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대한외과학회지

The Journal of The Korean Surgical Society

  • : 대한외과학회
  • : 의약학분야  >  외과학
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대한외과학회지
83권4호(2012년 10월) 수록논문
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KCI등재

1Original Articles : Outcome of triple-negative breast cancer in patients with or without markers regulating cell cycle and cell death

저자 : Dong Won Ryu , Chung Han Lee

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 187-195 (9 pages)

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Purpose: The genes p53 and B-cell lymphoma (bcl)-2 play an important role in regulating the mechanisms of apoptosis. In this paper, we retrospectively applied these factors to our series of triple negative breast cancer (TNBC) patients, in conjunction with an evaluation of the prognostic significance of these factors` influence on TNBC survival rate. Particular focus was placed on the role of bcl-2, p53, Ki-67. Methods: The study subjects, 94 women with TNBC, were a subset of patients operated at Kosin University Gospel Hospital from January 2000 to December 2005. Chi-squared tests were used for statistical analysis. Results: Positive staining for cytokeratin (CK)5/6 in 23 cases (24.5%), epidermal growth factor receptor in 15 cases (16.0%), bcl-2 in 26 cases (27.7%), p53 in 55 cases (58.5%) and Ki-67 in 74 cases (78.7%) was determined. Lymph node status, tumor size and expression of CK5/6 or Ki-67 were independent prognostic factors for patients with TNBC. Conclusion: Markers regulating cell cycle and cell death such as p53 and bcl-2 cannot be used to classify TNBCs into two subtypes with differing disease-free survival. But because our study is small in size, more abundant patient data will be needed to evaluate the factors` predictive role in regulating cell cycle and cell death.

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2Original Articles : Observational study of central metastases following thyroid Lobectomy without a completion thyroidectomy for papillary carcinoma

저자 : Jin Seong Cho , Jung Han Yoon , Min Ho Park , Sun Hyoung Shin , Young Jong Jegal , Ji Shin Lee , Hee Kyung Kim

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 196-202 (7 pages)

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Purpose: There are no guidelines for the optimal timing of the decision of when to perform completion thyroidectomy, and controversy exists regarding how the timing of completion thyroidectomy impacts survival patterns. We investigated the legitimacy of an observational strategy in central node metastasis after thyroid lobectomy for papillary thyroid cancer (PTC). Methods: We retrospectively evaluated 522 consecutive patients who underwent thyroid lobectomy. Of the 69 patients with central metastasis, 61 patients (88.4%) were included in an observational study under cautious evaluation with informed consent by the patients, and compared with an observation arm of 180 postlobectomy N0 (node negative proven) patients. Results: Of the 522 patients, six (1.1%) thyroid, five (0.9%) central, and two (0.4%) lateral recurrences were observed. Lateral recurrences occurred in the immediate completion N0 and Nx groups but not in the N1a observation arms. There were two (3.3%) central recurrences without thyroid or lateral recurrence on the observation arm of N1a observation patients. But two (1.1%) thyroid and three (1.7%) central recurrences were on the observation arm of N0 patients. In Kaplan-Meier survival curves for central or lateral recurrences between observation arms for the N1a and N0 groups, no significant difference was found between the N1a and N0 observation arms (P = 0.365). Conclusion: The timing of when to perform completion thyroidectomy in central metastases-proven patients after lobectomy for PTC should be based on the patient`s risk category.

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3Original Articles : The Effects of Helicobacter pylori on the prognosis of patients with curatively resected gastric cancers in a population with high infection rate

저자 : Hoon Hur , Sang Rim Lee , Yi Xuan , Young Bae Kim , Young Ae Lim , Yong Kwan Cho , Sang Uk Han

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 203-211 (9 pages)

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Purpose: The goal of this study was to assess the correlation between the Helicobacter pylori status of patients who underwent curative resection for gastric adenocarcinoma and their prognosis in Eastern societies where H. pylori infection is prevalent. Methods: Between 2006 and 2007, 192 patients who had a curative resection for the treatment of gastric adenocarcinoma were enrolled in the study. Of these patients, 18 were excluded due to an inexact evaluation of the H. pylori status, thereby leaving 174 patients in the final analysis. Serologic testing for H. pylori was assessed using an enzyme-linked immunosorbent assay kit for immunoglobulin G, and the histological presence of H. pylori was identified using the Giemsa stain. Results: Of the 174 patients, 111 patients (63.8%) were confirmed for H. pylori infection. H. pylori status did not correlate with the overall or disease- free survival. For patients with stage III or IV gastric cancer, a positive H. pylori status was a significant predictive factor for recurrence over that of a negative H. pylori status (P = 0.019). Negative H. pylori status was a predictive factor for recurrence in multivariable analysis (relative risk, 2.724; 95 confidence interval, 1.192 to 6.228). Conclusion: Helicobacter pylori status did not correlate with the clinicopathologic factors of gastric adenocarcinoma. However, a negative Helicobacter pylori status may be a predictive factor for recurrence in patients diagnosed with advanced gastric adenocarcinoma.

