Clinical characteristics of acute appendiceal diverticulitis / 대한외과학회지

PURPOSE: Diverticulitis of vermiform appendix is known as a rare cause of acute appendicitis, most of which are diagnosed after surgery. We compared appendiceal diverticulitis with acute appendicitis to study the clinical characteristics of appendiceal diverticulitis. METHODS: Among 1,029 patients who received appendectomy from January 2009 to May 2011, 38 patients with appendiceal diverticulitis (diverticulitis group) were compared with 98 randomly collected patients with acute appendicitis (appendicitis group) during the same period. Patients' characteristics, clinical features, laboratory findings, operative findings, and postoperative course were compared between the two groups. RESULTS: Thirty-eight patients (3.7%) were pathologically diagnosed with acute appendiceal diverticulitis among 1,029 cases of appendectomy. The mean age of patients in the diverticulitis group was significantly older than that of the appendicitis group (49.0 +/- 15.2 years vs. 25.4 +/- 14.2 years, P < 0.05). Mean duration of preoperative symptoms was longer in the diverticulitis group (3.6 +/- 3.8 days vs. 1.8 +/- 3.2 days, P < 0.05). The site of abdominal pain, fever, signs of localized peritonitis, accompanying gastrointestinal symptoms, and white blood cell count showed no differences between the two groups. Twenty-five patients (65.8%) of the diverticulitis group and 10 patients (10.2%) of the appendicitis group showed perforation of appendix (P < 0.05). Mean operating time and postoperative hospital stay were longer in the diverticulitis group (55.3 +/- 28.8 minutes vs. 41.4 +/- 17.8 minutes, 6.8 +/- 3.4 days vs. 4.9 +/- 1.5 days, P < 0.05). CONCLUSION: Acute diverticulitis of the appendix can be classified into quite different disease entities compared with acute appendicitis. Regarding high rates of perforation, immediate surgical treatment is needed for patients with a high index of suspicion of acute diverticulitis of the appendix.

A Rare Case of Primary Hyperparathyroidism Associated with Primary Aldosteronism, Hurthle Cell Thyroid Cancer and Meningioma

Multiple endocrine neoplasia type 1 (MEN1) syndrome includes varying combinations of endocrine and non-endocrine tumors. There are also a considerable number of atypical MEN1 syndrome. In this case, a 68-yr-old woman was referred to the Department of Endocrinology for hypercalcemia. Five years ago, she had diagnosed as primary hyperaldosteronism and now newly diagnosed as parathyroid hyperplasia with laboratory and pathologic findings. Hurthle-cell thyroid cancer was also resected during the parathyroid exploration and small meningioma was found on brain MRI. Her general condition has markedly improved and her adrenal mass and meningioma are being closely observed now. We could find the loss of heterozygosity of the MEN1 locus in parathyroid glands, suggesting a MEN1-related tumor, but not a germline mutation. Considering a variety of phenotypic expression and a limitation of current molecular analysis, periodic follow up will be needed in patients with a MEN1-like phenotype.

Comparison of Single Port and Conventional Laparoscopic Surgery in Acute Appendicitis / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic surgery is widely applied for treating acute appendicitis, and even the complicated cases. Single port laparoscopic surgery has recently been introduced and it is being increasingly accepted for treating acute appendicitis. The aim of this study is to evaluate the effectiveness of single port laparoscopic appendectomy as compared with that of conventional laparoscopic surgery. METHODS: Eighty-seven patients who underwent laparoscopic appendectomy were enrolled. The clinicopathologic characteristics, the perioperative courses and postoperative pain using the VAS (visual analog scale) were compared between the conventional (n=61) and single port (n=26) groups. RESULTS: There were no significant differences in age (28.2 Vs. 32.4, respectively), gender (29:32 Vs. 13:13, respectively) and BMI (22.3 Vs. 22.0, respectively) between the two groups. An extraperitoneal location of the appendix was found in 10 cases (16.4%) of the conventional group and in 4 cases (15.4%) of the single port group. Statistically, no significant difference was shown in terms of the degree of inflammation of the appendicitis. The average length of the operation was significantly shorter in the single port group compared to that of the conventional group (52.4 Vs. 41.3 minutes, respectively, p<0.05). The VAS at 6 hours after surgery (5.2 Vs. 6.0, respectively) and at the time of discharge (1.9 Vs. 1.9, respectively) showed no differences between the two groups. There was no difference for the postoperative hospital stay (3.8 Vs. 3.1 days, respectively) and the rate of postoperative complications (16.4% Vs. 7.7%, respectively) between the two groups. Wound infection was the most common complication. CONCLUSION: When regarding the minimal scar and invasiveness, single port laparoscopic appendectomy is feasible option for treating acute appendicitis. With accumulation of experiences and the development of instruments, additional studies are needed for the indications and advantages of single port surgery.

