Two Cases of Stercoral Perforation of Colon

While colon perforation as a complication of diseases such as carcinoma, colitis, diverticular disease, or abdominal trauma is not uncommon, spontaneous perforation of the colon is rare. Although spontaneous perforation is classified as either stercoral or idiopathic on the basis of its etiological background, the pathological mechanisms of the lesions have yet to be determined in detail. Stercoral perforation is a very rare cause of acute abdomen, with fewer than 70 cases documented in the literature; and idiopathic perforation is also infrequently reported. Both disease entities have often been grouped together as idiopathic or spontaneous perforation, resulting in confusion. We report herein two cases of stercoral perforation of the sigmoid colon. The clinical features, diagnosis, and treatment of the disease are reviewed. Surgeons should be aware of the possibility of this fatal disease, despite its rare incidence. Furthermore, it is important to recognize the condition at an early stage of the disease because it has significantly high mortality if surgery is delayed.

Axillary Lymph-Node Metastases in Patients with T1 Breast Cancer

PURPOSE: In T1 tumors, the reported incidence of lymph-node metastases ranges from 21% to 35%. We analyzed the pathological parameters of T1 tumors for their association with the likelihood of axillary lymph-node metastases. Our objectives were to determine if standard pathologic factors can predict lymph-node metastases in T1 tumors and to provide a basis for patient selection for nonradical surgery. METHODS: Sixty-five patients with T1 unilateral invasive breast cancer were studied. All patients underwent axillary dissection from 1990 to 1999 at Masan Samsung Hospital, and the pathologic status of the nodes was reviewed. The associations between the incidence of axillary lymph-node metastases and pathologic factors, including age, size, histologic subtype, nuclear grade, hormone receptor status, and lymphatic/vascular invasion, were analyzed. RESULTS: Of the 65 patients, 21 (32.3%) had nodes that were positive for metastases. The independent predictor of lymph-node metastases in the multivariate logistic regression analyses was a tumor size larger than 1 cm (p<0.05). However, other predictors showed nonspecific findings. CONCLUSION: These results suggest that the characteristics of the primary tumor can help assess the risk for axillary lymph-node metastases. Axillary lymph-node dissection should be performed routinely for all patients with lesions with a tumor more than 1 cm in size. Although a routine axillary dissection or radiation therapy to the axilla might be spared in selected patients who are assessed to be at minimal risk, new prognostic factors for providing reliable assurance of the absences of axillary lymph-node metastases must be investigated.

A Case of Colon Cancer in Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome is an autosomal dominant disease characterized by hamartomatous polyps in the gastrointestinal tract and by mucocutaneous melanin pigmentations. The relationship between gastrointestinal polyps and the syndrome has been discussed for many years, and many reports have recently suggested an association between the development of gastrointestinal carcinomas and the presence of the syndrome. The reasons for such an association are unknown; some possible reasons are 1) the transformations of some hamartomas into adenomatous polyps and cancer, 2) malignant transformation of adenomatous polyps, or 3) de novo occurrence of malignant tumors. We here present our clinical experience with a 53-year-old male patient who had Peutz-Jeghers syndrome and an adenocarcinoma at the hepatic flexure of the colon.

Composite Carcinoma-Carcinoid Tumor of the Common Bile Duct: A case report

The occurrence of a carcinoid admixed with an adenocarcinoma of the gastrointestinal tract is an unusual phenomenon which has been reported in the esophagus, stomach, gallbladder, colon, and appendix. Herein, we describe an extremely rare case of a composite tumor of the common bile duct. A 50-year-old woman who suffered from right upper abdominal pain and jaundice was found on radiographical investigations and operation to have a tumor in the common bile duct. Histopathologically, the resected tumor was composed mainly of solid nests of atypical round cells and partially of a well-differentiated adenocarcinoma showing a mutual transition in the mucosal layer. Both immunohistochemical and ultrastructural analyses confirmed a composite tumor: a neuroendocrine cell carcinoma and a tubular adenocarcinoma.

