A case of malignant fibrous histiocytoma with invasion into great vessels and heart which was confused with benign myxoma / 대한내과학회지

Cardiac tumors are rare. Benign myxoma is the most common among them. Malignant fibrous histiocytoma is a tumor originating from primitive mesenchymal cell and found most commonly in four extremities. Since this disease was first described by Shah in 1978, there have been a lot of case reports of cardiac malignant fibrous histiocytoma. If originating in the heart, it is usually found in left atrium which is unusual for malignant cardiac tumor. Since the advent of the echocardiography as a diagnostic tool in the cardiac disease, a lot more cases of cardiac tumor have been reported. Here, we report a case of cardiac malignant fibrous histiocytoma in a 67 year old man presenting with dyspnea who, at first sight, seemed to have benign myxoma but turned out to have malignant fibrous histiocytoma. However, strictly speaking,the case we found is a cardiac invasion of the retroperitoneal malignant fibrous histiocytoma.

Laparoscopic Suture Rectopexy for Rectal Prolapse

PURPOSE: This study was undertaken to eveluate the early results of the laparoscopic suture rectopexy in the treatment of rectal prolapse. METHODS: From May 1999 to July 2001, laparoscopic suture rectopexy (LSR) was successfully performed in 26 patients and the results were compared to those of 5 patients with open suture rectopexy (OSR) and 6 patients with open resection rectopexy (ORR). Preoperative and postoperative functional assessment included Wexner's incontinence score, constipation score, and anorectal manometry. RESULTS: Immediate postoperative morbidity was minimal in all groups. Bowel function was resumed significantly sooner (P=0.001), the numbers of the analgesics injection were significantly fewer (P<0.001) and postoperative hospital stay was significantly shorter (P<0.001) in the LSR than in the open groups. Postoperatively, the anal resting and squeezing pressures increased slightly and Wexner's incontinence score decreased significantly in all groups of patients. Constipation score decreased slightly in all groups of patients after surgery. There was one mucosal prolapse recurrence after surgery in the LSR. CONCLUSIONS: Laparoscopic suture rectopexy for rectal prolapse can be performed safely. Recovery is uneventful and of shorter duration after the laparoscopic than after the open approach. Functional results are obtained similarly with both approaches.

Current Trend of Inflammatory Bowel Disease

PURPOSE: Inflammatory bowel disease (IBD) has steadily increased, according to westernized life style, popular use of colonoscopy, and development of pathology and diagnostic radiology. However, there is no avaliable data about epidemiology of IBD in Korea. Even though our data is not a standard of IBD patients in Korea, it is possible to understand the trend of IBD. METHODS: From Jan. 1995 to Dec. 2000, cases of ulcerative colitis (UC), Crohn's disease (CD), and indeterminate colitis (ID) were evaluated retrospectively. Annual incidence of IBD at our hospital was calculated with using new IBD patients/new out-patients. To compare the incidence of CD with that of intestinal tuberculosis (TB), intestinal TB cases from Jan. 1997 to Dec. 2000 were evaluated. RESULTS: Total number of IBD patients was 651: UC (480, 73.7%), CD (149, 22.9%) and ID (22, 3.4%) in order of frequency. Male was more prevalent than female (1.2:1), especially in CD (2.5:1). However, there was no difference of sex in UC. Mean age was 37.9 ( 14.1) years old, ranging from 11 to 79. CD patients (25.1 9.4) were younger than UC (41.9 13.0). Incidence of IBD out of new out-patients increased annually:0.30% (53 cases) in 1995, 0.31% (67 cases) in 1996, 0.37% (99 cases) in 1997, 0.38% (100 cases) in 1998, 0.54% (158 cases) in 1999 and 0.58% (174 cases) in 2000. The most common types of UC and CD were proctitis (52.3%) and ileocolic type (59.7%), respectively. Incidence of CD was more prevalent than that of intestinal TB (2.5:1). CONCLUSION: About 0.5% of new out-patients had IBD and the number of patients of IBD increased annually. CD patients were younger than those of UC and male was predominant. The number of patients with CD exceeded that of intestinal TB patients.

