The adenocarcinoma of appendix and fallopian tube are both very rare. The incidence rate for fallopian tube is less than 1% of all genital malignancies. Fallopian tubes have been very rarely associated with synchronous tumorigenesis, and to the authors knowledge, the combination of mucinous adenocarcinoma of appendix has never been previously reported. The authors experienced a extremely rare case of synchronous adenocarcinoma of appendix and fallopian tube in 56 years old female patient who has suffered for 10days from RLQ abdominal pain. Pathologic examination of the resected specimen revealed a synchronous mucinous type adenocarcinoma of vermiform appendix and fallopian tube.
Abdominal Pain ; Adenocarcinoma* ; Adenocarcinoma, Mucinous ; Appendiceal Neoplasms ; Appendix* ; Carcinogenesis ; Fallopian Tube Neoplasms ; Fallopian Tubes* ; Female ; Humans ; Incidence ; Middle Aged ; Mucins

PURPOSE: Numerous methods exist for diagnosing nonpalpable testis in treatment of cryptochidism. However, there is no clinically established data for the rational diagnostic tool of nonpalpable testis in terms of expenses. We tried to establish a current conventional diagnostic course of nonpalpable testis. We then evaluated the efficacy of ultrasonography, physical examination under general anesthesia and laparoscopy for diagnosing nonpalpable testis. METHODS: Between March 2000 and February 2005, 103 boys(129 testes) with undescended testes were treated in our department. There were 31 testes(24.0%) that were not palpable at physical examination. These patients were evaluated with ultrasonography and repeated physical examination under general anesthesia. In the cases where testes could not be detected with ultrasonography and physical examination under general anesthesia, laparoscopy was performed to diagnose nonpalpable testis. RESULTS: In 31 cases of nonpalpable testis, 13 testes were detected with ultrasonography and 15 testes became palpable with physical examination under general anesthesia. All of the remaining 16 nonpalpable testes were confirmed with laparoscopy. CONCLUSION: Physical examination under general anesthesia was superior to ultrasonography in making a diagnosis of nonpalpable testis. Ultrasonography and physical examination under general anesthesia could reduce the incidence of diagnostic laparoscopy. Therefore, it is recommended that ultrasonography, physical examination under general anesthesia and laparoscopy must be performed conventionally in order to diagnose nonpalpable testis.
Anesthesia, General ; Child* ; Cryptorchidism* ; Diagnosis ; Humans ; Incidence ; Laparoscopy ; Male ; Physical Examination ; Testis ; Ultrasonography

BACKGROUND: Valve replacement in children has many problems such as the durability of prosthetic valve, thomboembolism and hemorrhage. But recently, the necessity of valve replacement in children increased and the above problems were solved party. So the number of valve replacement in children increased progressively. RESULTS: Valve replacement in 47 children were done at Seooul National University Chidren's Hospital from March 1986 to July 1991. The patients were composed of 25 males and 33 females. 25 patients had congenital heart disease and 22 patients rheumatic heart disease. 45 patients received single valve repalcement, 2 patients double valve repalcement, and among all of them, 2 patients redo-replacement. The major valve lesion was mitral insufficiency and post-operative status in view of NYHA functinonal class was improved in most patients. The mechanical valves were applied to 45 patients and tissue valves to 2 patients. The indication of valve replacement were progressive increase in ventricular volume, major regurgitant fraction over grade III decrease in exercise tolerance and vegetation. The overall early mortality was 8.5% and late mortality 0%. There were post-operative complication rate of 30% and late complication rate 14%, and among the later, valve faliure was reported in 2 pantients and thromboembolism in 1 patient. The complication-free rate was 97.7% at post-operative 1 month, 91.3% at 12 months, 90% at 36 months and 60% at 48 months. 43 patients received anticoagulation and/or antiplatelet therapy, but there was no critical indication for this. CONCLUSION: These results suggest that cardiac valve replacement in children have been effective therapeutic modality even though various problems still remain, but we propose that sufficient long-term follow-up and clinical research be needed.
Child* ; Exercise Tolerance ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Valves* ; Hemorrhage ; Humans ; Male ; Mitral Valve Insufficiency ; Mortality ; Rheumatic Heart Disease ; Thromboembolism