Primary Malignant Neoplasms of the Small Intestine: Histopathologic Determinants of Recurrenec and Survival

Primary malignant neoplasms of the small intestine account for only a small percentage of gastro intestinal tumors, but their prognosis is one of the worst. We reviewd the clinical features, diagnostic procedures, and outcome of surgical treatment in 29 patients with primary neoplasms of the small bowel in order to identify aspects of management that might be improved. A retrospective review of cases from 1981 to 1996 identified 29 patients with primary small intestinal tumors. Four histologic groups were identified: adenocarcinoma, 11 patients; lymphoma, 10 patients; malignant stromal tumor, 7 patients; carcinoid, 1 patient. There were 20 men and 9 women. The mean age was 47.5 years(median age: 51 years). The median follow-up was 19.1 months. Survival analysis was done by Kaplan-Meier methods. Preoperative diagnosis of a small intestinal tumor were rarely made because symtoms are vague and nonspecific, so preoperative diagnoses were made in only 11 of the 29 patients (37.9%). The median survival was 20.73 (+/-3.75) months for adenocarcinomas, 21.00 (+/-7.99) months for lymphomas, and 24.50 (+/-5.89) months for stromal tumors. Curative resection was achieved in 17 (58.6%) of the 29 patients, and the mean survival was significantly longer for this gruop (32.27 months vs 7.67 months, p<0.001). Of the 17 curative resections, the disease recurred in 8 patients (47.1%). Wide surgical resection of early lesions is the only potentially curative treatment, but it is possible in only a minority of patients.

Results of Treatments for Pyogenic Liver Abscesses

Pyogenic liver abscess has been a life-threatening disease with a uniformly fatal outcome if left untreated. Changes in the etiology, clinical manifestations, methods of diagnosis, treatment and prognosis of pyogenic liver abscess have occurred slowly, but continuously, over the past century. Modern imaging techniques, improved drainage procedures, and appropriate antibiotic therapy have substantially reduced the mortality and the morbidity. A review of 103 patients with pyogenic liver abscess who were treated at Masan Samsung Hospital over a 5-year period from January 1992 to December 1996 was undertaken to characterize recent trends in diagnosis and management. There were 60 males and 43 females whose ages ranged from 11 to 85 years (mean 62.3 years). The peak age was in the 6th decade. Pyogenic liver abscess more often involved the right lobe (65.1%) than the left lobe (26.2%), and a single abscess was encountered more often than multiple abscesses in a 2.2:1 ratio. Upper abdominal pain, fever, and chills were the most common symptoms, and upper abdominal tenderness was the most common physical finding. An elevated serum alkaline phosphatase was seen in 73.8% of all patients and was the most common biochemical abnormality. Biliary tract disease was the most frequent underlying disorder. In the bacteriological study, we obtained positive cultures in 89.3% of the cases:65.0% were Gram-negative organism, 17.5% were Gram-positive organism, and 6.8% were anaerobes. E. coli was the most frequently cultured organism (31.5%). Ultrasonography and/or CT scanning was employed in the diagnosis and the follow up of all patients. Surgical open drainage was performed in 52 cases (50.5%) and percutaneous closed drainage in 51 cases (49.5%). The outcome of surgical open drainage was similar to that of percutaneous closed drainage, except for the mortality rate. Post-treatment complications occurred in 26 cases (25.2%), and the most frequent complication was a pulmonary problem (8.7%). The mortality rate due to pyogenic liver abscess was 7.8%, and the most common cause of death was sepsis.

