ABSTRACT
We describe a case of actinomycosis of the gallbladder mimicking carcinoma. Sonography showed a hypoechoic mass replacing gallbladder lumen and engulfing a stone; contrast-enhanced computed tomography showed a heterogeneously enhanced thickened gallbladder wall with subtle, disrupted luminal surface enhancement, which formed a mass. As a result of the clinical and radiologic presentation, our impression was of gallbladder carcinoma. Actinomycosis should be included in the differential diagnosis when sonography and computed tomography findings show a mass engulfing the stone in the gallbladder and extensive pericholecystic infiltration with extension to neighboring abdominal wall muscle.
Subject(s)
Aged , Humans , Male , Actinomycosis/diagnostic imaging , Cholecystectomy , Contrast Media , Diagnosis, Differential , Gallbladder Diseases/microbiology , Gallbladder Neoplasms , Tomography, X-Ray ComputedABSTRACT
Patients with Peutz-Jeghers syndrome often suffer complications of the polyps, such as intussusception, bowel obstruction, and bleeding. Furthermore, repeated operations may be required in some patients, which may result in short-bowel syndrome. Intraoperative enteroscopy during a laparotomy for this syndrome was introduced. This can avert multiple enterotomies and decrease bowel resection segments. We report the cases of three consecutive patients with Peutz-Jeghers syndrome who recently underwent intraoperative enteroscopy via enterotomy with successful removal of most small-bowel polyps. The large polyps of the jejunum required an enterotomy for their removal, but smaller polyps at the lower ileum were identified and removed by using intra-operative total enteroscopy. A more complete polypectomy can be performed using this technique, thus allowing patients with Peutz- Jeghers syndrome a longer interval between laparotomies and a reduction in the symptoms attributed to polyps.
Subject(s)
Humans , Endoscopy , Hemorrhage , Ileum , Intestinal Polyps , Intraoperative Care , Intussusception , Jejunum , Laparotomy , Peutz-Jeghers Syndrome , PolypsABSTRACT
PURPOSE: Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by a decreased aortomesenteric angle that causes a duodenal obstruction. It usually occurs after a period of weight loss, nausea or vomiting due to a partial obstruction of the third portion of the duodenum. If conservative management fails, then a laparotomy, with a duodenojejunostomy, is indicated. A minimally invasive laparoscopic approach to the retroperitoneum, or duodenal, operation has recently been introduced. Although the role of laparoscopy in the management of SMA syndrome is not clearly defined, a laparoscopic duodenojejunostomy may be an alternative approach for its surgical treatment. METHODS: We retrospectively reviewed and analysed our experience of 8 cases of SMA syndrome, and included another 45 cases that had previously been reported in the Korean literature since 1967. RESULTS: There was no gender predominance, but SMA syndrome was more common in younger patients. There were several diseases, or underlying conditions, associated with gastrointestinal, or other general conditions, in SMA syndrome. With respect to its surgical management, most cases in Korea were treated with a duodenojejunostomy. We recently experienced two cases of superior mesenteric artery syndrome, which were treated laparoscopically. The operation time and lenghth of hospital stay were acceptable, with no complications. CONCLUSION: SMA syndrome shows a greater predominance in young age, and is associated with many other diseases, or conditions, in Korea. A duodenojejunostomy is the best choice of operative procedure for the treatment of SMA syndrome. A laparoscopic duodenojejunostomy is also a feasible, alternative option in the treatment of SMA syndrome, providing the benefits of a definitive and minimally invasive surgical technique for a duodenal obstruction.