Radical Reresection for T2 Gallbladder Cancer Patients Diagnosed following Laparoscopic Cholecystectomy

PURPOSE: Despite advances in imaging techniques, laparoscopic cholecystectomy (LC) gives many advantages to some patients with suspected gallbladder cancer. The aim of this study was to investigate clinicopathological features and to analyze the risk factors of recurrence after radical reresection for T2 gallbladder cancer patients diagnosed following LC. METHODS: From January 2002 to December 2009, the data of 21 consecutive patients for radical reresection for T2 gallbladder cancer were reviewed, retrospectively. The significance of the variables for recurrence was examined by the Kaplan-Meier method and log-rank test followed by multivariate analyses using Cox's proportional hazard model. RESULTS: Of the 21 patients studied, 11 were men and 10 were women. Lymph node metastasis was present in 7 patients (33.4%). The 5-year survival rate and disease-free survival rate in those patients were 75.3% and 67.9%, respectively. In the univariate analysis, the male gender (P=0.0047), poorly differentiated tumor (P=0.0169), presence of lymph node metastasis (P=0.0012), presence of lymphovascular invasion (P=0.0259) and presence of perineural invasion (P=0.0096) were significant factors related to recurrence after radical reresection. In the multivariate analysis, the presence of lymph node metastasis was an independently significant factor (5-year disease free survival rate, 20.9% vs. 83.8% in the absence of lymph node metastasis; P=0.015). CONCLUSION: For patients with T2 gallbladder carcinoma diagnosed following LC, radical reresection is highly recommended and the presence of lymph node metastasis is an unfavorable prognostic factor that calls for additional treatment after radical surgery.

Is the Yersinia enterocolitica Possible Infectious Agent in Acute Appendicitis?

PURPOSE: With increasing frequency, Yersinia enterocolitica is being recognized as an important bacterial cause of acute gastrointestinal infection with abdominal pain. In addition, the association of Y. enterocolitica infections with acute appendicitis has been suggested. This study was undertaken to ascertain whether Y. enterocolitica is a possible infectious agent in acute appendicitis. METHODS: Between December 2007 and April 2008, 162 patients who underwent appendectomy for presumed appendicitis, enrolled in this prospective study. After surgical excision of appendix, a portion of each specimen was cultured for Y. enterocolitica with highly selective media (Cefsulodin-Irgasan-Novobiocin agar). RESULTS: Pathologically, 150 of the patients had appendicitis and 12 patients had normal appendices. Only one of the 150 patients (0.7%) with appendicitis was found to be culture positive for Y. enterocolitica, while it was not detected from normal appendices. CONCLUSION: The authors were unable to implicate Y. enterocolitica as a major pathogen in acute appendicitis within the Seoul area. However, we thought there to be more need for investigation for association of Y. enterocolitica with acute appendicitis over a broader area and season.

