Primary carcinoma of the uterine tube is one of the least common gynecologic malignancies with a reported incidence of approximately 0.3%. As a result of it, the experience of any one physian is limited. Almost all cases are adenocarcinoma and the cilinical presentation is generally nonspecific, of which the most common symptom is postmenopausal vaginal bleeding. Primary fallopian tube carcinima is infrequently diagnosed before explolatory laparotomy and the majority of patients have extensive disease at diagnosis. We have experienced a case of fallopian tube cancer and report with brief review of literature
Adenocarcinoma ; Diagnosis ; Fallopian Tube Neoplasms ; Fallopian Tubes* ; Female ; Humans ; Incidence ; Laparotomy ; Uterine Hemorrhage

A 25-year-old female visited the clinic with abdominal pain and poor oral intake. She was diagnosed with Crohn’s disease and had a history of using infliximab for 4 years. She had no previous operative history. Magnetic resonance enterography demonstrated the progression of a penetrating complication that involved the distal ileum and complex entero-enteric fistula between the terminal ileum and sigmoid colon. Surgery was conducted using the da Vinci SP surgical system. In the operative field, severe adhesion was observed between the terminal ileum, adjacent ileum, cecum, and the sigmoid colon. After adhesiolysis of the small bowel and right colon was performed, the fistula tract between the sigmoid colon and terminal ileum was identified and resected. Then, simultaneous ileocecectomy and anterior resection was performed. The operation was completed without any intraoperative complications and patient’s recovery was uneventful. She was discharged postoperatively, after 8 days.

Recurrent colonic perforation in patients already having colostomy is extremely rare and only a few cases had been reported. Herein, we report 2 cases of recurrent colonic perforation at the proximal part of the colostomy in geriatric patients resulting from different causes, which might be caused by stercoral perforation and recurrent colonic ischemia, respectively. Based on our experience, surgeons should consider correcting chronic constipation even in patients who already have a colostomy.Additionally, transverse colostomy should be considered as a surgical treatment in patients with sigmoid colostomy for recurrent perforation due to colonic ischemia.

PURPOSE: We evaluated the easily-assessable risk and prognostic factors of septic shock in children with neutropenic fever (NF) which developed after anticancer chemotherapy. METHODS: We retrospectively reviewed the medical records and laboratory data of 97 children who received anticancer chemotherapy at Dong-A University Hospital and had NF between March, 1993 and February, 2001. RESULTS: There were 223 episodes of NF in 97 children, of which 71 episodes (31.8%) of bacteremia and 18 episodes (8.1%) of septic shock developed. The incidence of septic shock was associated with fever duration (> 5 days, odds ratio=7.367, P=0.0159), tachycardia (odds ratio=11.857, P=0.0001), and serum bicarbonate level (<24 mEq/L, odds ratio=6.235, P=0.0378), whereas not with the underlying disease, age, sex, causative organisms, absolute neutrophil count, absolute monocyte count, absolute phagocyte count, the presence of central venous catheter, the accompanied focal infection, and the use of hematopoietic growth factor. Septic shock developed 3.2 (1~11) days after NF. The prognosis of septic shock patients was not associated with the therapeutic timing, antibiotics, fever duration, tachycardia, or serum bicarbonate level. CONCLUSION: We suggest that the fever duration, tachycardia, and serum bicarbonate level could be important risk factors of septic shock in children with NF. Although We could not reveal the prognostic factors in children with septic shock, further studies will be required.
Anti-Bacterial Agents ; Bacteremia ; Central Venous Catheters ; Child ; Drug Therapy ; Fever* ; Focal Infection ; Humans ; Incidence ; Medical Records ; Monocytes ; Neutropenia ; Neutrophils ; Phagocytes ; Prognosis ; Retrospective Studies ; Risk Factors* ; Shock, Septic* ; Tachycardia

