Solitary Duodenal Metastasis from Breast Cancer

A 65-year-old female patient experienced melena for 10 days. Gastroduodenoscopy revealed a tumor in the duodenum, a portion of which was taken for biopsy, which showed a malignant tumor. She underwent pancreatoduodenectomy, and the final tumor pathology revealed invasive ductal carcinoma from the breast, which was confirmed using immunostaining of milk fat globule antigens. Nineteen years before, she had received a radical mastectomy due to invasive ductal carcinoma of the right breast. Hematogenous metastasis occurs in 33% of patients with breast cancer, mainly to the liver and lung, in invasive ductal carcinoma (IDC), and to the gastrointestinal tract, peritoneum, and retroperitoneum in invasive lobular carcinoma (ILC). Solitary metastatic duodenal tumors from breast cancer, especially IDC, is rare, particularly after a long time. This rare case is presented with a literature review.

Clinical Analysis of Colorectal Perforation : Focus on Unusual Causes

PURPOSE: Colorectal perforation is a rare malady, but it usually presents abdominal emergency with high morbidity and mortality. It is very difficult to diagnose stercoral, idiopathic, or steroid induced perforation because these are very rare, but they show high mortality. The aims of this study are to: 1) evaluate and compare the characteristics of stercoral, idiopathic and steroid induced perforation with other perforations; and to 2) guide the diagnostic approach and treatment of these rare colon perforations. METHODS: We retrospectively reviewed thirty five patients underwent surgery for colorectal perforation at the Department of Surgery, Daedong Hospital, from November 1996 to January 2005. Age, gender, perforation site, grade of peritonitis, methods of operation and mortality rates were compared between the various causes. Logistic regression was used to evaluate their effect on mortality. RESULTS: There were 10 cases of iatrogenic colorectal injuries (28%), 7 of steroid induced colorectal perforation (20%), 5 of stab (14%), 4 of diverticulitis (11%), 4 of stercoral (11%), 3 of idiopathic (8%), and 2 of cancer induced perforation (5%). Total mortality rate of all the cases was 28.5% (10 out of 35) but the mortality of stercoral, steroid induced and idiopathic perforation was 57% (8 out of 14). The mortality rate was higher in older age group (60 years above) (40%), stercoral (75%), steroid induced (57%) and idiopathic (33%), preoperative systemic inflammatory response (SIRS) (42%), preoperative septic shock (83%), abnormal WBC count (10,000/mm3 above or 4,000/mm3 below) (53%), left colon perforation (36%) and diffuse peritonitis (56%). The mortality rate was lower in young age group (13%), iatrogenic (10%), stab (0%), right colon perforation (10%) and localized peritonitis (5%). The peritonitis grade (Hinchey's stage) of idiopathic group, cancer and stercoral was worse (III-IV grade: 75%, 100%, 75%) than that of diverticulitis, iatrogenic and stab (III-IV grade: 25%, 30%, 40%). CONCLUSION: The stercoral, steroid induced and idiopathic colorectal perforation was rare, difficult to diagnose but it showed high mortality. The characteristics of these are an older age, presenting with a high peritonitis grade, preoperative SIRS, preoperative septic shock, and occurrence below the splenic flexure. If surgeons encounter these perforations, they should perform prompt surgical management and intensive postoperative care to reduce the mortality.

