1.Gallstone Perforation of the Ileum Found during an Operation for CBD Malignancy.
Bugoan CHO ; Youngil CHOI ; Donghoon SHIN
Journal of the Korean Surgical Society 2007;72(3):254-257
Gallstone is a common disease with a prevalence of about 10%, but biliary ileus is a rare entity with a frequency of about 1% for all the symptomatic patients. We are reporting on a case of perforated terminal ileum that was due to gallstone, and this was without any associated intestinal obstruction or bilioenteric fistula. A 76 year old man presented with a history of jaundice and dark colored urine for a 3-month duration with no clinical features of intestinal obstruction. There was no past history of biliary tract disease. The abdominal radiograph demonstrated no biliary stones or classical findings of gallstone ileus, but there was a suspicion of cholangiocarcinoma. Laparotomy was performed. A perforation of terminal ileum was identified in the mesenteric border of the terminal ileum and adjacent to ileocecal valve, and it was wrapped by omentum. A small 1.5 cm sized stone was impacted in the mesentery at the site of the perforation. The perforation site was closed. Cholecystectomy and proximal common bile duct resection with Roux-en-Y choledochojejunostomy was then performed.
Aged
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Biliary Tract Diseases
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Cholangiocarcinoma
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Cholecystectomy
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Choledochostomy
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Common Bile Duct
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Fistula
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Gallstones*
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Humans
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Ileocecal Valve
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Ileum*
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Ileus
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Intestinal Obstruction
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Jaundice
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Laparotomy
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Mesentery
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Omentum
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Prevalence
2.A Clinical Review of Papillary Microcarcinoma of the Thyroid.
Bugoan CHO ; Jaeyoung CHOI ; Jeong Hoon KIM
Korean Journal of Endocrine Surgery 2006;6(2):87-93
PURPOSE: Most cases of papillary microcarcinomas of the thyroid (PMC) are not palpable and are clinically asymptomatic. The natural history of the microcarcinoma is unclear and remains debatable. There is continued discussion of whether thyroid microcarcinomas should be treated surgically and to what extent surgical removal should be extended. The main goal of this study was to analyze the clinical features and to determine the appropriate surgical treatment for well differentiated PMC in one lobe of the thyroid with favorable features in regard to consideration of radical surgery. METHODS: We studied 134 patients with the histological diagnosis of PMC from March 2003 to January 2006. The tumor was defined as 10 mm or less in the greatest diameter according to the World Health Organization guidelines. For all patients we confirmed the diagnosis by ultrasoundguided fine-needle aspiration biopsy (US-FNAB) preoperatively. There were 11 men and 123 women. The age at initial treatment ranged from 22 to 74 years (mean 46). Thyroid resection was lobectomy in 31 (23.1%) and total thyroidectomy (TT) in 103 (76.9%). CCND was performed routinely at the time of thyroidectomy. Lateral neck dissection was carried out in eight patients (5.9%) who had biopsy-proven metastatic cervical lymphadenopathy demonstrated clinically or by imaging. Patient records were reviewed retrospectively. Categorical variables were analyzed using the chi-square test or Fisher's exact test. Two-sided Student's t-test was used to compare paired data. RESULTS: The mean tumor size was 6.77 mm. PMC was associated in 36.6% (49/134) with lymph node metastasis, in 20.1% (27/134) with multifocality and in 26.9% (36/134) with capsular invasion. The mean tumor size differences influenced lymph node metastasis (LNM) (P<0.05). Capsular invasion (38.8%, 19/49) and multifocality (30.6%, 15/49) were associated with LNM (P=0.018, 0.022 respectively). The subdivision of primary tumors according to size (
Biopsy, Fine-Needle
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Diagnosis
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Female
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Follow-Up Studies
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Humans
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Incidence
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Lymph Node Excision
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Lymph Nodes
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Lymphatic Diseases
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Male
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Mortality
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Natural History
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Neck Dissection
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Neoplasm Metastasis
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Recurrence
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Retrospective Studies
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Thyroid Gland*
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Thyroidectomy
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World Health Organization