Insulinoma is the most frequent endocrine tumor of the pancreas and the first of the endocrine-secreting tumor of the gut to be recognized by Nicholls in 1902. Recurrent episodes of hypoglycemia is the main cause of the symptoms and signs which were sweating, pallor, dizziness, habitual change, convulsion and coma. In 1935, Whipple and Frants were described so-called “Whipple's triad”: the patient's symptoms occur with fasting or exercise; at the time of symptoms, the serum glucose in 50mg/dl or less; and the symptoms are relieved by the administration of glucose. While these criteria were timely, they proved to be rather nonspecific and may be found in other conditions that result in fasting hypoglycemia. We experienced a 44-year-old female patient who had repeated attacks of convulsion, unconsciousness and coma for 3 years. Although she has been treated with anticonvulsant, the symptoms and signs were not disappeared. At the time of administration, she was a full coma state due to hypoglycemia and was dramatically reversed by intravenous administration of the glucose solution. The preoperative test such as provocative test, abdominal CT and celiac angiography revealed insulinoma and after enucleation the pathologic diagnosis was the same. We like to report an adult female patient with insulinoma and the review of literatures briefly.
Administration, Intravenous ; Adult ; Angiography ; Blood Glucose ; Coma ; Diagnosis ; Dizziness ; Fasting ; Female ; Glucose ; Humans ; Hypoglycemia ; Insulinoma* ; Pallor ; Pancreas ; Seizures ; Sweat ; Sweating ; Tomography, X-Ray Computed ; Unconsciousness

No abstract available.
Animals ; Rats* ; Reperfusion*

PURPOSE:It is important to evaluate the healing process of avascular necrosis (AVN) involving femoral head after treatment. The purpose of this study was to assess the usefulness of pinhole bone scintigraphy in the AVN of femoral head after surgery. MATERIALS AND METHODS: We analyzed the changing pattern of pinhole bone scintigram in 21 femoral heads of 16 patients (14 lesions/11 male, 7 lesions/5 female, mean age: 39.4 yrs) before and after multiple drilling or vascularized bone grafting for AVN of the femoral head. In all patients, pre-operative scintigrams were obtained at 1 to 3 months before treatment and the first post-operative scintigrams were obtained at 1 to 3 months after treatment. All patients were followed for 2 to 4 years after operation. RESULTS: The findings of the pinhole scintigrams were divided into three patterns: 1) curvilinear, 2) scattered spotty and 3) undetermined. The 10 of 11 lesions with curvilinear pattern had good postoperative clinical and radiological follow-up findings. However, all 6 lesions with scattered spotty pattern showed poor postoperative findings, which necessitated total hip joint replacement. Of the 4 lesions with undetermined pattern, 2 required total hip joint replacement. There was significant difference in postoperative prognosis between the curvilinear and scattered spotty patterns (p<0.05). CONCLUSION: We conclude that the pattern of pinhole bone scintigram obtained within 1 to 3 months after multiple drilling or vascularized bone graft operation is a useful prognostic indicator in the AVN of femoral head.
Bone Transplantation ; Female ; Follow-Up Studies ; Head* ; Hip Joint ; Humans ; Male ; Necrosis* ; Prognosis* ; Radionuclide Imaging* ; Technetium Tc 99m Medronate ; Transplants*

Hemangiopericytoma is a rare vascular tumor arising from pericytes. The tumor usually develops in the skin or subcutaneous tissue, particularly in the extremities.4 pulmonary origin of hemangiopericytoma is known to be quite rare. It has the potential to become a highly malignant lesion, so wide excision is the treatment of choice. We present a case of primary malignant hemangiopericytoma of the lung and discuss the clinical symptoms, diagnosis, therapy and prognosis within the context of a brief review.
Diagnosis ; Hemangiopericytoma* ; Lung* ; Pericytes ; Prognosis ; Skin ; Subcutaneous Tissue

Local control is the important prognostic factor in cancer treatment because local control decrease the relative risk of metastatic spread and increse distant metastasis free survival. IORT is the modality which could increase local control without incressing complication, combined with curative operation. Eventhough we could achieve significant deacreased local failure by IORT and curative resection, it should not be committed as a main treatment modality without proving acceptable complications. Therapeutic Radiology Department of Yeungnam University Medical Center have tried 58 IORT from June 15, 1988, and performed 53 IORT in patients with gastric cancer. No local failure has been reporte? by regular follow up so far. Nine cases(17%) of treatment related complifaiton were reported including intestinal obstrution, hemorrhage, sepsis, and bone marrow depression. These complications could be comparable to Jo's 25.2% (chemotherapy + operation), Kim's 18% (chemotherapy only in inoperable patients), because our treatment regimen is consisted of IORT (1500 cGy), external irradiation(--4500 cGy) and extensive chemotherapy (FAM, 5FU+MMC, BACOP). Our data encouraged us to re-inforce further IORT in stomach cancer treatment.
Academic Medical Centers ; Bone Marrow ; Depression ; Drug Therapy ; Follow-Up Studies ; Hemorrhage ; Humans ; Neoplasm Metastasis ; Radiation Oncology ; Sepsis ; Stomach Neoplasms*

