Splenic hamartomas are rare benign tumors, which are usually small in size and asymptomatic and which are discovered incidentally at surgery or autopsy. The authors report on a case of splenic hamar toma in a 35-year-old man with intermittent left upper quardrant pain, who underwent an elective splenc tomy. Final pathology confirmed diagnosis of a hamartoma of the red pulp in the spleen. The patient's symptoms were resolved after the splenectomy. A splenic hamartoma should be kept in mind in the differential diagnosis of splenic tumors. The authors suggest that a splenectomy is indicated in cases where malignancy cannot be excluded and in cases of associated clinical symptoms or hematologic disorders.
Adult ; Autopsy ; Diagnosis ; Diagnosis, Differential ; Hamartoma* ; Humans ; Pathology ; Spleen* ; Splenectomy

Congenital absence of the gallbladder is a rare anomaly and an interesting subject. The overall incidence of gallbladder agenesis is said to approximately 0.035% to 0.065%. It is extremely difficult to make the correct diagnosis of gallbladder agenesis preoperatively in symptomatic patients because its clinical and radiological features are like those of cholecystitis, cholelithiasis, or choledocholithiasis in patients with anatomically normal biliary tracts. Gallbladder agenesis is suspected when the surgeon or the pathologist has failed to identify the gallbladder in its usual position but ectopic location or necrosis of the gallbladder from any causes should be ruled out. Recently, two cases of gallbladder agenesis were encountered in adult patients. We summarize our experience and give a brief review of the literature.
Adult ; Biliary Tract ; Cholecystitis ; Choledocholithiasis ; Cholelithiasis ; Diagnosis ; Gallbladder* ; Humans ; Incidence ; Necrosis

Focal nodular hyperplasia (FNH) is a benign hepatic tumor that likely represents a local hyperplastic response of hepatocytes to a congenital vascular anomaly. The histological feature of focal nodular hyperplasia is dominated by a progressive fibrotic process. Focal lesions of the liver represent a significant diagnostic problem for various imaging modalities. Because of that, in some cases, the distinction between focal nodular hyperplasia and other primary hepatic neoplasms is not possible. In the present report, we describe focal nodular hyperplasia observed in three patients with and without chronic liver disease. These patients were disclosed by various imaging procedures. Under the clinical impression of a hepatocellular carcinoma, operations were performed. The results were consistent with the typical observation in focal nodular hyperplasia. We report three cases of focal nodular hyperplasia of the liver mimicking hepatocellular carcinomas in patients with and without chronic liver disease.
Carcinoma, Hepatocellular ; Focal Nodular Hyperplasia* ; Hepatocytes ; Humans ; Liver Diseases ; Liver Neoplasms ; Liver*

Gastrointestinal autonomic nerve tumors (GANT) are uncommon neoplasms of the gastrointestinal tract. The GANT is a specialized form of stromal neoplasm with the feature of myenteric plexus derivation. We report a patient with a GANT of the small intestine and liver metastasis. The patient was admitted for evaluation of hematochezia and a palpable abdominal mass. A CT of the abdomen showed an exophytic mass arising from the distal ileum and exhibiting deep ulceration and air-cavity formation, and a huge cystic mass in the right lobe of the liver. The gross appearance of a surgical specimen of the liver showed a huge cystic mass, containing liquified hemorrhagic fluid, with an irregular nodular peripheral portion. Its capsule was intact. An ileal mass, measuring 9x5 cm and arising from the submucosal layer, with deep ulceration was seen. Histological examination of the liver and the ileal mass revealed a malignant stromal tumor with neural differentiation on immunohistochemical staining.
Abdomen ; Autonomic Pathways* ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans ; Ileum ; Intestine, Small ; Liver* ; Myenteric Plexus ; Neoplasm Metastasis ; Ulcer