BACKGROUND: Adenocarcinoma arising in the body or tail of the pancreas tends to be metastasized at the time of diagnosis, is mostly in inoperable stage, and poor in prognosis. In this study, we evaluated the adenocarcinoma arising in the body or tail of the pancreas and investigated the prognostic factors and ideal treatment. MATERIAL AND METHODS: We retrospectively analyzed 33 patients who were cytologically or histologically confirmed as adenocarcinoma in the body or tail of the pancreas at Samsung Medical Center from October 1994 to December 1999. RESULTS: The mean age of the patients in the resectable and unresectable groups were 63.4 and 60.6 year-old, respectively. The mean CA19-9 level was higher in unresectable group (5166.2u/ml), compared to the resectable group (964.7u/ml).(p=0.039) In the resectable group, the body was the most common location of the tumor, and in the unresectable patient group, the tail was more prevalent.(p= 0.021) The mean survival time of the resectable group was 15.1months. The univariate analysis of the resectale group showed that the age, sex, lymph node metastasis, chemotheraeutic modalities, radiotherapeutic modalities, and the location of tumor were not significantly related with the prognosis. In unresetable group, the mean survival time was 6.4months. The mean survival time were 3.3 months in patients over 60 year-old and 9.9 months in patients less than 60, showing statistically significant difference.( p=0.007) The mean survival time were 12.2 months and 3.4 months in patients who received the chemotherapy and who did not, respetively.(p=0.004) Evaluating the relationship between the extent of metastasis and survival, the mean survival length of single metastasis was 9.3 months, showing significantly higher survival length compared that of multiple metastasis.(p=0.027) Patient's sex, radiotherapeutic modality and location of the tumor were not significantly related with the prognosis. Multivariate analysis of prognostic factor showed that the patietnt's age (p=0,842), the extent of metastasis( p=0.458), and chemotherapeutic modality (p=0.078) were unrelated with prognosis. CONCLUSION: In adenocarcinoma arising in the body and tail of the pancreas, the CA19-9 level and tumor location could be utilized as indicating factors of the operability of the tumor. Age, sex, lymph node metastasis, and location of the adenocarcinoma are not significantly related with the survival length in both the resectable and unresectable groups. Also, in both groups, the chemotherapeutic and radiotherapeutic modalities were not related with the survival length.
Adenocarcinoma* ; Diagnosis ; Drug Therapy ; Humans ; Lymph Nodes ; Middle Aged ; Multivariate Analysis ; Neoplasm Metastasis ; Pancreas ; Prognosis* ; Retrospective Studies ; Survival Rate

No abstract available.
Lithotripsy* ; Shock* ; Ureter*

A 70-year old man presented with postprandial upper abdominal pain of two months duration, accompanied by indigestion, weight loss, and anorexia. There was no abnormality noted in the lab results. Abdominal CT showed a 3-cm round cystic mass in the tail of the pancreas. A distal pancreatectomy was done. The patient was discharged in 9 days. The cystic wall was composed of a keratinizing squamous epithelium surrounded by subepithelial, dense lymphoid tissue. Some clusters of the sebaceous gland were noted but there was no sweat gland or hair follicle. These findings were consistent with a lymphoepiethelial cyst with sebaceous differentiation. The patient was followed up for 12 months post operatively, and no recurrence was noted.
Abdominal Pain ; Aged ; Anorexia ; Dermoid Cyst* ; Dyspepsia ; Epithelium ; Hair Follicle ; Humans ; Lymphoid Tissue ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Recurrence ; Sebaceous Glands ; Sweat Glands ; Tomography, X-Ray Computed ; Weight Loss

A 70-year old man presented with postprandial upper abdominal pain of two months duration, accompanied by indigestion, weight loss, and anorexia. There was no abnormality noted in the lab results. Abdominal CT showed a 3-cm round cystic mass in the tail of the pancreas. A distal pancreatectomy was done. The patient was discharged in 9 days. The cystic wall was composed of a keratinizing squamous epithelium surrounded by subepithelial, dense lymphoid tissue. Some clusters of the sebaceous gland were noted but there was no sweat gland or hair follicle. These findings were consistent with a lymphoepiethelial cyst with sebaceous differentiation. The patient was followed up for 12 months post operatively, and no recurrence was noted.
Abdominal Pain ; Aged ; Anorexia ; Dermoid Cyst* ; Dyspepsia ; Epithelium ; Hair Follicle ; Humans ; Lymphoid Tissue ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Recurrence ; Sebaceous Glands ; Sweat Glands ; Tomography, X-Ray Computed ; Weight Loss

