Sonographic Analysis of Malignant Thyroid Nodules by Surgeon / 대한내분비외과학회지

PURPOSE: Ultrasound is most effective study for evaluating thyroid nodules. In this review, we discuss that sonographic findings to differentiate benign from malignant nodules and suggest recommendations for indications of fine needle aspiration biopsy and thyroid nodule management. METHODS: Sonographic scans of 206 thyroid nodules in 164 patients were candidated for this study. We evaluated sonographic findings by shape, calcification, margin, and echogenicity, retrospectively. Sonographic findings that suggested malignancy included microcalcifications, a speculated margin, marked hypoechogenicity and a shape that was taller than wide. The final diagnosis of lesion as benign (n=180) or malignant (n=26) was confirmed by fine needle aspiration biopsy and follow-up (>6 months). We demonstrated the difference of the sensitivity, specificity, positive predictive value, negative predictive value and accuracy. RESULTS: Of 206 thyroid nodules, 26 were malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy based on our sonographic classification method were 84.6%, 73.9%, 31.9%, 97.0% and 75.2%. CONCLUSION: Sonography can be helpful for making the differentiation between and malignant nodules. So, when well trained surgeon find thyroid nodules on sonography, we can make correct diagnosis of malignant nodules.

Colonoscopic Perforations: 4 Years' Experience / 대한소화기내시경학회지

BACKGROUND/AIMS: Many physicians agree that colonoscopy is the best modality for either the diagnostic evaluation or use in therapy for colorectal disease. Although the incidence of perforations that occur after colonoscopy is low, the increasing number of performed colonoscopies may pose a relevant health problem with including the often lethal consequences. This study aimed to determine the frequency of perforation and the management of colonoscopic perforation. Modern Korean society has adopted westernized dietary habits, and this has led to an increased incidence of colorectal disease such as colorectal cancer, polyps and diverticulosis. METHODS: We conducted a retrospective review of the medical records of all the patients who underwent colonoscopy complicated by colon perforation between January 2004 and December 2007. The patients' demographics, the purpose of colonoscopy, the location of the perforation, the management and the outcome were compared. RESULTS: A total of 5254 patients underwent either a diagnostic or therapeutic colonoscopy procedure during four consecutive years at a single institution. Iatrogenic colonoscopic perforations (0.2%) were diagnosed in 11 patients (seven males and four females). Perforations occurred in six patients during a diagnostic colonoscopy and these occurred in five patients during a therapeutic colonoscopy. Free air in the peritoneum or retroperitoneum was seen in all the patients, as depicted on plain X-rays. Seven patients were treated with surgical intervention and four patients were treated with conservative management. One of the 11 patients with a perforation expired on postoperative day 47 due to infective endocarditis. CONCLUSIONS: The rate of iatrogenic colonoscopic perforation is still very low. Although perforation is a very serious complication and it can be a lethal malady, early recognition and treatment are very critical factors to optimize the patient outcome. Although a gold standard therapeutic modality has not been established, the patients who present with the signs and symptoms of generalized peritonitis are recommended to undergo early surgical intervention.

A Case of Thoraco-abdominal Penetrating Injury with an Scaffolding Pipe following a Falling

An increase has been see in fall injuries at construction sites and in penetrating injuries by iron bars or pipes associated with the fall. In particular, a thoraco-abdominal penetrating injury had the worse prognosis, and multiple organ injury occurred because of blunt trauma associated with fall. Iron bars were the most common penetrating materials, and pipe penetrating injuries were uncommon. However, because the diameter of the pipes were large than those of the bars, penetrating injuries associated with pipes were more often fatal. A secondary thoraco-abdominal injury worsened the prognosis. We reported a case of a 33-year-old man with a thoraco-abdominal trauma secondary to a penetrating injury with a scaffolding pipe following a fall.

