Extramammary Paget's disease is a rare malignant disease associated with underlying adenocarcinoma, or not. Two cases with a unique clinical presentation are described and we wish to call attention to the malignant potential of chronic scaly and erythematous lesions of perianal and genital area.
Adenocarcinoma ; Male ; Paget Disease, Extramammary* ; Penis* ; Scrotum*

Cysts of the spleen are uncommon disease entities and can be classified as either primary (true) or secondary (pseudo-) depending on the presence of a true epithelial lining. True nonparasitic cysts of spleen are very rare, and the majority of the cases are classified as epidermoid cysts. True splenic cysts were found in three children during the last eleven years (1989~1999) in Yeungnam University Hospital. Two of the children were girls and one was boy. The age at diagnosis ranged from 7 to 15 years. Abdominal ultrasonography was utilized to the initial diagnosis, and computerized tomography was done for the detailed studies. Radionuclide scanning was performed in a patient. Surgical resection (one partial splenectomy and two total splenectomies) was performed. The cysts were from 4cm to 9cm in maximum diameter. Pathologic finding was epidermoid cyst of the spleen.
Child ; Diagnosis ; Epidermal Cyst ; Female ; Humans ; Male ; Spleen ; Splenectomy ; Ultrasonography

Purpose: The aim of this study was to compare the short-term outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) in elderly patients with hepatic tumors. Methods: From January 2013 to December 2019, a retrospective study was conducted for a total of 143 patients with over 70 years of age, who underwent liver resection for hepatic tumors. Forty-five patients who received biliary reconstruction at the same time were excluded. According to surgical approaches, 98 patients were classified into LLR and OLR groups. All postoperative complications were classified according to the Clavien-Dindo grading system and the Comprehensive Complication Index (CCI). Results: Incidence of the postoperative complications was not statistically different between LLR and OLR groups. The CCI was significantly lower in the LLR group, with a median of 8.556, and a median of 19.698 in the OLR group (p=0.042). The length of hospital stay in the LLR group was significantly shorter than in the OLR group (p=0.008). Conclusion LLR is safe and feasible as a treatment for hepatic tumor in elderly patients with potentially less postoperative complications compared to OLR.

Radical hysterectomy with pelvic lymph node dissection (RHPLD) was considered as primary management of cervical cancer (stage I and IIa). RHPLD provides for resection of paracervical and paravaginal tissues at the lateral pelvic walls, transaction of the uterosacral ligament, ligation of uterine vessels and excision of pelvic lymph node from the surrounding vessels. The urinary tract disturbance was the most frequent and significant postoperative complication. Among 82 patients who had undergone radical hysterectomy with pelvic lymph node dissection for cervical cancer from July 1983 to December 1989, 43 patients who were treated for urologic complications, were reviewed retrospectively. The age distribution was even from 4th to 6th decades. The common urologic complications were neurogenic bladder dysfunction 28 (34.2%). Ureteral injury 15 (18.3% ), UTI 12 (14.6% ), stress incontinence 5 (6.1%). Each urologic complication and its management are discussed.
Age Distribution ; Humans ; Hysterectomy* ; Ligaments ; Ligation ; Lymph Node Excision* ; Lymph Nodes* ; Postoperative Complications ; Retrospective Studies ; Ureter ; Urinary Bladder, Neurogenic ; Urinary Tract ; Uterine Cervical Neoplasms

Carcinoma of the gallbladder is an uncommon but highly malignant tumor with a poor five year survival rate. Early detection is very important for successful treatment because this tumor is very hard to cure in cases where it has advanced beyond the reach of surgical treatment. The purpose of this review was to evaluate risk factors for carcinoma of the gallbladder and determine the best management approach.. Solitary polys, more than one cm are considered to be predisposing factors for gallbladder carcinoma when they are found to be echopenic, sessile, and with a high cell density. Anomalous union of the pacreato-biliary duct(AUPBD) without a choledochal cyst is also considered to increase risk for gallbladder carcinoma. A polyps size of more than one cm and an AUPBD are indications for prophylactic cholecystectomy. The presence of gallstones is a well-established risk factor for the development of gallbladder carcinoma; risk appears to correlate with the stone size and the duration of chronic cholecystitis. Metaplastic changes of the gallbladder epithelium present with chronic cholecystitis and may indicate a premalignant lesion. Abnormal forms of cholecystitis such as xanthogranulomatous or a porcelain gallbladder also have malignant potential; cholecystoenteric fistula as well as bacterial infection of the gallbladder(typhoid, helicobacter species) also has malignant potential. In this review, the risk factors associated with carcinoma of the gallbladder are summarized with special attention to gallstones, polyps,AUPBD, and chronic inflammation.
Bacterial Infections ; Causality ; Cell Count ; Cholecystectomy ; Cholecystitis ; Choledochal Cyst ; Dental Porcelain ; Epithelium ; Fistula ; Gallbladder* ; Gallstones ; Helicobacter ; Inflammation ; Polyps ; Risk Factors ; Survival Rate

