Generalized Peritonitis due to Acute Fulminant Amoebic Colitis

An acute fulminant amoebic colits rarely develops as a complication of amoebiasis, and is difficult to diagnose and treat when it occurs. It is a life-threatening disease, and associated with a very high mortality rate. Herein, a case 42-old-year man, who had a generalized peritonitis caused by an acute fulminant amoebic colitis, is reported, with a review of the literature. He died of multiple organ failure, following sepsis and disseminated intravascular coagulation, on the 19th day after his operation, despite treatment with aggressive surgery and anti-amoebic agents. An emergency laparotomy should be considered when an acute fulminant amoebic colitis deteriorates despite the use of intensive anti-amoebic therapy, especially when there is an acute episode suggestive of perforation. A primary total resection of the diseased colon is one of the treatments of choice.

Neuroendocrine Carcinoma of the Stomach: A Clinicopathologic Study of 18 Cases

PURPOSE: Neuroendocrine carcinomas of the stomach account for only about 0.3% of all gastric tumors. The prognosis of this disease is very poor compared with the common type of gastric adenocarcinoma. The purpose of this retrospective study was to review the clinicopathologic features of 18 cases of this unusual gastric tumor and to establish a treatment strategy for this tumor. MATENRIALS AND METHODS: Excluding 2 cases of non-curative resection and 1 case of operative mortality, 18 cases of typical neuroendocrine carcinoma who had curative resection from January 1991 to December 2000 at Asan Medical Center were analyzed; 6841 gastric cancer patient were treated surgically during the same period. RESULTS: The mean age at the time of diagnosis was 58.6 years (range: 35~75 yr). Sixteen patients were male, and two were female. Eleven tumors (61.1%) developed in the lower part of the stomach, three (16.7%) in the middle part, and three (16.7%) in the upper part. One tumor involved the entire stomach. Eight cases (44.4%) were Borrmann type 2, and six case (33.3%) were Borrmann type 3. The mean tumor size was 6.94 cm (range: 0.6~15 cm). Nine cases (50%) showed recurrence of the disease, and eight of them died within 20 months. Of the nine recurred cases, 7 cases (77.8%) showed liver metastasis. The mean disease-free interval was 6.8 months (range: 2.5~11 months) after surgical resection, and the mean survival was 17.9 months (range: 8~40 months) for recurrence cases. One patient with liver metastasis was treated with a liver-wedge resection just after diagnosis and was still alive for 37.5 months postoperatively. There were 9 deaths after the median follow-up period of 40 months (range: 8~72 months). CONCLUSION: Gastric neuroendocrine carcinomas frequently recur at the liver, even in early stage cancer, and have a poor prognosis. We experienced a case of successful control of hepatic metastasis by surgical resection and a case of a small cell carcinoma which was successfully controlled with systemic chemotherapy.

Clinical Observation of Bile Culture and Chronological Change of Bacteriology

BACKGROUND: Intraoperative collection of bile and a bile culture are of use in predicting bacterial infection in the biliary system. The aim of this study was to identify chronological changes in the bacteriology of the bile in the age and sex distributions for biliary tract disease of the patients. METHODS: We retrospectively reviewed the clinical records of 722 patients who had been operated on for biliary tract disease at the Department of Surgery Ewha Womans University Hospital, from Jan. 1979 to July 1998 and on whom intraoperative bile culture had been performed. We divided the 722 patients into two group based on the time of their treatment, period A being 1979-1988 and period B being 1989-1998. The statistical analysis was done by using the Mantel-Haenszel Chi-Square test. RESULTS: The overall bile culture positive rate was 56% (404 cases), and the male-to-female ratio was 1:1.64. There was no significant statistical difference in the sex ratio between the two periods (period A: 1:1.78, period B: 1:1.55) (p>0.05). Overall, the most commonly isolated organism in the bile was Escherichia coli (137 cases, 30%). Comparing the two periods, we found that the Enterococcus species was an organism found increasingly in biliary tract infections (period A: 0%; period B: 17%) whereas infection by Escherichia coli was significantly decreased in the latter period (period A: 43%; period B: 28%) (p<0.05). The sixth decade (29.1%) was the most prevalent age overall. The age distribution for period A showed no statistical difference between the 5th (21.58%) and the 7th decades (21.94%), but there was significant difference between the 7th (29.95%) and the 5th decades (16.89%) in the age distribution for period B (p<0.05). CONCLUSIONS: According to the above results, we concluded that there were significant chronological changes in the bacteriology of the bile & in the age distributions between the two periods, but no such difference was observed between the sex distribution.

