No abstract available.
Constriction, Pathologic*

No abstract available.
Diagnosis*

The prognosis of distal pancreatic cancer is even poorer than that of pancreatic head cancer because of its late symptom onset and tendency of aggressive retroperitoneal invasion at diagnosis. Since the first Appleby's operation in 1952, it has been performed in stomach cancer by several surgeons. But the survival benefit is still controversial. Appleby's operation includes total gastrectomy, splenectomy, distal pancreatectomy, celiac trunk division with ligation of common hepatic artery(CHA) and retroperitoneal lymph node dissection. In 1976, Nimura first adopted this method for distal pancreatic cancer. We report a case of modified Appleby's operation for distal pancreatic cancer. The patient was 44- year old female. Her chief complaint was epigastric pain for 2 weeks. Preoperative liver function test was within normal range and CA19-9 was elevated to 200 U/ml. Preoperative CT angiography showed 4.5x3cm sized, pancreatic mass in body and tail area invading splenic artery and celiac trunk from its left side. In operation, splenectomy and distal pancreatectomy was initially performed. After ligation of CHA, we confirmed intact proper hepatic artery(PHA) flow by doppler and then divided CHA. After confirmation of intact gastric blood flow, left gastric artery(LGA) was divided. Celiac axis(CA) was divided near its origin. Then we dissected retroperitoneal lymph nodes. There was minor pancreatic leakage controlled by conservative management. CA19-9 was normalized to 33 U/ml on the 16th postoperative day. She was discharged on the 28th postoperative day and underwent adjuvant chemotherapy and radiotherapy. There is no evidence of recurrence for 15 months of follow-up. We suggest that modified Appleby's operation should be considered for radical resection of distal pancreatic cancer which is invading CA or major CA branch but not involving PHA and superior mesenteric artery(SMA), if the CA root is resectable and PHA flow is intact from SMA after ligation of CHA.
Angiography ; Chemotherapy, Adjuvant ; Diagnosis ; Female ; Follow-Up Studies ; Gastrectomy ; Head and Neck Neoplasms ; Humans ; Ligation ; Liver Function Tests ; Lymph Node Excision ; Lymph Nodes ; Pancreatectomy ; Pancreatic Neoplasms* ; Prognosis ; Radiotherapy ; Recurrence ; Reference Values ; Splenectomy ; Splenic Artery ; Stomach Neoplasms

Pancreatoduodenectomy has been a standard procedure for periampullary cancer. Even when the benign lesion is limited to the pancreatic head, the same procedure has been applied if the lesion should be removed surgically. The duodenum has a key role in the digestive physiologic function. However, removal of the pancreatic head while preserving the duodenum has been considered a very risky procedure because of duodenal ischemia. Since the vascular anatomy of the peripancreatic area was thoroughly examined and a meticulous dissection technique was developed, duodenum-preserving procedure has been tried by several surgeons with success. In this paper we report our experience of duodenum-preserving pancreatic head resection. To our knowledge this is the first report in Korea. The lesions were insulinoma and two serous cystadenomas located at the pancreatic head. Total removal of the pancreatic head was performed trying to preserve pancreaticoduodenal vascular arcade without a Kocher maneuver. The common bile duct was totally preserved in all cases and cholecystectomy with T-tube choledochostomy was performed in one case. The pancreatic duct was ligated just distal to the ampullary portion and the distal pancreas was anastomosed to the posterior wall of the stomach. Operation time was 7 hours 30 minutes in one and 5 hours and 30 minutes in two cases. Transfusion was not required at all. Pancreatic leakage was developed in one case and cured with conservative management. Any complication related to the preservation of the duodenum(leakage or obstruction) had not developed. The patients were discharged on postoperative 46 day(due to pancreatic leakage), 18 days and 11 days respectively. In conclusion, duodenum-preserving pancreatic head resection is recommended for benign pancreatic head lesions, such as benign cystic tumor and localized chronic inflammation.
Cholecystectomy ; Choledochostomy ; Common Bile Duct ; Cystadenoma, Serous ; Duodenum ; Head* ; Humans ; Inflammation ; Insulinoma ; Ischemia ; Korea ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Stomach

The gallstones from one hundred consecutive patients having stones in the gallbladder only were analyzed using both gross appearance and infrared spectrophotometry. There were 47 males and 53 females, and the sex ratio was 1:1.13. The most prevalent age was in the fifties in both sexes. Grossly, the number (and also the percentage) of cases of pure cholesterol, mixed cholesterol, calcium bilirubinate, black pigment, and combination stones were 4, 42, 23, 30, and 1, respectively. In the analysis by infrared spectrophotometry, the number of cases of cholesterol, calcium bilirubinate, and calcium carbonate stones were 44, 42, and 14, respectively. The accordance of gross appearance with infrared spectrophotometric classification was statistically significant (p=0.049). A comparison of cholesterol stones with pigment stones showed no difference based on either the sex or the age distribution, but there was a significant difference not only in terms of color, shape, and cut-surface (p=0.000) but also in terms of the number of stones (p=0.045). In conclusion, gallstone classification by gross appearance may be a rapid and relatively accurate method. Further study to standardize gallstone classification by various analytic methods is recommanded.
Age Distribution ; Bilirubin ; Calcium Carbonate ; Cholesterol ; Classification ; Female ; Gallbladder* ; Gallstones* ; Humans ; Male ; Sex Ratio ; Spectrophotometry, Infrared

