Lipoblastoma, a rare benign tumor of adipose tissue, occurs in infants and young children. The prevalent sites are chiefly the upper and the lower extremities and less commonly the head, neck, trunk, mesentery, mediastinum, and retroperitoneum. Circumscribed forms (benign lipoblastoma) are more common and superficially located. Diffuse forms (diffuse lipoblastomatosis) are more deeply situated. Prognosis is excellent after excision. The recurrence rate after surgical excision is low and tumors recur mainly in the deep diffuse type because of incomplete removal of the tumor. Therefore, wide local excision appears to be the treatment of choice. We experienced a 4-year-old boy who presented with a palpable mass on the left upper abdomen and was suspected to be a benign lipoblastoma of the retroperitoneum on computerized axial tomography. The tumor was completely excised. Final histologic examination confirmed the diagnosis of a benign lipoblastoma.
Abdomen ; Adipose Tissue ; Child* ; Child, Preschool ; Diagnosis ; Head ; Humans ; Infant ; Lipoblastoma* ; Lower Extremity ; Male ; Mediastinum ; Mesentery ; Neck ; Prognosis ; Recurrence

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that occurs once in 3,000 live births. Patients with NF1 are prone to develop malignancies, particularly neural tumors, that is, malignant schwannoma and glioma in adults. For non-neural tumors, the NF1 incidence is increased in rhabdomyosarcomas, leukemia, malignant melanomas, breast cancer, lung cancer, thyroid cancer, and other organ cancers. The NF1 gene seems to increase the risk for carcinogenesis. A case of NF1 associated with metachronous cancers, such as breast cancer (1991) and small-bowel leiomyosarcoma (1997), in the same patient is reported. Investigation of the patient's family revealed four further cases (offsprings) of multiple neurofibromatosis. The relevant literature on the subject is reviewed.
Adult ; Breast Neoplasms ; Carcinogenesis ; Genes, Neurofibromatosis 1 ; Glioma ; Humans ; Incidence ; Leiomyosarcoma ; Leukemia ; Live Birth ; Lung Neoplasms ; Melanoma ; Neurilemmoma ; Neurofibromatoses ; Neurofibromatosis 1* ; Rhabdomyosarcoma ; Thyroid Neoplasms

BACKGROUND: Immediate operative management has been applied to infants and children with an attacks of adhesive small-bowel obstruction (ASBO), but this treatment has been controversial. We retrospectively reviewed 30 patients who were admitted from 1992 to 1996 because of adhesive small-bowel obstructions. METHODS: Immediate operation was reserved for the 7 patients that presented with fever and leukocytosis and /or localized abdominal tenderness or complete obstruction. The remaining 23 patients initially underwent conservative treatment. RESULTS: Although 20 episodes were cured with conservative treatment, 3 cases subsequently required surgical intervention. No adverse occurrences were observed during or after the delayed operations. Recurrence occurred in 3 cases after surgery and in 2 cases after conservative treatment. In the study, we found that the age at the recent laparotomy, the time elapsed between the recent laparotomy and the obstructive episode, and the primary condition necessitating the laparotomy correlated significantly with the success of conservative treatment. CONCLUSIONS: We conclude that in the treatment of ASBO in children, conservative treatment through the use of abdominal decompression, antibiotics, fluid-electrolytes, physical therapy, etc. has to be applied first for patients without significant evidence of strangulation and complete obstruction.
Adhesives* ; Anti-Bacterial Agents ; Child* ; Fever ; Humans ; Infant ; Laparotomy ; Leukocytosis ; Lower Body Negative Pressure ; Recurrence ; Retrospective Studies

