Adult ; Female ; Humans ; Hysterectomy ; Leiomyoma ; diagnosis ; Middle Aged ; Muscle Neoplasms ; complications ; surgery ; Uterine Neoplasms ; complications ; surgery

Gastrointestinal leiomyomas are commonly found in the stomach, and but 3% of them arises from the colon. Colonic leiomyomas are often found incidentally during colonoscopic examination. Most of patients with colonic leiomyoma are asymptomatic, but patients with large size leiomyoma occasionally have abdominal mass, hemorrhage, intestinal obstruction or perforation. Pedunculated leiomyomatous polyp is rare. Leiomyomatous polyps are occasionally misjudged as adenomatous polyps by endoscopist. We report a case of pedunculated leiomyomatous colonic polyp in 65 year-old female patient. She has complained of intermittent hematochezia and lower abdominal discomfort for 5 months. During colonoscopy, an 1 cm sized long pedunculated polyp at the splenic flexure was detected. It was removed by colonoscopic snare polypectomy. Leiomyomatous polyp was confirmed by microscopic and immunohistochemical findings.
Aged ; Anus ; Colonic Neoplasms/complications/*diagnosis ; *Colonoscopy ; English Abstract ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; *Leiomyoma/complications/*diagnosis

OBJECTIVE: A number of preexisting clinical conditions are generally accepted as contraindications for total vaginal hysterectomy. The purpose of this study was to evaluate the validity of these contraindications. METHODS: The TVH-A group consisted of 230 patients who have undergone vaginal hysterectomy. These patients (1) had a large uterus (>280 gm), (2) were either nulliparous or had no previous vaginal delivery, or (3) had a history of previous abdominal or vaginal operation. The TVH-B group was composed of patients who did not present with any contraindications when they underwent vaginal hysterectomy. Patients of the TAH group underwent abdominal hysterectomy. The records for all patients were analyzed according to age, weight, parity, primary diagnosis, uterine weight, duration of operation, blood loss, analgesia, hospital stay, and postsurgical complications. RESULTS: No significant difference in age and weight was observed between the three groups. The average number of vaginal deliveries performed was lower in the TVH-A group. Uterine myoma, carcinoma in situ, and adenomyosis were common preoperative diagnoses in all groups. The most common contraindication for total vaginal hysterectomy in the TVH-A group was history of previous operation (54.8%); large uterus (44.8%) and nulliparity (21.3%) ranked second and third, respectively. Durations of operation, hospital stay, and pain were longer, bleeding volume was greater, and incidence of postoperative complications was higher in the TAH group than in the other groups (p<0.01). Previous cesarean delivery did not affect various operative characteristics among women undergoing vaginal hysterectomy (p<0.01). CONCLUSION: Our data indicate that a history of previous operation, large uterus, and nulliparity rarely constitute contraindications to vaginal hysterectomy.
Adenomyosis ; Analgesia ; Carcinoma in Situ ; Diagnosis ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Incidence ; Leiomyoma ; Length of Stay ; Parity ; Postoperative Complications ; Uterus

The purpose of study was to retrospectively assess the possibility of simultaneous breast reduction and tumor excision in women with benign tumor and mammary hyperplasia. Performance status of the patient, appropriate operation technique and postoperative results were analyzed. Evaluation was made regarding four patients who underwent simultaneous breast reduction and tumor excision with more than 6 months follow up. The types and locations of the tumor, corresponding operation technique, postoperative complication such as flap necrosis, subjective alteration in sensorium around the nipple-areolar complex and esthetic satisfaction were assessed. Preoperative radiologic examinations, histologic findings of the fine needle aspiration, and postoperative biopsy were equivalent. The histologic types revealed were tubular adenoma, leiomyoma and lipoma(2 cases). The tumor was each located in lower lateral quadrant, subpectoral, inframammary fold, and upper lateral quadrant of breast, respectively. Regarding the location of tumor and status of mammary hyperplasia, each breast reduction was done with superior, inferior and medial pedicle(2 cases). There were no postoperative complications and esthetic satisfaction rate was high in all patients. When accurate diagnosis based on preoperative radiologic and histologic evaluation and appropriate selection of operative technique were done, simultaneous breast reduction with excision of benign tumor showed satisfying outcome without postoperative complication even along with esthetic satisfaction.
Adenoma ; Biopsy ; Biopsy, Fine-Needle ; Breast ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hyperplasia ; Leiomyoma ; Mammaplasty* ; Necrosis ; Postoperative Complications ; Retrospective Studies

Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. If a patient had tachypnea, cold sweating and hypoxemia in postoperative period, PTE must be thought to be one of possible causes of tachypnea. We have experienced one case of PTE after operation. A 40 year-old woman underwent total hystrectomy and partial omentectomy due to huge, bizarre shaped and inflammatory myoma presenting as an abdominal mass with abscess pocket accompanied by severe and adhesion. At the 5 th postoperative day tachypnea and hypoxemia were developed suddenly. PTE was confirmed with lung perfusion scan and leg edema with deep vein thrombosis occurred later. Proper cardiopulmonary support and anticoagulant therapy were done and the patient was recovered and discharged in improved condition.
Abscess* ; Adult ; Anoxia ; Diagnosis ; Edema ; Female ; Humans ; Leg* ; Leiomyoma* ; Lung ; Myoma ; Perfusion ; Postoperative Complications ; Postoperative Period ; Pulmonary Embolism* ; Sweat ; Sweating ; Tachypnea ; Venous Thrombosis*

Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. If a patient had tachypnea, cold sweating and hypoxemia in postoperative period, PTE must be thought to be one of possible causes of tachypnea. We have experienced one case of PTE after operation. A 40 year-old woman underwent total hystrectomy and partial omentectomy due to huge, bizarre shaped and inflammatory myoma presenting as an abdominal mass with abscess pocket accompanied by severe and adhesion. At the 5 th postoperative day tachypnea and hypoxemia were developed suddenly. PTE was confirmed with lung perfusion scan and leg edema with deep vein thrombosis occurred later. Proper cardiopulmonary support and anticoagulant therapy were done and the patient was recovered and discharged in improved condition.
Abscess* ; Adult ; Anoxia ; Diagnosis ; Edema ; Female ; Humans ; Leg* ; Leiomyoma* ; Lung ; Myoma ; Perfusion ; Postoperative Complications ; Postoperative Period ; Pulmonary Embolism* ; Sweat ; Sweating ; Tachypnea ; Venous Thrombosis*

Primary tumor of the renal pelvis and ureter is relatively rare disease, but usually malignant. It's prognosis is dependent upon the early detection, accurate diagnosis, procedure for treatment, and tumor grade and stage. Therefore, urologist should endeavor after accurate diagnosis and definitive treatment. A clinical observation was done on the 11 patients with renal pelvic tumor and the 3 patients with ureteral tumor at the Department of Urology, Kyungpook National University Hospital during the period of 4 years from January, 1978 to December, 1981. The results were as follows: 1. There were 9 men and 5 women, giving a ratio of 1.8 to 1. The average age at presentation of the 14 patients was 51.4 years. 2. On excretory urogram, nonvisualization of the kidney was the most prevalent sign in 10 patients. Retrograde pyelogram was done in 11 patients in whom findings of IVP were not sufficient for diagnosis. Renal angi0graphy was done in 9 patients. 3. Urine cytology was positive in 2 of 14 patients. 4. Of the 13 patients treated, 12 were proved to have transitional cell carcinoma, and 1 was leiomyoma. In 3 of the 11 patients with renal pelvic tumor, Concomitant ureteral tumor was present at diagnosis. And in 2 of the 11 patients with renal pelvic tumor developed subsequent urothelial tumors in the ureter and/or bladder after simple nephrectomy. 5. Nephroureterectomy including resection of a bladder cuff was done in 11 patients, and in 2 of these was also performed lymphadenectomy. Simple nephrectomy was done in 2 patients with renal pelvic tumor under the misdiagnosis of renaltuberculosis. 6. Postoperative complications developed in 3 cases, wound infection, pneumothorax, and death, in each case.
Carcinoma, Transitional Cell ; Diagnosis ; Diagnostic Errors ; Female ; Gyeongsangbuk-do ; Humans ; Kidney ; Kidney Pelvis* ; Leiomyoma ; Lymph Node Excision ; Male ; Nephrectomy ; Pneumothorax ; Postoperative Complications ; Prognosis ; Rare Diseases ; Ureter* ; Urinary Bladder ; Urology ; Wound Infection

