Melanoma is a malignant neoplasm of melanocytes most frequently arising from the skin, but primary melanoma can also arise from the mucosa of the gastrointestinal tract. Gastrointestinal melanomas are most commonly metastases from a cutaneous melanoma. Primary melanoma of the stomach is rare and carries a poor prognosis. Reported here is the case of a 75-year-old man with a primary gastric melanoma who presented with a melena, abdominal pain, and weight loss. Most cases of melanoma are treated by excision of the primary tumor. Patients with melanoma have been treated with adjuvant chemotherapy, radiation therapy, and immunotherapy. None of these modalities has been demonstrated to prolong the survival rate. To improve long-term disease-free survival, early diagnosis and surgical intervention are very important.
Abdominal Pain ; Aged ; Cardia* ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Early Diagnosis ; Gastrointestinal Tract ; Humans ; Immunotherapy ; Melanocytes ; Melanoma* ; Melena ; Mucous Membrane ; Neoplasm Metastasis ; Prognosis ; Skin ; Stomach* ; Survival Rate ; Weight Loss

A benign cecal ulcer is an uncommon lesion. The etiology remains unknown, and there are no pathognomonic lesions or symptoms. Lower gastrointestinal tract hemorrhage secondary to benign cecal ulcer is the most common complication. Herein, the case of a 24-year-old man with a benign cecal ulcer presenting with a massive lower gastrointestinal tract hemorrhage requiring transfusion until a exploratory laparotomy and right hemicolectomy, is reported with a review of the literature. Surgical intervention is warranted if malignancy is suspected or if the patient has signs of uncontrollable hemorrhage, perforation, or peritonitis.
Hemorrhage* ; Humans ; Laparotomy ; Lower Gastrointestinal Tract* ; Peritonitis ; Ulcer* ; Young Adult

PURPOSE: The number of resected lymph nodes can influence the current N staging. This study examined the significance of the metastatic lymph node ratio on the survival of patients with pT2 gastric cancer. METHODS: The records of 176 patients who had undergone curative gastrectomy and diagnosed with pT2 gastric cancer by pathology, between February 1990 and October 2002 were retrospectively reviewed. Those patients with other organ metastases or those who had undergone a dissection of less than 15 lymph nodes were excluded. The clinicopathologic prognostic variables were evaluated using the SPSS statistical program. RESULTS: There were 115 men and 61 women with a mean age of 59 years. The median survival period was 93 months (2~184 months). Metastatic lymph nodes were found in 100 cases (56.8%), a mean of 34.6 lymph nodes were dissected, a mean of 3.2 lymph nodes metastasized, and a mean metastatic lymph node ratio of 0.09 was found. According to the UICC TNM classification, the number of stage IB (N0) cases was 76 (43.2%), stage II (N1) was 74 (42.0%), stage IIIA (N2) was 18 (10.2%), and stage IV (N3) was 8 (4.5%). The overall 5-year survival rate was 75.2%. According to the UICC TNM classification, the 5-year survival rate was stage IB, II, IIIA, and IV was 88.6%, 74.3%, 39.5%, and 33.3%, respectively. The metastatic lymph node ratio (nR) was divided into 4 categories; nR0 (76) = 0, 0 Classification ; Female ; Gastrectomy ; Humans ; Lymph Nodes* ; Male ; Neoplasm Metastasis ; Pathology ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate*

We had experienced 2 cases of acute phlegmonous gastritis confirmed by endoscopy, microbiological study and surgical pathologic findings. The first was a 61- year-old female who had been diagnosed as the communicating hydrocephalus and the other was a healthy 60-year-old female. Enterococcus fecalis & Klebsiella pneumoniae, Enterococcus fecalis & E.coli were cultured from the gastric tissue and juice obtained by endoscopy in each patient. In both patients, endoscopic findings showed numerous large ulcers and edema with necrotic material and exudate over the whole stomach. Operation findings were markedly edematous and overall ulcerative mucosa in one patient, and hyperemic outlet stricture in the other. Pathologic findings were acute necrotizing inflammation, involving the mucosa and submucosal layer, consistent with acute phlegmonous gastritis. After operation and antibiotics therapy, the patients were rapidly improved. We reported 2 cases of acute phlegmonous gastritis with the review of literature.
Anti-Bacterial Agents ; Cellulitis* ; Constriction, Pathologic ; Edema ; Endoscopy ; Enterococcus ; Exudates and Transudates ; Female ; Gastritis* ; Humans ; Hydrocephalus ; Inflammation ; Klebsiella pneumoniae ; Middle Aged ; Mucous Membrane ; Stomach ; Ulcer

