Duodenal gastrointestinal stromal tumors (GISTs) are uncommon and a relatively small subset of GISTs whose optimal surgical procedure has not been well defined. Because submucosal spread and local lymph node involvement is infrequent in GISTs, wide margins with routine lymph node dissection may not be required. Various techniques of limited resection for duodenal GISTs have been described depending on the site and the size of the tumors. In this study, we report two cases of GIST involving the third and fourth portion of the duodenum successfully treated by segmental duodenectomy with end-to-end duodenojejunostomy. This technique should be considered as a treatment option for GIST located at the third and fourth portion of the duodenum.
Duodenum ; Gastrointestinal Stromal Tumors ; Lymph Node Excision ; Lymph Nodes

The influence of thyroxine upon n the cardiac uptake of catecholamines was investigated in rabbits. A single injection of thyroxine(1.0m/kg) into rabbits did not affect the concentration of myocardial catecholamines. However, this dose of thyroxine greatly increased the cardiac uptake of catecholamine following injection of 2.0mg of norepinephrine as compared to that of untreated normal animals and it remained elevated for several hours. Similarly thyroxine also enhanced the accumulation of myocardial catecholamines following administration of dopa(60-80mg/kg) and epinephrine(1.0-1.5mg/kg).
Animal ; Catecholamines/metabolism* ; Epinephrine/metabolism ; Heart/drug effects* ; Male ; Myocardium/metabolism* ; Norepinephrine/metabolism ; Rabbits ; Thyroxine/pharmacology* ; Tritium

BACKGROUND: Patients with liver injury can be managed by various techniques, including simple closure, electrocautery, hemostatic agent application, temporary packing, perihepatic drainage, and hepatic resection. Two different types of hepatic resections can be employed in selected and advanced hepatic injury; resectional debridement and anatomical hepatic resection. The aim of this study was to consider the role of hepatic resection in the management of severe liver trauma and to define the roles of the different types of resections. METHODS: Two hundred two patients with traumatic liver injury underwent surgical treatment from July 1989 to June 1998 at the Department of Surgery, Soonchunhyang University Chunan Hospital. From them, the records of forty-six patients who received hepatic resections in the same period were collected. Demographic, clinical, operative, and postoperative data were collected and analyzed. RESULTS: Among the patients with resectional management, the peak incidence was in the third and the fourth decades. The male-to-female ratio was 3.1:1. The most frequent injury mechanism was blunt trauma (95.7%). There was one postoperative death among the 8 anatomical resections (12.5%) and nine postoperative deaths among the 38 resectional debridements (24.4%). The overall mortality rate was 21.7%. There were no intraoperative deaths. Postoperative complications occurred in 11 patients (23.9%). CONCLUSIONS: Hepatic resection can play a major role in the management of hepatic trauma. It can be indicated in cases of deep laceration in the liver involving major vascular structures or the bile duct, extensive devitalization of the hepatic parenchyma, and hepatic venous bleeding. In selected cases, an anatomical resection can be successful by making a clear line of resection through anatomical planes away from any damaged parenchyma.
Bile Ducts ; Chungcheongnam-do ; Debridement ; Drainage ; Electrocoagulation ; Hemorrhage ; Humans ; Incidence ; Lacerations ; Liver* ; Mortality ; Postoperative Complications

It is common practice to reject potential grafts with fatty change over 30%. We report a case of successful liver transplant using a graft with 70% fatty liver. The patient was a 53 year old male with alcoholic liver cirrhosis who had received endoscopic varix ligation (EVL) for esophageal varix bleeding 4 months ago. He presented with esophageal varix bleeding and drowsy mentality, and was admitted to the ICU via the emergency room. He received EVL again. Preoperative total bilirubin was 11.4 mg/dl, prothrombin time was 40%. The donor was a 50 year old male with diabetes. Liver biopsy showed 70% fatty liver. The operation took 10 hours, and there was no intraoperative complication. Sixteen days after the operation, liver enzymes were normal but total bilirubin was elevated up to 10.26 mg/dl. Liver biopsy was done. Biopsy showed almost no fatty liver but it showed moderate rejection, so steroid recycling was done. Total bilirubin decreased steadily. But 38 days after the operation, ascites increased, and follow-up liver biopsy again showed almost no fatty change but showed severe rejection. Steroid pulse therapy was done, and after pulse therapy the amount of ascites decreased, and the patient was discharged 56 days after the transplantation in tolerable condition. Brain death donor liver grafts with severe fatty liver increase the risk of post transplant complications such as renal failure. But since severe fatty liver does not always cause primary nonfunction, it may be considered as transplant grafts in selected cases.
Ascites ; Bilirubin ; Biopsy ; Brain Death ; Emergencies ; Esophageal and Gastric Varices ; Fatty Liver ; Follow-Up Studies ; Hemorrhage ; Humans ; Intraoperative Complications ; Ligation ; Liver ; Liver Cirrhosis, Alcoholic ; Male ; Prothrombin Time ; Recycling ; Rejection (Psychology) ; Renal Insufficiency ; Tissue Donors ; Transplants ; Varicose Veins