PURPOSE: Laparoscopic surgery of the abdomen has grown rapidly in popularity due to the benefits, including a low level of post operative pain, early recovery, short hospitalization and excellent cosmetic results. Concerning tumor resection, most benign gastric tumors are ideal for the use of the non invasive method of a laparoscopic procedure. To evaluate the feasibility of laparoscopic surgery for benign gastric tumors, we analysed the clinicopathological findings, post operative course and prognosis. METHODS: Between January 1995 and August 2001, laparoscopic surgery was performed on 18 patients with benign gastric tumors at the Department of Surgery at Yonsei University Hospital. To evaluate the feasibility of laparoscopic surgery for these lesions, the sex, age, pathologic diagnosis, operative methods, tumor location, tumor size, operative time, recurrence, gas passing time and diet recovery time were analyzed. RESULTS: The patients group consisted of 3 men (16.7%) and 15 women (83.3%), with a mean age of 51.9+/-15.0 years (range, 23~80). The histopathological examinations showed 12 mesenchymal tumors (5 leiomyomas, 4 stromal tumors, 3 Schwannomas), 2 mucosa origin tumors (1 retention polyp, 1 villous adenoma), 2 ectopic pancreata, 1 carcinoid tumor and 1 lipoma. The operation methods were 14 laparoscopic wedge resections of stomach, 1 laparoscopic assisted partial gastrectomy and 1 gastrotomy and polypectomy. In 2 patients, a laparotomy was required following the laparoscopy due to difficulties in detecting the tumors. In one of the 2 converted cases, preoperative endoscopic marking of the tumor site was performed, but the dye was spread very widely from the mid body to the prepylorus. The other tumor was located on the lesser curvature of the upper third, around the esophagogastric junction, but it was not exactly identified. The tumors were located in the upper, middle, and lower third of the stomach in 7, 9 and 2 cases, respectively. As a circumferential location, 7 tumors were mainly situated on the anterior wall, 6 on the posterior wall, 3 on the greater curvature and 2 on the lesser curvature. All tumors, even those on the lesser curvature and posterior wall, were able to be resected with laparoscopy. The size of the resected tumors averaged 2.2+/-0.9 cm (range, 0.8~4.3). The resection margins were all negative. The operation time averaged 145.8+/-57.0 min (range 70~280). The time to passing gas averaged 2.2+/-0.9 days (range 1~4). The recovery time to a soft diet averaged 5.9+/-1.9 days (range, 2~9). The postoperative course of all the patients was uneventful, and there were no postoperative complications with the exception of one case of diet intolerance. During the follow up there have been no recurrences to date. CONCLUSION: With its proper application in benign gastric tumors, laparoscopic surgery needs to identify the exact site of a tumor, can contribute significantly to an improved patient outcome because it is less complicated and safer compared to conventional gastrectomy methods.
Abdomen ; Carcinoid Tumor ; Diagnosis ; Diet ; Esophagogastric Junction ; Female ; Follow-Up Studies ; Gastrectomy ; Hospitalization ; Humans ; Laparoscopy* ; Laparotomy ; Leiomyoma ; Lipoma ; Male ; Mucous Membrane ; Operative Time ; Polyps ; Postoperative Complications ; Prognosis ; Recurrence ; Stomach