BACKGROUND: Advanced age alone should not be a serious deterrent to surgery. Preoperative evaluation of concomitant illness, operation time, accurate and minimal, but adequate surgery will serve to minimize morbidity and mortality in elderly patients. METHODS: The total number of surgical patients admitted to Kwang Hye Hospital, Pusan, from March 1994 to August 1996 was 3211, and the number of surgical geriatric patients admitted during the same period was 214. Operations were performed on 139 patients. We recorded information about age, sex, anesthesia type, operation time, non malignancy vs malignancy, emergency vs elective "Surgery", coexisting disease, and APACHE II score, and we examined the patients for results affecting postoperative morbidity and mortality. RESULTS: Postoperative complications occured in 55 cases (39.6%), and the operative mortality was 2.2%. The significant factors affecting postoperative morbidity were emergency operation, malignancy and APACHE II score. The operation time and coexisting diseases were not significant. Age had little effect on the postoperative prognosis CONCLUSIONS: Performance of elective surgery and preoperative evaluation of the APACHE II score are important factors.
Aged ; Anesthesia ; APACHE ; Busan ; Emergencies ; Humans ; Mortality ; Postoperative Complications ; Prognosis

Incorporation of laparoscopic techniques into the gastrointestinal surgeon's armamentarium has led to a renewal of interest in the anatomy of mesenteric arteries because hemorrhagic complications can be a major cause of conversion and/or morbidity during laparoscopic intestinal surgery. BACKGROUND: Since a colonic resection with laparoscopic techniques has become a common procedure, the limited exposure currently provided in laparoscopic intestinal resection demands a precise knowledge of mesenteric vascular anatomy to avoid such complications and to expedite the procedure. Historically, It was thought that the arterial supply to the right colon consisted of three arterial branches (middle colic artery, right colic artery, ileocolic artery) arising independently from the superior mesenteric artery (SMA). However, on recent reports and clinical observations, two colonic arteries only arising independently from the SMA are more common than three colonic arteries. METHODS: We reviewed 40 cases of angiography which focused on the SMA and it's branches. RESULTS: We found the ileocolic artery in 39 of 40 cases, the middle colic artery in 39 of 40, and the right colic artery in 19 of 40. Based on the existence of the right colic artery in our review, about half (47.5%) of the cases had a right colic artery directly arising from this SMA. CONCLUSION: This knowledge may help lower the risk of vascular complications during laparoscopic intestinal surgery.
Angiography* ; Arteries* ; Colic ; Colon* ; Mesenteric Arteries ; Mesenteric Artery, Superior*

BACKGROUND: Pancreatic pseudocysts are localized collections of pancreatic secretions in a cystic structure that lack an epithelial lining and occur as a result of surrounding tissues walling off and containing a pancreatic duct disruption. METHODS: This is paper presents a clinical analysis of 32 cases of pancreatic pseudocysts treated from January 1987 to July 1997 at Pusan Medical Center. RESULTS: The results are summarized briefly as follows: 1) The age and the sex distributions of these patients showed that 19 cases occurred between the 3rd and the 4th decades and the male-to-female ratio was 10.3:1. 2) Pancreatitis was most frequently associated with pancreatic pseudocysts (75%). 3) Common clinical manifestations were abdominal pain (89%), abdominal tenderness (78%), nausea and vomiting (56%), abdominal mass (32%), abdominal distension (31%). 4) Abdominal CT and ultrasound were major diagnostic methods. 5) The location of the peudocysts were the body (41%), head and tail (31%), the tail (22%), and others (6%). 6) The sizes of the pseudocysts were as follows less than 5 cm (5 cases), 5-10 cm (19 cases), above 11 cm (8 cases) in 32 cases. 7) Valuable laboratory data for a pancreatic pseudocyst were blood WBC count (above 10,000/mm in 78%), serum amylase (above 160 unit/L in 62%), urine amylase (above 300 unit/L in 56%), blood glucose (above 110 mg/L in 50%), serum alkaline phosphatase (above 250/L in 44%). 8) The surgical methods in 29 cases were excision (1 case), external drainage (4 cases), cystogastrostomy (7 cases), cystojejunostomy (16 cases), cystoduodenostomy (1 case). 9) Postoperative complications were encountered in 13 cases, and many of the cases involved pulmonary complications and wound infections. CONCLUSIONS: Currently, treatment of patients with pancreatic pseudocysts is based on the clinical setting, the presence or absence of symptoms, the age and size of the pseudocyst, and the presence or absence of complications. In the most common clinical settings, a pseudocyst is discovered after an episode of acute alcoholic pancreatitis.
Abdominal Pain ; Alkaline Phosphatase ; Amylases ; Blood Glucose ; Busan ; Drainage ; Head ; Humans ; Nausea ; Pancreatic Ducts ; Pancreatic Pseudocyst* ; Pancreatitis ; Pancreatitis, Alcoholic ; Postoperative Complications ; Sex Distribution ; Tomography, X-Ray Computed ; Ultrasonography ; Vomiting ; Wound Infection

