A Case of Bilateral Tubo-Ovarian Abscesses in a One-and-Half Year-Old Girl

Tubo-ovarian abscess is an end-stage disease of acute pelvic inflammatory disease (PID). Since most cases of PID are caused by sexually transmitted microorganisms, this is very rare in children. Here, we report an 1 1/2-year-old girl with bilateral tubo-ovarian abscesses. She was admitted to our Department with chief complaints of fever, vomiting and diarrhea. Abdominal ultrasonography and CT scanning of the patient showed solid and cystic masses in pelvic cavity. It was very difficult to differentiate the lesions from abscess and tumor. In addition, intravenous pyelography (IVP) and abdominal CT scanning of the patient showed both hydronephrosis and ureteral dilatation. Because of severe visceral adhesions, we could not perform laparoscopic examination of the pelvic masses. By exploratory operation and frozen biopsy, the masses were confirmed as tubo-ovarian abscesses and they were drained. In the bacterial culture, K. pneumoniae and E. coli were grown. The patient was treated with sensitive antibiotics and recovered from her disease. After 4 weeks of operation, IVP showed no abnormal findings and voiding cystourethrography (VCUG) showed grade I vesicoureteral reflux of the left side. It was suggested the hydronephroses were developed by the ureteral obstruction of tubo-ovarian abscesses.

Clinical Significance of Hyperplastic Polyps in the Distal Colon

To determine whether hyperplastic polyps found in the distal colon are associated with proximal adenomas, and to judge whether patients with distal hyperplastic polyps found during sigmoidoscopy might benefit from full colonoscopy. METHODS: We retrospectively analyzed 2333 consecutive patients who were examined with colonoscopy between January 1991 and December 1994. RESULTS: 247 of 2333 patients (10.6%) had one or more colonic polyps. The prevalence of adenomatous polyps alone was 72.5%, hyperplastic polyps 22.7%, and both 0.52%. The proportion of patients with distal hyperplastic polyps and proximal adenomatous polyps (4.4%) was not significantly different from the proportion of those without distal hyperplastic polyps (1.6%). Patients with distal adenomatous polyps, on the other hand, were significantly more likely to have proximal adenomatous polyps than those without distal adenomatous polyps. CONCLUSIONS: Distal hyperplastic polyps are not strong predictors of risk for proximal adenomatous polyps. Based on the results of this study, we do not believe that finding a hyperplastic polyp during sigmoidoscopy justifies doing a full colonoscopy to search for proximal adenomatous polpys.

Treatment of Acute Colonic Pseudo-obstruction (Ogilvie's Syndrome) with Intravenous Neostigmine

Acute colonic pseudo-obstruction is a functional disorder that closely mimics a mechanical large-bowel obstruction. Two such patients were treated by pharmacological manipulation of the parasympathetic innervation to the colon with intravenous neostigmine infusion. The two responded to treatment with passage with flatus and stool within several minutes with complete resolution of the symptoms, although the first patient required two additional infusions and the second patient required one additional infusion for subsequent recurrence. Dizziness occurred in one patient, and no other serious side effects were apparent. This pharmacological approach to the management of acute colonic pseudo-obstruction is suggested as an alternative to the other treatment options of colonoscopic decompression or surgery when conservative management has failed.

