A Case of Therapy-Related Acute Myeloid Leukemia Following 5-Fluorouracil Chemotherapy

No abstract available.

Effect of Modified Rhomboid Excision and Limberg Flap for the Treatment of Recurrent Pilonodal Sinus

PURPOSE: Recurrence of a pilonidal sinus after surgery is well known. Many surgical techniques have been developed but there is no efficient method available. This study evaluated the results of a Modified Rhomboid excision and Limberg flap of a pilonidal sinus, and examined the value of this method. METHODS: Five patients, who had been treated with a modified rhomboid excision and Limberg flap procedure for recurrent pilonidal sinus, were evaluated. The patient's age, gender, duration of symptoms, length of hospital stay, complications, time required for the return to normal activity, and prior history of surgery were evaluated. RESULTS: The mean age of the 5 patients (4 males and 1 female) was 22.7 years, and all had a history of previous surgery. The mean duration of symptoms was 4.2 years. Only one patient developed seroma. The mean hospital stay was 7.2 days, and the mean time to normal activity was 14.4 days. There was no recurrence. CONCLUSION: Modified Rhomboid excision and Limberg flap procedure is the optimal method for treating recurrent pilonidal sinus with low complication and recurrence rates.

Differences in Bacterial Translocation Across the Large andSmall Bowel Walls after Ischemia and Reperfusion Injury

PURPOSE: Bacterial translocation is a major problem after ischemic bowel injuries such as mesenteric vessel obstruction or bowel strangulation. In this study, we investigated the differential character of bacterial translocation from the large and small bowel using Escherichia coli labeled with technetium 99m (99mTc-E.coli). METHOD: Male Sprague-Dawley rats weighing 200~300 g underwent laparotomy. The superior mesenteric artery and marginal arteries of the proximal jejunum and distal colon were occluded for 30 minutes and then re-perfused for 4 hours. A suspension containing 99mTc-E.coli was injected into the lumen of the proximal colon (group 1) and distal ileum (group 2). In the sham operation group (groups 3, 4), 99mTc-E.coli was also injected in the same manner without induction of ischemia and reperfusion injury. Two hours after E. coli injection, blood, mesenteric lymph nodes (MLN), liver, spleen, and lung were collected for quantitative analysis of radioactivity. Large and small bowel specimens were also harvested for microscopic examination. Student's t-test was used for statistical analysis. P< or =0.05 was considered statistically significant. RESULT: Compared with group 1, group 2 showed a significant increase in 99mTc-E.coli translocation from the lumen to all organs investigated, except with regard to MLN. The sham operation group (groups 3, 4) showed scanty bacterial translocation. The mucosal epithelial cell layers of both groups (groups 1, 2) were comparatively intact. CONCLUSION: The 99mTc-E.coli method was found to be suitable for studies of bacterial translocation from the small and large bowels. Bacterial translocation is much more likely to occur across the small bowel wall than across the large bowel wall.

Primary Choriocarcinoma of the Stomach Presenting as Gastric Hemorrhage

We report a case of primary gastric choriocarcinoma with liver metastasis and transverse colon invasion. A 51-year-old man presented with sudden syncope, and a gastroscopic biopsy showed gastric adenocarcinoma with recent bleeding. A palliative subtotal gastrectomy and segmental resection of the transverse colon was done, and formal histopathologic findings proved the tumor to be a choriocarcinoma with poorly differentiated adenocarcinoma. Choriocarcinoma is characterized by biphasic histologic patterns composed of syncytiotrophoblasts, cytotrophoblasts, and positive immunostaining for cytoplasmic hCG, as well as an increased serum hCG levels. This unusual tumor probably resulted from dedifferentiation of a primary adenocarcinoma. Therefore, in the case of a poorly differentiated adenocarcinoma of the stomach, meticulous examination to detect trophoblastic differentiation on tissue sections and evaluation of serum hCG should be made. This tumor is rapidly invasive and resistant to multiple chemotherapies.

