Post-Traumatic Guillain-Barre Syndrome / 대한신경근육질환학회지

Guillain-Barre syndrome (GBS) is acute inflammatory demyelinating polyradiculoneuropathy, which is often related to post-infectious etiology. However, GBS has also been reported to be caused by non-infectious factors such as trauma. This report describes a rare case of post-traumatic GBS with dramatic response to immunoglobulin therapy. And here, we also discussed about the importance of differential diagnosis with critical illness polyneuropathy.

A Case of Anti-NMDA Receptor Encephalitis with Normal Findings on Initial Diagnostic Tests

No abstract available.

Asymptomatic Bilateral Internal Carotid Artery Occlusion with Ring Finger Protein 213 Gene Polymorphism

No abstract available.

A Clinical Review in 1,108 Cases of Suspected Appendicitis: with Focusing on the Characteristics of Reproductive Age Women

PURPOSE: Appendicitis is the most common abdominal surgical emergency. The diagnosis of appendicitis can be difficult, occasionally taxing the diagnostic skills of even the most experienced surgeon, and especially for diagnosing reproductive women. This study was designed to evaluate the various pathologies of the appendix and the other intraabdominal organs in patients who were preoperatively diagnosed with acute appendicitis, and we wanted to analyze the difference of the perioperative results between the reproductive women and the other patients. METHODS: The study was a retrospective analysis of 1,108 appendectomies that were performed from September 2003 to August 2006. The data were analyzed for the following parameters: the age-related and sex-related incidence of acute appendicitis, the rates of negative appendectomy, negative operation and appendicular perforation, and the incidence of other encountered pathologies. In addition, we present the clinical results of the reproductive women. RESULTS: The diagnostic accuracy for acute appendicitis was 87.2%. The negative appendectomy rate was 11.6% and it was significantly higher (20.8%) in the reproductive women than in the male patients of the same age (P=0.001). On the clinical analyses of the reproductive aged appendicitis group showed they a shorter pain duration and a higher WBC count, and more frequent epigastric discomfort, nausea, vomiting and RLQ tenderness (P< 0.05). CONCLUSION: We noted a high rate of negative appendectomy among reproductive female patients, so more care should be taken to diagnose these patients.

Clinicopathological Analysis of Solid Pseudopapillary Tumor (SPT) of the Pancreas

PURPOSE: Solid pseudopapillary tumor (SPT) of the pancreas is a rare benign or low-grade pancreatic neoplasm with distinct clinicopathologic features. The purpose of this study was to evaluate the clinical presentation of SPT and to examine the etiology of this tumor by performing immunohistochemical staining. METHODS: From October 1994 to March 2005, 35 cases of SPT who underwent operations were retrospectively reviewed. The clinicopathologic findings and late results of treatment were studied in 7 cases of borderline malignant SPT and in 28 cases of the benign SPT. Immunohistochemical staining was performed for alpha1-antitrypsin, alpha1-antichymotrypsin, neuron specific enolase, chromogranin, synaptophysin, vimentin and cytokeratin. RESULTS: The mean age of the patients was 31.8 years. SPT's were more common in women (77.1%) and the tumors were usually located in the body and the tail of the pancreas (68.6%). There were statistically significant differences in the men (P=0.016), for the masses with calcification (P=0.029), and for the solid masses (P=0.018) between the malignant SPT (including the borderline malignant SPT) and the benign SPT (P=0.014). The SPTs stained positive for alpha1-antitrypsin, neuron specific enolase, and vimentin in all cases, and they were alpha1-antichymotrypsin positive in 94.1% (16/17), chromogranin positive in 18.8% (3/16), synaptophysin positive in 12.5% (2/16), and cytokeratin positive in 18.2% (2/11). All 35 patients underwent curative resection and they are all alive without any evidence of recurrence at a mean follow-up of 44.2 months. CONCLUSION: SPT is a rare tumor that behaves less aggressively than other pancreatic tumors, and surgical resection can result in cure. This tumor thought to originate from a stem cell capable of differentiating into endocrine cells or exocrine cells.

Intestinal Obstruction Due to a Torsional Huge Meckel's Diverticulum

Meckel's diverticulum is an uncommon cause of acute abdominal pain and small bowel obstruction in adults. We present a case of a 28-yr-old man with acute pain for whom the diagnosis of Meckel's diverticulum was not suspected until exploratory laparotomy was performed. The procedure revealed a huge gangrenous Meckel's diverticum that was torsioned, and it gave rise to ileal obstruction.

