• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.18
• /
• pp.8281-8285
• /
• 2016

Background: Helicobacter pylori is a cause of chronic gastritis, peptic ulcer disease, and gastric malignancy, infection being a serious health problem in Thailand. Recently, clarithromycin resistant H. pylori strains represent the main cause of treatment failure. Therefore this study aimed to determine the prevalence and pattern of H. pylori resistance to clarithromycin in Suranaree University of Technology Hospital, Suranree University of Technology, Nakhon Ratchasima, Northeastern Thailand, Nakhon Ratchasima province, northeast of Thailand. Materials and Methods: This hospital-based cross-sectional study was carried out between June 2014 and February 2015 with 300 infected patients interviewed and from whom gastric mucosa specimens were collected and proven positive by histology. The gastric mucosa specimens were tested for H. pylori and clarithromycin resistance by 23S ribosomal RNA point mutations analysis using real-time polymerase chain reactions. Correlation of eradication rates with patterns of mutation were analyzed by chi-square test. Results: Of 300 infected patients, the majority were aged between 47-61 years (31.6%), female (52.3%), with monthly income between 10,000-15,000 Baht (57%), and had a history of alcohol drinking (59.3%). Patient symptoms were abdominal pain (48.6%), followed by iron deficiency anemia (35.3%). Papaya salad consumption (40.3%) was a possible risk factor for H. pylori infection. The prevalence of H. pylori strains resistant to clarithromycin was 76.2%. Among clarithromycin-resistant strains tested, all were due to the A2144G point mutation in the 23S rRNA gene. Among mutations group, wild type genotype, mutant strain mixed wild type and mutant genotype were 23.8%, 35.7% and 40.5% respectively. With the clarithromycin-based triple therapy regimen, the efficacy decreased by 70% for H. pylori eradication (P<0.01). Conclusions: Recent results indicate a high rate of H. pylori resistance to clarithromycin. Mixed of wild type and mutant genotype is the most common mutant genotype in Nakhon Ratchasima province, therefore the use of clarithromycin-based triple therapy an not advisable as an empiric first-line regimen for H. pylori eradication in northeast region of Thailand.

• Journal of Gastric Cancer
• /
• v.1 no.1
• /
• pp.38-43
• /
• 2001

Purpose: Roux stasis syndrome is the main complication of a Roux-en-Y gastrojejunostomy. The aim of this study was to compare the occurrence rate of Roux stasis syndrome with the passing of time in a conventional Roux-en-Y gastrojejunostomy and in an uncut Roux-en-Y gastrojejunostomy. Materials and Methods: 50 patients (31 men and 19 women) had a conventional Roux-en-Y reconstruction and 53 patients (35 men and 18 women) had an uncut Roux-en-Y reconstruction. The Roux stasis syndrome was defined by clinical criteria only. The criteria included one of the four following conditions at the time of follow-up: chronic upper abdominal pain, postprandial fullness, persistent nausea, and intermittent vomiting that are worsened by eating. Follow-up after surgery was done in all patients at $7\∼12,\;13\~18,\;19\~24,\;25\~30$, and $31\∼36$ months. Results: According to the criteria, the Roux stasis syndrome occurred in 40.0$\%$ of the patients at 7$\∼$12 months, 33.3$\%$ at $13\∼19$ months, $35.3\%$ at $19\∼24$ months, $32.0\%$ at $25\~30$ months, and $33.3\%$ at $31\∼36$ months after a conventional Roux-en-Y operation. The syndrome occurred in $22.6\%$ of the patients at $7\∼12$ months, $15.2\%$ at $13\∼18$ months, $17.1\%$ at $19\∼24$ months, $19.2\%$ at $25\∼30$ months, and $20\%$ at $31\∼36$ months after an uncut Roux-en-Y reconstruction. Conclusion: In terms of occurrence pattern, only a little variance existed one year after both procedures. Comparing the Roux stasis syndrome in both procedures, the uncut Roux operation had better results than the conventional Roux operation.

