PURPOSE: The placement of a drainage tube in the common bile duct, following a choledochotomy, has become accepted as routine procedure since it was first reported, by Abbe, in 1892. However, many complications are associated with T-tube drainage, such as bile peritonitis after its removal, accidental dislodgement, bile leakage from the T-tube track and a high incidence of postoperative bacteremia, have been reported. This study was designed to evaluate the primary closure as a suitable surgical technique in placce of T-tube drainage following a choledochotomy METHODS: Between January and December 2002, primary closures were performed in 41 cases and T tube drainage in 112, following a choledochotomy. These cases were divided into 2 groups (group A: primary closure, and group B: T-tube drainage). The medical records of the patients were reviewed, and the following data analysed -age, sex, preoperative laboratory value, intraoperative finding, postoperative laboratory value, complication, and days of postoperative hospital stay. RESULTS: There were no significant differences observed in the data of the investigated parameters, with the exception of the mean post-operative hospital stay. The mean post- operative hospital stays were 11.82 and 18.08 days in groups A and B (P=0.0034), respectively. The complication rates of each group showed no statistical difference. However bile peritonitis or bile leakage after T-tube removal developed 5 cases from group B. There were 2 and 5 deaths due to MODS & ARDS, respectively. CONCLUSION: A primary closure, following a choledochotomy, may be a suitable alternative technique to T-tube drainage under reasonable conditions.
Bacteremia ; Bile ; Choledocholithiasis* ; Common Bile Duct ; Drainage* ; Humans ; Incidence ; Length of Stay ; Medical Records ; Multiple Organ Failure ; Peritonitis

A 78-year-old woman was referred to this hospital because of exertional dyspnea for 2 weeks. Although she was treated with anti-tuberculous medication under the assumption that she had tuberculous pleuritis, her dyspnea continued. Physical examination revealed diminished breath sounds over the left lung field. Chest radiography showed a large left pleural effusion. The pleural effusion revealed malignant cell dominant exudates with a high adenosine deaminase level. Serological tests were negative for HIV. Computed tomography scan of the chest and abdomen showed pleural effusion, but no mass or pathological lymph nodes were detected. The biopsy specimen of the pleura was diagnosed as malignant B cell lymphoma with plasmacytoid features, suggesting a possibility of primary effusion lymphoma. Polymerase chain reaction assay of tumor was positive for HHV-8 DNA. She underwent pleurodesis during Video-Assisted Thoracic Surgery, and her dyspnea subsequently improved.
Abdomen ; Adenosine Deaminase ; Aged ; Biopsy ; DNA ; Dyspnea ; Exudates and Transudates ; Female ; Herpesvirus 8, Human ; HIV ; Humans ; Lung ; Lymph Nodes ; Lymphoma, B-Cell ; Lymphoma, Primary Effusion ; Physical Examination ; Pleura ; Pleural Effusion ; Pleurisy ; Pleurodesis ; Polymerase Chain Reaction ; Serologic Tests ; Thoracic Surgery, Video-Assisted ; Thorax

BACKGROUND/AIMS: The caudal-related homeobox transcription factor, Cdx2, plays an important role in proliferation and differentiation of intestinal epithelial cells. Its expression is confined to normal and neoplastic intestinal epithelium. We evaluated Cdx2 expression in advanced colorectal cancers to determine the correlation between Cdx2 expression and clinicopathologic characteristics. METHODS: Four hundreds twenty consecutive colorectal cancers were included in the study. Cdx2 expression was investigated by immunohistochemistry using tissue microarrays constructed from surgically resected specimens. 145 invasive breast cancers, normal tissues from gastric mucosa, liver, lung, kidney and ovary were used as control. Nuclear staining was considered to be positive and the result was divided into 3 categories. RESULTS: In the colorectal cancers, Cdx2 was expressed in 380 of 420 (90.5%) cases, and 349 of 380 (83%) cases showed strong and diffuse staining and 31 of 420 (7.5%) cases showed weakly positive staining. Forty patients (9.5%) of colorectal cancer were negative for Cdx2. All of the invasive breast cancers and all non-neoplastic control tissues except the regions of intestinal metaplasia in gastric mucosa, which showed strong Cdx2 expression, were negative for Cdx2. Loss of Cdx2 expression was observed more frequently in cases with deeper invasion (p<0.05), lymph node metastasis (p<0.05), poor histologic differentiation (p<0.001), and distant metastasis (p<0.05). CONCLUSIONS: Cdx2 could be a highly sensitive marker to detect metastasis from intestine and might be useful as a novel prognostic marker in colorectal cancers.
Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms/*metabolism/pathology ; Female ; Homeodomain Proteins/*metabolism ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Tumor Markers, Biological/analysis

An abdominal pregnancy is defined as an ectopic pregnancy, which implants in the peritoneal cavity and can be classified as either primary or secondary. The incidence of abdominal pregnancy is increased after IVF or GIFT, induced abortion, endometriosis, and intrauterine devices may also contribute to an increased incidence. Early diagnosis and appropriate surgical management, regardless of stage of gestation, appear to be important in achieving good results. A case of early primary abdominal pregnancy which was implanted on the left uterosacral ligament. We report the case and brief review of literature.
Abortion, Induced ; Early Diagnosis ; Endometriosis ; Female ; Incidence ; Intrauterine Devices ; Ligaments ; Peritoneal Cavity ; Pregnancy ; Pregnancy, Abdominal* ; Pregnancy, Ectopic

There are some clinical evidences that hepatitis B virus(HBV) infection may cause IgA nephropathy. To evaluate clinical significances and pathogenetic roles of HBV infection in patients with IgA nephropathy, we studied that varius clinical and lab- oratory findings in 172 patients with IgA nephrop-athy as serum hepatitis B surface antigen (HBsAg) positive (19 cases) and negative group (153 cases). The result was as following: 1) The incidence of positive serum HRsAg was 11.0%(19/172 cases) in patients with IgA nephropathy and it was higher than that of the randomized age-sex matched general population(4.1%) but has no significance statistically. 2) There was no significant differences in incidence of hypertension, serum levels of IgA, C3, SGOT, SGFf between HBsAg postive and negative group. 3) The cases of nephrotic range proteinuria (3.5g/ day) was more prevalent in HBsAg positive group (31.6%) than that in negative group(7.2%). significantly (p<0.05). 4) The cases of impaired renal function (serum creatinine more than 1.4mg/dL) were more frequent in HBsAg positive group (42.19%) than that in neg-ative group (13.1%) significantly(p<0.05).
Aspartate Aminotransferases ; Creatinine ; Glomerulonephritis, IGA* ; Hepatitis B Surface Antigens* ; Hepatitis B* ; Hepatitis* ; Humans ; Hypertension ; Immunoglobulin A* ; Incidence ; Prognosis ; Proteinuria