Spontaneous perforation of bile duct in adults is very rare, with less than 30 cases described in the literature to date. We repoit a case of a 65-year-old man who presented with severe colicky abdominal pain and fever, just like symptoms of peritonitis. ERCP provided a preoperative noninvasive confirmation of the diagnosis of the rupture of right intrahepatic duct. The patient was performed T-tube choledochotomy and drainage of retroperitoneal bile collection. The etiolgy, diagnosis, and treatment of spontaneous perforation of bile duct is discussed.
Abdominal Pain ; Adult ; Aged ; Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis* ; Drainage ; Fever ; Humans ; Peritonitis ; Rupture

To evaluate the character, management and clinical results of the posterior capsular rupture during cataract surgery, we retrospectively studied the cataract surgeries that were performed between May 1989 and Decemeber 1991. We discovered 64 eyes in which the posterior capsule was torn. The overall incidence of this complication was 4.4%. Our chart review of these surgical procedure revealed that the tear occurred most frequently during the nucleus removal(44%), occured more frequently at the periphery than the center and the extent was mostly below one-third of the whole posterior capsular surface(75%). We performed vitrectomy(58%) and peripheral iridectomy(14%). Posterior capsular lenses were implallted in 56 cases. The predicted power of lens calculated with SRK-II fomula and manufacturer's A-constant was approximately 0.46 diopter less than actual postoperative refraction. Final visual acuity of 20/40 or better was achieved in 73% of the 64 cases. Our results revealed that when properly managed, a torn posterior capsule is compatible with an excellent visual outcome.
Cataract* ; Incidence ; Retrospective Studies ; Rupture* ; Visual Acuity

Carcinoid is the most common tumor in the appendix and most often occurs in young patient. A case of mesoappendiceal invasion of carcinoid of appendix in presented and the literature review for indications for right hemicolectomy. A 38-year-old man was admitted to hospital after 3 day with right lower quadrant pain. The appendectomy was performed. At gross pathologic examination the appendix measured 7.5 cm in length and 1.6 cm in diameter. The serosal surface is congested and covered with yellow white fibrinoid material. The cut surface revealed a focal thickening of wall, measured 0.7 x 0.5 cm at 2 cm from tip of the appendix. Light microscopy revealed a typical carcinoid tumors infiltrating periappendiceal fat tissue. The patient was readmitted 4 weeks postoperatively for an elective right hemicolectomy. At exploratory laparotomy, there were no palpable lymph nodes. Exploration of the distal ileum, small bowel, and remaining abdomen did reveal any other carcinoid tumors.
Abdomen ; Adult ; Appendectomy ; Appendix ; Carcinoid Tumor* ; Estrogens, Conjugated (USP) ; Humans ; Ileum ; Laparotomy ; Lymph Nodes ; Microscopy

PURPOSE: A traumatic diaphragmatic rupture (TDR) is a diagnostic challenge and the associated injuries determine the outcome in those diagnosed early. A TDR has long been considered to be a marker of the severity of injury with an average reported Injury Severity Score (ISS) between 31 and 50. This report reviewed the TDR cases in order to emphasize the method and timing of the diagnosis, associated injuries and the outcome. METHODS: A retrospective analysis was performed on 30 patient treated for TDR between August 1998 and september 2002. RESULTS: The mean age of the patients was 33.4 years and the injury predomiantly affected males (male: female=2: 1). Blunt trauma by TA was the most common cause of the TDR (25 patients). The ruptured sites were on the left in 22 cases and on the right in 8 cases. The most common symptom was chest pain (23 cases) followed dyspnea (21 cases). Liver injuries and a pneumo-hemothorax were the most common associated injuries. The mean CRAMS scale was 6.47 and Injury Severity Score (ISS) was 18.93. Eighteen TDR cases were suspected based on the abnormal chest X-ray findings. Nineteen cases underwent surgery within 6 hours after the trauma (early diagnosis). Although many complications occurred in 11 cases, there were no lethal complications. The mean size of the diaphragmatic rupture was 9.77 cm and an intraabdominal organ herniation had not occurred in ruptures smaller than 6 cm. Surgical repair of the diaphragm was performed via a laparotomy in 20 cases and thoracotomy in 7 cases. A left side TDR was preferred to a laparotomy whereas a right sided TDR was preferred to a thoracotomy. Pulmonary complications (atelectasis, pneumonia, pleural effusion) occurred in 14 cases postoperatively. CONCLUSION: The patient's complaints and physical findings were not a reliable indicator of the diagnosis, but usually a manifestation of the associated injuries. A suspicion and routine chest X-ray was the most reliable diagnostic tool, even though the chest X-ray was normal in 12 cases. A high rate of early diagnosis can be achieved using an aggresive investigation protocol, suspicion and a combined radiologic evaluation in multiple trauma patients. Although pulmonary complications occurred in the early diagnosed cases, lethal complications and long term sequela were directly related to the time of diagnosis. The higher ISS had many complications (11 cases) but there were no lethal complications, long term sequela.
Chest Pain ; Diagnosis ; Diaphragm ; Dyspnea ; Early Diagnosis ; Humans ; Injury Severity Score ; Laparotomy ; Liver ; Male ; Multiple Trauma ; Pneumonia ; Retrospective Studies ; Rupture ; Thoracotomy ; Thorax