A Case of Thoraco-abdominal Penetrating Injury with an Scaffolding Pipe following a Falling

An increase has been see in fall injuries at construction sites and in penetrating injuries by iron bars or pipes associated with the fall. In particular, a thoraco-abdominal penetrating injury had the worse prognosis, and multiple organ injury occurred because of blunt trauma associated with fall. Iron bars were the most common penetrating materials, and pipe penetrating injuries were uncommon. However, because the diameter of the pipes were large than those of the bars, penetrating injuries associated with pipes were more often fatal. A secondary thoraco-abdominal injury worsened the prognosis. We reported a case of a 33-year-old man with a thoraco-abdominal trauma secondary to a penetrating injury with a scaffolding pipe following a fall.

Abdominal Pregnancy Presenting as Massive Lower Gastrointestinal Bleeding

An ectopic pregnancy in the abdominal organs is very rare. Primary intestinal pregnancy is considered the rarest form of extrauterine pregnancy, and only a few well-documented cases have been reported. Herein, a case of an abdominal pregnancy in a 25-year-old woman, with massive lower gastrointestinal bleeding, is reported. The source of bleeding could not be identified, despite gastroscopy, ultrasonography and angiography investigations. A diagnostic laparotomy disclosed an abdominal pregnancy, causing an erosion of the jejunal wall at the site of the pregnancy, with massive lower gastrointestinal bleeding. An abdominal pregnancy is seldom included in the differential diagnosis of lower gastrointestinal bleeding. The possibility of intestinal erosion in an abdominal pregnancy should be borne in mind in cases of lower gastrointestinal bleeding.

Clinical Study of Perforated Duodenal Ulcer

PURPOSE: There has been considerable controversy about whether acid reduction surgery is a definitive surgical treatment for perforated duodenal ulcer with numerous methods having been described. The controversy has increased with the development of the Proton Pump inhibitor and the discovery of Helicobacter Pylori (HP), because the recurrence and morbidity have been shown to decrease with simple closure followed by a good medical therapy against HP and the ulcer. This study is an evaluation of simple closure as an alternative treatment of perforated duodenal ulcer. METHODS: This retrospective study reviewed the records of 288 patients with surgically-treated ulcer perforation. After 62 patients were excluded, 128 patients treated with simple closure were compared with 98 patients treated with definitive surgery. In the simple closure group, we compared 50 patients treated with Proton Pump inhibitor and 78 patients treated with H2 blocker. Also, the influence of various factors such as age, delayed operation, size of ulcer perforation, operative methods, associated diseases, and complications were analyzed to evaluate recurrence, morbidity and mortality. RESULTS: After mean follow up for 53.7 months, 56.6% of patients treated with simple closure had fewer post operative complications and a lower recurrence rate compared with definitive surgery. The infection rate by HP of 81.6% in our study was similar to that of other studies. Some factors as age (>60), duration of symptoms (>24 hours), size of ulcer perforation (>10 mm), associated disease and operative time showed an influence on the mortality. CONCLUSION: Recent advances in the treatment of perforated peptic ulcer such as the development of the Proton Pump inhibitor and the discovery of HP have shown that after simple closure, an adequate medical treatment of ulcer can effectively decrease the recurrence rate, morbidity and mortality.

Comparison Transilluminated Powered Phlebectomy with the Conventional Surgical Treatment of Primary Varicose Vein of the Lower Limbs