PURPOSE: To evaluate the feasibility and efficacy of a laparoscopic wedge resection with hand-sewing closure in gastroduodenal tumors. METHODS: Laparoscopic wedge resections were performed in 16 patients with gastroduodenal tumors between May 2000 and December 2002 at Ewha Womans University Mok-Dong Hospital. Every case, with the exception of one, was performed via an extragastric approach, with a transgastric approach performed in the exception. Excision of lesion was performed manually using electrocautery and ultrasonic coagulating shears and closed by a manual (not use autosuture stapler) intracoporeal running suture. RESULTS: Of the 16 cases, two were performed with a laparoscope-assisted method, but there were no conversion to open surgery. Mean size of lesions was 27.9 mm in diameter and mean operation time was 219 minutes. In all cases, a complete tumor excision with negative surgical margins was obtained. The final pathologic diagnoses were: ectopic pancreas 4 cases, gastrointestinal stromal tumor 3 cases, leiomyoma 2 cases, adenomyoma 2 cases, tubular adenoma 1 case, Brunner's gland hyperplasia 1 case, carcinoid tumor 1 case, eosinophilic granuloma 1 case, and post endoscopic mucosectomy state for early gastric cancer 1 case. The average number of days to the first postoperative oral food intake and hospital stay were 3.1 and 6.0 days, respectively. There were no postoperative complications. CONCLUSION: A laparoscopic wedge resection with hand-sewing closure should be considered as a valid treatment option for selected gastroduodenal tumors, in terms of its feasibility, safety, and cost. A more efficient surgical instrument and technique should be developed in the future.
Adenoma ; Adenomyoma ; Carcinoid Tumor ; Conversion to Open Surgery ; Diagnosis ; Eating ; Electrocoagulation ; Eosinophilic Granuloma ; Female ; Gastrointestinal Stromal Tumors ; Humans ; Hyperplasia ; Leiomyoma ; Length of Stay ; Pancreas ; Postoperative Complications ; Running ; Stomach Neoplasms ; Surgical Instruments ; Sutures ; Ultrasonics

Objectives: We performed this study to review the clinical availability of the classical intrafascial SEMM hysterectomy (CISH), and report our experience for 2 years restrospectively. METHODS: From March 1999 to February 2001, 100 cases of CISH were performed at the Department of Obstetrics and Gynecology, College of Medicine, Kangdong Sacred Heart Hospital, Hallym university. We performed this procedure by 3 steps. The dissection of uterus was done by classical suture methods (including extracorporeal and intracorporeal suture techniques) to uterine isthmic portion. And then transvaginal cylindrical coring out of the cervical tissue was done using a cervix corer, the Calibrated Uterine Resection Tools (CURT) for resection of cervical tissue especially transformation zone. Finally, the dissected uterus was extracted by using a Serrated Edged Macro-Morcellator (SEMM) without colpotomy. We reviewed the patient's data retrospectively and made phone calls to each patients. RESULTS: The indications for CISH, based on the pre-and intraoperative diagnosis, were leiomyoma, adenomyosis, endometrial hyperplasia and chronic pelvic inflammatory disease or pelvic pain, in order of frequency. The mean operative time was 126 minutes and the mean hemoglobin change was 1.27 gm/dL. The mean hospital days were 5.7 days and the mean age of the patients was 44.6 years old. There were no definite intra- and postoperative complications except for 3 cases of CO2 retentions and 2 cases of delayed bleeding on cervical stump. The mean days to first sexual contact after surgery were 34.5 days. In view of sexual feeling, 86% of the patients didn't feel any difference and only 13% felt worse than before. During postoperative follow-up, the cervical cytologic study were found no endocervical cells at all of 44 checked patients. CONCLUSION: The CISH procedures can be safely performed by well-trained laparoscopists, and this technique minimally alters the anatomy and integrity of the pelvic floor and vagina. Therefore the reductions of surgical morbidity, blood loss, hospitalization and postoperatve discomfort were obtained. Through the preservation of the anatomical relations of the pelvic floor and the function of female sexuality, this technique is the new proposal in gynecologic surgery.
Adenomyosis ; Cervix Uteri ; Colpotomy ; Diagnosis ; Endometrial Hyperplasia ; Female ; Follow-Up Studies ; Gynecologic Surgical Procedures ; Gynecology ; Heart ; Hemorrhage ; Hospitalization ; Humans ; Hysterectomy* ; Leiomyoma ; Obstetrics ; Operative Time ; Pelvic Floor ; Pelvic Inflammatory Disease ; Pelvic Pain ; Postoperative Complications ; Retrospective Studies ; Sexuality ; Sutures ; Uterus ; Vagina