Leiomyosarcomas of the stomach are unusual tumors, accounting for 1% to 3% of all malignant tumors and 17% to 20% of all smooth muscle tumors of the stomach. It is difficult to diagnosis these tumors preoperatively because of its vague symptoms and signs or producing symptoms only late. Despite their rarity and difficulty in diagnosis, thier diagnosis is important due to more favorable prognosis aasociated with these tumors than that of gastric carcinoma. Recently, endoscopy is being used with increasing frequency, but because these are submucosal lesions the diagnosis of thease tumors cannot be easily made through the endoscope. We experienced a case of relatively full-brown leiomyosarcoma in gastric fundus. Endoscopy showed 6x6cm sized, definite margined, protruding mass on gastric fundus, with central deep ulceration coated with blood clots. The mucosa overlying the mass was intact, smoothly effaced and the bridging fold was also visible. Postoperative ultrasound showed large protruding mixed echogenic solid mass with contral deep excavation due to ulcer, and intact serosa, so suggestive of endogastric tumor. We believed endoscopy combined with endoscopic ultrasound is probably useful method in early diagnosis of gastric submucosal tumors, especially exogastric type or early small tumors
Camellia ; Diagnosis ; Early Diagnosis ; Endoscopes ; Endoscopy ; Gastric Fundus ; Leiomyosarcoma* ; Mucous Membrane ; Prognosis ; Serous Membrane ; Smooth Muscle Tumor ; Stomach* ; Ulcer ; Ultrasonography

Gastational choriocarcinoma is a malignant neoplasm of trophoblast. It may occur after hydatidiform mole, spontaneous abortion, normal pregnancy, and even an ectopic pregnancy. Extragenital choriocarcinoma is a rare tumor which attracts interest because of its controversial pathogenesis. It has been reported to occur within the lung, mediastinum, breast, prostate, thymus, pineal, nose, liver, bladder, and biliary tree, as well as most parts of the gastrointestinal tract. We experienced a case of primary choriocarcinoma of stomach with a metastasis to the liver of a 54-year-old man. So, we present a case with a review of literature.
Abortion, Spontaneous ; Biliary Tract ; Breast ; Choriocarcinoma* ; Female ; Gastrointestinal Tract ; Humans ; Hydatidiform Mole ; Liver ; Lung ; Mediastinum ; Middle Aged ; Neoplasm Metastasis ; Nose ; Pregnancy ; Pregnancy, Ectopic ; Prostate ; Stomach ; Thymus Gland ; Trophoblasts ; Urinary Bladder

BACKGROUND: The expansion and strengthening of primary care is approved as the only method to revise the ineffective health care system in Korea. In such a system, we intended to analyze the functional and regianal distribution of specialists by investigating and classifying the hospitals where residents who completed their training in a university hospital located in Seoul for seven years are working and by acquiring the distribution of the subjects who are practicing as primary care physicians by year, specialties and location. METHODS: We selected 384 specialists, all of whom were trained as residents at a university hospital located in Seoul from 1987 to 1993. The hospitals they worked at were classified as primary, secondary and tertiary care hospitals according to the classification in the health care administration. The location of primary care hcspitals among them was plotted an two maps; one of Seoul, the other of Korea. RESULTS: The number of females in the subjects was 68(17.7%) and that of males 316(82.3%). The number of practitianers was 156(40.6%) and that of specialists working at the secondary care hospitals was 55(14.3%), and 147 specialists were working at the tertiary care hospitals(38.3%). With regard to the pereentage of practitioners, dermatologic specialists presented with 60%, and relatively high group included obstetrics and gynecology(59.2%), family medicine(54.5%), plastic surgery(52.6%), otolaryngology (52.0%), pediatrics(51.7%), and orthopedics(48.6%).In tertiary care hospital, chest surgery showed 72.7% as highest. Radiologic ancology presented with 66.7% and anatamical pathology with 66.7%. As to the location of primary care hospitals, 41.0% were in Seoul and 38.5% in Kyungkido. And the rest of the 20. 5% were located in other areas of Korea. CONCLUSIONS: Considering the results of the study that show a great number of specialists are actually practicing as primary care physicians after their specialists training, the present training system of specialists needs to be revised and cantrolled in structure.
Classification ; Delivery of Health Care ; Female ; Gyeonggi-do ; Humans ; Korea ; Male ; Obstetrics ; Otolaryngology ; Pathology ; Physicians, Primary Care ; Primary Health Care ; Secondary Care ; Seoul ; Specialization ; Tertiary Healthcare ; Thorax

Trichuriasis is an intestinal infection of human beings caused by Trichuris trichiura, more commonly known as whipworm because of its whip-like appearance. It is characterized by the invasion of the colonic mucosa by the adult trichuris. It is prevalent throughout the world, especially in tropical areas. Diagnosis is made typically by the identification of characteristic barrel-shaped eggs in the feces, although adult worms may be seen rarely at sigmoidoscopy or colonoscopy. We report five cases of whipworm infection that was diagnosed on colonoscopic examination.
Adult ; Colon ; Colonoscopy ; Diagnosis* ; Eggs ; Feces ; Humans ; Mucous Membrane ; Ovum ; Sigmoidoscopy ; Trichuriasis ; Trichuris