BACKGROUND: Portal hypertension is a pathologic phenomenon caused by increased pressure in the portal vein. It's clinical importance lies in the development of secondary complications, such as variceal bleeding, hypersplenism, ascites, and hepatic encephalopathy. Especially, bleeding from esophagogastric varices is the single most life-threatening complication of portal hypertension. Nevertherless, these days, non-invasive techniques, such as endoscopic sclerotherapy, endoscopic band ligation, and a transjugular intrahepatic portosystemic shunt (TIPS) are available for treatment of variceal bleeding. However, a surgical procedure like a distal splenorenal shunt (DSRS) is still indicated in selective patients when a non-invasive technique has failed. Thus we reviewed and analyzed our experi ence with a distal splenorenal shunt for treatment of variceal bleeding in portal hypertension. METHODS: We retrospectively analyzed the medical records of 22 cases who had undergone a distal splenorenal shunt from 1980 to 1988 for treatment of portal hypertension with it's secondary com plications according to the patients age, sex, cause of disease, presence of secondary complications of portal hypertension, preoperative treatment, improvement of symptoms, mortality, survival rate, etc. All cases were treated preoperatively with non-invasive technique such as endoscopic sclerotherapy, endoscopic band ligation, a TIPS. RESULTS: The patients' average age was 45.5 years old. The most common cause of cirrhosis was of a viral origin. The duration for the symptoms of portal hypertension was 3.6 years. All cases had a history of recurrent variceal bleeding, and one case had hepatic encephalopathy. Preoperatively endoscopic sclerotherapy was done in 19 cases, and endoscopic band ligation was done in 3 cases. Of these 22 cases, only one case required a TIPS for decompression of the portal vein. According to the Child-Pugh classification, 12 cases were in class A and 10 cases were in class B. The estimated blood loss during the operation was about 800 to 1,900 cc. After operation, no recurrent variceal bleeding was found. The one case with hepatic encephalopathy was also controlled. A liver transplantation was Performed in onepatient, 4 years after DSRS. The operative mortality was 0%, and the survival rate for 1-year was 95%; that for 5-years was 50%. CONCLUSIONS: A distal splenorenal shunt is still a good modality for treating of portal hypertension with it's secondary complications, especially with variceal bleeding, and it could also serve as an excellent long-term bridge to liver tranplantation.
Ascites ; Classification ; Decompression ; Esophageal and Gastric Varices* ; Fibrosis ; Hemorrhage ; Hepatic Encephalopathy ; Humans ; Hypersplenism ; Hypertension, Portal ; Ligation ; Liver ; Liver Transplantation ; Medical Records ; Mortality ; Portal Vein ; Portasystemic Shunt, Surgical ; Retrospective Studies ; Sclerotherapy ; Splenorenal Shunt, Surgical* ; Survival Rate ; Varicose Veins

BACKGROUND: The current health care system demands provision of quality patient care in a cost-effective manner. A clinical path defines an optimal sequencing and timing of intervention by a health care team. This path facilitates the streamlining of this process. Implementation of clinical paths may decrease hospital cost without increasing complications in acute appendicitis patients. METHODS: A prospective evaluation of a clinical pathway for acute appendicitis (during March 1999) was conducted and the results were compared with those for control patients (during Feb 1999). Pregnant patients or patients with chronic disease were excluded. The patients with acute appendicitis were classified into three groups: A-type for acute focal and suppurative appendicitis, B-type for gangrenous appendicitis, and C-type for perforative appendicitis. RESULTS: The data for 40 patients with a clinical pathway were compared to those for 30 control patients. The mean age was 25.3 11.7 years in the pathway group versus 39.3 15.8 years in the control group. The mean hospital duration were 4.5 days for the pathway with A-type appendicitis versus 5 days for the control patients (p<0.05) and the mean hospital cost was 85.73% of that for the control group (p<0.05). In B- and C-type, the hospital duration and the cost were not different. The satisfaction rates were increased in all the types of pathway patients. The complication rates for in all the pathways were no different from those for the control patients. CONCLUSION: The clinical pathway with A-type appendicitis decreased the duration of hospitalization and the cost without adversely affecting the diagnosis or the therapy. The clinical paths were useful as means to minimize cost while increasing patient satisfaction.
Appendicitis* ; Chronic Disease ; Critical Pathways* ; Delivery of Health Care ; Diagnosis ; Diagnosis-Related Groups* ; Hospital Costs ; Hospitalization ; Humans ; Patient Care ; Patient Care Team ; Patient Satisfaction ; Prospective Studies

BACKGROUND: Hepatic artery chemoembolization represents an alternative treatment for patients of metastasis or primary hepatic malignant lesions. The aims of this study was confirm the usefulness, the complications and the survival benefits of chemoembolization for patients with colorectal carcinoma metastasis to the liver. METHODS: During 3 years, 23 patients with multiple or bulky unresectable liver metastasis from colorectal cancer were treated with chemoembolization using adriamycin, cisplatin or mitomycin with lipiodol . Repeated treatments were perform at 6- to 8-week intervals. RESULTS: Hepatic metastases were detected at the initial diagnosis of colorectal cancer in 15 patients. The metastatic lesions included 7 cases of a single bulky lesion and 16 cases of multiple lesions. A decrease of at least 25% of the baseline CEA level occurred transiently in 43% of the cases. The median survival for all 23 patients was 10 months after initiation of chemoembolization, and the 1-year survival rate was 36%. Complications were liver abscesses with cholecystitis, thrombocytopenia, and ascites. CONCLUSION: Chemoembolization is feasible treatment modality for patients with multiple or un resectable hepatic metastases from colorectal cancer.
Ascites ; Cholecystitis ; Cisplatin ; Colorectal Neoplasms* ; Diagnosis ; Doxorubicin ; Ethiodized Oil ; Hepatic Artery ; Humans ; Liver ; Liver Abscess ; Mitomycin ; Neoplasm Metastasis* ; Survival Rate ; Thrombocytopenia ; United Nations

