Obstructive Jaundice Due to Compression of the Common Bile Duct by Variant Right Hepatic Artery / 대한췌담도학회지

Extrahepatic bile duct can be compressed by right hepatic artery (RHA) and cause a variety of hepatobiliary symptoms. This condition is referred to as RHA syndrome. A 20-year-old man was admitted because of jaundice. No stones or tumor were visible on CT scan and endoscopic retrograde cholangiopancreatography. However, RHA was seen traversing and compressing the mid common bile duct (CBD) with resultant upstream dilatation. The patient was diagnosed with obstructive jaundice due to compression of the CBD by variant RHA originating from gastroduodenal artery. After separation and mobilization of the variant RHA, obstructive jaundice was resolved. Herein, we report a case of a variant form of RHA syndrome that was successfully managed by surgery.

A Case of Primary Hepatic B-cell Lymphoma of Mucosa-associated Lymphoid Tissue (MALT)-Type / 대한혈액학회지

Mucosa-associated lymphoid tissue (MALT) lymphoma is a low grade B cell lymphoma that, occurs in numerous sites including the stomach, ocular adnexa, thyroid, lung and breast; however, primary hepatic lymphoma is extremely rare. Only about 20 cases have been reported world wide. We recently experienced a case of primary hepatic B-cell lymphoma of the MALT type in a 63-year old female patient. She presented with abdominal pain. The CT, ultrasonogram and PET-CT showed a hepatic nodular mass. A biopsy specimen of the liver revealed MALT lymphoma. There was no evidence of the lymphoma in the extrahepatic lesion. She received segmentectomy of liver and was then treated with CVP (cyclophosphamide, vincristine and prednisolone) chemotherapy. She has been followed up for 6 months since the therapy, and she remains asymptomatic.

Laparoscopic Adrenalectomy: A Comparison with Open Adrenalectomy / 대한내분비외과학회지

PURPOSE: The advent of laparoscopic abdominal surgery made it possible to perform a laparoscopic adrenalectomy (LA). We have successfully performed 10 such operations since November 21, 1995. We retrospectively compared the effectiveness and the safety of a laparoscopic adrenalectomy with the effectiveness and the safety of an open adrenalectomy (OA). METHODS: The 45 patients with adrenal diseases who underwent an adrenalectomy from March 1990 to January 1998 were included in this study. Ten (10) laparoscopic cases comprised the study group, and 17 of the 32 open adrenalectomy cases, performed by anterior approach, comprised the control group. RESULTS: No one died from an adrenalectomy. Nine cases (45%) from the OA group needed transfusions (average: 661 ml), but one patient from the LA group, who had required a conversion to a celiotomy, required a transfusion (400 ml). The operating times were, on average, 191 minutes in the OA group and 230 minutes in the LA group (p=0.0384). The average size of the masses was 6.5 cm. The first days of walking after the operation was 3.4 days for the OA group and 1.3 days for the LA group (p=0.0002). The patients' former regular diets were started on days 6.9 and 3.2 for the OA and LA groups, respectively (p=0.0001). Postoperative in-hospital days were 17.5 for the OA group and 7.9 for the LA group (p=0.0001). CONCLUSION: In comparison with an open adrenalectomy, a laparoscopic adrenalectomy showed better convalescent features: that is, less chance of transfusion, earlier recovery, faster resumption of the former diet, shorter postoperative hospital stays, and cosmesis. We think and suggest that a laparoscopic adrenalectomy is a safe and effective procedure, and hopefully it will become the standard choice of operation for various adrenal diseases.

Laparoscopic Adrenalectomy: A Comparison with Open Adrenalectomy / 대한내분비외과학회지

PURPOSE: The advent of laparoscopic abdominal surgery made it possible to perform a laparoscopic adrenalectomy (LA). We have successfully performed 10 such operations since November 21, 1995. We retrospectively compared the effectiveness and the safety of a laparoscopic adrenalectomy with the effectiveness and the safety of an open adrenalectomy (OA). METHODS: The 45 patients with adrenal diseases who underwent an adrenalectomy from March 1990 to January 1998 were included in this study. Ten (10) laparoscopic cases comprised the study group, and 17 of the 32 open adrenalectomy cases, performed by anterior approach, comprised the control group. RESULTS: No one died from an adrenalectomy. Nine cases (45%) from the OA group needed transfusions (average: 661 ml), but one patient from the LA group, who had required a conversion to a celiotomy, required a transfusion (400 ml). The operating times were, on average, 191 minutes in the OA group and 230 minutes in the LA group (p=0.0384). The average size of the masses was 6.5 cm. The first days of walking after the operation was 3.4 days for the OA group and 1.3 days for the LA group (p=0.0002). The patients' former regular diets were started on days 6.9 and 3.2 for the OA and LA groups, respectively (p=0.0001). Postoperative in-hospital days were 17.5 for the OA group and 7.9 for the LA group (p=0.0001). CONCLUSION: In comparison with an open adrenalectomy, a laparoscopic adrenalectomy showed better convalescent features: that is, less chance of transfusion, earlier recovery, faster resumption of the former diet, shorter postoperative hospital stays, and cosmesis. We think and suggest that a laparoscopic adrenalectomy is a safe and effective procedure, and hopefully it will become the standard choice of operation for various adrenal diseases.

