• Journal of Veterinary Clinics
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• v.29 no.2
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• pp.169-172
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• 2012

A 12-year-old castrated male Shih-tzu dog presented with vomiting, anorexia, and weight loss. The patient's medical history and hematological, radiographic, ultrasonographic, and endoscopic findings were used for diagnosis. The patient's medical history showed that he was being treated for chronic kidney disease since a few weeks. The serum biochemical analysis showed moderate azotemia. However, abdominal radiographic and ultrasonographic findings showed the presence of a mass in the pylorus area of the stomach. On gastrointestinal endoscopic examination, the proliferative mass was found in the pyloric antrum. The histopathological results of the endoscopic biopsy specimen indicated that it was strongly suspected a gastric adenoma; therefore, we surgically excised the pyloric outflow region via a Y-U pyloroplasty. The histopathological examination of the surgically excised specimen also indicated that the mass was a gastric adenoma. After surgical treatment, the patient's condition improved gradually, and the clinical symptoms diminished in approximately 3 weeks after surgery. The patient's condition was well controlled until recently, i.e., 18 months after surgery. This case report describes the clinical findings, imaging characteristics, endoscopic findings, and histopathological features of a gastric adenoma in the pyloric outflow tract of a dog.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.3
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• pp.417-422
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• 2019

Hemodynamically unstable pelvic fractures show a remarkably high mortality rate of 40% to 60%. However, their standard of care remains controversial. We report here a case of a 78-year-old woman who was admitted to the Emergency Department with pelvic pain following a fall. Based on pelvic radiography, she was diagnosed with an unstable pelvic fracture. Her blood pressure was 60/40 mmHg, and owing to her unstable vital signs, emergency angiography was performed without computed tomography (CT). Both internal iliac arteries were embolized without sub-branch selection for prompt control of pelvic bleeding. Following embolization, her vital signs were stabilized. Subsequent CT revealed free intra-abdominal air, suggesting bowel perforation had occurred and necessitating emergency laparotomy. An approximately 1 cm-sized free perforation of the small intestine was identified intraoperatively, and primary closure was performed. A retroperitoneal hematoma identified intraoperatively was not explored further because it was a non-expanding and non-pulsatile mass. The patient was admitted to the Intensive Care Unit and transferred to the general ward on postoperative day 3. In this case, the hemodynamically stable pelvic fracture with bowel perforation was successfully and safely treated by prompt angioembolization without conducting CT.

• Physical Therapy Korea
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• v.26 no.3
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• pp.67-75
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• 2019

Background: Stress urinary incontinence (SUI) is an involuntary leakage of urine from the urethra when intra-abdominal pressure increases, such as from sneezing, coughing, or physical exertion. It is caused by insufficient strength of the pelvic floor and sphincter muscles, resulting from vaginal delivery, obesity, hard physical work, or aging. The pelvic floor electrical stimulator is a conservative treatment generally used to relieve the symptoms of urinary incontinence. it recommended to applied before surgery is performed. Objects: The purpose of this study was to determine if the transcutaneous electrical stimulation (TCES) would be effective for the physiological symptoms and psychological satisfaction of women with SUI for an 8-weeks intervention. Methods: Easy-K is a specially designed user-friendly TCES. Five female who were diagnosed with SUI by a gynecologist but who did not require surgical intervention were included in this study. Intervention was implemented over an 8-week period. Outcome measures included vaginal ultrasonography, Levator ani muscle (LAM) contraction strength, incontinence quality of life (I-QOL), and female sexual function index (FSFI) questionnaires. Results: The bladder neck position significantly decreased across assessment time. Funneling index and urethral width significantly decreased after 8 weeks of intervention (p<.05). The bladder necksymphyseal distance and posterior rhabdosphincter thickness statistically increased and the anterior rhabdosphincter thickness showed a tendency to increase. All participants demonstrated a significant increase in the LAM contraction score across three assessment times (p<.05). Although the total score of the I-QOL did not show significant improvement, it steadily increased and among I-QOL subscales, only the "avoidance" subscale showed statistical improvements (p<.05). The total score of the FSFI statistically improved and the "desire" score significantly changed (p<.05). Conclusion: The TCES is recommended for women who want to apply conservative treatments before surgery and who have suffered from SUI in aspects of sexual function and quality of life.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.1
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• pp.91-97
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• 2022

