Perioperative Management without Blood Transfusion in a Patient with Massive Hemoperitoneum Who Refused a Transfusion

Although there are many controversies about clear-cut guidelines for blood transfusion, blood transfusions are critically important and essential in many emergency cases involving trauma to abdominal organs. However, occasionally there are certain situations in which blood transfusions cannot be made, despite clear indications for urgent blood transfusion based on clinical and laboratory findings. One is the case in which the patient refuses to receive a blood transfusion for reasons based on religious beliefs. We present a case of successful perioperative management without blood transfusion in a patient, a Jehovah's Witness, with a massive hemoperitoneum due to an injury caused by a motor vehicle accident.

Spontaneous Rupture of Spleen in a Patient with Malarial Infection

Malaria is a protozoan disease transmitted by the bite of infected mosquitoes. During acute and chronic malarial infection, altered splenic structure and function produce asymptomatic enlargement or com plications such as hematoma formation, rupture, hypersplenism, or cyst formation. Spontaneous splenic rupture occurs during acute infection, usually during the primary attack. However, rupture occurring in chronic malarial splenomegaly is seldom spontaneous; obvious trauma is almost always the precipitating event. Recently, conservative therapy has been applied in all cases of malarial splenic rupture. Surgical therapy should be reserved for patients with severe rupture or for those with continued or recurrent bleeding. We report the case of a recently treated 25-year-old male who had acute malaria complicated by fever and by severe abdominal pain, tenderness, and distension, a condition that may result in splenic rupture. At operation, the spleen was slightly enlarged and multiple tearing was found in the lateral surface of the capsule. A splenectomy was preformed.

Spontaneous Rupture of Spleen in a Patient with Malarial Infection

Malaria is a protozoan disease transmitted by the bite of infected mosquitoes. During acute and chronic malarial infection, altered splenic structure and function produce asymptomatic enlargement or com plications such as hematoma formation, rupture, hypersplenism, or cyst formation. Spontaneous splenic rupture occurs during acute infection, usually during the primary attack. However, rupture occurring in chronic malarial splenomegaly is seldom spontaneous; obvious trauma is almost always the precipitating event. Recently, conservative therapy has been applied in all cases of malarial splenic rupture. Surgical therapy should be reserved for patients with severe rupture or for those with continued or recurrent bleeding. We report the case of a recently treated 25-year-old male who had acute malaria complicated by fever and by severe abdominal pain, tenderness, and distension, a condition that may result in splenic rupture. At operation, the spleen was slightly enlarged and multiple tearing was found in the lateral surface of the capsule. A splenectomy was preformed.

A Clinical Analysis of 475 Cases of Colorectal Cancer

Colorectal cancer is the third most common malignant neoplasm worldwide and the fourth most common cancer in Korea. Recently, incidence of colorectal cancer is increasing steadily. Because of advances in diagnostic tools, such as colonofiberoscopy, early detection of colorectal cancers is available. The survival rates of colorectal cancer is increasing due to early detection and advances in adjuvant therapy, such as chemotherapy and radiotherapy. The clinical analysis was made on 475 patients with colorectal cancer who have been admitted and operated at the Department of Surgery, Chonnam University Hospital, from January, 1987 to December, 1996. The results were as follows: 1) The peak age group was in the sixth(29.7%) and seventh decade(29.7%) followed by the fifth decade(17.3%) of life. The male: female ratio was 1.1:1. 2) The annual incidence was increased steadily, but since 1994, plateau in incidence has occurred. 3) The most common site was the rectum(62.7%). 4) Common symptoms and signs were anal bleeding(40.1%) and abdominal pain (28.1%). According to site, anal bleeding was the most common complaint in the rectum and left sided colon and abdominal pain was in other colons and cecum. 5) The most common stage by TNM staging system was stage II (38.7%). 6) Most cases of colorectal cancer were adenocarcinoma(97.7%), well differentiated lobular adenocarcinoma(55.6%) in which was the most common histopathologic type. 7) Preoperative circulating CEA(carcinoembryonic antigen) level was checked in 396 patients(83.4%). CEA was less than 10.0 ng/ml in 295 cases(74.5%) and more than 10.0 ng/ml in 101 cases(25.6%). 8) DNA ploidy was checked in 197 cases(41.5%). There ware aneuploid in 102 cases, diploid in 95 cases. 9) Curative surgery were performed in most cases. The most common surgical procedure was low anterior resection(35.4%). 10) Postoperative complications were developed in 63 patients(13.3%). The most common complication was wound infection in 12 cases(19.0%). 11) The overall 5-year survival rate for patients with colorectal cancer was 55.9%. The difference of 5-year survival rate between diploidy and aneuploidy of DNA content was not significant statically(p=0.97). But, patients of preoperative serum CEA level over 10 ng/ml had a low survival rate compared with those under 10 ng/ml(p=0.0002). And also those of tumor size over 3 cm had a low survival rate compared with those under 3 cm(p=0.002).

Undifferentiated ( Embryonal ) Sarcoma of the Liver: A case report including immunohistochemical, electronmicroscopic and flow-cytometric study

Undifferentiated(embryonal) sarcoma of the liver developing predominantly in the late childhood is extremely rare in malignant hepatic tumors. It has been described by a variety of terms such as malignant mesenchymoma, embryonal sarcoma, fibromyxosarcoma, embryonal rhabdomyosarcoma or primary sarcoma of the liver. The tumor usually presents a huge mass containing solid and sometimes cystic components, and is cmposed of large stellate and spindle cells in an abundant myxoid matrix. The treatment of choice is surgical resection with or without adjuvant chemotherapy and/or radiotherapy, but the prognosis of this disease has been reported extremly poor. We experienced a case of undifferentiated(embryonal) sarcoma of the liver recently which was confirmed by pathological examinations in a 18-year-old boy. He visited our hospital for examination of the progressive growing RUQ abdominal mass detected incidentally. On physical examination, a firm, non-tender, hard, fixed, huge, abdominal mass was palpated in the right upper quadrant of abdomen. Abdominal ultrasonography, computerized tomography and magnetic resonance imaging showed a 10x15cm sized mass confined to the left lobe of the liver, and it was hypovascular mass on angiography. We performed left lobectomy including the tumor and it was confirmed as undifferentiated (embryonal) sarcoma of the liver by pathologic examination. We herein report this case including histologic, electronmicroscopic and flow cytometric results with the review of literatures.