Initial Experience with Laparoscopic Surgery for Treating Upper Gastrointestinal Disease / 대한내시경복강경외과학회지

PURPOSE: Performing laparoscopic surgery for upper gastrointestinal disease has gradually been increasing. The aim of this study is to review the initial experience with laparoscopic surgery for treating upper gastrointestinal diseases. METHODS: We retrospectively studied a total of 76 patients who underwent laparoscopic surgery for upper gastrointestinal disease from April 2003 to December 2008. The clinical features and surgical outcomes were analyzed. RESULTS: The types of upper gastrointestinal diseases that were treated by laparoscopic surgery were early gastric cancer (n=45), advanced gastric cancer (n=6), gastric submucosal tumor (n=14), duodenal ulcer stricture (n=5), duodenal ulcer perforation (n=2), superior mesenteric artery syndrome (n=2), gastroesophageal reflux (n=1) and dysphagia due to parkinsonism (n=1). There were 11 operative morbidities (14.5%), including 1 operative mortality (1.3%). CONCLUSION: Although this study shows the narrow range of indications for performing this laparoscopic procedure and the surgical experience is rather limited, laparoscopic surgery was applied for treating various upper gastrointestinal diseases. Based on this experience, surgeons should make efforts to improve the surgical outcomes.

A Case of Infantile Hemangioendothelioma of the Liver Treated with Hepatic Embolization and Lobectomy / 소아과

Infantile hemangioendothelioma (IHE) of the liver is the most common vascular tumor in infants before the age of 6 months. It is a histologically benign tumor with potentially life-threatening complications. The clinical manifestations are variable, ranging from asymptomatic forms to intractable high-output heart failure. In addition, abdominal mass, intraperitoneal hemorrhage due to rupture of mass, respiratory distress, hematologic abnormalities and jaundice can occur. Diagnostic work-up is through doppler ultrasound sonography, computed tomography scan, magnetic resonance imaging and angiography. Treatment consists of medical treatment, interventional therapy, surgical resection and liver transplantation. We experienced symptomatic IHE in a premature neonate who presented with high output heart failure and respiratory distress. Initial medical treatment and steroid therapy failed to improve his condition. Coil embolization of left hepatic artery resulted in improvement of respiratory symptoms. However, a left lobectomy was performed because the mass size was not decreased with development of collateral vessels. The infant was well, after a successful discharge from the hospital.

A Case of Choledochal Cyst Complicated by Liver Cirrhosis on Pathology in a 20-Month-Old-Girl / 소아과

Choledochal cyst is considered to be congenital anomalies of the biliary tract, characterized by varying degrees of cystic dilatation at various segments of the biliary tract. A 20-month-old girl was admitted to Eul-Ji general hospital because of abdominal distension. Physical examination revealed marked splenomegaly and hepatomegaly with nodular surface and hard consistency. Laboratory examination showed elevated transaminase level, alkaline phosphatase level and gamma glutamyltranspeptidase level without evidence of cholestasis. Diagnostic imaging study revealed choledochal cyst with Todani classification type 1. Cholecystectomy and Roux-en-Y choledochojejunostomy was performed, and wedge liver biopsy showed diffuse periportal fibrosis with cirrhotic change and ductular proliferation in the portal area. After operation, hepatosplenomegaly and abnormal laboratory examinations improved rapidly, and in 9 months, the liver and spleen became not palpable. We experienced a case of choledochal cyst complicated by liver cirrhosis on pathology in a 20 month-old girl, and removal of choledochal cyst improved clinical manifestations rapidly.

Spontaneous Hepatic Rupture Following an Uncomplicated Pregnancy and Delivery / 한국간담췌외과학회지