Backgrounds/Aims: Metastatic lesions of the pancreas (PMET) account for 1%-5% of all malignant solid pancreatic lesions (SPL). In this study we evaluated the utility of endoscopic ultrasonography with fine needle aspiration (EUS-FNA) in diagnosing PMET. Methods: Patients who underwent EUS-FNA at a community referral center between 2011-2017 for SPL were identified. Clinical, radiologic, and EUS-FNA features of those with PMET were compared to those with primary solid tumors of the pancreas: pancreatic adenocarcinoma (PDAC) and neuroendocrine tumors (PNET). Results: A total of 191 patients were diagnosed with solid pancreatic malignancy using EUS-FNA: 156 PDAC, 27 PNET, and eight (4.2%) had PMET. Patients with PMET were less likely to have abdominal pain (25.0% vs. 76.3% vs. 48.2%; p < 0.01) or obstructive jaundice (37.5% vs. 58.3% vs. 0%; p < 0.01) compared to PDAC and PNET. Those with PMET were more likely to have mass lesions with/without biliary or pancreatic ductal dilatations (100% vs. 86.5% vs. 85.2%; p < 0.01) and lower CA19-9 (82.5 ± 43.21 U/mL vs. 4,639.30 ± 11,489.68 U/mL vs. 10.50 ± 10.89 U/mL; p < 0.01) compared to PDAC and PNET. Endosonographic features were similar among all groups. Seven (87.5%) patients with PMET had a personal history of malignancy prior to PMET diagnosis. The primary malignancy was renal cell carcinoma in five PMET. Conclusions: PMET are exceedingly rare, comprising less than 5% of SLP. Patients with PMET are less likely to present with symptoms and mostly identified by surveillance imaging for the primary malignancy.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.296-302
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• 2002

The classic approach for esophagectomy is via the combined thoracic and abdominal approach. Controversy exists whether patients with esophageal carcinoma are best managed with Ivor-Lewis esophagectomy(ILO) as combined thoracic and abdominal approach or transhiatal esophagectomy(THO). The THO approach is known to be superior with respect to operative time, severity of leak, morbidity/mortality, and length of stay, but may represent an inferior cancer operation as a result of survival disadvantage due to inadequate mediastinal clearance compared with ILO. Accordingly, we reviewed the results of our esophageal resections to compare these outcome parameters for each operative approach. Material and Method: From January 1993 to July 2001, We performed a retrospective review of all esophagectomies performed at Keimyung University Dongsan ·Medical Center; 27 underwent THO, and 45 underwent ILO Result: The two groups were comparable in terms of age, sex, and stage of the disease. Mean tumor length and mean operative time were 3.81cm and 354 minutes for THO versus 5.31cm and 453 minutes for ILO, respectively (p<0.01 and p<0.001). Respiratory complications were 11.1% for THO versus 35.6% for ILO(p<0.05). Hospital mortality was 11.1% for THO versus 22.2% for ILO. There were no significant differences between THO and ILO with respect to other types of complications, amount of blood transfusion, leak and stricture rates, and hospital stay. Overall long-term survival at 5 years was 37%, respectively. Conclustion: There was no significant difference in long-term survival of patients of both operative approach. ILO had significant difference in respiratory complications associated with hospital mortality. Hence, THO is a valid alternative to ILO for well selected patients. And either approach appears to be acceptable depending on the surgeons, preferences and experiences.

• Journal of Embryo Transfer
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• v.22 no.1
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• pp.63-67
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• 2007

This study was performed to evaluate the efficacy of sodium carboxymethylcellulose (SCMC) for the prevention of postoperative uterus and ovary adhesion formation in the Korean black goats. Twenty adult female Korean black goats randomly were divided into five groups with four animals in each group. After the routine laparotomy, catheter for injection was inserted into the abdomen. Before abdominal closure, saline, 1% SCMC, 2% SCMC or 0.4% HA solution (50ml/10kg of body weight/head) were injected in the abdominal cavity in each group. Three weeks after surgery, second laparotomy was performed and the adhesions were scored on a scale of 0 to 10 according to their vascularity and adhesion size in uterus and ovary. This trial was repeated the four times with the interval of three weeks. In the first and second trial, the group treated with 2% SCMC significantly reduced the adhesion formation than other treatment groups (P<0.05). In the third trial, the adhesion formation was significantly reduced in 2% SCMC and 1% SCMC (P<0.05). In the fourth trial, 2% SCMC reduced the adhesion formation. However, there was no significant difference among other groups. This study showed that the 2% SCMC administered at the end of the surgery reduced the adhesion formation in the Korean black goats.

