Portal, Mesenteric, and Splenic Vein Thrombosis Following a Splenectomy for Myeloid Metaplasia

Postsplenectomy portal, mesenteric, or splenic vein thrombosis is a rare, but often fatal, complication which may be related to thrombocytosis, abnormal platelet function, and stasis in the splenic vein remnant. In the recent literature, there have been reports concerning portal and mesenteric venous thrombosis complicating splenectomy for hematologic disoders. Many thrombosis have occurred following splenectomy for myeloid metaplasia and have been associated with postsplenectomy thrombocytosis. The vast majority of patients with idiopathic myelofibrosis remain incurable, and current management is directed towards alleviating the symtoms and improving the quality of life. The splenectomy for myeloid metaplasia is palliative and carries a significant morbidity, and mortality. Under these circumstances, repeated assessment of indications, morbidity and duration of patient survival is of importance to physi cians and surgeons participating in the management of myeloid metaplasia. Because of the significant incidence and high mortality of postsplenectoimy thrombosis in myeloid metaplasia, the prophylactic use of anticoagulant agents and antiplatelet drugs and long-term maintenance therapy are necessary. At the time of the splenectomy, an attempt should be made to ligate the splenic vein as close as possible to its junction with the idiopathic myelofibrosis. A small bowel resection is indicated if focal, persistent paralytic ileus of mecanical obstruction occurs.

Portal, Mesenteric, and Splenic Vein Thrombosis Following a Splenectomy for Myeloid Metaplasia

Postsplenectomy portal, mesenteric, or splenic vein thrombosis is a rare, but often fatal, complication which may be related to thrombocytosis, abnormal platelet function, and stasis in the splenic vein remnant. In the recent literature, there have been reports concerning portal and mesenteric venous thrombosis complicating splenectomy for hematologic disoders. Many thrombosis have occurred following splenectomy for myeloid metaplasia and have been associated with postsplenectomy thrombocytosis. The vast majority of patients with idiopathic myelofibrosis remain incurable, and current management is directed towards alleviating the symtoms and improving the quality of life. The splenectomy for myeloid metaplasia is palliative and carries a significant morbidity, and mortality. Under these circumstances, repeated assessment of indications, morbidity and duration of patient survival is of importance to physi cians and surgeons participating in the management of myeloid metaplasia. Because of the significant incidence and high mortality of postsplenectoimy thrombosis in myeloid metaplasia, the prophylactic use of anticoagulant agents and antiplatelet drugs and long-term maintenance therapy are necessary. At the time of the splenectomy, an attempt should be made to ligate the splenic vein as close as possible to its junction with the idiopathic myelofibrosis. A small bowel resection is indicated if focal, persistent paralytic ileus of mecanical obstruction occurs.

Mirizzi Syndrome with Cholecystobiliary Fistula

BACKGROUND: Mirizzi syndrome is a rare presentation of long-standing cholelithiasis. It occurs when gallstones become impacted in either the gallbladder neck or the cystic duct, causing an obstruction of the common hepatic duct by extrinsic compression. Furthermore, impacted stones may cause pressure necrosis of the adjacent bile duct and produce a cholecystobiliary fistula. Although the definition of this syndrome varies somewhat among authors, Csendes et al. defined four evolving stages of patients with Mirizzi syndrome and cholecystobiliary fistulas. The aim of this study was to observe the clinical characteristics and to review the literature for better management in this clinical situation. METHODS: We retrospectively observed 7 patients who had been diagnosed with Mirizzi syndrome and cholecystobiliary fistulas perioperatively at Hanyang University Hospital. RESULTS: The 6 male patients and the one female patient had an average age of 58 years (range, 39 to 74 years). Jaundice was present in all patients. Six patients complained of abdominal pain, and two patients had acute inflammatory signs, such as fever/chill. Preoperative evaluations suggested Mirizzi syndrome in only two patients. A cholecystectomy was performed in all patients, followed by repair of the common hepatic duct and T-tube choledochostomy in three patients. A hepaticojejunostomy was required for the three difficult patients. The Csendes et al. classification was type I in one patient, type II in four, and type III in two. CONCLUSIONS: Since preoperative diagnosis of Mirizzi syndrome remains difficult, a high index of suspicion is required to diagnosis the condition, and awareness of the cholecystobiliary fistula condition is of the utmost importance for safe and optimal management.