PURPOSE: Patients with gallbladder cancer tend to have advanced, unresectable tumor at the time of presentation and they face a dismal prognosis in the absence of a standard chemotherapy regimen. This study was performed to evaluate the outcomes of patients with gallbladder cancer and who underwent postoperative gemcitabine-based chemotherapy. METHODS: From March of 2001 to February of 2008, a total of 27 patients underwent operation for gallbladder cancer. They underwent two types of gemcitabine-based chemotherapy. One type of regimen was the combined administration of gemcitabine 1,000 mg/m2 and 5-fluorouracil 200 mg/m2. The other one was combined administration of gemcitabine 1,000 mg/m2 and cisplatin 70 mg/m2. RESULTS: Among the 27 patients, 15 patients were treated with gemcitabine-based chemotherapy and 12 patients were treated with many kinds of the best supportive care without chemotherapy. The median survival was 29.1+/-2.7 months and 15.7+/-2.8 months, respectively. The median survival and disease free survival for the gemcitabine based chemotherapy group who received curative resection was 31.6+/-2.5 and 15.7+/-3.2 months, respectively. The median survival and disease free survival for the patients without chemotherapy after curative resection was 16.3+/-2.9 and 15.7+/-3.2 months, respectively. CONCLUSION: Patients with gallbladder cancer and who received adjuvant gemcitabine-based chemotherapy had a relatively favorable prognosis. Especially, gemcitabine-based combination chemotherapy could be effective and acceptable for the treatment of gallbladder cancer patients who have undergone curative resection.
Cisplatin ; Deoxycytidine ; Disease-Free Survival ; Drug Therapy, Combination ; Fluorouracil ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Prognosis

The authors report a 58-year-old woman with low-grade fibromyxoid sarcoma primarily located in the right paravertebral area with extension to L4 neural foramen. The patient complained lower back pain with radiating pain along the posterolateral aspect of the right lower leg. She underwent subtotal surgical removal and Cyber Knife therapy. Diagnosis was made by strikingly characteristic microscopic appearance of a bland spindle cell sarcoma which contained numerous giant collagen rosettes and was also supported by immunohistological findings. The diagnostic image findings and literatures are reviewed and discussed.
Collagen ; Female ; Humans ; Leg ; Low Back Pain ; Middle Aged ; Sarcoma

PURPOSE: To investigate the efficacy of SPIO (superparamagnetic iron oxide) enhanced MR imaging for the detection of colorectal liver metastasis, compared to the intraoperative ultrasound (IOUS). MATERIALS AND METHODS: Thirteen patients who underwent IOUS during surgery for colorectal liver metastasis as well as a liver MR before and after administration of SPIO. The mean patient age was 57 years (age range: 43-77). Two observers reviewed the SPIO-enhanced MR via a double blind test. We evaluated the efficacy of the SPIO-enhanced MR compared to the results of IOUS. RESULTS: Following IOUS, 55 lesions were found, including 32 metastases, 20 cysts, 2 calcifications, and 1 coagulation necrosis. The interobserver correlation of the SPIO-enhanced MR is significant, with a kappa index of 0.839. Radiologist 1 and 2 missed three lesions in three patients. Two of the patients had multiple liver lesions (six and eight, respectively), whereas the other patient had tumor recurrence following hepatic surgery for liver metastasis. In the other nine patients, MR detected all lesions. The sensitivity and positive predictive value of the SPIO-enhanced MR was 94.5%, and 100%, respectively. CONCLUSION: The SPIO-enhanced liver MR shows a good correlation to IOUS, especially in the case of patients who had fewer than three lesions. Therefore, the SPIO-enhanced MR may help to plan a surgical resection of colorectal liver metastasis.
Contrast Media ; Humans ; Iron ; Liver ; Liver Neoplasms ; Necrosis ; Neoplasm Metastasis ; Recurrence

No abstract available.
Cystitis* ; Ultrasonography*

It is rare to find spontaneous cervical bleedings for which a wide variety of etiologies have been reported. We experienced a case of spontaneous cervical bleeding that caused emergency operation. We present this case with a review of the literature. This case demonstrates a potentially lethal complication in patients with neurofibroma. Neurofibroma is an inherited disease, classified as 'classical (type I, von Recklinghausen, multiple or peripheral neurofibromatosis)', 'central (type II, bilateral acoustic neurofibromatosis)' and other types. The pathognomic features of classical neurofibromatosis are cafe-au-lait spots and neurofibromas. Other clinical features are variably expressed and occurnece of severe hemorrhage is an unusual complication. Conservative management do not stop the hemorrhage. Surgical exploration must be undertaken for cure.
Acoustics ; Cafe-au-Lait Spots ; Emergencies ; Hemorrhage* ; Humans ; Neck* ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1*

Spitting as an ictal phenomenon has rarely been reported. It is considered to indicate a seizure onset in the nondominant temporal lobe. Three cases with ictal spitting were found in 81 consecutive patients who underwent temporal lobe resections due to intractable temporal lobe epilepsy. Two had evidence of the right temporal ictal onset. One had the left temporal ictal onset, but the Wada test demonstrated language dominance in the right hemisphere. Three all had mesial temporal sclerosis. One had recollection of her episodes of spitting with a gustatory aura, whereas the other patients had no awareness of this symptom. These cases support previous studies suggesting that spitting is a lateralizing sign to nondominant temporal lobe epilepsy.
Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Sclerosis ; Seizures ; Temporal Lobe*