Prognostic Analysis in Colorectal Cancers Requiring Emergency Operations

Purpose: Emergency operative interventions for colorectal cancers are usually required in those patients with obstruction and perforation, even though they represent poor prognosis and low resectability. The purpose of this study is to evaluate clinical characteristics and survival rates of colorectal cancer patients with obstruction, perforation or both. METHODS: The clinical characteristics, resectabilities and survival rates of 433 patients with colorectal cancers who were operated on at the department of surgery, Hanyang University from March 1999 to March 2003 were retrospectively analyzed through medical records and telephone surveys. The patients were grouped as follows: Group1, without obstruction or perforation (n=387), Group2, with obstruction only (n=22), Group3, with perforation only (n=14) and Group4, with both complications (n=10). RESULTS: Patients with complications had higher operative mortality (group2: 9.1%, group3: 14.3%, group4: 10%) than those without complications (2.6%). Patients with perforation only (group 3) and with both complications (group 4) had poorer 5-year survival rates (group 3: 25%, group 4: 25%) than group1 (51.1%), however there was no statistical significance for the group with obstruction only. Conclusion: Colorectal cancer patients with perforation had poorer operative mortalities and survival rates, and the obstructed cases had poorer operative mortality. These poor prognosis appeared to be largely a function of more advanced stage of disease due to peritoneal seeding of cancer cells for the perforated cases and higher operative mortality because of other secondary complications for obstructed cases. Earlier diagnosis and prompt operative interventions should be attempted in those with suspected complications.

Clinical Experience of Partial Resection of Desmoid Tumor and Perforated Small Bowel for Unresectable Desmoid Tumor with Small Bowel Perforation after IPAA for FAP

A complicated unresectable desmoid tumor is a life threatening disease. An unresectable desmoid tumor with perforation of the small bowel, was experience at my institute. In this case, the desmoid tumor had invaded major vessels, so that complete resection of the tumor would necessitate resection of most of the small bowel. A desmoid tumor with perforation of the small bowel following ileal pouch anal anastomosis for familial adenomatous polyposis is rare. If the patent had not undergone the operation, they would not have survived. Also, had the tumor with a perforated bowel been completely, resected, they also would not have survived. Therefore, a partial resection of the desmoid tumor and perforated small bowel was performed, with a good result. It is not necessary to abort such an operation, with potentially fatal consequences, due to an unresectable desmoid tumor with a perforated small bowel. Herein, this case is reported with a review of the literature.

Linitis Plastica in Colon, Rectum and Ileum Mimicking Crohn's Disease

Primary linitis plastica of the colon, rectum and ileum is very uncommon, especially when it mimicks the colonic Crohn's disease. We observed this uncommon disease in a 26-year-old male. Barium enema showed characteristics of multiple consentric lesions in the entire colon, and some irregularity in mesenteric border of the terminal ileum. Colonofiberscopic finding showed multiple cobble stone appearance of the colon with a skipped area. The result of the biopsy illustrated that there was a poorly differentiated adenocarcinoma 5 cm from the anal verge. A longitudinal duodenal ulcer was discovered using the gastroscopic method. Upper gastrointestinal and small bowel series showed a suspicious gastric and duodenal Crohn's disease, and also showed ileum involvement. Operative finding showed a lead pipe appearance of the total colon, and the rectum was very fixed to the bladder and pelvic floor. The mesentery of the colon was thickened, and some portion of mesenteric creeping of the ileum was found to be mimicking Crohn's disease. The duodenal wall was also thickened. The biopsy result showed that there was a total involvement of the colon, rectum and ileum with signet-ring cell type adenocarcinoma with intact mucosa with the exception of a little portion of the rectum. This disease is very uncommon, and it is difficult to diagnose preoperatively, especially in Oriental countries.

Clinical Evaluation of Wide Excision and Simple Primary Closure of Pilonidal Sinus

PURPOSE: Recurrence after surgery for the pilonidal sinus is well known. Many operative techniques have been developed, but an efficient method has not yet been developed. The aim of this study was to evaluate the results of a wide excision and simple primary closure of the pilonidal sinus, and to assess the usefulness of this method. METHODS: The patient's age and sex, duration of symptoms, length of hospital stay, complications, recurrence rate, time required for the return to normal activity, and past history of surgery were evaluated. RESULTS: The mean age of 42 patients was 21.2 years, 41 of these patients were male. 15 patients had a histoty of a previous operation. Twelve had a history of an incision and drainage, and 3 had a history of an excision. The mean duration of the symptoms was 3.5 years. Six among the 42 patients suffered from a complication, and there was only 1 case of recurrence. CONCLUSION: A wide excision and a simple primary closure of the pilonidal sinus is an easy, simple method and the recurrence rate is also low. Therefore, it is still a desirable method of treatment for the pilonidal sinus.

Delayed Superficial Transposition of Cephalic Vein for Salvage of Brachiocephalic FIstula

The small diameter and sclerosis of the veins are the main causes of failure of autogenous arterio-venous fistula(AVF) for hemodialysis. In addition, the deep location of veins prevents adequate access postoperatively, as exemplified by the frequent requirement of transposition of basilic veins either primarily or delayed. As for the cephalic veins, superficial transposition was not emphasized. We report a case of brachiocephalic AVF which required delayed superficial transposition for access. We emphasize that the depth of veins should be considered for adequate creation of AVF.