Clinical Evaluation for the Effect of Intraoperative Intraperitoneal Chemotherapy in Advanced Gastric Cancer

BACKGROUND: Peritoneal carcinomatosis is the most common type of treatment failure in gastric cancer patients. For the purpose of decreasing the rate of peritoneal carcinomatosis, intraperitoneal chemotherapy is a very attractive treatment modality, especially in the aspect of direct infusion of the anti-cancer regimen into the peritoneal cavity. METHODS: The effects of intraperitoneal chemotherapy with cisplatin were evaluated using 360 gastric adenocarcinoma patients with serosal invasion who had received a curative gastric resection from June 1992 to June 1996. Among them, 136 cases were treated by installation of cisplatin 100 mg (mixed with 800 ml of normal saline) into the peritoneal cavity before closing the peritoneum, and the solution was drained out 2 hours later. An analysis was performed to determine the differences of survival rate and mode of recurrence between the intraperitoneal cisplatin installation group and the control group (who did not receive the intraperitoneal chemotherapy). RESULTS: The differences between those two groups were not statistically significant. We assume that such results were due to the patients being more advanced in the cisplatin-treated group than in the control group, although the comparison was between identically staged groups. CONCLUSIONS: Intraperitoneal chemotherapy with cisplatin did not show an improved survival rate and did not change the recurrent mode after surgery for serosal invasive gastric cancer. However, well- designed, prospective, randomized study should be performed. Also a prospective randomized study with other kinds of regimens or a more tolerable dose for each regimen will be needed for a correct evaluation of the effect of intraperitoneal chemotherapy.

Evaluation of the New UICC Staging System for Gastric Carcinoma / 대한암학회지

PURPOSE: There are several kinds of classificatian dealing with the staging of the gastric adenocarcinoma. However, such different staging systems pose difficulty in the inter- institutional or intemational comparison of the disease status and the treatment results. The purpose of this study is to evaluate each staging system and to assess the usefulness of the new UICC-TNM staging system (1997) for gastric adenocarcinoma. MATERIAL AND METHODS: We retrospectively analysed 473 cases of gastric adenocarcinoma who were operated at the Department of General Surgery, Hanyang University Hospital during the period from 1992 to 1996. Using these cases, we analyzed their cumulative 5-year survival rate according to three kinds of staging systems; old UICC-TNM staging system (1987), new UICC-TNM staging system (1997), and the Japanese staging system for gastric carcinoma (1993). RESULTS: The follow up rate was 94.3% and the median follow up period was 30.3 months. All of these three systems showed a statistically significant survival difference according to their different classifications. When the distribution of stage between old and new UICC-TNM staging system was compared, 95 cases (20.1%) were subjected to stage shifting, which involves 12.1% of up-staging and 8.4% of down-staging. Stage shifting was most prominent in stage IIIb (68.8%). The cumulative 5-year survival rate according to the new UICC-TNM staging system was 99.1% in stage Ia, 81.4% in stage Ib, 75.2% in stage II, 45.9% in stage IIIa, 21.0% in stage IIIb, and 19.4% in stage IV. CONCLUSION: We conclude that the new UICC-TNM staging system is simple, practically convenient, and highly reproducible, and it showed a statistically significant survival difference according to their staging classification.

The Evaluation of Liver Cytosol Extracts Affecting Liver Regeneration after Partial Hepatectomy in Rat

