The extrahepatic bile duct cancers(EBDC) are rare and are found late stage in their course. Because of their location in close proximity to the liver, hepatic artery, and portal vein, they are often unresectable. However, high survival rates after an aggressive surgical resection has been reported lately. This report presents the results of 62 cases with EBDC operated at the Department of Surgery, Pusan National University Hospital, from 1988 to 1997. EBDC usually occurs in older age group. especially between 60~70 years of age, and the mean age was 56.6 years. Sex ratio(male:female) was 5.2:1 with male predominance. Frequent clinical manifestations in order of frequency were jaundice(82.3%), abdominal pain(69.4%), pruritus(35.5%), anorexia(33.9%), fever and chill(32.3%), weight loss(22.6%). The laboratory findings were increased alkaline phosphatase(93.5%), bilirubin(77.4%), SGOT(77.4%), SGPT(69.4%). Elevated CEA(>5ng/dl) was 28.6%. The preoperative diagnostic accuracy was 100.0% in ERCP and PTC, 96.4% in abdominal CT, and 95.3% in ultrasonogram. The most common site of the cancer was lower third of the bile duct(61.3%), followed by upper third(27.4%) and middle third(11.3%). Curative resection was possible in 33 cases(53.2%) and the other 29 cases were received palliative biliary decompression. Postoperative complications were bile leakage(30.6%), wound infection( 25.8%), intraabdominal hematoma(19.4%), cholangitis(17.7%), and UGI bleeding(11.3%). The dead cases were 5 cases(8.0%) of all 62 cases and the causes of death were sepsis in 3 cases(4.8%) and UGI bleeding 2 cases(3.2%). By TNM classification(AJCC, 1992) stage IV(64.5%) was most common and stage II(25.9%) was next in order. Among the 62 adenocarcinoma, 25 cases were poorly-differentiated lesion(40.3%), 19 cases were moderately-differentiated lesion(30.6%), and 18 cases were well-differentiated lesion(29.0%). In conclusion, the survival rates of EBDC were higher low staged, curative resected, well differentiated and lower third located groups than high staged, palliative resected, poorly differentiated and upper third located groups.
Adenocarcinoma ; Bile ; Bile Ducts, Extrahepatic* ; Busan ; Cause of Death ; Cholangiopancreatography, Endoscopic Retrograde ; Decompression ; Fever ; Hemorrhage ; Hepatic Artery ; Humans ; Liver ; Male ; Portal Vein ; Postoperative Complications ; Sepsis ; Survival Rate* ; Tomography, X-Ray Computed ; Ultrasonography ; Wounds and Injuries

No abstract available.
Drug Therapy* ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Leukemia, Myeloid, Acute*

OBJECTIVES: This study was performed to investigate the incidence and the clinical significance of inlet patch of heterotopic gastric mucosa in Koreans. This lesion can be found by close observation around the upper esophageal sphincter during upper gastrointestinal endoscopy. METHODS: From March 1, 1996 to July 8, 1996, at Kwak's hospital, randomly selected 271 patients undergoing routine diagnostic upper gastrointestinal endoscopy were included in this study. Patients with the inlet patch were confirmed by histology. Clinical symptoms observed through medical history were recorded. RESULTS: Twenty-six cases(9.6%) of the 271 patients studied had heterotopic gastric mucosa which was found at or just below the upper esophageal sphincter, varing from 3 to 30mm in diameter. It was velvety red in color and distinct from the surrounding normal squamous esophageal mucosa, resembling the Z-line at the esophagogastric junction. Parietal cells were identified in all 18 cases in which biopsy specimen contained deep glands, and chief cells were found in 14 cases. Histologically, fundic gland type was most frequent. The symptoms were relatively mild, 5 out of 6 patients who complained of throat discomfort were relieved by H2 antagonists. CONCLUSION: In Koreans the incidence of heterotopic gastric mucosa in the upper esophagus was similar to the reports from western countries unlike Barrett's esophagus. The etiology of these patches appeared to be congenital rather than acquired from reflux of gastric acid. This was supported by its location in the proximal esophagus and lack of correlation with reflux esophagitis. It must be considered as one of the differential diagnosis of a patient who complains of throat discomfort during diagnostic upper gastrointestinal endoscopy. Attention needs to be paid to find possible development of complications such as stricture and adenocarcinoma in patients with the inlet patch of heterotopic gastric mucosa.
Adenocarcinoma ; Barrett Esophagus ; Bays* ; Biopsy ; Constriction, Pathologic ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Esophageal Sphincter, Upper ; Esophagitis, Peptic ; Esophagogastric Junction ; Esophagus ; Gastric Acid ; Gastric Mucosa* ; Humans ; Incidence* ; Mucous Membrane ; Pharynx ; Rabeprazole

