PURPOSE: To report a case of spontaneous separation of idiopathic epiretinal membrane in an elderly patient. CASE SUMMARY: A 61-year-old male presented with decreased visual acuity in the right eye. He was diagnosed with idiopathic epiretinal membrane (ERM) in the right eye and posterior vitreous detachment (PVD) in both eyes. The patient underwent pars plana vitrectomy and ERM removal in the right eye. At postoperative 1 year, his vision in the right eye had improved, but idiopathic ERM developed in the left eye and visual acuity in the left eye decreased. Three years later, the ERM in the left eye resolved spontaneously and his vision increased. CONCLUSIONS: Herein we present a rare case of spontaneous separation of idiopathic ERM associated with a pre-existing PVD in an elderly patient and reviewed the available literatures regarding the possible mechanisms for the spontaneous separation of ERM in the presence of a pre-existing PVD.
Aged* ; Epiretinal Membrane* ; Humans ; Male ; Middle Aged ; Visual Acuity ; Vitrectomy ; Vitreous Detachment

Endodermal sinus tumor (EST) is a rare malignant germ cell tumor arising usually in the gonads such as the testis or ovary. However, 10-15% of EST cases may arise in the extragonadal sites, such as sacrocoxygeal area, mediastinum, vagina, brain and retroperitoneum in a frequent occurring order. To our knowledge there are only 2 case reports of extragonadal EST, one originating from the omentum in 1998, and another which was localized in the pelvis in 2003. We report one case of extragonadal sinus tumor which arose in appendix and mesentery in the 19-year-old female with a review of the literature.
Appendix* ; Brain ; Endoderm* ; Endodermal Sinus Tumor* ; Female ; Gonads ; Humans ; Mediastinum ; Mesentery* ; Neoplasms, Germ Cell and Embryonal ; Omentum ; Ovary ; Pelvis ; Testis ; Vagina ; Young Adult

There has been a mistake, claimed and confirmed by all the authors of Vol 50(1), 2012, p. 1-9 issue, that first author should have been Il-Han Kim instead of Kwan-Tae Noh.

BACKGROUND: A pancreaticoduodenectomy is the procedure of choice in patients with periampullary cancer. Because of the improvement in the postoperative mortality and morbidity over the past several decades, the indications for pancreaticoduodenectomy are becoming more extended. The aim of this study was to determine the incidence, the origin, and the present management strategy for early and late complications following this operation. METHODS: In one hundred twenty-two patients who had undergone a pancreaticoduodenectomy for periampullary cancer, mid bile-duct cancer, and other benign or malignant diseases during the period from Oct. 1994 to Dec. 1997 postoperative complications and operative mortality were analyzed retrospectively. RESULTS: Thirty-nine patients were treated for common bile-duct cancer, 37 patients for cancer, 22 patients for ampulla of Vater cancer, 5 patients for duodenal cancer, 4 patients for advanced gastric cancer, 2 patients for gall bladder cancer, and 13 patients for benign diseases or traumatic injury of the pancreas. A standard pancreaticoduodenectomy was performed in 92 patients, a pylorus-preserving pancreaticoduodenectomy in 12 patients, a total pancreatectomy in 11 patients, and a hepatopancreaticoduodenectomy in 7 patients. Of all the patients, 6 patients were treated with a pancreticoduodenectomy with combined portal vein resection. There was one hospital death. Postoperative complications occurred in 66 patients, and 24 patients had more than one. In 10 patients with complications, reoperative treatment was performed. The remaining 56 patients underwent the conservative treatments. CONCLUSIONS: The pancreaticoduodenectomy remains a formidable procedure despite the low mortality rate reported recently. Postoperative complications following a pancreaticoduodenectomy are common and their prompt recognition and appropriate management are of great importance in contributing to a successful outcome for the majority of patients.
Ampulla of Vater ; Duodenal Neoplasms ; Gallbladder Neoplasms ; Humans ; Incidence ; Mortality ; Pancreas ; Pancreatectomy ; Pancreaticoduodenectomy* ; Portal Vein ; Postoperative Complications* ; Retrospective Studies ; Stomach Neoplasms