PURPOSE: Sulphomucin is secreted by immature foveolar cells of the stomach and is expressed in gastric adenocarcinomas. Carcinoembryonic antigen (CEA) is well known to be expressed in gastric adenocarci nomas and is correlated with the cellular differentiation of gastric adenocarcinomas. However, at the moment, there are no conclusions about the relationships between the expression of sulphomucin and pathological classifications. METHODS: This study was designed to determine the significance of expression of sulphomucin and CEA in advanced gastric adenocarcinomas. Also, these two factors were compared with established clinicopathological prognostic factors. Thirty-two paraffin-embedded surgical specimens of gastric adenocarcinomas were obtained from January 1993 to December 1995 and were selected for study. The expressions of sulphomucin and CEA were studied by using the Spicer method and immunohistochemical staining with CEA 2-7 monoclonal antibody. RESULTS: The expressions of sulphomucin and CEA were positive in 9 (28%) cases and 25 (78%) cases, respectively. There was a significant correlation between sulphomucin expression and histologic differentiation (p<0.05). However, the expression of CEA was correlated with neither clinopathological factors nor sulphomucin expression. CONCLUSION: These results suggest that expressions of sulphomucin are well correlated with cellular differentiations of advanced gastric adenocarcinomas.
Adenocarcinoma* ; Carcinoembryonic Antigen ; Classification ; Noma ; Stomach

PURPOSE: Sulphomucin is secreted by immature foveolar cells of the stomach and is expressed in gastric adenocarcinomas. Carcinoembryonic antigen (CEA) is well known to be expressed in gastric adenocarci nomas and is correlated with the cellular differentiation of gastric adenocarcinomas. However, at the moment, there are no conclusions about the relationships between the expression of sulphomucin and pathological classifications. METHODS: This study was designed to determine the significance of expression of sulphomucin and CEA in advanced gastric adenocarcinomas. Also, these two factors were compared with established clinicopathological prognostic factors. Thirty-two paraffin-embedded surgical specimens of gastric adenocarcinomas were obtained from January 1993 to December 1995 and were selected for study. The expressions of sulphomucin and CEA were studied by using the Spicer method and immunohistochemical staining with CEA 2-7 monoclonal antibody. RESULTS: The expressions of sulphomucin and CEA were positive in 9 (28%) cases and 25 (78%) cases, respectively. There was a significant correlation between sulphomucin expression and histologic differentiation (p<0.05). However, the expression of CEA was correlated with neither clinopathological factors nor sulphomucin expression. CONCLUSION: These results suggest that expressions of sulphomucin are well correlated with cellular differentiations of advanced gastric adenocarcinomas.
Adenocarcinoma* ; Carcinoembryonic Antigen ; Classification ; Noma ; Stomach

