Cholangiocarcinomas originate from the bile duct mucosa and can occur at any level of the biliary tract. Approximately 40 to 60% of cases are found at the hilar level.-Currently, a curative surgical resection is the only treatment method. The surgical treatments of a hilar cholangiocarcinoma are challenging but the diagnostic accuracy has improved with the better preoperative imaging and noninvasive diagnostic techniques. Using the percutaneous transhepatic choledochoscope,-direct visualization of the extent and possible invasion of the tumor is possible, which provides information for determining the extent of the resection. During an endoscopic examination, it is also possible to-pathologically confirm a carcinoma and drain biliary system to relieve an obstruction. Portal vein embolization to increase the volume of the future remaining liver has been attempted in steps of-accomplishing an extended surgical resection of hilar cholangiocarcinoma.- The 5-year survival of hilar cholangiocarcinoma is still poor, ranging from 20~40% after a curative resection with-a median survival of 12-16 months. A R0 resection is the most important prognostic factor that affects the survival significantly . The choice of surgical procedure is determined by the location of the tumor. In general, unilobar involvement even with ipsilateral encasement of the hepatic artery or portal vein branch, and/or ipsilateral secondary biliary radicals with associated lobar atrophy are considered resectable. In carefully selected candidates,-an extended hepatic resection with a concomitant en bloc resection of the vascular structures and accompanied by a reconstruction along with a biliary excision has been advocated for complex hilar tumors to attain some survival benefit through a R0 resection. We review the recent trends in various diagnostic methods and surgical treatments for hilar cholangiocarcinoma.
Atrophy ; Bile Ducts ; Biliary Tract ; Cholangiocarcinoma* ; Hepatic Artery ; Liver ; Mucous Membrane ; Portal Vein ; Prognosis

No abstract available.
Acupuncture* ; Mycobacterium chelonae* ; Mycobacterium* ; Nontuberculous Mycobacteria

The optimal management of hepatic metastases in colorectal carcinoma patients has become increasingly complex with the myriad of available treatment options. Because the timing of any therapy has become integral to the success of the treatment, a collaborative approach involving multiple specialties is needed for achieving the best patient outcome. Surgical resection is the most effective therapy for metastatic colorectal cancer isolated to the liver. Liver resection of colorectal metastases is associated with three- and five-year survival rates close to 40~60% and 30~50%, respectively. Because the technique for hepatic resection has improved, patients with multiple, biloba, and huge metastases can undergo resection. Every liver resection should be planned after intraoperative ultrasonography, and an anatomical surgical procedure should be preferred instead of wedge resection. Since some of patients diagnosed with metastatic colorectal disease are initially classified as unresectable, neoadjuvant chemotherapy is being increasingly employed to downsize colorectal metastasis. The greatest benefit of the preoperative approach is the potential to convert patients with initially unresectable metastatic disease to a resectable state. Although various prognostic risk factors have been identified, there has been no dependable staging or prognostic scoring system for metastatic hepatic tumor. As surgeons become more proficient in the technical aspects of resection, the patient selection criteria as based on the biologic determinants of the outcome are becoming increasingly important. The goal of this review is to provide the optimal management, treatment and follow-up for patients with colorectal metastasis to the liver.
Colorectal Neoplasms ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver* ; Neoplasm Metastasis* ; Patient Selection ; Risk Factors ; Survival Rate ; Ultrasonography

No abstract available.
Fingers* ; Leg Ulcer* ; Leg* ; Scleroderma, Systemic* ; Ulcer*

No abstract available.
Alzheimer Disease ; Dementia ; Humans ; Venous Thrombosis

Adrenal myelolipoma is a rare benign, non-functioning tumor that is frequently discovered incidentally. We report here on a case of a 47-year-old woman with an incidentally found adrenal tumor. She was slightly obese and had been diagnosed with diabetes. Her blood sugar level was well-controlled with oral hypoglycemic agents. All the laboratory test results were within normal limits. The abdomen CT scan revealed a well-demarcated homogenous solid mass that was 9cm in diameter, and it consisted of fat tissues. The differential diagnosis for malignant tumors was necessary, so we performed complete surgical excision. The patient recovered well without any major complications. If the diagnosis of adrenal myelolipoma is definite, then regular follow-up of this type of patient is sufficient. However, as the differential diagnosis with malignant tumors is rather difficult and as spontaneous hemorrhage can persist in the giant myelolipomas that are greater than 10cm in diameter, performing complete surgical excision is inevitable.
Abdomen ; Adrenal Gland Neoplasms ; Blood Glucose ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypoglycemic Agents ; Middle Aged ; Myelolipoma