BACKGROUND/AIMS: Benign bile duct stricture from iatrogenic injury is a serious complication in general surgery. In spite of more knowledge and improved techniques, bile duct stricture remains a critical problem. METHOD AND RESULTS: We have experienced eight cases of post-operative bile duct stricture between September 1994 and April 1996. 6 cases of Initial operations were done in SMC, and two cases were transferred. The cases were analysed. The causative operations consisted of two cholecystectomy with bile duct exploration, three Whipples procedure, one right lobectomy of liver, one duodenal diverticulectomy and one Billorth I gastrectomy. According to the classification of Bismuth, three were type 1, two were type 2, two were type 3 and one was type 4. The pathogenesis of stricture included direct injury in five cases, ischemia in one and excessive fibrosis in two. PTBD was used and repaired by hepaticojejunostomy in all cases. Even after short-term follow-up, we had no recurrent cases. CONCLUSION: Bile duct injury is an inevitable complication, but prophylaxis is the best treatment and therefore more attention must be given to biliary tree anatomy during upper abdominal surgery, especially during aggressive lymph node dissection in malignant disease. When bile duct injury was discovered during operation, Roux-en-Y hepaticojejunostomy was the best treatment. We preferred 2.5 magnification loupe during bilo-enteric anastomosis in normal size bile duct. PTBD was used for corrective surgery and the results were satisfactory.
Bile Ducts* ; Bile* ; Biliary Tract ; Bismuth ; Cholecystectomy ; Classification ; Constriction, Pathologic* ; Fibrosis ; Follow-Up Studies ; Gastrectomy ; Ischemia ; Liver ; Lymph Node Excision

BACKGROUND/AIMS: Anomalous connection between the choledochus and the pancreatic duct is considered to be a factor in the development of carcinoma of the biliary tract. There is especially a malignant potential for gallbladder cancer without dilatation of bile duct. We intend to find the clinical significance of anomalous pancreaticobiliary ductal union (APBDU) and biliary malignancy, and the correlation between type of APBDU and that of biliary malignancy (gallbladder of bile duct). Our purpose is to certificate the propriety of prophylactic cholecystectomy and to recall operation. METHOD AND RESULTS: We reviewed 880 ERCP cases from September 1994 through February 1996. There were fifteen cases of APBDU and six cases of biliary tumor associated with APBDU. They consisted of three gallbladder cancer with all P-C type union, two bile duct cancer with C-P type union and one villous adenoma in dilated bile duct. In one reoperation case in which cystojejunostomy had already been performed, there was no evidence of malignancy, but one was inoperable due to multiple liver metastasis. CONCLUSION: The patients with APBDU showed an increase of gallbladder cancer occurrence and furthermore those with the C-P type of APBDU, not associated with bile duct dilatation had a higher occurrence. And therefore were censidered preventive cholecystectomy and in operation to divide the biliary duct and pancreatic duct. Preoperative CA 19-9 test is helpful in finding the hidden cancer and is a guide to preventive operation in APBDU patients and to post-operative follow-up.
Adenoma, Villous ; Bile ; Bile Duct Neoplasms ; Bile Ducts ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Common Bile Duct ; Dilatation ; Follow-Up Studies ; Gallbladder Neoplasms ; Humans ; Liver ; Neoplasm Metastasis ; Pancreatic Ducts ; Reoperation

Von Recklinghausen's disease (VRD) is known to be associated with various neoplasms of both neural crest and nonneural crest origin. Approximately 25% of all patients with VRD have documented gastrointestinal involvement. However, most of these tumors are benign neurofibromas. Less commonly, leiomyomas, sarcomas, ganglioneuromas and carcinoids have been reported. We report two cases of synchronous biliary cancer (gallbladder & ampulla of Vater) in patients with von Recklinghausen Disease with jejunal stromal tumors. One case (F/39) was diagnosed as an adenocarcinoma of Vater's ampulla and adenoma of the gallbladder. She underwent a pancreaticoduodenectomy. Another patient (M/55) was diagnosed as an adenocarcinoma of the Vater's ampulla and squamous cell carcinoma of the gallbladder. He underwent a right lobectomy of the liver and a pancreaticoduodenectomy (HPD).
Adenocarcinoma ; Adenoma ; Ampulla of Vater ; Biliary Tract Neoplasms* ; Biliary Tract* ; Carcinoid Tumor ; Carcinoma, Squamous Cell ; Gallbladder ; Ganglioneuroma ; Humans ; Leiomyoma ; Liver ; Neural Crest ; Neurofibroma ; Neurofibromatoses ; Neurofibromatosis 1* ; Pancreaticoduodenectomy ; Sarcoma