Penetrating Injury of Inferior Vena Cava by Abdominal Stab Wound

Injuries of the inferior vena cava (IVC) might be caused by a blunt trauma, which usually affects the retrohepatic portion. Injuries of the infrahepatic IVC are usually caused by penetrating injuries and rarely occur in Korea. We report a case of a penetrating injury of the IVC at the infrahepatic suprarenal portion with a review of other reported cases.

A Clinical Review of Initial 20 Cases of Laparoscopic Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholaminesecreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

A Clinical Review of Initial 20 Cases of Laparoscopic Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholaminesecreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

A Case of Linitis Plastica Involving the Entire Colon, Ileum, and Appendix / 대한소화기학회지

Linitis plastica of the colon is an uncommon presentation of primary colorectal cancer. This entity of colorectal cancer is characterized by a diffuse infiltrating tumor with desmoplastic reaction and poor prognosis. Although widespread infiltration is the main feature of linitis plastica, the tumor extending to more than 2 segments of the colon is uncommon. We report a case of primary linitis plastica involving the entire colon, ileum and appendix. The clinical characteristics are discussed with a review of literatures.

A Case of Persistent Primary Hyperparathyroidism Caused by Parathyroid Carcinoma Recurred Along Esophagus / 대한내분비외과학회지

Primary hyperparathyroidism is most commonly caused by an adenoma but rarely by carcinoma of the parathyroid gland. The common clinical manifestations were bone pain, recurrent urinary stone and asymptomatic. Parathyroid carcinoma is different from the parathyroid adenoma in that the invasion to the surrounding tissue or metastasis to the regional lymph nodes and persistent hyperparathyroidism are common in parathyroid carcinoma. It is important that radical en-bloc resection of parathyroidal mass including the lobe of the thyroid that is on the same side and post op follow up is important as well. There is the need of radical surgery even in recurrence of metastatic parathyroid carcinoma for improving hypercalcemia. We experienced a 50-year-old man with primary hyperparathyroidism caused by a parathyroid carcinoma in the left lower parathyroid which was confirmed by histopathologic findings. He was cured by using en-bloc resection of the parathyroid including the left lobe of the thyroid and a left side modifed radical neck dissection. But after 2 months hypercalcemia occurred again and therefore examination with computed tomography, endoscopic ultrasonography and esophagogram revealed a metastasis to the upper and mid esophagus. We opened the chest cavity and resected the surrounding mass of the esophagus. the mass was confirmed to be metastatic tissue from parathyroid carcinoma by histopathologic finding. therefore we report this case.

Paraplegia with Rapid Deterioration in a Thrombocytopenic Patient: A Case Report of Acute Aortic Thrombosis

Acute aortic occlusion is rare but poses a high mortality and morbidity. Prompt diagnosis and treatment is essential. Typical presentation is rest pain with bilateral absent femoral pulse. When the non-typical symptoms predominate such as paraplegia, acute abdomen or sudden-onset hypertension, diagnosis may be difficult. We experienced a case of acute aortic thrombosis who suddenly developed paraplegia and rapidly deteriorated within several hours. When the paraplegia developed, he was under treatment with heparin and urokinase, was thrombocytopenic, and the femoral arteries were pulsatile. Spinal cord compression due to bleeding complication had to be ruled out. Duplex sonography and lumbar CT scan were not diagnostic. Aortic thrombosis was diagnosed by abdominal CT scan. This case illustrates the need for high suspicion of acute aortic occlusion presenting with paraplegia especially in patients with associated atherosclerotic disease.

New Operative Method for Transsphincteric Fistula

PURPOSE: The complications after surgery for trans sphincteric anal fistula are anal incontinence due to cutting of the external anal sphincter muscle and recurrent anal fistula. Several methods have been developed to alleviate this condition, but they still have many complications. We performed surgery for transsphincteric anal fistula by a new method with excellent results and therefore report this new method as another treatment modality for transsphincteric anal fistula. METHODS: We performed surgery for transsphincteric anal fistula on 12 patients at Hanyang University Kuri Hospital between March 1999 and December 2001. RESULTS: There were no recurrences in any of the 12 patients, all of whom kept continence after surgery. Our operative method involve coring out and fistulectomy, laying open, closure of the defected external sphincter muscle and partial closure of the skin of the external opening. CONCLUSION: Our simple and modified method for transsphincteric anal fistula showed excellent results, especially in terms of the rate of recurrence and fecal incontinence. We therefore recommended this easy and simple method for surgery for transsphincteric anal fistula.

