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ABSTRACT: BackgroundThe technique of sentinel lymph node (SLN) mapping in patients with colorectal cancer varies between reports, and the optimal
method has not been established. The purpose of this study was to determine the optimal injection technique for SLN mapping.
MethodsSixty-nine consecutive patients who underwent curative surgery for colorectal cancer were enrolled. The SLNs was identified
intraoperatively by subserosal blue dye injection (in vivo) or by submucosal injection after standard colectomy (ex vivo).
If negative by conventional hematoxylin and eosin staining analysis, all lymph nodes, SLNs and non-SLNs, were subjected to
further analysis by multi-level section and immunohistochemical examination.
ResultsThe in vivo and ex vivo injected groups were similar in demographic character, tumor size, and histological grade. The mean
number of SLNs identified was 2.3 in the in vivo group and 2.6 in the ex vivo group (p=0.192). The detection rate of SLNs by blue dye injection was somewhat higher in the ex vivo group than in the in vivo group:
90.6 vs. 81.1% (p=0.219). The false-negative rate was 23.5% for the in vivo group and 13.3% for the ex vivo group (p=0.392). The upstaging rate, which was 18.5% overall, was similar in both groups (p=0.538).
ConclusionsThese findings suggest that ex vivo blue dye injection is an effective alternative to in vivo injection for identifying SLNs
in patients with colorectal cancer. Because of its simplicity and applicability in routine clinical settings, further investigation
of the ex vivo mapping technique is warranted.
World Journal of Surgery 04/2012; 33(3):539-546. · 2.36 Impact Factor
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ABSTRACT: A pregnant woman in the mid-third trimester developed complications with enlarged fetal abdomen and polyhydramnios. Prenatal ultrasound visualized dilated bowel, intraperitoneal calcifications, ascites, hydroceles and polyhydramnios, giving the impression of meconium peritonitis. The fetal abdomen continued to increased in size, and maternal dyspnea due to polyhydramnios was aggravated. She underwent a cesarean section at 36 + 1 weeks' gestation. The delivery was followed by severe neonatal respiratory distress due to the huge mass in the abdomen. The tumor was successfully removed by emergency surgery and diagnosed as immature gastric teratoma. No other associated anomaly was found. The infant made a good progress after the operation.
Journal of Obstetrics and Gynaecology Research 02/2012; 38(2):449-51. · 0.94 Impact Factor
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ABSTRACT: Intra-abdominal application of anti-adhesive barriers may reduce the extent and severity of postoperative adhesions. This study was designed to compare the effectiveness of a sprayable liquid barrier (a mixed solution of sodium hyaluronate and carboxymethylcellulose) with two conventional sheets.
Eighty male Sprague Dawley rats underwent laparotomy with subsequent multiple intestinal wall abrasions and abdominal wall injury. Afterwards, sodium hyaluronate and carboxymethylcellulose (HA-CMC) solutions were intraperitoneally sprayed or a film barrier of either oxidized regenerated cellulose (ORC) or polylactic acid (PA) was placed under the incision. At postoperative d 21, the rats underwent relaparotomy and complete adhesiolysis. Three investigators, who were blind to the group assignment, scored the extent of adhesion formation and resected specimens for histologic examination of fibrosis and inflammation. Expression profiles of parameters as mediators (macrophages [CD68]) in cellular inflammation response were analyzed.
Mean adhesion scores in rats that received HA-CMC solution (7.6±2.3) and ORC membrane (8.1±2.2) were lower than in rats that received PA film (10.7±2.5) and the control group (11.2±2.6) (P<0.05 for each comparison). In addition, there were significantly fewer adhesions located between large and small intestine in the HA-CMC solution group than in the control and each of the film barrier groups (P<0.05 for each comparison).
This study suggests that both HA-CMC solution and ORC membrane decrease the overall incidence of postoperative adhesions. However, the mixed solution of HA-CMC appeared to be superior to ORC membrane because this sprayable solution is easy to use and suitable for site-specific adhesion prevention after multifocal bowel trauma.
Journal of Surgical Research 06/2011; 168(1):49-55. · 2.25 Impact Factor
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ABSTRACT: The goal of this study was to evaluate the effect of peritrocal, intraperitoneal, or combined peritrocal-intraperitoneal ropivacaine on the parietal, visceral, and shoulder tip pain after laparoscopic cholecystectomy.
Eighty patients were randomly assigned to four groups. Group A received peritrocal and intraperitoneal saline. Group B received peritrocal saline and intraperitoneal ropivacaine. Group C received peritrocal ropivacaine and intraperitoneal saline. Group D received peritrocal and intraperitoneal ropivacaine. The parietal, visceral, and shoulder tip pain were assessed at 2, 4, 8, 12, 24, and 48 h postoperatively using a visual analog scale (VAS). The frequency of the patient pushing the button of the PCA and fentanyl use were also recorded.
In visceral pain, significantly lower VAS scores were observed in Group B from 2 to 4 h and in Group D from 2 to 8 h. In parietal pain, significantly lower VAS scores were observed in Group C from 4 to 24 h and in Group D from 2 to 12 h. In shoulder tip pain, significantly lower VAS scores were observed in Group B from 4 to 48 h and in Group D from 2 to 12 h. The fentanyl use and the frequency to push the button of the PCA were the highest in Group A and the lowest in Group D at every time point.
We conclude that peritrocal infiltration of ropivacaine significantly decreases parietal pain and intraperitoneal instillation of ropivacaine significantly decreases the visceral and shoulder tip pain. Their effects are additive with respect to the total pain.
