Multiple gastric caner, now considered to be a sort of multiple primary cancer by Moertel's classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Although its incidence is rare and it has never been reported in Korea yet, the report of multiple gastric cancer is increasing with lengthened life survival and improved diagnostic method. We recently experienced two cases of triple gastric cancer, the one in 53-years-old male who had well differentiated adenocarcinoma(EGC IIb+c) on antrum, poorly differentiated adenocarcinoma on cardia and moderately differentiated adenocarcinoma on mid-body, and the other in 65-years-old female who had two poorly differentiated adenocarcinoma on cardia and anterior wall of low body and moderately differentiated adenocarcinoma (EGCIIc) on posterior wall of low body. Triple gastric cancer is rare, so we reported 2 cases of triple gastric cancer.
Adenocarcinoma ; Cardia ; Classification ; Female ; Humans ; Incidence ; Korea ; Male ; Stomach ; Stomach Neoplasms*

A schwannoma is a benign tumor that originates from the peripheral nerve sheath. Schwannomas occur most commonly in the head and neck region involving the brachial plexus and the spinal nerves. The lower limbs are less commonly affected. This paper presents a case of a patient with a schwannoma showing atypical localization at the digital nerve of the foot causing neurological symptoms.
Brachial Plexus ; Foot ; Head ; Humans ; Lower Extremity ; Neck ; Neurilemmoma* ; Peripheral Nerves ; Spinal Nerves ; Toes*

PURPOSE: Conventional laparoscopy using a two-dimensional (2D) has limited performance because of insufficient representation of the stereoscopic effect. Development of three-dimensional (3D) imaging technology has improved depth perception, shortened the execution time and reduced error number. This study was designed to identify the effects of 3D imaging on surgical performance for skilled professionals and surgical residents. METHODS: Two laparoscopic skills tasks, each with three repetitions, were performed by seven experienced laparoscopic surgeons, two minimally experienced laparoscopic surgeons, and three inexperienced surgical residents under both 2D and 3D conditions with two cadavers. Outcome measures were time for task completion and subjective assessment of performance. RESULTS: Suturing was completed by all participants and anchoring with V-Loc was performed by 10 participants. Suturing and anchoring time were significantly shorter with 3D laparoscopic in all participants (suturing time, p=0.011; anchoring time, p=0.005). Significant differences were observed between experienced and minimally experienced surgeons (suture time, p=0.021; anchoring time, p=0.018). There was no significant difference among inexperienced surgical residents, but they preferred 3D imaging over 2D. CONCLUSION: 3D laparoscopy is associated with a significantly shorter time for performance by experienced surgeons. Our results suggest that 3D laparoscopy will be helpful for surgeons conducting laparoscopic procedures.
Cadaver* ; Depth Perception ; Imaging, Three-Dimensional ; Laparoscopy* ; Outcome Assessment (Health Care) ; Surgeons

Amyotrophic lateral sclerosis (ALS) is a degenerative disease of motor ganglia in the anterior horn of spinal cord and spinal pyramidal tracts. The impairments of respiratory function and weakened upper airway muscle affect anesthetic management. General anesthesia may cause respiratory problem. Regional anesthesia such as spinal and epidural anesthesia is also relative contraindication for patients with a motor neuron disease, including ALS, for the fear of exacerbating the disease. Therefore patients with ALS are needed careful management during perioperative period. We report a case of epidural anesthesia for transurethral ureteroscopic lithotripsy in a patient with ALS. The patient recovered from anesthesia without exacerbating the disease.
Amyotrophic Lateral Sclerosis ; Anesthesia ; Anesthesia, Conduction ; Anesthesia, Epidural ; Anesthesia, General ; Animals ; Ganglia ; Horns ; Humans ; Lithotripsy ; Motor Neuron Disease ; Muscles ; Perioperative Period ; Pyramidal Tracts ; Spinal Cord

Antley-Bixler syndrome is a congenital anomaly of multiple bones and cartilage, and this was first reported by Antley and Bixler in 1975. It is characterized by craniosynostosis, midface hypoplasia with choanal stenosis and atresia, radiohumeral synostosis and femoral bowing. This is sometimes accompanied by cardiac, renal, gastrointestinal and genital malformations. The risk of respiratory distress is high in the infants with this syndrome, and this is most commonly caused by choanal stenosis and atresia. Careful anesthetic management is needed for these infants because of the potential risk of a difficult airway and respiratory complications. We report here on our experience with the anesthetic management of a neonate with Antley-Bixler syndrome and we review the relevant literature.
Anesthesia ; Antley-Bixler Syndrome Phenotype ; Cartilage ; Constriction, Pathologic ; Craniosynostoses ; Humans ; Infant ; Infant, Newborn ; Synostosis

Thymolipoma is rare benign tumor of the thymic gland and mostly occurs at anterior mediastinum. Thymolipoma comprises 2~9% of thymic tumor and less than 1% of mediastinal mass. Therefore, thymolipoma should be differentiated from anterior mediastinal tumor such as thymoma, germ cell tumor and lymphoma. These tumors resemble cardiomegaly, pleural effusion, basal atelectasis, pericardial tumor and cyst, pleural tumor, lung cancer and pulmonary sequestration, and differentiated from above mentioned diseases. Though most cases are asymptomatic, there can be dyspnea with compression of adjacent organ by mass effect, and myasthenia gravis. We experienced a thymolipoma simulating cardiomegaly and report the case with the review of literatures.
Bronchopulmonary Sequestration ; Cardiomegaly* ; Dyspnea ; Lung Neoplasms ; Lymphoma ; Mediastinum ; Myasthenia Gravis ; Neoplasms, Germ Cell and Embryonal ; Pleural Effusion ; Pulmonary Atelectasis ; Thymoma ; Thymus Neoplasms

