A case of Combined Resection for Synchronous Primary Carcinoma of Gallbladder and Duodenum

PURPOSE: The incidence of multiple primary malignant tumor has ranged from 0.7% to 11% in the medical literature. Various organs in the digestive system are the sites of multiple primary cancer (MPC). MPC may be synchronous or metachronous depending on the interval between their diagnosis. To the best of our knowledge, there are only rare reports of resected cases of synchronous primary carcinomas that developed in the GB and duodenum. METHODS: We present here a patient who underwent an operation for synchronous primary carcinomas of the GB and duodenum. A 51-year-old female was admitted for postprandial abdominal discomfort. CT scan and MRI of the abdomen showed a 3 x 2 cm sized heterogenously enhancing mass in the GB and a 3.7 x 2.7 cm sized hetrogenously enhancing mass in the 2nd portion of the duodeum. The laboratory findings, including the tumor markers, were non-specific. An elective operation was done under the impression of combined GB cancer and cancer in the 2nd portion of the deuodenum. On the operative findings, there was a 3 x 2.5 cm sized mass in the GB and a 5 x 4 cm sized duodenal mass with near complete luminal obstruction 3 cm distal from the pyloric ring. Radical cholecystectomy with wedge resection of the liver bed and Whipple's operation was performed. RESULTS: On microscopic examination, the GB mass was well differentiated adenocarcinoma and the duodenal mass was moderately differentiated adenocarcinoma, and one lymph node (a lymph node along the common hepatic artery) among the 18 dissected lymph nodes was invaded by tumor cells. The microscopic findings showed that the GB mass and duodenal mass were synchronous primary carcinomas. The patient recovered uneventfully and is alive and doing well without evidence of recurrence at 21-months of follow up evaluation. CONCLUSIONS: We report here on a case of combined curative resection for synchronous primary carcinomas of the gallbladder and duodenum.

Bone Mineral Density in Postsurgical Thyroxine Replacement / 대한내분비외과학회지

PURPOSE: Bone turnover is increased in patients suffering with hyperthyroidism, and this results in osteoporosis. Especially after total thyroidectomy for the treatment of thyroid papillary cancer, it is necessary to pay attention to osteoporosis because we must treat these patients with suppressive thyroxine therapy. METHODS: Among the patients who underwent endocrine surgery of Chonnam National University, 110 cases had taken thyroxine for more than one year. We analyzed them on the basis of their medical record. The study consisted of women between 45 and 74 years of age who were treated with thyroxine for more than one year, who had total thyroidectomy performed for thyroid papillary carcinoma and who taken thyroxine for 12~142 months (mean: 53 months). We measured the bone mineral density at the lumbar spine and the femoral neck with using dual energy X-ray absorptiometry. RESULTS: The bone mineral density of the lumbar spine and femur neck was significantly reduced with the increasing the duration of thyroxine medication. Yet this was not significant after adjusting by age. There was correlation between the TSH levels and bone mineral densities. CONCLUSION: After total thyroidectomy, it may be necessary to evaluate the bone mineral density of the patients who were treated with suppressive thyroxine and also to warn them about osteoporosis.

Internal Hernia as a Complication of Laparoscopic Nephrectomy

A-57-year-old male patient suddenly developed cramping pain in the left lower abdomen with a slight abdominal distension. He had undergone a laparoscopic nephrectomy for transitional cell carcinoma 7 days earlier. An abdominal CT scan revealed a dilated small bowel loop and an internal hernia was suspected. Surgery revealed a herniation of the jejunal loop through defects in the retroperitoneum, which was successfully reduced. We report a case of an internal hernia following a laparoscopic nephrectomy. To the best of our knowledge, this is the only reported case of an internal hernia as a complication of laparoscopic nephrectomy.

Effects of Bilateral Ureteral Obstruction on Renal Aquaporin Expression / 대한신장학회잡지

