Two Cases of Resection of Localized Sclerosing Encapsulating Peritonitis

Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon, is generally recognized as a rare complication of continuous ambulatory peritoneal dialysis (CAPD), and the prognosis is very poor. The causes of SEP are multifactorial, including acetate in dialysate, recurrent peritonitis and dialysate con tamination with antiseptics containing chlorhexidine. Patients experience the characteristic symptoms and signs of nausea, vomiting, abdominal pain, and partial or intermittent bowel obstruction, and weight loss and malnutrition develop in severe case. We performed bowel resection on two patients with SEP, one idiopathic, and the other from CAPD. We briefly review the literature, and discuss the pathophysiology and the management of SEP.

A Case of Adenoma Arising in a Choledochal Cyst: A case report

Bile duct adenomas are discovered incidentally during surgery or at autopsy. Especially, the occurrence of an adenoma in a choledochal cyst is very rare. Biliary carcinomas are known to be related to choledochal cysts. The association of an adenoma in a choledochal cyst with the carcinoma is not definite. We have experienced a case of a tubular adenoma arising in a choledochal cyst. Recently, a 24-year-old female was admitted with complaints of right upper quadrant abdominal pain and indigestion. Abdominal ultrasonography and ERCP showed a fusiform dilation of the common bile duct. During the operation, a tiny polyp was discovered in the cyst. We performed a cyst excision and a Roux-en-Y hepaticojejunostomy. On microscopic examination, the polyp was diagnosed as a tubular adenoma.

Abdominal CT Scanning in Adult Intussusception

Intussusception is a relatively common disease in children, but it is a rare clinical entity in adults. More than 80% of all patients with intussusception are less than two years of age, but adults account for only 5 to 10 percent of all intussusception cases. The significance of this disease in the aspect of statistics is mentioned as "rule of fives", which means 5% of all intussusceptions occur in adults, and it accounts for up to 5% of all cases of bowel obstruction in adults. In children, classic symptoms include episodic abdominal pain, "current-jelly" stool and a sausage-shaped abdominal mass on examination. However, in adults, it is likely to appear with non-specific gastrointestinal trouble without classic symptoms. Therefore, it is very important to use early diagnositic tool. In contrast to childhood intussusception, which is idiopathic in 90% of cases, adult intussusception has a definable lesion in more than 90% of cases 3). Tumors, both benign and malignant, are the most frequent cause of intussusecption in adults. We experienced seven cases of adult intussusception at Inha hospital from Jan. 1994 to Dec. 1997. The patients of adult intussusception are classified as three cases of ileoileal type and four ileocecal type. There were no specific signs or symptoms with patient experienced. It included abdominal pain, diarrhea and palpable mass. Their diagnosis was made in six patients using abdominal CT scan. It is difficult to define a diagnosis preoperatively, because the symptom of adult intussusception are variable and insignificant among individuals. We had been taken the final diagnostic tool with the abdominal CT scan in six of seven patients, which revealed "target lesions" in all cases. So, it is useful in the diagnosis of adult intussusception. Bowels were resected for the treatment of adult intussusception. The extent of the resection was contained the lesion and the defunctioned segments. The operations were performed as four segmental resections of small bowel and three ileocecal resections. The pathological findings were disclosed as three tumors, three lymphadenopathies and a adhesion of bowel. We concluded that the abdominal CT scanning is a usefull diagnostic tool in the diagnosis of adult intussusception.

Germline Mutation of BRCA2 Gene in Korean Breast / Ovarian Cancer Families / 대한암학회지

PURPOSE: Recent discovery of BRCA1 and BRCA2 genes has made it possible to perform presymptomatic diagnosis in hereditary breast/ovarian cancer families. We have previously reported germline mutations of the BRCA1 gene in Korean hereditary breast/ovarian cancer families. In that study two out of 13 families were found to have germline mutations in BRCA1 gene. One was a nonsense mutation in codon 1815, and the other was a frameshift mutation due to 2 base-pair deletion in codon 1701 of BRCA1 gene. This study was intended to identify germline mutations of the BRCA2 gene in Korean breast/ovarian cancer families. MATERIALS AND METHODS: Peripheral blood DNA was obtained from 10 breast cancer patients registered at the Korean Hereditary Tumor Registry with positive family history of breast and/or ovarian cancer. Exons 11 and 27 of the BRCA2 gene(together accounting for 50% of the coding region of the BRCA2 gene) were amplified by polymerase chain reaction(PCR) and screened for mutations by in vitro transcription/translation method. For confirmation of the mutations, automatic sequencing of the PCR products displaying abnormal truncated protein bands was perfomed. RESULT: We identified an abnormal truncated protein in the exon 11 of the BRCA2 gene from a member of hereditary breast cancer family, SNU-B4. Sequencing analysis revealed a 4 bp deletion in codons 1248-49 of the exon 11, resulting in frameshift that led to premature stop codon and truncation of the protein product. CONCLUSION: We have identified a germline mutation from a Korean hereditary breast cancer family. So far only one case of the same mutation has been registered in Database of BRCA2 mutation (BIC) by a commercial genetic diagnosis company, Myriad Genetics, Inc. Identification of the germline mutation in BRCA2 gene should aid in the accurate presymptomatic diagnosis of the at-risk members in this family.