BACKGROUND: A pancreaticoduodenectomy is the procedure of choice in patients with periampullary cancer. Because of the improvement in the postoperative mortality and morbidity over the past several decades, the indications for pancreaticoduodenectomy are becoming more extended. The aim of this study was to determine the incidence, the origin, and the present management strategy for early and late complications following this operation. METHODS: In one hundred twenty-two patients who had undergone a pancreaticoduodenectomy for periampullary cancer, mid bile-duct cancer, and other benign or malignant diseases during the period from Oct. 1994 to Dec. 1997 postoperative complications and operative mortality were analyzed retrospectively. RESULTS: Thirty-nine patients were treated for common bile-duct cancer, 37 patients for cancer, 22 patients for ampulla of Vater cancer, 5 patients for duodenal cancer, 4 patients for advanced gastric cancer, 2 patients for gall bladder cancer, and 13 patients for benign diseases or traumatic injury of the pancreas. A standard pancreaticoduodenectomy was performed in 92 patients, a pylorus-preserving pancreaticoduodenectomy in 12 patients, a total pancreatectomy in 11 patients, and a hepatopancreaticoduodenectomy in 7 patients. Of all the patients, 6 patients were treated with a pancreticoduodenectomy with combined portal vein resection. There was one hospital death. Postoperative complications occurred in 66 patients, and 24 patients had more than one. In 10 patients with complications, reoperative treatment was performed. The remaining 56 patients underwent the conservative treatments. CONCLUSIONS: The pancreaticoduodenectomy remains a formidable procedure despite the low mortality rate reported recently. Postoperative complications following a pancreaticoduodenectomy are common and their prompt recognition and appropriate management are of great importance in contributing to a successful outcome for the majority of patients.
Ampulla of Vater ; Duodenal Neoplasms ; Gallbladder Neoplasms ; Humans ; Incidence ; Mortality ; Pancreas ; Pancreatectomy ; Pancreaticoduodenectomy* ; Portal Vein ; Postoperative Complications* ; Retrospective Studies ; Stomach Neoplasms

BACKGROUND: Chromogranin A (CgA) is a 49-kDa glycoprotein produced by endocrine cells and is stored and secreted together with the resident hormones of electron-dense core secretory granules. Although the physiologic role of this protein is still unclear, recent data suggest that it may play a critical role in the maturation of secretory granules. This study was performed in order to evaluate the clinical significance of CgA expression in bile duct cancer. METHODS: The cases of 113 patients who underwent operations for bile duct cancer from 1986 to 1995 were reviewed for clinicopathologic characteristics, and deparaffinized sections of formalin-fixed tumor tissue samples were immunostained for CgA by using ABC method. RESULTS: Forty cases (35.4%) had tumor cells stained with CgA. Although poorly differentiated tumors (n=8) were not stained by CgA, no differences were noted in the positive rates for other clinico-pathologic characteristics, including age, sex, extent of disease, lymph-node metastasis, gross type, location of the tumor, and AJCC TNM stage. Eighty-three (83) curatively resected patients were analyzed for survival time based on clinico pathologic characteristics and CgA positivity. There was no difference in the overall survival time between the CgA positive (n=28) and negative (n=55) patients. However, in cases (stage III or IV, n=51) with lymph-node metastasis or adjacent organ invasion, patients (n=17) with a CgA- positive tumor had a significantly better prognosis than those (n=34) with a CgA-negative tumor (p=0.0318). The prognoses for the 28 cases with CgA-positive tumors did not correlate with known prognostic factors, including the TNM stage. Therefore, a CgA positive tumor may have a different tumor biology from that of a CgA negative tumor. CONCLUSIONS: Neuroendocrine differentiation in bile duct cancer is not a rare phenomenon and may be associated with a good prognosis for advanced bile duct cancer patients who have undergone a curative resection.
Bile Duct Neoplasms* ; Bile Ducts* ; Bile* ; Biology ; Chromogranin A ; Endocrine Cells ; Glycoproteins ; Humans ; Neoplasm Metastasis ; Prognosis ; Secretory Vesicles

