Primary Hepatic Leiomyosarcoma: A case report

The liver is a distinctly unusual locus for a primary leiomyosarcoma. In October 1994, a 64-year-old female patient was admitted with palpable mass at the right upper abdomen for 2 months. Ultrasonography and Computed Tomography revealed a big cystic nature tumor at the right lobe of the liver. A right lobectomy was undertaken. On gross examination of the specimen, the tumor size was measured a 7.5 cm 16.0 cm 4.5 cm. On a cut section, cystic degeneration was showed and the color of the solid component was grayish. Microscopic examination growth pattern of the tumor to be expansive with no capsule. Finally the leiomyosarcoma of the liver was diagnosed with 5 to 6 mitosis per 10 high power fields. In September 1995, follow-up Computed Tomography revealed a recurred mass on segment 4 of the liver. A tumonectomy was performed. Twenty-one months after the second operation, recurrence was noted on the remaining liver and intraabdomen. Debulking surgery of the intraabdominal mass with intraperitoneal chemotherapy was undertaken. We report this case of primary hepatic leiomyosarcoma with a review of the literatures.

Passive Bowel Movement with a New Colostomy Device: An Acute Experiment in Dog

In some clinical situations such as cerebrovascular accident, pelvic bone fracture or any bed ridden states patients do not have self control of their bowel movement. Nursing care around the perianal area is not an easy job. There is no devices which substitude the work because of the chracteristics of the anatomy of the anorectum and the fecal matter made of solid and gel state component. AIM: to evaluate the possibility of passive evacuation of the fecal matter from the rectum with a newly developed silicon device. MATERIAL AND METHODS: A New Colostomy Device (NCD; US Patent No. 5,569,216) for fixing in the stoma or rectum of human body, includes an internal balloon, a ring figured external balloon surrounding the internal balloon, a connecting tube disposed under the both internal and external balloons and supply tube containing a pair of air passages and an enema fluid passages. It is designed to be inserted into the rectum and is held in place by an inflatable external balloon and drains irrigated fecal matter through a thin collapsible connecting tube which exist in the anal canal. Six mongrel dog with 20~25 kg of body weight was used for the acute experiment. Three types (1.5, 2.0, 2.5 cm in luminal diameter of the solid portion) of NCD were applied in 3 consecutive every other days. For softening of the stool, normally harder than that of human, Psyllium dextrose 30 gm was added to the daily food. Average 750 cc of tepid water was administered through the device for bowel irrigation. Anesthesia was not used in each procedures. The amount evacuated fecal matter and remained solid stool in rectum were checked. To evaluate the rectal mucosal injury anoscopic examinations were performed. RESULTS: Stool evacuation was closely correlated with the intemal diameter of the device and stool component. The device with 2.5 cm in luminal diameter passed fecal matter well enough in 5 of 6 dogs however, smaller devices did not. Accidental prolapse of NCD were noted in 4 of 6 cases with 2.5 cm sized and all of 1.5 and 2.0 sized devices eventually until last push. CONCLUSION: The NCD with 2.5 cm of internal diameter could be used in selected clinical situations.

Application of a New Colostomy Device in Incontinent Dog Model

BACKGROUND: Recently developed electrically stimulated gracilis neosphicter or artificial sphincter is quite a promising trial in fecal incontinence However, surgical technique is not simple, the devices are expensive and only specialists can perform the procedures successfully. The aim of this study is to evaluate the efficacy of a newly developed simple silicon device in incontinent dog model. METHODS: A New Colostomy Device (NCD; US Patent No. 5,569,216) for fixing in the stoma or rectum of human body, includes an internal balloon, a ring figured extemal balloon surrounding the internal balloon, a connecting tube disposed under the both infernal and external balloons and supply tube containing a pair of air passages and an enema fluid passage. It is designed to be inserted into the rectum and is held in place by an inflatable external balloon and drains irrigated fecal matter through a thin collapsible connecting tube which exist in the anal canal. Six mongrel dog with 22~26 kg of body weight were prepared. Anal incontinence was made by bilateral severing of the internal and external sphincters and puborectalis muscle under the general anesthesia. Marlex mesh ring was applied to the anal canal as Thiersch wire for the prevention of NCD expulsion in straining. After then, NCD with 2.5 cm of luminal diameter was inserted to the rectum proximal to the Malex mesh ring. Daily irrigation and evacuation was done with 800~1000 cc of tepid water in each dogs. Daily food contained 30 gm of Psyllium dextrose. RESULTS: Initially 6 dogs were observed for 7 days. Daily irrigation made evacuation of fecal matter well in each dogs. There was no prolapse of device through the anal orifice. Anoscopic examination after 7 days showed no rectal and anal mucosal injury. Two dogs were kept for 40 days as same manner. Sometimes spontaneous bowel movement without water irrigation was noted when the stool were loose. Weelky anoscopic examination revealed no evidence of mucosal injuries for 40 days also. There was no septic or other complication. CONCLUSION: NCD evacuated fecal matter well enough to empty the rectum in all incontinence dog model. Adequate sized NCD could be used for clinical trials in selected incontinence patients.

