Small bowel obstruction caused by cryptorchidism in an adult

Small bowel obstruction (SBO) is a common complication after abdominal surgery, and can occur due to many reasons. However, cryptorchidism can cause SBO in patients with no history of abdominal surgery. We report the case of a 67-year-old man with SBO caused by adhesions between an undescended testis and the terminal ileum.ope

Ossiculoplasty in Difficulty：A Method to Improve Stability of TORP

Background and Objectives：Primary goals of surgery for chronic ear disease are infection control and hearing restoration. When performing ossiculoplasty with total ossicular replacement prosthesis (TORP), it is difficult to keep the prosthesis stable. We intended to establish a method for stabilizing TORP in ossiculoplasty and to evaluate the results of the procedure. Subjects and Method：Thirty nine cases of ossiculoplasty performed between January 2000 and February 2003 were analyzed. The follow-up period was from 6 to 31 months (mean 13.1). The pure tone average threshold of the frequencies of 0.5, 1, 2, 3 kHz was used to evaluate results. The degree of hearing improvement, previous mastoid operation method, disease, and extrusion rate of prosthesis were analyzed. To stabilize the TORP, we made a hole in the tragal cartilage and put the shaft of the prosthesis into the hole. Results：A successful hearing gain was defined as a postoperative air-bone gap of ≤ 20 dB. According to this criteria, the success rate was 43.6%. Averages of pre and postoperative air conduction were 57.6 dB and 47.1 dB, respectively. The degree of hearing improvement according to the types of mastoid surgery were 48.1% and 33.3% for intact canal wall mastoidectomy and open cavity mastoidectomy, respectively. Four patients underwent reoperation. The findings were 2 cases of short TORP and 2 cases of empty middle ear space, but prostheses were stable in each case. There was one case of extruded prosthesis (2.6%). Conclusion：With our method, TORP was kept stable in the oval window niche. However, for hearing improvement, other factors such as middle ear mucosa status or Eustachian tube function are important and further investigation is needed.ope

The Effectiveness of the Directive Counseling in Tinnitus Retraining Therapy

Background and Objectives：Tinnitus retraining therapy (TRT) was introduced as a new method for tinnitus management, and it is currently an efficacious therapy in use. In this article, we would like to show the effectiveness of directive counseling in TRT on tinnitus management. Materials and Method：A total of 1,100 patients who visited tinnitus clinic at the Severance Hospital from 1999 to 2002 were included in this study. Their characteristics and negative associations of tinnitus were investigated. Forty-six patients who were managed with directive counseling were evaluated with questionnaires about the psychoacoustic characteristics of tinnitus and the subjective changes in tinnitus. Results：Tinnitus was developed after stress (35.6%), fatigue (32.0%) and exposure to noise (21.4%), and it was negatively associated with hearing loss (51.8%), continuation of tinnitus (51.6%) and sleep disorder (17.5%). Factors such as awareness, loudness, annoyance, the effect on life tinnitus had were decreased after directive counseling. And the tinnitus handicap inventory (THI) score was also significantly decreased. Conclusion：Directive counseling in TRT which includes explanation of neurophysiology of tinnitus should be tried preferentially before habituation occurs.ope

The clinical features and optimal treatment of anorectal malignant melanoma

Anorectal malignant melanoma (AMM) is a very rare and aggressive disease. The purpose of this article is to review the clinical features of AMM, to understand treatment options, and optimal therapy by reviewing pertinent literature. Traditionally an abdominoperineal resection (APR) sacrificing the anal sphincter has been performed for radical resection of cancer, but recently, wide excision of AMM is attempted since quality of life after surgery is an important issue. Some authors reported that there was no difference in five-year survival between the patient who underwent an APR and wide excision. The goal of both APR and wide excision was to improve survival with R0 resection. Adjuvant chemoradiation therapy can be performed to achieve an R0 resection. AMM shows very poor prognosis. At this time, research on AMM is insufficient to suggest a treatment guideline. Thus, treatment options, and a therapeutic method should be selected carefully.ope

Perianal Paget's Disease

The incidence of extramammary Paget's disease (EMPD) is very low. An 84-year-old Korean man was treated with topical and oral medications at a local dermatologic clinic for a year, but the symptoms did not improve. He visited Severance Hospital and underwent a perianal skin biopsy and was finally diagnosed with EMPD. The authors performed a wide local excision according to a 1-cm margin around the lesion. For the skin and the soft tissue defects, bilateral inferior gluteal artery perforator flap transpositions were performed. The size of the lesion was 14 cm(2) × 9 cm(2), and the lateral and the basal margins were all disease free.ope

Is the learning curve of robotic low anterior resection shorter than laparoscopic low anterior resection for rectal cancer?: a comparative analysis of clinicopathologic outcomes between robotic and laparoscopic surgeries.

