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What is the pancreatic duct size limit for a safe duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy? A retrospective study

  • Kit-Fai Lee;Kandy Kam Cheung Wong;Eugene Yee Juen Lo;Janet Wui Cheung Kung;Hon-Ting Lok;Charing Ching Ning Chong;John Wong;Paul Bo San Lai;Kelvin Kwok Chai Ng
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.26 no.1
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    • pp.84-90
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    • 2022
  • Backgrounds/Aims: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) remains a dreadful complication. Duct-to-mucosa pancreaticojejunostomy (DTMPJ) is a commonly performed anastomosis after PD. This study aims to evaluate whether there is a size limit of pancreatic duct below which POPF rate increases significantly after DTMPJ. Methods: A retrospective study was performed from a database with prospectively collected data on consecutive patients undergoing DTMPJ. Results: Between the years 2003 and 2019, a total of 288 patients with DTMPJ were recruited. POPF occurred in 56.3% of the patients, of which 43.8% were biochemical leak, 8.7% were grade B, and 1.4% were grade C. Overall operative morbidity was 51.4%, of which 19.1% were major complications. Five patients (1.7%) died within 90 days of operation. Patients with grade B/C POPF had significantly soft pancreas (p < 0.001), smaller duct size (p = 0.031), and a diagnosis of carcinoma of the pancreas (p = 0.027). When a clinically significant POPF rate was analysed based on the pancreatic duct diameter, pancreatic duct size ≤ 1 mm had the highest POPF rate (35.7%). There was a significant difference in POPF rate between adjacent ductal diameter ≤ 1 mm and > 1 mm to 2 mm (35.7% vs 13.3%; p = 0.040). Multivariable analysis showed that for the soft pancreas, pancreatic duct diameter ≤ 1 mm was the only significant predictive factor for POPF (p = 0.027). Conclusions: DTMPJ can be safely performed for pancreatic duct > 1 mm without significantly increased POPF risk.

The Characteristics of Heavy Metal Accumulations in Feral Pigeon (Columba livia) Feathers for Environmental Monitoring (환경모니터링을 위한 집비둘기 깃털의 중금속 축적특성 연구)

  • Lee, Jangho;Lee, Jongchun;Lee, Sang Hee;Kim, Myungjin;Lee, Eugene;Han, Areum;Shim, Kyuyoung
    • Journal of Environmental Impact Assessment
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    • v.23 no.6
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    • pp.492-504
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    • 2014
  • Feral pigeon (Columba livia) has been known as a good indicator for accumulations of chemical pollutants in urban areas. However, it is against the animal rights to kill the indicator species in order to monitor pollutants accumulations in wild birds. Eggs and feathers of birds, therefore, have been used as non-invasive monitoring materials. Even though eggs are a good indicator for accumulations of lipophilic pollutants, but unsuitable for some heavy metals such as lead and cadmium because bird's ovary builds a sort of barrier to inhibit higher accumulations of some heavy metals in the eggs. Therefore, feathers instead of eggs have been used as a non-invasive indicator for accumulations of heavy metals. However, there are few studies of heavy metal accumulations of feral pigeon in Korea. In this study, we characterized the characteristics of heavy metal accumulations of feathers in relation to internal organs (bloods, viscera and bones) in feral pigeons between two sites (Hangang Park representing urban area and Hampyeong Park for rural area). The samples from the Hangang Park showed significantly higher lead (Pb) concentrations in the blood, liver and bone than those from Hampyeong Park. The Pb concentration in the feathers was also significantly higher at Hangang Park than at Hampyeong Park. The analytical result for the breast, wing and tail feathers, and the internal organs (blood, lung, liver, kidney and bone) indicated that the Pb concentrations in the feathers were significantly positively correlated with the levels in the kidney and bone. Overall, feathers of feral pigeon may be candidate for bioindicator to monitor for Pb accumulations in urban areas.

