Malignant tumors arising from tendon and aponeurosis are very rare. Among those reported most have been interpreted as synovial sarcoma or fibrosarcoma until Enzinger in 1965 described a new type which he called “Clear Cell Sarcoma of Tendon and Aponeurosis”. The tumor has a uniform and distinctive clinical and morphological pattern which distinguishes it from other groups of tenosynovial tumors. The problem of its histogenesis remains, especially its relation to synovial sarcoma. In this paper, we reported one case which is believed to be “Clear Sarcoma in the thigh”.
Clothing ; Fibrosarcoma ; Sarcoma ; Sarcoma, Clear Cell ; Sarcoma, Synovial ; Tendons ; Thigh

Thirty one cases of acromioclavicular injuries were treated in both Kangnam Sacred Heart Hospital and Hangang Sacred Heart Hospital during the period from May 1974 to April 1981. Three cases were classified to type 2 injuries and twenty eight were type 3. Among 31 cases one of the type 2 injuries was treated with closed reduction followed by thoracobrachial cast and remaining thirty received surgical treatment. Twenty one cases were operated on by technique of Weaver and Dunn, 8 cases by modified Phemister method and one case by Stewart technique. Preperative and postoperative stress film were evaluated and cap the coracoclavicular distance were measured. In twelve complete dislocation the authors modified the original Weaver and Dunn procedure by taking a bone chip along with the acromial end of the coracoacromial ligament. This seemed to provide a strong bony fulcrum for the suture of the ligament to clavicle as well as promoting bone to bone union. The results of this modified procedure were excellent.
Clavicle ; Dislocations ; Heart ; Ligaments ; Methods ; Sutures

Intrahepatic stones are found predominantly in southeast Asia and causes serious problems including obstructive jaundice, cholangitis, and liver abscesses. The operative principles for resolving these problems are complete removal of the stones within intrahepatic and extrahepatic ducts and establishment of adequate drainage. The clinical features and follow-up results of 90 patients with intrahepatic stones who were treated surgically at the Department of Surgery of St. Benedict Hospital during the period of 10 years from January 1987 to December 1996 are presented. This study includes all the gallstones located in the intrahepatic ducts above the confluence of the main hepatic ducts. Biliary bypass operations were performed in 30 cases (33%) with 29 biliojejunostomies and one choledochoduodenostomy. Five of the 29 hepaticojejunostomies had subcutaneous jejunal limb. Partial hepatectomies were performed in 20 cases (22%) with 16 left lateral segmentectomy and 4 of left hepatic lobectomies. The overall postoperative complication rate was 40%: 70% in the hepatic resection group and 31% in the non-hepatic resection group. The relative incidence of good results was higher in the hepatic resection group (68%) than in the non-hepatic resection group (41%) and in the biliary bypass operation group (54%) than in the non-biliary bypass operation group (41%). In conclusion, an aggressive hepatic resection with biliary bypass operation should be performed, if permitted, in patients with intrahepatic stones.
Asia, Southeastern ; Cholangitis ; Choledochostomy ; Drainage ; Extremities ; Follow-Up Studies ; Gallstones ; Hepatectomy ; Hepatic Duct, Common ; Humans ; Incidence ; Jaundice, Obstructive ; Liver Abscess ; Mastectomy, Segmental ; Postoperative Complications

