In 1861 Rokitanski laid down the law that the pyloric ring served as a barrier to the duodenal spread of gastric cancer. Although this theory was generally accepted, direct spread of gastric carcinoma into the duodenum has been reported. We report a case of gastric cancer spreading into the duodenum that was diagnosed by endoscopic duodenal biopsy and review the literature.
Biopsy ; Duodenum* ; Endoscopy ; Jurisprudence ; Stomach Neoplasms

The transsphenoidal approach is the choice of surgical approach for the treatment of pituitary tumors located on the upper portion of the sphenoid sinus. The proximity of vital anatomic structures (e.g. optic nerve, carotid artery, carvernous sinus, and anterior cranial fossa) surrounding the sphenoid sinus makes it difficult for surgeons to recognize the precise location during the transsphenoidal approach. We report 16 cases of transsphenoidal approach performed via the navigation system to identify vital anatomic structures and important surgical landmarks. We analyzed 16 patients to perform the transcrural transcolumellar approach under the guidance the navigation system for pituitary tumor resection. For the verification of important anatomic structures during operation, the navigation system demonstrates the position and direction of the probe on CT scans in real time. The intrasphenoidal septum was in the midline in only four cases but not so in the other 12 cases. However, the posterior portion of the bony nasal septum attached to the anterior wall of the sphenoid sinus was located in the mid-portion of the sphenoid sinus in all cases. Without any serious damage to the important structures around the sella turcica, we successfully performed the pituitary tumor operation in all cases. Using the navigation system, we identified the relationship between the sella turcica and surrounding important structures on CT scan in real time, and successfully removed the pituitary tumors without complications. In addition, we suggest that the posterior portion of the bony nasal septum attached to the anterior wall of the sphenoid sinus may be one of the available landmarks for the localization of the midline during a transsphenoidal approach.
Carotid Arteries ; Humans ; Nasal Septum ; Neuronavigation ; Optic Nerve ; Pituitary Neoplasms* ; Sella Turcica ; Sphenoid Sinus ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Sleep disordered breathing (SDB) in children can have an effect on the quality of life as it may produce sleep disturbance, physical symptoms, and emotional distress in daytime function. It may also lead to the change of children's personality and behavior. We aimed to estimate the impact of SDB in children on the quality of life and the correlation between the quality of life and personality or behavioral problem. SUBJECTS AND METHOD: A total of 116 children aged 4 through 15 years old (M: 79, F: 37) with symptoms of snoring, mouth breathing, sleep apnea and physical examination results demonstrating tonsillar size of 3+ or greater were included. Two standard questionnaires, K-CBCL (Korean Child Behavior Checklist) and KPI-C (Korean Personality Inventory for Children) were used for evaluation of personality and behavior in children, and then a clinical analysis was carried out by pediatric psychologist for interpretation. To evaluate the quality of life in children, two other standard questionnaires, KOSA-18 (Korean Obstructive Sleep Apnea-18 Survey) and KOSA-6 (Korean Obstructive Sleep Apnea-6 Survey), were given to the parents of the children to complete. RESULTS: There was a significant correlation between the KOSA-18 score and the K-CBCL total problem behavior T score, the mean of KPI-C T scores (R=0.513, R=0.435 respectively), KOSA-6 score and K-CBCL total problem behavior T score, the mean of KPI-C T scores (R=0.347, R=0.398 respectively). CONCLUSION: In children, the larger the impact of SDB on the quality of life is, the higher the rate of personality or behavioral problem is. Therefore, the early and active treatment is needed in children with SDB who are scored highly by KOSA-18 or KOSA-6.
Adolescent ; Child Behavior ; Child* ; Humans ; Mouth Breathing ; Parents ; Personality Inventory ; Physical Examination ; Psychology ; Quality of Life* ; Surveys and Questionnaires ; Sleep Apnea Syndromes* ; Snoring