It was known that the regenerating liver cytosol accelerated liver regeneration, whereas normal liver cytosol inhibited it during first 28 hours, but promoted it later by the thymidine incorporation test. In experiments, Sprague-Dawley male rats were divided into 3 experimental groups (A, B and C) which had 10 rats in each. Also, each group was equally subdivided into 2 subgroups such as A-8 and A-28 in the A group, B-8 and B-28 in the B group and C-8 and C-28 in the C group. All groups were partially hepatectomized equally. The remnant livers were procured at 8 hours in the 3 subgroups A-8, B-8 and C-8 and at 28 hours in the other 3 subgroups A-28, B-28 and C-28. Another experiment was performed in 10 rats under the same partial hepatectomy to get the average weight of the remnant liver. These data could be taken as the initial weight of the remnant liver in the above experimental animals. The normal saline, normal liver cytosol extract and regenerating liver cytosol extract were injected intraperitoneally after the partial hepatectomies, 4 ml of in the A, B, and C groups, respectively. Since specific structural changes might precede demonstrable functional alterations, morphometric measurements were done in the histological specimens of the 3 subgroups A-8, B-8, and C-8. The remnant livers, obtained in all six subgroups, were weighed to calculate the regeneration rates. The overall results are as follows : 1) The liver regeneration rates in the six subgroups were 4.1% in A-8, 3.8% in B-8, 4.3% in C-8, 28.4% in A-28, 16.7% in B-28, and 32.8% in C-28. 2) The morphometric study showed that the nucleus/cytoplasm ratios in the three subgroups were 0.1389 in A-8, 0.2048 in B-8, and 0.3705 in C-8. These results mean that regenerating liver cytosol extract promotes liver regeneration and that normal liver cytosol extract inhibits it during first 28 hours after a partial hepatectomy, but promotes cell division for subsequent regeneration.

NAT2 Polymorphism and Individual Genetic Susceptibility to Colorectal Cancer Patients in Korea

To determine the frequencies of the genotypes of NAT2 gene in healthy Korean populations and to identify the high-risk genotypes of NAT2 gene in colorectal cancer patients, 115 healthy controls and 109 cancer patients were analyzed using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP). The distribution of NAT2 polymorphism in healthy Korean was found to be 7.8% of S/S genotype, 48.7% of S/F genotype, and 43.5% of F/F genotype. And the frequency of phenotypes was 8% of slow acetylator and 92% of rapid acetylator. S/S genotype of colorectal cancer patients was slightly more frequent than that of healthy controls(11.9% vs 7.8%). The relative risk of S/S genotype to colorectal cancer was estimated to be 1.41, taking the risk of F/F genotype as a baseline(1.00). These results suggest that the distribution of frequencies of NAT2 genotypes is very unique in Korean characterized by extremely low frequency of slow acetylator geno type(S/S) in comparison to the other ethnic groups. And the slow acetylator genotype(S/S) in Korean was found to be more susceptible to colon cancer. Therefore, S/S genotype may have a certain role an colonic carcinogenesis in Korean.

Clinicopathological Analysis of Krukenberg Tumor Arising from Stomach Cancer

BACKGROUND: The Krukenberg tumor (KT) is a metastatic or primary ovarian tumor of the signet-ring cell type. The incidence of this tumor is higher in Korea than in Western countries due to the higher incidence of gastric cancer in Korea. This tumor arises more commonly in the relatively young age group, especially women in the prememopausal period. We tried to find the clinicopathological (CP) characteristics of this tumor and also tried to confirm the appropriateness of the classification by the Japanese Research Society for Gastric Cancer which classifies a KT as P2. METHODS: We observed 23 cases of KT which were diagnosed from July 1984 to December 1997 at the Department of General Surgery, Hanyang University Hospital and analyzed their CP factors. RESULT: The age distribution ranged from 30 to 67 years old, and the mean age was 43.3 years old. The most common symptom was lower abdominal pain. The tumor occurred at the bilateral ovaries in 17 cases (74%). Two patients who manifested a KT without other metastatic findings during gastric cancer surgery survived 20 months and 8 months (still alive), whereas 21 cases with peritoneal seeding (PS)(P2) and 6 cases which manifested a KT combined with PS had mean survival durations (MSD) of 7.4 months and 7.2 months, respectively. The MSDs for three patterns of recurrence were 21.4 months for KT cases (8 cases), 21.4 months for PS cases (47 cases), and 5.0 months for KT combined with PS cases (7 cases). In patients under the age of 50 years old who showed signet-ring cell type gastric cancer, the incidence of a KT as a coincidental finding or as a form of recurrence was 24.1% when the tumor showed serosal invasion. CONCLUSIONS: The prognosis for a patient with a KT was relatively better than that for patient with other forms of PS, which is due to the difference in the resectability of these two forms of P2 cancer.This indicates a need to reconsider the P2 classification. If the gastric cancer with a signet-ring cell type and more than T3 in women under the age of 50 years old, we have to consider the necessity for a preventive oophorectomy because of the high incidence of KTs under such conditions.