Local Excision of Rectal Carcinoma

PURPOSE: Curative local excision of the rectal cancer had been advocated by many surgeons over the standard abdominoperineal resection (APR) for lower rectal cancer due to its low complication rate and improved quality of life. The aim of this study was to evaluate the result of the local excision for rectal cancer. METHOD: We prospectively analyzed 31 rectal cancer patients (including 2 patients of carcinoid tumor) who were suitable indication for local excision between Oct. 1993 and Dec. 1998 at Mokdong Hospital. RESULTS: The age of the patients ranged from 39 to 81 years (>60 years: 77.8%) while sex ratio was 1:5 (M:F). Of 31 patients, 29 patients were located below 4 cm from anal verge. Other two were in between 7 cm and 10 cm from the anal verge. The tumor size ranged from 0.7 cm to 5 cm, most commonly within 3 cm. Invasion depth by tumor were as follows: 12 patients in mucosa; 7 patients in submucosa; 4 patients in inner muscle layer; 6 patients in outer muscle layer; and 2 patients in whole layer. Ten patients had well-differentiated tumors and 17 patients had moderately differentiated tumors, while one patient had mucinous histologic type. Seventy percent of patients with muscular layer invasion received adjuvant radiation therapy. Six patients received oral chemotherapeutic agent and 4 received immunopotentiator. During the follow-up period (mean: 18.4 months, range: 1~54 months), no local recurrence was found in the patients who were operated under curative intent. CONCLUSION: We concluded that this method can be favorabe choice for the treatment of early rectal cancer without lymph node involvement if strict indication of the local excision for rectal cancer could be applied.

Osteogenic Sarcomatous Carcinoma of the Gallbladder: A case report / 한국간담췌외과학회지

Sarcomatous carcinoma of the gallbladder is a very rare disease. There are few case reports worldwide. We experienced a case of sarcomatous carcinoma of the gallbladder. This 45-year-old male patient complained abrupt and continuos right upper quadrant pain for 4 hours. He was diagnosed as acute calculous cholecystits on abdominal sonography. He received laparoscopic cholecystectomy after conservative treatment for 3 days. During the operation the wall of gallbladder was so hard, thickened that cancer was suspected and the frozen biopsy proved osteogenic sarcomatous carcinoma. So, operation was converted to open laparotomy and a right hepatic lobectomy and choledochus resection with regional lymph node dissection was done. On 25th day of surgery, ascitic fluid collection was noticed on abdomen and multiple hematogenous metastasis on remnant liver was found on abdominal CT scan. The patient expired on 48th day of surgery due to cancer cachexia.

Establishment of Canine Partial Liver Autotransplantation Model and Protective Effect of Prostaglandin I2 on the Ischemia-Reperfusion Injury / 대한이식학회지

BACKGROUND: The pathogenesis of primary non function or delayed graft function after liver transplantation is not yet clearly defined. However it is presumed that these unhappy events most likely attributes to the Kupffer cell-mediated, reperfusion injury aggravating the sinusoidal endothelial cell damage following preformed ischemic insults. Prostaglandin (PG) I2 and its analogues were reported to protect the liver against ischemic injury thereby be efficacious for the use during the preservation of harvested liver. Prevention of platelet aggregation, vasodilation, stabilization of lysosomal membranes, and inhibition of thromboxane generated by platelets may be the attributable biological activities of PGI2. PURPOSES: We designed this experimental study to assess the effect of continuous PGI2 infusion during in situ liver splitting on the bile flow from liver segment during resection and after reimplantation, and to establish our unique autotransplantation model in mongrel dogs before warming-up of living donor partial liver transplantation in the clinic. METHODS: Mongrel dogs weighing 15-25 kg were used after fasting for 12 hours. After endotracheal intubation under monitoring, abdomen was opened through the Chevron incision extending to xiphoid process. Initially, the right hepatic duct was ligated and divided. The common bile duct was divided, the end being cannulated proximally and drained. Basal bile flow was measured for 1 hour as a reference value. The left partial graft including the right medial, quadrate, left medial, left lateral lobe, and the papillary process of caudate lobe was resected en bloc. After cold flushing ex vivo, the harvested segment was immediately reimplanted orthotopically. In PGI2 group, PGI2 50 microgram was slowly infused through splenic venous cannulation. After closing the abdomen, the bile flow was measured continuously. RESULTS: Eleven out of 24 dogs were alive 12 hours after surgery; 5 in PGI2 and 6 in control group. Basal mean bile flow (BF) rate were 2.9 ml/hr/100 gm of liver tissue in control vs. 2.5 ml/hr/100 gm in PGI2 group. This difference did not reach the statistical significance. However, postoperative BF increased significantly in PGI2 group; 0.45 ml/hr/100 gm in contro vs. 1.71 ml/hr/100 gm in PGI2 group (p=0.04). CONCLUSION: Continuous infusion of PGI2 through the splenic vein during the harvest of the liver could mitigate the manipulation injury. The BF reflecting the quality of resected liver segment was relatively well preserved in PGI2 group after canine autotransplantation model. This model is not complicated, and will be useful for the mastery of surgical techniques for the living donor partial liver transplantation in the clinic.