KCI등재

4Original Articles : Transumbilical single port Laparoscopic appendectomy using basic equipment: a comparison with the three ports method

저자 : Jun Suh Lee , Young Il Choi , Sung Ho Lim , Tae Ho Hong

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 212-217 (6 pages)

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Purpose: Single port laparoscopic surgery is a rapidly evolving laparoscopic surgical approach. We report a comparison of transumbilical single port laparoscopic appendectomy (TUSPLA) and conventional laparoscopic appendectomy (CLA) in a Korean military hospital. Methods: This single-center retrospective study of 63 patients who received laparoscopic appendectomy was conducted between May 2011 and October 2011. Nineteen patients received TUSPLA and 44 patients received CLA. Clinical outcomes such as operation time, hospital stay, postoperative pain, diet, and postoperative complication were reviewed. Results: There were no statistically significant differences between TUSPLA and CLA patients, respectively, in operation time (58.9 minutes vs. 52.3 minutes, P = 0.262), duration of hospitalization (10.2 days vs. 10.6 days, P = 0.782), mean visual analogue scale score (2.6 vs. 2.5, P = 0.894), and return to diet (1.6 days vs. 1.7 days, P = 0.776). There were two cases (10.5%) of short-term complications in the TUSPLA group and four cases (9.1%) of short-term complications in the CLA group. All patients were fully recovered at discharge. Conclusion: TUSPLA is a feasible alternative for CLA. When a glove port is used, no special instruments are needed. Thus, it can be performed in a hospital equipped with basic laparoscopic surgical instruments.

KCI등재

5Original Articles : Proposal of an endoscopic retrograde cholangiopancreatography-elated perforation management guideline based on perforation type

저자 : Woo Il Kwon , Jin Young Jang , Ji Kon Ryu , Yong Tae Kim , Yong Bum Yoon , Mee Joo Kang , Sun Whe Kim

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 218-226 (9 pages)

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Purpose: Consensus for endoscopic retrograde cholangiopancreatography (ERCP) related perforation management is lacking. We aimed to identify candidate patients for conservative management by examining treatment results and to introduce a simple, algorithm-based management guideline. Methods: A retrospective review of 53 patients with ERCP-related perforation between 2000 and 2010 was conducted. Data on perforation site (duodenum lateral wall or jejunum, type I; para-Vaterian, type II), management method, complication, mortality, hospital stay, and hospital cost were reviewed. Comparative analysis was done according to the injury types and management methods. Results: The outcome was greater in the conservative group than the operative group with shorter hospital stay (20.6 days vs. 29.8 days, P = 0.092), less cost (10.6 thousand United States Dollars [USD] vs. 19.9 thousand USD, P = 0.095), and lower morbidity rate (22.9% vs. 55.6%, P = 0.017). Eighty-one percent (17/21) of type I injuries were operatively managed and 96.9% (31/32) of type II injuries were conservatively managed. Between the types, type II showed better results over type I with shorter hospital stay (19.3 days vs. 30.6 days, P = 0.010), less cost (9.5 thousand USD vs. 20.1 thousand USD, P = 0.028), and lower complication rate (18.8% vs. 57.1%, P = 0.004). There was no difference in mortality. Conclusion: Type II injuries were conservatively manageable and demonstrated better outcomes than type I injuries. The management algorithm suggests conservative management in type II injuries without severe peritonitis or unsolved problem requires immediate surgical correction, including operative management in type I injuries unless endoscopic intervention is possible. Conservative management offers socio-medical benefits. Conservative management is recommended in well-selected patients.

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6Original Articles : Prognostic factors for gallbladder cancer in the Laparoscopy era

저자 : Hak Youn Lee , Young Hoon Kim , Ghap Joong Jung , Young Hoon Roh , Si Young Park , Nam Uk Kang , Soon Hwa Yoon , Jin Han Cho , Myung Hwan Roh , Sang Young Han , Sung Wook Lee , Yang Hyun Baek , Jin Sook Je

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 227-236 (10 pages)

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Purpose: Hepatobiliary surgery has changed dramatically in recent decades with the advent of laparoscopic techniques. The aim of this retrospective study was to compare survival rates according to stages, adjusting for important prognostic factors. Methods: A retrospective study of a 17-year period from January 1994 to April 2011 was carried out. The cases studied were divided into two time period cohorts, those treated in the first 9-years (n = 109) and those treated in the last 7-years (n = 109). Results: An operation with curative intent was performed on 218 patients. The 5-year survival rates according to the depth of invasion were 86% (T1), 56% (T2), 45% (T3), and 5% (T4). The number of cases of incidental gallbladder cancer found during 3,919 laparoscopic cholecystectomies was 96 (2.4%). Incidental gallbladder cancer revealed a better survival rate (P = 0.003). Iatrogenic bile spillage was found in 20 perforations of the gallbladder during laparoscopic cholecystectomies, 16 preoperative percutaneous transhepatic gallbladder drainages and 16 percutaneous transhepatic biliary drainages; only percutaneous transhepatic biliary drainage patients showed a significantly lower survival rate than patients without iatrogenic bile spillage (P < 0.034). Chemoradiation appeared to improve overall survival (P < 0.001). Multivariate analysis also revealed that time period, type of surgery, surgical margin, lymphovascular invasion, lymph node involvement, and chemoradiation therapy had significant effects. Conclusion: This study found that the prognosis of gallbladder cancer is still determined by the stage at presentation due to the aggressive biology of this tumor. Early diagnosis, radical resection and appropriate adjuvant therapy can increase overall survival.