Risk Factors for the Pancreatic Leakage after Pancreaticoduodenectomy

PURPOSE: A pancreaticoduodenectomy is the procedure of choice in patients with periampullary cancers. Recently, marked improvements in both morbidity and mortality rates have been reported following a pancreaticoduodenectomy. However, leakage at the pancreaticoenteric anastomosis remains a common and serious complication following a pancreaticoduodenectomy. Various measures directed towards prevention of pancreatic leakage have been studied over the past few decades. The aim of this study was to identify the risk factors for and prevention of pancreatic leakage following a pancreaticoduodenectomy. METHODS: A retrospective review of 75 patients, which had undergone a pancreaticoduodenectomy by the same surgeon between September 1997 and October 2004, was conducted. RESULTS: Ten, 30, 19 and 3 patients were treated for pancreatic head, common bile duct, ampullary, duodenal cancers, with a further 13 treated for benign diseases. Standard and pylorus-preserving pancreaticoduodenectomies were performed in 11 (14.7%) and 64 patients (85.3%), respectively. Postoperative complications were observed in 46 cases (61.3%), with 13 (17.3%) of these developing postoperative pancreatic fistula. The operative mortality rate was 1.3% (1 case). The pancreatic fistula with no peritoneal signs (which were observed in 12 patients) healed under simple drainage, without the need for reoperation. The analysis of factors for pancreatic fistula indicated no significant differences in age, sex, symptoms and signs, combined diseases, laboratory values, preoperative biliary drainage, operative times, blood transfusion, types of pancreatic stent or pathologic diagnosis when comparing those with and without pancreatic leakage; however, the pancreatic fistula rate (29.6%) during the early period (1997 to 2000) was significantly higher (10.4%) than during the latter period (2001 to 2004). CONCLUSION: This study suggests that accumulated experience of pancreaticoduodenectomies may reduce the incidence of pancreatic fistula and contribute to the prevention of pancreaticojejunal leakage complications. The number of cases enrolled in this study was small, as well as the data having heterogeneity, resulted in a limited statistical power and ability to interpret negative results. Therefore, to further understand the risk factors that contribute to pancreatic fistula, the need for a randomized controlled study is suggested.

Presidential Address: Past, Present, and Future of Vascular Surgery (I) Control of Massive Exsanguinating Bleeding from Liver Injury in Shock (II) Management of Traumatic Pancreatic Transection (III) Traffic Injuries in Passenger Cars. -Comments on Seatbe

No abstract available.

Jejunal Interposition after Total Gastrectomy

PURPOSE: The aim of this study was to evaluate the short-term outcome of a jejunal interposition, by comparing it with a conventional Roux-en-Y gastrojejunostomy, after a total gastrectomy. MATENRIALS AND METHODS: For 28 patients (20 men and 8 women) with a gastric adenocarcinoma, who underwent an isoperistaltic simple jejunal interposition, weight, hemoglobin, hematocrit, serum protein and albumin, and cholesterol levels were checked before the operation and at 1 year and 2 years after the surgery. Also, endoscopy was performed to confirm reflux esophagitis. In this study, the data were collected between January 1993 and July 1999 at Chungnam National University Hospital, and the results were compared with those of the Roux-en-Y procedure. RESULTS: The body weights at 1 year and 2 years after the surgery had returned to 86.0% and 87.6% of the recent original body weight in the jejunal interposition (JI) group and to 90.8%, 87.0%, respectively in the Roux-en-Y (RY) group. The levels of hemoglobin (g/dl) were 13.3, 12.5, and 11.9 in the JI group, and 13.8, 12.6, and 12.1 in the RY group at the time of the operation and at 1 year, and 2 years after the surgery, respectively. The total serum protein (g/dl) levels were 7.1, 7.2, and 7.5 in the JI group and 7.1, 7.0, and 7.2 in the RY gropu at the time of the operation and at 1 year and 2 years after the surgery, respectively. The serum albumin (g/dl) levels were 4.2, 4.1, and 4.2 in the JI group and 4.2, 4.2, and 4.2 in the RY group at the time of the operation and at 1 year, and 2 years after the surgery, respectively. The total serum cholesterol (mg/dl) levels were 186.5, 174, and 164 in the JI group and 213.7, 171.1, and 141.0 in the RY group at the time of the operation and at 1 year and 2 years after the surgery, respectively. The endoscopic finding showed that reflux esophagitis occurred in 7.1% of the patients in the JI group and in 3.5% in the RY group. CONCLUSION: We think that from the view point of quality of life, a jejunal interposition, as well as a Roux-en-Y procedure, is a useful reconstruction methods for a total gastrectomy.

Roux Stasis Syndrome in Conventional Roux-en-Y Gastrojejunostomy and Uncut Roux-en-Y Gastrojejunostomy after Subtotal Gastrectomy