The frequencies of multiple synchronous carcinomas of the colon and the rectum have been reported to range from 2.1 to 6.3%. Currently, the frequency is higher in colorectal cancer patients, and the diagnosis is better due to the many diagnostic tools that have been developed. There are a few reported cases of five cancers in a patient at the same time. We report here on the case of five synchronous cancers arising from the colon and the rectum in a patient without a familial history of colon cancer or of genetic predisposing factor. The patient was a 62-yr-old woman who presented with frequently loose stool for six months and intermittent abdominal pain for two months. Colonoscopic examination revealed two adenocarcinomas, one each at the sigmoid colon and the rectum; the cancer in the sigmoid colon was obstructed at nearly 40 cm above the anal verge. Computed tomographic colonoscopy revealed many other polyps and masses in the colon and a metastatic mass at segment 8 in the liver. A total proctocolectomy and ileostomy were performed. Histologic evaluation revealed the five lesions to be adenocarcinomas invading the pericolic fat; 1 out of 30 lymph nodes was invaded by the cancer cells.
Abdominal Pain ; Adenocarcinoma ; Colon ; Colon, Sigmoid ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Female ; Humans ; Ileostomy ; Liver ; Lymph Nodes ; Polyps ; Rectum

PURPOSE: Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) for the treatment of gallbladder disease. However certain cases still require conversion to open procedures. Identifying these patients at the risk of conversion remains difficult. This study evaluated risk factors that may predict conversion from a laparoscopic to an open procedure. METHODS: From January 1994 to December 2004, a total of 582 laparoscopic cholecystectomies were performed at Seoul Medical Center. A retrospective analyses of clinical parameters including patient demographics, clinical histories, laboratory data, ultrasound results, intraoperative details and postoperative pathologic findings were performed. RESULTS: A total of 30 patients (5.2%) had their cholecystectomies converted to an open procedure. Causes for conversion were inability to correctly identify the anatomy of surgical field due to adhesion and inflammation (56.7%), bile duct injury (13.3%), bleeding (13.3%) and others (16.7%). Univariate analysis showed that ASA (the classification of American Society of Anesthesiologists, p = 0.034), previous abdominal operation history (p = 0.008), RUQ tenderness(right upper quadrant tenderness, p = 0.002), acute cholecystitis (p < 0.001) and time elapsing between diagnosis and operation (p = 0.013) to be risk factors. Multivariate analysis revealed that acute cholecystitis (4.2 greater odds ratio [OR] of conversion, p = 0.002) and previous abdominal operation history (3.6 greater odds ratio [OR] of conversion, p = 0.003) were positive independent predictive factors for conversion to open cholecystectomy. CONCLUSION: Although laparoscopic cholecystectomy is a safe and beneficial procedure in the management of patients with gallbladder disease, there are still many chances of conversion of laparoscopic to open cholecystectomy. In this study, patients with acute cholecystitis and previous abdominal operation histories were more likely to require conversion to an open procedure. These two positive independent predictive factors can help operators to make early decision and to counsel patients undergoing laparoscopic cholecystectomy with regards to the posibility of conversion to an open procedure.
Bile Ducts ; Cholecystectomy* ; Cholecystectomy, Laparoscopic ; Cholecystitis, Acute ; Classification ; Conversion to Open Surgery ; Demography ; Diagnosis ; Gallbladder Diseases ; Hemorrhage ; Humans ; Inflammation ; Multivariate Analysis ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Seoul ; Ultrasonography

PURPOSE: Fitz-Hugh-Curtis (FHC) syndrome has been described as perihepatitis associated with pelvic inflammatory disease during surgery. Recently, on computerized tomography a linear enhancement of the liver capsule was detected in a patient with FHC syndrome. We studied to evaluate the clinical course of the disease. METHODS: Sixteen patients diagnosed with FHC syndrome from CT findings were retrospectively studied from April, 2006 to June, 2008. RESULTS: The mean age of the patients was 25.9 (19~35) years and mean duration of abdominal pain was 3.9 (1~14) days. The most common complaint was right upper quadrant area pain (11 cases, 68.8%). 12 patients showed leukocytosis and all the patients had elevated serum C-reative protein levels. All the patients had normal liver function. Among the 9 patients which had polymerase chain reaction test for sexually transmitted disease (Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrheae, Mycoplasma hominis), all showed more than one positive results (Chlamydia trachomatis 6 cases, Ureaplasma urealyticum 6 cases, Mycoplasma hominis 2 cases). On simple abdomen X-ray, 7 cases (43.8%) showed paralytic ileus. 14 cases received only antibiotic treatment, but 1 case had to take operation (laparoscopic-assisted adhesiolysis) due to constant abdominal pain and prolonged ileus. CONCLUSION: It is important to rule out FHC syndrome by using CT findings, especially young women with right upper abdominal pain and PID. Usually, FHC syndrome can be treated easily with proper antibiotics.
Abdomen ; Abdominal Pain ; Anti-Bacterial Agents ; Chlamydia Infections ; Female ; Gonorrhea ; Hepatitis ; Humans ; Ileus ; Intestinal Pseudo-Obstruction ; Leukocytosis ; Liver ; Mycoplasma ; Mycoplasma hominis ; Neisseria ; Pelvic Inflammatory Disease ; Peritonitis ; Polymerase Chain Reaction ; Retrospective Studies ; Sexually Transmitted Diseases ; Ureaplasma urealyticum