PURPOSE: This study was designed to compare Transilluminated Powered Phlebectomy (TIPP) with conventional surgical treatment (high ligation of the greater saphenous vein and above knee stripping with varicosectomy). METHODS: 428 cases of varicose veins, managed surgically at our hospital, were reviewed. A retrospective review of clinical records, between November 2000 an March 2003, was performed. The patients were divided into one of two groups: TIPP or a conventional operation. All the patients had at least a C2 CEAP disease. RESULTS: The demographics, hospital stays and operating times for the two groups were similar. However, a TIPP was associated with significantly fewer incisions (4.4+/-1.5 vs 8.2+/-3.9; P<0.001) and recurrence (n=14, 6% vs n=24, 12%; P=0.003). The incidence of a postoperative hematoma developing was more common with TIPP (n=20, 9% vs n=1, 0.5%; P=0.023). The problem of a hematoma formation in TIPP was solved by the insertion of a small closed suction drain. Skin perforation and wrinkling, and dermatosclerosis, were only complicated in the TIPP. The mean pain scores (out of 10) for the TIPP and conventional operation groups, at 2 and 7 days and 4 weeks, were 4.8, 1.4 and zero, and 4.8, 2.8 and zero, respectively. The cosmetic satisfaction score was higher in the TIPP group (8.7 vs 5.7; P<0.001). CONCLUSION: With respect to pain, cosmetic satisfaction and residual varicose, the outcomes in the TIPP group were significantly better than those in the conventional operation group.

A Case of Endometrial Cyst of the Pancreas / 대한산부인과학회잡지

Endometriosis is a benign disease, characterized by the presence of endometrial glands and stroma in ectopic localization. This disease is common in women of reproductive age, accounting for approximately 10- 15%. But, endometriosis of the pancreas is an extremely rare condition. To our knowledge, only three cases of cystic endometriosis of the pancreas have been reported all over the world and have never been reported in Korea. The authors have experienced one case of endometrial cyst of the pancreas and report our case with a brief review of literature.

Clinical Significance of Invasive Ductal Carcinoma with Predominant Intraductal Component in Breast Cancer -Comparison with T1 Invasive Ductal Carcinoma- / 한국유방암학회지

PURPOSE: In the WHO classification of breast carcinoma, invasive ductal carcinoma with predominant intraductal component (IDC with PIC) has been defined as carcinomas in which the component of ductal carcinoma in situ amounts to four times more than the invasive element in area. This study was designed to evaluate the clinicopathological significance of IDC with PIC. METHODS: Five hundred and seventy nine patients with breast cancer (154 IDC with PIC and 425 with T1 invasive ductal carcinomas) treated with mastectomy or breast conserving surgery between 1989 and 1998 at the Asan Medical Center were divided into two study groups (IDC with PIC and T1 IDC) and compared the clinicopathological characteristics and survival of both groups. RESULTS: By comparison with the T1 IDC, the IDC with PIC has several distinct features including younger mean age of occurrence (45.3 years vs 48.3 years, P=0.002), larger mean tumor size (3.5 cm vs 1.6 cm, P<0.001), lower incidence of axillary lymph node metastasis (15.7% vs 31.3%, P<0.001) and estrogen receptor positivity (45.7% vs 59.2%, P=0.03), higher incidence of low histologic grade (78.7% vs 61.7%, P=0.002) and cancer detection rate by screening without symptom (21.6% vs 11.5%, P=0.003) or clinical manifestation of nipple discharge (17.3% vs 4.3%, P<0.001) and microcalcification with or without mass on mammography (58.7% vs 30.2%, P<0.001). There were no significant difference in the cumulative 5-year overall and disease-free survival rates (93.1% vs 90.1%, P=0.78; 89.5% vs 86%, P=0.23). In the IDC with PIC group, tumors larger than 2 cm in size were more frequently metastasized to axillary lymph nodes than tumors smaller than 2 cm, but this finding was not significant (P=0.07). CONCLUSION: Invasive ductal carcinoma with predominant intraductal component showed less invasive and more low-grade malignant characteristics than T1 invasive ductal carcinoma. Survival was not statistically different.