PURPOSE: The purpose of this study was to investigate the effects of a mouthguard on stress distribution under mandibular impact. MATERIALS AND METHODS: The FEM model of head consisted of skull, maxilla, mandible, articular disc, teeth, and mouthguard. The impact locations on mandible were gnathion, the center of inferior border, and the anterior edge of gonial angle. And the impact directions were vertical, oblique (45degrees), and horizontal. The impact load was 800 N for 0.1 sec. RESULTS: When vertical impact was applied, the similar stress and the distribution pattern was occurred without the relation of the mouthguard use (P>.05). The model with mouthguard was dispersed the stress to the teeth, the facial bone and the skull when the oblique (45degrees) impacts were happened. However, the stress was centralized on the teeth in the model without mouthguard (P<.05). The model with mouthguard was dispersed the stress to the teeth, the facial bone and the skull when the horizontal impacts was occurred. However, the stress was centralized on the teeth without mouthguard (P<.05). For all impact loads, stress concentrated on maxillary anterior teeth in model without mouthguard, on the contrary, the stress was low in the model with mouthguard and distributed broadly on maxillary anterior teeth, facial bone, and skull. CONCLUSION: The mouthguard was less effective at shock absorbing when vertical impact was added. However, it was approved that mouthguard absorbed the shock regarded to the oblique (45degrees) and horizontal impact by dispersing the shock to the broader areas and decreasing the stress.
Facial Bones ; Finite Element Analysis ; Head ; Mandible ; Maxilla ; Shock ; Skull ; Tooth

PURPOSE: The purpose of this study was to evaluate the utility of Gd-DTPA-enhanced dynamic MRI (DMRI) in earlydiagnosis and the assessment of disease processing in experimentally-induced crescentic glomerulonephritis (CGN)in rabbits. MATERIALS AND METHODS: In six rabbits, CGN was induced by an injection of anti-glomerular basementmembrane Ab. A time-signal intensity curve (TSC) was obtained from DMRI on the day before, and at 1, 4, 7, 15, 45and 113 days after the induction of CGN. Sequential renal biopsies and blood sampling (serum creatinine) wereperformed on the same days, and the results of DMRI and TSC, were compared. RESULTS: In normal kidneys, sequentialDMRI demonstrated the intratubular passage of Gd-DTPA as an inwardly migrating, thin, dark, band pattern. On days1 and 4, the thin dark band appeared but was poorly defined and TSC revealed a delay in peak time. On days 7 and15, movement of the band was seen to be weak and slow, and there was no centripetal migration. The maximal signalintensity of TSC was delayed, and the curves declined very slowly. On days 45 and 113, the dark band pattern wasvery weak and slow, and again there was no centripetal migration. CONCLUSION: GD-DTPA-enhanced DMRI may be ofvalue in the evaluation of disease processing and the severity of CGN.
Animals ; Biopsy ; Gadolinium DTPA* ; Glomerulonephritis ; Kidney ; Magnetic Resonance Imaging* ; Nephritis ; Rabbits

Four cases of mucinous ductal ectasia of the pancreas are presented, along with a review of the literature. Mucinous ductal ectasia is a clinicopathologic entity characterized by dilation and filling of the main pancreatic duct or its side branches with thick, viscid mucus, leading to recurrent acute pancreatitis or symptoms that mimic chronic pancreatitis. Three of the patients were male (M:F=3:1) and the patients were 54~74 years old. The symptoms of two patients were abdominal pain and they had a frequent admission history due to pancreatitis. One patient had jaundice, and one patient presented no symptoms. In all of the patients, the tumor was located in the read of the pancrease and the size of tumor was about 3 cm. A total pancreatectomy was performed, and three pancreatico-duodenectomy were performed. The pathologic report revealed that two cases were malignant and two cases were borderline malignant. The tumor marker did not correlate with the presence of malignancy. Because mucinous ductal ectasia is recognized as a premalignant disease, the treatment of choice is pancreatic resection.
Abdominal Pain ; Dilatation, Pathologic* ; Humans ; Jaundice ; Male ; Mucins* ; Mucus ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Pancreatitis ; Pancreatitis, Chronic ; Pancrelipase