Small Cell Cancer of the Duodenum

Primary small cell cancer of the duodenum is very rare. Only six cases have been reported previously. The patient of this case report was a twenty-year-old male who suffered from frequent nausea and vomiting being accompanied by weight loss. The poorly differentiated neuroendocrine cancer was initially diagnosed by endoscopic biopsy and the patient underwent pancreaticoduodenectomy. The diagnosis was refined as primary small-cell neuroendocrine cancer of which the histological appearance was identical to pulmonary and extrapulmonary small-cell carcinoma. The neuroendocrine differentiation was demonstrated by the positive immunoreactions for neuron-specific enolase. This case emphasizes the need to include the duodenum as a possible primary site when metastatic small cell neuroendocrine carcinoma is seen in the absence of apparent pulmonary disease.

Greater Omental Torsion

Primary or idiopathic greater omental torsion is an uncommon cause of an acute surgical abdomen. The etiology of omental torsion is as yet unknown. The preoperative diagnosis is usually hard, and generally made at laparotomy, due to the objective rareness and absence of typical symptoms. Resection of the infarcted segment is the treatment of choice, offering rapid recovery, and reducing the possibility of adhesion formation. A case of primary omental torsion is reported, with a review of the literature.

Transection of the Internal Jugular Vein by a Neck Stab Injury : A case report

Injuries to the internal jugular vein rarely occur in Korea. However, neck veins are damaged more frequently than any other structure by neck stab injuries, and jugular venous injuries are caused almost exclusively by penetrating neck trauma. Vascular injury is the leading cause of death from trauma. Bleeding from injury to jugular veins is a main contributing factor of mortality as a result of penetrating neck trauma. When we meet a patient of neck stab injury, we must do a careful physical examination and some selective special diagnostic studies. Patients with penetrating neck injuries who are taken directly to the operating room are those with severe external hemorrhage and expanding hematoma and those who are hemodynamically unstable despite of resuscitation. A 22-year-old woman received a stab injury to the neck. On the neck CT scan, the patient was revealed to have a pseudoaneurysm caused by transection of the internal jugular vein. The patient recovered well from the injury as a result of a selective operation, an end-to-end anastomosis. We report that case of a penetrating neck injury resulting in transection of the internal jugular vein and give a review of other reported cases.

Hemangioma with Phleboliths, Misdiagnosed as Sialoliths in Submandibular Gland

Hemangiomas are relatively common benign lesions in head and neck, and are easily diagnosed when they present as cutaneous lesions. However, when a vascular lesion is located within the deeper tissues without a cutaneous component, it results in a large differential diagnosis and sometimes is misdiagnosed even using modern imaging studies. In certain instances, simple radiographic studies may be helpful in diagnosis. Hemangioma in the submandibular gland is extremely rare and when it has phleboliths within it, it is easily confused with calculis in the salivary gland. Recently we experienced one such case. The 63-years-old man complained of a painful bulging mass without cutaneous lesions in the right submandibular area, which had occurred in 2 or 3 times over a 2 year periods. Plain skull films revealed two radioopaque densities in submandibular area and ultrasonography revealed similar findings. Preoperatively he was thought to have sialoliths of a submandibular gland, but it was confirmed as a hemangioma with phleboliths after the operation.