Clinical and Physiologic Characteristics of Rectal Prolapse in Males

This study compares the sexual differences among rectal prolapse patients regarding the clinical and the physiologic characteristics with emphasis on males. METHODS: The clinical data, functional status and operative records of 43 patients, who had completed both clinical and functional evaluations were collected in a prospective database and were analyzed according to sex. The functional status of the patients was evaluated by Wexner's constipation score (0~30), Wexner's incontinence score (0~20), anorectal manometry, and pudendal nerve terminal motor latency (PNTML). RESULTS: The incidences of rectal prolapse in males (n=22) and in females (n=21) were similar. The age of onset for males was lower (mean standard deviation, 19.6 19.59 (50% in childhood) vs 52.0 20.75 years; p=0.001) and the duration of symptoms was longer (31.5+/-19.87 vs 12.5+/-14.31 years; p<0.001). Surgery in males was most commonly performed during the sexually active years (51.2+/-16.34 vs 64.5+/-13.19; p=0.006). The incidence of mucosal prolapse in males was higher (10/22 vs 4/17; p=0.065). The incidences and the severities of defecation difficulty in males and females were similar (n=12, mean Wexner score=8.4 vs n=12, mean Wexner score=9.9; p=NS) but, the incidences and the severities of fecal incontinence were lower in males (n=4, mean Wexner score=4.3 vs n=17, mean Wexner score= 14.2; p<0.001). The maximum resting pressure was higher in males (39.2+/-21.46 vs 26.3+/-19.98 mmHg; p=0.049), and the maximum squeezing pressure was better preserved (131.2+/-62.63 vs 67.5+/-37.99 mmHg; p<0.001). No significant difference existed in the PNTML. Female patients underwent abdominal resection rectopexy (n=6), perineal rectosigmoidectomy with lavatoroplasty (n=11), and Delorme's procedure (n=4), but all male patients preferred the perineal approach (rectosigmoidectomy with lavatoroplasty (n=8), Delorme's procedure (n=14)) for fear of sexual dysfunction after the abdominal approach. CONCLUSIONS: These findings suggest that the mechanism for developing rectal prolapse in male and female may be different and that surgical treatment should be tailored to the patient.

Dissecting Aneurysm Originating in the Abdominal Aorta: A case report

Although almost all cases of spontaneous aortic dissection originate in the thoracic aorta, dissections limited to the abdominal aorta occur very rarely. According to the previous literatures, localized abdominal aortic dissections account for 1~4% of all aortic dissections. The predisposing factors of spontaneous abdominal aortic dissection are similar to those of thoracic aortic dissection. Many patients have a history of hypertension and the incidence appears to be greater in patients with congenital heart diseases, pregnancy or Marfan's syndrome. And it occurs 3 times more frequently in men than in women. Histologically, atherosclerosis is the most common finding. In many cases, presenting symptoms and signs are not specific, so that this disease entity can be overlooked at bedsides. In our case, the patient was a 76-year-old man who had a vague periumbilical pain occurred one day before. He had no trauma history nor other illness. Abdomino-pelvic CT showed 4x7 cm sized dilatation of abdominal aorta from below the renal arteries to just above the aortic bifurcation site and compatible with aortic dissecting aneurysm. We performed aneurysmectomy and restored arterial continuity with an aorto-bifemoral bypass using dacron. The patient's postoperative course was relatively uneventful and he remains well one year after operation. In conclusion, because of its rarity and nonspecific symptoms and signs, spontaneous aortic dissection confined to the abdominal aorta may be misdiagnosed by physicians. And usually, untreated aortic dissections have a lethal course. So, more accurate diagnostic approaches and optimal managements are needed for good outcome.

The Prognostic Significance of Tumor Microvessel Density in Gastric Carcinoma / 대한암학회지

PURPOSE: This study was carried out to evaluate the relationship with other clinicopathologic factors and prognostic significance of tumor microvessel density in gastric carcinoma. MATERIALS AND METHODS: Eighty three cases of primary gastric carcinoma(stage 1b, II, and III) were analysed retrospectively who underwent curative gastrectomy at Wonkwang university hospital from July, 1987 to June, 1992. Tumor microvessels were stained by immunohistochemical method using anti-CD31 on paraffine embedded tissues, and were counted within 10x objective field(about 0.74 mm2) in the area of the most intense neovascularization. RESULTS: The overall 5 year survival rate was 57.8%. Depth of invasion, lymph node metastasis, and stage were the prognostic factors(p or =6 cm(p=0.049), 33.3 in 45 cases of well differentiated type, 32.9 in 30 cases of poorly differentiated type, and 41.5 in 8 cases of signet ring cell type(p 0.042). But there was no significant difference of MVC between other parameters such as age, sex, tumor location, gross finding, depth of invasion, lymph node metastasis, and stage. The 5 year survival rates of 47 cases of MVC 34 were 59.6% and 55.6% respectively(p>0.05). There was no significant difference between 5 year survival rates of MVC 34 group adjusted for other parameters. CONCLUSION: Tumor microvessl density may related with tumor size and histologic type, and have no significance in 5 year survival rates of gastric carcinoma.

Coronary Artery Bypass Surgery: A Report of 8 Cases

We carried out coronary artery bypass grafting using saphenous vein on 8 patients from May, 1987 through January, 1988 at Hanyang University Hospital in Seoul. There were 4 men and 4 women and the mean age was 58.3 years. Except for 1 patient, they were all diagnosed as unstable angina not responding to medical therapy. The average ejection fraction was 66.9%, and no operative death was found. Two sequential anastomoses were performed in one patient. There was no significant event to influence adversely on postoperative prognosis. During the mean follow up period of 6.3 months, none of the patients experienced new symptoms and all of them remain relatively well off the medications used pre and perioperatively execpt for aspirin and persantin.

