Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also review the relevant literature about chylous ascites with particular reference to the management of this rare disease.
Chyle ; Chylous Ascites ; Humans ; Pancreatic Neoplasms ; Pancreatitis ; Parenteral Nutrition, Total ; Peritoneum ; Portal Vein ; Rare Diseases ; Rupture ; Thrombosis

No abstract available.
Anemia, Iron-Deficiency* ; Ferritins* ; Iron*

Hepatoid adenocarcinomas of the stomach are gastric carcinomas with both adenocarcinomatous and hepatocellular differentiations. The tumor was characterized by high serum alpha-fetoprotein (AFP) levels. A 73-year-old male patient was admitted to the hospital with abdominal pain. Gastrofiberscopy revealed a gastric tumor occupying the antrum and pylorus. Radical subtotal gastrectomy was done and the result of biopsy was poorly differentiated adenocarcima of stomach and stage 3B. At postoperation 8 month, AFP was elevated and liver mass was detected on CT. Right extended hepatectomy was done under the impression of primary liver tumor. But, the biopsy revealed metastatic hepatoid adenocarcinoma of the stomach. Re-examination of the resected stomach was done and the result was hepatoid adenocarcinoma of the stomach. Two months later, after the hepatic resection, multiple metastases developed. This type of tumor has frequent early liver metastasis and poor prognosis. Therefore, early diagnosis and more careful investigation for liver metastasis are recommended.
Abdominal Pain ; Adenocarcinoma ; Aged ; alpha-Fetoproteins ; Biopsy ; Early Diagnosis ; Gastrectomy ; Hepatectomy ; Humans ; Liver ; Male ; Neoplasm Metastasis ; Prognosis ; Pylorus ; Stomach

BACKGROUND: The pacreaticoduodenectomy is the procedure of choice for neoplasm of periampullary region. However, some complications such as glucose intolerance and maldigestion are developed on postoperative long-term follow-up. The aim of this study is to evaluate the volume change of remnant pancreas and difference of thickness change between PPPD and Whipples'operation. Material and METHODS: From November, 1988 to June, 1998, 110 patients with periampullary neoplasms had undergone pancreaticoduodenectomy in our hospital(Whipple procedure 67, pylorus-preserving pancreaticoduodenectomy 43). We selected 19 patients who had regular interval follow-up during at least 1 year and didn't have operation related complications and recurrence(Whipple procedure 8, PPPD 11). We examined the size of body and tail of pancreas on preoperative CT and postoperative CT. Medical records were reviewed to find body weight changes, occurrence of glucose intolerance and steatorrhea. RESULTS: The size of body and tail of pancreas were 16.2+/-3.9mm and 12.1+/-5.0mm preoperatively, 10.8+/-3.9mm and 8.3+/-3.5mm postoperatively(p<0.001). However, there was no significant difference between Whipple and PPPD group. The body weight reduced to 95% of preoperative body weight, but it didn't show statistic sigificance. The occurrence of glucose intolerance and steatorrhea were insignificant. CONCLUSION: We conclude that pancreatic atrophy develop in patients underwent pancreticoduodenectomy. But, the difference of thickness change between PPPD and Whipples'group is no significance. We suggest that further study is need to find out the cause of pancreatic atrophy and correlation between atrophy and resection method such as duodenum preserving pancreatic head resection versus pancreaticoduodenectomy. Also we recommend that long-term follow-up study is necessary to find out correlation between pancreatic atrophy and pancreatic endocrine, exocrine insufficiency.
Atrophy ; Body Weight ; Body Weight Changes ; Duodenum ; Follow-Up Studies ; Glucose Intolerance ; Head ; Humans ; Medical Records ; Pancreas* ; Pancreaticoduodenectomy* ; Steatorrhea

