Multiple biliary papillomatosis involves an epithelial field change of the intrahepatic and extrahepatic portions of the biliary tree. Pathologically it is benign, occasionally with dysplasia, but the clinical behavior is regarded as having a low-grade malignant potential. Such malignancy is rare but the prognosis is poor if it is impossible to remove the tumor completely. Here, we report one case of multiple biliary papillomatosis in the biliary tree.
Biliary Tract ; Papilloma* ; Prognosis

PURPOSE: Pancretojejunostomy leakage is the most dreaded complication after a pancratoduodenectomy. However, little is known about what causes the leakage and how to prevent it. The aim of this study was to dentify the risk factors for pancreatic leakage. This paper describes our experience of its management. METHODS: Between Aug. 1996 and Aug. 2003, 75 consecutive patients with periampullary cancer or benign disease received a pancreatoduodenectomy. The patients' clinical characterisitcs, pathological features and surgical findings were retrospectively evaluated. The patients were classified into those with major complication and rhose with no complications and the risk factors were analyzed. Pancreatic leakage, intraabdomnial fluid collection and abscess, intraabdomnial bleeding were categorized as major complications related to a pancreatic fistula. RESULTS: The postoperative mortality and morbidity rate was 2.6% and 36%, respectively. Univariate analysis showed that the pancreatic texture, pathologic diagnoses and comorbidity were significant risk factors for major complications (P= 0.003, 0.045, 0.02). Multivariate analyses revealed that the, pancreatic texture was the only significant risk factor (P=0.003). The preoperative serum albumin level and pancreatic texture were significant risk factors for pancreatic leakage (p=0.03, 0.025) and multivariate analysis showed that the pancreatic texture was also the most significant risk factor. CONCLUSION: Considering that the pancreatic texture is the most significant risk factor for a pancreatic fistula, the technical skill and experience of the surgeon appears to be important for its prevention.
Abscess ; Comorbidity ; Diagnosis ; Hemorrhage ; Humans ; Mortality ; Multivariate Analysis ; Pancreatic Fistula* ; Pancreaticoduodenectomy ; Retrospective Studies ; Risk Factors* ; Serum Albumin

The major reason for the chronic graft loss is chronic rejection. The only predictive factor for chronic rejection is a prior acute rejection episode resulting in a poorer long-term outcome. Also the number of acute rejection episodes is a strong predictor of long-term allograft failure. This study evaluated the impact of a first acute rejection episode and the severity of the rejection and the number of acute rejection episodes on allograft survival. Total of 136 renal transplant were performed between August 1987 to January 1996 at Wonkwang university hospital, and we studied 108 renal transplants that were followed for a minimum of 1.5 years. Acute allograft rejection was mainly diagnosed by clinical evaluation and laboratory data. Transplant patients were divided into three groups according to the time to the first acute rejection; no rejection (group I, n=44); acute rejection during the first 6 months (group II, n=42), acute rejection after 6 months (group III, n=22) and divided into four groups according to the number of acute rejection episodes; no rejection (Group A, n=44), one time (Group B, n=24), two times (Group C, n=23), and more than three times (Group D, n=17). Five-year allograft survival rate for group I-III was 96.4%, 82.7%, 58.5%, respectively (p<0.05 for each comparison to group I). Later acute rejection episodes were associated with worse response to rejection therapy and Group III had higher serum creatinine concentration after rejection therapy than Group II (2.46 1.13 mg/dl vs 1.19 0.7 mg/dl, p<0.05). Five-year allograft survival rate for group A-D was 93.4%, 73.2%, 57.4%, 74.5%, respectively, Group A shows higher graft survival rate, but there was not significant difference in long-term allograft survival among Group B-D. We conclude that late occurrence of a first acute rejection portends a worse prognosis for long-term allograft survival and decreases response to rejection therapy and results in poor graft function. Prevention of later rejection may require a broader focus, with additional efforts directed at improving patient compliance and renal allograft monitoring.
Allografts ; Creatinine ; Graft Survival* ; Humans ; Kidney Transplantation ; Patient Compliance ; Prognosis ; Survival Rate ; Transplants*