BACKGROUND: Obstruction of urinary tract is common cause of renal disfunction. Recent discovery of aquaporin water channels expressed in the kidney and various organs has faciliated our understanding of water transport across the permeable epithelial cell membrane. This study was performed to investigate the effects of bilateral ureteral obstruction on renal expression and cellular distribution of these water channels in rat kidney. METHODS: Male Sprague-Dawley rats were divided two groups. The abdominal cavity was opened and 2-0 silk ligatures were proximally placed on both ureters in experimental group. Sham-operated group was treated in the same procedures except ligation. After closure of the abdomen, the animals were maintained for 48 hr while being given food and water ad libitum. Kidney sections of both groups were processed for immunohistochemistry using antibodies to aquaporin-1, 2, 3, and 4. RESULTS: Immunoreactivity for aquaporin-1 of sham-operated kidney was detected in the apical and basolateral plasma membrane of proximal tubules and thin limb of Henle loop. That of bilateral ureteral obstructed kidney was decreased in the both tubules, especially in the proximal tubules and thin limb of Henle loop of inner medulla. Immunoreactivity for aquaporin-2 of sham-operated kidney was the most prominent in apical region and moderate in cytoplasm of the principal cells of entire collecting ducts. That of obstructed kidney was markedly decreased in entire collecting duct, especially inner medulla except inner stripe of outer medulla. The decrease was in parallel between the apical region and cytoplasm. Immunoreactivity for aquaporin-3 of sham-operated kidney was the most prominent in the basolateral plasma membrane of principal cells of entire collecting duct. That of obstructed kidney was decreased in entire collecting duct. Papillary epithelium was stained in obstructed kidney. Immunoreactivity for aquaporin-4 of sham-operated kidney was moderate in the basolateral plasma membrane of principal cells of collecting ducts of inner stripe of outer medulla and inner medulla. In obstructed kidney, immunoreactivity was detected in cortical and outer stripe of outer medullary collecting duct, and decreased in inner stripe of outer medulla and inner medulla. A marked heterogeneity was observed in inner medullary collecting duct. CONCLUSION: These results indicate that alterations of expression of aquaporin proteins after bilateral ureteral obstruction may lead to change in renal functions, such as urine concentrating ability.

A Case of Synchronous Double Primary Cancer Associated with the Biliary Tract

Multiple synchronous malignancies are defined as the occurrence of two or more primary malignant tumors whose pathogenetic processes are believed to be independent or unrelated. Multiple synchronous biliary carcinomas are not frequently reported. The diagnosis is often made as a result of incidental intraoperative discovery of a gallbladder mass during surgical treatment of extrahepatic cholangiocarcinoma. We experienced a case of synchronous double primary cancer of the gallbladder and distal common bile duct confirmed by pathologic evaluation, and report the case with a review of the clinical literature.

A Case of Tuberculous Splenic Abscess

Splenic abscesses in the tropics assume importance because of their unusual aetiology. They may be secondary or primary. Splenic tuberculosis is rare and a delay in diagnosis is common. The authors report a patient with splenic and mesenteric tuberculosis who was admitted to the hospital because of an abdominal cyst incidentally detected on ultrasonogram during prenatal fetal monitoring in the Department of Obsterics. The patient had already been treated with anti-tuberulous drugs for the previous 18 months after being diagnosed as tuberulous pleuritis. Abdominal sonography and computerized tomography revealed the presence of multiple hypoechoic and hypodense splenic lesions and mesenteric cysts. Diagnostic splenectomy and excision of the mesenteric cysts revealed multiple necrotic masses in the spleen, consistent with the microscopic findings of caseating granulomatous inflammation. Following splenectomy, the patient was also treated with an anti-tuberculosis regimen with no recurrence of symptoms.

Multivariate Analysis of Prognostic Factors in Colorectal Cancers

PURPOSE: Colorectal cancer is one of the most common gastrointestinal malignancies in Korea. However, there have been few studies concerning the prognosis of colorectal cancer in Korea. The purpose of this study is to elucidate the prognostic factors of colorectal cancer and identify those independent prognostic factors. METHODS: A total of 960 cases with colorectal cancer who received surgery at Chonnam University Hospital of Korea between Jan 1, 1980 and Dec 31, 2000 were analyzed retrospectively with respect to several prognostic factors including age, sex, location of tumor, histologic grade, stage, Borrmann type, depth of invasion, invasion of lymph node, tumor size, liver metastasis, peritoneal seeding, preoperative serum CEA level and DNA ploidy. Survival curves were estimated by the Kaplan-Meier method, and differences were analyzed by the Log-rank test. The Cox proportional hazard model was used for multivariate analysis. The data was considered to be significant when the p value was less than 0.05. RESULTS: The mean age was 57 years and median follow-up was 26.7 months. By univariate analysis, significant prognostic factors were stage by TNM, histologic grade, invasion of lymph node, liver metastasis, peritoneal seeding, depth of invasion, Borrmann type and preoperative serum CEA level. By multivariate analysis, TNM stage was the most obvious independent prognostic factor. Histologic grade and depth of invasion were also significant independent prognostic factors. CONCLUSION: In this study, TNM stage, histologic grade and depth of invasion were revealed independent prognostic factors.