• The KIPS Transactions:PartB
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• v.19B no.2
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• pp.123-126
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• 2012

This paper proposed a method to separate a liver into left and right liver lobes for simple and exact volumetry of the river graft at abdominal MDCT(Multi-Detector Computed Tomography) image before the living donor liver transplantation. A medical team can evaluate an accurate river graft with minimized interaction between the team and a system using this algorithm for ensuring donor's and recipient's safe. On the image of segmented liver, 2 points(PMHV: a point in Middle Hepatic Vein and PPV: a point at the beginning of right branch of Portal Vein) are selected to separate a liver into left and right liver lobes. Middle hepatic vein is automatically segmented using PMHV, and the cutting line is decided on the basis of segmented Middle Hepatic Vein. A liver is separated on connecting the cutting line and PPV. The volume and ratio of the river graft are estimated. The volume estimated using 2 points are compared with a manual volume that diagnostic radiologist processed and estimated and the weight measured during surgery to support proof of exact volume. The mean ${\pm}$ standard deviation of the differences between the actual weights and the estimated volumes was $162.38cm^3{\pm}124.39$ in the case of manual segmentation and $107.69cm^3{\pm}97.24$ in the case of 2 points method. The correlation coefficient between the actual weight and the manually estimated volume is 0.79, and the correlation coefficient between the actual weight and the volume estimated using 2 points is 0.87. After selection the 2 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. The mean ${\pm}$ standard deviation of the process time is $57.28sec{\pm}32.81$ per 1 data set ($149.17pages{\pm}55.92$).

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.6 no.1
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• pp.24-31
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• 2003

Purpose: As diagnostic tools for Hirschsprung's disease (HD), barium enema and rectal biopsy have radiation exposure and invasiveness respectively; however anorectal manometry does not have these disadvantages. We therefore performed this study to evaluate the diagnostic efficacy of anorectal manometry. Methods: We reviewed medical records of infants with one or two symptoms of vomiting, abdominal distension, chronic diarrhea or constipation who had a anorectal manometry followed by barium enema and/or biopsy from July 1995 to May 2002. We evaluated the sensitivity, specificity and predictive value of anorectal manometry and barium enema for diagnosis of HD. We also measured sphincter length, median value of balloon volume at which rectoanal inhibitory reflex (RAIR) occurred. Results: All 61 patients received anorectal manometry, 33 of 61 received barium enema. 18 of 61 were diagnosed as HD according to histology and 43 of 61 were evaluated as a control. The sensitivity, specificity, positive predictive value, negative predictive value of anorectal manometry and barium enema for diagnosis of HD were 1.00, 0.91, 0.82, 1.00 and 0.93, 0.67, 0.70, 0.92 respectively. The mean value of sphincter length in control was $1.68{\pm}0.67$ cm and correlated with age, weight and significantly longitudinal length. The median value of balloon volume at which RAIR occurred was 10 mL and did not correlated with age, weight and longitudinal length. Conclusion: This study suggests that anorectal manometry is an excellent initial screening test for Hirschsprung's disease because of its safety and accuracy.

• Journal of Gastric Cancer
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• v.7 no.2
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• pp.82-87
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• 2007

