Sarcomatoid carcinoma of the small intestine is an extremely rare malignant neoplasm that usually has a poor prognosis. We report a case of sarcomatoid carcinoma arising in the small intestine in a 62-year-old man who was hospitalized for abdominal pain. Computed tomography revealed wall thickening of the small intestine. The resected specimen showed a gray-whitish solid mass with hemorrhage and necrosis. Microscopically, the tumor was composed of pleomorphic spindle and discohesive polygonal cells with frequent mitosis. No carcinomatous component was recognized. Immunohistochemistry revealed coexpression of cytokeratin and vimentin by the tumor cells, whereas expressions of C-kit, CD34, HMB-45, smooth muscle actin, and desmin were negative. The diagnosis was sarcomatoid carcinoma of the small intestine.
Abdominal Pain ; Actins ; Desmin ; Hemorrhage ; Humans ; Immunohistochemistry ; Intestine, Small ; Keratins ; Middle Aged ; Mitosis ; Muscle, Smooth ; Necrosis ; Prognosis ; Vimentin

Obesity is a chronic disease with serious health consequences, but weight loss is difficult to maintain through lifestyle intervention alone. Bariatric surgery is considered to be the most effective treatment modality in maintaining long-term weight reduction and improving obesity-related conditions in morbidly obese patients. Since the properly executed pharmacologic treatment is a good option for weight reduction. Surgeons should be aware of the efficacy and side effects of medical treatment.
Bariatric Surgery* ; Chronic Disease ; Humans ; Life Style ; Obesity ; Surgeons ; Weight Loss*

Surgical resection is the best treatment for operable metastatic liver cancer. Large metastatic cancer usually has low operability, so a debulking modality of mass is needed to increase operability. Chemotherapy and radiotherapy were commonly used as neoadjuvant treatments. Cyberknife stereotactic radiosurgery systems were only considered as one of the palliative treatment modalities for inoperable or surgically complex tumors. But, in this case, we applied Cyberknife as the preoperative debulking modality for large hepatic metastasis of adrenocortical carcinoma. After Cyberknife treatment 3 cyclex2,700 cGY, tumor size decreased (metastatic liver mass decreased to 15x9 cm from 19x12.5 cm, adrenal mass decreased to 5x3 cm from 7.4x4.5 cm). We could then resect the tumor completely by extended right hemihepatectomy & right adrenalectomy. A preoperative multidisciplinary approach, including chemotherapy and radiation therapy can be considered to increase operability. So, cyberknife can be considered an additional modality as a neoadjuvant radiotherapy.
Adrenalectomy ; Adrenocortical Carcinoma ; Liver ; Liver Neoplasms ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Palliative Care ; Radiosurgery