To investigate the pathologic change of gallbladder mucosa related to gallstone formation, 52 mice were fed a lithogenic diet containing 1% cholesterol and 0.5% cholic acid and we evaluated the sequential morphologic changes in the gallbladder from two days to 40 weeks. Cholesterol gallstones began to appear after two weeks and all the mice had gallstones after eight weeks. At two days, the mitotic index was at its highest. The gallbladder mucosa showed progressive hyperplastic change with earlier papillary projection of the folds and later inward proliferation. At the same time of stone formation, mucous cells forming glands appeared. Their histochemical profile of mucin was different from that of normal epithelium. Numbers of mucous cells increased gradually until 24 weeks but slightly decreased afterward. These results suggest hyperplasia and metaplasia are closely related to the gallstone formation. Hyperplasia is probably reactive to irritating effect of lithogenic bile or stone. Metaplasia and cholesterol gallstone may develop simultaneously, and act synergistically.
Animal ; Cholelithiasis/pathology* ; Cholelithiasis/etiology ; Cholelithiasis/chemically induced ; Cholesterol/administration & dosage ; Cholic Acid/administration & dosage ; Diet* ; Gallbladder/pathology* ; Mice ; Mice, Inbred C57BL ; Mucous Membrane/pathology

OBJECTIVE: To evaluate of the perinatal outcome of twin gestations complicated by a single anomalous fetus. METHODS: The study included all patients with twin gestations diagnosed with a major fetal anomaly in one fetus in the second trimester during 1997-2000. Twins with anomalies in both fetuses and minor anomalies were excluded. From a total of 717 twin deliveries, there were 24 twin pregnancies with single anomalous fetus observed in Department of Obstetrics and Gynecology, CHA Hospital. Outcomes assessed included gestational age at diagnosis and delivery, antenatal complications, type of anomalies and perinatal mortality rate. RESULTS: The incidence of single anomalous fetus with twin pregnancies was 3.3% in the study population. There were 24 twin pregnancies with one anomalous fetus, and their median gestational age at delivery was 35+3 weeks (range 27-39). The incidence of preterm delivery was 54.2% (13/24) and growth restriction and respiratory distress syndrome of the normal sibling were 12.5% (8/24) and 8.3% (2/24), respectively. Eight cases (33.3%) of preterm deliveries, 3 cases (12.5%) of severe preeclampsia were noted and 2 cases (8.3%) of the pregnancies were complicated with both conditions. Regarding the type of anomalies, chromosomal anomalies and central nervous system (CNS) anomalies were the most common with 5 cases (20.8%) each. Perinatal outcomes of the normal twin and the anomalous twin were compared. There were 2 cases (8.3%) of neonatal death in the normal twin compared with 9 cases (37.5%) of intrauterine death, 9 cases (37.5%) of neonatal death in the abnormal twin. CONCLUSION: Our study shows that the presence of a major anomaly in one fetus in a twin gestation significantly increased the risk of preterm delivery and risk of intrauterine fetal death and neonatal death rate in anomalous fetus. This information may provide useful information for counseling patients about their options when faced in dilemma.
Central Nervous System ; Counseling ; Diagnosis ; Female ; Fetal Death ; Fetus* ; Gestational Age ; Gynecology ; Humans ; Incidence ; Mortality ; Obstetrics ; Perinatal Mortality ; Pre-Eclampsia ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy, Twin ; Siblings

We present a rare case of abdominal compartment syndrome due to a bulimic attack in a 19-year-old female patient with bulimia nervosa. She was admitted to our emergency room with complaints of progressive abdominal pain following bulimia. Computed tomography showed dilated stomach with food and air pressed other visceral organs and major abdominal vessels. Decompression using nasogastric tube or gastric lavage tube failed. At laparotomy, we performed gastrotomy and decompression was performed. After decompression, she fell into hypovolemic shock due to bleeding in the intra-gastric and peritoneal cavity. Twelve hours after the operation, the patient died due to refractory hypovolemic shock from uncontrolled bleeding following decompression of abdominal compartment. It should keep in mind that binge-eating habits in patients with bulimic nervosa could cause abdominal compartment syndrome due to gastric distension and this may be a potentially fatal condition.
Abdominal Pain ; Bulimia ; Bulimia Nervosa ; Compartment Syndromes ; Decompression ; Emergencies ; Female ; Gastric Lavage ; Hemorrhage ; Humans ; Intra-Abdominal Hypertension ; Laparotomy ; Peritoneal Cavity ; Reperfusion Injury ; Shock ; Stomach ; Young Adult