The Characteristics of Heavy Metal Distributions in the Tissues of Feral Pigeon (Columba livia) as a Bio-monitoring Indicator (환경오염 지표종인 집비둘기의 생체조직 내 중금속 분포 특성)

  • Lee, Jangho;Lee, Jongchun;Park, Jong-Hyouk;Lee, Eugene;Shim, Kyuyoung;Jang, Heeyeon;Kim, Myungjin
    • Journal of Environmental Impact Assessment
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    • v.25 no.6
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    • pp.502-513
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    • 2016
  • In this study, heavy metal distributions in the tissues of feral pigeon (Columba livia) were characterized using samples collected from bio-monitoring sites (Hangang Park and Hampyeong Park) of the NESB (National Environmental Specimen Bank), Korea, in order to evaluate the feasibility of feral pigeons as an indicator for the environmental monitoring. Cadmium (Cd) was analyzed to be accumulated in kidneys at higher concentration than in the other tissues. Such trend can also be found in the reviews on the Cd accumulations of the 34 cases including 17 avian species which showed that 31 cases had the highest Cd concentrations in the kidney among tissues. However, lead (Pb) was found to be richest in the bones in this study. 17 cases out of 30 reviewed cases had the highest Pb concentration in bones, whereas other 10 cases showed the highest concentration in kidneys, and 3 cases in livers. Therefore, kidneys together with bones can be a main target organ to test cadmium exposure to different habitat environments depending on physiological traits of birds. Zinc (Zn) was found to be the highest concentration in the pigeon livers of Hangang Park, but not in the bones. In contrast, the 13 cases of 16 reviewed cases had the highest Zn concentration in bones, and the 3 cases in livers. In addition, the heavy metal distribution patterns in relations to the metal accumulation mechanisms (a competition between Pb and Ca, a function of methallothionein protein, and etc.) were discussed.

Clinical Comparison of Two Types of Hook Plate in Surgical Treatment of Acromioclavicular Dislocation - AO Hook Plate and Wolter Plate - (견봉 쇄골 관절 탈구의 수술적 치료에서 두 가지 갈고리 금속판의 임상적 비교 - AO Hook Plate와 Wolter Plate -)

  • Choi, Jea-Yeol;Kim, Eugene;Jeong, Haw-Jae;Ahn, Jin Whan;Shin, Hun-Kyu;Park, Se-Jin;Lee, Seung-Hee;Lee, Jae-Wook;Choi, Kyu-Bo
    • Clinics in Shoulder and Elbow
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    • v.15 no.2
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    • pp.123-129
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    • 2012
  • Objective: To evaluate if acromial locking in hook plate is necessary for surgical treatment of acromioclavicular dislocation by compare Wolter plate and AO hook plate. Methods: Seventy one patients who have Rockwood type III to V acromioclavicular joint dislocation treated with AO hook plate and Wolter plate were involved. Among them, 39 patients were treated with Wolter hook plate and 32 patients with AO hook plate. The Constant-Murley score and the range of motion of shoulder joint were measured on postoperative 1st ,$3^{rd}$, $6^{th}$ and $12^{th}$ months, and the radiological complications involving plate and bone were investigated. Results: Constant-Murley score of postoperative one year were $83.2{\pm}6.8$ in AO hook plate group and $85.2{\pm}5.3$ in Wolter plate group without statistical difference (p<0.05). Faster recover of forward elevation and external rotation were examined in Wolter plate group at first and third months after surgery than those of AO hook plate group, but there were no significant difference between after six months or later after surgery. Four cases of loosen or broken screws and one case of pull-out of plate were found in Wolter plate group. Seven cases of subacromial bony erosion and one periprosthetic fracture were found in AO hook plate group. Conclusion: Although clinical outcomes of both two methods were same, no matter if acromial locking system was or not. More radiological complication of plate and bone were found in AO hook plate than that of Wolter plate. However also had disadvantage like larger incision during surgery.

