Leiomyomas are very common benign tumors in the uterus and it is rare condition to present the retroperitoneal leiomyoma. The author reported a 48-year-old female patient who presented right pelvic mass with urinary incontinence and lower abdominal discomfort. Based on the preoperative imaging, provisional diagnosis was mesenchymal sarcoma. In the intraoperative findings, huge mass abutting to the uterus was observed in retroperitoneal space beneath the right broad ligament. After the exposure the retroperitoneal space, we encountered the well-demarcated tumor measuring 8 x 6 cm in diameter and this tumor attached the right surface of the uterus with fibrotic tissue. Pathologic findings demonstrated retroperitoneal uterine leiomyoma.
Broad Ligament ; Diagnosis ; Female ; Humans ; Leiomyoma* ; Middle Aged ; Retroperitoneal Neoplasms ; Retroperitoneal Space ; Sarcoma* ; Urinary Incontinence ; Uterus*

Meckel's diverticulum is a common congenital anomaly in the small bowel. Most cases of Meckel's diverticulum are asymptomatic and are found incidentally. We herein report on a case of a 21-year-old male patient who complained of lower abdominal pain and febrile sensation with incidentally diagnosed gangrenous change of Meckel's diverticulum due to axial torsion itself. A 21-year-old man presented to our institution with acute lower abdominal pain. No accurate focus on abdominal pain such as appendicitis or diverticulitis was observed on abdominal ultrasonography and abdominal CT scan. However, the physical examination of the patient revealed the symptom of localized peritonitis with fever. Finally, laparoscopic exploration was performed to determine the cause of acute abdominal pain. During the operation, we found gangrenous change of Meckel's diverticulum with axial torsion itself and laparoscopic Meckel's diverticulectomy was performed. The patient made an uneventful recovery and was discharged on the 6th postoperative day.
Abdominal Pain ; Appendicitis ; Diverticulitis ; Fever ; Gangrene* ; Humans ; Laparoscopy ; Male ; Meckel Diverticulum* ; Peritonitis ; Physical Examination ; Sensation ; Tomography, X-Ray Computed ; Torsion Abnormality ; Ultrasonography ; Young Adult

Squamous cell carcinoma (SCC) of the stomach is relatively rare. We report a patient with a primary SCC of the stomach that was initially misdiagnosed as a submucosal tumor. The patient was a 64-year-old male who had a large submucosal tumor in the gastric fundus. Gastric endoscopy, endoscopic ultrasonography and abdominal computed tomography indicated a malignant submucosal tumor with multiple lymph node metastases. The patient underwent a total gastrectomy and a regional lymph node dissection. Histologically, the tumor was identified as a primary SCC of the stomach.
Carcinoma, Squamous Cell* ; Endoscopy ; Endosonography ; Gastrectomy ; Gastric Fundus ; Humans ; Lymph Node Excision ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis ; Stomach*

PURPOSE: Atherosclerotic risk factors are highly associated with the progression and severity of cerebrovascular disease; the carotid artery intima-media thickness (IMT) correlates well with the known risk factors for atherosclerosis. The aims of this study are to evaluate the associations of the carotid artery IMT with the atherosclerotic risk factors and to determine the reference values of the carotid artery IMT in healthy subjects who were without cardiovascular symptoms. METHOD: Ultrasound high-resolution B-mode imaging of the carotid artery was performed in 273 subjects (168 men, 105 women). We investigated the mean carotid artery IMT and the correlation between the carotid artery IMT and the atherosclerotic risk factors. RESULT: The mean carotid artery IMT values were 0.70+/-0.25 mm in the common carotid artery, 0.61+/-0.15 mm in the internal carotid artery, 0.55+/-0.26 mm in the external carotid artery and 0.92+/-0.45 mm in the carotid bulb. The mean carotid artery IMT was significantly increased with increasing age (P<0.05), and particularly in males. Age, systolic and diastolic blood pressure, body mass index, total cholesterol and LDL cholesterol levels correlated with the mean carotid artery IMT. Especially, the presence of plaque (26 subjects) was correlated with the mean carotid artery IMT in the internal carotid artery (P<0.05) and bulb (P<0.01). CONCLUSION: This study revealed the correlation between the carotid artery IMT and the atherosclerotic risk factors; we also elucidated the reference values for the mean carotid artery IMT in healthy subjects who were without cardiovascular diseases and symptoms.
Atherosclerosis ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Cholesterol ; Cholesterol, LDL ; Humans ; Male ; Reference Values ; Risk Factors* ; Ultrasonography