Detection of Gastric Cancer Micrometastases in Lymph Nodes by Keratin 19 mRNA with RT-PCR

BACKGROUND: In gastric cancer, lymph-node status is the most important discriminant of patient outcome. In spite of its prognostic importance, lymph-node status is usually examined by a routine histological examination using only one hematoxylin and eosin (H-E) section prepared from a representative cut surface of each lymph node. In order to overcome this drawback, new means based on the polymerase chain reaction (PCR) have recently developed to detect micrometastases in lymph nodes. METHODS: Gastric cancer tissues and lymph nodes were obtained from 9 primary gastric adenocarcinoma patients who underwent gastric resection. A total of 80 lymph nodes and 9 gastric cancer tissues were analyzed by both histologic and molecular examination of keratin 19 mRNA. Regional lymph nodes obtained from patients with benign peptic ulcer perforation were used as normal control lymph nodes. RESULTS: 1) Keratin 19 mRNA was expressed in all patients with gastric cancers, but in none of the 10 normal control lymph nodes. 2) Keratin 19 mRNA was detected in all of the 8 lymph nodes which were histologically metastasis-positive. Of the 72 lymph nodes which were histologically metastasis- negative, 67 were found not to express keratin 19 mRNA, but 5 were found to express keratin 19 mRNA. 3) Especially, of the 3 early gastric cancers which were histologically metastasis-negative, one was found not to express keratin 19 mRNA, but two were found to express keratin 19 mRNA. CONCLUSIONS: Keratin 19 reverse transcripture (RT)-PCR a more sensitive method than histological examination for the detection of gastric micrometastases in lymph nodes and may serve as a useful clinical factor in establishing accurate staging for prognosis and in planning optimum management.

Solid and Papillary Epithelial Neoplasm of the Pancreas

BACKGROUND: Solid and papillary neoplasms of the pancreas are very rare tumors that occur predominantly in young women. Most of them are diagnosed because of their large sizes and because they are present with an asymptomatic abdominal mass. Most reports indicate that these large palpable, abdominal masses occur in females in their second and third decades of life. Only a few cases of solid and papillary epithelial neoplasms of the pancreas have been reported. METHOD: Here in, eight cases were reviewed which were treated at the Department of Surgery, Catholic University Medical College affiliated hospital from 1988 to 1996. RESULT: The diagnosis is often implied by radiologic examination with ultrasonography, UGI, ERCP, and computed tomography. Most cases showed well-encapsulated, round, or lobulated masses consisting of both cystic and solid areas. The hallmark histologic pattern of this tumor is a solid and papillary epithelial pattern in a pancreatic neoplasm. There is no specific marker for this neoplasm which could elucidate the obscure histogenetic origin and the phenotypic differentiation. Concluion: Therefore, surgical excision is the primary form of treatment and has favorable results.

Laparoscopic Duhamel Procedure for Hirschsprung's Disease: The first two cases in Korea

The Duhamel procedure has been the authors' treatment of choice for children with Hirschsprung's disease over the last 15 years. Owing to advancements in instrumentation and technique, laparoscopic correction of some congenital anomalies, including congenital megacolon, have become possible. In March and May of 1997, laparoscopic Duhamel procedures were performed on a girl and boy aged 7 months and 2 years and 9 months, respectively. The primary diagnosis in both patients was Hirschsprung's disease, which was confirmed by barium-enema and mucosal suction biopsy. The boy did not need construction of a loop colostomy, while the girl had a colostomy made neonatally. Using 4 trocars, the sigmoid colon, proximal rectum, and posterior rectal wall were mobilized laparoscopically. Immdeiately after severing the proximal resection line, the proximal end was pulled down posterior to the dentate line for side-to-side anastomosis with GIA and Endo-GIA staplers perineally. The colonic remnant was then resected with staplers and harvested through the right lower quadrent port site. Operative time was 210 minutes for the boy and 200 minutes for the girl. No perioperative complications were noted, and conversion to laparotomy was never required. Regular diet was resumed 4 days (boy) and 2 days (girl) after the operations. Postoperative hospital stay was 7 days in the two cases. We successfully performed laparoscopic Duhamel procedures for the first time in Korea, and think it feasible, safe, andminimally invasive owing to size reduction of the incision and avoidence of intraperitoneal opening of the bowel.