Clinical Significance of Invasive Ductal Carcinoma with Predominant Intraductal Component in Breast Cancer: Comparison with T1 Invasive Ductal Carcinoma

PURPOSE: In the WHO classification of breast carcinoma, invasive ductal carcinoma with predominant intraductal component (IDC with PIC) has been defined as carcinomas in which the component of ductal carcinoma in situ amounts to four times more than the invasive element in area. This study was designed to evaluate the clinicopathological significance of IDC with PIC. METHODS: Five hundred and seventy nine patients with breast cancer (154 IDC with PIC and 425 with T1 invasive ductal carcinomas) treated with mastectomy or breast conserving surgery between 1989 and 1998 at the Asan Medical Center were divided into two study groups (IDC with PIC and T1 IDC) and compared the clinicopathological characteristics and survival of both groups. RESULTS: By comparison with the T1 IDC, the IDC with PIC has several distinct features including younger mean age of occurrence (45.3 years vs 48.3 years, p=0.002), larger mean tumor size (3.5 cm vs 1.6 cm, p<0.001), lower incidence of axillary lymph node metastasis (15.7% vs 31.3%, p<0.001) and estrogen receptor positivity (45.7% vs 59.2%, p=0.03), higher incidence of low histologic grade (78.7% vs 61.7%, p=0.002) and cancer detection rate by screening without symptom (21.6% vs 11.5%, p=0.003) or clinical manifestation of nipple discharge (17.3% vs 4.3%, p<0.001) and microcalcification with or without mass on mammography (58.7% vs 30.2%, p<0.001). There were no significant difference in the cumulative 5-year overall and disease-freesurvival rates (93.1% vs 90.1%, p=0.78; 89.5% vs 86%, p=0.23). In the IDC with PIC group, tumors larger than 2 cm in size were more frequently metastasized to axillary lymph nodes than tumors smaller than 2 cm, but this finding was not significant (p=0.07). CONCLUSION: Invasive ductal carcinoma with predominant intraductal component showed less invasive and more low-grade malignant characteristics than T1 invasive ductal carcinoma. Survival was not statistically different.

Patterns of Locoregional and Systemic Failure after a Mastectomy in Breast Cancer and Risk Factors Predicting Failure

PURPOSE: In spite of improved local control and adjuvant therapy in breast cancer, many patients after a modified radical mastectomy suffer from locoregional or systemic failure. The purpose of this study was to assess both the patterns of failure following a mastectomy and the predictive factors affecting the risks of locoregional or systemic failure. METHODS: The study population consisted of 195 patients who developed locoregional or systemic failure from among 1,187 patients treated by using a modified radical mastectomy between July 1989 and October 1998 at the Asan Medical Center's Breast Clinic. The median follow-up time following the mastectomy was 41 months (range; 1-119 months). RESULTS: Isolated locoregional recurrence (LRR) developed in 46 patients (24%), LRR with distant metastasis in 43 (22%), and only distant metastasis in 106 (54%). The sites of LRR were as follows: the chest wall, 52%; the ipsilateral supraclaviclar node, 22%; and the axillary node, 15%; etc. The first sites of distant metastasis were as follows: bone, 46%; lung, 38%; liver, 12%; brain, 6%; and pleura, 6%; etc. Local or systemic failure appeared within the first 3 years following the mastectomy in 75-82% of the patients, and within 5 years in 95-98%. Multivariate analysis showed that increasing initial tumor size, increasing number of involved nodes, negative progesterone receptor, and increasing histologic grade were significant factors for increased risks of LLR or distant metastasis. CONCLUSION: Half of the locoregional recurrences following a mastectomy are isolated. T-stage, nodal status, progesterone receptor, and histo logic grade may help to identify patients at risk for locoregional or systemic failure after a mastectomy.