Subject(s)
Humans , Arteries , Duodenal Obstruction , Duodenum , Korea , Laparoscopy , Laparotomy , Length of Stay , Mesenteric Artery, Superior , Mesentery , Nausea , Retrospective Studies , Superior Mesenteric Artery Syndrome , Surgical Procedures, Operative , Vomiting , Weight LossABSTRACT
Superior mesenteric artery (SMA) syndrome is rare disorder, which is caused by a reduction in the aortomesenteric angle causing a duodenal obstruction. It is usually occurs after a period of weight loss, nausea, and vomiting by a partial obstruction of the third portion of the duodenum. If conservative management fails then a laparotomy with a duodenojejunostomy is indicated. Recently, a minimally invasive or laparoscopic approach to the retroperitoneum or duodenal detachment was introduced. Although the role of a laparoscopy in managing SMA syndrome is not clearly defined, a laparoscopic duodenojejunostomy may be an alternative approach to the surgical treatment of SMA syndrome cases. Two cases of superior mesenteric artery syndrome that were treated laparoscopically after medical therapy failure are described. The 4-port procedure was performed. A dilated bowel on the third portion of the duodenum was observed below the transverse mesocolon and to right of the superior mesenteric artery. A proximal loop of the jejunum was anastomosed to the duodenum using an endoscopic GIA stapler. The surgery time and hospital length of stay were acceptable. No complications were encountered in this study. A laparoscopic duodenojejunostomy is a feasible alternative option for treating SMA syndrome. It provides the benefits of being a definitive and minimally invasive surgical technique in a duodenal obstruction.
Subject(s)
Adult , Female , Humans , Male , Duodenostomy , Duodenum/diagnostic imaging , Jejunum/surgery , Laparoscopy , Superior Mesenteric Artery Syndrome/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
PURPOSE: KAI1/CD82 gene is a recently identified metastasis suppressor gene on human chromosome 11p11.2. Alteration to or reduction of this molecule may allow tumor cells to invade the surrounding tissue and blood vessels. Decreased KAI1 expression seems to be involved in the progression of human prostate, lung and possibly breast cancer, and recently has been demonstrated in several colorectal cell lines. The aim of this study is to determine whether the gene is altered to investigate it in the progression and metastatic process of rectal carcinoma. In addition, its prognostic significance is also evaluated. METHODS: Total 108 tumor samples from primary, metastatic rectal carcinoma were prepared for immunohistochemical study with an anti-KAI1 polyclonal antibody. To analysis the correlation between KAI1 expression and clinicopathological parameter and to evaluate for relation expression and survival. RESULTS: Decrease of KAI1 protein expression was associated with the depth of invasion of tumor (P < 0.0001) and node metastasis (P < 0.05). Liver metastasis showed reduced KAI1 expression when compared with their corresponding primary tumor. Although there was a trend for deteriorating survival from patients with KAI1-positive tumors to those with KAI1-decreased and -negative tumors, it was not significant statistically (P Subject(s)
Humans
, Kangai-1 Protein
, Blood Vessels
, Breast Neoplasms
, Cell Line
, Chromosomes, Human
, Down-Regulation
, Genes, Tumor Suppressor
, Liver
, Lung
, Neoplasm Metastasis
, Prostate
, Rectal Neoplasms
ABSTRACT
BACKGROUND/AIMS: Recent studies suggest possibility of continuous and prolonged liver ischemia exceeding one hour. We compared mortality rates, liver function, serum Interleukin-6(IL-6) concentration and liver cell necrosis after continuous and intermittent hepatic ischemia in rats. METHODS: Sixty rats were divided into 6 groups to compare 7 day mortality rate. Continuous and intermittent left hepatic inflow occlusion was performed for a total period of 45, 60 and 90 minutes. In a separate study, following 90 minutes continuous or intermittent ischemia, systemic blood was sampled at 0 minute, 6 hours and 24 hours after final clamp release for measurement of SGOT, SGPT and IL-6. Pathologic examination was performed 24 hours or 7 days after reperfusion accordingly. RESULTS: There were no differences in the mortality rates within seven days. There were no differences in the level of SGOT, SGPT and IL-6 between each experimental group. In a pathologic examination, similar liver cell necrosis was found in each group until 24 hours of reperfusion. However, at 7 days after reperfusion, significantly higher grade of hepatic necrosis was noted in the group having continuous ischemia compared with intermittent ischemia of 90 minutes(p<0.05). CONCLUSION: Continuous ischemia is associated with significant risk in the aspect of pathologic study, although it did not affect short term mortality rates.