Submandibular gland abscess is exceptionally rare in neonates. We present a case of submandibular gland abscess and etiology, investigations and treatment for this very rare condition. The patient was a 15-day-old neonate with a swelling in the right submandibualr region. She was born after a full term and showed a sign of dehydration. An ultrasound examination demonstrated a multiple lobulated echoic lesion and the right submandibular gland was nonvisible. A CT scan revealed a hypodense round mass measuring 2.5x2.8x2.8 cm and a multiple hyperdense lesion, but no right submandibular glands. A dignosis of submandibular abscess in association with acute suppurative sialadenitis was made. Under general anesthesia, the neck abscess was drained by a 2-cm long incision at two finger-breadths (3 cm) below the inferior border of the ramus of mandibule. A large amount of greenish pus emerged immediately after dividing the platysma. The submandibular salivary gland was nearly not found. Specimen from the pus were taken for the culturing of bacteria, fungi, actinomycetes, and tuberculosis. The wound was irrigated by normal saline and penrose drain was inserted. The antibiotics was administered for 7 days. A three-week follow-up showed no evidence of infection.
Abscess ; Actinobacteria ; Anesthesia, General ; Anti-Bacterial Agents ; Bacteria ; Dehydration ; Follow-Up Studies ; Fungi ; Humans ; Infant, Newborn ; Neck ; Salivary Glands ; Sialadenitis ; Submandibular Gland ; Suppuration ; Tuberculosis

The first case report of granular cell tumor was by Abrikossoff in 1926, the tumor has been named with more than 20 different synonyms. It is found usually in the tongue, oral cavity, and the skin. It occurs rarely in the esophagus. Esophageal granular cell tumor is a benign lesion which can be diagnosed by endoscopic biopsy. Large symptomatic lesion can be removed by polypectomy. A 29-year-old female visited our hospital for intermittent epigastric pain and anterior chest discomfort. Endoscopy showed a 0.6 *0.4 cm whitish yellow nodule in the mid-esophagus, 25 cm from the incisor teeth. Endoscopic polypectomy was performed with "O"-type rubber band for endoscopic variceal ligation(EVL). A case of esophageal granular cell tumor conformed by S-100 protein stain is reported with the review of literature.
Adult ; Biopsy ; Endoscopy ; Esophagus* ; Female ; Granular Cell Tumor* ; Humans ; Incisor ; Mouth ; Rubber ; S100 Proteins ; Skin ; Thorax ; Tongue ; Tooth

No abstract available.
Adenosine* ; Dipyridamole* ; Dobutamine* ; Exercise Test*

A total 48 cases of tuberculous lesion in the lymph nodes(43 cases), lung (3 cases) and soft tissue(2 cases), was subjected to fine needle aspiration cytology(FNAC). The age of the patients ranged from 19 to 77 year-old(average 33.6 years in age) and the male to female ratio was 1:4. Thirty-four cases (70.8%) demonstrated distinct granulomatous reaction with or without caseastion necrosis, nine cases(18.8%) showed no granulomas, but large amount of necrotic debris with numerous polymorphonuclear cells and histiocytes, and five cases (10.4%) revealed acellular material only. The overall AFB positivity in smears was 62.5%. In areas associated with granulomatous reaction and necrosis, AFB positivity was 55.8%, while it was 80.0% in cases with acellular necrotic material. There were 2 cases of parasitic infestation which could not be easilty differentiated from tuberculosis based on aspiration smears only.
Biopsy, Fine-Needle* ; Diagnosis* ; Female ; Granuloma ; Histiocytes ; Humans ; Lung ; Male ; Necrosis ; Tuberculosis*