Clinical Analysis of Desmoid Tumor

Desmoid tumor is a infrequent, but particular type of fibromatosis (dysplastic lesion of connective tissue), usually originating in the fascial sheath or musculoaponeurotic tissue of the body. It is characterized by its propensity for slow, incessant growth and by its nonmetastastic but locally aggressive behavior. While rarely associated with this tumor, morbidity and mortality occur when there is encroachment on vital structures. Because of the scarcity of data, the relatively small number of patients and the pathological resembrance to low-grade fibrosarcoma, desmoid tumor may be easily misdiagnosed and wrong conclusions regarding its biological behavior may be drawn. Also, the optimal treatment for this tumor remains controversial. At present, the most successful method of control of desmoid tumor is complete excision with a clear margin of normal tissue surrounding the tumor. To better delineate the natural history and the result of managing patients with this disease, we have reviewed all patients with desmoid tumor treated at our hostital from 1985 to 1996, and the following results were obtained : The male-to-female ratio was 1 : 2.7, and a childbearing-aged female preponderance was present like most reports. Seven of 22 patients(32 %) developed local recurrence. The recurrence of desmoid tumor was not related to patient's sex/age, location/size of the tumor, and previous operative history. Even though desmoid tumor is not pathologically malignant, it should be regarded as clinical malignancy and be treated by wide excision with pathologically-proven safe resectional margin.

Remnant Gastric Cancer

Remnant gastric cancer is defined broadly as cancer that develops in the remnant stomach after the resection of nonmalignant or malignant lesions. Generally speaking, remnant gastric cancer is defined as its interval between previous gastrectomy and the detection of remnant gastric cancer must be over 10 years in the previous malignant or nonmalignant lesions. From Aug. 1988 to Dec. 1995, fifteen patients who were operated as remnant gastric cancer (broad definition) in Hanyang Universty Hospital was reviewed as follows. Sex distribution was 12 cases in male and 3 cases in female. Peak incidence of age was 5th and 6th decades.The T.N.M. staging was at first operation: benign disease in 6 cases, stage I in 4 cases, stage IIIa in 1 case, stage IIIb in 2 cases and unknown stage in 2 cases, and at 2nd operation; stage I in 3 cases,stage II in 1 case, stage IIIa in 2 cases, stage IIIb in 5 cases, stage IV in 4 cases. The interval between first and second operation was as follows : less than 5 years in 4 cases, 5 to 10 years in 2 cases, 10 to 15 years in 3 cases, and over 20 years in 6 cases. The procedure at first operation was Billroth II procedure, and the procedure at 2nd operation was as follows: total gastrectomy with Roux-en-Y esophagojejunostomy in 12 cases,total gastrectomy with loop esophagojejunostomy in 2 cases,dismentling partial gastrectomy with Roux-en-Y gastrojejunostomy in 1 case. In our opinion,early diagnosis of remnant carcinoma following gastric surgery by the endoscopic follow up and aggresive surgery are important to improve disease free interval and patient survival.

Hepatic Resection for Intrahepatic Stones

The intrahepatic stones and associated cholangitis result in progressive biliary stricture, hepatic atrophy, hepatic abscess and ultimately in irreversible liver cirrhosis and biliary malignancy of the liver. Although removal of intrahepatic stones using stone fragmentation and cholangioscope has been a general treatment modality, hepatic resection with removal of the affected ducts should be required for a permanent cure. We experienced hepatic resection of 100cases with intrahepatic duct calculi from November 1978 to May 1996 in the Department of Surgery, Hanyang University Hospital. The results were as follows: 1) The peak incidence of age was noted in the 4th decade (35 cases, 35.0%),5th decade (26 cases, 26.0%). 2) The male to female ratio was 46(46.0%):54(54.0%) in 100 cases. 3) Previous biliary operation(cholecystectomy with T-tube choledochostomy) was done in 30(30.0%) cases. 4) The most common clinical symptom and sign were RUQ pain(75 cases, 75.0%) and RUQ tenderness(75 cases, 75.0%). 5) In the lab findings, Alk P(55 cases, 55.0%) and ALT(52 cases, 52.0%) were especially increased. 6) 80 cases(80.0%) of intrahepatic stones were found in the left intrahepatic duct and 60 cases(60.0%) of Intrahepatic duct stones were associated cholelithiasis and/or choledocholithiasis. 7) 79 out of 100 cases had left lateral segmentectomy,15 out of 100 cases had left lobectomy, 3 cases had right lobectomy, 1 case pleurisegmentectomy, 1 case bisegmentectomy and 1 case atypical resection of the liver. 8) The incidence of residual stones was 10.0% and the incidence of recurrent cholangitis was 9.0%(9 cases). 9) The postoperative complications were wound complications(16 cases, 16.0%), chest complications(13 cases, 13.0%), bile leakage(4 cases, 4.0%), subhepatic abscess(3 cases, 3.0%). 10) The intrahepatic stones were combined with 3 cholangiocarcinoma,2 hepatocellular carcinoma and 1 GB cancer.

