PURPOSE: There are a number of conditions that can lead to a hypercoagulable state, however, protein C and S deficiencies are frequently described as causes of the hypercoagulable states. The aim of this study was to evaluate the clinical features and prognosis of vascular diseases associated with protein C and/or S deficiencies and to determine an adequate treatment modality for such cases. METHODS: We prospectively evaluated 7 cases with vascular disease caused by protein C and/or S deficiencies confirmed with serologic tests. RESULTS: Four patients showed venous thrombosis, 1 peripheral arterial insufficiency, 1 cerebral venous thrombosis and peripheral arterial insufficiency, and 1 portal vein thrombosis. Surgical intervention was required in 5 patients. Full anticoagulation with heparin sodium followed by warfarin sodium was done in all patients. CONCLUSION: Protein C and S deficiencies may influence clinical management. Patients presenting with atypical vascular involvement without evidence of other risk factors should be evaluated for a hypercoagulable state. Once the diagnosis is made, patients should be treated with full anticoagulation.
Diagnosis ; Heparin ; Humans ; Prognosis ; Prospective Studies ; Protein C* ; Risk Factors ; Serologic Tests ; Vascular Diseases* ; Venous Thrombosis ; Warfarin

Malrotation is rare in older children. We performed laparoscopic Ladd's procedure for a 14-year-old girl who was diagnosed with malrotation. She presented with a history of intermittent abdominal pain for 3 month. Diagnosis was made by UGI study and abdominal sonography. Laparoscopic exploration confirmed the diagnosis of malrotation. Laparoscopic Ladd's procedure and appendectomy were carried out. The patient was able to resume oral intake on the day of the operation, and was discharged 2 days after surgery. There was no further complaint during the 5 months of follow up, and the small incisional scar satisfied the patient and her parents. Our experience confirms that laparoscopy can be used for the diagnosis and treatment of children with malrotaton.
Abdominal Pain ; Adolescent ; Appendectomy ; Child* ; Cicatrix ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Parents

Parathyroid carcinoma is a rare disease and its incidence has been reported to be 0.5-5% of all primary hyperparathyroidism cases. Compared to adenoma, parathyroid carcinoma shows higher levels of serum calcium and parathyroid hormone. When there is evidence of generalized bone disease along with the involvement of a neck mass in the hypercalcemic patient, parathyroid carcinoma should not be ruled out. The histological characteristics of malignant cells include nuclear pleomorphism, an increase in Nucleus/ Cytoplasm (N/C) ratio, hyperchromatism, abnormal mitosis and prominent nucleoli. Furthermore, malignat cases involve capsular and vascular invasion as well as metastasesis to the lungs, cervical lymph nodes and bones. The biological behavior of parathyroid carcinoma seems to be variable with a wide range of malignancy. Surgical excision is the first therapeutic option. In this paper, we report and review our experience in a case of parathyroid carcinoma in a 66- year-old female with hypercalcemia, ureteral stones and a neck mass.
Bone Diseases ; Calcium ; Cytoplasm ; Female ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary ; Incidence ; Lung ; Lymph Nodes ; Mitosis ; Neck ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Rare Diseases ; Ureter

Primary lymphoma of the thyroid gland is relatively rare disease. Its incidence varies in different series from 1% to 5% of all thyroid malignancies. Most primary thyroid lymphoma are of non-Hodgkin's type, have a B-cell phenotype, and arise in a background of autoimmune thyroiditis in about 80% of cases. A 69-year old woman presented with anterior neck swelling. Ultrasonography and computed tomography demonstrated a heterogenous soft tissue mass in both thyroid lobes and lymphadenopathy. Total thyroidectomy with lymph node dissection was performed. Histopathological findings demonstrated high-grade mucosa-associated lymphoid tissue (MALT)-type lymphoma with Hashimoto's thyroiditis. Radiation therapy was performed. We report a case of primary thyroid lymphoma with Hashimoto's thyroiditis.
Aged ; B-Lymphocytes ; Female ; Humans ; Incidence ; Lymph Node Excision ; Lymphatic Diseases ; Lymphoid Tissue ; Lymphoma* ; Neck ; Phenotype ; Rare Diseases ; Thyroid Gland* ; Thyroidectomy ; Thyroiditis* ; Thyroiditis, Autoimmune ; Ultrasonography