• Journal of the Institute of Electronics Engineers of Korea SP
• /
• v.47 no.1
• /
• pp.17-24
• /
• 2010

This paper proposed the method to separate a liver into left and right liver lobes for exact volumetry of the river graft at abdominal MDCT(Multi-Detector Computed Tomography) image before living donor liver transplantation. On the image of segmented liver, 4 points(the middle point of Inferior Vena Cava, a point of Middle Hepatic Vein, a point of Portal Vein, a middle point of gallbladder fossa) are selected. A liver is separated into left and right liver lobes on the basis of the 4 points. The volume and ratio of the river graft are estimated. The volume estimated using 4 points and the manual volume that radiologist processed and estimated are compared with the weight measured during surgery to support proof of the exact volumetry. After selection the 4 points, the time involved in separation a liver into left and right river lobe and volumetry of them is measured for confirmation that the algorithm can be used on real time during surgery. This study progressed to ensure donor's and recipient's safe who will undergo the liver transplantation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.34 no.2
• /
• pp.220-229
• /
• 2008

Purpose: The present study was aimed to examine the effect of acellular dermal matrix ($AlloDerm^{(R)}$) grafted to the experimental tissue defect on tissue regeneration. Materials and Methods: Male albino rabbits were used. Soft tissue defects were prepared in the external abdominal oblique muscle. The animals were then divided into 3 groups by the graft material used: no graft, autogenous dermis graft, and $AlloDerm^{(R)}$ graft. The healing sites were histologically examined at weeks 4 and 8 after the graft. In another series, critical sized defects with 8-mm diameter were prepared in the right and left iliac bones. The animals were then divided into 5 groups: no graft, grafted with autogenous iliac bone, $AlloDerm^{(R)}$ graft, $AlloDerm^{(R)}$ graft impregnated with rhBMP-2, and $AlloDerm^{(R)}$ graft with rhTGF-${\beta}1$. The healing sites of bone defect were investigated with radiologic densitometry and histological evaluation at weeks 4 and 8 after the graft. Results: In the soft tissue defect, normal healing was seen in the group of no graft. Inflammatory cells and foreign body reactions were observed in the group of autogenous dermis graft, and the migration of fibroblasts and the formation of vessels into the collagen fibers were observed in the group of $AlloDerm^{(R)}$ graft. In the bone defect, the site of bone defect was healed by fibrous tissues in the group of no graft. The marked radiopacity and good regeneration were seen in the group of autogenous bone graft. There remained the traces of $AlloDerm^{(R)}$ with no satisfactory results in the group of $AlloDerm^{(R)}$ graft. In the groups of the $AlloDerm^{(R)}$ graft with rhBMP-2 or rhTGF-${\beta}1$, there were numerous osteoblasts in the boundary of the adjacent bone which was closely approximated to the $AlloDerm^{(R)}$ with regeneration features. However, the fibrous capsule also remained as in the group of $AlloDerm^{(R)}$ graft, which separated the $AlloDerm^{(R)}$ and the adjacent bone. Conclusions: These results suggest that $AlloDerm^{(R)}$ can be useful to substitute the autogenous dermis in the soft tissue defect. However, it may not be useful as a bone graft material or a carrier, since the bone defect was not completely healed by the bony tissue, regardless of the presence of osteogenic factors like rhBMP-2 or rhTGF-${\beta}1$.

• Journal of Yeungnam Medical Science
• /
• v.7 no.2
• /
• pp.39-48
• /
• 1990

Congenital duodenal obstruction in the newborn infant may be due to a variety of causes. Duodenal obstruction often presents with bilious vomiting and upper abdominal distention. Diagnosis is usually established on plain x-ray of the abdomen by the classic finding of the double-bubble. In the period July 1986 to June 1990, 16 patients with congenital duodenal obstruction were operated and the following results were obtained. 1. Sixteen patients were comprised of 11 males and 5 females, the ratio of male and female was 2.2:1. 2. Thirteen patients(81%) had been admitted to our hospital during one month of life. 3. Congenital duodenal obstruction was in 16 cases; malrotation in eight(50%), annular pancreas in six(38%), type 1 atresia in one(6%), and wind-sock anomaly in one(6%). 4. There were two premature patients and six patients of small for gestational age. 5. Overall, bilious vomiting, occurring in three fourths, was the single most frequent presenting complaint. 6. Polyhydramnios occurred in two of the patients. 7. Diagnosis was possible with clinical symptom and simple abdomen. 8. The operative procedures performed were ; duodenoduodenostomy in five, duodenojejunostomy in two, excision of wind-sock membrane in one, and Ladd's procedure in eight. 9. A total of ten asociated congenital anomalies were found in six patients. 10. Postoperative complications occurred in five cases(31%).