Clinical Study of Congenital Duodenal Obstruction / 영남의대학술지

Successful management of duodenal obstruction in newborn infant implies not only satisfactory nutrition but also achivement of normal growth. To aid early diagnosis and management, we evaluated the diagnostic methods, operative interventions and clinical characteristics of thirty-nine infants with congenital duodenal obstructions. In the 11-year period from July 1986 through June 1997, thirty-nine patients with congenital duodenal obstruction (23 males and 16 females) were treated and reviewed at the Department of Pediatric Surgery, Yeungnam University Hospital. The ratio of male to female was 1.4:1, and 29 cases(74.1%) among total 39 patients were newborn. There were 5 premature patients and 16 patients of small for gestational age. The most common causes of the congenital duodenal obstruction was malrotation (26 cases, 66.7%) and followed by annular pancreas (9 cases, 23.1%), type 1 atresia (3 cases, 7.7%) and wind-sock anomaly (1 case, 2.6%). Common symptoms were vomiting, abdominal distention, jaundice. Plain abdominal X-ray study combined with upper gastrointestinal series was the most commonly used diagnostic method. The operative procedures were performed by same pediatric surgeon utilizing Ladd's procedure in 26, duodenoduodenostomy in 8, duodenojejunostomy in 4, excision of wind-sock membrane in 1. A total of 15 associated congenital anomalies were found in 9 patients. Postoperative complications occurred in 13 (33.3%). Overall mortality was 2.6%(1/39). Bilious vomiting and plain abdominal radiologic study were most useful for the diagnosis of congenital duodenal obstruction. Early diagnosis and operative intervention were important to prevent complications such as sepsis and peritonitis.

Clinical Analysis of Infantile Hypertrophic Pyloric Stenosis

Infantile hypertrophic pyloric stensosis (IHPS), which occurs three of 1,000 live births, is a major cause of nonbilious vomiting of early infancy, but its etiology and pathogenesis are still obscure. The operation of pyloromyotomy as described by Ramstedt in 1912 remains the standard of care for the treatment of IHPS. From January 1990 to July 1997, 64 infants with IHPS were reviewed at department of Pediatric Sursery, Yeungnam University Hospital. The ratio of male to female was 7:1, and the most prevalent age group was between 2 weeks and 8 weeks (81.2%). There were 37 (57.8%) first born babies among total 64 infants. The body weight percentile at admission was lower than 50 percentile in all 64 cases. Onset of symptoms was predominantly between 2week and 4weeks in 23 cases (35.9%). All had a history of nonbilious vomting, generally projectile in nature. In the measured serum electrolytes, hypokalemia was noted in 14 cases (21.9%), hypochloremia was observed in 26 cases (40.6%). In the preoperative ultrasonography, the average muscle thickness, diameter, and length of the pylorus were 6.3mm, 12.3mm, and 17.8mm, respectively. A total of thirteen associated anomalies were noted in twelve patients. All 64 cases were treated with Fredet-Ramstedt pyloromyotomy. There were postoperative complications of wound infection in 3 cases. Intermittent nonprojectile vomiting was presented in 13 cases (20.3%) after operation, but one of them was relieved in 13 days and the rest were relieved within one week by adjustment of oral intake.

Appraisal of Anterior Approach in Right Hepatic Lobectomy / 한국간담췌외과학회지

BACKGROUND/AIMS: Despite recent advances in liver surgery, complication and mortality rate in hepatectomy are still high compared to other abdominal surgeries. Intraoperative stress such as bleeding, vascular occlusion, excessive mobilization and prolonged operation time is the most important factor in postoperative complications. Anterior approach avoiding hepatic mobilization and vascular occlusion in right hepatic lobectomy is a useful method for decreasing intraoperative stress. We investigated the effectiveness of anterior approach in right hepatic lobectomy. METHODS: We studied 33 cases of right hepatic lobectomy for malignant tumor between January 1993 and June1997. Thre were 13 cases of Anterior approach (group A) and 20 cases of classic right hepatic lobectomy (group B). We analyzed liver function test, arterial ketone body ratio(AKBR), operation time, blood transfusion during operation, hospital stay, and postoperative complications. RESULTS: Total bilirubin levels at first and seventh postoperative days were 2.1+/-0.6mg/dl, 0.9+/-0.2mg/dl in group A and 2.7+/-1.3mg/dl, 1.0+/-0.3mg/dl in group B. AST were 189+/-65.3 IU/L, 43+/-13.5 IU/L in group A and 325+/-67.8 IU/L, 51+/-18.2 IU/L in group B. ALT were 169+/-30.5 IU/L, 52+/-17.4 IU/L in group A and 295+/-70.3 IU/L, 52+/-16.6 IU/L in group B. AKBR at intraoperative and immediate postoperative period were 0.58+/-0.06, 0.62+/-0.03 in group A and 0.38+/-0.04, 0.40+/-0.08 in group B. Neither operation time (in group A : 380.5+/-61.1 minutes, in group B : 342.9+/-54.8 minutes), transfusion volume during operation (group A : 1222+/-802cc, group B : 1410+/-476cc), nor hospital stay (group A : 22.8+/-3.5 days, group B : 19.1+/-1.4 days) were different between the two groups. Complication rate was lower in group A compared to that of group B (30.8% vs. 40.0%). There was 1 mortality in group B and no mortality in group A. CONCLUSIONS: It is suggested that right hepatic lobectomy through the anterior approach is a useful surgical procedure to reduce intraoperative surgical stress and postoperative complications.