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

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

No abstract available.
Guillain-Barre Syndrome ; Plasmapheresis*

Gatric duplication is a rare congenital anomaly. Thus for about 90 cases of gastric duplication have been recorded in the literature. It is less frequent than small intestinal or eosphageal duplication, and accounts for only 3.8% of all gastrointestinal tract duplication. Most gastric duplications are seen during the first year of life. Palpable abdominal mass and gastric outlet obstruction in infancy are most common presentation. We experienced a case of non-communicating gastric duplication. A 12-year-old girl visited St. Mary's Hospital because of indigestion, intermittent vomiting, and left upper quandrant pain for about 40 days. She have had intemittent abdominal pain with concomitant increased level of amylase since 5 years old. Physical examination showed a hen's egg sized palpable mass on left upper quadrant of the abdomen. Upper GI series and barium enema revealed only indentation of duodenal C-loop, and sonogram and abdominal CT demonstrated isolated cystic mass along the greater curvature of gastric antrum. She had taken an operation under the impression of pancreatic pseudocyst. Operation revealed a cystic mass, located along the greater curvature. There was no pathologic change in the pancreas. Microscopic findings of the cyst wall revealed normal gastric mucosal lining and common muscle layer, shared with gastric antral muscle layer.
Cysts

Three rare tumors of the oral cavity are presented. Lingual chondromas, approximately twenty to thirty cases appear to have been reported since the lesion was first described by Berry in 1892, which are usually seen on the lateral borders in the anterior two thirds of the tongue, while the ventral surface and the posterior third are rarely involved. Chondromas of the tonsil are of very rare occurrence, which are thought to arise as a result of metaplasia, rather than from embryonic rests, with chronic fibrosing inflammation being the inciting factor. Because of its rarity, the following cases of chondroma of the tongue and tonsil are being added to small list of such case reported in the literature.

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

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