OBJECTIVE: Screw fixation via the paraspinal muscle sparing approach and by percutaneous screw fixation are known to diminish the risk of complications, such as, iatrogenic muscle injury as compared with the conventional midline approach. The purpose of this study was to evaluate tissue injury markers after these less traumatic screw fixation techniques for the treatment of L4-L5 spondylolisthesis. METHODS: Twenty-two patients scheduled for posterior lumbar interbody fusion (PLIF) at the L4-L5 segment for spondylolisthesis were prospectively studied. Patients were divided into two groups by screw fixation technique (Group I: paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Levels of serum enzymes representing muscle injury (CK-MM and Troponin C type 2 fast), pro-inflammatory cytokine (IL-8), and anti-inflammatory cytokine (IL-1ra) were analyzed using ELISA techniques on the day of the surgery and 1, 3, and 7 days after the surgery. RESULTS: Serum CK-MM, Troponic C type 2 fast (TNNC2), and IL-1ra levels were significantly elevated in Group I on postoperative day 1 and 3, and returned to preoperative levels on postoperative day 7. No significant intergroup difference was found between IL-8 levels despite higher concentrations in Group I on postoperative day 1 and 3. CONCLUSION: This study shows that percutaneous screw fixation procedure is the preferable minimally invasive technique in terms of minimizing muscle injury associated with L4-L5 spondylolisthesis.
Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin 1 Receptor Antagonist Protein ; Interleukin-8 ; Muscles ; Prospective Studies ; Spondylolisthesis ; Troponin C

PURPOSE: To evaluate the relative value of arterial, portal and delayed phase images in the measurement of hepatic metastatic mass arising from gastrointestinal malignant tumor using spiral CT. MATERIALS AND METHODS: Thirty-three with 45 metastatic tumors of the liver underwent tri-phasic spiral CT. For this purpose one or two lesions were chosen in each patient whose primary tumor was shown to be stomach cancer(n=15), colon cancer(n=16), or ileal cancer(n=1). Tumor size ranged from 1 to 12.2 (mean, 4.3)cm. Arterial, portal and delayed phase images were obtained at 30 -35 seconds, 70 -75 seconds, and 3 minutes, respectively, after the injection of contrast materials. Using a work station, two radiologists independently measured the longest diameter of the selected lesions, and a second measurement was taken three days later. Contrast, as well as intra-and interbserver differences among the three phases, was statistically analysed. RESULTS: Intra- and interobserver difference were, espectively, 2.3 and 3.8 mm during the portal phase; 3.3 and 4.6 mm during the arterial phase; and 2.9 and 4.5 mm during the delayed phase. ANOVA with Tukey's multiple comparison showed that none of these differences were statistically significant. Contrast between mass and liver parenchyma was especially clear during the portal phase (p=0.0001, using the Kruskal-Wallis CONCLUSION: Intra- and interobserver differences in the measurement of hepatic metastatic tumors were statistically insignificant during all three phases. The least difference and best contrast were seen during the portal phase.
Colon ; Contrast Media ; Humans ; Liver ; Stomach ; Tomography, Spiral Computed*

PURPOSE: We performed this study to assess the suitability of conventional angiography (CA) vs. multi-detector row helical CT angiogram (MD-CTA) as a method of preoperative diagnostic imaging for low extremity arterial surgery. METHODS: From February 2004 to September 2006, 23 patients (4 claudicants, 19 limb-threatening ischemia) were studied with CA and MD-CTA preoperatively. The site and degree of stenotic or occlusive lesions in arterial segments from the renal artery to the dorsalis pedis artery were compared with both methods. We also compared the surgical inflow and outflow site changes in preoperative planning based on CA and MD-CTA and the final outcome. Additional diagnostic value and test-related complications were also analyzed. RESULTS: The median age of patients was 68 years old (range: 43~89 years), with a male to female ratio of 1.3:1. Twenty-three patients had CA after an MD-CTA scan. One hundred fifty lesions were detected in these patients. The total ratio of consistency for occlusion in CA vs. MD-CTA was 69.6%. Three patients received amputation treatment and eleven patients received a bypass operation. The agreement between the preoperative plan based on MD-CTA and the final operation was 100%, even in critical limb ischemia. There were no serious complications related to the tests. CONCLUSION: These findings suggest that MD-CTA is an adequate preoperative imaging study of infrainguinal arterial surgery and may be substituted for conventional angiography without any serious complications.
Amputation ; Angiography ; Arteries ; Diagnostic Imaging ; Extremities ; Female ; Humans ; Ischemia ; Male ; Renal Artery ; Tomography, Spiral Computed