BACKGROUND: In congenital heart disease, the lung perfusion through stenosed pulmonary artery is usually decreased. And this decrement of lung perfusion also occurs with diaphragmatic palsy after the operation of congenital heart disease. It is difficult to delineate the amount of lung perfusion in case of combination of pulmonary artery stenosis and diaphragmatic palsy. We examined the change of lung perfusion after the induction of diaphragmatic palsy in rabbits. METHODS: We dissected left phrenic nerves in 20 rabbits to induce left diaphragmatic palsy. The lung perfusion scan was performed with 99mTc-MAA and the movement of diaphragm was examined with fluoroscopy. They were performed as baseline data and on 3rd and 10th day postoperatively. The amount of left lung pefusion before and after diaphragmatic palsy was compared and analysed in 12 rabbits which definitely had diaphragmatic palsy. RESULTS: Weight of the rabbits was 1.65+/-0.26 kg. Left lung perfusion percent was 45.93+/-6.42% before operation and these were 32.48+/-6.09% and 37.62+/-3.39% on the 3rd and 10th postoperative day, respectively. Left lung perfusion was significantly decreased just after diaphragmatic palsy but it was not changed thereafter. The decrement of lung perfusion was not affected by the body weight. The decreased amount of left lung perfusion was reciprocally correlated with the body weight of the rabbits on the postoperative 3rd day but not 10th day. CONCLUSION: Left lung perfusion percent of the rabbits was decreased 7% with the induction of diaphragmatic palsy and the decreased amount was reciprocally correlated with the body weight just after the diaphragmatic palsy was induced.
Body Weight ; Constriction, Pathologic ; Diaphragm ; Fluoroscopy ; Heart Defects, Congenital ; Lung* ; Paralysis* ; Perfusion* ; Phrenic Nerve ; Pulmonary Artery ; Rabbits

Vitiligo, which is characterized by depigmentation of skin and mucosa is a common skin disease, affecting 1-4% of population. Although the pathogenesis is not clear, the basic defect lies in a decrease or absence of melanocytes. Vitiligo causes cosmetic disfiguration and exerts negative effects on quality of life. Phototherapy and topical agents such as corticosteroids, calcineurin inhibitors, and vitamin-D derivatives are basic treatment modalities. Recently, prostaglandin analogues have been reported to be effective on pigmentation of vitiligo lesions. We present three patients with periorbital vitiligo, who did not respond to established treatments such as tacrolimus and excimer laser, responding to application of latanoprost, a prostaglandin F2alpha analogue.

A 63-year-old woman was referred to a breast surgeon with a breast mass discovered incidentally during follow-up study after colon cancer surgery. Invasive adenocarcinoma was revealed on core needle biopsy. Wide excision of the breast including the tumor was performed. On standard histological examination the tumor showed features of moderately differentiated adenocarcinoma. The immunohistochemistry study revealed positive results for cytokeratin (CK)20 and CDX2, but negative for CK7. These are typical characteristics for colon cancer. Considering her history of subtotal colectomy for sigmoid colon cancer, it is presumable that the mass in the breast was of colonic origin, and it was an extremely rare case of metastasis to the breast from primary colorectal neoplasm. Although the instance is rare, clinicians should keep the possibility of breast metastasis from colorectal cancer in mind for early and correct diagnosis.
Adenocarcinoma ; Biopsy, Large-Core Needle ; Breast ; Colectomy ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Middle Aged ; Neoplasm Metastasis ; Sigmoid Neoplasms

The annular pancreas in adults is a rare congenital anomaly that is detected after development of complications, such as gastric outlet obstruction, recurrent pancreatitis, and peptic ulcer. Duodenal bypass is the procedure of choice for treating duodenal obstruction caused by the annular pancreas in both children and adults. Duodenoduodenostomy is routinely performed in neonates and children. In adults, duodenojejunostomy or gastrojejunostomy are recommended, because the duodenum is less mobile. We report a case of annular pancreas in a 33-year-old male that was successfully treated with laparoscopic gastrojejunostomy.
Adult ; Child ; Duodenal Obstruction ; Duodenum ; Gastric Bypass ; Gastric Outlet Obstruction ; Humans ; Infant, Newborn ; Laparoscopy ; Male ; Pancreas ; Pancreatic Diseases ; Pancreatitis ; Peptic Ulcer