Subject(s)
Animals , Rats , Alanine Transaminase , Aspartate Aminotransferases , Interleukin-6 , Ischemia , Liver , Mortality , Necrosis , Reperfusion , Reperfusion InjuryABSTRACT
Natural Killer cell lymphoma pursued a highly aggressive clinical course, with the aggressiveness and poor prognosis in this biologically distinct primary gastrointestinal lymphoma, a more vigorous systemic therapy should be considered in the addition to surgery. We report an unusual case of aggressive primary Natural Killer cell (NK cell) lymphoma of the cecum. A 38-year old man admitted for intractable fever, diarrhea, and hematochezia. The patient diagnosed as primary NK cell cecal lymphoma with perforation after surgical resection. The primary lesion was deep ulceration with perforation and it revealed metastasis to liver. The immunophenotype of the tumor cell were CD56+, CD3+, UCHL-1+, CD45RO+, polyclonal IGH, TCRr, so confirmed NK cell type lymphoma.
Subject(s)
Adult , Humans , Cecum , Diarrhea , Fever , Gastrointestinal Hemorrhage , Killer Cells, Natural , Liver , Lymphoma , Neoplasm Metastasis , Prognosis , UlcerABSTRACT
Backgroud/Aims: Because the status of the main pancreatic duct (MPD) is the most important determinant for pancreatic trauma associated morbidity and mortality, early diagnosis and optimal treatment are critical, especially in MPD injury. METHODS: Twenty-three pancreatic trauma patients were divided into two groups according to the interval between trauma and endoscopic retrograde pancreatography (ERP). The clinical and laboratory findings, CT and ERP results were described. The treatment modality and its clinical outcome were assessed according to ERP findings. RESULTS: The pancreatic duct was injured in 14 of the 23 trauma patients: 11 MPD injuries and 3 branching duct injuries. CT scan correctly predicted the MPD injury in only 6 (54.5%) of the 11 patients, whereas ERP correctly demonstrated the origin and the degree of pancreatic duct injury in all patients. Through contrast leakage from the MPD into peritoneal cavity, ERP confirmed an MPD injury in 8 patients and they underwent surgical exploration. Three patients who showed parenchymal leakage from branching duct recovered with conservative treatment. Transpapillary pancreatic stents were successfully inserted into the distrupted MPD in 3 patients who showed that the contrast leakage was confined to the pancreatic parenchyme and they achieved complete resolution of the pancreatic leaks after a 3-month follow-up period. The late ERP group (>72 hours after trauma) had a significantly higher pancreas associated complication rate and a tendency to a longer hospital stay than the early ERP group. CONCLUSIONS: Early ERP is the most useful tool for demonstrating the presence of MPD injury as well as planning the optimal treatment modality according to the degree of pancreatic duct injury.
Subject(s)
Humans , Early Diagnosis , Follow-Up Studies , Length of Stay , Mortality , Pancreas , Pancreatic Ducts , Peritoneal Cavity , Stents , Tomography, X-Ray ComputedABSTRACT
Backgroud/Aims: Because the status of the main pancreatic duct (MPD) is the most important determinant for pancreatic trauma associated morbidity and mortality, early diagnosis and optimal treatment are critical, especially in MPD injury. METHODS: Twenty-three pancreatic trauma patients were divided into two groups according to the interval between trauma and endoscopic retrograde pancreatography (ERP). The clinical and laboratory findings, CT and ERP results were described. The treatment modality and its clinical outcome were assessed according to ERP findings. RESULTS: The pancreatic duct was injured in 14 of the 23 trauma patients: 11 MPD injuries and 3 branching duct injuries. CT scan correctly predicted the MPD injury in only 6 (54.5%) of the 11 patients, whereas ERP correctly demonstrated the origin and the degree of pancreatic duct injury in all patients. Through contrast leakage from the MPD into peritoneal cavity, ERP confirmed an MPD injury in 8 patients and they underwent surgical exploration. Three patients who showed parenchymal leakage from branching duct recovered with conservative treatment. Transpapillary pancreatic stents were successfully inserted into the distrupted MPD in 3 patients who showed that the contrast leakage was confined to the pancreatic parenchyme and they achieved complete resolution of the pancreatic leaks after a 3-month follow-up period. The late ERP group (>72 hours after trauma) had a significantly higher pancreas associated complication rate and a tendency to a longer hospital stay than the early ERP group. CONCLUSIONS: Early ERP is the most useful tool for demonstrating the presence of MPD injury as well as planning the optimal treatment modality according to the degree of pancreatic duct injury.