Spontaneous rupture of the liver in pregnancy is extremely uncommon. The most of cases have occurred in pregnancy with preeclampsia/eclampsia. We report one case of spontaneous capsular rupture following an uncomplicated pregnancy. A 33 year old woman was admitted at 38 weeks of gestation to the Obstetrics department. On admission her pulse and blood pressure were normal and there was no proteinuria. On the next day, a cesarean section was performed with delivery of a male infant (3.8 kg). but persistent uterine bleeding was developed due to uterine atony. and then subtotal hysterectomy was performed. Postoperatively she was remained unstable requiring further transfusion of blood and fresh frozen plasma. She was reoperated for controling persistent bleeding and evacuation hematoma of previous hysterectomy site. Postoperatively she was stable during 48 hours. However she again became hypotensive and on examination was noted intra-abdominal fresh bleeding. Laboratory evaluation demonstrated a high level of LFT. Contrast enhanced CT revealed subcapsular hematoma rupture and active bleeding of liver. We tried to embolized the terminal hepatic arterial branch for controling the ruptured subcapsular hematoma. and then she was stable but after 5th days, liver necrosis was developed and progressed to abscess. Despite radiologic drainage, necrotic abscess was remained persistently. She was managed with open drainage and debridement of necrotic liver. After 2 weeks, she was discharged without any morbidity.

Intravenous Atropine Sulfate Therapy for Infantile Hypertrophic Pyloric Stenosis

The purpose of this study is to evaluate the applicability of intravenous atropine sulfate therapy in infantile hypertrophic pyloric stenosis (IHPS). From 1998 to 2000 among 35 cases of IHPS, pyloromytomy was performed in 13 (Group A), and intravenous atropine was given as a primary therapy in 22 cases (Group B). In group A, all cases were cured completely. In group B, 13 (59 %) out of 22 cases were successfully treated with atropine, but 9 were failed therapy, and required operation. The recovery period to normal feeding and the hospital stay of the successful atropine group were longer than those of pyloromyotomy, 8.6 days vs. 2.9 days and 13.2 days vs. 4.1 days, respectively. In conclusion, intravenous atropine therapy did not replace pyloromyotomy, but it might be an alternative for the selected patients with contraindications for operation.

A Case of Islets Cell Hyperplasia Diagnosed by Selective Arterial Calcium Stimulation Test / 대한내분비학회지

We report a 40-year-old female patient with clinical findings suggestive of insulinoma. Although imaging studies did not reveal any tumors in the pancreas, a selective arterial calcium stimulation test(SACI), procedurally simpler and more effective than transhepatic pancreatic venous sampling, was performed. And then near total pancreatectomy was carried out because the possibility of small insulinoma could not be completely excluded. Grossly, the surgically removed pancreas did not reveal any tumors. However, the pancreas exhibited islets cell hyperplasia. To our knowledge, this is the first reported authentic case in a Korean adult of islet-cell hyperplasia diagnosed by selective arterial calcium stimulation test.

Infrainguinal Reconstruction vs Primary Amputation in Critical Limb Ischemia

PURPOSE: Many physicians persist in the belief that attempted revascularization is inappropriate for many patients with limbs threatened by ischemia. They continue to recommend primary amputation. Unfortunately, amputation for lower-extremity ischemia is frequently followed by infirmity, institutionalization, and death for the patient. We have reviewed our experiences on primary amputation versus infrainguinal revascularization. METHODS: Between Jan. 1992 and Dec. 1997, 56 infrainguinal reconstructions and 28 primary amputations were performed in 84 patients with critical ischemia of lower extremity. RESULTS: The male to female ratio was 11 to 1, and the most prevalent age group was the 6th decade. The etiologies were atherosclerosis obliterans in 82.1% and Buergers disease in 10.7%. The associated diseases were hypertension (38.1%), diabetes (27.4%) and cerebrovascular accidents (21.4%). The locations were iliac in 8.3%, femoral in 73.8%, popliteal in 7.1%, tibial in 9.5%, and peroneal in 2.4%. Clinical categories were divided into acute limb ischemia in 27.4% (grade II in 13.1% and III in 14.3%), and chronic limb ischemia in 72.6% (grade I in 13.1%, II in 32.1%, and III in 27.4%). Preoperative risk was evaluated with Goldmans index, ASA scale, and Eagles criteria. According to Eagles criteria, 24 patients (28.6%) showed a low risk, 49 patients (58.3%) had a moderate risk, and 11 patients (13.1%) had a high risk. Of the 84 patients, the following surgical techniques were used, femoro-popliteal bypass in 36 (64.3%), femoro-femoral in 13 (23.2%), femoro-tibial in 10 (17.9%), popliteo-tibial in 6 (10.7%), femoro-peroneal in 1 (1.2%), axillo-femoral in 1 (1.2%), below-knee amputation in 15 (53.6%), above-knee amputation in 12 (42.9%), and hip disarticulation in 1 (3.6%). The mean follow up period was 13.7 months. The mortality for revascularization was 3.6%, which was significantly different from the mortality of primary amputation (14.3%). The 1-month and 1-year and 2-year secondary graft patency rates were 90.8%, 85.3%, and 83.3%, respectively. CONCLUSION: Patients who underwent revascularization had a lower perioperative mortality rate (P<0.05), a lower complication rate (P<0.05), and an increased long-term survival rate (P<0.05) than the group of patients who underwent primary amputation. In summary, the results of this present study suggest that all patients with limb threatened by ischemia should be treated with revascularization by an experienced vascular surgeon rather than with primary amputation.