Clinical Analysis for Mucinous Cystic Neoplasms of the Pancreas

PURPOSE: Mucinous cystic neoplasms are at best potentially malignant and present a spectrum of neoplasia ranging from benign neoplasms to invasive carcinoma. The purpose of this study was to investigate the clinicopathologic characteristics relevant to the specific diagnosis of mucinous cystic neoplasms of the pancreas. METHODS: We retrospectively reviewe the clinical features and histopathologic findings of 34 cases who underwent op-erations with mucinous cystic neoplasms of the pancreas from October 1994 to March 2005. RESULTS: There were 25 mucinous cystadenoma (73.5%), 6 mucinous cystic tumor of borderline malignant potential (17.6%), 1 in situ mucinous cystadenocarcinoma (2.9%), 2 invasive mucinous cystadenocarcinoma (5.9%). Their ages ranged from 23 to 76 years with a mean of 44.2. The 88.2% of the patients were women. The 94.1 % of the tumors were located in the body or tail of the pancreas. The tumor size ranged from 2 to 17 cm, especially the mean size of invasive mucinous cystadenocarcinoma was 13.5 cm. The accuracy of CT for diagnosing was 81.8% and that of US was 53.3%. After a follow-up duration from 5 to 103 months, all patients are still alive. However, recurrent disease developed in all of the 2 patients with invasion. CONCLUSION: Our results suggest that complete surgical resection is certainly the gold standard treatment for mucinous cystic neoplasms. A histologic diagnosis of invasive cysta-denocarcinoma portends a dismal prognosis, so close long term follow up is necessary due to tumor recurrence.

Surgical Management for Intraductal Papillary Mucinous Tumor (IPMT) of the Pancreas Confined to Branch Duct

PURPOSE: Intraductal papillary mucinous tumor (IPMT) of the branch duct type has been reported that it is associated with less aggressive histologic features than the main duct type. The purpose of this study was to evaluate the clinicopathologic features and the optimal management of branch duct type IPMT. METHODS: From October 1994 to November 2004, 30 cases who underwent operations with branch duct type IPMT were reviewed retrospectively. Clinicopathologic findings and late results of treatment were studied in 20 cases of the benign (adenoma, borderline malignancy) group and in 10 cases of the malignant (carcinoma in situ, invasive carcinoma) group. RESULTS: There were statistically significant difference in the 3 factors (mural nodule (P=0.030), diameter of the main pancreatic duct (P=0.036), main location of the tumor (P= 0.031)). There was no statistically significant difference in th survival analysis between the main duct type IPMT including combined type IPMT and the branch duct type IPMT (P=0.572), but there was significant difference between the benign group and the malignant group of the branch duct type IPMT (P=0.049). CONCLUSION: The long-term follow up result of the branch duct type IPMT is similar to that of the main and combined duct type IPMT. Therefore, it is not safe just to monitor the branch duct type IPMT. Our results suggest that surgery is certainly the gold standard treatment for the branch duct type IPMT. And after operation, close long term follow up with appropriate treatment is necessary due to tumor recurrence.

Adenosquamous Carcinoma of the Pancreas

Adenosquamous carcinoma of the pancreas is a rare tumor; its clinical features and radiologic findings are not well known, so the definite preoperative diagnosis of this tumor is quite difficult. We report a case of adenosquamous carcinoma of the pancreas. A 47-year-old woman was admitted on April 2005 to our hospital with a complaint of left upper quadrant pain. The serum CA 19-9 and CEA level were increased up to 4019.08 U/ml and 13.13 ng/ml, respectively. An abdominal computed tomographic (CT) revealed a 10x9 cm sized well-defined homogenous lobulated mass in the pancreas tail. Under the impression of solid-pseudopapillary neoplasm (SPN) or nonfunctioning islet cell tumor, distal pancreatectomy and splenectomy with wedge resection of stomach were performed. The specimen consisted of a huge pancreatic mass that was attached to the posterior wall of stomach. The cut surface of pancreatic mass revealed a huge whitish infiltrative mass. Microscopically, glandular elements of ductal adenocarcinoma were admixed with solid squamoid complexes or squamous cell carcinoma components. Although the origin of the adenosquamous carcinoma has not been well proven, the histopathological findings of our case support the theory of squamous metaplasia.