Subject(s)
Humans , Early Diagnosis , Follow-Up Studies , Length of Stay , Mortality , Pancreas , Pancreatic Ducts , Peritoneal Cavity , Stents , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Temporary interruption of blood flow to the liver is often unavoidable during operations for extensive injury of the liver or for major liver resection. Following ischemia- reperfusion, transient dysfunction of the liver occurs. It has been suggested that reactive oxygen metabolites play an important role in microvascular reperfusion injury. Superoxide dismutase (SOD) and dimethylthiourea (DMTU) are known to be antioxidants that scavenge oxygen free radicals to reduce microvascular reperfusion injury. This experiment studied the effect of SOD and DMTU on warm ischemia-reperfusion injury to the liver and compared inflow occlusion and hepatic vascular exclusion (HVE) after 20 minutes of ischemia. METHODS: One hundred fourteen healthy male Sprague-Dawley rats weighing around 250 g were used. The rats were divided into control (n=18) and experimental groups (n=96). The control groups included sham, SOD, and DMTU control groups. The experimental groups included inflow occlusion, SOD- pretreated inflow occlusion, DMTU-pretreated inflow occlusion, and inflow and outflow occlusion (HVE) groups. These 4 experimental groups had 24 rats each. The rats were sacrificed immediately, and at 24 hours, 48 hours, and 72 hours after reperfusion, and specimens were obtained from left anterior lobe of the liver. The specimens were prepared using routine methods for electron-microscope observations. RESULTS: The ultrastructures of the hepatocytes in all the experimental groups were similar to those of the normal control rats after just 20 minutes of ischemia. In the inflow occlusion group, dilatation and sacculation of the cisternae of the endoplasmic reticulum and mitochondria with many electron dense granules were observed in the hepatocytes after 24 hours of reperfusion. In the course of reperfusion, damage progressed until 72 hours after reperfusion. The HVE group showed more serious changes than the inflow occlusion group. The SOD- and the DMTU-treated groups showed clear attenuation of liver damage after 48 and 72 hours of reperfusion.CONCLUSION: The ultrastructural changes of hepatocytes after 20 minutes of ischemia became more prominent by prolonging the reperfusion time. The changes after hepatic inflow occlusion were less prominent than those after HVE. DMTU and SOD attenuated the injury to hepatocytes after warm ischemia-reperfusion.
Subject(s)
Animals , Humans , Male , Rats , Antioxidants , Dilatation , Endoplasmic Reticulum , Free Radicals , Hepatocytes , Ischemia , Liver , Mitochondria , Oxygen , Rats, Sprague-Dawley , Reperfusion , Reperfusion Injury , Superoxide Dismutase , SuperoxidesABSTRACT
PURPOSE: Prolonged hepatic ischemia followed by reperfusion in surgery or transplantation results in severe cell death. Apoptosis is one type of cell death and occurs under various conditions. Apoptosis differs from necrosis not only morphologically but also in the mediators and mechanism of injury. It has been recently recognized that oxygen-free radicals are major mediators of apoptosis during ischemia/reperfusion. It was reported that pretreatment with a radical scavenger, such as catalase or superoxide dismutase (SOD) attenuated the apoptotic cell death and that old animals showed a higher catalase, SOD, glutatione peroxidase activity in their livers than young rats. This study was designed to characterize the types of cells within the liver and the extent to which those cells undergo apoptosis during ischemia/reperfusion in rats of different ages and to investigate the effect of dimethylthiourea (DMTU), a scanvenger of reactive hydroxyl radicals, on the induction of apoptosis in old rats. METHODS: Young male Sprague-Dawley rats at 5 weeks of age weighing about 200 gm and old rats at 15 weeks of age weighing about 450 gm were subjected to 30-minute ischemia. Liver ischemia was performed by inflow occlusion. Another group of old rats was injected with DMTU before the clamping. The rats were sacrificed immediately and at 1, 3, and 24 hour(s) after reperfusion. The specimens were prepared using in-situ staining for apoptotic cell and bodies by using terminal deoxytransferase-mediated dUTP- biotin nick-end labelling (TUNEL) methods. RESULTS: The number of apoptotic sinusoidal endothelial cells was larger than the number of hepatocytes during ischemia/reperfusion. The apoptosis of hepatocytes significantly increased at 1 hour and at 3 hours in the young group. Although the number of cells in the old group was lower than that in young rats, an increase of TUNEL positive hepatocytes cells was noted at 1 hour. There was significant increase in the DMTU-pretreated old rats until 24 hours afterreperfusion. The number of apoptotic sinusoidal endothelial cells was noticeably higher in DMTU- pretreated old rats than you only defined two groups previously: old and young in the other group. In young rats, but not old rats, an increase of positive sinusoidal endothelial cells was observed at 1 hours after reperfusion. CONCLUSION: These results suggested that old rats have more resistance to ischemia/reperfusion injury than young rats and that DMTU dose not attenuate apoptosis of sinusoidal endothelial cells after ischemia/reperfusion, but dose attenuate apoptosis of hepatocytes in the liver.