Studies on Relationship between Expression of ras , p53 , c-erbB2 and p53 and Phenotypic Expression Using Mucin Histochemistry in Human Gastric Carcinomas / 대한암학회지

PURPOSE: Recent studies have shown that the expression of mucin is organ- and cell-type specific and it is increasingly possible that its change could result from oncogene activation.To evaluate histogenesis and prognostic factors for gastric carcinoma, we studied the oncoprotein expression in gastric cancer cells classified by mucin phenotye. MATERIALS AND METHODS: Mucin histochemistry and immunohistochemistry for ras, c-erbB2, and p53 oncoprotein expression were performed in 101 surgically resected gastric carcinoma specimens. PAS-Con A, GOS, and HID-AB staining techniques were employed in identifying mucosubstances, RESULTS: Of the 101 specimens studied, 73(72.3%) revealed as having mixture of various mucin-secreting cancer cells. Overall, ras immunoreactivity was observed in 72(71.3%), c-erbB2 in 7(6.9%), and p53 in 47(46.5%). Of the 73 mucus-secreting carcinomas, the surface mucous cell type were shown in 65 (89.0%), the pyloric gland cell type in 48(65,8%), the sialomucin type in 47(64.4%), and the sulfomucin type in 54(74.0%). There was significant association between mucin secretion and ras expression, but not c-erbB2 and p53 expression. There was no significant association between mucin secreting cell types and Lauren classification. Ras expression was correlated with serosal invasion, lymph node metastasis and poor prognosis. CONCLUSION: The phenotypic expression by mucin histochemistry may be not more important for studying of histogenesis in gastric carcinoma than Lauren classification. Ras expression is a poor prognostic indicator and may be correlated with phenotypic expression of surface mucous cell and intestinal cell type in gastric carcinoma.

Appendiceal Diverticulitis

Appendiceal diverticula are uncommon lesions. A retrospective study of appendiceal diverticula was done for 1379 appendectomies is performed from June 1991 to May 1996. Thirty-six cases (2.6%) of appendiceal diverticula were found. Only one case was detected operatively; the rest of them were diagnosed pathologically. These thirty-six cases have been classified into three groups: 23 cases of primary appendiceal diverticulitis, 8 of secondary appendiceal diverticulitis, and 5 of simple diverticulosis. The clinical manifestations of primary appendiceal diverticulitis were different from those of typical acute appendicitis. Primary appendiceal diverticulitis was seen mainly after the fourth decade of life. The pain came on rather insidiously and seemed to extend over a longer period. A history of previous attack was frequent. The rate of perforation in primary appendiceal diverticulitis was 78.2%.The false form of appendiceal diverticula was more common in most series. Also, no case was detected in appendectomies performed on many patients under 10 years of age with a diagnosis of appendicitis. They seemed to develop after birth and were seen frequently along the mesenteric border. The rate of mucosal hyperplasia in appendiceal diverticula was 61.1%, higher than that for appendicitis. Vascular hiatus between muscular bundles along the mesenteric side, and the mesenteric covering over the diverticula, as well as the inability of false diverticula to endure high intraluminal pressures, seem to be pathophysiologically associated with the cause and the high perforation rate in appendiceal diverticula. The clinical picture and the pathologic findings of primary appendiceal diverticulitis are definitely different from those of acute appendicitis. We suggest primary appendiceal diverticulitis be regarded as a clinical entity, not a variant of acute appendicitis. The patient with atypical right lower quadrant pain should be examined with this diagnosis in mind.

Differential Diagnosis of Medchanical Bowel Ostruction and Paralytic Ileus on CT Features

PURPOSE: To evaluate CT findings for the differential diagnosis of mechanical bowel obstruction and paralytic ileus. MATERIALS AND METHODS: Without information relating to clinical or operative findings, we retrospectively analyzed the CT scans of 24 patients with mechanical bowel obstruction and 19 patients with paralytic ileus. Final diagnosis was confirmed by operation (n=26), or by clinical symptoms, radiologic findings and follow-up study CT findings were obtained : 1) the diameter of the most dilated part of the small bowel, and the thickness and enhancing pattern of the dilated small bowel wall; 2) the diameter of the most dilated part of the descending colon and the ratio of the diameter of the small bowel to that of the descending colon; 3) the number of transitional zones, length and thickness. and 4) associated ascites and its location. RESULTS: The mean diameters of the most dilated part of the small bowel in mechanical bowel obstruction and paralytic ileus were 3.6cm and 2.9cm, respectively. The diameter of the small bowel in mechanical bowel obstruction was significantly greater than in paralytic ileus(p< .05). The mean thickness of dilated small bowel wall was 4.0mm in mechanical bowel obstruction and 2.4mm in paralytic ielus, and target-like enhancement was prominent in mechanical bowel obstruction (46%) (p< .05). he mean diameter of the most dilated part of the descending colon was not significantly different to that of the most dilated part of the small bowel, but the ratio of the diameter of the small bowel to that of the colon was 2.9 in mechanical bowel obstruction and 1.9 in paralytic ileus, respectively, which was statistically significant (p< .05). A transitional zone was seen in 23 cases (96%) of mechanical bowel obstruction and in nine (47%) of paralytic ileus. In mechanical bowel obstruction, mean transitional zone length was 2cm, shorter than that of paralytic ileus (3.4cm) (p< .05) The thickness of transitional zone and the presence of ascites and its locations were not significantly different between mechanical bowel obstrction and paralytic ileus. CONCLUSION: In the differential diagnosis of mechanical bowel obstruction and paralytic ileus, the following CT findings were considered useful : diameter of the most dilated part of the small bowel ; thickness and target-like enhancing pattern of dilated small bowel wall ; ratio of the diameter of the small bowel to that of the descending colon ; and the number of transitional zones, and their length.

A clinical comparison of the patients having simple gall stones with the patients having other hepato-biliary stones(complex gall stones)

No abstract available.

Primary adenocarcinoma of the appendix

No abstract available.

Evaluation of CT densities of intrahepatic duct stones

No abstract available.