BACKGROUND: Postoperative ileus is not an infrequent problem in clinical practice and is the major cause of morbidity with occasional mortality. The purposes of this study were to analyze clinical features and to assess associated risk factors in postoperative mechanical ileus. METHODS: We reviewed the cases of 43 patients with mechanical ileus who had undergone exploration from among the 1631 colorectal cancer patients treated between June 1989 and December 1997. RESULTS: The causes of postoperative ileus were postoperative adhesion, recurrence of cancer, and hernia, and these causes were closely associated with postoperative periods (period I, <4 months; period II, 4-12 months; period III, >12 months). Adhesion was the most common cause of obstruction in the early postoperative period (period I, 86%), while cancer recurrence increased with time (period I: 7%, period II: 36%, period III: 53%). The clinical features of simple and strangulated obstructions were not significantly different. We could find no significant correlation between clinicopathological findings of the tumor and postoperative ileus requiring surgery. Among 874 rectal cancer patients, 122 patients (15.1%) received adjuvant radiation therapy (RT) postoperatively. The cases receiving RT presented a significant increase in the incidence of postoperative ileus and surgical treatment (28% vs 7.5%, 15% vs 1%, respectively, p<0.001). CONCLUSIONS: major cause of postoperative mechanical ileus requiring surgery in colorectal cancer patients was adhesion until one year postoperatively and cancer recurrence thenafter. Postoperative RT seems to be a risk factor of postoperative mechanical ileus.
Colorectal Neoplasms* ; Hernia ; Humans ; Ileus* ; Incidence ; Mortality ; Postoperative Period ; Rectal Neoplasms ; Recurrence ; Risk Factors

BACKGROUND: Small bowel tumors are relatively uncommon, accounting for only 3 to 6% of all gastrointestinal tumors. Their infrequency and the lack of specific symptoms can result in delayed diagnosis and poor prognosis. The purpose of this study was to find a relationship between the pathology and the clinical features of primary tumors of the jejunum and the ileum. METHODS: We analyzed the clinicopathological findings of 28 patients with primary tumors of the jejunum and the ileum who had undergone surgery at the Department of Surgery, Asan Medical Center, between June 1989 and December 1997. RESULTS: Among the 28 patients, there were 20 men and 8 women. The mean age was 54 years (13-76 years). The tumors consisted of 10 malignant gastrointestinal stromal tumors (GISTs), 7 lymphomas, 6 benign GISTs, 3 adenocarcinomas, and 2 lipomas. The clinical symptoms of these patients were abdominal pain (54%), GI bleeding (32%), nausea & vomiting (14%), weight loss (14%), palpation of abdominal mass (11%), and dizziness (11%). The preoperative complications were bleeding (32%), perforation (18%), intussusception (11%), and obstruction (7%). Bleeding was found in GISTs only and was more frequent in benign GISTs(100%) than in malignant GISTs (30%). Perforation was found in malignant tumors only (25%). Among the 20 patients with malignant tumors, chemotherapy was done in 13, and the 2-year survival rate was 75%. CONCLUSIONS: Early diagnosis of small bowel tumors is essential to prevent complications such as bleeding and perforation and to reduce mortality. Early diagnosis and surgery seem to be indispensable to a good outcome in symptomatic patients.
Abdominal Pain ; Adenocarcinoma ; Chungcheongnam-do ; Delayed Diagnosis ; Dizziness ; Drug Therapy ; Early Diagnosis ; Female ; Gastrointestinal Stromal Tumors ; Hemorrhage ; Humans ; Ileum* ; Intussusception ; Jejunum* ; Lipoma ; Lymphoma ; Male ; Mortality ; Nausea ; Palpation ; Pathology ; Prognosis ; Survival Rate ; Vomiting ; Weight Loss