No abstract available.
Cholecystectomy, Laparoscopic*

Adrenal myelolipomas are rare benign tumors consisting of mature fat and hematopoietic elements resembling bone marrow. Due to the frequent use of ultrasound and computerized tomography their presence is now more frequently discovered. Although these tumors are usually asymptomatic and only found incidentally at autopsy, they can cause local symptomes or hemorrhage requiring surgical excision. We present the case of a large surgically and histologically confirmed, adrenal myelolipoma with retroperitoneal hemorrhage due to spontaneous rupture in a 32-year old man.
Adrenal Glands ; Autopsy ; Bone Marrow ; Hemorrhage* ; Myelolipoma* ; Rupture, Spontaneous* ; Ultrasonography

Adrenal myelolipomas are rare benign tumors consisting of mature fat and hematopoietic elements resembling bone marrow. Due to the frequent use of ultrasound and computerized tomography their presence is now more frequently discovered. Although these tumors are usually asymptomatic and only found incidentally at autopsy, they can cause local symptomes or hemorrhage requiring surgical excision. We present the case of a large surgically and histologically confirmed, adrenal myelolipoma with retroperitoneal hemorrhage due to spontaneous rupture in a 32-year old man.
Adrenal Glands ; Autopsy ; Bone Marrow ; Hemorrhage* ; Myelolipoma* ; Rupture, Spontaneous* ; Ultrasonography

Laparoscopic cholecystectomy has been popularized all over the world as the treatment of choice for unnecessory symptomatic or asymptomatic gall stones. Initially, this surgery was applied to limited indications, but nowadays the indications of the surgery have been expanded to include severe, inflamed, complicated patients with gall stones, which used to be thought of as contraindications in the past. Surgeon,s technical improvement and newly devised surgical instruments made it possible to expand the limit of surgical indications for laparoscopic cholecystectomy. However, anatomical disorientation due to severe inflammed gall bladder is still the drawback to the possible occurrence of laparoscopic bile duct injury and bleeding. We have a clinical analysis of 32 cases of laparoscopic cholecystectomy for acute cholecystitis or G.B.empyema, surgical time,safety and case were evaluated. Two patients were converted to open laparotomy because of intraoperative bile duct injury and anatomical disorientation by hepatic flexure colonic interposition. As a result, we suggest that even in patients with subphrenic abscess or bile peritonitis secondary to G.B.empyema could be the indications for the laparoscopic cholecystectomy if surgeon's ability or patient's condition allow it.
Bile ; Bile Ducts ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Cholelithiasis* ; Colon ; Gallstones ; Hemorrhage ; Humans ; Laparotomy ; Peritonitis ; Subphrenic Abscess ; Surgical Instruments ; Urinary Bladder

The classic clinical manifestations of acute suppurative cholangitis were first described by Charcot in 1877 as a triad of fever(and chill),jaundice and right upper quadrant pain. In 1959,Reynolds and Dargan characterized acute suppurative cholangitis as a distinct clinical entity manifested by a clinical pentad of Charcot,s three signs plus shock and central nervous system depression.We have clinical analysis of acute suppurative cholangitis,218 cases who were admitted in Chonnam Hospital from Jan.1989 to Dec.1995.All cases were treated conservatively initially,and then delayed operation was performed when the patients were improved from the septic condition by cholangitis.
Central Nervous System ; Cholangitis* ; Humans ; Jeollanam-do ; Shock

Paget's disease is classified, according to location, as mammary or extramammary disease. Extramammary Paget's disease especially in the vulva is extremely rare. Several hundred cases have been described worldwide. Patients with Paget's disease of the vulva are usually white and postmenopausal. The cause of which remains elusive. A case of vulva Paget's disease is presented with brief review of literature.
Humans ; Paget Disease, Extramammary ; Vulva

