Organ-preserving and minimally invasive surgery should be considered in treating benign and borderline pancreatic lesions. However, total pancreatectomy is recommended for several pancreatic pathologies involving the entire pancreas. With the development of laparoscopic experiences and technique, laparoscopic pylorus-preserving pancreaticoduodenectomy (PPPD) and subtotal (extended) distal pancreatectomy are regarded as safe surgical procedure. Therefore, laparoscopic total pancreatectomy can be composed of two different surgical processes; (1) laparoscopic PPPD, and (2) subtotal (extended) distal pancreatectomy. Especially, subtotal (extended) distal pancreatectomy can be done by combined splenectomy or by excision or conserving both splenic vessels. When total pancreatectomy cannot be avoided in clinical situation, laparoscopic total pancreatectomy is feasible, safe, and can be a potential option. Techniques and potential indications will be discussed in this presentation.

Organ-preserving and minimally invasive surgery should be considered in treating benign and borderline pancreaticlesions. However, total pancreatectomy is recommended for several pancreatic pathologies involving the entirepancreas. With the development of laparoscopic experiences and technique, laparoscopic pylorus-preservingpancreaticoduodenectomy (PPPD) and subtotal (extended) distal pancreatectomy are regarded as safe surgicalprocedure. Therefore, laparoscopic total pancreatectomy can be composed of two different surgical processes;(1) laparoscopic PPPD, and (2) subtotal (extended) distal pancreatectomy. Especially, subtotal (extended) distalpancreatectomy can be done by combined splenectomy or by excision or conserving both splenic vessels. Whentotal pancreatectomy cannot be avoided in clinical situation, laparoscopic total pancreatectomy is feasible, safe, andcan be a potential option. Techniques and potential indications will be discussed in this presentation.

No abstract available.
Leukemia* ; Leukemia, Megakaryoblastic, Acute*

Though the primary carcinoma of the vermiform appendix is rare, the secondary carcinoma of the vermiform appendix is extremely rare. About fourty cases have been reported through the world. The breast is most common primary site, and adenocarcinoma is most common form. The metastatic carcinoma of the vermiform appendix, from squamous cell carcinoma of the uterine cervix, were extremely rare. The authors experienced a case of metastatic squamous cell carcinoma of the vermiform appendix, in thirty-two years old housewife. She was diagnosed with carcinoma of the uterine cervix on December, 1983, and treated with a radical hysterectomy on February, 1984, at Chicago, and with a radiation therapy. She had been suffered from palpable masses on left axilla and left neck region, and and coughing and chest pain. After an excision biopsy, on August, 1984, she showed intestinal obstruction sign including abdominal distension with abdominal pain. A right-sided hemicolectomy was performed on November, 1984. During gross examination, the wall of the distal portion of the vermiform appendix was moderatery thickened, and showed homogeneous light yellow cut surface. On microscopic examination, there were clusters of tumors that had negative stained preparations. On electron microscopic examination, the secretory granules were not found, and the characteristics of squamous cells, including intercellular spaces, desmosomes and tonofibrils, were noted.
Adenocarcinoma ; Neoplasm Metastasis

PURPOSE: In clinically suspected ankylosing spondylitis of sacroiliac (SIJ) and hip joints with normal or minimal secondary bone change in simple X-ray films, we evaluated the role of MRI in sacroiliac and hip joints. MATERIALS AND METHODS: Authors evaluated 11 cases (36 joints;SIJ 14, hip 22) confirmed as spondylitis by clinical, laboratory, and radiologic findings, and compared the detectability of involvement of joints by simple X-ray film and MRI. Authors analysed MR findings for the presence of pannus and its si, intensities (SI), change of articular cartilage, bony erosion and sclerosis, subchondral bone cysts,.~ osteophytosis, bone marrow edema, joint effusion, adjacent soft tissue change, and contrast enhancement ofi pannus. RESULTS: MRI detected not only 20 joints (SIJ 11, hip 9) detected in simple X-ray, but also additional 7 joints (SIJ 3, hip 4). MRI depicted simultaneous involvement of SIJ and hip joints in 5 of 11 cases (SIJ 10 joints, hip9 joints), and bilateral involvement of SIJ and hip joints in 4 among the 5 cases. MRI also demonstrated pannus, which were not detected in conventional films, as intermediate SI on T1WI and high SI on T2WI, in all 27 joints (SIJ 14, Hip 13). Gd-DTPA enhanced T1WI revealed enhancement of pannus in 7 cases (17 joints). CONCLUSION: MRI was a valuable modality in evaluation of clinically suspected ankylosing spondylitis of SIJ or hip joints with normal or minimal secondary bone change in simple X-ray. Simultaneous evaluation of SIJ and hip joints is suggested in clinically suspected ankylosing spondylitis or other joint diseases.
Bone Marrow ; Cartilage, Articular ; Edema ; Gadolinium DTPA ; Hip Joint* ; Hip* ; Joint Diseases ; Joints ; Magnetic Resonance Imaging ; Sclerosis ; Spondylitis ; Spondylitis, Ankylosing* ; X-Ray Film