Acute Pancreatitis in Children

Acute pancreatitis(AP) in children is not common but can be associated with severe morbidity rates and its diagnosis is often delayed. Thus, reported mortality rates range from 0 to 78%. We have treated 26 patients with AP from 5 to 17 years of age over the past 17 years. We are intended to assess the relevance of the prognostic criteria used to assess severity of adult AP and to review the etiology, clilical presentation, diagnosis, and management of AP in children. The authors retrospectively reviewed 26 children with AP managed in Kyung Hee University Hospital from 1978 to 1995. Among 26 patients with AP, male were 12, and female were 14. And the mean age of patients was 11.8 years. In 9(34.6 %), no definitive cause was identified. Common causes of AP were trauma(23.1 %) and biliary tract disease(23.l%). Other etiologies were viral infection(15.4%) and post ERCP(3.8%). The presenting features were abdominal pain(92.3%), vomiting(61.5%), fever(l9.2%), submandibular pain(l1.5%), and abdominal mass(7. 6%). Back pain was rare(3.8%). Abdominal ultrasonographic findings were abnormal in 10 of 16 patients(62.5%) and abdominal CT findings were abnormal for 9 of 9 patients(100%). Seventeen patients(65.3%) were managed conservatively, and nine patients(34.6%) required surgical treatment. There was no mortality. To evaluate the severity of disease, we used the Imrie prognostic criteria used to assess the severity in adult AP. The number of positive criteria was correlated to the duration of hospitalization(r2=0.91) but statistically insignificant(p > 0.05). But, the number of positive criteria was correlated to the operative incidence(r2 = 0.93) and statistically significant(p < 0.05). The common causes of AP in children were unkown origin(34.6%), trauma(23.l %), and bili.ary tract disease(23.1 %). Ultrasonography and computed tomography were useful imaging tools of AP in children. The Imrie criteria used to evaluate the severity in adult AP were suspected to be valuable to asssess the severity of AP in children.

A Cloacal Exstrophy Variant Associated with Hindgut Duplication

Diphallus is a rare congenital anomaly and is frequently associated with duplication of the urinary tract and rectosigmoid, and commonly associated with vertebral anomalies. Remzi reported less than 100 cases of duplication of all or a portion of the penis, but about 10 cases of complete diphallus with exstrophy of cloaca was reported, and a case of complete diphallus associated with hingut duplication was reported, and complete diphallus with displacement of bladder associated hindgut duplication and imperforate anus was not reported in Korea. We experienced a case of the complete diphallus associated with displacement of bladder, hindgut duplication, and imperforate anus as a variant of cloacal exstrophy. A review of published cases suggests that this may be the first example of a complete dip hall us with displacement of bladder coexisting with the hindgut duplication and imperforate anus.

Clinical analysis of intussusception in infants and children

No abstract available.

A clinical study of 5-year survival rate of stomach cancer according to postoperative anticancer chemotherapy / 대한암학회지

No abstract available.

Primary sclerosing cholangitis

No abstract available.

Adenomyoma of the small intestine: a rare cause of intussusception in an infant

No abstract available.