In operations of the lower extremities in elderly patients, regional anesthesia is preferred over general anesthesia because regional anesthesia is associated with less deep vein thromboses, pulmonary emboli, bleeding, transfusion volume, and can better control post-operative pain. During surgery, a drop in core temperature frequently occurs. In elderly patients, temperature control and compensatory abilities are physiologically impaired. During induction of regional anesthesia, such as spinal anesthesia, elderly patients often do not complain of coldness, despite the decrease in the core temperature. Also, problems associated with hypothermia can easily be overlooked because anesthesiologists are less concerned about measuring the body temperature of patients than they are during induction of general anesthesia. Because perioperative hypothermia can cause various complications, such as infection, bleeding, cardiac injury, and shivering, closer attention is necessary. We report a case of hypothermia that developed during total hip arthroplasty under combined spinal-epidural anesthesia.
Aged ; Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal ; Arthroplasty ; Body Temperature ; Cold Temperature ; Hemorrhage ; Hip ; Humans ; Hypothermia ; Lower Extremity ; Shivering ; Venous Thrombosis

Hyperplastic gastric polyps (HPPs) are the most common type of gastric polyps. They are assumed to be caused by chronic inflammation and regenerative proliferation, although this has not been clearly investigated yet. Many studies suggested the development of fundic gland polyps and carcinoid during long-term proton pump inhibitor (PPI) therapy, but the relationship between PPIs and HPPs is still unclear. We encountered a patient who showed aggravation of HPPs after long-term use of PPIs. A 58-year-old male patient with liver cirrhosis visited our hospital because of hematemesis. We started PPI medication after confirming esophageal variceal bleeding and duodenal ulcer with blood clot in its base via emergency endoscopy. He took PPIs for three years because of an intractable duodenal ulcer. There was a marked increase in the size of the pre-existing polyps and in the development of new polyps. We presumed that the PPIs caused the aggravation of the HPPs, so we stopped their administration. After five months, the HPPs shrank and the polyps were partially degraded. More prospective studies are needed to investigate the relationship between HPPs and PPIs.
Carcinoid Tumor ; Duodenal Ulcer ; Emergencies ; Endoscopy ; Esophageal and Gastric Varices ; Hematemesis ; Humans ; Inflammation ; Liver Cirrhosis ; Male ; Middle Aged ; Polyps* ; Proton Pump Inhibitors* ; Proton Pumps* ; Protons*

A choledochocele is an expanded sac of the duodenal side of the distal common bile duct (CBD), and is categorized as a type III choledochal cyst. Unlike other choledochal cysts, it can be easily overlooked because of its very low prevalence, non-specific clinical symptoms, and lack of distinctive radiological findings. However, a patient having a repeated pancreaticobiliary disorder with an unknown origin, frequent abdominal pain after cholecystectomy, or repeated non-specific gastrointestinal symptoms can be suspected as having a choledochocele, and a more accurate diagnosis can be achieved via endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound. Because it rarely becomes malignant, a choledochocele can be treated via endoscopic sphincterotomy (EST) and surgical treatment. The authors were able to diagnose choledochocele accompanied by a stone in a patient admitted to the authors' hospital due to cholangitis and pancreatitis. The patient's condition was suspected to have been caused by a distal CBD stone detected via multiple detector computed tomography and ERCP, and was successfully treated via EST.
Abdominal Pain ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Choledochal Cyst* ; Common Bile Duct* ; Diagnosis ; Gallstones ; Humans ; Pancreatitis ; Prevalence ; Sphincterotomy, Endoscopic ; Ultrasonography