PURPOSE: Pancreatic cystic neoplasm is a rare disease. It should be resected regardless of the presence of symptoms due to the possibility of malignancy. Standard pancreatic resection such as PPPD or distal pancreatectomy accompanies the loss of a significant amount of normal pancreatic parenchyma and may cause an impairment of normal pancreatic functions. On the contrary, pancreatic enucleation is known to have risks of pancreactic fistula or abscess. The aim of this study is to elucidate whether segmental resection of the pancreas is a safe and effective treatment in cystic neoplasms in the head and neck of the pancreas. METHODS: We reviewed the medical records of seven patients treated with central segmental resection of the pancreas for cystadenoma at Ewha Womans University Mokdong Hospital from December 2000 to April 2001. All lesions were located at the head and neck of the pancreas. A cephalic stump was sutured for closure of minute pancreatic ductal leakage and hemostasis, and the distal stump was anastomosed with a Roux-en-Y jejunal loop. Postoperative pancreatic functions, complications, and follow up results were analysed. RESULTS: The mean age of the patients was 48.14 (+/-9.55) years old. The pathological diagnoses were 4 cases of serous cystadenoma and 3 cases of mucinous cystadenoma. The mean size was 2.03 (+/-0.7) cm. The average operating time was 299.3 (+/-44.2) minutes. There were two cases of minor complications that were mild pancreatic fistulas without symptoms. There was no operative mortality, impairment of pancreatic function, or recurrence. The mean postoperative hospital stay was 23.6 days. CONCLUSION: Segmental resection of the pancreas can be a rational therapeutic option for cystic neoplasms in the head and neck of the pancreas in terms of the potential benefit of preserving pancreatic function.
Abscess ; Cystadenoma ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diagnosis ; Female ; Fistula ; Follow-Up Studies ; Head* ; Hemostasis ; Humans ; Length of Stay ; Medical Records ; Mortality ; Neck* ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Pancreatic Ducts ; Pancreatic Fistula ; Rare Diseases ; Recurrence

PURPOSE: Hemorrhage following pancreatoduodenectomy is a severe, life-threatening complication. This study was conducted to suggest methods of the prevention and management of hemorrhagic complications. METHODS: We reviewed medical records of 456 patients who had undergone pancreatoduodenectomy at Seoul National University Hospital between January 1991 and December 2000. RESULTS: Postoperative bleeding occurred in 21 patients. Early hemorrhage within the postoperative 5th day amounted 5 cases, which were caused by improper intra-operative hemostasis. Three of these patients were saved by prompt surgery and, in one patient, conservative management. Late hemorrhage after the postoperative 5th day included 16 cases, of which 12 patients (75%) were associated with pancreas anastomotic leaks and 8 patients displayed pseudoaneurysm. "Sentinel bleeding" was evident in 8 cases. Angiographic embolization was performed in 8 cases, achieving hemostasis in 7 cases. Reoperations were attempted in 7 cases with complete hemostasis in 2 cases. As a result, 15 of 21 patients obtained complete hemostasis and mortality rate from postoperative hemorrhage was 28.6% (6/21). CONCLUSION: Successful hemostasis was achieved by surgery in case of early hemorrhage and by angiographic embolization in late hemorrhage. In order to prevent hemorrhage following pancreatoduodenectomy, meticulous hemostasis and considerate operative techniques for avoiding pancreatic anastomotic leaks or vascular injury are essential.
Anastomotic Leak ; Aneurysm, False ; Hemorrhage* ; Hemostasis ; Humans ; Medical Records ; Mortality ; Pancreas ; Pancreaticoduodenectomy* ; Postoperative Hemorrhage ; Seoul ; Vascular System Injuries

PURPOSE: CYP2D6 and N-acetyltransferase (NAT2) are polymorphic enzymes which are expressed in the hepatocyte in a genotype-determined manner. They are known to be involved in the inactivation and activation of various mutagens and carcinogens, respectively. The activities of the two enzyme systems are associated with the genetic susceptibility of many human cancers. METHODS: This study was performed to determine the genotype frequencies of the two enzyme systems in primary hepatocellular carcinoma patients and healthy controls. One hundred healthy controls and 55 liver cancer patients were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: In the healthy controls, the CYP2D6 wild type allele frequency was 0.985 and the CYP2D6*4 frequency was 0.015. No CYP2D6 poor-metabolizer was detected. No significant differences were found in the hepatocellular carcinoma patients group. Among the controls, the frequencies of F, S1, S2 and S3 alleles of the NAT2 system were 0.725, 0.01, 0.14 and 0.125, respectively. The genotype frequencies were found to be 0.91 for the rapid acetylator and 0.09 for the slow acetylator. No significant differences were found in the hepatocellular carcinoma group. CONCLUSION: The distribution of CYP2D6 and NAT2 polymorphism is very unique in the Korean population, as characterized by the extremely low frequency of CYP2D6 poor-metabolizer and NAT2 slow acetylator. CYP2D6 and NAT2 polymorphisms did not seem to play an important role in the hepatic carcinogenesis in the Korean population.
Alleles ; Carcinogenesis ; Carcinogens ; Carcinoma, Hepatocellular* ; Cytochrome P-450 CYP2D6* ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Hepatitis B ; Hepatocytes ; Humans ; Korea* ; Liver Neoplasms ; Mutagens