Suture Omentopexy of Perforated Duodenal Ulcer: Laparoscopic vs. Open Surgery

PURPOSE: Perforated duodenal ulcer can be treated by variable methods ranging from non-operative management to immediate definitive acid-reduction surgery. With the current availability of potent H2 blocker, proton pump inhibitor, and effective Helicobacter pylori (H. pylori) eradication regimens, ulcer recurrence is usually low and the need for definitive surgery has been reduced. Furthermore, the introduction of laparoscopic closure makes the principles of conventional surgical approach weakened at present and surgeons are faced with the choice of definitive surgery or omental patch repair, open or laparoscopic surgery. The aims of this study were to evaluate the feasibility and efficacy of laparoscopic omental patch repair in comparison with conventional surgery and to investigate the status of H. pylori infection and the role of eradication of H. pylori. In addition, we tried to introduce our unique surgical experience using a 3-port technique. METHODS: We treated 31 patients of perforated duodenal ulcer laparoscopically and compared with 30 patients operated by conventional omental patch repair. The patients treated by laparoscopy were evaluated for H. pylori status postoperatively. H. pylori infected patients received 1 or 2 weeks course of Omeprazole plus Amoxicillin and Clarithromycin. RESULTS: Laparoscopic repair was successful in 26 cases and the conversion rate was 16.1%. There was no statistically significant difference in terms of operative time and mortality. Morbidity was comparable between both groups, but the wound infection was more common in the open group. The clinical course and hospital stay were significantly shorter in the laparoscopic group. H. pylori infection rate was 47% and there were 2 cases of ulcer recurrence and 2 cases of reperforation in H. pylori negative patients. CONCLUSIONS: Laparoscopic closure of perforated duodenal ulcer using a 3-port technique is a technically feasible and safe alternative to open repair, with early recovery and low morbidity. H. pylori is positive in about half of perforated duodenal ulcer patients and should be eradicated in positive patients. Other risk factors on ulcer perforation should be identified.

A Case of Bilateral Tubo-Ovarian Abscesses in a One-and-Half Year-Old Girl

Tubo-ovarian abscess is an end-stage disease of acute pelvic inflammatory disease (PID). Since most cases of PID are caused by sexually transmitted microorganisms, this is very rare in children. Here, we report an 1 1/2-year-old girl with bilateral tubo-ovarian abscesses. She was admitted to our Department with chief complaints of fever, vomiting and diarrhea. Abdominal ultrasonography and CT scanning of the patient showed solid and cystic masses in pelvic cavity. It was very difficult to differentiate the lesions from abscess and tumor. In addition, intravenous pyelography (IVP) and abdominal CT scanning of the patient showed both hydronephrosis and ureteral dilatation. Because of severe visceral adhesions, we could not perform laparoscopic examination of the pelvic masses. By exploratory operation and frozen biopsy, the masses were confirmed as tubo-ovarian abscesses and they were drained. In the bacterial culture, K. pneumoniae and E. coli were grown. The patient was treated with sensitive antibiotics and recovered from her disease. After 4 weeks of operation, IVP showed no abnormal findings and voiding cystourethrography (VCUG) showed grade I vesicoureteral reflux of the left side. It was suggested the hydronephroses were developed by the ureteral obstruction of tubo-ovarian abscesses.

The Mechanism of Retinoic Acid-induced Growth Suppression in Head and Neck Squamous Cancer Cell Lines / 대한암학회지

PURPOSE: Retinonic acid (RA) has been reported to induce differentiation and growth inhibition in various head and neck squamous cancer cell (HNSCC) lines. We hypothesized that this growth inhi bition might be explained by RA-induced apoptosis on cell cycle arrest mechanism. Therefore, we studied the degree of RA-induced apoptosis with variable RA concentration and exposure duration. MATERIAL AND METHODS: The flow cytometric evaluation of apoptosis degree and cell cycles were carried out with 7-amino actinomycin D (7AAD) and propium iodide (PI) respectively, with var ious RA exposure durations (2, 3, 6 day) and concentrations (conrol, 10 6, 10 7, 10 8, 10 9, 10 10 mole). Two different HNSCC lines (1483, SqCC/Y1) were used and the experiment was repeated twice. RESULTS: The maximal fraction of apoptosis in 1483 and SqCC/Y1 cell lines were observed at same concentration and exposure duration (1483: 6th day & 10 6, mole, and SqCC/Y1: 6th day & 10 6 mole). In our experimental model, RA did not induce specific cell cycle arrest in these HNSCC lines. However we observed S phase fraction increase in SqCC/Y1 cell line after RA treatment. CONCLUSION: We suppossed that in HNSCC lines, RA-induced cell growth inhibition could be explained by not only RA-induced apoptosis but also cell cycle arrest. Futher, in vitro study has been carried out to elucidate the RA-iduced cell growth inhibition mechanism in our laboratory.

