No abstract available.

The distinctive diagnosis of Crohn's disease (CD) and ulcerative colitis (UC) is based on a combination of clinical, histologic, endoscopic, and radiologic data. Both UC and CD show characteristic, but non-specific, pathological features that may overlap and result in a diagnosis of indeterminate colitis (IC), which was proposed by pathologists for colectomy specimens in 1978, usually from patients operated on for severe colitis, especially in cases of acute fulminant disease of the colorectum. The subgroup of patients with an uncertain diagnosis has been classified as IC. Later, the same terminology was used for patients showing no clear clinical, endoscopic, histologic, or other features allowing a diagnosis of either UC or CD. More recently, the term IC has been applied to biopsy material when it is not been possible to differentiate between UC and CD. However, this term IC has suffered varying definitions, which in addition to numerous difficulties in diagnosing inflammatory bowel disease, has led to much confusion. In resected specimens, the term colitis of uncertain type or etiology is preferred. Over time, the majority of patients remain with a diagnosis of IC or show symptoms similar to UC. Ileal pouch anal anastomosis can be performed in such patients, with outcomes of pouch failure and with functional outcomes that are similar to those in patients with UC, but with increased risk of postoperative pouch complications. This review addresses the definition of indeterminate colitis, its pathology, its natural history, and the outcomes of restorative proctocolectomy.
Biopsy ; Colectomy ; Colitis ; Colitis, Ulcerative ; Crohn Disease ; Humans ; Inflammatory Bowel Diseases ; Natural History ; Proctocolectomy, Restorative

Ischemic preconditioning (IPC) is a phenomenon that a brief episode of ischemia to a tissue renders the tissue resistance from a subsequent prolonged ischemia. It is generally accepted that this protection is a receptor-mediated process, and is realized via signal transduction pathways. Protein kinase C (PKC), known to play key regulatory roles in cellular processes, has been proposed as a primary cellular mediator of preconditioning. However, the role of PKC in eliciting cardioprotection remains controversial. The evidences for the 'PKC hypothesis' of preconditioning in various tissue and organs are summarized. Especially in intestine, a brief ischemia induced a reversible epithelial injury to the jejunum that is associated with activation of several PKC isoforms. Injury induced by an additional period of ischemia is reduced by the prior IPC, and this effect is abolished by non-selective PKC inhibition but not by a selective inhibitor of cPKC/or PKCdelta. This result suggest that activation of nPKC isoform (especially PKCepsilon) during and following ischemic insults may play an important role in protection against I/R injury in the intestine, and this mechanism is identical with previous study in heart tissue.
Heart ; Intestines ; Ischemia ; Ischemic Preconditioning* ; Jejunum ; Protein Isoforms ; Protein Kinase C* ; Protein Kinases* ; Signal Transduction

Purpose: Inguinal hernia (IH) repair is very commonly performed in children. While open repair (OR) is the standard approach, laparoscopic repair is increasingly used. This study was aimed to investigate safety and feasibility of laparoscopic repair of pediatric IH compared to OR. Methods: We retrospectively enrolled 105 pediatric patients with IH repair between January 2011 and October 2019. The laparoscopic procedures performed were laparoscopic percutaneous extraperitoneal closure (LPEC), and three-port mini-laparoscopic repair (TLR). The OR was performed as per usual technique. Results: Thirty-nine patients underwent OR, 16 LPEC, and 50 TLR. The preoperative laterality of IH was 45 patients (42.9%) on the right side, 50 (47.6%) on the left side, and 10 (9.5%) on both sides. It was, however, diagnosed postoperatively in 27 patients (25.7%) on the right side, 38 (36.2%) on the left side, and 40 (38.1%) on both sides. Of the 63 patients who presented with unilateral IH in the laparoscopic groups, 32 (50.8%) had synchronous contralateral patent process vaginalis (PPV) which were simultaneously repaired. This was significantly more common in children under 3 years of age. Operative time in unilateral or bilateral repair was significantly shorter in the laparoscopic repair groups (p < 0.001). Ipsilateral recurrence was not observed in any group. Metachronous contralateral IH occurrence was not significantly different between groups. Conclusion Laparoscopic IH repair may have benefit in terms of shorter operation time and diagnosis of unpredicted contralateral PPV compared to OR.