PURPOSE: Liver resection (LR) has been the treatment of choice for hepatocellular carcinoma (HCC), but resection and survival rates remain low, and recurrence is common in cirrhotic patients. This study was designed to evaluate the outcome after resection of potentially transplantable early HCCs and compare it with that for liver transplantation (LT) as reported in the literature. METHODS: We studied 109 patients with HCC under the Milan criteria who underwent LR at Kyungpook National University Hospital from September 1997 to May 2002. The patients were divided into two groups: group A had a single tumor and group B had two or three tumors. RESULTS: The mean age was 56.1+/-8.1 years and the male-to-female ratio was 4.7: 1. Most of the patients had chronic liver disease due to viral hepatitis, but had preserved hepatic function. Overall survival rates (SR) at 1, 2, 3, and 4 years were 86.7, 69.4, 44.8, and 13.3%, respectively, and the corresponding disease-free survival rates (DFSR) were 74.2, 53.8, 41.6, and 23.7%. SR and DFSR were not significantly different between the two groups, although group B tended to have lower SR and DFSR. At a median follow-up of 25.3 months, 52 patients experienced recurrence, most of whom had intrahepatic recurrence within 2 years after resection. At the time of the diagnosis of recurrence, 34 patients were considered eligible for LT. CONCLUSION: Although most of the patients had preserved hepatic function, LR of early HCC showed low survival rates and high recurrence rates compared with those after LT reported in the literature and in our experiences. Therefore, in the absence of limiting factors, LT may be the better option for surgical treatment of patients with early HCC, even when preserved hepatic function is maintained.
Carcinoma, Hepatocellular* ; Diagnosis ; Disease-Free Survival ; Follow-Up Studies ; Gyeongsangbuk-do ; Hepatitis ; Humans ; Liver Diseases ; Liver Transplantation ; Liver* ; Recurrence ; Survival Rate

PURPOSE: Natural killer (NK) cells have a spontaneous cytotoxic capacity against tumor cells. NK cell infiltration is known to be related to the prognosis of colorectal cancer, but their prognostic significance has not been determined. The purpose of this study was to determine the prognostic importance of NK cell infiltration in colorectal cancer. METHODS: Ninety-one patients, diagnosed with colorectal cancer, between Jan. 1994 to Dec. 1995, and consequently operated on at the Department of surgery, Korea University college of medicine, were retrospectively reviewed. Immunohistochemical stains were performed for NK cells using the monoclonal antibody CD57 (IOT-10; 1: 50 diluted; Chemicon, Temccula, U.S.A.). The intratumoral CD57 expressions were divided into 4 grades. Intensity 0 was defined as a total absence of CD57 expression in the tumor cells, Intensities 1+, 2+ and 3+ were defined as less than 25, 25~50 and more than 50% expression, respectively. Consecutively, intensities 0, 1+ and 2+ were regarded as low CD57 expression, with 3 regarded as high CD57 expression. The clinical characteristics, 5-year survival rates and recurrence rates by stage, according to the CD57 expression, were then analyzed. RESULTS: Patients with high CD57 expression showed better survival rates and lower recurrence rates than those with low CD57 expressions (77.8 versus 53.4% and 14.8 versus 25.0%, respectively, P=0.0856). According to stage, the patient with high CD57 expressions showed better survival rates than those with low CD57 expressions in stages II and III (76.4 versus 69.9% [P=0.6802] and 66.7 versus 40.0% [P=0.4496], respectively). CONCLUSION: Although there was not statistical significance, these data suggest that high intratumoral infiltration of NK cells, as determined by the CD57 expression, seems to be a favorable prognostic factor in colorectal cancer, although further study will be needed.
Colorectal Neoplasms* ; Coloring Agents ; Humans ; Killer Cells, Natural* ; Korea ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: This study was performed to find out the risk factors for recurrence and prognosis of early gastric cancer (EGC) patients by evaluating the recurrence, overall survival, and disease-specific survival after curative resection. METHODS: Out of 4217 patients who had undergone gastric resections for gastric adenocarcinoma from 1987 to 1997, the records of 1264 curatively resected EGC patients were reviewed retrospectively. Risk factors that determined recurrence, overall survival, and stomach cancer specific survival were investigated by using uni-variate and multi -variate analyses. RESULTS: Among the 1264 patients, 62 patients (4.9%) were diagnosed as having recurrent cancer and 162 patients died during follow-up. Of these 162 patients, 53 (4.2% of 1264, 32.7% of 162) patients died of gastric cancer whereas 92 died of non-gastric cancer causes and 17 died of unknown causes. In uni-variate analyses, the depth of invasion and lymph node metastasis were risk factors for recurrence and gastric cancer-specific survival while age, histologic type, depth of invasion, and lymph node metastasis were risk factors for overall survival. In multi-variate analysis, lymph node metastasis was the only risk factor for recurrence and gastric cancer-specific survival, while age was the only risk factor for overall survival. In a detailed analysis of prognoses based on lymph node metastasis, recurrence and gastric cancer related death were more frequently noted in patients with 3 or more lymph node metastasis and with extra- perigastric lymph node metastasis. CONCLUSION: Although EGC patients treated by curative resection showed good prognosis, those with lymph node metastasis have risks of recurrence and gastric cancer- related death. Considering the high rate of recurrence and gastric cancer-related death, more attention should be given to EGC patients with 3 or more lymph node metastases and/or extra-perigastric lymph node metastases. Adjuvant chemotherapy might be recommended for these high-risk patients.
Adenocarcinoma ; Chemotherapy, Adjuvant ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms* ; Survival Rate*