Purpose: In gastric cancer patients with gastric outlet obstruction, there are several complications such as malnutrition and vomiting. Palliative enteral stenting is a less invasive procedure as compared with a gastrojejunostomy. The aim of this study was to determine whether there was a significant difference between patients that undergone palliative enteral slanting and patients that had received a bypass gastrojejunostomy. Materials and Methods: One hundred patients underwent palliative entering stenting and 3f patients were subjected to a surgical bypass gastrojejunostomy. We reviewed the medical records of the patients with gastric outlet obstruction secondary to far advanced gastric cancer that were diagnosed using a gastrofibroscope, UGI and abdominal CT, and were admitted to our institution between January 2000 and August 2006. The outcome of stent placement for gastric outlet obstruction was compared with palliative gastrojejunostomy during the same period. We excluded patients with recurrent gastric cancer and double cancer from this study. Results: There were significant differences between the group of patients that underwent slanting and the group of patients that received a gastrojejunostomy regarding the age of patients ($67{\pm}12$ vs. $57{\pm}9$, P<0.001) but not between the sex of the patients (M : F, 2 : 1 vs. 2 :1, P=0.637). The most common complication of stenting was tumor ingrowth (16/100, 16%) and the second most common complication was stent migration (14/100). Failure of the procedure occurred in only three patients. Twenty-three patients underwent re-slanting and one patient required open conversion with a gastrojejunostomy. The median time to the first meal was $4{\pm}2$ days in the stent group of patients and $6{\pm}2$ days in the gastrojejunostomy group of patients (P=0.001). The median postoperative hospital stays were 9 days in the stent group of patients and 15 days in the gastrojejunostomy group of patients (P=0.003). The mean survival periods were 11 months in the stent group of patients and 10 months in the gastrojejunostomy group of patients (P=0.937). Conclusion: There were no significant differences In the mean survival rates. An earlier first meal and a shorter hospitalization stay were found in the slanting group of patients compared to the bypass gastrojejunostomy group of patients. However, re-slanting was a concern due to tumor ingrowth and stent migration.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.711-720
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• 2003

Bakground : Complete resection by the surgery has been selected as the treatment of choice in lung cancer patients, but in cases of recurrence after excision or inoperable cases, the importance of anticancer chemotherapy has been emphasized. If one can select a set of the sensitive chemotherapeutic agents before anticancer chemotherapy, it will give more favourable results. Subrenal capsular assay has been recognized as a useful in-vivo chemosensitivity test of thoracic and abdominal tumors and it can be done in a short time for a rapid interpretation of tumor responsiveness to anticancer chemotherapeutic drugs. It has been reported that various kinds of cancer cells can be implantable to the kidney, but so far there is no comparative study of xenogeneic cell implantation on liver, spleen and kidney. The author implanted the human lung cancer cells under the capsule of S.D rat's liver, spleen and kidney respectively and compared the pattern of growth and histology. Material and Method: After incubation of human lung cancer cell line (SW-900 G IV) in RPMI 1640 (Leibovitz L-15 medium) culture media, 3${\times}$3${\times}$3 mm size fibrin clots which contain 108 cancer cells were made. Thereafter the fibrin clots were implanted at subcapsule area of liver, spleen and kidney of S.D. female rat. For immune suppression, cyclosporin-A (80 mg/Kg) was injected subcutaneously daily from post-implantation first day to sixth day. The body weight was measured at pre and post implantation periods. The growth pattern and the size of tumor mass were observed and the pathologic examination and serum tumor marker tests were performed. Result: Body weight increased in both of control and experimental groups. Serum Cyfra 21-1 was not detected. Serum levels of CEA and NSE revealed no significant change. The SCC-Ag increased significantly in implanted group. The growth rate of human lung cancer cells which was implanted on spleen was higher than on liver or kidney. The surface area, thickness, and volume of tumor mass were predominant at spleen. The success rates of implantation were 80% on kidney, 76.7% on spleen and 43.3% on liver. Pathologic examination of implanted tumors showed characteristic findings according to different organs. Tumors that were implanted on kidney grew in a round shape, small and regular pattern. In the spleen, tumors grew well and microscopic neovascularization and tumor thrombi were also found, but the growth pattern was irregular representing frequent daughter mass. Human lung cancer cells that were implanted in the liver, invaded to the liver parenchyme, and had low success rate of implantation. Microscopically, coagulation necrosis and myxoid fibrous lesion were observed. Conclusion: The success rate of implantation was highest in the kidney. And the mass revealed regular growth that could be measured easily. The SCC-Ag was presented earlier than CEA or Cyfra21-1. The Cyfra21-1 was not detected at early time after implantation. The best model for tumor implantation experiment for chemosensitivity test was subrenal capsular analysis than liver and spleen and the useful serum tumor marker in early period of implantation was the SCC-Ag.