A Clinical Review of Neonatal Intestinal Obstruction

BACKGROUNDS: Intestinal obstruction is one of the main causes of neonatal operations. It is caused by congenital factors, inherited diseases, and acquired diseases. A study was made to understand the status of neonatal intestinal obstruction cases at our hospital. METHODS: This was a clinical analysis of 53 cases of neonatal intestinal obstruction which had been experienced from March 1992 to February 1998 at the Department of General surgery, Sung-Ae General Hospital. RESULTS: 1) Operations for neonatal intestinal obstructions accounted for 42.4% of all neonatal operations. 2) There were 38 males and 15 females; the male-to-female ratio was 2.5:1. 3) Gestational period of 9 cases (16.9%) was less than 36 weeks and the weight in 10 cases (18.8%) wre below 2,500 gm at birth. 4) The main clinical symptoms on admission were vomiting or abdominal distension. 5) There were 49 cases (92.4%) of mechanical obstruction and 4 cases of a paralytic ileus. 6) Associated anomalies were present in 9 cases (16.9%). 7) The postoperative complication and motality rates were 30.1% and 7.5% respectively. CONCLUSIONS: Our clinical data might provide clinical suspicisions leading to early diagnosis and treatment.

Optimal Scan Time of Dual-phase Spiral CT in Normal Rabbit Liver: Effect of Contrast Injection Rate

PURPOSE: To determine the effect of contrast injection rate on rabbit liver enhancement and the optimaltem-poral window for dual-phase spiral CT of rabbit liver at each injection rate. MATERIALS AND METHODS: Usingspiral CT, seven New Zealand White rabbits underwent dynamic scanning at one level of liver. Three protocols ofcontrast injection rates were employed, namely 0.3 ml/sec(group 1), 1ml/sec(group 2) and 2 ml/sec(group 3). During120 seconds of total scan time, the scan interval was 3 seconds. Densities of the aorta, liver and portal veinwere averaged in equivalent time. The different injection rate protocols were compared for peak enhancement/timeon a time density curve. RESULTS: Mean peak enhancement (HU) in equivalent time(secs) was 310/18(group 1),383/9(group 2) and 357/6(group 3) in the aorta ; 34/36, 40/36 and 41/30 in the liver ; and 135/36, 153/24 and170/21 in the portal vein. The temporal window during the arterial phase was 12-21 sec(group 1), 6-12 sec(group2), and 6-12 sec(group 3). The temporal window during the portal phase was from 30 sec(0.3ml/sec), 21sec(1ml/sec)and 21 sec(2 ml/sec). CONCLUSION: During dual-phase spiral CT, the temporal window for liver scanningshould be determined according to each contrast injection rate. A slow contrast injection rate prolongs thetemporal window during the arterial phase.

Deletion of the Importin-alpha Gene in the Breast Cancer Cell

BACKGROUND: BRCA1 (breast-cancer gene 1) is a tumor suppressor gene that accounts for nearly all families of both early onset breast and ovarian cancer and about 45% of families with breast cancer only. Sporadic nonhereditary breast cancer is recognized as the most common form of this malignancy. However, presence of germ-line mutations in the BRCA1 gene of these tumors is an infrequent event. The BRCA1 protein includes a ring domain and an acidic domain, both of which are characteristics of certain transcription factors, as well as two putative nuclear localization signals (NLS) that interact with importin-alpha. The normal BRCA1 protein is located in the nucleus of most breast-cell types whereas the BRCA1 protein of breast cancer cells is aberrantly localized in the cytoplasm. This mislocation of the BRCA1 protein in breast cancer cells may be due to defects in the NLS receptor-mediated pathway for the nuclear import of the BRCA1 gene product. Identification of importin-alpha mutations as a cellular protein responsible for the nuclear import of BRCA1 in breast-cancer cell lines and primary breast cancers is the focus of this investigation. METHODS: A series of 15 surgical samples of breast cancer and 3 samples of breast-cancer cell lines (Hs578T, ZR75-1, MCF-7) was assayed for the presence of the deletion mutant in importin-alpha by using both RT-PCR amplification of importin-alpha transcripts and sequencing analysis. RESULTS: Three of the 15 primary breast cancers and 1 of the 3 breast-cancer cell lines showing deletions in importin-alpha transcripts produced two different truncated transcripts. 1208 bp deletions were observed in transcripts from breast cancer (T-1, T-3) and ZR75-1, which is specified by the nucleotide 251-1458 of the transcript. Another transcript encoded by primary breast cancer (T-2) included a 1312 bp deletion in the nucleotide 61-1372 of the transcript. CONCLUSIONS: The deletions eliminated part of the importin-alpha transcript segment encoding the putative NLS-binding domain but not the importin-beta binding domain, suggesting that these deletion mutants could not bind to NLS of the BRCA1 protein. These results suggest that the composite effects of mislocationof the BRCA1 protein by deletion of the NLS-binding domain in importin-alpha may contribute to tumorigenesis in sporadic breast cancer.