Solid and papillary epithelial neoplasm (SPEN) of the pancreas is a rare tumor with low malignant potentiality that usually occurs in young females. Preoperative evaluation, especially radiologic tests, including ultrasonography and CT scan, is helpful in the diagnosis. These studies demonstrate a well-demarcated large mass with solid and cystic portions, frequently in the tail or body of the pancreas. Complete resection is usually curative, however local invasion and/or metastasis may occur. The authors report a case of a solid and papillary epithelial neoplasm of the pancreatic body in a 14-year old child at St. Benedict Hospital and review the literature.
Adolescent ; Child* ; Diagnosis ; Female ; Humans ; Neoplasm Metastasis ; Neoplasms, Glandular and Epithelial* ; Pancreas* ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND/AIMS: The eradication rate of the first-line triple therapy (a proton pump inhibitor, clarithromycin, and amoxicillin) for Helicobacter pylori infection has gradually decreased in Korea. We evaluated whether clinical parameters, clarithromycin resistance, and CYP2C19 genotype can affect the eradication failure. METHODS: A total of 203 patients with H. pylori-positive chronic gastritis were consecutively enrolled. They received clarithromycin-based triple therapy for 7 days. A clarithromycin resistance test was performed by detection of A2142G and A2143G point mutations in H. pylori 23S rRNA. The CYP2C19 genotype was examined for polymorphism G681A of exon 5 and G636A of exon 4 by polymerase chain reaction with restriction fragment length polymorphism. Eradication was assessed by a ¹³C-urea breath test 4 weeks after treatment. RESULTS: Of 203 patients, 190 completed the study. The eradication rate was 64.0% according to intention-to-treat analysis and 68.4% by per-protocol analysis. CYP2C19 genotypes were identified as follows: 75 poor metabolizers, 75 intermediate metabolizers, and 40 rapid metabolizers. Nonetheless, this polymorphism was not significantly associated with eradication failure (p = 0.682). Clarithromycin resistance was detected in 33/190 patients (17.4%), and their eradication rate was zero. Clarithromycin resistance (odds ratio [OR], 19.13; 95% confidence interval [CI], 9.35 to 35.09) and female gender (OR, 1.73; 95% CI, 1.15 to 4.25) were significantly associated with eradication failure. The other clinical parameters such as age, cigarette smoking, alcohol intake, the body mass index, hypertension, and diabetes were not significantly associated with eradication. CONCLUSIONS Clarithromycin resistance and female gender are factors affecting H. pylori eradication failure in patients with chronic gastritis.

This is a retrospective review of 33 patients with large cell lung carcinoma treated at Yonsei University Cancer Center between Jan. 1985 and Dec. 1989. Of the thirty-three patients, twenty eight were men and five women. Median age was 59 years. Large cell undifferentiated carcinoma was the most common pathologic type, 78.8%. Twenty one of thirty three patients had far advanced diseases, stage IIIB-IV at the time of initial diagnosis. Pleural effusion was initially presented in 12 patients, and SVC syndrome appeared in 5 patients. As to location of the primary tumor, 19(57.6%) appeared in the right lung and 14 (42.4%) in the left. Patients with a centrally located primary tumor mass were nearly the same as those peripherally located (17 vs. 16). Fifteen of thirty three patients developed metastasis involving not only bone, brain, the opposite lung, adrenal gland but also soft tissue, skin, pancreas and appendix. Treatment was individualized with 19 treated radically and 14 palliatively. After treatment, only two patients showed a complete response. Long term survival was observed in 4 patients: 1 (24 mo.), 2 (41 mo.) and 1 (54 mo.). The overall 2 year survival rate was 14.3% while the median survival time was 6.0 months. Through the analysis of the various factors affecting survival, we observed that pleural effusion-absent group and complete response group had a statistical significant better survival rate (p<0.01).
Adrenal Glands ; Appendix ; Brain ; Carcinoma ; Carcinoma, Large Cell* ; Diagnosis ; Female ; Humans ; Lung* ; Male ; Neoplasm Metastasis ; Pancreas ; Pleural Effusion ; Retrospective Studies ; Skin ; Survival Rate

Background: This study evaluated the outcomes of medial patellofemoral ligament (MPFL) reconstruction using a gracilis tendon suture technique for patients with patellar instability. Potential factors affecting clinical efficacy were also evaluated. Methods: This study included 22 patients diagnosed with patellar instability, who underwent MPFL reconstruction using a gracilis tendon. Their mean age was 21.5 years (range, 15–48 years), and the mean follow-up period was 26.8 months (range, 12–66 months). Clinical evaluation included the determination of Kujala, Lysholm, and Tegner scores. Radiographic evaluation included changes in congruence angle and arthritic changes in the patellofemoral joint. Additionally, patients were examined for any complications, including recurrent dislocation. Factors affecting clinical efficacy were also evaluated. Results: All clinical scores improved at final follow-up. The mean congruence angle improved from 23.6° before surgery to –6.5° at final follow-up. Two of 15 patients developed osteoarthritic changes in the patellofemoral joint. Dislocation recurred in 2 patients with type C trochlear dysplasia, which showed a statistically significant association with recurrent dislocation when compared to type A and B dysplasia (p = 0.026). Kujala scores were significantly lower among patients with abnormal patellar tilts (p = 0.038), and Lysholm scores were significantly lower among patients with femoral internal rotation deformity (p = 0.024). Conclusions Satisfactory results were obtained after MPFL reconstruction using a gracilis tendon suture technique for patients with patellar instability. However, dislocation recurred in patients with type C trochlear dysplasia, and clinical efficacy was lower among patients with femoral internal rotation and patellar tilt.