Isolated obstruction of the splenic vein leads to segmental portal hypertension, which is mainly originated from pancreatic disease, such as chronic pancreatitis, pancreatic pseudocyst, pancreatic cancer. The clinical manifestation are devoid of ascites and encephalopathy, but presented with gastric variceal bleeding. We experienced 27-year-old male patient who complained of hematochezia and melena. After work-up with CT and angiography, we performed operation with the impression of pancreatic tumor associated with splenic vein occlusion. It resulted nonfunctioning pancreatic endocrine tumor. Often called islet cell tumor, pancreatic endocrine tumor has various names according to secreted hormones, such as insulinoma, Zollinger-Ellison syndrome and glucagonoma. It was classified as nonfunctioning tumor if there were any evidence of hormone secretion by radioimmunoassay and immunohistochemistry. Surgical excision and adjuvant medical therapy is the mainstay of therapy. We performed tumor resection and splenectomy for control of gastric variceal bleeding due to splenic vein occlusion.
Adenoma, Islet Cell ; Adult ; Angiography ; Ascites ; Esophageal and Gastric Varices* ; Gastrointestinal Hemorrhage ; Glucagonoma ; Humans ; Hypertension, Portal ; Immunohistochemistry ; Insulinoma ; Male ; Melena ; Pancreas* ; Pancreatic Diseases ; Pancreatic Neoplasms ; Pancreatic Pseudocyst ; Pancreatitis, Chronic ; Radioimmunoassay ; Splenectomy ; Splenic Vein ; Zollinger-Ellison Syndrome

PURPOSE: Local excision of early rectal cancers with favorable histologic features can provide comparable survival rate to radical surgery with minimal morbidity and mortality, showing excellent functional results. But, still worried about high local recurrence rate and poor survival rates for local excision. This study was performed to investigate complications and evaluate oncological out comes after local excision for rectal cancers. METHODS: We evaluated 80 cases underwent local excision among 1681 patients with rectal cancer between January 1989 and December 2000. The mean age was 58+/-11 years and median follow up period was 24 (range: 1-82) months. Type of surgery for early rectal cancer were transanal excision in 51 cases (63.8%), transsphincteric approach in 12 cases (15%) and endoscopic submucosal resection alone in 17 cases (21.2%). RESULTS: The distance from the anal verge was 5.9+/-2.6 cm and the mean tumor size was 2.5+/-2.0 cm. Pathological depth of invasion revealed 52 Tis, 21 T1, 6 T2, and 1 T3 tumors. Cellular differentiation was well-differentiated tumor in 73% and moderately-differentiated in 27%. On histologic examination, 65% of them comprised underlying adenoma component. Leakage from the closure site was observed in two cases of transsphincteric approach. One case required abdominoperineal resection and the other was managed by temporary colostomy. Adjuvant chemoradiation was performed in 10 cases: one Tis with positive resection margin, 6 deep T1, and 3 T2 tumors. Five tumors was salvaged by immediate surgery: one T1 with positive resection margin, 3 T2 with positive resection margin, and 1 T3. During the follow up period, one local recurrence was developed after 25 months of surgery and salvaged by low anterior resection. CONCLUSION: Local excision for rectal cancer can be performed safely in strictly selected patients and meticulous surgical technique according to tumor location is mandatory to reduce postoperative complications.
Adenoma ; Colostomy ; Follow-Up Studies ; Humans ; Mortality ; Postoperative Complications ; Rectal Neoplasms* ; Recurrence ; Survival Rate

Kaposi's sarcoma is a rare and slowly progressive disease that primarily affects the skin but has an associated visceral involvement. It can occur in the HIV-positive patients or patients treated with immunosuppressants. However, it is extremely rare in the patients receiving the treatment for inflammatory bowel disease. We used corticosteroid for the treatment of ulcerative colitis in 60-year-old woman. Then, Kaposis's sarcoma occured in the skin and colon of the patient. Since she was HIV-negative, we believed that it was developed from the condition of corticosteroid-induced immunosuppression. We present a case of skin and colonic Kaposi's sarcoma in a HIV-negative woman following treatment with corticosteroid for ulcerative colitis.
Aged ; Colitis, Ulcerative/*complications/drug therapy ; Colonic Neoplasms/*complications/diagnosis ; English Abstract ; Female ; Humans ; Sarcoma, Kaposi/*complications/diagnosis ; Skin Neoplasms/*complications/diagnosis