p53 Mutation and Functional Analyses by Using Yeast Functional Assay / 대한암학회지

PURPOSE: Mutation of the p53 tumor suppressor gene is the most common genetic defect in all human tumors. Because of the widespread mutations and polymorphism in the p53 gene, the conventional screening methods cannot distinguish between polymorphisms or functionally silent mutations and inactivating mutations. It is well known that plasmids can be generated by homologous recombination in vivo in the yeast by cotransforming the PCR product with a linearized yeast expression vector encoding part of a gene and a selectable marker gene. The aim of this study is to develop more easy and reliable method for functional assay of p53 mutation. MATERIALS AND METHODS: We constructed a gap vector which can reliably and conveniently be used to screen p53 mutations in a simple yeast growth assay. The gap vector was constructed as follows: About 100 bp DNA fragments containing parts of N- and C- terminal portion of p53 were cloned into XbaI/SmaI and HindIII/XhoI sites of yeast expressing vector, respectively. The gap vector was obtained by double cutting with SmaI and HindIII followed by gel elution. Yeast was transformed with the reporter vector containing three tandem copies of the consensus p53 binding site by lithium acetate-mediated method. RT-PCR amplification of p53 transcripts from cell lines or tumor tissues was carried out. To investigate whether p53 gene is mutated or not, yeast containing reporter gene was cotransformed with PCR product and linearized gap vector, plated on SD medium minus histidine, and incubated for 3 days. The colonies on selective media were isolated and characterized. RESULTS: The tumor tissues examined were one hepatocellular carcinoma, three breast cancers, two stomach cancers and two colon cancers. One hepatocellular carcinoma tissue had mutation in both alleles of the p53 gene, and 7 cancer tissues had heterozygous mutations in the p53 gene. The result of functional assay was well correlated with mutational analysis by sequencing. CONCLUSION: p53 functional assay system might be easy and reliable method for functional screening of p53 on tumor tissues and this might be used for screening of other mutated gene. This technique, FASAY, requires only a few steps, can be automated readily and should permit screening for germline or somatic heterozygous mutations in any gene whose function can be monitored in yeast.

Identification of Atypical Mycobacterium with the Polymerase Chain Reaction in Tuberculous Lymphadenitis

Tuberculous lymphadenitis is easily mistaken for an infection by only mycobacterium tuberculosis. However, many cases reveal atypical mycobacterium. Treatment of atypical mycobacterium differs from that of M. tuberculosis and M. bovis. Usual anti-tuberculous medication is the response to M. tuberculosis and M. bovis, but not to atypical mycobacterium. Excision and antibiotic therapy is the known treatment of choice for atypical mycobacterium. We used the polymerase chain reaction(PCR) for differential diagnosis of tuberculosis from lymphadenitis, and by using PCR we were able to differentiate the infecting organism as typical or atypical mycobacterium. We excised 50 case of cervical lymphadenitis, and PCR was done with Primer I(IS6110), which is specific for M. tuberculosis and M. bovis, and with Primer II(65 KDa Ag), which covers all mycobacterium species. The results obtained by PCR were compared with the pathologic results(control): sensitivity 81.8%, specificity 88.9%, false positive ratio 11.1%, false negative ratio 18.2%, typical mycobacterium 45.5%, and atypical mycobacterium 45.5%. These findings suggest that PCR is a good diagnostic tool for the early detection of tuberculous lymphadenitis and for differentiation of mycobacteria in cervical lymphadenitis.