Echocardiographic Evaluation of Left Ventricular Function in Patients with Dilated Cardiomyopathy

The term dilated(congestive) cardiomyopathy refers to a variety of cardiac disorders that have in common ventricular dilation and reduced myocardial contractility, and is derived from the common late clinical manifestation of congestive heart failure. Since echocardiography can evaluate several aspects of anatomical structures and cardiac function, it has provide a valuable contribution to the understanding of ventricular function and diagnosis of dilated cardiomyopathy. The purpose of this study is to perform the echocardiographic evaluation of left ventricular function in 44 patients with dilated cardiomyopathy and to compare the patients with normal individuals. The patients, 24 males and 20 females, had a mean age of 53.0 and body surface area of 1.61m2. Normal individuals as a control group, 10 males and 10 females, had a mean age of 47.2 and body surface area of 1.67m2. Among 44 patients with dilated cardiomyopathy, 22 cases had a history of heart failure and in 15 cases systolic murmur was heard at the apex. The cardiothoracic ratio was 0.7+/-0.1 on chest X-ray which showed significant difference when compared to normal control group, being 0.4+/-0.1(p<0.01) One case showed left ventricular thrombus and in 8 cases small mounts of pericardial effusion were noted. Among the 44 patients two had uremia, one had a history of myocarditis, one patient was young female whose illness began during the peripartum period and one had a diabetes mellitus. Results obtained were as follows; 1) Mitral valve echocardiogram (1) DE amplitude and EF slope of mitral valve(16.5+/-3.3mm and 83.5+/-3.65mm/sec respectively) showed significant decrease when compared to normal control group (20.1+/-3.0 mm and 102.4+/-28.9 mm/sec respectively) (p<0.01 and p<0.05). (2) EPSS (25.5+/-7.6mm) and the distance between posterior cusp of mitral valve and left ventricular posterior wall (9.1+/-2.1mm) showed significant increase (p<0.01) when compared to normal control group (7.1+/-2.1mm and 5.9+/-1.2mm). The ratio of the separation of two mitral leaflets to the left ventrticular diastolic dimension (0.4+/-0.1) showed significant showed significant decrease in patients when compared to normal control group (p<0.01) (3) Among 44 patients with dilated cardiomyopathy, 12 cases showed B-notch in mitral valve. 2) Echocardiographic findings of aortic valve. Left atrial size was markedly increased (37.7+/-7.5mm) when compared to nomal control group (29.1+/-4.9) (p<0.01). The ratio of left atrial size to aortic dimension was 1.3+/-0.3, showing significant increase when compared to normal control group (0.99+/-0.3) (<0.01). And 4 cases showed systolic notch in aortic valves. 3) Echocardiographic findings of left ventrcle and ventricular septum. (1) Left ventricular diastolic and systolic dimensions (41.8+/-7.8mm/m2 and 36.7+/-7.2mm/m2) were markedly increased in patient with dilated cardiomyopathy, when compared to normal control group (30.4+/-2.6mm/m2 and 11.4+/-3.2mm/m2) (p<0.1, both). Left ventricular diastolic and systolic volume (181.5+/-91.0ml/m2 and 136.6+/-69.7ml/m2) were also significantly higher in patients with dilated cardiomyopathy when compared to normal control group (79.1+/-23.8mm/m2 and 19.4+/-2.5ml/m2) (p<0.01, both). (2) Ejection fraction (0.32+/-0.10) percent fractional shortening (12.3+/-4.6) and mVcf (0.5+/-0.2 cric/sec) showed significant decrease in patients when compared to normal control group (0.74+/-0.05, 34.6+/-6.7 and 1.4+/-0.2) (p<0.01, all). Thus, We could find the reduced myocardial contractility in dilated cardiomyopathy. (3) Systolic amplitudes of venticular septum (LSa) and ventricular posterior wall (Ena) were markedly decreased (p<0.01). The sum of both values (LSa+ENa) also showed significant decrease (12.0+/-4.2mm) when compared to normal control group (p<0.01) (4) Thickness of ventricular septum and ventricular posterior wall showed slight increase in patients, but there was no significant changes when compared to normal group. 4) Systolic time interval Echocardiograms showed significant increase in ratio of preejection period to ejection time, when compared to normal group (p<0.01). Thus, the author observed that in dilated cardiomyopathy the contractility of left ventricle was significantly reduced and the left ventricular diameter and diastolic volume of left ventricle showed marked increase. And also the decreased motions of ventricular septum and posterior wall of left ventricle were noted.