A Cystic Mesothelioma in the Right Colon: A case report

Cystic mesothelioma of the peritoneum is a very rare tumor which has a clinically and histologically benign nature. It occurs predominantly in young to middle-ged women and tends to recur locally. It affects chiefly the pelvic peritoneum-articularly the cul-e-ac, uterus, and rectum. We report a case of cystic mesothelioma of the visceral peritoneum which was located anterior to the ascending colon. A 54-ear-ld female patient visited our hospital with a palpable tender mass in the right flank. A computed tomographic scan of the abdomen showed a multicystic mass with an enhancing wall and septum in front of the ascending colon. The patient underwent a right hemicolectomy, and the mass was completely removed. Grossly, the tumor consisted of a multilocular cyst containing clear, serous, or gelatinous fluid and partially solid areas. Microscopically, the solid areas were composed of fibrous tissue, and the lining cells varied from flattened to cuboidal cells with a strong positive reactivity for cytokeratin and mild positive reactivity for epithelial membrane antigen on immunohistochemical staining. These findings suggest that the tumor was mesothelial in origin.

A Case of Heterotopic Ossification in Mesentery of Intestine

Primary heterotopic ossification has been previously noted in abdominal laparotomy scars, but the presence of ectopic bone within the peritoneum is extremely rare and chracterized by new bone formation in a tissue which does not normally undergo ossification. Our patient in a 59-year-old man who underwent operation for acute cholecystitis had formation of heterotopic bone involving mesentery of intestine. The features of various types of ectopic calcification are discussed, and several theories concerning the pathogenesis and treatment of heterotopic ossification are examined.

En-Bloc Resection of Extended Total Gastrectomy VS. Total Gastrectomy for Proximal Gastric Cancer

It is very important to select the appropriate operative method in cancer surgery. For proximal gastric cancer, a total gastrectomy (TG) has usually had less morbidity and mortality than an extended total gastrectomy (ETG). To compare and evaluate the results of a TG with those of an ETG, the authors analyzed 50 cases treated by a TG and 50 cases treated by an ETG during the last 12 years. The results were as follows: The post operative complication rates were 34% for a TG and 54% for an ETG, the average operation time was 3 hours 53 minutes for a TG and 3 hours 42 minutes for an ETG, the postoperative fasting period was 7.1 days for a TG and 6.5 days for an ETG, and the mean length of hospital stay was 21.4 days for a TG and 22.6 days for an ETG. the ETG had a higher complication rate than the TG, but there was no statistical difference between the operation times, the postoperative fasting periods, and the length of stay in the hospital. from our experience, it is suggested that the ETG is easier, or almost the same, to carry out than the TG procedure. Therefore, we recommend an ETG for proximal gastric cancer to achieve better curative results.

The Diagnostic Value of Serum C-Reactive Protein in Patients Suspected to Have Acute Appendicitis

C-reactive protein(CRP), a normal constituent of the serum in healthy individuals, increases in response to various bacterial infections and cellular necrosis. To find out if the C-reactive protein concentration is of any value in the diagnosis of acute appendicitis, ninety consecutive patients suspected to have acute appendicitis were studied prospectively. Of these, 54 patients(group A) had acute appendicitis and 6 patients(group B) underwent surgery with a diagnosis of acute appendicitis; however, histopathology disclosed a normal appendix. Seventeen patients(group C) had no identifiable cause for their illness and 13 patients(group D) had an identifiable cause for their illness, though not appendicitis. The mean serum CRP value was 49.00mg/L in group A, 18.92mg/L in group B, 20.31mg/L in group C, and 63.22mg/L in group D. Within group A, the mean CRP value in the 36 patients with the inflammed appendix was 33.56mg/L. The mean value in the 7 patients with the gangrenous appendix was 73.16mg/L, and 97.61mg/L in 11 patients with the perforative appendix. Serum CRP levels were normal in two patients with acute appendicitis. Besides these 2 patients, all patients with normal CRP had a normal appendix found at the time of operation or their symptoms resolved spontaneously. It is concluded that an increase in CRP levels to more than 5 mg/L is not a definitive indicator of acute appendicitis. However, when there is doubt about the diagnosis of acute appendicitis, a normal serum CRP level should be used as a basis for the decision to defer surgery.

