• Clinical and Experimental Pediatrics
• /
• v.51 no.8
• /
• pp.874-878
• /
• 2008

Purpose : This study was undertaken to develop an animal model of periventricular leukomalacia (PVL) induced by in utero clamping of pregnant rat aorta in fetal rats. Methods : A timed pregnanct Sprague-Dawley rat on embryonic day 21 just prior to delivery was sedated and anesthetized, and a Harvard ventilator for small animals was applied. Following laparotomy, the maternal aorta was clamped reversibly for 40 minutes using a surgical clip. The fetal rats were then delivered by Cesarean section, resuscitated if necessary, and reared by a surrogate mother rat until postnatal day 21 to obtain the brain specimen. After systemic perfusion and fixation, $10{\mu}m$ thick serial brain sections were obtained and stained for pathologic examination and assessment of ventriculomegaly. Ventriculomegaly was assessed by the measured ventricle to total brain volume ratio. Results : Eight out of eleven fetal rats (73%) survived in the ischemia group after induction of in utero ischemia by clamping maternal rat aorta, and all ten survived in the control group. Body and brain weights measured at postnatal day 21 were significantly lower in the ischemia group compared to the control group. In pathologic findings, significant ventriculomagaly ($3.67{\pm}1.21%$ vs. $0.23{\pm}0.06%$) was observed in the ischemia group compared to the control group; although cystic lesion was not observed, mild (n=6) and moderate (n=2) rerefaction of the brain tissue was observed. Conclusion : A fetal rat model of PVL induced by in utero clamping of pregnant rat aorta was developed.

• Journal of Gastric Cancer
• /
• v.8 no.4
• /
• pp.237-243
• /
• 2008

Purpose: Postoperative Infectious complications are recognized as major complications that are associated with surgery. Although many studies have focused on the risk factors of postoperative complications, little is known about the risk factors of infectious complications after gastric cancer surgery, and especially after elective gastrectomy. There is now more and more interest in the risk factors of infectious complications in relation to controlling infection and as indicators of qualitatively assessing infectious complications. The aim of this study was to evaluate the risk factors related with infectious complications after performing elective gastrectomy for treating gastric cancer. Materials and Methods: We retrospectively reviewed a total of 788 patients who had undergone elective gastrectomy for gastric cancer between Jan. 2000 and Dec. 2007. The characteristics of the patients were divided according to the patients' factors and the operations' factors. Results: The patients' mean age was 58.9 (range: 24~91) years; 545 were male and 243 were female. The mean duration of the hospital stay was 20.3 days (range: 5~135 days), the mean operation time was 181.3 minutes (range: 65~440 minutes). The total complication rate was 17.1% (n=135) and the complication rate was 38.5% (n=52) among the 135 patients with infectious complications. The infectious complications were surgical site infection (59.7%), Pneumonia (19.3%), intra-abdominal abscess (11.5%), pseudomembranous colitis (5.7%), bacteremia (1.9%) and hepatic abscess (1.9%). On the univariate analysis, the significant risk factors were male gender, blood transfusion, smoking at the time of diagnosis, alcohol drinking, diabetes mellitus and previous cardiovascular disease (P<0.05 for all). On multivariate analysis that used a logistic regression model, the significant independent risk factors were smoking at the time of diagnosis (OR: 2.877. 95% CI: 1.449~5.713), blood transfusion (OR: 3.440, 95% CI: 1.241~9.534), diabetes mellitus (OR: 3.150, 95% CI: 1.518~6.538), and previous cardiovascular disease (OR: 2.784, 95% CI: 1.4731~5.2539). Conclusion: Pre- or post-operative blood transfusion and the patient's medical history such as previous cardiovascular disease, diabetes mellitus, smoking etc. are the risk factors for infectious complications after undergoing elective gastrectomy for gastric cancer. The patients that have these risk factors need to be treated with great care to prevent infectious disease after elective gastrectomy.