A spontaneous rupture into the sigmoid colon and peritoneal cavity is a most unusual complication for a mature cystic teratoma of the ovary. A 38-year-old woman with acute lower abdominal pain, presenting as peritonitis, visited our hospital. Physical examination revealed tenderness, rebound tenderness, and vague palpable mass in the right lower quadrant of the abdomen. A pelvic computed tomographic scan demonstrated a right ovarian cystic mass with bone and fat tissue, which had ruptured into the sigmiod colon, and peritoneal fluid collection. During a laparotomy, the ovary tumor was found to be densely adherent to the rectosigmoid junctional wall; also a solid element of the ovary tumor containg hair and skin tissue seemed to be in continuity with colonic lumen, and the ovarian wall was ruptured with spillage of purulent exudate into the peritoneal cavity. En bloc resection of the tumor-bearing segment of the sigmoid colon, together with the adherent right ovary and salpinx was carrried out. The diagnosis of a mature teratoma of the ovary was made by histologic examination of a surgical specimen; the tumor had perforated the sigmoid colon wall, had protruded into the bowel lumen, and had ruptured the intraperitoneal cavity due to inflammation its wall.
Abdomen ; Abdominal Pain ; Adult ; Ascitic Fluid ; Colon ; Colon, Sigmoid* ; Diagnosis ; Exudates and Transudates ; Fallopian Tubes ; Female ; Hair ; Humans ; Inflammation ; Laparotomy ; Ovarian Cysts ; Ovary* ; Peritoneal Cavity* ; Peritoneum ; Peritonitis ; Physical Examination ; Rupture* ; Rupture, Spontaneous ; Skin ; Teratoma*

A 61-year old female presented with intermittent abdominal pain. Further examination showed an pelvic mass, partially obstructing the sigmoid colon. A search of the past medical records revealed that a primary low-grade ESS of the uterus had been treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy 10 years earlier. Surgical resection was performed under suspicion of recurrent ESS and subsequent pathologic examination of the tumor mass specimen established the recurrent LGSS and free resection margin. Then she has been treated with megestrol acetate and doing well for about 1 year since the surgical resection of the pelvic mass.
Abdominal Pain ; Colon, Sigmoid ; Female ; Humans ; Hysterectomy ; Medical Records ; Megestrol Acetate ; Middle Aged ; Recurrence* ; Sarcoma, Endometrial Stromal* ; Uterus

A fifty year old Korean female was admitted with a few months history of general malaise. On admission, positive HBs Ag, negative HBs Ab and HBe Ag was negative. The liver function tests showed AST 274 U/L, ALT 126 U/L, CEA 1.87 ng/ml. With the clinical impression of chronic hepatitis B, abdominal CT and ERCP were performed and demonstrated a narrowing of the distal common bile duct suggesting a malignant etiology. The Whipple's procedure was done. The intraoperative finding revealed neoplastic involvement of the distal 1 cm of the common bile duct with severe narrowing and proximal dilatation. Microscopic findings demonstrated cystically dilated ductular structures and intervening irregular hypertrophic smooth muscle bundles.
Adenomyoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Dilatation ; Female ; Hepatitis B, Chronic ; Humans ; Liver Function Tests ; Muscle, Smooth ; Tomography, X-Ray Computed

PURPOSE: Acute appendicitis is one of the most common surgical diseases and the accuracy of diagnosis has been reported to be between 71% and 85%. In this study we tried to determine whether abdominal sonographic examination is critical to the decision to operate and whether its use is essential before surgery of patients with clinically diagnosed or suspected acute appendicitis. METHODS: A total of 552 patients with clinically diagnosed acute appendicitis from January 2000 to December 2001 were enrolled in this study. All patients underwent an abdominal graded compression sonography performed by a staff radiologist. RESULTS: A total of 535 patients (96.9%) with positive findings of appendicitis proceeded to surgery. 17 patients (3.1%) were found to have other diseases. Of the 535 patients undergoing operation, 531 (99.3%) were proved to have appendicitis by pathologic reports. The 17 patients with negative findings in sonography underwent operation or CT examination; 12 (70.6%) were proved to have appendicitis. Abdominal sonography for detecting acute appendicitis had a sensitivity of 97.8%, a specificity of 55.6%, an accuracy of 97.1%, a positive predictive value of 99.3%, and a negative predictive value of 29.4%. CONCLUSION: Abdominal sonography is therefore one of the most useful examinations in diagnosing acute appendicitis before surgery and our experience suggests that patients with clinically suspected acute appendicitis should routinely undergo abdominal sonographic examination.
Appendicitis* ; Diagnosis ; Humans ; Sensitivity and Specificity ; Ultrasonography