Concurrence of Colon Cancer and Dermatomyositis

Dermatomyositis is a severe, idiopathic systemic disorder with predominant involvement of skin and skeletal muscle. The association of adult dermatomyositis and malignancy in particular has generated much attention. The reported prevalence of cancers in this disease varies from 6.7% to 52.2%. We experienced a concurrent case of transverse colon cancer and dermatomyositis on 67 year old female patient and report with review of literatures.

Two Case of Squamous cell Carcinoma of the Stomach in the Antrum

Squamous cell carcinoma of the stomach is very rare with a reported incidence of 0.09% of all resected gastric malignancies. We report here two cases of squamous carcinomas and a brief review of literatures. A 74-year old female was admitted because of epigastric pain and vomiting. Abdominal CT, UGI and endoscopic findings revealed a Borrmann type III gastric cancer on the posterior wall of the antrum with pyrolic obstruction and multiple liver metastases. Palliative distal gastrectomy with gastrojejunostomy was performed. The histopathologic diagnosis was adenosquamous cell carcinoma. She died of malnutrition and multiple organ failure 5 months after the operation. The other case was a 53-year old male admitted because of indigestion. Abdominal CT, UGI and endoscopic findings revealed a Borrmann type III gastric cancer on the greater curvature of the antrum with multiple enlargements of the perigastric lymph nodes. Distal subtotal gastrectomy with gastrojejunistomy was performed. The histopathologic finding revealed squamous cell carcinoma. He was discharged after FEC(5-FU, etoposide, cispatin) chemotherapy uneventfully.

Reasonable Time for Removal of the Nasogastric Tube after a Radical Gastrectomy

The necessity for routine prophylactic nasogastric tube decompression after a gastrectomy is still in controversy. Several reports have indicated that nasogastric tube decompression is unnecessary and that the tube may even be harmful with serious discomforts. A D2 gastrectomy (which means a D2 lymph node dissection during gastric cancer surgery) for a gastric carcinoma is an extensively destructive procedure which takes a longer operation time than a conventional gastrectomy, destroys both sympathetic and parasympathetic nerve fibers in the upper retroperitoneum, and may interfere with the gastrointestinal motility after the operation. Therefore, we have carried out a retrospective study with 206 gastrectomized gastric-cancer patients to evaluate the necessity of nasogastric tube decompression and whether the tube influences the gas-passing time, the morbidity, and mortality after operation.

A Case of Retrograde Jejunojejunal Intussusception into the Braum Anastomosis after Billroth II Operation

N/AA case of retrograde intussusception of efferent limb into Braun side-to-side jejunojenunal anastomosis after gastric surgery is presented. Intussusception is an uncommon and well-recognized complication after gastric surgery. A 60-year old female was admitted to Hanyang University Hospital with a chief complaint of epigastric pain and hematemesis of 6 hours duration. Patient had a history of distal gastrectomy with gastrojejunostomy due to early gastric cancer(Stage I) 3 years ago. Emergency abdominal CT revealed jejunojejunal intussusception into Braun anastomosis. Exploration and segmental resection of jejunum with end-to-end reanastomosis were performed.

Multiple polyposis coli

No abstract available.

Hepatic resection for metastases from colorectal carcinoma

No abstract available.

Histopathological review of low anterior resection for rectal cancer

No abstract available.

A clinical analysis of 311 cases of hemorrhoids

No abstract available.

Histopathological review of low anterior resection for rectal cancer

No abstract available.