Surgical Treatment for Hepatolithiasis with Hidden Intrahepatic Cholangiocarcinoma

PURPOSE: Hepatolithiasis causes many complications as well as an intrahepatic cholangiocarcinoma, which means that it should definitely be treated. However, it is difficult to make an accurate diagnosis for a concurrent cholangiocarcinoma prior to surgery. This study examined the surgical treatment for a hepatoithiasis with a hidden intrahepatic cholangiocarcinoma. METHODS: A retrospective analysis for patients who had undergone a hepatic resection for hepatolithiasis between September 1994 and July 2004 was made by comparing them in two groups. One group comprised of patients with hepatolithiasis only (group H) and the other group comprised of patients with hepatolithiasis and a hidden cholangiocarcinoma of which the preoperative diagnosis had failed (group HC). The prognostic factors, such as age, gender ratio (M: F), symptoms and the duration of their onset, tumor markers and total bilirubin, preoperative radiological findings, intraoperative findings, and operation type were analyzed. RESULTS: Group H consisted of 261 patients and the group HC consisted of 5. In group HC, 2 cases of tumor necrosis were misdiagnosed as a liver abscess, 1 case of hilar cholangiocarcinoma was misdiagnosed as severe cholangitis, and another case of intrahepatic cholangiocarcinoma was misdiagnosed as duct dilatation with periductal inflammatory proliferation. On the other hand, the presence of a history of a undergoing hepatobiliary surgery, the preoperative radiological findings of a liver abscess and lymphadenopathy, the type of surgery, and the site of the intrahepatic stones were statistically different in the two groups. CONCLUSION: A hidden cholangiocarcinoma should be suspected preoperatively in cases in whom there is a history of undergoing hepatobiliary surgery, the preoperative radiological findings of a liver abscess or lymphadenopathy. In addition, a meticulous exploration for a possible incidental tumor mass with an additional consultation of a frozen biopsy should be carried out intraoperatively to determine if the preoperative finding of a liver abscess is a tumor necrosis.

Surgical Outcome and Prognostic Factors of Primary Gallbladder Carcinoma

PURPOSE: Cancer of the gallbladder, which is the eighth most common malignancy of the digestive system in Korea, is almost always associated with an unfavorable prognosis, and the clinical outcome has not improved much over the past couple of decades. This study was intended to examine our surgical experience and to evaluate the prognostic significance of the clinicopathological factors for a primary carcinoma of the gallbladder. METHODS: The data of 202 patients with gallbladder carcinomas operated on at our surgical department over a period of 10 years from May 1994 to Dec. 2003 were retrospectively reviewed. RESULTS: Overall, the 5-year survival was 46.8% with the median survival of 58.8 months. The histopathological type and grade, TNM stage, stage grouping, symptom, CA 19-9 level, and jaundice were significant prognostic factors. Among the 85 patients with T2 cancer, the outcome after a resection was better than that after simple cholecystectomy. CONCLUSION: A complete tumor resection and no lymph node involvement are associated with a good prognosis. The long-term survival may be achieved by an early diagnosis with a curative, radical resection. Additionally, a radical resection may be beneficial for patients with a T2 gallbladder carcinoma.

Safety of Donor in Adult-to-Adult Living Donor Liver Transplantation

PURPOSE: Right lobe donation was advocated to overcome size-mismatch between left lobe and larger-size recipient in living donor liver transplantation (LDLT), however, safety of donor is a major concern. The purpose of this study is to evaluate the safety of donor in adult-to-adult LDLT. METHODS: Retrospective analysis of 104 adult-to-adult LDLT was performed by comparison of left lobectomy (n=50) and right lobectomy (n=54) groups. RESULTS: The median age of donors was 28 years and offsprings were most common donors (33.7%). The right lobe graft provided larger mass by 60% than left lobe. The ratio of residual liver volume to total liver volume, operation time, intraoperative blood loss, and postoperative ICU stay showed significant differences in both groups. Recovery of liver profiles was delayed by several days in right lobectomy group, but all donors recovered uneventfully. There was no mortality nor sequela in both groups. Severe postoperative complications occured more frequently in right lobectomy group, and they were bile leakage (n=3), postoperative bleeding (n=5), and portal vein thrombosis (n=1). All complications were controlled with safety. CONCLUSION: Right lobe harvesting can be safe but should be performed only by expert operators because there is potential operative risk. To minimize operative complications, attention should be paid to every step of procedures and to postoperative surveillance.