PURPOSE: We evaluated the usefulness of 24 hour/3 hour radio-uptake ratio, lesion to non-lesion ratio, in differentiating bony metastases from acute (<2 months) and healing ( 2 months) fractures. MATERIALS AND METHODS: Sixty-three patients (age range: 26-81, 32 males, 31 females) having 90 lesions (30 bone metastases, 30 acute fractures, 30 healing fractures) were included. Bone scans were obtained 3 and 24 hours after administration of 740 MBq of 99mTc-MDP. The ratio of radio-uptake in the lesion to normal area was measured as 24/3 hour radio-uptake ratio ([lesion/non-lesion RUR at 24 hour]/[lesion/non-lesion RUR at 3 hour], 24/3 RUR) and analyzed clinical significance in differentiating bone metastases from acute or healing fractures. RESULTS: Mean 24/3 RUR were 1.22+/-0.18 for bone metastases, 1.25+/-0.14 for acute fractures, and 0.99+/-0.15 for healing fractures. 24/3 RUR values of bone metastases and acute fractures were not significantly different. But 24/3 RUR values of bone metastases and healing fractures, and those of acute and healing fractures were found to be significantly different (p<0.001). When 24/3 RUR of 1.0 was considered as the cut off point separating metastases from fracture, a sensitivity of 100% (30/30) was obtained. The specificity was 0% (0/30) in separating metastases from acute fractures, and 47% (14/30) in separating metastases from healing fractures. When 24/3 RUR of 1.2 was considered as the cut off point, sensitivity of 53% (16/30) in the diagnosis of bone metastasis, and specificity of 37% (11/30) in separating metastases from acute fractures, and 100% (30/30) in separating metastases from healing fractures were obtained. CONCLUSION: 24/3 RUR is useful in differentiating bone metastases from healing fractures, but not in differentiating bone metastases from acute fractures. A 24/3 RUR of less than 1.0 suggests healing fractures. A 24/3 RUR of more than 1.2 suggests bone metastases or acute fractures.
Diagnosis ; Humans ; Male ; Neoplasm Metastasis* ; Radionuclide Imaging* ; Sensitivity and Specificity ; Technetium Tc 99m Medronate

Hydrops fetalis is diagnosed when abnormal fluid collections are manifest in two or more fetal compartments, including abdominal ascites, pleural effusions, pericardial effusions, skin edema, polyhydroamniosis and placental edema. Although fetal hydrops was hystorically most commonly associated with Rh blood group isoimmunization, the availability of Rh immunoglobulin has increased the proportion of fetuses affected due to nonimmune etiologies. We have experienced a case of nonimmune hydrops fetalis at 32 weeks of gestation in a 27-year-old woman and reported that with brief review of related literatures.
Adult ; Ascites ; Edema ; Female ; Fetus ; Humans ; Hydrops Fetalis* ; Immunoglobulins ; Pericardial Effusion ; Pleural Effusion ; Pregnancy ; Skin