BACKGROUNDS/AIMS: Traumatic pancreatic injury is rare and various surgical procedures can be applied according to the severity of injury. We reviewed our experience of pancreatic injury and investigated the clinical outcome. METHODS: Fifty-six patients were treated conservatively or with surgery for pancreatic injury at the Department of Surgery, Korea University Medical Center of Korea University College of Medicine from January 2001 to February 2012. RESULTS: Forty-one men and 15 women were included (mean age, 32 years; range, 5-66 years). Twelve patients were hypotensive at admission. According to the American Association for the Surgery of Trauma grade, 15 patients were grade I, 16 were grade II, 10 were grade III, 13 were grade IV, and one patient was grade V. A total of 41 patients underwent exploratory surgery. Complications developed in 35 patients, and 19 patients demonstrated intra-abdominal abscesses associated with pancreatic leakage. Four mortalities occurred. More adult patients (n=42) required intensive care than that of pediatric patients (n=14) (p=0.03). However, more pediatric patients had hyperamylasemia at admission (p=0.023). A significantly higher proportion of patients in the hypotensive group had blunt abdominal injuries, associated extra-abdominal injuries, combined intra-abdominal injuries, longer ICU stays, and a higher mortality rate. CONCLUSIONS: Associated intra-abdominal and extra-abdominal injuries are frequent in patients with traumatic pancreatic injury. Despite the complication rate, most patients recovered. Mortalities were associated with combined injuries being placed into bleeding, hypovolemic shock, and multiorgan failure.
Abdominal Abscess ; Abdominal Injuries ; Academic Medical Centers ; Adult ; Female ; Hemorrhage ; Humans ; Hyperamylasemia ; Critical Care ; Korea ; Male ; Pancreatic Fistula ; Shock

A 60-year-old female was admitted with epigastric pain lasting a month. Preoperative diagnosis was choledochal cyst with anomalous pancreaticobiliaryductal union (APBDU), C-P type. A papillary mass measuring 2.5 x 1.9 cm was found adjacent to the pancreaticocholedochal junction. Gallbladder (GB) cancer was also observed. Pyloric-preserving pancreaticoduodenectomy (PPPD) was performed. The patient received adjuvant chemotherapy/radiation therapy on the tumor bed. The gallbladder cancer showed serosal invasion, while the bile duct cancer extended into the pancreas. Although common bile duct (CBD) cancer lesion showed focally positive for p53 and the gallbladder cancer lesion showed negative for p53, the Ki-67 labeling index of the CBD cancer and GB cancer were about 10% and 30%, respectively. Nine months after curative resection, a stricture on the subhepatic colon developed due to adjuvant radiation therapy. Localized peritoneal seedings were incidentally found during a right hemicolectomy. The patient underwent chemotherapy and had no evidence of tumor recurrence for two years after PPPD.
Bile Duct Neoplasms ; Choledochal Cyst ; Colon ; Common Bile Duct ; Constriction, Pathologic ; Female ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Middle Aged ; Neoplasms, Multiple Primary ; Pancreas ; Pancreaticoduodenectomy ; Recurrence ; Seeds

Hepatolithiasis is characterized by its intractable nature and frequent recurrences that require multiple operative interventions. Intrahepatic stones consist of calcium bilirubinate in most cases, but these stones contain more cholesterol than the stones in the common bile duct. The pathogenesis of primary bile duct stones is based upon bile stasis and infection. Bile duct stricture and dilatation of the duct are usually present in cases with brown pigmented stones. In addition to cholangitis, liver abscess and longstanding sepsis, intrahepatic stones and strictures can cause secondary biliary cirrhosis and intrahepatic cholangiocarcinomas. Pyogenic cholangitis that's due to strictures and hepatolithiasis tends to recur; therefore, operations such as stricturoplasty, hepaticojejunostomy and liver resection are inevitable. The primary goals of surgery are to eliminate stones and the atrophic liver tissue, and to correct the bile stasis. Recent advances have been made in noninvasive treatments, such as percutaneous transhepatic cholangioscopic lithotripsy (PTCSL). Because postoperative residual stones and recurrent stones occur frequently, PTCSL and dilatation therapy will improve the outcomes of patients suffering with hepatolithiasis combined with bile duct stricture.
Bile ; Bile Ducts ; Bilirubin ; Cholangiocarcinoma ; Cholangitis ; Cholesterol ; Common Bile Duct ; Constriction, Pathologic ; Dilatation ; Humans ; Lithotripsy ; Liver ; Liver Abscess ; Liver Cirrhosis, Biliary ; Recurrence ; Sepsis ; Stress, Psychological

Obtaining the basic statistical data on cancer diseases is essential to plan cancer research and to determine the proper tools to use for diagnosing and treating cancer. By using the national wide cancer registry, more accurate data has been collected and more informative cancerrelated statistical data can be calculated such as the occurrence rate, the death rate, the survival rate and so on. In Korea, the primary liver cancer registry has been active since 2003, and the clinical data from 10,886 patients has been collected. Unfortunately there are time and security limitations for recording and sharing this data and so a more convenient system is required. Therefore, we have revised the original primary hepatoma cancer registry to give a summary of research itself and an analysis of patients' data for the government's national wide evaluation and management of primary hepatoma.
Carcinoma, Hepatocellular ; Humans ; Korea ; Liver Neoplasms ; Survival Rate