BACKGROUND: Severe acute lung injury(ALI), also known as the adult respiratory distress syndrome(ARDS), is a heterogenous nature of dynamic and explosive clinical synrome that exacts a mortality of approximately 50%. Endotoxin(ETX) is an abundant component of the outer membrane of gram-negative bacteria capable of inducing severe lung injury in gram-negative sepsis and gram-negative bacterial pneumonia, which are among the most common predisposing causes of ARDS. The influx of PMNs into airway tissue is a pathological hallmark of LPS-induced lung injury. And th3re is a substantial evidence suggesting that cytokines are important mediators of lung injury in gram-negative sepsis. However, the kinetics of phagocytes and cytokines by an exact time sequence and their respective pathogenic importance remain to be elucidated. This study was performed to investigate the role of phagocytes and proinflammatory cytokines in ETX-induced ALl through a time course of changes in the concentration of protein, TNFa and IL-6, and counts of total and its differential cells in BALF. The consecutive histologic findings were also evaluated. METHOD: The experimental animals, healthy male Sprague-Dawley, weighted 200+/-50g, were divided into controland ALI-group. ALI was induced by an intravenous administration of ETX, 5mg/kg. Above mentioned all parameters were examined at 0(control), 3, 6, 24, 72 h after administration of ETX. TNFa and IL-6 conc. in BALE were measured by a bioassay. RESULTS: The protein concentration and total leukocyte count(TC) in BALF was significantly increased at 3h compared to controls(p<0.05). The protein conc. was significantly elavated during observation period, but TC was significantly decreased at 72h(p<0.05 vs. 24h). There was a close relationship between TC and protein cone. in BALF(r = 0.65, p <0.001). The PMN and monocyte count was well correlated with TC in BALF, and the correlation of PMN(r=0.97, p<0.001) appeared to be more meaningful than that of monoeyte(r = 0.61, p<0.001). There was also a significant correlation between protein cone. and PMN or monocyte count in BALF(PMN vs. monocyte r = 0.55, p<0.005 vs. r = 0.64, p<0.001). The count of monocyte was significantly elavated during observation period though a meaningful reduction of PMN count in BALF at 72h, this observation suggested that monocyte may, at least, partipate in the process of lung injury steadly. In this sudy, there was no relationship between IL-6 and TNFt conc., and TNFa but not IL-6 was correlated with TC(r 0.61, p <0.05) and monocyte(r = 0.67, p<0.05) in BALF only at 3, 6h after ETX introduced. In particular, the IL-6 cone. increased earlier and rapidly peaked than TNFz cone. in BALF. In histologic findings, the cell counts of lung slices were increased from 3 to 72h(p<0.001 vs. NC). Alveolar wallthickness was increased from 6 to 24h(p<0.001 vs. NC). There was a significant correlation between the cell counts of lung slices and alveolar wall-thickness(r= 0.61, p<0.001). This result suggested that the cellular infiltrations might be followed by the alterations of interstitium, and the edematous change of alveolar wall might be most rapidly recovered to its normal condition in the process of repair. CONCLUSION: We concluded that although the role of PMIN is partly certain in ETX-induced ALI, it is somewhat inadequate to its known major impact on ALL Alveolar macrophage and/or non-immune cells such as pulmonary endothelial or epithelial cells, may be more importantly contributed to the initiation and perpetual progression of ETX-induced ALI. The IL-6 in ETX-induced ALI was independent to TNFa, measured by a bioassay in BALF. The early rise in IL-6 in BALF implies multiple origins of the IL-6.
Acute Lung Injury* ; Administration, Intravenous ; Adult ; Animals ; Biological Assay ; Cell Count ; Cytokines ; Epithelial Cells ; Gram-Negative Bacteria ; Humans ; Interleukin-6 ; Kinetics ; Leukocytes ; Lung ; Lung Injury ; Macrophages, Alveolar ; Male ; Membranes ; Monocytes ; Mortality ; Phagocytes* ; Pneumonia, Bacterial ; Rats, Sprague-Dawley ; Sepsis

Pyogenic liver abscess is a rare but highly lethal disease. The diagnosis and treatment of pyogenic liver abscess has been evolving owing to specific antibiotic therapy, ultrasonography, abdominal computed tomography with improved percutaneous and operative techniques. However, pyogenic liver abscess may present as a rapidly fatal outcome. These unfavorable results are mainly attributed to the increasing numbers of patients with malignant disease and biliary tract disease. Carcinoma of the gallbladder has remained an uniformly fatal neoplasm characterized by early metastasis and rapid fatal course. In early stage, the symptom is nonspecific and often mimics benign biliary tract disease. We experienced a case of the gallbladder carcinoma presenting with pyogenic liver abscess in a 78-year-old female patient. Surgical drainage and cholecystectomy were done. The microscopic finding of resected gallbladder revealed large cell neuroendocrine carcinoma of gallbladder.
Aged ; Biliary Tract Diseases ; Carcinoma, Neuroendocrine* ; Cholecystectomy ; Diagnosis ; Drainage ; Fatal Outcome ; Female ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Liver Abscess ; Liver Abscess, Pyogenic* ; Neoplasm Metastasis ; Ultrasonography

