features between mucosal (M) and submucosal (SM) cancers and to evaluate treatment modality for EGC. METHODS: We analyzed clinicopathologic data on 345 surgically treated patients with early gastric cancer between September 1983 and December 1996 at the Department of Surgery, Korea University College of Medicine: 183 patients with mucosal cancer and 162 patients with submucosal cancer. RESULTS: The rate of detection of EGC has been increasing as high as 25% since 1990. There were significant differences between M and SM cancers with regard to the location of the tumor, lymph node metastasis and histologic type. The SM cancer had lower 1/3 in location, more lymph node metastasis and more differentiated than M cancer. Nodal involvement was evident in 49 patients (14.2%): 6.6% (12/183) with M cancer and 22.8% (37/162) with SM lesions. The 5-year survival rate of all patients was 94.7%: 95.3% in M cancer and 94.0% in submucosal SM cancer. The 5-year survival rates for SM cancer were 96.1% in node-negative cases and 86.3% in node-positive cases with significance and M cancer had no survival difference. CONCLUSIONS: As early gastric cancer can be cured by surgery, the submucosal carcinomas in this series had no indications for less extensive treatment, such as endoscopic or laparoscopic limited surgery. These carcinomas should be subject to standard surgery with gastrectomy and combined dissection of lymph nodes.
Subject(s)
Humans , Gastrectomy , Korea , Lymph Nodes , Neoplasm Metastasis , Retrospective Studies , Stomach Neoplasms , Survival RateABSTRACT
Macroamylasemia is a condition of persistent, elevated serum amylase activity with no apparent clinical symptoms of a pancreatic disorder. In Korea, however, no such case has been reported to date. We report a case of a 17-year-old female diagnosed with macroamylasemia and acute appendicitis. One day earlier, she developed epigastric and right lower quadrant abdominal pain. She was characterized by high level of serum amylase, but normal lipase. Amylase isoenzyme analysis demonstrated increased fraction of salivary type and follow-up amylase level was persistently increased. Immunofixation disclosed the macroamylase binding with an immunoglobulin, consisting of IgA and kappa chain. The patient was treated by appendectomy, and the abdominal pain subsided.
Subject(s)
Female , Humans , Adolescent , Amylases/blood , Appendectomy , Appendicitis/enzymology , Appendicitis/blood , Immunoglobulin A/blood , Immunoglobulin kappa-Chains/blood , Isoenzymes/blood , Protein BindingABSTRACT
BACKGROUND: There has been a general feeling among surgeons that recurrence or metastasis following a curative gastric resection is a hopeless surgical proposition. This study was conducted to evaluate the clinical features and significance of relaparotomy following a gastrectomy for gastric cancer. METHODS: Fifty-six cases of relaparotomies following resection for 53 gastric cancer patients, which were performed over a nine-year period, were investigated retrospectively. On preoperative diagnosis, there were 17 cases of remnant and anastomotic recurrence, 15 cases of intestinal obstruction, 7 cases of cholecystitis, 7 cases of rectosigmoid obstruction, 5 cases of E-loop obstruction and 5 cases of other diseases. RESULTS: Of all the laparotomies eleven cases (19%) were non-recurrence, benign diseases and forty-six (81%) were recurrence. In the 17 cases of remnant and anastomotic recurrence, re-resection was possible in 13 (76%) and major postoperative complications developed in 4 cases with 2 cases of death within one month. Also 6 of 7 re-resected cases which was stage I at first operation were still alive well. In 15 cases of mechanical obstruction, 5 cases were non-recurrence and 10 cases involved recurrence, of which 6 had a bypass or enterostomy and 4 an exploration only. All cholecystitis cases had a cholecystectomy; metastasis was found in 2 cases. Rectal obstruction and E-loop obstruction all involved recurrence and a palliative resection was possible in only one case of each type of obstruction. CONCLUSIONS: In a relaparotomy of remnant and anastomotic recurrence, most of the survival-improving re-resection cases were in stage I at the first operation. In late-onset cholecystitis tumor recurrence should be suspected and a relaparotomy of the malignant obstruction, with bypass and ostomy procedure, can be justified for symptomatic relief.
Subject(s)
Humans , Cholecystectomy , Cholecystitis , Diagnosis , Enterostomy , Gastrectomy , Intestinal Obstruction , Laparotomy , Neoplasm Metastasis , Ostomy , Postoperative Complications , Recurrence , Retrospective Studies , Stomach NeoplasmsABSTRACT
PURPOSE: Despite gsstric cancer is one of the most common ma1ignancies, its prognosis has not been improved significantly. Therefore, it is important to know what clinical and pathological factors relate to survival in gastric carcinoma in order to improve survival rate. The aim of this retrospective study was to evaluate treatment results and to analyze the factors that affect the survival of patients with gastric carcinoma. MATERIALS AND METHODS: A total of 1,580 patients with primary gastric adenocarcinoma who had been treated surgically during the period 1983-1996 at the Department of Surgery, Korea University College of Medicine was studied to evaluate the treatment outcome. Prognostic factors were investigated by univariate and multivariate analyses in 1,407 resected patients. RESULTS: The 5-year survival rate was 57.1% in all case, 62.4% in resected cases, and there was no survivor at 2.5 year in unresectable cases. In univariate analysis, gross type, maximum tumor diameter, depth of invasion, lymph node involvement, distant metastasis, histologic type and type of operation were found to correlate significantly with survival. Multivariate analysis indicated that lymph node involvement, depth of invasion and type of cancer were independently conelated with survival. The stage-related survival rates (UICC, 1987) were 95.8% (stage Ia), 87.6% (stage Ib), 76.7% (stage II), 51.3% (stage 1IIa), 25.5% (stage IIlb), 9.4% (stage IV) and the stage-related survival rates (UICC, 1997) 95.8% (stage Ia), 87.6% (stage Ib), 76.4% (stage II), 55.2% (stage IIla), 24.0% (stage IIIb), 13.4% (stage IV). There was no difference between two staging systems. CONCLUSIONS: These results suggest that lymph node involvement, depth of invasion, and gross type were the most important prognostic factors, indicating that they may be helpful as predictors of long-term survival and in planning the treatment.