Mature cystic teratomas of the ovary are one of the most common ovarian neoplasms found in reproductive age women. Malignant transformation is an uncommon complication in a mature cystic teratoma of the ovary, usually being reported in about 1-3% of cases. Of malignant transformations, squamous cell carcimona is the most common type and sarcomatous transformation is rare, its prognosis is poor. Adenocarcinoma occurs with less frequency. We experienced a case of squamous cell carcinoma and adenocarcinoma arising in mature cystic teratoma of the ovary, so we present this case with brief review of the literature.
Adenocarcinoma* ; Carcinoma, Squamous Cell* ; Female ; Humans ; Ovarian Neoplasms ; Ovary* ; Prognosis ; Teratoma*

PURPOSE: To identify the characteristic ultrasonographic findings of the normal appendix in children in order to detect it more easily and so to exclude acute appendicitis from a diagnosis with more confidence. MATERIALS AND METHODS: Among 64 patients presenting with right lower quadrant pain, 44 patients, excluding 15 patients diagnosed as acute appendicitis and 5 patients with non-visualization of the appendix due to severe ileus and obesity, were evaluated for the point of incidence, the thickness and the presence of folding of the inner hypoechoic band of the normal appendix. The age of the patients ranged from 3 to 15 years with a mean age of 6.5 years. Two patients were operated on and we correlated the preoperative ultrasonographic findings with the histologic findings. RESULTS: In all the cases of the 44 patients with normal appendix, the inner hypoechoic band was discovered, which was seen as a linear structure without folding along the whole length of appendix. This measured as 0.75 mm (0.3-1.5 mm) for the mean thickness. The inner hypoechoic band corresponded to the mucosal layer that had abundant lymphoid tissue on the histologic examination. CONCLUSION:For the pediatric normal appendix, the inner hypoechoic band without folding is present, and this corresponds to the mucosal layer with abundant lymphoid tissue.
Appendicitis ; Appendix* ; Child* ; Diagnosis ; Humans ; Ileus ; Incidence ; Lymphoid Tissue ; Obesity ; Ultrasonography*

PURPOSE: Midurethral sling procedure has become one of the most commonly performed procedures for the treatment of female stress urinary incontinence(SUI). Although complication rate is very low, some patients are required further treatment to correct unwanted problems after surgery as it continues to be more widely used. We evaluated the mesh-related complications in those who required further procedures after midurethral sling procedures. MATERIALS AND METHODS: From January 2000 to December 2005, female patients who underwent additional surgery because of complications after midurethral sling procedures for stress urinary incontinence were evaluated in this study. RESULTS: In 675 patients, 298 received a tension-free vaginal tape(TVT) and 377 received a Monarc(transobturator route, TOT) as a sling material at 3 different hospitals. 34(5.0%) out of 675 patients required additional surgery to correct complications including obstructive voiding symptoms, mesh extrusion, failed or recurred SUI, wound pain and mesh in the bladder. Mean age of 34 patients was 54.7, and TVT was used in 21(7.0%) out of 298 patients, Monarc was used in 12(3.4%) out of 377 as midurethral sling materials. In 19 patients who showed obstructive voiding symptoms, all were cured by mesh cutting and in 8 patients who complained of immediate recurrence of SUI, 7 showed complete dryness by shortening the loosen mesh. Mesh extrusion with vaginal erosion were observed in 3 and all were cured by segmental resection of mesh without recurrence of SUI. 2 patients who showed recurrence of SUI after 2 years of TVT received Monarc procedure. Mesh in the bladder which was found after 6 months of TVT was managed by endoscopic resection of mesh with Monarc procedure in 1, and suprapubic pain after TVT was improved by resection of TVT segment through suprapubic incision in 1. All reoperation procedures were performed by local anesthesia except 1(mesh in the bladder). CONCLUSION: These data demonstrate that midurethral sling is an excellent surgical procedure with low complication rate, high success rate in reoperation. However, care must be taken to reduce reoperation rate in applying tension of mesh on urethra because most patients(27 out of 34) who required reoperation have complained of obstructive voiding symptoms(19) and persistent incontinence(8).
Anesthesia, Local ; Female* ; Humans ; Recurrence ; Reoperation* ; Suburethral Slings* ; Urethra ; Urinary Bladder ; Urinary Incontinence* ; Wounds and Injuries