Carcinoma of the gallbladder is an uncommon but highly malignant tumor with a poor five year survival rate. Early detection is very important for successful treatment because this tumor is very hard to cure in cases where it has advanced beyond the reach of surgical treatment. The purpose of this review was to evaluate risk factors for carcinoma of the gallbladder and determine the best management approach.. Solitary polys, more than one cm are considered to be predisposing factors for gallbladder carcinoma when they are found to be echopenic, sessile, and with a high cell density. Anomalous union of the pacreato-biliary duct(AUPBD) without a choledochal cyst is also considered to increase risk for gallbladder carcinoma. A polyps size of more than one cm and an AUPBD are indications for prophylactic cholecystectomy. The presence of gallstones is a well-established risk factor for the development of gallbladder carcinoma; risk appears to correlate with the stone size and the duration of chronic cholecystitis. Metaplastic changes of the gallbladder epithelium present with chronic cholecystitis and may indicate a premalignant lesion. Abnormal forms of cholecystitis such as xanthogranulomatous or a porcelain gallbladder also have malignant potential; cholecystoenteric fistula as well as bacterial infection of the gallbladder(typhoid, helicobacter species) also has malignant potential. In this review, the risk factors associated with carcinoma of the gallbladder are summarized with special attention to gallstones, polyps,AUPBD, and chronic inflammation.
Bacterial Infections ; Causality ; Cell Count ; Cholecystectomy ; Cholecystitis ; Choledochal Cyst ; Dental Porcelain ; Epithelium ; Fistula ; Gallbladder* ; Gallstones ; Helicobacter ; Inflammation ; Polyps ; Risk Factors ; Survival Rate

PURPOSE: Ischemia and reperfusion (I/R) injury is a major cause of hepatic failure after liver surgery, but there is no direct method to monitor it in real-time (like an ECG in heart disease) during surgery. Recently we found the possible role of bioelectrical impedance (BEI) to monitor I/R injury in liver, but the mechanism responsible for ischemia-related BEI changes has not been clearly determined. METHODS: The authors used a LCR meter to quantify BEI changes at 0.12 KHz. Livers were subjected to 70% partial ischemia for 120 minutes, and ATP content, cation changes in extracellular fluid (ECF; determined using an in vivo intracellular microdialysis technique), hepatocyte sizes, and histological changes were then examined. RESULTS: Liver tissue BEI was found to increase gradually during the first 60 minutes of ischemia and then tended to plateau. During the same period, intracellular ATP content decreased to below 20% of the baseline level, [Na+] in ECF decreased from 150.4+/-3.8 to 97.8+/-10.6 mmol/L, and [K+] in ECF increased from 7.5+/-0.3 to 34.3+/-5.5 mmol/L during the first 60 minutes of ischemia. Hepatocyte diameter increased by approximately 20% during the first 60 minutes of ischemia. CONCLUSION: This study suggests that BEI changes during hepatic ischemia are probably caused by sodium and potassium concentration changes in the ECF due to reduced intracellular ATP content.
Adenosine Triphosphate ; Cations ; Electric Impedance ; Electrocardiography ; Extracellular Fluid ; Heart ; Hepatocytes ; Ischemia ; Liver ; Liver Failure ; Microdialysis ; Organothiophosphorus Compounds ; Potassium ; Reperfusion ; Reperfusion Injury ; Sodium

No abstract available.

There has been a dramatic change in surgical care over the past 30 years with the introduction of laparoscopic surgery. It was my great fortune that I could experience laparoscopic surgery during my resident training period. After beginning to work for my hospital in 1995, I tried laparoscopic surgery in many surgical fields, including hepatobiliary and pancreatic (HBP), colon, stomach, and vascular surgery (endoscopic saphenous vein harvesting, endoscopic subfascial perforating vein interruption to treat skin complications in patients with deep vein insufficiency in the lower leg). In Sabiston, Textbook of Surgery, published in 1997, laparoscopic Whipple and major liver resection were not accepted at the time but now are. There are three possible reasons that may explain this shift. The first one is the 30 years of experience using advanced techniques; all of us know that “Seeing is believing,” and “A thousand hearings are not worth one seeing.” Next is the availability of three-dimensional imaging with magnification which enables us to perform difficult surgeries. The last one is the use of good instruments and an advanced surgical platform. In this paper, I would like to share my past and recent trials with advanced HBP laparoscopic surgery, as well as its current status in Korea and future directions.

There has been a dramatic change in surgical care over the past 30 years with the introduction of laparoscopic surgery. It was my great fortune that I could experience laparoscopic surgery during my resident training period. After beginning to work for my hospital in 1995, I tried laparoscopic surgery in many surgical fields, including hepatobiliary and pancreatic (HBP), colon, stomach, and vascular surgery (endoscopic saphenous vein harvesting, endoscopic subfascial perforating vein interruption to treat skin complications in patients with deep vein insufficiency in the lower leg). In Sabiston, Textbook of Surgery, published in 1997, laparoscopic Whipple and major liver resection were not accepted at the time but now are. There are three possible reasons that may explain this shift. The first one is the 30 years of experience using advanced techniques; all of us know that “Seeing is believing,” and “A thousand hearings are not worth one seeing.” Next is the availability of three-dimensional imaging with magnification which enables us to perform difficult surgeries. The last one is the use of good instruments and an advanced surgical platform. In this paper, I would like to share my past and recent trials with advanced HBP laparoscopic surgery, as well as its current status in Korea and future directions.