PURPOSE: Roux stasis syndrome is the main complication of a Roux-en-Y gastrojejunostomy. The aim of this study was to compare the occurrence rate of Roux stasis syndrome with the passing of time in a conventional Roux-en-Y gastrojejunostomy and in an uncut Roux-en-Y gastrojejunostomy. MATENRIALS AND METHODS: 50 patients (31 men and 19 women) had a conventional Roux-en-Y reconstruction and 53 patients (35 men and 18 women) had an uncut Roux-en-Y reconstruction. The Roux stasis syndrome was defined by clinical criteria only. The criteria included one of the four following conditions at the time of follow-up: chronic upper abdominal pain, postprandial fullness, persistent nausea, and intermittent vomiting that are worsened by eating. Follow-up after surgery was done in all patients at 7~12, 13~18, 19~24, 25~30, and 31~36 months. RESULTS: According to the criteria, the Roux stasis syndrome occurred in 40.0% of the patients at 7~12 months, 33.3% at 13~18 months, 35.3% at 19~24 months, 32.0% at 25~30 months, and 33.3% at 31~36 months after a conventional Roux-en-Y operation. The syndrome occurred in 22.6% of the patients at 7~12 months, 15.2% at 13~18 months, 17.1% at 19~24 months, 19.2% at 25~30 months, and 20% at 31~36 months after an uncut Roux-en-Y reconstruction. Conclusion: In terms of occurrence pattern, only a little variance existed one year after both procedures. Comparing the Roux stasis syndrome in both procedures, the uncut Roux operation had better results than the conventional Roux operation.

Huge Inflammatory Myofibroblastic Tumor Arising from the Abdominal Wall

An inflammatory myofibroblastic tumor (IMT) is a rare tumor in the abdominal cavity. A number of descriptive terms have been used to describe inflammatory tumors with myofibroblastic proliferation. The etiology and the biologic behaviors of IMTs are still unknown. Extensive pathologic examination is important to prevent misdiagnosis, and the need for long- term follow up is emphasized. Recently, we experienced a case of a huge inflammatory myofibroblastic tumor of the abdominal cavity in a young male. The patient had a painless mass in the entire abdomen. The resected specimen revealed a 15X14X12 cm3 mass involving the posterior rectus sheath, mesentery, ascending, and descending colon; and omentum. We present our experience with that along with a review of literature.

A Clinical Study of the Uncut Roux-en-Y Gastrojejunostomy Using a Short Roux Limb after Subtotal Gastrectomy

PURPOSE: The restoration of intestinal continuity following subtotal gastrectomy for gastric malignancy as well as benign gastric disease is an important area for research. The aim of this study was to compare the uncut Roux-en-Y reconstruction using a short Roux limb (20 to 30 cm) with the uncut Roux-en-Y reconstruction using a long Roux limb (more than 40 cm). METHODS: 48 patients (33 men and 15 women) underwent uncut Roux-en-Y reconstruction using a short Roux limb (short Roux limb group), and 32 patients (19 men and 13 women) had the Roux-en-Y operation using a long Roux limb (long Roux limb group). We assessed the outcome of these operations on the occurrence of Roux stasis syndrome, the endoscopic findings, and the required period for the nasogastric tube. RESULTS: Roux stasis syndrome occurred in 9 patients (18.8%) in the short Roux limb group, and in 10 patients (31.3%) in the long Roux limb group (p value 0.201). Pathological endoscopic finding were observed in 5 patients (10.4%) in the short Roux limb group, and in 6 patients (18.8%) in the long Roux limb group (p=0.292). CONCLUSION: Comparing the short Roux limb group with the long Roux limb group in uncut Roux-en-Y reconstruction after subtotal gastrectomy, We can conclude that uncut Roux-en-Yreconstruction using a short Roux limb is an effective reconstruction procedure to alleviate Roux stasis syndrome, reflux gastritis and esophagitis.

Epidermal Growth Factor Dependent Expression of Plasminogen Activator and Plasminogen Activator Inhibitor in Rat Hepatocytes in Primary Culture

PURPOSE: In order to clarify the the role of epidermal growth factor (EGF) in the regulation of plasminogen activator (PA) and plasminogen activator inhibitor (PAI) during liver regeneration, we investigated the EGF-dependent gene expression of PA and PAI-1 in rat hepatocytes in primary culture. METHODS: Hepatocytes were isolated from rats using a two step perfusion technique and cultivated in dishes precoated with rat tail collagen. DNA synthesis of the hepatocytes by EGF treatment was measured with (3)H-thymidine incorporation. Gene expression for PAI-1, uPA and tPA was examined using Northern blot hybridization analysis. RESULTS: EGF treatment increased the (3)H-thymidine incorporation of the hepatocytes up to 36 hours and normal polygonal hepatocyte morphology was achieved simultaneously. tPA and PAI-1 mRNA were detected in the control hepatocytes. With the EGF treatment, the tPA mRNA level increased with time up to 48 hours, however the PAI-1 mRNA level rapidly increased to 1 hour and then decreased quickly to the control level. On the contrary, uPA mRNA was not detected in hepatocytes with or without treatment of EGF. The EGF-dependent induction of tPA and PAI-1 mRNA was a protein synthesis independent process. CONCLUSION: These results suggest that differential expression of tPA and PAI-1 mRNA by EGF in hepatocytes may play an important role in the regulation of liver regeneration. Among PAs, tPA seemed to be more important in EGF dependent growth or regeneration of primary hepatocytes in the rat since uPA mRNA was not induced in primary hepatocyte cultures in spite of EGF treatment.