The Clinical Characteristics of Endobronchial Anthracofibrotic Pigmentation (기관지 탄분 섬유화증의 임상양상)

  • Lim, Dongmee;Son, Jiwoong;Choi, Eugene
    • Tuberculosis and Respiratory Diseases
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    • v.60 no.3
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    • pp.337-341
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    • 2006
  • Objectives : Endobronchial anthracofibrotic pigmentation, which presents as dark black or brown pigmentation mucosal changes of multiple bronchi combined with bronchial fibrosis and obstruction, is not a rare finding when performing diagnostic bronchoscopy for Koreans. This study was performed to define the clinical characteristics and to determine the association of these finding with the Korean life style and such other diseases as coal workers, pneumoconiosis or tuberculosis in the patients with anthracofibrotic pigmentation. Methods : This retrospective analysis was conducted on 70 (5.2%) patients with endobronchial anthracofibrotic pigmentation, among a total of 1340 patients who underwent bronchoscopy. The distinctive clinical features, the personal life style, the past medical history, the histology and microbiology, the radiologic finding and the natures of the bronchoscopic lesions were analyzed. Results : This mean age of the patients with anthracofibrotic pigmentation was $60.6{\pm}9.2$ year old and the male to female ratio was 1:1.7. The common respiratory symptoms of these patients were coughing and sputum (81%, 57/70), and this was followed in order by dyspnea and hemoptysisir. The symptoms were not related with smoking and an occupational history such as being a coal worker and so on. Pneumonia was most common finding on the radiologic studies. On bronchoscopy, the right middle lobe bronchus was most commonly involved. The most common associated disease was tuberculosis, and 40 cases (57.1%) were diagnosed by AFB staining, TB PCR, bronchoscopic guided tissue biopsy and a past history of tuberculosis. Other diseases related with anthracotic pigmentation were hypertension, diabetes, COPD, lung cancer, pneumoconiosis and asthma. Conclusion : These results suggest that endobronchial anthracofibrotic pigmentation was mostly related with pulmonary tuberculosis rather than with coal- related disease. Endobronchial anthracofibrotic pigmentation was more prevalent in older age females in Korea.

Manufacturing process and food safety analysis of sous-vide production for small and medium sized manufacturing companies: Focusing on the Korean HMR market (중소규모 생산업체의 수비드 제품 생산을 위한 공정 및 안전성 분석: 한국 HMR 시장 중심으로)

  • Choi, Eugene;Shin, Weon Sun
    • Korean Journal of Food Science and Technology
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    • v.52 no.1
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    • pp.1-10
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    • 2020
  • The present study identified the restrictions on the use of sous-vide products in the Korean HMR market for small and medium-sized manufacturing companies. A detailed literature review revealed that the HMR market in Korea is close to saturation. Notably, the technologically advanced products produced using sous-vide seem to display significant potential to overcome market saturation. The sous-vide method differs from conventional cooking techniques and is characterized by maintenance of food texture along with flavor enhancement. However, due to the unfamiliarity of the manufacturers with this method and the unclear food safety regulations, mass food manufacturing companies do not agree on using this method; hence, sous-vide production is usually undertaken by small/medium sized companies catering primarily through online marketing portals. This study highlights the various restrictions to the implementation of sous-vide production, and discusses several practical implications of sous-vide production that would help users of this technique enter the HMR market.

Evaluation of the Measurement Uncertainty from the Standard Operating Procedures(SOP) of the National Environmental Specimen Bank (국가환경시료은행 생태계 대표시료의 채취 및 분석 표준운영절차에 대한 단계별 측정불확도 평가 연구)