Laparoscopic surgery is now a commonly used procedure for biliary tract disease because of the small incision, the shorter hospital stay, lower postoperative pains, and prompt recovery. Acute or subacute cholecystitis has been considered a contraindication because the procedure becomes time consuming and complicated. However, improvements in surgical technique and development of better surgical equipment has lead to interest in the use of laparoscopy for acute cholecystitis. However, the proper timing for the operation is still questionable. The authors analyzed 28 cases of laparoscopic cholecystectomies performed for acute cholecystitis between January 1992 and first half of 1997 in order to determine the clinical significant of using a laparoscopic cholecystectomy for patients with acute cholecystitis. For all 28 cases of histopathologically confirmed acute cholecystitis, we analyzed the of surgical method, mean hospital stay, mean operating time, and postoperative analgesic requirement. Each subjects were also analysed year by yearly to determine laparoscopic cholecystectomy for acute cholecystitis. As to histopathologic type, 81% were calculous cholecystitis, and 19% were acalculous cholecystitis. Empyema cases accounted for 46% of the total number of cases. During the 1992, all cases was treated by using a gas technique, but in 1995, the gas technique was used in only 60% of the cases. In 1996, a gasless technique surpassed gas technique was used in 57.2% of the cases. In 1997, all cases were treated by using a gasless technique. The mean hospital stay gradually decreased through the years from 6.75 days in '92, to 5.85 days in '95, 5.8 days in '96 and 5 days in '97. The mean operation time also showed a decrease from 100 min in '92, to 139 min. in '95, 104.64 min in '96 and 90 min in '97. A postoperative analgesic was used 1.5 times in '95, 1.14 times in '95, 1 time in '96 and 0.8 time in '97. In conclusion, the laparoscopic approach to treating acute cholecystitis has reduced the hospital stay, and the mean operation time due to the use of a gasless technique and to development of better laparoscopic instruments. Also, the use of the gasless technique is more treat cost effectiveness, so, the gasless laparoscopic technique is becoming popular as a way to acute cholecystitis in the laparoscopic era.
Acalculous Cholecystitis ; Biliary Tract Diseases ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute* ; Cost-Benefit Analysis ; Empyema ; Humans ; Laparoscopy ; Length of Stay ; Pain, Postoperative ; Surgical Equipment

PURPOSE: There is concern about the potential adverse effects on hepatic function due to increased intraabdominal pressure during pneumoperitoneum. The changes in hepatic function following a laparoscopy assisted distal gastrectomy (LADG) and conventional open distal gastrectomy (ODG) for gastric cancer were compared. METHODS: Between July 2004 and May 2005, 60 patients diagnosed with early gastric cancer at Kangnam St' Mary's hospital; 30 each having undergone LADG and ODG were studied. The levels of alkaline phosphatase (ALP), total bilirubin (TB), aspartate transferase (AST) and alanine transferase (ALT) between the two groups were compared at 24 and 72 hours postoperatively. RESULTS: The age, sex, body mass index and preoperative hepatic function were not different between the two groups. The operative times were significantly longer in the LADG than the ODG group (298 vs. 184 minutes, P < 0.000). There was no postoperative hepatic failure or mortality in either group. The levels of ALP decreased, but those of total bilirubin remained unchanged from the preoperative baselines in both groups, with no significant difference between the two groups. After a LADG, the levels of AST and ALT increased 3.7 and 3.5 fold 24 hours after surgery, whereas after an ODG, the levels of AST and ALT increased 1.9 and 1.5 fold. In the LADG group, the levels of AST and ALT were significantly increased compared to the ODG group (P < 0.05), but returned close to the baseline levels within 72 hours. On the third postoperative day, there were no significant differences in the levels of AST and ALT between the two groups (P > 0.05). CONCLUSION: After a LADG, the levels of hepatic transaminases were immediately elevated, but returned to normal levels within 72 hours. A LADG with prolonged pneumoperitoneum is considered safe in patients with normal liver function prior to the operation. In addition, to evaluate the safety of a LADG in the patients with decreased hepatic function, a large scaled randomized prospective trial will be required.
Alanine ; Alkaline Phosphatase ; Aspartic Acid ; Bilirubin ; Body Mass Index ; Gastrectomy* ; Humans ; Laparoscopy ; Liver ; Liver Failure ; Mortality ; Operative Time ; Pneumoperitoneum ; Prospective Studies* ; Stomach Neoplasms ; Transaminases ; Transferases

PURPOSE: To analyze the benefit and feasibility of this procedure compared with those of open method. METHODS: Abdominal procedure includes laparoscopic gastric mobilization, celiac axis lymph node dissection, formation of the gastric tube, and pyloromyotomy. The actual procedure performed during open surgery is the same as those of laparoscopic surgery except for the main incision. Minimally invasive esophagectomy (MIE) was performed on 54 patients with esophageal cancer. The short-term outcomes, including postoperative complications were analyzed and compared with 44 cases of open method. RESULTS: Although the total operative time was not different between 2 groups (349.8 minutes vs. 374.8 minutes, P = 0.153), the operation time of abdominal procedure was shorter in laparoscopic group (90.6 minutes vs. 162.1 minutes, P < 0.001). Operation related complications and hospital stay were not significantly different between the 2 groups. The number of transfused patients was significantly smaller in laparoscopic group (11.1% vs. 27.9%, P = 0.030). CONCLUSION: Laparoscopic gastric tubing with pyloromyotomy is a feasible and safe treatment option for patients with esophageal cancer.
Axis, Cervical Vertebra ; Esophageal Neoplasms* ; Esophagectomy ; Feasibility Studies ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Operative Time ; Postoperative Complications ; Surgical Procedures, Minimally Invasive