Extrahepatic Biliary Schwannomas: A Case Report

Benign schwannomas arise in neural crest-derived Schwann cells. They can occur almost anywhere in the body, but their most common locations are the central nervous system, extremities, neck, mediastinum, and retroperitoneum. Schwannomas occurring in the biliary tract are extremely rare and mostly present with obstructive jaundice. We recently experienced a case of extrahepatic biliary schwannomas in a 64-yr-old female patient who presented with intra- and extrahepatic bile duct and gallbladder stones during a screening program. To the best of our knowledge, extrahepatic biliary schwannomas associated with bile duct stones have not been reported previously in the literature.

Preoperative Staging of Rectal Cancer by CT & MRI

Accurate staging of rectal cancer preoperatively is important to plan a proper treatment and to predict treatment results. For the preoperative staging of rectal cancer, computed tomography (CT), transrectal ultrasonography (TRUS), and magnetic resonance imaging (MRI) have been used, but the role of them remains controversial. This research was intended to compare and analyze the accuracy of CT and MRI in the preoperative staging of rectal cancer. METHODS: From January 1998 to June 1999, sixty patients were studied by CT and MRI before their operations for rectal cancer in our institution, but two patients with local excision were excluded in N-staging as objects. The patients who had preoperative irradiation were also excluded in this study. Preoperative staging with CT and MRI were conducted by one radiologist according to 1997's TNM classification based on AJCC. On the results of pathological findings after operation, preoperative staging with CT and MRI were classified into T-staging and N-staging. Accuracy and agreement rate between pathological staging and preoperative staging by CT and MRI were compared and analyzed by Kappa value. RESULTS: The accuracy of CT was 68 percent in T-staging, and 58 percent in N-staging, MRI showed accuracy of 82 percent in T-staging and 64 percent in N-staging. In the T-staging, the agreement rate between pathological staging and CT staging was 0.54 (95% confidence interval), while the agreement rate was 0.70 in MRI staging, resulting in a higher agreement rate with MRI than with CT. In the N-staging, the agreement rate between pathological staging and CT staging was 0.38, with a relatively lower agreement rate, while the agreement rate was 0.56 in MRI staging. In our study, MRI showed a higher agreement rate than CT. CONCLUSIONS: In the future, more research should be conducted, but it can be conclued that in preoperative staging for rectal cancer, MRI using body arrayed coil has a better accuracy than CT. Subsequently MRI staging should be considered as a more useful investigation method before operation than CT.

Laparoscopic Management of Vesicouterine Fistula due to Intrauterine Device / 대한비뇨기과학회지

We report the vesicouterine fistula due to migration of intrauterine device in 35-year-old woman, who had suffered from dysuria and watery vaginal discharge for 4 months. The vesicouterine fistula was confirmed by ultrasonography, cystoscopy and fistulography, and treated with laparoscopic fistulectomy.

Primary Aldosteronism

BACKGROUND: Management of primary aldosteronism has undergone dramatic changes in the past 40 years. This retrospective study was carried out to review our surgical experience and postoperative outcome and to identify the clinical charateristics of primary aldosteronism. METHODS: Twenty-five patients who underwent an adrenalectomy for primary aldosteronism from 1983 to 1997 were included in the study. All patients were operated on at the Department of Surgery, School of Medicine, Kyung-Hee University. We reviewed the records of 18 women and 7 men, ranging in age from 22 to 59 years. Data examined included clinical presentation, biochemical results, hormonal evaluation, localization studies, operative results, pathologic details, and postoperative outcome. The diagnosis of primary aldosteronism was based on a demonstration of hypertension, hypokalemia, elevated plasma aldosterone concentration, and suppressed plasma renin activity. Localization studies, including computed tomography (CT) and ultrasonography (US) were performed in all patients. A follow-up study was conducted by either reviewing clinical records, telephone contact, or examination of patients during return visits. RESULTS: Hypertension and hypokalemia were present in all patients. Serum potassium ranged from 1.4 to 3.2 mEq/L (2.3+/-0.5; mean+/-standard deviation {SD}mEq/L), and hypokalemia was considered an important diagnostic clue. We found the accuracy rate for CT results in our patients to be 96.0% (24 patients). An adrenal venous sampling was performed in one patient whose CT results were not confirmatory. A unilateral adrenalectomy was performed through posterior (22 patients), an anterior transabdominal (1 patient), or a lateral transabdominal laparoscopic (2 patients) approach. A laparoscopic adrenalectomy will minimize postoperative pain and hospital stay. The histological findings were 23 aldosterone-producing adenomas and 1 nodular hyperplasia. During a mean follow-up of 31.6 months, 22 (91.7%) of the 24 patients required no further antihypertensive treatment. CONCLUSION: Primary aldosteronism due to an aldosterone-producing adenoma can be diagnosed and localized expeditiously, and surgical treatment can be performed safely.