BACKGROUND: S100 beta protein has been reported to be an early marker of brain injury. It is released from the glial cell and Schwann cell specifically after brain injury, and it,s serum concentration correlates with the severity of injury. The aim of this study was to measure the serum concentration of S100 beta protein during cardiac surgery and to reveal the correlation between cerebral oxygenation and S100 beta protein. METHODS: Eighteen patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) were enrolled in this study. After induction of general anesthesia, the arterial-jugular venous oxygen difference (AjDO2), regional cerebral oxygen saturation (rSO2) and lactate oxygen index (LOI) were measured. They were measured after induction (T0), during CPB (T1) and at the end of CPB (T2). Serum S100beta protein was measured at T0, T2, T3 (5 hours after CPB), and T4 (24 hours after CPB) using an immunoluminometric assay. We observed correlations between rSO2, AjDO2, LOI and the S100beta protein concentration. RESULTS: Serum concentrations of S100 beta protein were 0.18 +/- 0.20, 5.72 +/- 4.25, 1.06 +/- 1.38 and 0.58 +/- 0.44 (micro gram/L) at T0, T2, T3 and T4 respectively (normal value Anesthesia, General ; Brain Injuries ; Cardiopulmonary Bypass* ; Humans ; Lactic Acid ; Neuroglia ; Oxygen ; S100 Calcium Binding Protein beta Subunit ; Staphylococcal Protein A* ; Thoracic Surgery

Somatostatinoma is a rare form of neuroendocrine tumor that was first described in 1977. Most tumors have involved the pancreas, and gastrointestinal tract involvement is rare. Somatostatinomas of the ampulla of Vater are extremely rare and present distinct clinical and pathologic differences. Pancreatic somatostatinoma has been associated with a clinical syndrome of dyspepsia, mild diabetes, cholelithiasis, steatorrhea, and hypochlorhydria, but duodenal somatostatinoma, in general, has been clinically silent. A further contrast is that duodenal carcinoid tumors, mainly gastrinoma, tended to be benign, whereas ampullary carcinoid tumors, mainly somatostatinoma, exhibited malignant behavior. Therefore, definite diagnosis is important for treatment and prognosis, and is performed by image study, immunohistochemistry and electron microscopic examination. We report a case of somatostatinoma of the ampulla of Vater in a 51-year-old male. He complained of generalized abdominal pain for a few days. Gastrofiberscopically, a 1.2 cm sized bulging mass was observed on the ampulla of Vater. Radiologically, on abdomen CT, a protruding enhancing mass was revealed in the duodenum. In octreoscan, there was an abnormal focus off increased radiouptake in the infrahepatic area. He underwent a pancreatoduodenectomy. Grossly, the mass was an intraluminary protruding polypoid submucosal mass with focal ulceration in the ampulla of Vater. Histologically, it showed well-differentiated nonpleomorphic tubular cell nest and psammoma bodies. Immunohistochemically, the tumor cells showed a neuroendocrine nature with synaptophysin immunostain and intense staining only for somatostatin.
Abdomen ; Abdominal Pain ; Achlorhydria ; Ampulla of Vater* ; Carcinoid Tumor ; Cholelithiasis ; Diagnosis ; Duodenum ; Dyspepsia ; Gastrinoma ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Neuroendocrine Tumors ; Pancreas ; Pancreaticoduodenectomy ; Prognosis ; Somatostatin ; Somatostatinoma* ; Steatorrhea ; Synaptophysin ; Ulcer

Esophageal fibrovascular polyps are rare, benign, submucosal tumors of the upper digestive tract that usually have an indolent course until the lesion attains a very large size. The most frequent complaints associated with these tumors include dysphagia and foreign body sensation. However, a long pedunculated polyp can regurgitate into the pharynx or oral cavity and cause asphyxia and sudden death if the larynx is occluded. We describe the case of a 51-year-old man who experienced snoring and occasional asphyxia during sleep. Upper endoscopy was performed, which indicated the presence of a pedunculated esophageal polyp that regurgitated into the vocal cords. The polyp was removed using a polypectomy snare and was confirmed to be a fibrovascular polyp based on pathologic examination findings. Three months after the excision of the polyp, the patient was found to be doing well without any further occurrence of asphyxia or sleep disturbances.
Asphyxia* ; Death, Sudden ; Deglutition Disorders ; Endoscopy ; Esophagus ; Foreign Bodies ; Gastrointestinal Tract ; Humans ; Larynx ; Middle Aged ; Mouth ; Pharynx ; Polyps* ; Sensation ; SNARE Proteins ; Snoring ; Vocal Cords

Central venous catheterization is used to provide a large amount of fluid, total parenteral nutrition and to administer antitumor agents with few complications reported. We report an uncommon case of pleural effusion that occurred after central venous catheterization. In many cases, the mechanism for the pleural effusion after central venous catheterization occurs through an injury to the superior vena cava by the continuous mechanical force of the catheter tip, the flow of large amount of fluid and an osmotic injury to the wall of the vein. This case is somewhat different in that the central catheter was placed in an aberrant vessel resulting in the pleural effusion. A post-placement chest roentgenogram and the correct approach of catheterization are important for preventing this complication.
Antineoplastic Agents ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters* ; Parenteral Nutrition, Total ; Pleural Effusion* ; Thorax ; Veins ; Vena Cava, Superior