Clinical Analysis of Stage I and II Breast Cancer

PURPOSE: The combination of conservative surgery and radiotherapy is currently accepted as the preferred treatment for most patents with clinical stage I or II breast cancer. However, there is large amount of controversy concerning the optimal means of selecting patients and the details of the treatment technique. Breast cancer patients are being treated both in university hospitals and in community hospitals. Generally, the radiation therapy is not available in many community hospitals. Radiation therapy, which generally follows either a mastectomy or conservative surgery, is an important procedure. Therefore, the type of hospital facilities may influence which surgical procedures are selected. The authors conducted this study to analyse the current patterns of care for early invasive breast cancer in a hospital without a radiation therapy unit, even though the patient could receive such treatment from another affiliated hospital. METHODS: 131 cases of stage I and II breast cancer patients were reviewed between 1987 and 1997, and the types of treatments including surgery, radiation therapy and systemic therapy, were analysed retrospectively. RESULTS: The surgical procedures used were mainly a modified radical mastectomy (124/131, 94.7%), followed by breast conservation surgery (4/131, 3.1%), a total mastectomy (2/131, 1.5%) and a radical mastectomy (1/131, 0.8%). Radiation therapy was applied to 19 stage II patients (N=105), but not to any of the stage I patients (N=26). Systemic adjuvant therapy was done with chemotherapy (39/131, 29.8%), hormone therapy (17/131, 13.0%) and a combination of both modalities (67/131, 51.1%), with an exception of 8 cases. CONCLUSION: Breast conservation therapy for breast cancer patients was underutilized. The selection of the therapeutic method may be influenced by the facilities of the particular hospital. For proper treatment of early stage breast cancer, a surgeon must keep in close contact with bothe a radiologist and a radiotherapist, even in other affiliated hospitals.

Malignant Duodenocolic Fistulas: Report of 2 cases

Malignant duodenocolic fistula is a rare complication of advanced right colon cancer. The surgeon becomes involved not only with the cancer lesion, but also with the physiologic complications, such as electrolyte imbalance and malnutrition. We experienced 2 cases of duodenocolic fistulas arising from right side colon cancers. One of the patients was surgically treated by right hemicolectomy and pancreatico-duodenectomy and another case was lost to follow-up. We report these cases with a brief review of the literature.

Clinical Analysis of Stage I and II Breast Cancer / 한국유방암학회지

PURPOSE: The combination of conservative surgery and radiotherapy is currently accepted as the preferred treatment for most patents with clinical stage I or II breast cancer. However, there is large amount of controversy concerning the optimal means of selecting patients and the details of the treatment technique. Breast cancer patients are being treated both in university hospitals and in community hospitals. Generally, the radiation therapy is not available in many community hospitals. Radiation therapy, which generally follows either a mastectomy or conservative surgery, is an important procedure. Therefore, the type of hospital facilities may influence which surgical procedures are selected. The authors conducted this study to analyse the current patterns of care for early invasive breast cancer in a hospital without a radiation therapy unit, even though the patient could receive such treatment from another affiliated hospital. METHODS: 131 cases of stage I and II breast cancer patients were reviewed between 1987 and 1997, and the types of treatments including surgery, radiation therapy and systemic therapy, were analysed retrospectively. RESULTS: The surgical procedures used were mainly a modified radical mastectomy (124/131, 94.7%), followed by breast conservation surgery (4/131, 3.1%), a total mastectomy (2/131, 1.5%) and a radical mastectomy (1/131, 0.8%). Radiation therapy was applied to 19 stage II patients (N=105), but not to any of the stage I patients (N=26). Systemic adju-vant therapy was done with chemotherapy (39/131, 29.8%), hormone therapy (17/131, 13.0%) and a combination of both modalities (67/131, 51.1%), with an exception of 8 cases. CONCLUSION:Breast c0onservation therapy for breast cancer patients was underutilized. The selection of the therapeutic method may be influenced by the facilities of the particular hospital. For proper treatment of early stage breast cancer, a surgeon must keep in close contact with bothe a radiologist and a radiotherapist, even in other affiliated hospitals.

Comparison of Barium Reduction and Pneumatic Reduction of Intussusception in Children: A Surgeon's View

PURPOSE: Pneumatic reduction has rapidly replaced traditional barium reduction owing to its potential advantages, such as higher reduction rate and greater safety; however, the effects on surgery after reduction failure have not been studied. In this study, we evaluated the influences of attempted barium and pneumatic reductions on subsequent surgical procedures. METHODS: One hundred and sixty-one barium reductions were performed on 158 patients while 153 pneumatic reductions were performed on 145 patients. Statistical comparisons of these two reduction methods were made regarding the following variables: the reduction rates, frequencies of bowel perforations and recurrences, mean operation times, fasting periods, and durations of admission. RESULTS: The reduction rates were similar for both groups with barium reduction being successful in 67.1% of the cases (108/161) and pneumatic reduction in 69.3% (106/153). Two cases of bowel perforation occurred during the pneumatic reductions, none were noted during the barium reductions. Recurrence of intussusception was noted in three cases initially reduced with barium and in nine cases reduced pneumatically. The mean operation time (130.7 minutes vs. 81.7 minutes), postoperative fasting time (61.6 hours vs. 37.6 hours), and duration of admission (6.7 days vs. 5.4 days) were significantly prolonged in the pneumatic reduction group. CONCLUSION: A part from a comparable reduction rate pneumatic reduction demonstrated no favorable outcome relative to barium reduction. Furthermore, it resulted in some obstacles to surgery and recovery, such as prolonged operation time, fasting period, and duration of admission.