Clinical Study of the Pylorus Preserving Proximal Subtotal Gastrectomy

PURPOSE: Many clinics have abandoned the use of a proximal subtotal gastrectomy for adenocarcinomas of the stomach because of the poor survival rate, the high incidence of operative complication, and the lack of an advantage saving the antral stump. The authors performed an esophagogastrostomy after a proximal subtotal gastrectomy without pyloroplasty and evaluated the outcome of this pylorus-preserving proximal subtotal gastrectomy. METHODS: After the pylorus-preserving proximal subtotal gastrectomy in 16 patients with a gastric adenocarcinoma, the status of the esophageal and gastric mucosa was evaluated using endoscopy, and the function of the pylorus was estimated using an upper gastrointestinal series. In this clinical study, the data were collected between September 1996 and August 1999 at Chungnam National University Hospital. RESULTS: The function of the pylorus of the stomach was well preserved without any severe reflux from the duodenum. The incidences of esophagitis and gastritis were 11 out of 16 patients and 3 out of 16 patients, respectively, in this operation. Esophageal stricture developed in 5 out of 16 patients. CONCLUSION: The pylorus-preserving proximal subtotal gastrectomy (without conventional pyloroplasty) is effective in terms of preventing postoperative reflux gastritis. The emptying mechanism of the pyloric sphincter and the reservoir function of the stomach were well preserved in this study. We think that the pylorus-preserving proximal subtotal gastrectomy is one of useful methods for early adenocarcinomas of the proximal stomach. However, reflux esophagitis and stricture of the esophagogastrostomy site are common problems to be solved in the future.

Hamartoma of the Spleen

Splenic hamartomas are rare benign tumors, which are usually small in size and asymptomatic and which are discovered incidentally at surgery or autopsy. The authors report on a case of splenic hamar toma in a 35-year-old man with intermittent left upper quardrant pain, who underwent an elective splenc tomy. Final pathology confirmed diagnosis of a hamartoma of the red pulp in the spleen. The patient's symptoms were resolved after the splenectomy. A splenic hamartoma should be kept in mind in the differential diagnosis of splenic tumors. The authors suggest that a splenectomy is indicated in cases where malignancy cannot be excluded and in cases of associated clinical symptoms or hematologic disorders.

Surgical management of intrahepatic calculi / 한국간담췌외과학회지

The intrahepatic calculi are prevalent in east Asia and are regarded as malignant disease because diagnosis and treatment are difficult and complication and mortality are high. This study is a retrospective clinical review of 58 cases of patient with intrahepatic calculi in the Department of Surgery, Chungnam National University Hospital from July 1994 through June 1999. The incidence of intrahepatic calculi was 8.8% of total hepatobiliary calculi. The ratio of male to female was 1:2.4. The peak incidence was noted at the 6th decade (32.7%) and mean age was 52.1 years. About the site of stones, left intrahepatic duct (48.3%)was more prevalent than right intrahepatic duct (17.2%). 42 cases(72%) of the intrahepatic calculi were associated with GB stone(8%), CBD stone(45%) or both(19%). As to surgical method, choledochotomy with T-tube drainage was performed in 34 cases(59%), choledochoduodenostomy was in 3 cases(5%) and hepatic resection in 21 cases(36%). Among them choledochotomy with T-tube drainage was the most frequently performed procedure. The remnant stones are most commonly founded after choledochotomy and T-tube drainage (80%) followed after choledochoduodenostomy(33%) and after hepatic resection(24%). But, major postoperative complications such as bile leakage and intra-abdominal abscess are more frequent in casea of hepatic resection. So we suggest that agressive treatment modality such as hepatic resection is more reasonable than drainage procedure in the management of intrahepatic duct stone by the experienced expert.