BACKGROUND/AIMS: The use of diagnostic laparoscopy has been changed because of the development of lesser invasive radiologic tools, which is more useful in the diagnosis of diffuse liver diseases recently. The aim of this study was to evaluate the clinical value of laparoscopy in diagnosis of diffuse liver diseases during laparoscopic surgery and to find the relationship between laparoscopic gross finding and liver biopsy. METHOD: Sixty-five patients were performed laparoscopic cholecystectomy from March 1. 2001 to July 30 . 2001. We prospectively compared the result of liver biopsy with preoperative serum liver function test, ultrasonographic finding and liver surface characteristics as observed during laparoscopic surgery. RESULTS: The results of liver biopsy obtained in 59 cases were normal liver; 57.6%, mild steatosis; 15.4%, moderate to severe steatosis; 16.9%, chronic liver disease; 1.5%, cholangitis; 3.1% and cirrhosis; 1.5%. There was no correlation between preoperative liver function test and liver biopsy. However, the ultrasonographic finding was more correlated with liver diseases. The sensitivity of laparoscopic liver surface characteristics was 76.0%. The liver surface characteristics was well correlated with liver biopsy finding, especially in color of liver surface and contuor of liver margin. Importantly, when one more abnormal findings in liver surface characteristics were found, the positive predictability of liver disease was 56%. CONCLUSIONS: Diagnostic laparoscopy is a safe and accurate method for evaluating the diffuse liver diseases. If the abnormal findings of liver surface characteristics is found during laparoscopic surgery, one shoud confirm liver disease by liver biopsy.
Biopsy ; Cholangitis ; Cholecystectomy, Laparoscopic ; Diagnosis* ; Fibrosis ; Humans ; Laparoscopy* ; Liver Diseases* ; Liver Function Tests ; Liver* ; Prospective Studies

Cavernous angiomas of the cranial nerves are rarely reported. We report a case of a 33-year-old man affected by a cavernous angioma originated in the oculomotor nerve with it's palsy. Preoperative radiological findings are difficult to differentiate it from meningioma or neurinoma. Postopertive pathological report discloses it as cavernous angioma. We discuss radiological, pathological features and management of this vascular lesion of the cranial nerve.
Adult ; Cranial Nerves ; Hemangioma ; Hemangioma, Cavernous* ; Humans ; Meningioma ; Neurilemmoma ; Oculomotor Nerve* ; Paralysis ; Vascular Malformations

OBJECTIVE: The purpose of this study is to compare the incidence of possible complications of cervical lateral screw fixation and the achievements of bicortical purchase using the Roy-Camille, Magerl and the modified methods. METHODS: Six fresh-frozen cervical spine segments were harvested. The Roy-Camille technique was applied to C3 and C4, and the Magerl technique was applied to C5, C6, and C7 of one side of each cadaver. The modified technique was applied to the other side of each cadaver. The nerve root injury, violation of the facet joint, vertebral artery injury, and the bicortication were examined at each screwing level. RESULTS: No vertebral artery injury was observed in any of the three methods. One nerve root injury was observed in each cervical spine segment using the Roy-Camille method (8.3%), the Magerl method (5.6%), and the modified method (3.3%). Facet joint injuries were observed in two cervical spinal segments using the Roy-Camille method (16.7%) and three with the Magerl method (16.7%), while five facet joint violations occurred when using the modified method (16.7%). Bicortical purchases were achieved on ten cervical spinal segments with the Roy-Camille method (83.3%) and Magerl method (55.6%), while twenty bicortical purchases were achieved in the modified method (66.7%). CONCLUSION: The advantages of the modified method are that it is performed by using given anatomical structures and that the complication rate is as low as those of other known methods. This modified method can be performed easily and safely without fluoroscopic assistance for the treatment of many cervical diseases.
Achievement ; Cadaver ; Incidence ; Spine ; Vertebral Artery ; Zygapophyseal Joint