Clinical Evaluation of Laparoscopic Appendectomy

BACKGROUND: This study was performed to evaluate our experience on laparoscopic appendectomy. METHODS: Retrospective analysis was performed on 2,856 patients who had been operated by laparoscopic appendectomy under diagnosis of acute appendicitis at the Sung-Ae Hospital and Kwang-Myoung Sung-Ae Hospital from October 1991 to July 1998. RESULTS: Among 2,856 patients who had undergone laparoscopic appendectomy,2,379 patients (83.3%) were operated due to simple acute appendicitis, 275 patients (9.6%) due to perforated appendicitis. Operation time was 44.6 minutes for simple acute appendicitis and 60.3 minutes for perforated appendicitis. In perforated appendicitis, intra-peritoneal irrigation and drain insertion was performed. The length of hospital stay in patient with simple acute appendicitis was 3.7 days (5.82 days in conventional appendectomy) and patients with perfotrated appendicitis was 6.1 days (9.91 days in conventional appen-dectomy). Complications such as wound infection, intra-abdomen abscess, trocar site bleeding, subcutaneous emphysema developed in 43 (1.5%) patients (79/1,947, 4.5% in conventional appendectomy). In 202 (7.1%) patients, appendix was normal, but another diseases were detected, including acute pelvic inflammation, ovarian cyst, mesenteric lymphadenitis, enteritis, diverticulitis in order. CONCLUSION: Overall complication rate was lower in laparoscopic appendectomy compared with conventional appendectomy and the length of hospitalization of laparoscopic appendectomy was shorter. When the acute appendicitis is suspected, especially in the reproductive women, the laparoscopic approach would be better diagnostic and therapeutic value than conventional method. Therefore laparoscopic appendectomy would be replaced with conventional appendectomy.

Surgical Treatment by the Videothoracoscopy

Between 1992 and 1995 at Sung Ae Hospital, general surgery was performed on 39 patients with a spontaneous pneumothorax, a pyothorax, a traumatic hemopneumothorax. Thoracoscopic surgery was performed with laparoscopic materials and instruments. The mean age was 26.1 years (range 16 to 54). The female to male ratio was 6.8 : 1. The indication for this surgery were recurrence in 17 patient, persistent air leakage after closed thoracotomy in 12, a visible bleb on the chest X-ray or chest CT result in 5, diagnosis in 2, and bilateral occurrence in 1. Thoracoscopies were performed on 39 patients, but operation were performed on 37 patients. The two patients the bullae could not be found. The operative procedures were stapling with Endo-GIA (21 cases), Endo-loop ligation (15 cases), and thoracoscopic examination (1 case). Tirty-six of the 39 patients were treated successfully. The one case histories of two patients could not be found, and one case was managed through a limited posterolateral thoracotomy. The causes of failure were an obscured operative field due to massive bleeding and a foreign body which was two large to remove from the thoracic cavity through the skin incision. A total of 16 postoperative complications oscurred in 11 patients. This rate is somewhat higher than those of other reports because of our lack of experiences during the initial years of the study, but it decreased progressively as experience was accumulated and instruments were improved. Operative mortality was absent. These patients were cured of their problems and benefitted from the decreased trauma of access by reduced pain, rapid recovery, and decreased scarring of the skin. In conclusion, videothoracoscopic surgery carries low morbidity and mortality and high diagnostic and therapeutic success rates and can be effectively applied to the surgical treatment of thoracic disease.

Laparoscopic surgery in the management of the diverticulitis of the colon

No abstract available.

A case of with transient splenic hot uptake on Tc-methylene diphosphonate(MDP) bone scan following blunt abodominal trauma with underlying liver cirrhosis / 대한핵의학회잡지

No abstract available.