Seong-Pyo Mun

Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients

Purpose Extremely elderly patients who present with complicated gallstone disease are less likely to undergo definitive treatment. The use of laparoscopic cholecystectomy (LC) in older patients is complicated by comorbid conditions that are concomitant with advanced age and may increase postoperative complications and the frequency of conversion to open surgery. We aimed to evaluate the results of LC in patients (older than 80 years). Methods We retrospectively analyzed 302 patients who underwent LC for acute cholecystitis between January 2011 and December 2013. Total patients were divided into three groups: group 1 patients were younger than 65 years, group 2 patients were between 65 and 79 years, and group 3 patients were older than 80 years. Patient characteristics were compared between the different groups. Results The conversion rate was significantly higher in group 3 compared to that in the other groups. Hematoma in gallbladder fossa and intraoperative bleeding were higher in group 3, the difference was not significant. Wound infection was not different between the three groups. Operating time and postoperative hospital stay were significantly higher in group 3 compared to those in the other groups. There was no reported bile leakage and operative mortality. Preoperative percutaneous transhepatic gallbladder drainage and endoscopic retrograde cholangiopancreatography were performed more frequently in group 3 than in the other groups. Conclusion LC is safe and feasible. It should be the gold-standard approach for extremely elderly patients with acute cholecystitis.

The safety and efficacy of percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis before laparoscopic cholecystectomy

Purpose Laparoscopic cholecystectomy (LC) is the standard management for acute cholecystitis. Percutaneous transhepatic gallbladder drainage (PTGBD) may be an alternative interim strategy before surgery in elderly patients with comorbidities. This study was designed to evaluate the safety and efficacy of PTGBD for elderly patients (>60 years) with acute cholecystitis. Methods We reviewed consecutive patients diagnosed with acute cholecystitis between January 2009 and December 2013. Group I included patients who underwent PTGBD, and patients of group II did not undergo PTGBD before LC. Results All 116 patients (72.7 ± 7.1 years) were analyzed. The preoperative details of group I (n = 39) and group II (n = 77) were not significantly different. There was no significant difference in operative time (P = 0.057) and intraoperative estimated blood loss (P = 0.291). The rate of conversion to open operation of group I was significantly lower than that of group II (12.8% vs. 32.5%, P < 0.050). No significant difference of postoperative morbidity was found between the two groups (25.6% vs. 26.0%, P = 0.969). In addition, perioperative mortality was not significantly different. Preoperative hospital stay of group I was significantly longer than that of group II (10.3 ± 5.7 days vs. 4.4 ± 2.8 days, P < 0.050). However, two groups were not significantly different in total hospital stay (16.3 ± 9.0 days vs. 13.4 ± 6.5 days, P = 0.074). Conclusion PTGBD is a proper preoperative management before LC for elderly patients with acute cholecystitis.

The effect of laser diode irradiation on wound healing of rat skin.

Abstract Background: Light amplification by stimulated emission of radiation (LASER) diode irradiation (LDI) has some beneficial effects on the wound healing. However, little is known about the biochemical effect of LDI on wound healing. We have performed animal study to clarify the effect of LDI on wound healing based on microscopic findings. Methods: Eight-month-old male rats (NTacSam:SD, SamtakoBioKorea), weighting 250–300 g, were used. Round blade, of 1 cm diameter, was penetrated through the skin and subcutaneous level after elevating the skin just above the thoracic spine of the rats. Laser diode of 655, 785, and 850 nm wavelengths were irradiated to the skin wound for 9 days, 20 min a day. Eight rats were used in each four groups including non-irradiated group. Immunochemical staining was carried out to evaluate pan-cytokeratin and actin, and Massons trichrome staining was carried to evaluate the cellular and protein components relating to wound healing. Wound size was measured on 9th postoperative day with computer system. Result: Collagen formation was graded as 2+, 3+, and 4 + in the order of non-radiation group, 655, 785, and 850 nm irradiation groups, respectively. Myofibroblast was formed more abundantly in LDI group than in non-irradiated group. The mean values of proliferating cell nuclear antigen (PCNA) were 67.8 ± 5.0, 84.0 ± 4.6, 78.0 ± 6.8, and 74.2 ± 4.0 nm in the order of non-radiation group, 655, 785, and 850 nm irradiation groups, respectively. Mean values of defect size were 2,840 ± 124 um, 1,689 ± 125 um, 1,254 ± 94 um, and 1,423 ± 113 in the order of non-radiation group, 65, 785, and 850 nm groups, respectively. Conclusion: LDI has beneficial effects on the formation of fibroblast and collagen, and results in better wound healing.

Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

Purpose Laparoscopic subtotal cholecystectomy (LSC) can be an alternative surgical technique for difficult cholecystectomies. Surgeons performing LSC sometimes leave the posterior wall of the gallbladder (GB) to shorten the operation time and avoid liver injury. However, leaving the inflamed posterior GB wall is a major concern. In this study, we evaluated the clinical outcomes of standard laparoscopic cholecystectomy (SLC), LSC, and LSC removing only anterior wall of the GB (LSCA). Methods We retrospectively reviewed the medical records of laparoscopic cholecystectomies performed between January 2006 to December 2015 and analyzed the outcomes of SLC, LSC, and LSCA. Results A total of 1,037 patients underwent SLC. 22 patients underwent LSC; and 27 patients underwent LSCA. The mean operating times of SLC, LSC, and LSCA were 41, 74, and 68 minutes, respectively (P < 0.01). Blood loss was 5, 45, and 33 mL (P < 0.05). The mean lengths of postoperative hospitalization were 3.4, 5.4, and 5.8 days. Complications occurred in 24 SLC patients (2.3%), 2 LSC patients (9%), and 1 LSCA patient (3.7%). There was no mortality among the LSC and LSCA patients. Conclusion LSC and LSCA are safe and feasible alternatives for difficult cholecystectomies. These procedures help surgeons avoid bile duct injury and conversion to laparotomy. LSCA has the benefits of shorter operation time and less bleeding compared to LSC.

Synchronous double primary squamous cell carcinoma and adenocarcinoma of the extrahepatic bile duct: a case report

IntroductionSynchronous double cancers of the bile duct are exceptionally rare. We here report a case of synchronous squamous cell carcinoma and adenocarcinoma of the extrahepatic bile duct.Case presentationA 67-year-old Asian man visited our clinic complaining of jaundice and dark urine. Direct hyperbilirubinemia and an elevated cancer antigen 19–9 level were detected. Preoperative abdominal computed tomography and positron emission tomography showed two masses at the bifurcation of the common hepatic duct and at the distal common bile duct. After biliary drainage, we performed radical pylorus-preserving pancreaticoduodenectomy, without resection margin involvement. Pathological findings revealed that the proximal lesion was a squamous cell carcinoma and that the distal lesion was an adenocarcinoma. Both cholangiocarcinomas were confined to the fibromuscular layer, and there was no communication between the two tumors. Multiple conglomerated metastatic tumors were detected in his liver 3 months after surgery. He died 8 months after diagnosis.ConclusionsThe disease displayed very aggressive behavior and a very poor prognosis. The only chance for long-term survival is treatment with radical resection. Preoperative positron emission tomography-computed tomography is useful in detecting occult cancer.

4-channel Light Medical Therapy Apparatus for External Injury Cure

We developed the 4channel Light Medical Therapy Apparatus for External Injury Cure using a high brightness LED. This equipment was fabricated using a micro-controller and a high brightness LED, and designed to enable us to control light irradiation time, intensity, frequency and so on, Especially, to control the light irradiation frequency, FPGA was used, and to control the change of output value, TLC5941 was used. Control stage is divided into 4 levels by program. Consequently, the current value could be controlled by the change of level in Continue Wave(CW) and the output of a high brightness LED could be controlled stage by stage. Compared with one LED irradiation, several LEDs irradiation could increase optical power.

Characteristics of Low-level Light Source for Animal Cell Proliferation

This paper performed the basic study for developing the Photodynamic Therapy Equipment for medical treatment. We developed the equipment palpating cell proliferation using a high brightness LED. This equipment was fabricated using a micro-controller and a high brightness LED, and designed to enable us to control light irradiation time, intensity, frequency and so on. Especially, to control the light irradiation frequency, FPGA was used, and to control the change of output value, TLC5941 was used. Control stage is divided into 30 levels by program. Consequently, the current value could be controlled by the change of level in Continue Wave(CW) and Pulse Width Modulation(PWM), and the output of a high brightness LED could be controlled stage by stage. And then, each experiment was performed to irradiation group and non-irradiation group for both Rat bone marrow and Rat tissue cells. MTT assay method was chosen to verify the cell increase of two groups and the effect of irradiation on cell proliferation was examined by measuring 590 nm transmittance of ELISA reader. As a result, the cell increase of Rat bone marrow and tissue cells was verified in irradiation group as compared to non-irradiation group. The fact that specific wavelength irradiation has an effect on cell vitality and proliferation is known through this study.

A Study on the Cell Culture Controller using the High Brightness LED

We developed the equipment palpating cell proliferation using a high brightness LED. This equipment was fabricated using a micro-controller and a high brightness LED, and designed to enable us to control light irradiation time, intensity, frequency and so on. Especially, to control the light irradiation frequency, FPGA was used, and to control the change of output value, TLC5941 was used. Control stage is divided into 30 levels by program. Consequently, the current value could be controlled by the change of level in Continue Wave(CW) and Pulse Width Modulation(PWM), and the output of a high brightness LED could be controlled stage by stage.