PURPOSE: Although duodenal perforation following ERCP is very rare compared to other complications, it can result in a fatal outcome. To find the most effective treatment strategy, the cases experienced at our hospital were reviewed and analyzed. METHODS: A retrospective chart review, conducted at our hospital between December 1994 and April 2006, identified 15 periduodenal perforation cases related to ERCP; a rate of 0.53%. The following parameters were reviewed: clinical presentation of perforation, diagnostic methods, time to diagnosis and operation, method of management, length of stay and outcome. RESULTS: Fourteen patients were managed by surgery and one conservatively. Eleven patients were cured without complications, but four suffered from severe complications, and required several re-operations. Two patients (50%) of the re-operated group died. The mean time to surgery was longer in the re-operated than non-re-operated group (34.3+/-12.4 hours vs. 17.2+/-21.7 hours). The causes for the reoperation were an anastomosis blowout in the duodenotomy for transduodenal sphincteroplasty in 3 and duodenal perforation at the site of transduodenal sphincteroplasty in the remaining patient. All re-operated cases had large retroperitoneal fluid collection, as seen on CT scanning, and had been operated on by inexperienced surgeons. CONCLUSION: The early detection is important for the treatment of a duodenal perforation following ERCP. If surgical treatment is needed, it must be performed within 24 hours. Although the type of surgical procedure will depend on the surgeon's preference, a less invasive procedure, such as simple closure & drainage, will be adequate in cases with a delayed diagnosis, a septic condition or an inexperienced surgeon.
Cholangiopancreatography, Endoscopic Retrograde* ; Delayed Diagnosis ; Diagnosis ; Drainage ; Fatal Outcome ; Humans ; Length of Stay ; Reoperation ; Retrospective Studies ; Sphincterotomy, Transhepatic ; Tomography, X-Ray Computed

The laparoscopic cholecystectomy has been clearly established as the gold standard for the surgical treatment of calculous biliary diseases. The currently used most popular technique is the four-trocar technique. This prospective study was designed to examine whether or not three-trocar technique could be chosen as an alternative to the standard four-trocar technique. Prospective data were collected on 98 patients undergoing a laparoscopic cholecystectomy at Wonkwang University Hospital from December 1995 to July 1996. We excluded 40 cases of acute cholecystitis which under went an operative cholangiogram with conversion to the four-trocar method as unfit for this study. We evaluated all associated clinical factors for the three-trocar technique (28 cases); and the four-trocar technique (30 cases), and we analysed the operating time, the intraoperative gallbladder perforation, postoperative complications, the postoperative hospital stay, and the duration for compliants of pain. Between the two techniques, there were no significant differences in the operating times, the postoperative complications, the postopeative hospital stays, and the durations for complaint of pain. However, intraoperative gallbladder perforation more frequently developed in the three-trocar technique than in the four-trocar technique (4 cases versus 1 case, P=0.02). However, gallbladder perforation didn't cause a prolonged operating time; or any other postoperative complication. In our series, the three-trocar technique had results similar to those of the four trocar technique. Morever, the three trocar technique was more economical and had cosmetic advantages. We conclud that a qualified laparoscopic surgeon can choose the three-trocar technique as an alternative to the four-trocar technique.
Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Gallbladder ; Humans ; Length of Stay ; Postoperative Complications ; Prospective Studies ; Surgical Instruments

PURPOSE: There were many studies for adverse effects of carbon dioxide insufflation for laparoscopic cholecystectectomy, mainly focused on cardiovascular and respiratory system. The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects. However, its effect on tissue trauma & postoperative pain remains controversial. The aim of this study was to compare postoperative pain intensity between different insufflation pressures in laparoscopic cholecystecetomy. METHODS: We randomly allocated fifty four patients to 7 mmHg (LC7), 9 mmHg (LC9) and 12 mmHg (LC12) pneumoperitoneum group and examined operation time, postoperative pain intensity using visual analogue scale, amount of administered analgesics and complications prospectively. RESULTS: The characteristics of the patients were similar among groups. The procedure was successfully completed in all patients in the LC12 gruop, but in five patients of LC7 group and one patient of LC9 group the insufflation pressure was increased to 12 mmHg to complete the operation. There were no significant difference in postoperative pain scores, analgesic comsumptions among groups. There were difficulties to get a safe hemostasis and to create a adequate working space at acute cholecystitis in LC7 group. CONCLUSION: In our study, there was no superior advantage for postoperative pain when low pressure pneumoperitoneum was applied.
Analgesics ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Hemodynamics ; Hemostasis ; Humans ; Insufflation* ; Pain, Postoperative* ; Pneumoperitoneum ; Prospective Studies ; Respiratory System