  • Lee, Jongchun;Lee, Jangho;Park, Jong-Hyouk;Lee, Eugene;Shim, Kyuyoung;Kim, Taekyu;Han, Areum;Kim, Myungjin
    • Journal of Environmental Impact Assessment
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    • v.24 no.6
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    • pp.607-618
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    • 2015
  • Five years have passed since the first set of environmental samples was taken in 2011 to represent various ecosystems which would help future generations lead back to the past environment. Those samples have been preserved cryogenically in the National Environmental Specimen Bank(NESB) at the National Institute of Environmental Research. Even though there is a strict regulation (SOP, standard operating procedure) that rules over the whole sampling procedure to ensure each sample to represent the sampling area, it has not been put to the test for the validation. The question needs to be answered to clear any doubts on the representativeness and the quality of the samples. In order to address the question and ensure the sampling practice set in the SOP, many steps to the measurement of the sample, that is, from sampling in the field and the chemical analysis in the lab are broken down to evaluate the uncertainty at each level. Of the 8 species currently taken for the cryogenic preservation in the NESB, pine tree samples from two different sites were selected for this study. Duplicate samples were taken from each site according to the sampling protocol followed by the duplicate analyses which were carried out for each discrete sample. The uncertainties were evaluated by Robust ANOVA; two levels of uncertainty, one is the uncertainty from the sampling practice, and the other from the analytical process, were then compiled to give the measurement uncertainty on a measured concentration of the measurand. As a result, it was confirmed that it is the sampling practice not the analytical process that accounts for the most of the measurement uncertainty. Based on the top-down approach for the measurement uncertainty, the efficient way to ensure the representativeness of the sample was to increase the quantity of each discrete sample for the making of a composite sample, than to increase the number of the discrete samples across the site. Furthermore, the cost-effective approach to enhance the confidence level on the measurement can be expected from the efforts to lower the sampling uncertainty, not the analytical uncertainty. To test the representativeness of a composite sample of a sampling area, the variance within the site should be less than the difference from duplicate sampling. For that, a criterion, ${i.e.s^2}_{geochem}$(across the site variance) <${s^2}_{samp}$(variance at the sampling location) was proposed. In light of the criterion, the two representative samples for the two study areas passed the requirement. In contrast, whenever the variance of among the sampling locations (i.e. across the site) is larger than the sampling variance, more sampling increments need to be added within the sampling area until the requirement for the representativeness is achieved.

The Characteristics of Heavy Metal Accumulations in Feral Pigeon (Columba livia) Eggshells for Environmental Monitoring (환경모니터링을 위한 집비둘기 알 껍데기의 중금속 축적특성 연구)

  • Lee, Jangho;Lee, Jongchun;Park, Jong-Hyouk;Lee, Eugene;Shim, Kyuyoung;Kim, Myungjin;Shin, Youngkyu
    • Journal of Environmental Impact Assessment
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    • v.24 no.6
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    • pp.561-577
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    • 2015
  • The heavy metal accumulations of avian eggshells were studied in order to test a feral pigeon (Columba livia)'s eggshell as an indicator for the environmental monitoring of pollutants. The reviews on the eggs of the different 19 avian species showed that it is the eggshell rather than the egg content that can better reflect the heavy metals in the environment; in most cases the CVs (coefficients of variations) of the heavy metal concentrations in the eggshells were higher than those in the egg contents. This can indicate that the heavy metal accumulations are homeostatically controlled in the egg contents, but the accumulations in the eggshells are varied according to the environmental conditions. To test the reviews, the feral pigeon eggs from the two different sites, one representing urban and the other rural environment, were analyzed for lead (Pb) and cadmium (Cd). The result showed that the eggshells of the urban pigeons (Hangang) had the higher metal concentrations than those of the rural pigeons (Hampyeong). The same difference can also be found in the internal organs (liver, bone) and blood. However, the analyses of the egg contents between the two sites did not reveal the differences. In other words, the result suggests that the feral pigeons, like the other avian species, are able to control the heavy metals into the egg contents homeostatically. Therefore, it is more useful to use the feral pigeon eggshell rather than the egg content in case of monitoring heavy metals in different habitats.