• Journal of Gastric Cancer
• /
• v.10 no.1
• /
• pp.26-33
• /
• 2010

Purpose: We wanted to evaluate the technical feasibility and safety of totally laparoscopic total gastrectomy (TLTG) for treating early gastric cancer. Materials and Methods: The medical records of 11 consecutive patients who underwent TLTG after being diagnosed with early gastric cancer at Incheon St. Mary's Hospital, The Catholic University of Korea from February 2005 to September 2009 were retrospectively reviewed and their clinicopathologic characteristics and the surgical results wereinvestigated. Results: The mean operation time was $385.6{\pm}94.1$ minutes, the mean time for creating an intracorporeal anastomosis was $97.5{\pm}60.0$ minutes and the mean number of the harvested lymph nodes was $46.6{\pm}15.4$ The mean number of days after operation until starting a liquid diet was the $6.1{\pm}7.6^{th}$ postoperative day and the mean hospital stay after surgery was $14.2{\pm}11.9$ days. There was no case of open conversion, but there were 2 cases of intraoperative complication and 3 cases of postoperative complication. There was one case of postoperative mortality. The patient suffered from thrombocytopenia of an unknown cause, which was refractory to platelet transfusion, on $4^{th}$ postoperative day and the patient died of intraabdominal bleeding on the $6^{th}$ postoperative day. Conclusion: TLTG was a technically feasible and relatively safe procedure. However, a long time for creating the intracoproeal anastomosis and a long operation time are still problems to be solved.

• Journal of the Korean Society of Radiology
• /
• v.84 no.3
• /
• pp.615-626
• /
• 2023

Purpose To assess the outcomes of single-stage surgery following fluoroscopic stent placement for malignant colorectal obstruction. Materials and Methods This retrospective study included 46 patients (28 male and 18 female; mean age, 67.2 years) who had undergone fluoroscopic stent placement followed by laparoscopic resection (n = 31) or open surgery (n = 15) for malignant colorectal obstruction. The surgical outcomes were analyzed and compared. After a mean follow-up of 38.9 months, the recurrence-free and overall survival were estimated, and prognostic factors were evaluated. Results The mean interval between stent placement and surgery was 10.2 days. Primary anastomosis was possible in all patients. The mean postoperative length of hospitalization was 11.0 days. Bowel perforation was detected in six patients (13.0%). During the follow-up, ten patients (21.7%) developed recurrence; these included five of the six patients with bowel perforation. Bowel perforation had a significant effect on recurrence-free survival (p = 0.010). Conclusion Single-stage surgery following fluoroscopic stent placement may be effective for treating malignant colorectal obstruction. Stent-related bowel perforation is a significant predictive factor for tumor recurrence.

• Clinical and Experimental Reproductive Medicine
• /
• v.33 no.4
• /
• pp.229-236
• /
• 2006

Objective: We investigated the expression of uPA and uPAR in eutopic endometrium of advanced stage endometriosis and control patients. Methods: The 33 endometriosis patients and 32 controls were enrolled. Endometrial samples were obtained from 65 premenopausal women aged 29-44 years, undergoing laparoscopic surgery or hysterectomy for non-malignant lesions. Sufficient samples were collected from 33 patients with endometriosis stage Ill and IV and 32 controls without endometriosis confirmed by laparoscopic surgery. The mRNA expression of uPA and uPAR from eutopic endometrium were analyzed by RT-QC PCR. Results: The mRNAs of uPA and uPAR were expressed in eutopic endometrium from endometriosis and normal controls throughout the menstrual cycle. Uterine endometrium from women with endometriosis expresses significantly (p<0.05) higher levels of u-PA mRNA than endometrium from normal women without endometriosis in the proliferative phase. There were no significant differences in expression of uPAR in eutopic endometrium between controls and endometriosis patients. Conclusion: These results suggest that eutopic endometrium from endometriosis patients may be more invasive and prone to peritoneal implantation because of greater u-PA mRNA expression than endometrium from women without endometriosis. Thus, increased proteolytic activity may be one etiology for the invasive properties of the endometrium resulting in the development of endometriosis.