A heterotopic or ectopic pancreas is defined as the presence of pancreatic tissue that lacks anatomic and vascular continuity with the main body of the pancreas. Pancreatic heterotopia is characterized by the presence of pancreatic acinar, islet, and ductular elements. Most examples are incidentally encountered during surgery, and, on rare occasions, epigastric pain, weight loss, hemorrhage, gastric outlet obstruction, and intussusception have been directly attributable to the presence of the heterotopic pancreas. A malignant transformation in an ectopic pancreas is exceptional and intestinal obstruction of the small bowel by an adenocarcinoma arising in an ectopic pancreas has not been reported yet. We present the case of a ductal adenocarcinoma originating in the heterotopic pancreas in the jejunum of a 73-year-old man. The tumor was found to obstruct the jejunum at a distance of about 25 cm distal to the ligament of Treitz. The resected jejunum histologically showed a ductal adenocarcinoma that originated from the ectopic pancreas. To our knowledge, this would be the first case in Korea, which the patient presented with a small bowel obstruction due to a malignant transformation of an ectopic pancreas.
Adenocarcinoma* ; Aged ; Gastric Outlet Obstruction ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intussusception ; Jejunum* ; Korea ; Ligaments ; Pancreas* ; Weight Loss

Juvenile polyp of the large intestine is the most common polyp among children and has no malignant potential. We experienced a case of 3-year old male who presented with rectal bleeding and polyp. The polyp was spontaneously resected and the size was 35 50 10 mm. Pathologically, the polyp was consistent with juvenile polyp of the rectum.
Child* ; Child, Preschool ; Hemorrhage* ; Humans ; Intestine, Large ; Male ; Polyps* ; Rectum

PURPOSE: Antithrombin (AT) is one of the most important natural inhibitor of coagulation, and patients with disseminated intravascular coagulation (DIC) almost invariably have an acquired deficiency of anti thrombin. The aim of our study is to evaluate the effect of replacement of antithrombin in patients with DIC and low plasma antithrombin levels after trauma or surgery. METHODS: We conducted a retrospective trial in patients with documented DIC. The patients received a loading dose of AT (1,000 IU) initially, followed by 2,000 IU per day for 2-5 days. The complete blood count, the DIC profiles (fibrinogen, FDP, PT, PTT), the AT level, and the biochemial and clinical responses were evaluated. RESULTS: A total of 19 patients with DIC due to trauma and/or postsurgical complications were enrolled. One patient received AT on two separate occasions, so a total of 20 episodes of AT infusion were evaluated. The ratio of males to females was 15:4, and the median age was 56 (range: 6-82). Compared to the initial laboratory findings, the levels of AT, PT, and PTT, as well as the platelet count were significantly improved after the infusion of AT. Biochemical response was achieved in 14 (70%) episodes, but a beneficial clinical effect was obtained in only 8 (40%) episodes. CONCLUSION: Antithrombin concentrate may improve the general status of patients with DIC after trauma and/or surgery. More, extensive clinical trials are required in order to confirm this.
Antithrombin III* ; Blood Cell Count ; Dacarbazine ; Disseminated Intravascular Coagulation ; Female ; Humans ; Male ; Plasma ; Platelet Count ; Retrospective Studies ; Thrombin

BACKGROUND: Popular immunohistochemical techniques for assay of estrogen receptor(ER) allow the localization of positive cells in specific cell populations. Some of breast carcinomas composed of discrete populations of cells were negative for ER, while neighboring populations of cells were positive for ER. Such heterogeneity might be due to biological or artifactual causes. METHODS: We studied 67 tissue blocks for geographic heterogeneity within the level of ER and cytokeratin(CK) by staining ER and CK. Positive distribution of ER and CK was manually assessed. RESULTS: The immunohistochemical expression revealed 50 cases for ER-positive and 17 cases for ER-negative. In 50 ER-positive cancers, homogeneity was 38 cases, heterogeneity was 11 case, and artifactural change was developed in and one case. excluded in the analysis. The rate of heterogeneity of the ER-positive cancers was 22.4%(11/49). Comparisons of homogeneity and heterogeneity according to clinicopathologic risk factors in ER-positive breast cancer demonstrated that the heterogeneity of ER was significantly higher in each subgroups; relatively younger ages(< or =50yr), premenopausal status, early menarche(< or =15yr), early stage(< or =I b), DCIS in pathology, and lower positive expression rate of ER(<50%). CONCLUSION: Clinicopathologic risk factoes would be required to discover the heterogeneity of ER-positive breast cancer. Also a long-term follow-up study on risk factors, including disease free survival, response to anti-estrogen therapy, and survival according to heterogeneity of ER would be need.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Disease-Free Survival ; Estrogens* ; Immunohistochemistry ; Pathology ; Population Characteristics* ; Risk Factors ; Staining and Labeling