Thrombolytic Therapy Followed by Myotomy of Gastrocnemius Muscle in Popliteal Artery Entrapment Syndrome

Popliteal artery entrapment syndrome (PAES) is rare, but increasingly reported in the literature as a cause of lower limb arterial impairment. Management of a patient with PAES depends on the clinical pictures. Currently, myotomy of the medial head of gastrocnemius muscle with interposition grafting or bypass of diseased popliteal artery has been widely used in cases with a demaged or occluded artery. But, other less extensive therapeutic approaches were also performed instead of it. We present a case of type II popliteal entrapment syndrome in an 36-year-old male. Presenting symptom was exercise- induced pain in his right calf since one month ago. Arteriography showed occlusion in short segment of right popliteal artery and intact distal run-off arteries. After overnight urokinase thrombolysis, residual focal stenosis and medial deviation of popliteal artery were observed. CT scan showed abnormal structure between right popliteal artery and popliteal vein, so, diagnosis was established. After myotomy of the medial head of gastrocnemius muscle, the symptom resolved completely. Post-operative duplex scan showed normal blood flow, even in active plantar flexion of the foot. In our case, early diagnosis and combined approach of endovascular thrombolytic therapy followed by surgical release of popliteal artery enabled to avoid direct vascular surgery such as bypass or interposition grafting with resolution of ischemic symptoms. This thrombolytic therapy does not obviate surgery but may permit a less extensive procedure to be performed in PAES.

Mycophenolate Mofetil and Prednisolone as Maintenance Therapy in Hemolytic Uremic Syndrome after Kidney Transplantation / 대한이식학회지

Hemolytic uremic syndrome (HUS) after renal transplantation is infrequent but, severe complication of kidney transplantation. Cyclosporine (CyA) or Tacrolimus-induced microangiopathy may be the causative factor in posttransplant HUS. Early diagnosis of the syndrome and discontinuation of cyclosporine or tacrolimus occasionally led to reversal of the syndrome. Many therapeutic trials with variable maintenance immunosuppression protocols were proposed, but, there were no confirmed strategies to manage the posttransplant HUS. We present a case of de novo cyclosporine associated HUS occurring within first a few days after renal transplantation. Early diagnosis was done with presence of shistocytes in peripheral blood smear, thrombocytopenia, low haptoglobin, and renal dysfunction. Supportive therapy with OKT3 immunosuppression followed by mycophenolate mofetil (MMF) and prednisolone (Pds) maintenance therapy led to reversal of renal dysfunction and remission of HUS. In conclusion, in transplant recipients receiving CyA who suffer from HUS, MMF-based dual therapy may be considered. Maintenance treatment with MMF and Pds may be of benefit to more transplant recipients such as those suffering from other CyA or tacrolimus-related side effects.

Primary Neoplasms of the Small Bowel

BACKGROUND: Primary tumor of the small bowel is uncommon less than 6% of all gastrointestinal tumors. Its symptoms and signs are nonspecific and its diagnosis is difficult. METHODS: We analyzed 43 patients with primary small bowel tumor who had undergone operations at the Chungnam National University Hospital from January 1990 to December 1997. RESULTS: 1) In total 43 cases, 19 cases (44.2%) were male and 24 cases (55.8%) were female, benign tumors were 13 cases (30.2%) and malignant tumors were 30 cases (69.8%). The mean age was 51 year. 2) The primary sites of benign tumors were the duodenum in 5, jejunum in 3, ileum in 5 cases. The primary sites of malignant tumors were the duodenum in 13, jejunum in 9, ileum in 8 cases. 3) Polyp was most common benign tumor (30.7%), and leiomyosarcoma was most common malignant tumor (43.3%). 4) The most common symptom was abdominal pain (65.1%), followed by melena (34.9%) and weight loss (20.9%). The most common sign was palpable mass (39.5%) and anemia (39.5%). 5) In the duodenal tumors, the detectabilities of endoscopy and upper gastrointestinal series were 68.8% and 71.4%, respectively. In the jejunal and the ileal tumors, the detectabilities of small bowel series were 62.5% and 71.4%, respectively and those of abdominal computed tomogram were 50.0% and 42.9%, respectively. The accuracy of preoperative diagnosis was 7 cases (53.8%) in benign and 20 cases (66.7%) in malignant tumor. 6) In cases of malignant tumor, curative resection was performed in 18 cases (60.0%), palliative resection was performed in 10 cases (33.3%), and bypass procedure was performed in 2 cases (6.7%). In cases of benign tumor, small bowel resection was performed in 9 cases and excision of duodenal polyp was performed in 2 cases. 7) The mean follow-up period of malignant tumor of 27 cases except 3 hospital mortality cases was 35 months. During this time, 7 cases were dead due to recurrence. The mean survival time of 7 mortality cases was 20.4 months, of them 4 cases were leiomyosarcoma, 2 cases were adenocarcinoma, and 1 case was lymphoma. CONCLUSIONS: Because diagnosis of small bowel tumor is difficult and confirmed in late stage, high degree of suspicion and endeaver to discover it is important.