Identification of DNA Methylation Markers for NSCLC Using Hpall-Mspl Methylation Microarray (Hpall-Mspl Methylation Microarray를 이용한 비소세포폐암의 DNA Methylation Marker 발굴)

  • Kwon, Mi Hye;Lee, Go Eun;Kwon, Sun Jung;Choi, Eugene;Na, Moon Jun;Cho, Hyun Min;Kim, Young Jin;Sul, Hye Jung;Cho, Young Jun;Son, Ji Woong
    • Tuberculosis and Respiratory Diseases
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    • v.65 no.6
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    • pp.495-503
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    • 2008
  • Background: Epigenetic alterations in certain genes are now known as at least important as genetic mutation in pathogenesis of cancer. Especially abnormal hypermethylation in or near promoter region of tumor suppressor genes (TSGs) are known to result in gene silencing and loss of gene function eventually. The authors tried to search for new lung cancer-specific TSGs which have CpG islands and HpaII sites, and are thought to be involved in carcinogenesis by epigenetic mechanism. Methods: Tumor tissue and corresponding adjacent normal tissue were obtained from 10 patients who diagnosed with non small cell lung cancer (NSCLC) and underwent surgery in Konyang university hospital in 2005. Methylation profiles of promoter region of 21 genes in tumor tissue & non-tumor tissue were examined with HpaII-MspI methylation microarray (Methyl-Scan DNA chip$^{(R)}$, Genomic tree, Inc, South Korea). The rates of hypermethylation were compared in tumor and non-tumor group, and as a normal control, we obtained lung tissue from two young patients with pneumothorax during bullectomies, methylation profiles were examined in the same way. Results: Among the 21 genes, 10 genes were commonly methylated in tumor, non-tumor, and control group. The 6 genes of APC, AR, RAR-b, HTR1B, EPHA3, and CFTR, among the rest of 11 genes were not methylated in control, and more frequently hypermethylated in tumor tissue than non-tumor tissue. Conclusion: In the present study, HTR1B, EPHA3, and CFTR are suggested as possible novel TSGs of NSCLC by epigenetic mechanism.

The Secondary Contiguous or Non-contiguous Subchondral Bone Impactions in Subaxial Cervical Spinal Injury: Incidence and Associated Primary Injury Patterns (축추이하 경추 손상에서 이차적으로 발생하는 연속적, 비연속적 연골하골 압박손상의 빈도와 원발부위 손상 패턴)

  • Han, Jun Gu;Kim, Yeo Ju;Yoon, Seung Hwan;Cho, Kyu Jung;Kim, Eugene;Kang, Young-Hye;Lee, Ha Young;Cho, Soon Gu;Kim, Mi Young
    • Investigative Magnetic Resonance Imaging
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    • v.18 no.3
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    • pp.232-243
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    • 2014
  • Purpose : To evaluate the incidence of secondary contiguous or non-contiguous subchondral bone impactions (SBI) in subaxial cervical spinal injury and associated primary injury patterns. Materials and Methods: A retrospective review of computed tomography, magnetic resonance imaging, and medical records was carried out for 47 patients who had sustained a subaxial cervical spinal injury. Presence, number, level, and sites of secondary contiguous or non-contiguous SBI were recorded. To evaluate primary injury patterns, the level and number of primary injury sites of subaxial cervical spine injury, injury morphology, anterior/posterior discoligamentous complex (ADC/PDC) injury, posterior ligamentous complex (PLC) injury, spinal cord injury, and mechanism of injury (MOI) were analyzed. Differences in primary injury pattern of subaxial cervical spine injury and MOI between patients with and without SBI, and between contiguous or non-contiguous SBI were analyzed using the Mann-Whitney U test, Pearson's chi square test and Fisher's exact test. Results: Eighteen patients (18/47, 38.29%) had developed contiguous (n=9) or non-contiguous (n=9) SBI, most commonly involving T3 (15/47, 31.91%) and 3 levels (6/18, 33.33%). All SBIs had developed near the anterosuperior region of the body and the superior endplate and were the result of a high-impact MOI. SBIs were statistically significant in association with injury morphology and PLC injury (P=0.001, P=0.009, respectively) at the primary injury site. Non-contiguous SBI was more frequently accompanied by upper cervical spinal injuries in association with PDC injuries, as opposed to contiguous SBI, with statistical significance (P=0.009), while no other statistically significant differences were found. Conclusion: Secondary SBIs are common and probably associated with subaxial cervical spinal injuries with high energy compressive flexion forces.