A Clinical Study of Periappendiceal Abscess

This is a clinical analysis and review of one-hundred ninety-four patients with periappendiceal abscesses who were treated at the Departmeat of Surgery, Masan Samsung Hospital over a ten year period from January 1985 to December 1994. The following results were obtained. The incidence of periappendiceal abscesses was 7.24% of the total cases of appendicitis operated on during the same period, and most of the patients(43.8%) were over fifty years old. The male to female ratio was 1:1.02. 41.2% of the patients had operations within four days after their symptoms occurred. On admission, the most common physical finding was tenderness on the right lower quadrant of the abdomen (92.9%) and leukocytosis(> OR = 10,000/mm3) was noted on CBC in 82% of the patients. Abdominal sonograms revealed periappendiceal abscesses in 88% of the patients, 83% were revealed with barium enema and 88% with abdominal CT scan. Many patients(75.5%) visited the local clinic and were treated under the diagnosis of gastritis or enteritis instead of appendicitis. One-hundred eighty-three patients(94.3%) had appendectomies with drainages(94.3%), two patients had drainages of abscesses without appendectomy, six patients had ileocecal resections and three patients had right hemicolectomies. Microbiologically, E. coli was the most frequently cultured species(63%) from abscess, and Klebsiella, Enterococcus and Proteus were isolated in some cases. Postoperative complication occurred in seventy-five patients(38.6%) and the most frequent complication was wound infection(28.8%). There was no mortality and the mean hospital stay was fifteen days.

The incidence of Thyroid Carcinoma in Solitary Cold Nodules and in Multinodular Goiter

The management of thyroid nodules, about which widely differing views have been expressed for many years, is still a controversial subject. The primary reason for concern about thyroid nodules is that they might be malignant.The incidence of carcinoma in patients with multinodular goiters has reported to be considerably lower than in patients with a single nodule. In this retrospective study of 510 cases of thyroidectomies over a 14-year period, 151 patients with factors predisposing them to neoplasia, such as Grave's disease and thyroiditis, were eliminated. The remaining 93 patients with clinically evident multinodular goiters were compared with remaining the 226 patients with a solitary cold nodule. The incidence of carcinoma in the 266 patients with a solitary cold nodule was 15.4%. In the 93 patients with clinically evident multinodular goiters, the incidence of carcinoma was 18.3%. The difference is not significant. It is of interest that male patients with multinodular goiters had the highest incidence of carcinoma at 25.0%, whereas, males with a solitary cold nodule had an incidence of only 17.9%. In conclusion, once known factors that predispose patients to neoplasia are eliminated, there does not seem to be a significant difference in the incidence of thyroid carcinoma between patients with operatively and histopathologically proved solitary cold nodules and those with multinodular goiter.

Acute Appendicitis During Pregnancy

Diagnosis of acute appendicitis is often difficult in pregnant patients because the symptoms may be attributed to the pregnancy. Difficulty in diagnosis and delay in treatment may result in complication or death to the fetus or the mother. Forty pregnant women with acute appendicitis has been treated at Masan Samsung Hospital during the last 15-years. This report is a retrospective clinical analysis of 40 patients who underwent appendectomy. The results are as follows; The incidence of appendicitis during pregnancy was 1 in 655 pregnancies and the gestational stage at onset included 19 patients(47%) in the 1 trimester, 10 patients(25%) in the second trimester, and 11 patients(27%) in the third trimester. The majority of patients were 3rd decades (82%) and there was no significant difference between primiparity and multiparity in incidence of appendicitis. Twenty three(57%) patients had symptoms less than 12 hours and twenty nine (72%) patients were operated on within 12 hours following hospitalization. Vague right abdominal pain was the most predominant symptom and 19 patients had a clinical leukocytosis. Seven of the 40 patients were misdiagnosed as other than appendicitis and two patients had a exploratory laparotomy performed. Spinal anesthesia was preferably used for the first trimester and general anesthesia for the second and third trimester patients. One fetal loss occurred and no maternal deaths.

Seat belt injury

No abstract available.

Operative transhepatic hepaticostomy

No abstract available.

Lymphangiomatosis

No abstract available.

Lymphangiomatosis

No abstract available.