• Journal of Embryo Transfer
• /
• v.22 no.1
• /
• pp.69-74
• /
• 2007

This study was performed to determine the estrous cycles by macroscopic observation of the ovarian changes using the laparoscopy and to make use of these results for embryo transfer in Korean black goat (Copra hircus aegagrus). Laparoscopic examinations of the ovaries were performed from 2 days after $CIDR^(R)$ removal to 22 days after ovulation. The serial morphological changes of follicles and corpus luteum (CL) were observed. CL was classified corpus hemorrhagicum(CH), corpus luteum (CL) and corpus albicans (CA) by its maturation and regression. On the day before ovulation (Day 0), Graafian follicles (GF) were found on one or both ovaries. On the day (Day 1) and $2^{nd}$day (Day 2) of ovulation, and ovulation depression (OD) and an early stage corpus hemorrhagicum $(CH_1)$ were observed at the site of GF, respectively. On Days 3 to 4, more developed and enlarged corpus hemorrhagicum $(CH_2\;and\;CH_3)$ arised from the ovulation of the GF with well vascularization. On Days 5 to 6, it was identified that mature corpus luteum $(CL_3)$ was grown on the ovary, and fully developed CL with adjacent follicles were occupied most part of the ovary on Days 17 and 18. Then the size of CL was diminished, and completely luteal regression $(CL_1\;or\;CA)$ with new large follicle was identified on Days 20 and 22. From these results, the 4 stages of the estrous cycle in Korean black goats were 1) estrus (Day 0) for 1 day, 2) metestrus $(Day\;1{\sim}4)$ for 4 days (stage of CH development), 3) diestrus $(Day\;5{\sim}16/17)$ for 12 or 13 days (luteal stage), and 4) proestrus $(Day\;17/18{\sim}20/22)$ for 4 or 5 days (stage of luteal regression and follicular growing). Laparoscopy for observation of ovarian changes was invasive than laparotomy. Additionally, it had advantages of reduced adhesion and quick operation time. It was considered that laparoscopic examination of ovarian changes will be useful for embryo transfer in the Korean black goats.

• Journal of Chest Surgery
• /
• v.35 no.4
• /
• pp.255-260
• /
• 2002

Paraplegia remains unresolved as the most dreaded operative complication with surgical treatment of descending thoracic and thoracoabdominal aortic diseases. In this study, the neuroprotective effect of trimetazidine that has been used clinically for ischemic heart disease was investigated in a rabbit spinal cord ischemia model. Material and Method: Thirty-three New Zealand white rabbits were randomized as follows: control group undergoing abdominal aortic occlusion but receiving no pharmacologic intervention(Group 1, n= 17); TMZ group(Group 2, n= 16) receiving 3 mg/kg trimetazidine intravenously before the occlusion of the aorta. Ischemia was induced by clamping the abdominal aorta just distal to the left renal artery for 30 minutes. Neurologic status was assessed at 2, 24, and 48 hours after the operation according to the modified Tarlov scale, then the lumbosacral spinal cord was processed for histopathologic examinations 48 hours after the final assessment. Result: The average motor function score was significantly higher in the TMZ group(3.20 $\pm$ 0.77 vs 1.13 $\pm$ 1.25 at 2 hours, 3.50 $\pm$ 0.76 vs 1.45 $\pm$ 1.57 at 24 hours, and 3.91 $\pm$ 0.30 vs 1.86 $\pm$ 1.86 at 48 hours after operation; p value$\leq$0.05). Histologic observations were correlated with the motor scores. Conclusion: The results suggested that trimetazidine reduced spinal cord injury during aortic clamping and that it may have clinical utility for the thoracoabdominal aortic surgery:

• Journal of Veterinary Clinics
• /
• v.26 no.2
• /
• pp.176-180
• /
• 2009

Two year-old female miniature schnauzer was presented with depression, abdominal pain and inappetence. Physical examination revealed tachypnea, fever, and abdominal pain. Leukocytosis with neutrophilia was shown in complete blood count. Radiograph revealed the increase of opacity in parallel to vertebra and dislocation of descending colon. Calculi and sludge in bladder, hydronephrosis and dilation of proximal ureter in right kidney were observed in ultrasonographic examination; also, irregular shape of structure in retroperitoneal cavity was observed. Urinalysis showed protein urine and hemtauria. Many epithelial cells, spindle cells, calcium oxalate dihydrate crystals, struvite crystals, amorphous crystals and granular casts, WBC, cocci were examined in urine sediment test. ERD-kit test result was highly positive. Based on those test and excretory urogram pyelonephritis and complete unilateral obstruction of ureter were confirmed. A balloon type structure in retroperitoneal cavity was found through the exploratory laparotomy. In cytologic examination of aspirated fluid from dilated area many degenerated neutrophils and phagocytized cocci were observed. Staphylococcus intermedius was cultured from aspirated fluid. Based on these clinical results retroperitoneal abscesses caused by Staphylococcus intermedius was diagnosed with ureter obstruction and concurrent cystic calculi. Nephrectomy of right kidney with ureter was performed.

• Journal of Gastric Cancer
• /
• v.6 no.4
• /
• pp.207-213
• /
• 2006

Purpose: This study was performed to evaluate the usefulness of computed tomography (CT) gastrography in the surgical management of a gastric gastrointestinal stromal tumor (GIST). Materials and Methods: We retrospectively analyzed the clinicopathologic data of 38 patients who had undergone CT gastrography from among patients who had gastric GISTS surgically resected at the Department of Surgery, Seoul National University Hospital, between January 2001 and February 2006. We compared CT gastrography data, including tumor size and location and distance from the gastroesophageal junction or pylorus with endoscopic, surgical and pathologic findings. Results: The longitudinal tumor locations on CT gastrography and endoscopy were identical to the surgical findings. For tumor sizes on CT gastrography of less than 5 cm, we performed 11 (42.3%) laparoscopic wedge resections from among 26 cases. In the 12 cases with tumor sizes of 5 cm or over, only 1 (8.3%) laparoscopic wedge resection was performed. When the tumor was located in the middle third of the stomach, a laparoscopic wedge resection was performed in 88.9% (8/9) of the cases, but when it was located in the upper or lower third, a laparoscopic wedge resection was performed in only 13.8% (4/29) of the cases. Conclusion: Three-dimensional information from CT gastrography allows the surgeon to perform preoperative planning, including accurate localization.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.5 no.1
• /
• pp.51-61
• /
• 2002

Purpose: The most common causes of neonatal cholestasis are neonatal hepatitis (NH) and extrahepatic biliary atresia (EHBA). Since neonatal cholestasis presents with variable expression of same pathologic process and has similar clinical, biochemical, and histologic features between EHBA and idiopathic neonatal hepatitis (NH), differential diagnosis is often difficult. We reviewed the differences of clinical characteristics and laboratory data to find out any correlation between the results of $Tc^{99m}$ DISIDA scan and presence of acholic stool. Methods: Between June 1993 and January 2001, total 29 infants younger than 4 month-old underwent $Tc^{99m}$ DISIDA scan. Their biochemical tests and clinical course were reviewed retrospectively. Results: Patients who had negative intestinal activity on $Tc^{99m}$ DISIDA scan showed acholic stool and revealed higher serum direct bilirubin and urine bilirubin level. 18.2% of patients with acholic stool showed intestinal activity on $Tc^{99m}$ DISIDA scan and 81.8% of them did not. All the patients without acholic stool showed positive intestinal activity on $Tc^{99m}$ DISIDA scan. The result of $Tc^{99m}$ DISIDA scan and the presence of acholic stool showed high negative correlation (r :-0.858). Patients with acholic stool and negative intestinal activity on $Tc^{99m}$ DISIDA scan showed higher serum total bilirubin level. Patients without acholic stool and positive intestinal activity on $Tc^{99m}$ DISIDA scan showed higher serum level of ALT. Conclusion: Patients with acholic stool and negative intestinal activity showed high correlation, but 18.2% of patients with acholic stool showed positive intestinal activity. So operative cholangiogram or transcutaneous liver biopsy should be performed for confirmation.