BACKGROUND: Recently, partial pancreatectomy has been performed for treatment of benign pancreatic lesion with special attention to functional preservation of adjacent organs. In contrast to traditional pancreaticoduodenectomy( Whipple's procedure) and pylorus-preserving pancreaticoduodenectomy(PPPD), the duodenum-preserving pancreatic head resection(DPPHR) preserves stomach, duodenum, jejunum, extrahepatic bile duct, and this procedure is reported to preserve function of adjacent organs, to reduce morbidity and mortality rates. The indications of DPPHR are benign lesion of the head of the pancreas as well as complications of chronic pancreatitis, including distal common bile duct obstruction, duodenal obstruction, colonic stenosis, pseudocyst of the head of the pancreas, internal pancreatic fistula, portal or splenic vein stenosis. Also this procedure is indicated for the management of the pancreatic head injury. Reconstructive methods following resection of the pancreatic head are modified variously, this methods are end-to-end anastomosis of the pancreatic duct, Roux-en-Y pancreaticojejunostomy, pancreaticogastrostomy, pancreaticoduodenostomy. MATERIALS AND METHODS: The authors performed DPPHR in 4 patients; pseudocyst of the pancreatic head 1, pancreatic head injury 2, chronic pancreatitis 1. Two patients with pseudocyst of the pancreatic head and pancreatic head injury underwent end-to-end anastomosis of the pancreatic duct after resection of the head of the pancreas. This procedure involved insertion of feeding tube into the pancreatic duct and then end-to-end anastomosis of the pancreatic duct. Other two patients with pancreatic head injury and chronic pancreatitis underwent Roux-en-Y pancreaticojejunostomy after resection of the head of the pancreas. RESULTS: Two patients with end-to-end anastomosis of the pancreatic duct developed leakage of the anastomotic site of the pancreatic duct at 3rd and 8th postoperative days, respectively. So this patients were performed reoperation, Roux-en-Y pancreaticojejunostomy. But the peripancreatic abscess developed after reoperation and then performed drainage of the abscess. This patients were improved and discharged. Total hospital stay was 35days and 34days, respectively. Other two patients underwent Roux-en-Y pancreaticojejunostomy after resection of the head of the pancreas. This patients were improved without complications and discharged within 1 month. CONCLUSIONS: In our experiences, DPPHR can be appropriated in the treatment of complications of chronic pancreatitis, benign lesion of the head of the pancreas, pancreatic head injury. And we consider that the Roux-en-Y pancreaticojejunostomy is more safe reconstructive method, compare with the end-to-end anastomosis of the pancreatic duct.
Abscess ; Bile Ducts, Extrahepatic ; Colon ; Common Bile Duct ; Constriction, Pathologic ; Craniocerebral Trauma ; Drainage ; Duodenal Obstruction ; Duodenum ; Head* ; Humans ; Jejunum ; Length of Stay ; Mortality ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreatic Fistula ; Pancreaticojejunostomy ; Pancreatitis, Chronic ; Reoperation ; Splenic Vein ; Stomach

The causes of subclavian artery obstruction are arteriosclerosis, chest trauma, extrinsic compressive lesion of tumor or fibrosis, ateritis and coractation of aorta. Symptoms associated with subclavian artery obstruction can manifest dizziness, vertigo, ataxia, bilateral visual change because of vertebral-basilar artery insufficiency, or manifest fatigue, claudication, rest pain, digital necrosis because of arm ischemia. Treatment of subclavian artery occlusive lesion can be only medical treatment if patients was asymptomatic and a variety of surgical procedures-endarterectomy, carotid-subclavian bypass, subclavian- subclavian bypass, axillo-axillary bypass-can be recommended according to the state of surrounding vessel and general condition of patients. We experienced a case of subclavian artery obstruction in a 65 years-old male with severe claudication in left upper extremity and who had suffered from ischemic symptoms of left lower extremity. Patient was surgically treated by femoro-femoral bypass on occlusive lesion of the left lower extremity and carotid-subclavian transposition on left subclavian lesion. Postoperative result was excellent and claudication of left upper and lower extremities were completely relieved.
Aged ; Aorta ; Arm ; Arteries ; Arteriosclerosis ; Ataxia ; Dizziness ; Fatigue ; Fibrosis ; Humans ; Ischemia ; Lower Extremity ; Male ; Necrosis ; Subclavian Artery ; Thorax ; Upper Extremity ; Vertigo

PURPOSE: The CD44 is a cell surface adhesion molecule that plays a role in lymphocyte homing, cell migration, and cancer metastasis. It has been reported that the expression of CD44v6, which is one of the CD44 variants, is related to tumor progression, recurrence and metastasis in colorectal cancer This study examined the relationship between CD44v6 over-expression and the depth of invasion, lymph node metastasis, and evaluated the clinical significance of CD44v6 as a prognostic factor of colorectal cancer. METHODS: Immunohistochemical staining of CD44v6 was performed on 72 patients who underwent radical surgery for colorectal cancer. Positive expression of more than half of the carcinoma cells was regarded as `over-expression', and that of less than half was regarded as being `low-expression'. The degree of CD44v6 expression according to depth of the invasion and lymph node metastasis was analyzed, and the 5-year survival rate of the patients was calculated. RESULTS: CD44v6 over expression was identified in 22 cases (30.6%). There was a significant correlation between CD44v6 over-expression and a lymph node metastasis, but not between CD44v6 over-expression and the depth of invasion. In addition, the 5-year survival rate was lower in the CD44v6 over expression cases (31.8%) than in the low-expression cases (90.0%)(P<0.001) Multivariate analysis, CD44v6 was regarded as a significant prognostic factor for survival in colorectal cancer patients. CONCLUSION: These results suggested that CD44v6 over- expression might be a useful prognostic indicator in colorectal cancer.
Cell Movement ; Colorectal Neoplasms* ; Humans ; Lymph Nodes ; Lymphocytes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Survival Rate

Actinomycosis is a chronic suppurative bacterial infection produced by Actinomyces israeli. The three major clinical presentation include the cervicofacial, thoracic, and abdominal regions. Abdominal actinomycosis is a rare entity which presents some difficulty in establishing a correct preoperative diagnosis. The diagnosis is usually based on histologic demonstration of sulfur granules in pus or surgically resected specimen. Recently, authors experienced a case of actinomycosis of the greater omentum in 38-years old woman. The patient underwent surgery under the impression of periappendiceal abscess. A 6cm sized firm mass was noted in the transverse colon. Histologically the mass was composed of fibroinflammatory mass with multiple actinomycosis granules.
Abscess ; Actinomyces ; Actinomycosis* ; Adult ; Bacterial Infections ; Colon, Transverse ; Diagnosis ; Female ; Humans ; Omentum* ; Sulfur ; Suppuration