A Case of Tuberculous Encapsulating Peritonitis Presenting as Huge Intraabdominal Cystic Mass

Encapsulating peritonitis (EP) is a rare disease characterized by the formation of a membrane which encases all or part of the abdominal viscera. This disease occurs in patients receiving continuous ambulatory peritoneal dialysis (CAPD). Other etiologies are trauma, colitis, chemical irritation, and infrequently, intraperitoneal tuberculosis. The overall prevalence is 0.7-3.7% of the patients receiving CAPD. EP may be accompanied by intestinal obstruction, strangulation, poor wound healing, and nutritional problems. The diagnosis is usually made by using an exporatory laparotomy, and the treatment of choice is excision of the membrane with complete decortication. Here, we present a case of encapsulating peritonitis associated with tuberculous peritonitis. In this patient, a huge pseudocyst, 40 cm in its largest diameter and 7 kg in weight, was found intraperitoneally. The pseudocyst was removed surgically and proved to be formed due to tuberculous peritonitis by using Tbc-PCR.

Clinical Analysis of an Invasive Lobular Carcinoma in the Breast

BACKGROUND: The frequency of invasive lobular carcinomas is about 3% to 15% of all breast carcinomas. It is known that an invasive lobular carcinoma is different from other forms of breast cancer in the aspect of clinical characteristics and metastatic pattern. METHOD: To search of clinical characteristics of invasive lobular carcinomas, we restrospectively investigated 31 cases of invasive lobular carcinomas that had been treated from 1985 to 1996 at the Department of Surgery, Severance Hospital. RESULTS: The peak incidence was in the 40's (12 cases, 38.7%), and the average age was 45.8. The main clinical manifestation was a palpable mass on the breast at the time of visit to the hospital (30 cases, 96.8%), and the most frequent site was the upper outer quadrant (18 cases, 58.1%), followed by the upper inner quadrant (6 cases, 19.4%), of the breast. The most prevalent tumor size was 2-4 cm (14 cases, 45.2%), and the mean size was 3.27 cm. The negativity of the axillary nodes for invasive lobular carcinoma was 67.7%. According to the TNM system, there was 5 casess (16.1%) in stage I, 17 cases (54.8%) in stage IIa, 7 cases (22.6%) in stage IIb, and 2 cases (6.5%) in stage IIIb. The positivity of the estrogen receptor (ER) was 35.7%, and the positivity of the progesterone receptor (PR) was 54.5%. The overall 5-year survival rate was 82%, the overall 5-year disease-free survival was 70%, and the mean survival was 108 months. CONCLUSION: The clinical characteristics of an invasive lobular carcinoma seem to be similar to those of an invasive ductal carcinoma. Further studies are required to search for the clinical characteristics and for an adequate treatment.

Familial Breast Cancer

Familial or hereditary breast cancer has genetic heterogeneity and is transmitted vertically in an autosomal dominant fashion. About 5 to 10% of breast cancers are caused by the inheritance of mutations in dominant susceptibility genes. We retrospectively reviewed 50 breast cancer patients from 44 families. These patients had treated their breast cancer at the Department of Surgery, Yonsei University College of Medicine, from 1981 to 1996. There were no statistically significant differences between the familial breast cancers and the sporadic breast cancers in such clinicopathologic characteristics as major complaint, tumor location, tumor size, metastasis to axillary lymph nodes, stage distribution, histology distribution and hormone receptor status. For familial camcers, the mean survival was 125 months, the overal 5-year survival rate was 85%, and the overall 5-year disease-free survival rate was 70%.

Bilateral Breast Cancer

Among the 1760 cases of carcinomas of the breast treated between 1981 and 1996, there were 31 cases of bilateral breast cancer. Of these, 7 were synchronous tumors and the remaining 24 patients had metachronous tumors : 41.7% of all patients had presented within 5 years since the first primary tumors were detected and 73.3% of all patients had presented within 10 years. The mean age of the synchronous bilateral cancers was 39.9 (26~55), and the mean age at the diagnosis of the first cancers in the metachronous cancers was 44.75 (31~70) years old. The location of the tumor was the same in 64% and 68% of the synchronous and metachronous cancers, respectively, that had an identified histology. The mean survival of metachronous group was 70.5 months and that of synchronous group was 114.7 months. However, there was no statistical significance between the mean survival times of the two groups (p>0.05). We recommend a careful check-up for the opposite breast at the time of primary cancer treatment, as well as well an organized follow-up program for all patients having undergone treatment for breast cancer. Further investigations are required to determine the incidence of and risk factors for second cancer development in the opposite breast.

Result of Shunt Operation for Post-traumatic Hydrocephalus

We retrospectively reviewed all cases of hydrocephalus shunted in the Soonchunhyang University Hospital within a 5-year period and encountered 12 cases of posttraumatic hydrocephalus. When admitted, seven patients had a Glasgow Coma Scale value of 8 or less and, of the five patients with a Glasgow Coma Scale value above 8, two had an intraventricular hemorrhage, two had a subarachnoid hemorrhage alone. The mean interval from injury to the shunt was 110 days(range from 4 to 311 days). The intracranial pressure was measured by lumbar puncture in eight patients. It was less then 200mmCSF in five patients and above 200mmCSF in three patients. After shunting, six patients(50%) improved markedly and four(33%) slightly. Overall outcome was good recovery in three, moderate disability in three, severe disability in three, vegetative state in two, and death in one patient. Several prognostic factors such as Glasgow Coma Scale value on admission, CT findings, intracranial pressure, interval from injury to the shunt, degree of cortical atrophy, and surgical method are not related to the result of the shunt(p>0.1 by Fisher's test). Since there are no accurate predictors for the result of shunt at present, one can not be sure that the patient with negative prognostic factors will not improve. Shunting rather than simple observation could be a suitable therapeutic trial especially for the bedridden patients.