As robotic surgery was developed with ergonomic designs, there are expectations that the technical advantages of robotic surgery can shorten the learning curve. However, there is no comparative study, so far, to evaluate the learning curve between robotic and laparoscopic rectal cancer surgeries. Therefore, the aim of this study is to compare the learning curve of robotic low anterior resection (LAR) with laparoscopic LAR for rectal cancer.Patients who underwent robotic or laparoscopic LAR by a single surgeon were compared retrospectively (robot n = 89 vs laparoscopy n = 89). Cumulative sum (CUSUM) was used to evaluate the learning curve. The patients were divided into phase 1 (initial learning curve period) and phase 2 (post-learning curve period). The perioperative clinicopathologic characteristics were compared by phases and surgical procedures.According to CUSUM, the learning curve of robotic LAR was the 44th case and laparoscopic LAR was the 41st case. The learning phases were divided as follows: phase 1 (cases 1-41) versus phase 2 (cases 42-89) in the laparoscopic group, and phase 1 (cases 1-44) versus phase 2 (cases 45-89) in the robotic group. Comparison between phase 1 and phase 2 in each type of surgery showed no significant difference for the perioperative outcomes. Comparison between robotic and laparoscopic surgeries in each phase showed similar perioperative results. Pathologic outcomes were not significantly different in both procedures and phases.The learning curve of robotic LAR for rectal cancer was similar to laparoscopic LAR, and the clinicopathologic outcomes were similar in both the procedures.ope

Cost-effectiveness of robotic surgery for rectal cancer focusing on short-term outcomes: a propensity score-matching analysis

Although the total cost of robotic surgery (RS) is known to be higher than that of laparoscopic surgery (LS), the cost-effectiveness of RS has not yet been verified. The aim of the study is to clarify the cost-effectiveness of RS compared with LS for rectal cancer.From January 2007 through December 2011, 311 and 560 patients underwent totally RS and conventional LS for rectal cancer, respectively. A propensity score-matching analysis was performed with a ratio of 1:1 to reduce the possibility of selection bias. Costs and perioperative short-term outcomes in both the groups were compared. Additional costs due to readmission were also analyzed.The characteristics of the patients were not different between the 2 groups. Most perioperative outcomes were not different between the groups except for the operation time. Complications within 30 days of surgery were not significantly different. Total hospital charges and patients' bill were higher in RS than in LS. The total hospital charges for patients who recovered with or without complications were higher in RS than in LS, although their short-term outcomes were similar. In patients with complications, the postoperative course after RS appeared to be milder than that of LS. Total hospital charges for patients who were readmitted due to complications were similar between the groups.RS showed similar short-term outcomes with higher costs than LS. Therefore, cost-effectiveness focusing on short-term perioperative outcomes of RS was not demonstrated.ope

Comparative study of oncologic outcomes for laparoscopic vs. open surgery in transverse colon cancer

PURPOSE: Laparoscopic resection for transverse colon cancer is a technically challenging procedure that has been excluded from various large randomized controlled trials of which the long-term outcomes still need to be verified. The purpose of this study was to evaluate long-term oncologic outcomes for transverse colon cancer patients undergoing laparoscopic colectomy (LAC) or open colectomy (OC). METHODS: This retrospective review included patients with transverse colon cancer who received a colectomy between January 2006 and December 2010. Short-term and five-year oncologic outcomes were compared between these groups. RESULTS: A total of 131 patients were analyzed in the final study (LAC, 84 patients; OC, 47 patients). There were no significant differences in age, gender, body mass index, tumor location, operative procedure, or blood loss between groups, but the mean operative time in LAC was significantly longer (LAC, 246.8 minutes vs. OC, 213.8 minutes; P = 0.03). Hospital stay was much shorter for LAC than OC (9.1 days vs. 14.5 days, P < 0.01). Postoperative complication rates were not statistically different between the two groups. In terms of long-term oncologic data, the 5-year disease-free survival and overall survival were not statistically different between both groups, and subgroup analysis according to cancer stage also revealed no differences. CONCLUSION: LAC for transverse colon cancer is feasible and safe with comparable short- and long-term outcomes.ope

대장암에서 항암 바이러스의 면역 미세환경 변화 기전에 대한 연구

의학과Immunotherapy for malignancy, which stimulates the patients’ own immune system to treat cancers with low toxicity, has been effective for MSI-high colorectal cancer. MSI-high diseases are less than 10% of overall colorectal cancer. Recent studies concentrate on synergizing the effect of immune checkpoint inhibitor by combination. Among them is an oncolytic virus. Tumor volumes after local injection of Oncolytic virus (OV) with anti-PD1 antibody decreased compared with OV alone or anti-PD1 antibody alone. Moreover, CD4+ T lymphocyte infiltration markedly increased as well as CD8+T lymphocyte infiltration when combination of OV and anti-PD1 antibody applied. OV can immunomodulate as well as replicate and kill the cancer cell. The combination of OV and anti-PD1 antibody can benefit for patients with tumors that are resistant to other therapies.open박