No abstract available.
Duodenum*

The purpose of this study was to determine the clinical significance of nodal micrometastasis detected by immunohistochemistry in patients that had undergone curative surgery for pancreatic cancer. Between 2005 and 2006, a total of 208 lymph nodes from 48 consecutive patients with pancreatic cancer that had undergone curative resection were immunostained with monoclonal antibody against pan-ck and CK-19. Micrometastasis was defined as metastasis missed by a routine H&E examination but detected during an immunohistochemical evaluation. Relations between immunohistochemical results and clinical and pathologic features and patient survival were examined. Nodal micrometastases were detected in 5 (29.4%) patients of 17 pN0 patients. Nodal micrometastasis was found to be related to tumor relapse (P = 0.043). Twelve patients without overt nodal metastasis and micrometastasis had better prognosis than 5 patients with only nodal micrometastasis (median survival; 35.9 vs 8.6 months, P < 0.001). The Cox proportional hazard model identified nodal micrometastasis as significant prognostic factors. Although the number of patients with micrometastasis was so small and further study would be needed, our study suggests that the lymph node micrometastasis could be the predictor of worse survival and might indicate aggressive tumor biology among patients undergoing curative resection for pancreas cancer.
Aged ; Antibodies, Monoclonal/immunology ; Female ; Humans ; Immunohistochemistry ; Keratin-19/immunology/metabolism ; Lymph Nodes/pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Pancreatic Neoplasms/mortality/*pathology/surgery ; Prognosis ; Survival Rate

Inflammatory pseudotumor is a benign lesion mainly developed in respiratory system. It is difficult to distinguish from malignant lesions, so surgical biopsy is necessary. Of the extrarespiratory system, the inflammatory pseusotumor is rarely developed in the spleen, and first reported by Cotelingam and Jaffe in 1984. We report a case of the inflammatory pseudotumor in the spleen. A 59-years old woman has visited with a splenic mass detected on routine check. She denied the history of abdominal trauma or other diseases except urinary stone and had no subjective symptoms. Tumor markers were all within normal limits. For the differential diagnosis of the splenic mass, splenectomy was done. Grossly, 6x5x4.5 cm sized yellow, hard, well-demarcated mass was seen, and microscopically, prominent fibrosis and collagenation and partial infiltration of plasma cells and neutrophils were found. And the postoperative course was uneventable.
Biopsy ; Collagen ; Diagnosis, Differential ; Female ; Fibrosis ; Granuloma, Plasma Cell* ; Humans ; Middle Aged ; Neutrophils ; Plasma Cells ; Respiratory System ; Spleen* ; Splenectomy ; Biomarkers, Tumor ; Urinary Calculi

Because T1 Gallbladder cancer (GB) has shown a better prognosis than advanced GB cancer, some authors have considered it proper to perform only cholecystectomy. Yet there has been controversy regarding the optimum management owing to the lack of evidence. Thus, retrospectively evaluating the therapeutic effect of each of these surgical procedure is essential to establish the appropriate surgical procedures for treating T1a & T1b GB cancer. In this study, we systematically reviewed 33 articles on T1a & T1b GB cancer. In most of the series, the treatment of choice for patients with T1a was a simple cholecystectomy with a 5-year survival of 100%. For T1b GB cancer, there was no definite evidence to support the superiority of extended cholecystectomy as opposed to simple cholecystectomy. However, considering the low recurrence rate after extended cholecystectomy, it is recommendable for patients who have a low preoperative risk to undergo extended cholecystectomy. Since lymph node metastasis occurs in about 8% of patients with T1b GB cancer, lymph node dissection is needed for the purposes of treatment and staging.
Cholecystectomy ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies

A 64 year-old male, with a history of alcoholism, presented at our hospital with dyspnea. He had a history of admission to hospital for treatment of chronic pancreatitis 4 month ago. Chest radiography showed a marked amount of right pleural effusion. Thoracentesis revealed an exudate of amylase-rich fluid. After conservative management he was discharged, but 1 month later increased right pleural effusion was detected. A pancreaticopleural fistula was detected on ERCP and abdomen CT. After 2 months of conservative management, there had been no improvement of the fistula; therefore, the authors decided to operate. The pancreas was hard and atrophic, with severe adhesion to adjacent tissues. Several pancreatic duct stones were found intraoperatively, with a pseudocyst was also found at the body portion. A suspicious fistula tract was observed at the posterior aspect of the body, which was subsequently ligated. A distal pancreatectomy, with a lateral pancreaticojejunostomy, and an additional side-to-side choledochojejunostomy were performed. A small amount of right pleural effusion was detected, with thoracentesis performed on the 8th postoperative day. The pleural effusion did not show a pancreatic juice nature, with amylase and protein levels of 9 U/L and 2,127 mg/L, respectively. No further increase in the amount of pleural effusion was observed, and the patient was discharged on the 16th postoperative day, without any complications. There was no evidence of recurrence at the 6 month follow up.
Abdomen ; Alcoholism ; Amylases ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochostomy ; Dyspnea ; Exudates and Transudates ; Fistula* ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreatic Fistula ; Pancreatic Juice ; Pancreaticojejunostomy ; Pancreatitis, Chronic* ; Pleural Effusion ; Radiography ; Recurrence ; Thorax