The application of fine needle aspiration (FNA) cytology to the soft tissue tumors had been neglected. In recent years, however, FNA has been used increasingly in the preoperative diagnosis of these tumors due to its usefulness and accuracy. We present 3 cases of liposarcoma, myxoid, myxoid with round cell, and pleomorphic, diagnosed by FNA cytology with histologic confirmation. Good correlation between histologic and FNA cytologic findings was found. Although the cytologic appearances of liposarcomas varied with histologic type, the main criterion was the presence of atypical multivacuolated lipoblast with characteristically scalloped nuclei.
Biopsy, Fine-Needle* ; Diagnosis ; Liposarcoma* ; Liposarcoma, Myxoid ; Pectinidae

PURPOSE: This study was performed to determined by follow-up observation, the result of the arthroscopic treatment for advanced degenerative arthritis of the knee joint. MATERIALS AND METHODS: During the period from January 1991 to December 1995, 270 cases had been followed for more than one year after arthroscopic treatment for degenerative arthritis of the knee joint. There were 66 males and 204 females of average age 61 years. On the Kellgren and Lawrence radiological grading system, follow-up radiography was conducted after the treatment in those cases Grade III before the treatment. A clinical assessment was performed pain, range of motion and the Hospital for Special Surgery (HSS) knee score before and after operation, and the Baumgaertner scale was used for the 2 and 48 month follow-up after operation. Recurrence was considered to have occurred when conditions were the same as before treatment. RESULTS: According to the Baumgaertner scale, clinical assessment showed overall rates of excellent and good in 191 cases (70.8%) at 2 month post-operatively, and 157 cases (58.1%) at 48 month post-operatively. Comparing the radiologic results before and after treatment using Baumgaertner's scale. the radiologically lower grade was the better result And a degenerative symptom was aggravated an average of 3.8 years. CONCLUSION: This study shows that the arthroscopic treatment is an effective option if used during the early stage of degenerative arthritis of the knee joint.
Female ; Follow-Up Studies ; Humans ; Joints* ; Knee Joint ; Knee* ; Male ; Osteoarthritis ; Radiography ; Range of Motion, Articular ; Recurrence

PURPOSE: The placement of a drainage tube in the common bile duct, following a choledochotomy, has become accepted as routine procedure since it was first reported, by Abbe, in 1892. However, many complications are associated with T-tube drainage, such as bile peritonitis after its removal, accidental dislodgement, bile leakage from the T-tube track and a high incidence of postoperative bacteremia, have been reported. This study was designed to evaluate the primary closure as a suitable surgical technique in placce of T-tube drainage following a choledochotomy METHODS: Between January and December 2002, primary closures were performed in 41 cases and T tube drainage in 112, following a choledochotomy. These cases were divided into 2 groups (group A: primary closure, and group B: T-tube drainage). The medical records of the patients were reviewed, and the following data analysed -age, sex, preoperative laboratory value, intraoperative finding, postoperative laboratory value, complication, and days of postoperative hospital stay. RESULTS: There were no significant differences observed in the data of the investigated parameters, with the exception of the mean post-operative hospital stay. The mean post- operative hospital stays were 11.82 and 18.08 days in groups A and B (P=0.0034), respectively. The complication rates of each group showed no statistical difference. However bile peritonitis or bile leakage after T-tube removal developed 5 cases from group B. There were 2 and 5 deaths due to MODS & ARDS, respectively. CONCLUSION: A primary closure, following a choledochotomy, may be a suitable alternative technique to T-tube drainage under reasonable conditions.
Bacteremia ; Bile ; Choledocholithiasis* ; Common Bile Duct ; Drainage* ; Humans ; Incidence ; Length of Stay ; Medical Records ; Multiple Organ Failure ; Peritonitis

Peliosis hepatis is an uncommon liver condition involving abnormal dilation of hepatic sinusoids, eventually leading to blood-filled cavities within the hepatic parenchyma. Although the pathogenesis is not understood fully, peliosis hepatis has usually been associated with the use of anabolic steroid therapy, oral contraceptives, various malignancies or tuberculosis. We report a case of 59-year-old patient with cholangiocarcinoma with peliosis hepatis. The patient was admitted for evaluation of abdominal pain and fever. Abdomen CT showed a round cytic and solid mass with peripheral duct dilatation in liver. Grossly, the spongy-like solid mass and cyst was noted. Microscopically, the solid mass was composed of tubular and solid adenocarcinoma in fibrotic stroma and a blood-filled cavity with dilated sinusoids was noted.
Abdomen ; Abdominal Pain ; Adenocarcinoma ; Cholangiocarcinoma* ; Contraceptives, Oral ; Dilatation ; Fever ; Humans ; Liver ; Middle Aged ; Peliosis Hepatis* ; Tuberculosis