• Journal of the Korean Society of Radiology
• /
• v.81 no.6
• /
• pp.1348-1363
• /
• 2020

The newly revised 2018 Organ Injury Scale (OIS) has a similar format to the previous American Association for Surgery and Trauma (AAST) Emergency General Surgery Grading System, dividing the criteria for grading solid organ damage into three groups; imaging, operation, and pathology. The most significant alteration in the OIS system 2018 revision is the incorporation of multidetector CT (MDCT) findings of vascular injury including pseudoaneurysm and arteriovenous fistula. Similar to the previous OIS, the highest of the three criteria is assigned the final grade. In addition, if multiple grade I or II injuries are present, one grade is advanced for multiple injuries up to grade III. This pictorial essay demonstrates the MDCT findings of solid organ injury grades based on the 2018 OIS system.

• Radiation Oncology Journal
• /
• v.18 no.1
• /
• pp.40-45
• /
• 2000

Purpose : To evaluate the histopathological prognostic factors, relapse pattern and survival in patients with endometrial carcinoma who were treated with surgery and postoperative adjuvant radiotherapy (RT). Methods and Materials : From September 1991 to December 1997, 27 patients with endometrial carcinoma treated with surgery and postoperative adjuvant RT at Asan Medical Center were entered in this study. Surgery was peformed with total abdominal hysterectomy in six, total abdominal hysterectomy with pelvic lymph node dissection in eight and radical hysterectomy in 13 patients. External RT of 50.4 Gy was done to all patients and among these, additional high dose rate vaginal vault irradiation of 20$\~$25 Gy with fractional dose of 4$\~$5 Gy was boosted In 16 patients. The patients were followed for 6$\~$95 months(median 30). Results : The number of patients according to FIGO stage were I 18 (67$\%$), II 1 ($4\%$) and III 7 ($26\%$). Patients with poor histologic grade, deep myometrial invasion, adnexal involvement, lymphovascular invasion showed more pelvic lymph node involvement, but no statistical significance was indicated. The 5 year overall and disease free survival were 100$\%$ and 76.8$\%$, respectively. Relapse sites were pelvic, para-aortic lymph node, and multiple metastases including lung, and no vaginal relapse was developed. Factors that were associated with disease free survival were FIGO stage (p=0.01), lymphovascular invasion (p=0.03), pelvic lymph node involvement (p=0.0001). There was only one Grade 1 rectal bleeding without moderate to severe complications. Conclusion : Postoperative adjuvant RT is considered to reduce the loco-regional failure, resulting the improvement of survival. The group of patients with the risk of vaginal failure without vaginal vault irradiation should be investigated according to stage and grade.

• Radiation Oncology Journal
• /
• v.25 no.4
• /
• pp.201-205
• /
• 2007

Purpose: This retrospective study was conducted to assess outcome and to determine the prognostic factors in patients with a desmoid tumor treated with postoperative radiotherapy. Materials and Methods: Twenty-seven patients with a desmoid tumor who were treated with postoperative radiotherapy between June 1984 and October 2005 were analyzed. There were 13 male and 14 female patients. The age of the patients ranged from 3 to 79 years (median age, 28 years). Tumors were located in an extra-abdominal area (21 cases), and in the abdominal walls (6 cases). The tumor size ranged from 2.5 to 25 cm (median size, 7.5 cm) in the largest linear dimension. Thirteen cases received radiotherapy after initial surgery, and 14 recurrent cases received radiotherapy after additional surgery. The total radiation dose given was $45{\sim}66$ Gy (median dose, 59.4 Gy), and the fraction size was $1.8{\sim}2.0$ Gy. Results: The median follow-up period was 61 months (range, $12{\sim}203$ months). Two patients developed local progression and six patients experienced local recurrence. The 5-year disease-free survival rate and the 5-year progression-free survival rate were 61 % and 70%, respectively. Wide local excision was associated with better disease free survival with statistical significance (p=0.028). Radiotherapy after initial surgery (p=0.046) and a higher radiation dose of more than 60 Gy (p=0.049) were associated with better progression free survival with statistical significance. At the time of the last follow-up, the number of additional surgeries was higher in patients that received radiotherapy after reoperation (p<0.001). Conclusion: Radiotherapy after the initial operation improved local control and decreased the number of subsequent operations. Thus, postoperative radiotherapy after an initial operation is recommended in patients with a high risk of recurrence for a desmoid tumor.