Subject(s)
Humans , Adenocarcinoma , Korea , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Prognosis , Retrospective Studies , Survival Rate , Survivors , Treatment OutcomeABSTRACT
BACKGROUND/AIMS: The rate of laparoscopic appendectomy has been gradually increasing. The following studies were conducted to compare laparoscopic appendectomy (LA) with open appendectomy (OA). METHODS: We compared retrospectively 48 patients in the LA group with 135 patients in the OA group, all of whom were operated at Anam hospital, Korea University, from January 1996 to January 1997. Documentation included information such as age, sex, diagnostic method, postoperative diagnosis, misdiagnosis rate, operative time, conversion to open appendectomy, analgesics injection, hospital stay, and complicatians. RESULTS: 1) The mean age and male to female ratio were 28.5 years and 1: 2.4 in LA group, and 34.1 years and 1: 1.1 in OA group, respectively. 2) An abdominal sonogram was perfomed in 18.8% of the LA group and 28.9% in OA group (p 0.05). 6) The complication rate was 10.9% in the LA group and 15,5% in the OA group (p >0.05), but the wound infection rate was 2.2% in the LA group and 8.5% in the OA group (p<0.05). CONCLUSIONS: LA is a safe and effective operation for acute appendicitis, and is particularly superior to OA in regard to diagnosis, postoperative pain, wound infection, and cosmetic benefits.
Subject(s)
Female , Humans , Male , Analgesics , Appendectomy , Appendicitis , Diagnosis , Diagnostic Errors , Korea , Length of Stay , Operative Time , Pain, Postoperative , Retrospective Studies , Wound InfectionABSTRACT
PURPOSE: This study was carried out to evaluate the impact of combined splenectomy with total gastrectomy on survival and postoperative morbidity in advanced gastric cancer. PATIENTS AND METHODS: We performed a retrospective analysis of 193 patients who underwent curative resection among 289 patients with total gastrectomy during the period of Sep. 1983 through Dec. 1995 at the Department of Surgery, Korea University Hospital. RESULTS: Out of 11 clinicopathologic factors, 5 were associated with splenectomy through univariate analysis. The incidence of splenectomy increased when the patients with advanced gastric cancer had Borrmann type III, Gross T3 & T4 stage, greater than 4 cm of tumor size, Serosal invasion, or UICC stage IIIb, IV (p<0.05). Postoperative complication occurred more commonly in splenectomy group than in non-splenectomy group (20.2% vs 16.9%). The 5-year survival rate of Stage II was lower in splenectomy group than in non-splenectomy group (63.5% vs 83.5%) but that of Stage III was higher in splenectomy group than in non-splenectomy group (22.8% vs 17.3%), there was no significant difference between the survival rates across different stages. CONCLUSION: We could not find any beneficial effect of splenectomy in gastric cancer patients who underwent curative total gastrectomy in this retrospective analysis. There was no clinical evidence to support splenectomy as a general policy in patients with total gastrectomy. We conclude that the randomized prospective clinical trials using more precise criteria for the indication of splenectomy are needed in order to assess the beneficial effect of splenectomy.
Subject(s)
Humans , Gastrectomy , Incidence , Korea , Postoperative Complications , Prognosis , Retrospective Studies , Splenectomy , Stomach Neoplasms , Survival RateABSTRACT
Surgical advance on the general surgical department as minimal access procedure was changed into the laparoscopic cholecystectomy from open cholecystectomy for treatment of cholelithiasis. Laparoscopic cholecystectomy is far less invasive, less painful, less expensive, less complicative, high cosmetic and high eonservative procedure, and reduced hospitalization than open surgery. (continue...)
Subject(s)
Cholecystectomy , Cholecystectomy, Laparoscopic , Cholelithiasis , Hospitalization , KoreaABSTRACT
No abstract available.
ABSTRACT
The incidence of periampullary cancer has been steadily rising in Korea. In the present study, we have reviewed 766 cases of surgically treated periampullary cancers, including 122 cases of our own, which were published in the Korean literature from 1984 to 1992. The 6th decade was the most prevalent age group, occupying 38% of the patients. The ratio of male of female was 1.7 to 1. Approximately 60% of lesion located at the head of the pancreas. Computed tomography which had 85% sensitivity was the most commonly employed modality for a diagnosis. The diagnostic sensitivity of percutaneous transhepatic cholangiography was 72%, of endoscopic retrograde cholangiopancreatography was 71%, and of ultrasonography was 54% in order of frequency. Tumor markers such as CA-19, CEA, and CA-125 were also studied in pancreatic cancer. The combinations of these markers recorded a higher positivity than using solely. The resection rate for lesions at the head of the pancreas was 21%, and that of distal common bile duct, ampulla of vater, and duodenum were 37%, 85%, and 50%, respectively. The morbidity and mortality rates after pancreatoduodenectomy were 44% and 12%, respectively. TNM staging revealed 66% of patients were in stage III, 26% in stage I, and 8% in stage II. The actual 5-year survival rates for cancer of the head of the pancreas was 11%, and that of duodenal cancer, distal choledochal cancer, and ampullary cancer were 21%, 18%, and 15%, respectively. In nonresected group, none survived over 18 months after treatment. Relatively high portion of lymph node metastatic patients may explain the poor survival observed in our series.