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7Original Articles : The diagnostic values of preoperative Laboratory markers in children with complicated appendicitis

저자 : Hany Noh , Sei Jin Chang , Airi Han

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 237-241 (5 pages)

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Purpose: Accurate diagnosis and optimal management of acute appendicitis, despite being the most common surgical emergency encountered in emergency departments, is often delayed in pediatric patients due to nonspecific symptoms and communication barriers, often leading to more complicated cases. The aim of this study is to investigate the diagnostic significance of common laboratory markers. Methods: A total of 421 patients aged 15 and younger underwent surgical treatment for acute appendicitis. We conducted a retrospective analysis for white blood cell (WBC), C-reactive protein (CRP) and bilirubin. All patients were classified into simple or complicated appendicitis groups based on postoperative histology. Results: The mean age of the patients in the complicated appendicitis group was younger than that in the simple group (P = 0.005). WBC, CRP and bilirubin levels were significantly higher in the complicated appendicitis group (P < 0.001, <0.001, 0.002). The relative risk for complicated appendicitis was calculated using age, WBC, CRP and bilirubin. Elevated CRP levels were associated with the highest risk for complicated appendicitis (hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.38 to 4.65) followed by WBC (HR, 2.42; 95% CI, 1.07 to 5.46) and bilirubin (HR, 2.04; 95% CI, 1.09 to 3.82). The most sensitive markers for diagnosing complicated appendicitis were WBC (95.2%) and CRP (86.3%). Bilirubin levels showed the highest specificity at 74.8%. Conclusion: The risk of complicated appendicitis was significantly higher in patients younger than 10 years old. Preoperative WBC, CRP and bilirubin have clinical value in diagnosing complicated appendicitis with a HR of 2.0 to 2.5. Our results suggest that the utilization of WBC, CRP, and bilirubin can assist in the diagnosis of complicated appendicitis in pediatric patients, allowing prompt diagnosis and optimal management.

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8Case Rerorts : A rare reason of abdominal compartment syndrome: non-Hodgkin Lymphoma

저자 : Mehmet Abdussamet Bozkurt , Kaplan Baha Temizgonul , Osman Kones , Halil Alis

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 242-245 (4 pages)

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Abdominal compartment syndrome (ACS) is characterized by intra-abdominal hypertension (IAH) which affects all body systems. In healthy individuals, normal intra-abdominal pressure (IAP) is <5 to 7 mmHg. The upper limit of IAP is generally accepted to be 12 mmHg. ACS has been classified into primary, secondary, and tertiary subtypes. Non-Hodgkin lymphoma (NHL) is a rare reason for ACS. We report here one case of NHL as a primary retroperitoneal mass in an 80-year-old male patient who presented with IAH.

KCI등재

9Case Rerorts : Liver abscess developed after cadaveric Liver transplantation due to Ligation of an accessory right hepatic artery of the donor graft

저자 : Young Dong Yu , Dong Sik Kim , Geon Young Byun , Sung Ock Suh

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 246-249 (4 pages)

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It is important that extrahepatic arteries are identified precisely at the time of graft procurement. We present a case where the accessory right hepatic artery of the liver was ligated leading to postoperative liver abscess formation in the liver graft. A forty- seven-year-old female patient diagnosed with liver cirrhosis underwent orthotopic cadaveric liver transplantation due to altered mentality. The donor graft showed a variant of the hepatic artery anatomy where an accessory right hepatic artery arose from the superior mesenteric artery. This artery was accidentally transected during procurement. Since the back bleeding test using perfusion fluid was good, the artery was ligated. Postoperative abdominal computed tomography scan revealed a 6 cm low attenuating lesion in the liver. The patient underwent conservative treatment. We believe that even small accessory arteries (1 to 2 mm) should be reconstructed whenever possible to avoid postoperative complications such as liver abscess.

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10Case Rerorts : Endovascular treatment of ruptured infected aortic aneurysm with sepsis

저자 : Jeong Goo Kim , Jong Beom Kwon , Kuhn Park , Jong Ho Lee

발행기관 : 대한외과학회 간행물 : 대한외과학회지 83권 4호 발행 연도 : 2012 페이지 : pp. 250-253 (4 pages)

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The generally accepted treatment for infected aortic aneurysms involves open surgical resection and debridement, with in situ or extra-anatomical bypass. Occasionally, endovascular management can be substituted for the standard operation dependent on the patient`s condition. We report the case of an 81-year-old female with a ruptured infected aortic aneurysm and sepsis, successfully treated endovascularly. She had been on oral antibiotics for one year and is doing well 2 years after discharge.

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