BACKGROUND: Adenocarcinoma arising in the body or tail of the pancreas tends to be metastasized at the time of diagnosis, is mostly in inoperable stage, and poor in prognosis. In this study, we evaluated the adenocarcinoma arising in the body or tail of the pancreas and investigated the prognostic factors and ideal treatment. MATERIAL AND METHODS: We retrospectively analyzed 33 patients who were cytologically or histologically confirmed as adenocarcinoma in the body or tail of the pancreas at Samsung Medical Center from October 1994 to December 1999. RESULTS: The mean age of the patients in the resectable and unresectable groups were 63.4 and 60.6 year-old, respectively. The mean CA19-9 level was higher in unresectable group (5166.2u/ml), compared to the resectable group (964.7u/ml).(p=0.039) In the resectable group, the body was the most common location of the tumor, and in the unresectable patient group, the tail was more prevalent.(p= 0.021) The mean survival time of the resectable group was 15.1months. The univariate analysis of the resectale group showed that the age, sex, lymph node metastasis, chemotheraeutic modalities, radiotherapeutic modalities, and the location of tumor were not significantly related with the prognosis. In unresetable group, the mean survival time was 6.4months. The mean survival time were 3.3 months in patients over 60 year-old and 9.9 months in patients less than 60, showing statistically significant difference.( p=0.007) The mean survival time were 12.2 months and 3.4 months in patients who received the chemotherapy and who did not, respetively.(p=0.004) Evaluating the relationship between the extent of metastasis and survival, the mean survival length of single metastasis was 9.3 months, showing significantly higher survival length compared that of multiple metastasis.(p=0.027) Patient's sex, radiotherapeutic modality and location of the tumor were not significantly related with the prognosis. Multivariate analysis of prognostic factor showed that the patietnt's age (p=0,842), the extent of metastasis( p=0.458), and chemotherapeutic modality (p=0.078) were unrelated with prognosis. CONCLUSION: In adenocarcinoma arising in the body and tail of the pancreas, the CA19-9 level and tumor location could be utilized as indicating factors of the operability of the tumor. Age, sex, lymph node metastasis, and location of the adenocarcinoma are not significantly related with the survival length in both the resectable and unresectable groups. Also, in both groups, the chemotherapeutic and radiotherapeutic modalities were not related with the survival length.
Adenocarcinoma* ; Diagnosis ; Drug Therapy ; Humans ; Lymph Nodes ; Middle Aged ; Multivariate Analysis ; Neoplasm Metastasis ; Pancreas ; Prognosis* ; Retrospective Studies ; Survival Rate

PURPOSE: The number of laparoscopy-assisted distal gastrectomy procedures for the treatment of early gastric cancer patient to improve the quality of life has been gradually increasing. This study evaluated the technical feasibility, safety, and surgical results of LADG with lymphadenectomy by reviewing the initial experience. METHODS: From May 2003 to December 2005, 202 LADG with lymphadenectomy were performed on patients with a preoperative diagnosis of EGC. The clinicopathological features and surgical outcomes were analyzed. RESULTS: There were 128 males and 74 females with a mean age of 58 years (range 24~78). The mean operation time was 212 minutes (range 105~450) and the operation time has decreased gradually with increasing number of cases. There were 16 operative morbidities (7.9%) including three operative mortalities. The restoration of the bowel sound was noted at 3.1 postoperative days, soft diet was started at 4.4 postoperative days and the duration of the hospital stay was 7.7 days. There were 105 mucosal, 64 submucosal, 22 proper muscle, 4 subserosal and 7 serosal lesions. A total 163 patients were treated with D2, 37 with D1+beta and 2 with D1+alpha LN dissection. The mean number of lymph nodes retrieved was 35 (range=10~81). Lymph node metastasis was noted in 30 patients. CONCLUSION: This study shows that laparoscopic procedure can be applied safely and effectively for the patients with EGC. However, a prospective study comparing laparoscopy-assisted versus open gastrectomy for the short- and long-term surgical outcomes is needed.
Diagnosis ; Diet ; Female ; Gastrectomy* ; Humans ; Laparoscopy* ; Length of Stay ; Lymph Node Excision* ; Lymph Nodes ; Male ; Mortality ; Neoplasm Metastasis ; Quality of Life ; Stomach Neoplasms