Perforation of gallbladder is a serious complication of acute cholecystitis with alarmingly high mortality rate. These high mortality and morbidity rates were caused by delay in prompt diagnosis and adequate therapy. Especially, mortality and morbidity rates rise markedly in the elderly patient with severe systemic illness. In the patients of gallbladder perforation who are poor candidate for general anesthesia and major operation, percutaneous cholecystic drainage procedure is good alternatives. We experienced a case of gallbladder perforation which was treated successfully by non-operative percutaneous transhepatic cholecystic drainage(PTCCD) in 65-year-old female. She couldn't be a candidate for cholecystectomy or operative chlecystostomy because of severe adhesion of gallbladder to adjacent organ and tissue due to previous gallbladder empyema. We decided to take non-operative percutaneous transhepatic cholecystic drainage and percutaneous peritoneal drainage of abdominal abscess. Thereafter, we examined gallbladder by percutaneous transhepatic cholecystoscopylPTCCS)and rule out gallstone and gallbladder malignancy. So, we presented the case with the brief review of the literatures.
Abdominal Abscess ; Aged ; Anesthesia, General ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Diagnosis ; Drainage* ; Female ; Gallbladder* ; Gallstones ; Humans ; Mortality

No abstract available.
Angioplasty* ; Budd-Chiari Syndrome* ; Heart Ventricles* ; Stents*

We report our experience in five patients with malignant obstructive jaundice with a new self expandable metallic stent, a coil spring made from nickel-titanium alloy. Endoscopic biliary drainage(EBD) is a safe and effective noninvasive biliary drainage method and is indicated with malignant obstructive jaundice. In order to avoid being limited by the size of the instrumentation channel of the endoscope, expandable stents have been developed. The main problems with these expandable metal stents are tumor ingrowth leading to reobstruction, migration of the stent from its original position, and epithelial trauma by the distal hard edges of the stent. The new super-elastic metallic coil stent which has a very strong radial force (EndoCoil'" stent, Instent Co.) was developed to solve the above mentioned problems. The stent which is constricted over an introducing catheter is inserted by transduodenal approach. It expands spontaneously after release to its original 8 mm diameter. During the last 6.5 rnonths, 5 stents were inserted in patients with cholangiocarcinoma, pancreatic carcinoma and cancer of the ampulla of Vater to releave jaundice. Clinical improvement was achieved in all the patients except in one who died from multiple organ metastasis. After a mean follow-up of 6 month., patients had no evidence of biliary reobstruction. Although follow-up is short, these results are encouraging, and this new metallic stent seems to have several advantages over the current commercially available ones.
Alloys ; Ampulla of Vater ; Catheters ; Cholangiocarcinoma ; Drainage ; Endoscopes ; Follow-Up Studies ; Humans ; Jaundice ; Jaundice, Obstructive* ; Neoplasm Metastasis ; Stents*

No abstract available.
Immunoblastic Lymphadenopathy*

Subungual metastasis resulting from internal malignancies is an extremely rare event. A few cases of subungual metastasis from lung cancer have been reported. However, subungual metastasis arising from lung cancer without any other form of distant metastases has not been reported. The misdiagnosis of a solitary subungual metastases as a benign inflammatory lesion is an important problem as it may cause the misdiagnosis of a lower stage of lung cancer. We may be reporting the first case of a subungual metastasis from lung cancer without any other distant metastases.
Carcinoma, Squamous Cell/secondary* ; Carcinoma, Squamous Cell/radiography ; Carcinoma, Squamous Cell/pathology ; Case Report ; Human ; Lung Neoplasms/radiography ; Lung Neoplasms/pathology* ; Male ; Middle Age ; Nails*/pathology ; Radiography, Thoracic ; Skin Neoplasms/secondary* ; Skin Neoplasms/pathology ; Tomography, X-Ray Computed

OBJECTIVE: To Investigate the expression of vascular endothelial growth factor receptor-1, -2, and -3 (VEGFR-1, -2, and -3) mRNA in the eutopic and ectopic tissues in women with endometriosis. METHODS: At the time of laparoscopy or laparotomy for endometriosis, infertility or other benign gynecologic conditions, a biopsy specimen was taken from the endometrial cavity and a peritoneal endometriotic implant simultaneously whenever appropriate. For control samples, endometrial tissues were obtained from women without visual evidence of endomtriosis. We employed real time quantitative RT-PCR to quantify VEGFR gene expression of these tissues. Comparisions between each group were made using ANOVA (analysis of variance) and Kruskal-Wallis test and statistical significance was defined as p<0.05. RESULTS: The expression of VEGFR-1, -2, and, -3 mRNA was significantly higher in both eutopic and ectopic endometrial tissues of women with endometriosis than in control endometrial tissues during both proliferative and mid-secretory phase. In ectopic endometrial tissue, VEGFR-1 mRNA expression was significantly increased during the mid-secretory phase compared to the proliferative phase. There was a marked increase especially in VEGFR-3 mRNA expression in ectopic endometriotic lesions during the proliferative phase but its expression decreased during the mid-secretory phase. CONCLUSION: mRNA for VEGFR-1, -2, and -3 in an endometriotic lesions might be differentially expressed and their expression appears to be associated with the development of endometriosis.
Biopsy ; Choristoma ; Endometriosis* ; Female ; Gene Expression ; Humans ; Infertility ; Laparoscopy ; Laparotomy ; Receptors, Vascular Endothelial Growth Factor* ; RNA, Messenger ; Vascular Endothelial Growth Factor A* ; Vascular Endothelial Growth Factor Receptor-1 ; Vascular Endothelial Growth Factor Receptor-3