The first case of chyle ascites in childhood was reported by Morton in 1683. Its reported incidence varies between 1 in 50,000 to 100,000 in hospital admissions. The clinical picture is similar to that of acute diffuse peritonitis, and is most commonly mistaken as perforated appendicitis. Paracetesis, if performed, is the most useful diagnostic option. Treatment modalities fall into four areas-: Exploratory laparotomy with either direct ligation or drainage, A medium chain triglyceride diet, NPO and hyperalimentation or Venoperitoneal shunting. An 11-years old boy was admitted with RLQ pain. He had diffuse abdominal guarding. The initial diagnosis was perforated appendicitis, and appendectomy was performed. During the operation, the abdomen was found to contain 750cc of a thin, milky fluid. It was later diagnosed as chyle ascites. The small bowel mesentery and transverse colon were thickened and edematous, with a pale white subserosal exudate. The laboratory analysis of the ascites was as follows-: protein 4.6 g/dL, albumin 3.0 g/dL, triglyceride 700 mg/dL, cholesterol 113 mg/dL, glucose 209 mg/dL, LDH 848 U/L, and amylase 32 U/dL, with a pH of 9.0. An appendectomy was performed, and two drains placed in the pelvic cavity. In the postoperative-work-up from the abdominal CT scan, the results were normal. The patient-recovered and was discharged without complication 21 days postoperatively.
Abdomen ; Amylases ; Appendectomy ; Appendicitis* ; Ascites* ; Child ; Cholesterol ; Chyle* ; Colon, Transverse ; Diagnosis ; Diet ; Drainage ; Exudates and Transudates ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Laparotomy ; Ligation ; Male ; Mesentery ; Peritonitis ; Tomography, X-Ray Computed ; Triglycerides

Although obturator herniae are rare, they are associated with a high mortality, as diagnosis is often delayed and the condition tends to occur in the elderly. The preoperative diagnosis is difficult because of nonspecific symptoms and sign. They often produce a small bowel obstruction. The treatment is always surgical. Several repair techniques have been described: a sac ligation alone, a direct suture repair, and the use of autologous tissue or prosthetic repair. Recently, the placement of permanent mesh prostheses, in a clean contaminated operative field, has been performed due to the minimal wound-related morbidity and patient mortality. Thus, utilization of a permanent mesh in an obturator hernia is a new, simple and effective method for repair. Two cases of a strangulated obturator hernia were experienced in elderly women. The peritoneal cavity was not overly contaminated, with only necrotic foci on the herniated small bowel wall noted. A segmental resection of the small bowel was performed. Consequently, the hernia defect was closed with mesh- plug between the peritoneum and periosteum of the obturator foramen. Here, two cases of obturator herniae treated by use of a mesh-plug are reported, with a brief review of the literature.
Aged ; Diagnosis ; Female ; Hernia ; Hernia, Obturator* ; Humans ; Ligation ; Mortality ; Periosteum ; Peritoneal Cavity ; Peritoneum ; Prostheses and Implants ; Sutures

Mondor's disease is also called thrombophlebitis and it is not a common condition. The characteristics finding of Mondor's disease is a subcutaneous cord that is tender and tense. This disease commonly occurs in the breast and abdomen. The etiology of Mondor's disease is unknown, but the generally agreed on causes are trauma, excessive exercise and breast surgery. On rare occasions, this disease is related to malignancy, pregnancy, filariasis and so on. This disease is self limiting and it is usually treated conservatively and symptomatically. We treated one woman who had Mondor's disease on the anterior side of the left elbow. This is a very rare location for Mondor's disease and so clinicians need to be aware about the possibility of this unusual presentation for this disease.
Abdomen ; Breast ; Elbow ; Female ; Filariasis ; Humans ; Pregnancy ; Thrombophlebitis ; Transcutaneous Electric Nerve Stimulation

PURPOSE: Conventional laparoscopic appendectomy (LA) is a widely used treatment for appendicitis. Nowadays, single incision laparoscopic appendectomy (SILA) is increasingly used as an alternative treatment for appendicitis. The purpose of this study is to evaluate the clinical significance and differences between LA and SILA. METHODS: A total of 519 patients undergoing LA or SILA between January 2011 and December 2012 were identified in a retrospectively collected database. Patients' characteristics and peri-operative variables were analyzed. RESULTS: LA was performed in 485 patients and SILA was performed in 34 patients. Mean operation time for the LA group was 62.7 minutes (range 23.3~68.1) and that for the SILA group was 62.7 minutes (range 50.9~74.5). This difference of operation time was statistically significant. In the learning curve of SILA, operation time was gradually decreased. No significant differences in hospital stay and peri-operative complications were observed between groups. CONCLUSION: Although operation time for SILA was longer than that for LA, SILA was safe. Therefore, a prospective study should be conducted in order to confirm the possibility of application to most appendicitis patients.
Appendectomy ; Appendicitis ; Humans ; Laparoscopy ; Learning Curve ; Length of Stay ; Retrospective Studies