PURPOSE: This study was prospectively carried out to determine the concordance between the immunohistochemical assay (IHC) and the enzyme immunoassay (EIA) assessing estrogen receptor (ER) and progesteron receptor (PR) in breast cancer tissues. MATERIALS AND METHODS: Breast carcinoma tissues were obtained from 36 patients. Hormonal receptors were determined by IHC assay using polyclonal antimouse antibody and by EIA. The concordance between two methods and the concordance according to in age, tumor size, stage, and lymph node metastasis of breast cancer patient were analyzed. RESULTS: The concordant rate of ER status was 88.9% between IHC and EIA. ER-IHC(+)/EIA(-) were 3 cases and ER-IHC(-)/EIA(+) was 1 cases. ER-positive was 63.9% in IHC and 53.8% in EIA. The concordant rate of PR status was 86.1% between IHC an EIA. PR-IHC(+)/EIA(-) were 4 cases and PR-IHC(-)/EIA(+) was 1 cases. PR-positive was 61.1% in IHC and 52.8% in EIA. There was high concordance (76.2-100%) in age, tumor size, stage, and lymph node metastasis. CONCLUSIONS: There was high concordance between immunohistochemical assay and enzymeimmunoassay determining estrogen and progesteron receptors in the breast cancer. The IHC assay appears to be a resonable substitute for the EIA to determine hormonal receptors.
Breast Neoplasms* ; Breast* ; Estrogens ; Humans ; Immunoenzyme Techniques ; Lymph Nodes ; Neoplasm Metastasis ; Prospective Studies

PURPOSE: A heterotopic pancreas is defined as one for which pancreatic tissue is present outside its usual or habitual location and without an anatomic relation either of continuity or of vascularization with the pancreas proper. Most heterotopic pancreases are incidentally encountered during surgery, and on rare occasions, epigastric pain, weight loss, hemorrhage, gastric outlet obstruction, and intussusception have been directly attributable to the presence of a heterotopic pancreas. The purpose of this article is to report the clinical characteristics of the heterotopic pancreas. METHOD: We retrospectively observed 24 patients, who had been pathologically proven to have a heterotopic pancreas, at the Department of Surgery, Korea University Hospital, from Jan. 1990 to Dec. 1998. RESULTS: 16 of the 24 cases were found incidentally during operations due to by other primary diseases; 8 cases were symptomatic. The ratio of males to females was 1.18:1 and most common sites were the stomach and the duodenum (71%). The mean size of the lesion was 1.26 cm, and the sizes in symptomatic cases were larger (mean 1.89 cm) than those in cases where the lesions were found incidentally (mean 0.94 cm). We experienced a case of a ductal adenocarcinoma originating from the heterotopic pancreas in the jejunum of a 73 year old man. CONCLUSION: A heterotopic pancreas should be considered in the differential diagnosis of submucosal tumors, polyps, ulceration, and intestinal tumors, When suspected, an intraoperative frozen section is recommended, and the range and the method of the operation should be decided based on the results of the frozen section.
Adenocarcinoma ; Aged ; Diagnosis, Differential ; Duodenum ; Female ; Frozen Sections ; Gastric Outlet Obstruction ; Hemorrhage ; Humans ; Intussusception ; Jejunum ; Korea ; Male ; Pancreas* ; Polyps ; Retrospective Studies ; Stomach ; Ulcer ; Weight Loss