Laparoscopic Resection of Bleeding Dieulafoy's Lesion in the Jejunum Following Intraoperative Localization Using Endoscopy

A Dieulafoy lesion is a relatively rare, but potentially life threatening cause of gastrointestinal bleeding, which accounts for only 1~2% of acute cases. The most common site is the stomach and most extragastric lesions are frequently found in the duodenum followed by the esophagus, the colon, and rectum. However, jejunum and ileum are extremely rare. I report on a case of a 38-year-old female who underwent laparoscopic resection of a bleeding Dieulafoy's lesion in the jejunum following intraoperative endoscopy.

Case report of solitary giant hepatic lymphangioma

A hepatic lymphangioma is a rare benign neoplasm that is usually associated with systemic lymphangiomatosis. A solitary hepatic lymphangioma is extremely rare. Therefore, we present a rare case of a female patient who underwent right hepatectomy for solitary giant hepatic lymphangioma. A 42-year-old female presented to the emergency department with complaint of severe abdominal pain of the right upper quadrant. Abdominal computed tomography showed an approximately 23×30-cm sized, giant, relatively well-defined, homogenous cystic mass with few septa in the right liver (segments VII and VIII). The preoperative diagnosis was a giant hepatic cystadenoma or cystadenocarcinoma. We performed right hepatectomy. The permanent histopathological report revealed cystic lymphangioma of the liver. Although the prognosis of solitary hepatic lymphangioma after surgical resection is favorable, recurrence has been reported in literature.

The Influence of Mycophenolate Mofetil and Azathioprine on the Same Cadaveric Donor Renal Transplantation

In order to evaluate whether immunosuppressive agents such as mycophenolate mofetil (MMF) and azathioprine would differently influence the outcome of the renal transplants, we prospectively analyzed the incidence of acute rejection episodes, cytomegalovirus infection within the first 6 months following renal transplantation and 5 yr graft survival rate after minimizing influences of donor factors by grafting the same cadaveric donor kidney. There was no significant difference in sex, HLA mismatch, cold ischemic time, and patients' weight between the two groups. Contrary to the previous studies which demonstrated that MMF could lower the incidence of acute rejection episodes and improved graft survival rate, the two groups showed no significant difference in the incidence of acute rejection episodes and 5-yr graft survival rate as well. This discrepancy in these results might explain that donor factors could be important to cadaveric renal transplantation. Thus, we suggest that the influences of donor factors should be considered in further clinical studies of cadaveric renal transplantation.

Correlation between Vascular Endothelial Growth Factor (VEGF) Expression and Recurrence in Small Hepatocellular Carcinoma

PURPOSE: Angiogenesis occurs in response to tissue damage, and vitally important for tumor growth and metastasis. In several tumors, including hepatocellular carcinomas (HCC), vascular endothelial growth factor (VEGF) is one of the most potent tumor angiogenetic factors. This study was planned to evaluate the correlation between the expression patterns of VEGF and the clinicopathological features of patients with small HCC. METHODS: Twenty patients, who underwent curative partial hepatectomy from May 2000 to December 2003, were included in this study. Western blotting was used in order to observe the expression patterns of VEGF, and was performed on tissues acquired from tumor mass and non-tumor region resected specimens, using monoclonal mouse lgG (Santa Cruz, CA, USA) as a primary antibody. To determine the VEGF expression patterns, the tumor/ non-tumor ratio (T/N) of the expression level was calculated, and compared and analyzed with respect to the clinicopathological features of the patients. RESULTS: There were 19 males and 1 female, with an average age of 46.6 years. The average tumor size and T/N ratio were 2.4 cm and 1.077, respectively. Clinicopathological factors had no significances on the expression of VEGF. There were significantly higher disease free survival rates in patients with a T/N ratio > or = 0.8 (P=0.0004). CONCLUSION: These results suggest that the expression of VEGF in HCC cells, by itself, may be a significant factor in the recurrence prognosis of small HCC. Higher VEGF expressions in non-tumor tissues seem to be correlated with higher recurrence rates of HCC.

Risk Factors of Morbidity and Mortality Following Surgical Resection for Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Recently, mortality following surgical resection for hepatocelluar carcinoma has been reduced significantly. Morbidity, however, is still significant. This study evaluated the risk factors leading to morbidity and mortality. METHODS: 510 patients who had a hepatic resection form Nov. 1994 to Dec. 2001 were included. The patient demographics showed a mean age of 51.6 years with a male to female ratio of 4:1. The HBsAg was positive in 76.0% and the anti-HCV was positive in 8.2%. The mean tumor size was 5.2 cm, 26.2% of patients had preoperative transcatheter arterial embolization (TAE), and 8.7% had preoperative percutaneous transhepatic portal embolization (PTPE). Limited resection was performed in 259 cases (50.7%), and major resection was conducted in 251 cases (49.1%). Risk factors included age, sex, laboratory findings (liver function test, prothrombin time, albumin, glucose, alpha-fetoprotein, ICG test), preoperative TAE, PTPE, operation type, operation time, intraoperative transfusion, tumor size, and cirrhosis. RESULTS: The morbidity was 10.5% (54 cases). Operative death occurred in 5 cases (1.0%). Hospital death, including operative death, occurred in 6 cases (1.2%). Five cases were associated with hepatic failure and 1 case was associated with aspiration pneumonia accompanying hepatic failure. Transfusion (P=0.002), glucose (P=0.002), and prothrombin time (P=0.038) were significantly related to morbidity. Age (P=0.028), glucose (P=0.011), and TAE (P=0.046) were significantly related to mortality. CONCLUSIONS: Intraoperative transfusion, which is mainly related to intraoperative bleeding, should be reduced if possible to decrease morbidity. Diabetes mellitus patients and the elderly need careful perioperative management.

Congenital Duodenal Web in a Young Adult

Congenital duodenal web in adult life is an extremely rare condition, which results from an incomplete recanalization of the duodenum during early embryologic development. We report a case of congenital duodenal web in a 23-year-old man who complained of postprandial epigastric pain and fullness, as well as nausea since childhood. The plain abdomen showed a double-bubble sign. The UGI study showed a marked dilatation of the proximal duodenum and a delayed passage of barium into the third portion of the duodenum. Abdominal ultrasonography and CT revealed a marked dilatation of the proximal duodenum and a duodenal web with windsock deformity, which originated from the ampulla of Vater and extended to the third portion of the duodenum. A winsock web with a 0.9 cm eccentric aperture and a healed ulcer proximal to the ampulla of Vater were observed during a longitudinal duodenotomy. The web was excised circumferentially and the duodenum was closed transversely in a Heineke-Mikulicz fashion.

Infarction of Wandering Spleen with Torsion of Its Pedicle: A case report

Torsion of a wandering spleen is an unusual cause of an acute abdomen and is rarely diagnosed preoperatively. A splenectomy is the treatment of choice in cases of splenic torsion and infarction, while in patients with chronic symptoms, splenopexy may be attempted. I report a case with acute splenic infarction in a young male and review the clinical presentation, etiology, diagnostic procedures and treatment modalities in a wandering spleen.

Prognostic factors of operable breast cancer

No abstract available.