PURPOSE: There are two surgical procedures for proximal early gastric cancer (EGC): total gastrectomy (TG) and proximal gastrectomy (PG). This study aimed to compare the long-term outcomes of PG with those of TG. MATERIALS AND METHODS: Between January 2001 and December 2008, 170 patients were diagnosed with proximal EGC at Soonchunhyang University Cheonan Hospital, of which 64 patients underwent PG and 106 underwent TG. Clinicopathologic features, postoperative complications, blood chemistry data, changes in body weight, and oncological outcomes were analyzed and retrospectively compared between both groups. RESULTS: Tumor size was smaller and the number of retrieved lymph nodes was lower in the PG group. The postoperative complication rate was 10.9% in the TG group and 16.9% in the PG group. The incidence of Los Angeles grade C and D reflux esophagitis was significantly higher in the TG group. Hemoglobin level was higher and body weight loss was greater in the TG group at 2, 3, and 5 years postoperatively. The albumin levels at 3 and 5 years were lower in the TG group. There was no significant difference in the 5-year overall survival rates between the two groups (P=0.789). CONCLUSIONS: Postoperative complications and oncologic outcomes were observed to be similar between the two groups. The PG group showed better laboratory data and weight loss than did the TG group. Moreover, severe reflux esophagitis occurred less frequently in the PG group than in the TG group. PG can be considered as an effective surgical treatment for proximal EGC.
Body Weight ; Chemistry ; Chungcheongnam-do ; Esophagitis, Peptic ; Gastrectomy* ; Humans ; Incidence ; Lymph Nodes ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate ; Weight Loss

Bariatric surgery is considered to be the effective treatment alternative conducted over the lifetime for reducing weight in patients with clinically morbid obesity. For many patients, the benefits of weight loss, including decreases in blood glucose, lipids, and blood pressure as well as increase in mobility, will outweigh the risks of surgical complications. But patients undergoing bariatric surgery have the least risk for long-term diet-related complications as reported in several studies. Thus, with an increasing number of severely obese patients undergoing bariatric surgery, the multidisciplinary healthcare system will need to be managed continuously. Many nutrition support specialists will need to become familiar with the metabolic consequences for the frequent monitoring of nutrition status of the patients. South Korea has a very short history with bariatric surgery, and relatively few studies have been conducted on bariatric surgery. Therefore, the objective of this report was to compare the nutrient intake, weight loss, body fat composition, and visceral fat before and after the bariatric surgery.
Adipose Tissue* ; Bariatric Surgery* ; Blood Glucose ; Blood Pressure ; Delivery of Health Care ; Dietary Fats ; Humans ; Intra-Abdominal Fat* ; Korea ; Nutritional Status ; Obesity ; Obesity, Morbid ; Specialization ; Weight Loss

Distant metastasis from papillary thyroid carcinoma (PTC), particularly from papillary thyroid microcarcinoma, is rare. We present a case of perigastric lymph node metastasis from PTC in a patient with early gastric cancer and breast cancer. During post-surgical follow-up for breast cancer, a 56-year-old woman was diagnosed incidentally with early gastric cancer and synchronous left thyroid cancer. Therefore, laparoscopic distal gastrectomy with lymph node dissection and left thyroidectomy were performed. On the basis of the pathologic findings of the surgical specimens, the patient was diagnosed to have papillary thyroid microcarcinoma with perigastric lymph node metastasis and early gastric cancer with mucosal invasion. Finally, on the basis of immunohistochemical staining with galectin-3, the diagnosis of perigastric lymph node metastasis from PTC was made. When a patient has multiple primary malignancies with lymph node metastasis, careful pathologic examination of the surgical specimen is necessary; immunohistochemical staining may be helpful in determining the primary origin of lymph node metastasis.
Breast Neoplasms ; Diagnosis ; Female ; Follow-Up Studies ; Galectin 3 ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Middle Aged ; Neoplasm Metastasis* ; Stomach Neoplasms* ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroidectomy

Hepatoid adenocarcinoma of the stomach (HAS) is a rare form of gastric cancer that histologically resembles hepatocellular carcinoma and is characterized by large amounts of alpha fetoprotein in the serum. The prognosis of HAS is poor compared to that of primary gastric cancer with five-year survival rates of 9% and 44%, respectively. Here, we report five patients diagnosed with HAS. Our experience suggests that an advanced stage of HAS has an extremely poor prognosis, but early detection and radical surgery can help improve the prognosis of the disease.
Adenocarcinoma* ; alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Humans ; Prognosis ; Stomach ; Stomach Neoplasms ; Survival Rate

Since Kalloo and colleagues first reported the feasibility and safety of a peroral transgastric approach in the porcine model in 2004, various groups have reported more complex natural orifice transluminal endoscopic surgery (NOTES) procedures, such as the cholecystectomy, splenectomy and liver biopsy, in the porcine model. Natural orifice access to the abdominal cavity, such as transgastric, transvesical, transcolonic, and transvaginal, has been described. Although a novel, minimally invasive approach to the abdominal cavity is a peroral endoscopic transgastric approach, there are still some challenging issues, such as the risk of infection and leakage, and the method of gastric closure. Hybrid-NOTES is an ideal first step in humans. Human hybrid transvaginal access has been used for years by many surgeons for diagnostic and therapeutic purposes. Here, we report a transvaginal flexible endoscopic appendectomy, with a 5-mm umbilical port using ultrasonic scissors in a 74-year-old woman with acute appendicitis.
Abdominal Cavity ; Aged ; Appendectomy ; Appendicitis ; Biopsy ; Chimera ; Cholecystectomy ; Endoscopy ; Female ; Humans ; Liver ; Natural Orifice Endoscopic Surgery ; Resin Cements ; Splenectomy ; Ultrasonics

Hemochromatosis is an inherited genetic disorder of iron metabolism which can also occur as a secondary result of iron-overload. It leads to organ damage such as cardiomyopathy, liver cirrhosis, hypogonadism, and diabetes. This paper discusses a case of secondary hemochromatosis associated with repeated transfusions, presenting as asymptomatic hypoparathyroidism and subclinical hypothyroidism with multiple organ involvement. The 29-year-old female, who had severe aplastic anemia, received multiple transfusions totaling approximately 1,400 units of red blood cells over 15 years. During her routine laboratory examination, hypocalcemia was detected with decreased intact parathyroid hormone and increased thyroid stimulating hormone. Serum ferritin, iron, and total iron binding capacity had increased to 27,583.03 ng/mL, 291 microg/dL, and 389 microg/dL, respectively. She had unusually bronze skin and computed tomography revealed iron deposition in the thyroid, liver, and heart. Multiorgan involvement as seen in this case is rare in hemochromatosis associated with secondary transfusions. To the best of the author's knowledge, this is the first case report in Korea of hypoparathyroidism and subclinical hypothyroidism due to iron deposition in the parathyroid and thyroid gland.
Adult ; Anemia, Aplastic ; Cardiomyopathies ; Erythrocytes ; Female ; Ferritins ; Heart ; Hemochromatosis* ; Humans ; Hypocalcemia ; Hypogonadism ; Hypoparathyroidism* ; Hypothyroidism* ; Iron ; Korea ; Liver ; Liver Cirrhosis ; Metabolism ; Parathyroid Hormone ; Skin ; Thyroid Gland ; Thyrotropin