In recent years, increasing numbers of cases of the double primary cancer with different site origins in an individual have been reported. However, the occurrence of more than two primary cancer is relatively rare. We have experienced a case of synchronous triple primary cancer of non-Hodgkin's lymphoma associated with hepatocellular carcinoma and early gastric cancer in 64 years old woman who has been suffered from hepatitis B antigen (+) liver cirrhosis.
Carcinoma, Hepatocellular* ; Female ; Hepatitis B ; Humans ; Liver Cirrhosis ; Lymphoma, Non-Hodgkin* ; Middle Aged ; Stomach Neoplasms*

Tuberculous involvement of the colon is an uncommon clinical entity. Other colonic disease which should be considered in the differential diagnosis include inflammatory bowel disease such as Crohn's disease, ulcerative colitis and colon cancer. Intestinal tuberculosis most frequently involves the ileocecal area. The common presenting symptoms are abdominal pain, fever, weight loss and malabsorption. Pathologically, tuberculous colitis may present as an ulcerative type, hypertrophic type or in combination. Massive bleeding is said to be very rare even in the ulcerative type because of an obliterative endarteritis. We report a case of colonic tuberculosis presenting with massive bleeding in 52-year-old man with alcoholic liver cirrhosis, which was diagnosed by colonoscopic biopsy and acid-fast stain.
Abdominal Pain ; Biopsy ; Colitis ; Colitis, Ulcerative ; Colon* ; Colonic Diseases ; Colonic Neoplasms ; Crohn Disease ; Diagnosis, Differential ; Endarteritis ; Fever ; Hemorrhage* ; Humans ; Inflammatory Bowel Diseases ; Liver Cirrhosis, Alcoholic ; Middle Aged ; Tuberculosis* ; Ulcer ; Weight Loss

Congenital myotonic dystrophy is an almost always maternally-inherited autosomal dominant multisystem disorder of variable clinical expressions characterized by hypotonia and frequent respiratory distress at birth. The muscle weakness may be so severe, it may lead to death in the newborn period. We report a case of congenital myotonic dystrophy in a 34 weeks of gestational age premature infant born to a mother with polyhydramnios, presenting with hypotonia, respiratory insufficiency, feeding difficulties and arthrogryposis. A brief review of literature is given.
Arthrogryposis ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Mothers ; Muscle Hypotonia ; Muscle Weakness ; Myotonic Dystrophy* ; Parturition ; Polyhydramnios ; Respiratory Insufficiency

Congenital myotonic dystrophy is an almost always maternally-inherited autosomal dominant multisystem disorder of variable clinical expressions characterized by hypotonia and frequent respiratory distress at birth. The muscle weakness may be so severe, it may lead to death in the newborn period. We report a case of congenital myotonic dystrophy in a 34 weeks of gestational age premature infant born to a mother with polyhydramnios, presenting with hypotonia, respiratory insufficiency, feeding difficulties and arthrogryposis. A brief review of literature is given.
Arthrogryposis ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Mothers ; Muscle Hypotonia ; Muscle Weakness ; Myotonic Dystrophy* ; Parturition ; Polyhydramnios ; Respiratory Insufficiency

Granular cell tumor(formerly named to be granular cell myoblastoma) was first described by Abrikossoff in 1926 and is a rare tumor thought to be of Schwann cell origin. It can occur at any soft tissue of the body, but most cases are found at the tongue, skin, breast and GI tract. Only 6% of them occur in respiratory system. We report two cases of asymptomatic granular cell tumor of the bronchus that were detected incidentally by bronchoscopy. One patient had aspiration pneumonia, the other had immotile cilia syndrome. The former patient was simply observed and bronchoscopic extirpation of the tumor was done in the latter patient.
Breast ; Bronchi* ; Bronchoscopy* ; Ciliary Motility Disorders ; Gastrointestinal Tract ; Granular Cell Tumor* ; Humans ; Pneumonia, Aspiration ; Respiratory System ; Skin ; Tongue