A Case of endobronchial metastasis from prostatic carcinoma / 결핵

Carcinoma of the prostate is a common malignancy affecting elderly men. Lung metastasis from prostate cancer occurs frequently, but tumor metastasis to the central bronchi that clinically mimics primary bronchogenic carcinoma are very rare. We report a 73-year old man with endobronchial metastasis from prostatic carcinoma presented with respiratory symptom cough. Diagnosis of issues taken from materials which were used for bronchoscopic biopsy and prostate biopsy and immunohistochemical staining for prostate specific antigen(PSA) confirmed a case of endobronchial metastasis from prostatic carcinoma. Hormonal therapy(LHRH agonist) was applied to this patient.

Abdominal Actinomycosis Initially Diagnosed As a Colorectal Cancer or Periappendiceal Abscess / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonic actinomycosis is a rare disease with clinical and radiographic findings that overlap those of other inflammatory and neoplastic conditions. We performed this study to analyze clinical manifestation, characteristic radiologic findings of 5 cases of abdominal actinomycosis, which was initially diagnosed as a colorectal cancer or periappendiceal abscess. METHODS: We analyzed chief complaint, predisposing factor, presence of leukocytosis and sulfur granule, involved site, presence of LN involvement and abdominal CT findings, retrospectively. RESULTS: The most common clinical manifestation was abdominal pain. In 3 cases, predisposing factors were identifiable, which were intrauterine contraceptive device (IUD), previous appendectomy, and diabetes mellitus (DM) respectively. Leukocytosis was noted in 4 cases (80%) and sulfur granule in all 5 cases. Sigmoid colon was the most common involved site (4 cases) followed by appendix and rectum. On computed tomography, inhomogeneous mass or severe inflammation along the bowel wall or serosa was noted. Explorations were performed in 4 cases. Preoperative diagnosis was a colorectal cancer in 3 cases and periappendiceal abscess in 1 case. CONCLUSIONS: Actinomycosis should be born in mind in the differential diagnosis of patients with IUD, previous appendectomy and DM, presenting leukocytosis and CT finding of inhomogeneous mass and relatively uncommon LN involvement to eliminate unnecessary explorations.

A Case of Carcinoid Tumor of the Rectum / 대한소화기내시경학회지

Carcinoid tumor primarily affects the intestinal tract, which arise from the Kulchitsky cells found at the base of the crypts of Lieberk hn. Rectal carcinoids are relatively uncommon lesions, representing only 1.3 percent of all rectal tumors. Rectal carcinoids have benign course and are usually asymptomatic. While their prognosis is generally favorable, it is known that about 15% of these tumors metastasize. Rectal carcinoid tumors should be treated appropriately and aggressively when indicated. Present-day treatment programs call for radical cancer resection only for lesions larger than 2 cm in diameter and local resection for all others. We have experienced a case of carcinoid tumor of the rectum treated by endoscopic polypectomy.

A Case of Lower Esophageal Ring with Dysphagia / 대한소화기내시경학회지

Lower esophageal ring are uncommon. We experienced a case of lower esophageal ring in a 51-year-old man who had intermittent swallowing difficulty for 2 years. Endoscopy revealed a circumferential narrowing at 34 cm from the incisors and congested and eroded mucosa was noted proximal to the ring. Esophagography revealed an elevation of G-E junction above the diaphragm and a reflux of dye from the stomach into the esophagus with thickened and irregular esophageal wall.

Secondary augmentation rhinoplasty with dermofat graft

The nose is an important aesthetic projection affecting the profile of the face. Correction of the flat nose is one of the most popular aesthetic procedures in the orient. The Asian nose is characterized by flat, bulbous appearance due to thick and dense skin. Flared nostrils and restriction of nasal tip projection due to underdevelopement of the medial crus of alar cartilage, and short columella are also characteristic of Asian noses. Nasal augmentation has taken an increasingly important role in rhinoplasty. There are many procedures and materials for augmentation. Various implants have been used for many years but several kinds of complications have still occurred after these augmentations. After the primary augmentation rhinoplasty using foreign body such as paraffin, silicone, and ivory, some patients experienced complications. Experienced complications such as : 1) thinning of the skin on nose dorsum 2) hypertrophy of capsule 3) displacement of nasal tip 4) thinning of the skin creating dead space 5) movable implants In above cases, we could not reapply with silastic implant. In general, the use of foreign materials was mentioned only to be condemned for the purposes of above cases. The failure and complication rates were high, and the complications frequently result in distortions that were permanent and irreparable. In view of the availability, variety, and quality of autogenous materials, it was impossible to recommend anything but autogenous materials for secondary rhinoplasty. Dermofat was an autogenous material that could be as effectively used in nose dorsum. Its clinical record of survival and contouring in the author's practice has been excellent. Originally 276 patients underwent primary augmentation rhinoplasty. Out of the 276, 29 patients with nose complications underwent secondary augmentation rhinoplasty with dermofat. Our study, which began in September 1993 and ended in September 1996, concerned these 29 Patients. The follow up interval ranged for 3 to 36 months. Tissues must have time to heal so that an accurate assessment of the secondary procedure is made possible. The minimal time of two or three months is recommanded of patients with previous operation but we removed foreign body and then simultaneously augmented with dermofat when there is no evidence of inflammation and further resolution. As part of the procedure in order to minimize the scar on donor site, we harvested dermofat, in an elliptical shape, 5cm above from infra-gluteal fold. We harvested about 10% more dermofat than was required because of its potential decreased in volume caused by primary contracture and resorption. Primary contracture is the main cause of the decrease in volume. To prevent contracture, resorption and displacement of the dermofat, we have to accurately fix the implant in the central porticn of the nose. Using this method, we could have prevented complications and yielded more satisfactory results by accurately fixing the dermofat in the central portion.