• Journal of Chest Surgery
• /
• v.40 no.11
• /
• pp.765-769
• /
• 2007

Background: The curative treatment of choice for empyema is decortication of the pleura. The risks of this treatment however are increased for the patient with reduced pulmonary function, complicated calcification or septic shock. In the past, open window thoracostomy was a final stage treatment for chronic empyema. Relatively safe treatment of empyema could be achieved in difficult cases with a closure of the open window after open drainage and use of a myocutaneous flap (one stage or staged). Material and Method: A retrospective study of the cause, progression and final outcome of empyema patients who received open window thoracostomy was performed. 21 patients were followed from 1995 to 2004 in the department of Thoracic and Cardiovascular Surgery in the College of Medicine, Pusan National University. Result: The average age of the patients was $57.5{\pm}15.5$ years (range $25{\sim}78$ years), of whom 16 (76.2%) were men and five (23.8%) were women. Pulmonary function test results showed an average FEV1 of $1.58{\pm}0.49 L$. The type of empyema was tuberculous empyema in 13 cases (61.9%), aspergillosis in three cases (14.3%), parapneumonic empyema in three cases (14.3%) and post-resectional empyema in two cases (10%). Bronchopulmonary fistula was seen in 14 cases. Eight cases were complicated by severe calcification of the pleura. For the four cases of bronchopulmonary fistula, the patients' serratus anterior muscle was covered in their first operation. The average number of ribs resected was $4{\pm}1$. Closure of the open window thoracostomy was performed in 12 cases. The average time to closure after open drainage was $10.22{\pm}3.11$ months and the average defect of the empyemal cavity before the final operation was $330{\pm}110 cc$. Among the 12 cases, there were two cases of spontaneous closure. In two cases closure was only achieved by using the reserved skin fold during the first surgery. Of the remaining eight cases, in seven we used the myocutaneous flap (four cases of lattisimus dorsi muscle and three cases of pectoralis major muscle), and in one case we used soft tissue. As regards complications of the closure, tissue necrosis occurred in one case, which led to failed closure, and there was one case of abdominal hernia in the rectus abdominis muscle flap. One patient died within 30 days of the surgery and one patient died of metastatic cancer. Conclusion: A staged operation with a final closure using open window thoracostomy, which consists of open drainage, transposition of the muscle and a myocutaneous flap, can be a safe and effective option for the chronic empyema patient who is difficult to cure with traditional surgical methods.

• Advances in pediatric surgery
• /
• v.13 no.2
• /
• pp.203-211
• /
• 2007

A nationwide survey on acute appendicitis (AAP) was undertaken among members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and the case registration form for each patient during the 6 months period from the $1^{st}$ October, 2005 to $31^{st}$ March, 2006. Questionnaires were collected from 23 members. Four hundred seventy six patients were registered from 21 hospitals where the members were working. The male to female ratio was 1.67:1. Average age was 9 years and 5 months (range 21 months-20 years). Operations were performed on average 10.4 hours (range 1-230 hours) from arrival at hospital. The average operation time was 59.1 minutes. The average admission days were 5.8 days (range 2-45 days). The most frequent symptoms were abdominal pain (95.1 %), vomiting (50.6 %) and fever (43.7%). The average duration of symptoms was 42.2 hours (range 1 hour-22 days). Leukocytosis (WBC count > 10,000) was found in 85.9%. The most popular diagnostic tools were ultrasonography and CT. Open surgery was performed in 72.1 % and laparoscopic surgery in 27.5 %. Two laparoscopic surgeries were converted to open surgery (0.4 %). Simple appendicitis was found in 54.5 % and complicated appendicitis such as abscess, gangrenous change and perforation in 45.5%. According to the questionnaires 12 hospitals were performing open surgery only in all patients. Four hospitals were performing laparoscopic surgery in all patients. Seven hospitals are performing both surgical methods according to surgeon or occasion. Regarding the use of antibiotics in acute appendicitis, three kinds of antibiotics were used in 40 % of total simple appendicitis patients. The results showed the trend of management in acute appendicitis in Korea. Especially it is necessary for the members to discuss the use of antibiotics for prophylaxis in the simple appendicitis.