No abstract available.
Hemorrhage ; Hernia

PURPOSE: Several reports have suggested that the expressing of COX-2 is related to carcinogenesis and the prognosis of cancer. The aim of this study was to discover the relationship between the prognostic factors of a differentiated thyroid carcinoma (DTC) and the rate of COX-2 expression. METHODS: We performed immunohistochemical staining on well conditioned thyroid cancer paraffin specimens obtained from the patients that had undergone a thyroidectomy at the Department of Surgery, Chungbuk National University Hospital during 1994. The specimens were composed of papillary carcinomas (n=23), follicular carcinomas (n=9) and follicular adenomas (n=4). We analyzed the expressions of COX-2 in relation to age, distant metastasis, invasion to extrathyroidal tissue, mass size and risk group. A statistical analysis was performed using the Chi-square, Fishers Exact, and Mantel- Haenszel Chi-Square tests on the PC SAS system. RESULTS: COX-2 was expressed in 82% of the papillary carcinomas (19/23), 33% of the follicular carcinomas (3/9) and none of the follicular adenomas (0/4). There were no significant differences between the expression of COX-2 in all the items compared (P-value>0.05): i.e. age, distant metastasis, invasion to extrathyroidal tissues, mass size or risk group. CONCLUSION: COX-2 was expressed in 82, and 33% of the papillary and follicular carcinomas, respectively. The papillary carcinomas had a higher rate of expression than the follicular carcinomas, but this was not significantly correlated with the clinical and prognostic parameters. These results suggested that COX-2 might not be a prognostic factor in DTC.
Adenoma ; Carcinogenesis ; Carcinoma, Papillary ; Chungcheongbuk-do ; Cyclooxygenase 2* ; Humans ; Neoplasm Metastasis ; Paraffin ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: To determine the prevalence and characteristics of the hypoechoic halo sign in peripheral cholangiocarcinoma. MATERIALS AND METHODS: Seventeen sonograms of 17 patients with peripheral cholangiocarcinoma histologically proven by either percutaneous needle biopsy (n=16) or surgical biopsy (n=1) were retrospectively reviewed. The size, margin, homogeneity and internal echogenicity of the masses as well as their peritumoral ductal dilatation and intratumoral calcification were ascertained, and the presence of a hypoechoic halo, and if present, its thickness and type, were also determined. We arbitrarily defined a 'thin' and 'thick' halo respectively, as one with a thickness less than of less than 3 mm, and 3 mm or more, and classified halos as 'intratumoral', 'extratumoral', or 'mixed'. RESULTS: Tumor diameter ranged from 4 to 13.5 (mean, 7.3) cm, and the margin was well-defined in 15 cases (smooth: n=2; lobulated: n=13) and irregular in two. Echogenicity was slightly heterogeneous in 11 cases, severely heterogeneous in three, and homogeneous in three, while the central portion was hyperechoic in eight cases, isoechoic in seven, and hypoechoic in only two. A hypoechoic halo was detected in 10 of 15 tumors(67%) with isoechoic centers. In evaluating the halo, two cases in which the mass was hypoechoic were excluded. All ten hypoechoic halos were at least 3 (range, 4-13; mean, 8.3) mm thick; in two cases the presence of a halo was equivocal, and in three there was no halo. Eight of ten halos were the mixed type, two were intratumoral, and none were extratumoral. Peritumoral ductal dilatation was seen in four cases (24%), but no internal calcification was observed. CONCLUSION: US showed that the margins of peripheral cholangiocarcinomas were mostly well-defined and smooth (12%) or lobulated (76%), and that masses were mainly heterogeneous (64%). A hypoechoic halo, which in all cases was thick and in 80% of cases was mixed, was noted in 67% of tumors with a hyper (47%) or isoechoic (41%) center. A halo of this kind may be useful in isoechoic mass detection and also in the differentiation of hyperechoic peripheral cholangiocarcinoma from hepatic hemangioma, the most common hyperechoic benign tumor.
Biopsy ; Biopsy, Needle ; Cholangiocarcinoma* ; Dilatation ; Hemangioma ; Humans ; Prevalence ; Retrospective Studies

Traumatic thyroid hematoma is a rare problem in cases of blunt trauma, but it can be a life-threatening condition. We report here on a case of thyroid hematoma that was complicated with unexpected airway obstruction due to blunt trauma on the anterior neck. A 23-year-old man who developed neck painful swelling and dyspnea was admitted to the emergency room with a blunt neck injury after motor-bicycle accident, and he hit his anterior neck against the handle-bar. He had no previous thyroid pathology and other medical problems. On the initial examination, his vital signs were stable and the oxygen saturation was 97.8%. A computed tomography (CT) scan of the neck showed fragmentation and extensive hematoma within the right thyroid gland and dislocation of the trachea. No definite bleeding focus was identified on the angiography that was done through the carotid artery. Two hours later, the patient experienced sudden respiratory distress and the oxygen saturation dropped rapidly. The patient needed emerg encyendotracheal intubation and surgical intervention. He successfully underwent right lobectomy of the thyroid gland, and was discharged on the 6th hospital day without any complications. The thyroid function was normal after 3 months.
Airway Obstruction* ; Angiography ; Carotid Arteries ; Dislocations ; Dyspnea ; Emergency Service, Hospital ; Hematoma* ; Hemorrhage ; Humans ; Intubation ; Neck ; Neck Injuries ; Neck Pain ; Oxygen ; Pathology ; Thyroid Gland* ; Trachea ; Vital Signs ; Young Adult