Diagnosis of Tuberculous Cervical Lymphadenitis with Fine Needle Aspiration Cytology and Nested Polymerase Chain Reaction

BACKGROUND: Molecular methods have rapidly replaced the classic diagnostic procedures of tuberculosis. Especially, the nested polymerase chain reaction (nPCR) is widely used for the diagnosis of tuberculosis in various specimens. In our previous publication, we suggested the availability of nPCR in specimens of solid tissues and in fine needle aspirates for the diagnosis of tuberculous cervical lymphadenitis (TCL), but nPCR has the possibility of false positive due to its repetitive amplification and contamination. Also, nPCR shows variable sensitivity and specificity, depending on the kind of target sequence and the probe used. We intended to improve the diagnostic efficacy of nPCR by the means of combination with the result of fine needle aspiration cytology (FNAC). And we applied restriction fragment length polymorphism (RFLP) to the amplicon of nPCR to rule out false positives. METHODS: Thirty five specimens of aspirates from enlarged cervical lymph nodes of suspected TCL cases were examined by cytological examination and nPCR. Fifteen amplicons from nPCR were analyzed by RFLP. The sensitivity and the specificity were calculated in each nPCR and FNAC. The sensitivity and the specificity based on the result from combining nPCR and FNAC were also calculated. The results of RFLP were compared with the results of the corresponding nPCR. RESULTS: Twenty patients were definitely diagnosed as having tuberculosis based on the result of FNAC, nPCR, and tissue pathology. The sensitivity of FNAC was calculated to be 0.8, and the specificity was 0.92. The sensitivity of nPCR was calculated to be 0.76 and the specificity was 1.0. When we analyzed the patients infected with tuberculosis who had had positive results in FNAC or nPCR, the results showed a sensitivity of 0.95 and a specificity of 0.92. There were no different RFLP fragmentation patterns between the individual amplicons of the same nPCR results. CONCLUSIONS: The result of combining FNAC and nPCR offered good sensitivity and specificity in the diagnosis of TCL. It is suggested that anti-tuberculosis medication be immediately started when the result of FNAC or nPCR reveals a positive reaction. RFLP did not show any diagnostic value in our series, but it could be a great help in differential diagnosis of another strain of M. tuberculosis or atypical mycobacterium in treatment-resistant cases of TCL.

Rectal Obstruction Caused by Ischemic Colitis with Angiodysplasia: A case report

Angiodysplasia is a vascular lesion of the gut, which reveals intestinal bleeding as a major symptom. It is the cause of as much as 5~6% of the intestinal bleeding of unkown origin. Pathologically, it reveals anomalous submucosal vascular overgrowth, which is characterized by tortuous, dilated and thin-walled vessels. Because the lesion is mainly submucosal. It is hard to diagnosis with endoscopy and even in laparotpmy. Angiography has a low detection rate for angiodysplasia, but some of this typical findings are delayed excretion of dye into the venous structure around the lesion, vascular tuft in the arterial phase, and accelerated dye secretion into venous structure in the situation of arteriovenous malformation. Endoscopy, especially colonoscopy is so effective a diagnostic method as to make interventional therapy. Conjugated estrogen therapy is effective and is regarded as choice of treatment in the not-life-threatening intestinal bleeding caused by angiodysplasia. Surgery is only indicated in the case of uncontrolled bleeding. Intestinal obstruction has rarely been reported as another manifestation of intestinal angiodysplasia. Therefore pathologic definition should be confirmed, and research for pathophysiology of mucosal hypertrophy in the angiodysplasia is needed.