PURPOSE: The aim of this study is to describe the safety and efficacy of radiofrequency ablation (RFA) in the treatment of unresectable liver metastasis from colorectal cancer. METHODS: From January 1999 to December 2000, we undertook 48 RFA procedures in 36 patients with unresectable metastatic liver tumor from colorectal cancer. RFA was performed either via celiotomy (n=23) or using a percutaneous approach (n=25) under ultrasound guidance using a LeVeen needle electrode and a RF 2000 generator. Patients were followed with spiral computed tomographic scans at 1 week after RFA. RESULTS: RFA was performed in 15 patients with synchronous hepatic metastasis and 21 with metachronous hepatic metastasis. The mean tumor size was 3.1 cm (range; 0.5~7.2 cm). In 2 patients, complete ablation failed due to anatomic tumor location. Nine patients (25%) exhibited post RFA complications (9 cases of fever, 8 of abdominal pain, and 1 of hematoma) which showed spontaneous resolution and there was no treatment-related death. At a mean follow up of 10.1 months, 12 patients (33.3%) had recurred in the liver and 3 (8.6%) at the RFA site, while 16 (44.4%) remained clinically free of disease. CONCLUSION: Although RFA is a relatively safe procedure in patients with unresectable hepatic metastasis from colorectal cancer, the possible development of new metastatic disease after RFA is currently a limitation in this form of treatment. Further study on the efficacy of RFA versus other treatment modalities is needed.
Abdominal Pain ; Catheter Ablation* ; Colorectal Neoplasms* ; Electrodes ; Fever ; Follow-Up Studies ; Humans ; Liver ; Needles ; Neoplasm Metastasis* ; Ultrasonography

PURPOSE: Submucosal gastric carcinomas metastasize to lymph nodes more often than the intramucosal gastric carcinomas. The objectives of this study are to clarify the characteristics of submucosal gastric carcinomas, especially in reference to the status of lymph node metastasis, and to explore the possibility of a minimally invasive operation. MATERIALS AND METHODS: The clinicopathologic features of 88 patients with submucosal gastric carcinoma, all of whom were treated with a D(2)(+)alpha gastrectomy between January 1994 and December 1999, were examined retrospectively with respect to the status of lymph nodes. The size, depth of submucosal invasion, histologic differentiation, location, and macroscopic finding of the tumor were investigated in association with the presence or the absence of lymph node metastasis. RESULTS: Among the 88 patients, 15 (17.05%) had lymph node metastasis, and the status of metastasis was significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis was 0% (0/7) of up to 1.0cm and 18.5% (15/81) over 1.0 cm in size (P=0.034) and 6.1% (2/33) of up to 1.0 mm and 23.6% (13/55) over 1.0 mm in depth of submucosal invasion (P=0.042). CONCLUSION: The tumor size and depth of submucosal invasion are useful indicators of lymph node metastasis in submucosal gastric carcinoma. A minimally invasive operation can be applied for submucosal gastric carcinoma up to 1.0 cm in size. Further studies are needed to limited surgery for depth of submucosal invasion.
Gastrectomy ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Retrospective Studies

PURPOSE: By virtue of advances in scientific methods and technical systems, there has been a rapid growth in the number of end stage renal disease (ESRD) patients treated using continuous ambulatory peritoneal dialysis (CAPD) as their primary renal replacement therapy. However, there are various catheter related complications that are limiting factors in patient and catheter maintenance. This study was aimed at introducing of the techniques of CAPD catheter implantation designed for reducing the complication rate, as well as conducting an investigation of the incidence of CAPD catheter related complications and patient survival and catheter survival rates. METHODS: We performed 234 cases of CAPD catheter implantation using a conventional surgical method (n=162, between January 1993 and December 1997) or a modified surgical method (n=72, between January 1998 and December 1999), and retrospectively reviewed the patient's medical records to elucidate the incidence of early catheter related complications and the catheter removal rate in relation to the surgical methods. RESULTS: There were 21 cases (23.8%) of peritonitis in the modified group, which was less than that in the conventional group (79 cases, 48.8%) (P=0.036). There were 9 cases (12.5%) of exit site and tunnel infection in the modified group, which was less than that in the conventional group (36 cases, 22.2%) (P=0.019). We were able to reduce the peritonitis as well as exit site and tunnel infection by a long segment of tunneling and immobilization of the catheter to the skin. Nine cases of leakage (5.5%) have occurred in the conventional group and one case (1.3%) in the modified group; the difference was statistically significant (P=0.046). CONCLUSION: These results indicate that our modified surgical methods can reduce the rate of early catheter related complications.
Catheters* ; Humans ; Immobilization ; Incidence ; Kidney Failure, Chronic ; Medical Records ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Replacement Therapy ; Retrospective Studies ; Skin ; Survival Rate ; Virtues