Journal of Surgical Research 05/2011; 175(2):251-8. · 2.25 Impact Factor
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ABSTRACT: The accurate and early diagnosis of perforated appendicitis (PA) is important when a surgeon is making decisions with regard to time and method of operation that are critical in reducing morbidity and mortality. A total of 528 laparoscopic appendectomies were investigated with the review of data. Clinical factors for identifying PA and a comparison using computed tomography (CT) (prominent role in detection of appendicitis despite of its high cost) were done. Among the clinical factors, total duration of the symptoms before admission (cutoff value: 24.51 h, sensitivity/specificity 0.51/0.65) and highly selective C-reactive protein levels (cutoff value: 9.52 mg/L, sensitivity/specificity 0.80/0.69) had significance on PA (P=0.001) compared with the performance of CT (sensitivity/specificity 0.28/0.99). The total duration of the symptoms before admission and highly selective C-reactive protein levels were respectable predictors of PA compared with those when using CT, showing that it could be another diagnostic tool for identifying PA.
Surgical laparoscopy, endoscopy & percutaneous techniques 04/2011; 21(2):72-5. · 1.23 Impact Factor
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ABSTRACT: Enteropathy-type T-cell lymphoma (ETTL) is a rare disease with a poor prognosis. According to the World Health Organization (WHO) classification, it is a subtype of the peripheral T-cell lymphomas. This disease is associated with gluten-sensitive enteropathy, has a high risk of intestinal perforation and obstruction, and is refractory to chemotherapeutic treatment. We report the case of a 73-year-old woman who was diagnosed with enteropathy-type T-cell lymphoma of the small intestine, which was positive for the markers of cytotoxic T cells, CD3, CD8, and CD56, on immunohistochemical staining after resection of the perforated terminal ileum.
Yonsei medical journal 12/2009; 50(6):859-61. · 0.77 Impact Factor
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ABSTRACT: Peptic ulcer disease is uncommon in children and rarely suspected as a cause of abdominal complaints in this age group; the diagnosis is therefore made almost exclusively when complications develop. Peptic ulcer disease is usually not considered in the differential diagnosis of pediatric patients. We present the case of a 30-month-old boy with duodenal perforation due to a peptic ulcer without a known etiology. The patient was admitted through the emergency department due to severe hematochezia and ongoing anemia; he presented with neither abdominal pain nor abdominal distension. There were no medical problems, and no drugs, such as corticosteroids or nonsteroidal anti-inflammatory drugs, had been prescribed or administered recently. We tried to control the active bleeding by medical treatment including arterial embolization, but the active bleeding was not controlled. Finally, an exploratory laparotomy was performed. A discrete anterior perforation with active bleeding of the duodenal wall was found. After the operation, there were no complications and the patient recovered fully.
World Journal of Gastroenterology 10/2009; 15(38):4853-5. · 2.47 Impact Factor
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ABSTRACT: A desmoplastic small round cell tumor (DSRCT) is a rare, aggressive mesenchymal neoplasm. Although a DSRCT can develop at various sites, the intra-abdominal site is the most common location. These tumors are found most commonly among young adolescents and the prognosis is extremely poor. Multimodal treatment with surgery, chemotherapy and radiotherapy is very important for these rare cases, and this treatment can improve patient survival. In this report, we describe the case of an 8-year-old boy diagnosed with DSRCT located in the retroperitoneal space. The patient has undergone surgical resection and adjuvant chemoradiation therapy, and is currently alive without disease recurrence.
World Journal of Gastroenterology 10/2009; 15(33):4212-4. · 2.47 Impact Factor
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ABSTRACT: Fetal midgut volvulus is quite rare, and most cases are associated with abnormalities of intestinal rotation or fixation. We report a case of midgut volvulus without malrotation, associated with a meconium pellet, during the gestation period. This 2.79 kg, 33-wk infant was born via a spontaneous vaginal delivery caused by preterm labor. Prenatal ultrasound showed dilated bowel loops with the appearance of a 'coffee bean sign'. This patient had an unusual presentation with a distended abdomen showing skin discoloration. An emergency laparotomy revealed a midgut volvulus and a twisted small bowel, caused by complicated meconium ileus. Such nonspecific prenatal radiological signs and a low index of suspicion of a volvulus during gestation might delay appropriate surgical management and result in ischemic necrosis of the bowel. Preterm labor, specific prenatal sonographic findings (for example, the coffee bean sign) and bluish discoloration of the abdominal wall could suggest intrauterine midgut volvulus requiring prompt surgical intervention.
World Journal of Gastroenterology 04/2008; 14(9):1456-8. · 2.47 Impact Factor
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ABSTRACT: Expression of hTERT has been recognized an important factor in cellular aging and immortalization. Therefore, to analyze regulatory mechanism of hTERT expression, we investigated the CpG methylation pattern of the hTERT promoter as an epigenetic mechanism and its implication in transcriptional regulation of hTERT using tissues of colorectal carcinoma. As a result, we were able to observe an increased pattern of hTERT expression according to the malignant progression of colorectal carcinoma. Additionally, we could find that hTERT expression was induced when the P1 and P2 region of hTERT were sufficiently hypermethylated and, oppositely, the G1 region of hTERT was hypomethylated. Importantly, we could find three specific CpG sites (7th CpG of P2 and 11th and 2nd-10th CpGs of P1) closely related with the increasing of hTERT expression. These findings may provide important clues to deducing the expression mechanisms of hTERT.
Biochemical and Biophysical Research Communications 10/2007; 361(3):615-20. · 2.48 Impact Factor