Prognostic Value of nm23 Protein Expression and Tumor Angiogenesis in Breast Cancer

Mortality associated with human breast carcinoma is almost entirely due to subsequent cancer metastasis, but the molecular basis of this metastasis is not well established. The nm23 gene was originally identified by differential hybridization between two murine melanoma cell sublines which have low and high metastatic potential, and located in chromosome 17q22. This gene has been known to be involved in the metastasis of several cancers and its down-regulation usually associated with metastasis or disease progression in breast cancer. Tumor angiogenesis, the process leading to the formation of new vessels, plays a central role in tumor progression and distant metastasis. It is implicated in the phenomenon of dormant micrometastasis. This study was designed to determine the prognostic value of expression of the nm23 protein and tumor angiogenesis in breast cancer. Also, these two factors were compared with established clinicopathological prognostic factors and hormone receptors. 118 paraffin embedded surgical specimens of breast cancer were obtained from March, 1988 to February, 1994 and were selected for study. The expression of nm23 protein was studied by using immunohistochemical staining with anti-nm23/nuclear diphosphate kinase A. Tumor angiogenesis was quantified under light microscope by counting of the tumor microvessels(MVC) which were highlighted with anti-CD31 antibodies. The patient were allocated into two groups by mean number of MVC, one group was less 42 and the other was over 42. All the patients were female. The nm23 protein expression was positive in 74(63%) cases and was negative in 44(37%) cases. There was a significant correlation between nm23 protein expression and histologic grade(p=0.023). Positive expression of nm23 protein was correlated with positive estrogen(p=0.031) and progesterone receptors(p=0.001). Also Positive expression of nm23 protein was correlated with longer disease free survival(p=0.0026) and overall survival(p=0.0048). The group of MVC42. But the MVC and established clinicopathological prognostic factors did not show any correlation, neither with hormone status. When the nm23 protein and angiogenesis were considered together, 50 cases of negative nm23 protein and MVC<42 showed the best survival in overall(p=0.0111) and disease free survival(p=0.0114) among the four groups of each combination. In conclusion, the expression of nm23 protein and tumor angiogenesis can be used as new prognostic factors in conjunction with established other prognostic factors.

Incidence of Bone metastasis and Necessity of Preoperative Bone Scanning in Breast Cancer Patient

The bone scanning has been routinely used for initial report in 1970s showed a high incidence of positive-up to 45%-results in preoperative assessment of these patients. But recent reports have questioned the routine use of bone scanning in preoperative basis by the result of much lower positive result as rate less than 1%. On this point, we analyzed 224 cases of breast cancer, which were operatively managed in the period from January 1990 to January 1995 at the department of surgery, Korea university medical center. All the cases were performed bone scanning preoperatively and followed up more than 3 months. The analytic evaluation was done about age, stage of disease, serum alkaline phosphatase level according to menopausal status and its correlation to the result of bone scanning. The result was 14 positive cases(6.3%) from bone scanning in 224 breast cancer cases, but only 8 cases(3.6%) were true positive with bone metastasis. While 35 stage I cases and 69 stage IIa ones had no true positive, 1 among 63 stage IIb cases(1.6%), 5 among 46 stage IIIa cases(10.9%) and 2 among 11 of stage IIIb ones(18.2%) had true positive. There were high bone metastasis rate in premenopausal patients(5/108 cases, 4.6%) than postmenopausal patients(3/116, 2.6%) (p0.05). All true positive patients' alkaline phosphatase level shows within normal limits. According to this result, we think that preoperative bone scanning is unnecessary as a routine procedure in Stage I and IIa breast cancer patients. Stage IIb needs more and further study for confirming the indication of bone scanning as combinations with other predictive indicator or symptoms. About Stage III disease, we conclude the bone scanning is absolutely helpful.

Partial anomalous pulmonary venous drainage not associated atrial septal defect: one case report / 대한흉부외과학회지

No abstract available.