PURPOSE: Diverticular disease of the colon is relatively common in western population and rare in oriental population but in recent years the incidence is steadily increasing in oriental population including Korean, so more concerns and appropriate management are required. METHODS: We reviewed 111cases who had diverticular disease in the colon from January 1988 to May 1998 in the Soonchunhyang University Chunan Hospital. Of 111 cases, 87 cases were treated conservatively and 24 cases received a surgical treatment. RESULTS: The annual incidence increased progressively for the last 10 years. The mean age of the patients at the time of diagnosis was 49.6 years and the most common age-group was forth decades (25%). The diverticula were located in the right colon 89%, left colon 7% and both side 4%. Among 24 surgically treated cases, the most common preoperative diagnosis was acute appendicitis (75%) and the correct preoperative diagnosis was made only 3 cases (13%) who had previous appendectomy history, previous diagnosed history or received barium enema due to recurrent pain attack. The surgical procedures of the colonic diverticulosis were right hemicolectomy (6 cases), ileo-ascending colectomy (6 cases), diverticulectomy (2 cases), segmental resection of transverse colon (1 case), left hemicolectomy (1 case), appendectomy (2 cases), appendectomy with drainage (3 cases), appendectomy with drainage and diverticulectomy (3 cases). The postoperative complication was wound infection in all complicated cases. There was no postoperative mortality. CONCLUSIONS: The outcome of patients in our series is satisfactory despite of diagnostic inaccuracies. Preoperative barium study is recommended in those above the 40 years of age suspected the appendicitis. We recommend surgery for patients after two or three episodes of acute diverticulitis that resolves after medical treatment with antibiotics.
Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Barium ; Chungcheongnam-do ; Colectomy ; Colon* ; Colon, Transverse ; Diagnosis ; Diverticulitis ; Diverticulosis, Colonic ; Diverticulum ; Drainage ; Enema ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Wound Infection

Primary extranodal lymphoma of the liver is very rare, approximately thirty-one cases having been reported in the literature. We report one case of primary malignant lymphoma of the liver in a 26-year-old female, who was presented with palpable abdominal mass on the epigastrium for about 40 days. Laboratory findings revealed no specific abnormalities. Peripheral lymph nodes or spleen were not palpable. An abdominal ultrasonogram revealed a huge mass involving the entire left lobe of the liver. Left lateral segmentectomy of the liver was done. The resected lateral portion of left lobe of the liver showed a large solitary mass, 12 cm in the greatest dimension, with a yellowish gray fleshy solid cut surface. Though light microscopic feature was compatible with primary malignant lymphoma, diffuse large cell type, intermediate grade by the working formulation, undifferentiated carcinomas including hepatocellular carcinoma, plasmacytoma, and pleomorphic sarcomas could not be completely ruled out. Thus, marker studies and electron microscopic examination were performed. Immunoperoxidase stains for common leukocyte antigen was positive, and the Leder stain for myeloid granule was negative. Electron microscopic stuids revealed findings of neoplastic lymphoid cells, consistent with malignant lymphoma. Primary lymphoma of the liver has only rarely been reported, and its natural history is unclear. Many of the reported cases have been large cell lymphomas, as in this case.
Female ; Humans ; Carcinoma, Hepatocellular

No abstract available.
Guillain-Barre Syndrome ; Plasmapheresis*

No abstract available.
Down Syndrome* ; Leukemia, Megakaryoblastic, Acute*

We performed surgery for correction of abnormal head turn in 10 patients with congenital nystagmus. For 3 patients with a head turn of 30 degrees, a 40% augmented modified kestenbaum operation was performed. For 4 patients with a head turn of 45 degrees, a 40% augmented modified kestenbaum operation combined with a 3 - 4 mm recession of conjunctival and subconjunctival tissues was performed. Finally, for 3 patients with a head turn of 60 degrees, a 60% augmented modified kestenbaum procedure combined with a 3 - 4 mm recession of conjunctival and subconjunctival tissues was performed. At the final follow-up visit(averaging 5.9 months), 7 patients showed complete corrections of previous head turn and 3 patients showed a small residual head turn of less than 10 degrees to the same side of the preoperative head turn. The average amount of correction we obtained from the surgery described above were 26.7, 42.5 and 56.7 degrees for the patients who had had a preoperative head turn of 30, 45 and 60 degrees respectively. Among the 10 patients, 4 showed no change in corrected visual acuity, but 6 showed increased corrected visual acuity by over 1 Snellen line. From the above results, we concluded that if recession procedure of the conjunctival and subconjunctival tissues was combined with augmented modified Kestenbaum procedure, its effect for correction of abnormal head turn in a patient with congenital nystagmus could be enhanced.
Follow-Up Studies ; Head* ; Humans ; Nystagmus, Congenital* ; Visual Acuity