Malignant Cologastric Fistula: Report of three cases

Malignant cologastric fistulas are relatively rare. The fistulas probably result from the contiguous growth of a tumor or tumors as they permeate and penetrate all layers of the adjacent viscus and because of the behavior characteristics of mucinoid tumor types under going avascular necrosis aided by digestion of gastric juices. An almost constant finding in cases of cologastric fistulas originating from the colon cancer is that the tumors are bulky, infiltrating, and associated with a marked inflammatory reaction. Formation of the fistulous communications depend on the anatomic locations of the primary tumor. We experienced three cases of malignant cologastric fistulas recently, and we report these three cases.

Xanthogranulomatous Cholecystitis in a Patient with Hemophilia A: A case report

Xanthogranulomatous cholecystitis (XGC) is an uncommon, focal or diffuse destructive inflammatory process of the gallbladder that is assumed to be a variant of chronic cholecystitis. XGC is characterized grossly by irregular thickening of the gallbladder wall with the formation of a yellow mass (xanthogranuloma). Histologically the xanthogranuloma appears as yellow nodules or streaks in a thickened gallbladder wall and is composed of predominantly lipid-laden macrophages, inflammatory cells, and fibroblasts. These xanthogranulomatous foci may extend into adjacent structures, adhesions or ulcerations are often present, and fistula formation may occur. Although the pathogenesis of XGC is unclear, recurrent inflammation in the presence of calculi and biliary stasis are thought to be the main etiological factors because of the histologic evidence of chronic inflammation and the presence of gallstones in a majority of cases. XGC may lead to associated complications such as perforation, abscess, and fistula, and sometimes closely mimics a gallbladder carcinoma. During an operation for XGC, careful surgical technique is required to dissect the gallbladder and to excise the adjacent xanthogranulomatous tissue. Also a careful investigation to find the coincident gallbladder carcinoma is necessary. We report a case with XGC in a hemophilia A patient and a review of the clinical literatures.

Abdominal Aortic Reconstruction Using PTFE(Polytetrafluoroethylene)

Fifty cases of abdominal aortic reconstruction using PTFE were performed between january 1991 and february 1998 at the Department of Surgery, Chonnam University Hospital. The thirty-five of 50 cases were abdominal aortic aneurysm and the other 15 cases were aortoiliac occlusive disease. Patients were analysed on the basis of sex, age, associated disease, size of aneurysm, operative method, mortality, and cause of death. There were 43 men and 7 women and the mean age was 64.9 years. Hypertension in 24 cases is the most common associated disease, following by ischemic heart disease in 5 cases, COPD in 5 cases. Aorto-bifemoral bypass graft using PTFE was done in 17 cases and aorto-biiliac bypass in 33 cases. The most common complication following surgery was graft occlusion in 6 cases, and other complications were prosthetic infection, postoperative bleeding and ischemic colitis. The cases of death were hypovolemic shock (2), acute renal failure (1), and sepsis (1). There was no evidence of PTFE oriented prosthetic graft complications.