Clinical Review of Laparoscopic Cholecystectomy / 한국간담췌외과학회지

BACKGROUNDS: The biliary diseases were one of the most common diseases of intraabdominal diseases, and cholecystectomy was performed first in 1882 by Langenbuch, and since laparoscopic cholecystectomy( L.C) that was new noninvasive method of being avoid the laparotomies was performed first in France, in 1987 by Philippe Mouret, it has become the standard method of treatment for symptomatic cholelithiasis. Laparoscopic cholecystectomy offers the mafority of patients with symptomatic cholelithiasis as an improved treatment option, resulting in significantly less postoperative pain, shorter hospital stays, better cosmetic result, and more rapid return to normal activity than standard open cholecystectomy. METHODS: We compared the 82 patients who underwent laparoscopic cholecystectomy at Chung-nam National University Hospital from Jan. 1993 to Jun. 1998 to the 67 patients undergoing standard open cholectystectomy(O.C) during the same periods. RESULTS: 1) The mean age of L.C group was 53.9 years and that of O.C group was 58.0 years. The male to female ratio of L.C group was 1:1.47 and that of O.C group was 1:1.0. 2) Associated diseases were observed in 31 patients(37.8%) of the L.C group and 36 patients(53.7%) of the O.C group. 3) 6 patients(7.3%) had a previous abdominal operation, with appendectomy, the most frequent among them. 4) The shorter operative time and postoperative hospitalization stay were required to performed laparoscopic cholecystectomy than standad open cholecystectomy(p=0.03, p=0.02). 5) Postoperative compoications were occurred in 6 patients(7.3%) of L.C group. 1 patient was explorated, the remainders were recovered by conservative treatment. 6) On pathologic findings, chronic cholecystitis as seen in 70 pateints(85.4%) were the most frequent in the L.C group. In the O.C group, chronic cholecystitis as seen in 40 pateints(59.7%) were also the most frequent diseases. CONCLUSION: Laparoscopic cholecystectomy has the merits of short operation and admission time, lesser postoperative pain, smaller wound, rapid return to normal life than open cholecystectomy.

Clinical Evaluation of Adrenal Tumors

We retrospectively analyzed 40 adrenalectomies due to 13 cases of primary aldosteronism, 12 cases of Cushing's syndrome and 15 cases of pheochromocytoma, which were performed at Chungnam National University Hospital during the last 10 years. Of the 25 patients who presented with adrenal cortical tumors(primary aldosteronism and Cushing's syndrome), 23 had an adenoma and two had cortical hyperplasia. The overall ratio of males to females was 2:1. As to the age distribution, primary aldosteronism was predominant in the 4th and the 5th decades and Cushing's syndrome; in the 3rd and the 4th decades; however, pheochromocytoma was almost evenly distributed in 2nd through the 6th decades. Headaches, fatigue, and general weakness were the most frequent symptoms in primary aldosteronism; weight gain or a change in fat distribution in Cushing's syndrome; and headaches or blurred vision related to hypertension and palpitation in pheochromocytoma. Postoperative complications mostly occurred in patients with Cushing's syndrome: There were four wound infections, including one abdominal abscess, one pleurisy, one cerebral and cerebellar infaction, and two intestinal obstructions, but there were no postoperative deaths.