Laparoscopic Adrenalectomy A comparison with open adrenalectomy

BACKGROUNDS: The advent of laparoscopic abdominal surgery made it possible to perform a laparoscopic adrenalectomy (LA). We have successfully performed 10 such operations since November 21, 1995. We retrospectively compared the effectiveness and the safety of a laparoscopic adrenalectomy with the effectiveness and the safety of an open adrenalectomy (OA). METHODS: The 45 patients with adrenal diseases who underwent an adrenalectomy from March 1990 to January 1998 were included in this study. Ten (10) laparoscopic cases comprised the study group, and 17 of the 32 open adrenalectomy cases, performed by anterior approach, comprised the control group. RESULTS: No one died from an adrenalectomy. Nine cases (45%) from the OA group needed transfusions (average:661 ml), but one patient from the LA group, who had required a conversion to a celiotomy, required a transfusion (400 ml). The operating times were, on average, 191 minutes in the OA group and 230 minutes in the LA group (p = 0.0384). The average size of the masses was 6.5 cm. The first days of walking after the operation was 3.4 days for the OA group and 1.3 days for the LA group (p = 0.0002). The patients' former regular diets were started on days 6.9 and 3.2 for the OA and LA groups, respectively (p = 0.0001). Postoperative in-hospital days were 17.5 for the OA group and 7.9 for the LA group (p = 0.0001). CONCLUSIONS: In comparison with an open adrenalectomy, a laparoscopic adrenalectomy showed better convalescent features:that is, less chance of transfusion, earlier recovery, faster resumption of the former diet, shorter postoperative hospital stays, and cosmesis. We think and suggest that a laparoscopic adrenalectomy is a safe and effective procedure, and hopefully it will become the standard choice of operation for various adrenal diseases.

Clinical Analysis of Carcinoid Tumors

We reviewed 36 patients with carcinoid tumors, which had been diagnosed at the St. Mary's hospital, Kangnam St. Mary's hospital and St. Vincent's hospital affiliated with Catholic Medical Center during 18 years from July 1978 to June 1996. The peak age group was the third decade (25%), and the sex ratio of males to females was 1.57 : 1 with an age range of 13 to 73 years. The most common location of the tumors was the bronchus, 11 cases; next were the rectum, 9 cases, and the appendix, 5 cases. These were followed by the stomach, the duodenum, the ovaries, the gallbladder, the thymus, the sigmoid colon, and the ascending colon. One of cases had such widespread metastases that its primary site of origin could not be determined. According to the embryological classification, the foregut was the most common site, 15 cases; next were the hindgut, 10 cases, and the midgut, 7 cases. The malignant potential is determined by the size, the histological feature of the tumor, and the status of the regional lymph nodes. Among these, the size of the tumor was the most important; the extent of the resection was usually determined by the size of the tumors.There were no cases of classic carcinoid syndrome, but two cases of rectal and duodenal carcinoid tumors had symptoms similar to those of the carcinoid syndrome. We experienced three synchronous carcinomas and one metachronous carcinoma of different sites on the carcinoid tumors.

Preliminary Experience with Laparoscopic Colectomy: Comparison with Conventional Colectomy

Laparoscopic techniques are being applied to the surgical management of the colorectal disease. Comparing our twenty-month experience in laparoscopic colectomy with that of the conventional (open) colectomy, we evaluate the efficacy and the safety of laparoscopic operations in colorectal disease. From April 1994 to December 1995, thirty-five patients underwent a colorectal surgery at St. Vincent's Hospital, The Catholic University of Korea, College of Medicine. Nineteen patients (5 males and 14 females; mean age 54.8 years) were included in the laparoscopic group and fourteen patients (5 males and 9 females; mean age 50.9) were included in the open group. Two conversion cases were excepted due to unfitness for comparison. Malignancy were 15 cases in the laparoscopic group and 9 cases in the open group. To estimate the general advantage of laparoscopic surgery, we compared durations of wound pain and ileus, postoperative hospital stays, and operative time between two groups. Then surgical margins and numbers of lymph nodes harvested were compared between two groups for an evaluation of radical curability of malignant disease. The operative procedures of two groups included abdominoperineal resection, anterior resection, low anterior resection, sigmoid colectomy, right hemicolectomy, and Hartmann's procedure. The conversion rate of laparoscopic colectomy was 9.5 % (2 of 21). In the laparoscopic group, we experienced some advantages in duration of pain and ileus, and postoperative hospital stays, even though there was no statistical significance. Comparable surgical margins and numbers of lymph nodes harvested proved the laparoscopic procedures to be worthy of radical surgery. Between the two groups, morbidity and mortality showed no difference. Although the operative time of the laparoscopic group was longer than that of the open group, it can be decreased with more experience, development of better instruments, and the specialization. Even if we require a long-term survival rate, our data suggest that the laparoscopic colectomy can be accomplished effectively and safely with the accumulation of experience and the advancement of equipments.