Clinical Value of Prophylactic Ureteral Stent Indwelling During Laparoscopic Colorectal Surgery

One of the hazards of colorectal surgery is ureteric injury. The aim of this study was to evaluate the results of ureteric catheterization regarding its safety and operative time. One-hundred sixty two patients underwent laparoscopic segmental left or right colectomy. The mean time for placement of ureteric catheters was 11.4 min for the right hemicolectomy and 11.3 min for the left hemicolectomy group. The mean preparation times for right hemicolectomy and left hemicolectomy (group 1 vs. group 2) were 54.7 vs. 39.1 min (p=0.00001) and 61.4 vs. 47.6 min (p=0.006), respectively. There were no significant differences in the laparoscopic operative time in either the right or left hemicolectomy groups (134.2 vs. 145.5 min and 198.4 vs. 170.1 min, respectively). There was no morbidity directly related to the ureteric catheters and in fact the incidence of postoperative urinary tract infection was lower in group 1 (1.5%) than in group 2 (5.3%) (p<0.05). Although the use of ureteric catheters added a mean of 11.3 min to the surgical procedure, the overall anesthetic time for right hemicolectomy was no longer than that for left hemicolectomy. The morbidity rate was quite acceptable. Thus, ureteric catheters may be useful in selected cases of laparoscopic left and right colorectal resections.

A Case of Anal Fistula Which Has an External Opening in Thigh

Infection of the anal glands is the most common cause of anorectal abscess. Ductal obstruction may result in stasis, infection, and abscess formation. Drainage of the abscess through the perianal skin, whether spontaneous or operative, may lead to a fistula. the fistula in the fascial or fatty planes, especially within the intersphincteric space, located between the internal and the external sphincter extending into the ischiorectal fascia. Fistulas are usually divided into four main anatomic categories as described by Parks and colleagues in 1976.(1,2) The most commonly occurring is the intersphincteric fistula, constituting 70% of all anal fistulas. The infectious process starting from its origin passes directly downward to the anal margin, but there are some variants of these type of fistulas that are less common and more complex to treat. Transsphincteric (25%), suprasphincteric (4%), and extrasphincteric (1%) fistulas constitute the remaining 30% of other anal fistulas those are not intersphincteric. Extrasphincteric fistula is rare and difficult to treat. It begins from the perineal skin penetrating directly downward to the rectal wall above the levator ani. The tract it forms is completely outside the sphincteric apparatus. There are numerous causes to anal fistulas, including trauma, carcinoma, and Crohn's disease. We report a rare case of a 46 year old male patient with anal fistula which has a long abnormal course and an external opening in thigh. The patient suffered from pain on the external opening for 3 years, with dirty discharge.

Immediate Free TRAM Flap Reconstruction after Mastectomy in Breast Cancer Patients / 한국유방암학회지

PURPOSE: Despite the advocation of a breast conserving approach to the treatment of breast cancer, many women continue to surgically require or choose mastectomy for the treatment of breast cancer. In many cases, breast reconstruction after mastectomy is being performed using tissue expander, implants or a myocutaneous flap. In recent years, immediate free transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction has become an cosmetically and economically attractive alternative, compared to other types of reconstruction, although the technique is not easy. The author's experience with 25 successful immediate free TRAM flap reconstructions is reviewed. METHODS: We analyzed 25 cases of immediate free TRAM reconstruction that were performed at the Department of Surgery, Hanyang University Hospital, from August 1995 to June 2000, for age, histologic type, stage and estimated degree of patient satisfaction. RESULTS: The patient age distribution ranged from 26 to 58 years old, the mean age was 38.3, and the majority of tumors were invasive ductal carcinoma (13 cases) and intraductal carcinoma (8 cases). All tumor sizes were less than 3 cm (Tis: 8 cases, T1: 8 cases, T2: 7 cases) with the exception of the phyllodes tumors (8 cm and 6 cm). The stage was from 0 to IIB (0: 7 cases, I: 7 cases, IIA: 8 cases, IIB: 1 case, phyllodes tumor: 2 cases). Immediate posto-perative complications included 3 cases of bleeding and 1 case of wound infection at the donor site. According to the patients' expressed opinions, almost all patients were pleased with the result. There was no local recurrence during the follow-up period except for one case of bone metastasis that developed. CONCLUSION:This technique undoubtedly can play a major role in the so called "onco-plastic" surgical management of breast cancer.

A Clinical Review of 20 Initial Cases of Laparoscopic Adrenalectomy

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholamine-secreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.