OBJECTIVE: To evaluate the usefulness of infrared thermography in the diagnosis of unilateral carpal tunnel syndrome (CTS). METHOD: Thirty six patients confirmed electrodiagnostically as CTS and fifteen adults with normal electrodiagnostic study were included in this study. For the thermographic diagnosis, we measured the skin temperature of the palmar area of all 5 fingers, thenar area, hypothenar area and volar area of forearm bilaterally. We compared the interside peak temperature difference between median nerve innervated area and noninnervated area in three different groups (normal control, mild CTS and moderate to severe CTS groups). RESULTS: Thermography of the CTS patients showed significant temperature differences in more than one area of the median vasomotor nerve territory, and no significant temperature difference in all the areas that were not innervated by the median vasomotor nerve. When we considered interside temperature differences of more than 0.3 degrees C as abnormal findings, the sensitivity of thermography was 2.7% and the specificity was 86.6%. With more than 0.6 degrees C as abnormal, the sensitivity was 25% and the specificity was 66.6%. With more than 1.0 degrees C, the sensitivity was 8.3% and the specificity was 73.3%. There was no significant interside peak temperature difference in all groups. CONCLUSION: This study suggests that infrared thermography has low sensitivity and specificity, which implies that it is not useful for the diagnosis of CTS.
Adult ; Carpal Tunnel Syndrome ; Electrodiagnosis ; Fingers ; Forearm ; Humans ; Median Nerve ; Sensitivity and Specificity ; Skin Temperature ; Thermography

PURPOSE: To evaluate the average ten-year follow-up results of 98 total hip arthroplasties using Harris-Galante-II porous-coated acetabular components. MATERIALS AND METHODS: Ninety-eight hips were evaluated. The mean age of the patients was 45 years, and the mean follow-up was 121 months. The clinical and radiographic findings including the wear of the polyethylene liner were evaluated. The endurance of the acetabular component was analyzed using the Kaplan-Meier method. RESULTS: Retroacetabular osteolysis, dissociation of the PE liner and aseptic loosening of the acetabular component was observed in 25 hips (25.5%), 9 hips (9.2%), and 1 hip (1.0%), respectively. The average rate of liner wear was 0.16 mm/year. Twenty acetabular components (20.4%) were revised, and the survival probability of the acetabular components at 10 years was 87% (95% confidence limits, 83-90%). CONCLUSION: In this long-term follow-up study, the revision rate of Harris-Galante-II acetabular component was relatively high, and was associated with locking mechanism failure and retroacetabular osteolysis. However, the rarity of aseptic loosening suggests that excellent long-term fixation could be achieved with the surface treatment of a fiber-metal porous coating.
Acetabulum* ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Follow-Up Studies* ; Hip ; Humans ; Osteolysis ; Polyethylene

The ingestion of foreign bodies into the gut is rather common. Most these foreign bodies are passed out spontaneously without complications. Our patient was hospitalized for fever, nausea and vomiting for one week. On the initial endoscopic examination, a toothpick was seen to be impacted in the wall of the duodenal bulb. Air bubbles were noted at the site where the toothpick was removed. The duodenal perforation was treated with endoscopic hemoclipping. Abdominal CT showed free air in the periduodenum and there was a liver abscess. Therefore, liver abscess associated with duodenal perforation by the toothpick was diagnosed. On the cytology of the aspirated materials from the liver abscess, sulfur granule formation was noted and hepatic actinomycosis was diagnosed. The liver abscess was successfully treated with CT-guided abscess drainage and antibiotics. We report here on an unusual case of a liver abscess associated with duodenal perforation by a toothpick, along with a review of the literature.
Abscess ; Actinomycosis ; Anti-Bacterial Agents ; Drainage ; Eating ; Fever ; Foreign Bodies ; Humans ; Liver ; Liver Abscess ; Nausea ; Sulfur ; Vomiting