Clinical Evaluation of Adrenal Tumors

We retrospectively analyzed 40 adrenalectomies due to 13 cases of primary aldosteronism, 12 cases of Cushing's syndrome and 15 cases of pheochromocytoma, which were performed at Chungnam National University Hospital during the last 10 years. Of the 25 patients who presented with adrenal cortical tumors(primary aldosteronism and Cushing's syndrome), 23 had an adenoma and two had cortical hyperplasia. The overall ratio of males to females was 2:1. As to the age distribution, primary aldosteronism was predominant in the 4th and the 5th decades and Cushing's syndrome; in the 3rd and the 4th decades; however, pheochromocytoma was almost evenly distributed in 2nd through the 6th decades. Headaches, fatigue, and general weakness were the most frequent symptoms in primary aldosteronism; weight gain or a change in fat distribution in Cushing's syndrome; and headaches or blurred vision related to hypertension and palpitation in pheochromocytoma. Postoperative complications mostly occurred in patients with Cushing's syndrome: There were four wound infections, including one abdominal abscess, one pleurisy, one cerebral and cerebellar infaction, and two intestinal obstructions, but there were no postoperative deaths.

A Clinical Analysis of Primary Small Bowel Cancer / 대한암학회지

PURPOSE: Primary small bowel cancer is rare. In many cases, the diagnosis is difficult especially in jejunum and ileum, confirmed in advanced state with poor prognosis. This study was intended to clarify the characteristics of primary small bowel cancer. MATERIAL AND METHOD: We have reviewed 24 patients with primary small bowel cancer that have been operated at the Department of Surgery, hospital from Jan. 1990 until Dec. 1996. The clinical feature, diagnostic method, location and histologic finding of tumor, prognosis were analyzed. RESULTS: 1. The ratio of male to female was 1:1.18. The mean age was 53 years and the most prevalent age group was 6th decade (13 cases, 54.1%). 2. The most common primary site was jejunum (9 cases), followed by duodenum (8 cases) and ileum (7 cases). Leiomyosarcoma occurred most frequently in jejunum, adenocarcinoma in duodenum, and lymphoma in ileum. 3. The most common symptom was abdominal pain (66.7%), followed by anemia (54.2%), palpable mass (50%). 4. The accuracy rate of preoperative diagnosis or suspicion was 45.8%, and diagnostic measures were endoscopy in duodenum, small bowel series and/or abdominal CT. in jejunum and ileum. 5. Curative resection was performed in 14 cases (58.3%), and the cancer in which palliative resection was undertaken most frequently was leiomyosarcoma. 6. The mean follow-up period of 23 cases except 1 was 33 months, during this time 9 cases were dead, of whom 5 cases had leiomyosarcoma. CONCLUSION: Frequently, small bowel cancer is difficult in diagnosis, confirmed in late stage. High degree of suspicion and more endeavor to discover it is important and needed to bring a better result.

Endoscopic Review of Early Gastric Cancer / 대한소화기내시경학회지

In order to decide on appropriate treatment strategy against gastric cancer, an accurate preoperative evaluation of the depth of cancer invasion is essential. We studied 165 cases(19%) of early gastric cancer among 706 cases of gastric cancer. resected over a 6 year period. A retrospective study of early gastric cancer was done to evaluate the endoscopic accuracy and lymph node metastasis status, the following results were obtained: 1) The proportion of EGC according to macroscopic type was 68.5% of depressed type(II, III, IIa+III, IIc+III, III+IIc, IIb+IIc), 26% of elevated type(I, IIa, IIa+ IIb, IIa+IIc), 5.5% of flat type(IIb). 2) In the view of accuracy of endoscopic diagnosis, the rate of accurate diagnosis suitable for postoperative macroscopic type was 37.5%, the rate of unsuitable typed EGC was 33.3%, overestimation(diagnosed to AGC) was 20.6% and underestimation(diagnosed to benign diseases)was 8.6%. Overall accuracy of endoscopic diagnosis was 70.8%. 3) The cases confined to the mucosa were 40.6% and others were submucosal cancers(59.4%). 4) Positive lymph node metastasis was found in 1.5% of M-cancer and 18.4% of SM-cancer(overall 11.5%). 5) Node positive rate of differentiated cancer was 10.5%, undifferentiated carcinoma was 15.4%. There was no signficant difference in frequency of nodal metastasis according tumor size and macroscopic type. 6) Tumors which satisfy the following criteria may not metastasize to lymph nodes:(1) confined to the mucosa; (2) less than 2.0cm in diameter; (3) macroscopically elevated or flat; (4) histologically well or moderately differentiated.