Subject(s)
Animals , Humans , Male , Rats , Apoptosis , Biotin , Catalase , Cell Death , Constriction , Endothelial Cells , Hepatocytes , In Situ Nick-End Labeling , Ischemia , Liver , Necrosis , Peroxidase , Rats, Sprague-Dawley , Reperfusion , Superoxide DismutaseABSTRACT
Laparoscopic cholecystectomy has recently been accepted as a procedure of choice for treating cholelithiasis. Its complication rates were known to be comparable to classical cholecystectomy. Hemobilia is very rare after cholecystectomy but is one of the lethal complications that may occur weeks to months after the operation. Therefore, it is important to keep in mind that hemobilia due to communications between cystic duct and cystic artery or right hepatic artery pseudoaneurysms, can occur in the patients who have history of laparoscopic cholecystectomy when they have upper gastro-intestinal bleeding. Selective hepatic arteriography can be an important diagnostic and therapeutic modality having high success rate (81-96%). We report a case of hemobilia caused by cystic artery pseudoaneurysm following laparoscopic cholecystectomy which was undergone 1 month before admission, and will discuss the mechanism and the treatment of the pseudoaneurysm associated with hemobilia.
Subject(s)
Humans , Aneurysm, False , Angiography , Arteries , Cholecystectomy , Cholecystectomy, Laparoscopic , Cholelithiasis , Cystic Duct , Hemobilia , Hemorrhage , Hepatic ArteryABSTRACT
PURPOSE: We designed this study to find out the risk factors affecting the patency rate after creation of arteriovenous fistula (AVF) for maintenance hemodialysis. METHODS: From March 1997 to April 1999, a total of 206 AVF creation operations [126 of radiocephalic fistula (RCF), 59 of brachiocephalic fistula (BCF), and 21 of grafted fistula] in 165 patients were undertaken by single surgeon under the same surgical technique and principles. In 128 cases (62.1%), operation was performed for the first time and in 42 cases (20.4%), the trial was second time. However in remaining 36 cases (17.5%), the operation was three or more than three times. RESULTS: After a mean follow-up of 9 months, 27 patient death and 53 fistula failure were identified. The overall patency rate at 1- and 2-year were 72.6% and 61.1%. The success patency rate, excluding the early failure cases, at 1-and 2-year were 78.4% and 65.9%. In multivariate analysis, the presence of 2 or more than 2 times failed AVF episodes was the significant risk factor forecasting the poor fistula patency (p0.05). In univariate analysis, the 1- and 2 year patency rate of more than third AVF trial group were 53.2% and 25.3%, which showed significant poor patency rate comparing with the ones of first or second AVF trial group (76.73% in 1- and 67.9% in 2-year) (p=0.0197). CONCLUSION: In conclusion, repeated trial of AVF creation (= or >3) in itself was the most powerful significant risk factor affecting the patency rate after AVF creation. The successful first or second trial is very important to expect a long-term patency. Well designed surgery under delicate surgical technique in early referred patient should promise the long-term patency even in patients with diabetes or patients requiring grafted fistula.