BACKGROUND: Endoscopic Ultrasonography(EUS), a combination of endoscopy and ultrasonography is one of the most useful tools for diagnosis of digestive system diseases. EUS is useful in staging the primary tumor invasion and regional lymph node metastasis because of its ability to image the gut wall and adjacent structures in unique detail. We performed a study preoperatively for assessing the accuracy and limitation of EUS in gastric carcinoma. METHODS: In 75 patients(Male 54, Female 21, Mean age 62.3 years) with a gastric carcinoma confirmed by endoscopic biopsy, we performed EUS preoperatively. The results were compared with the postoperative histopathologic staging. RESULTS: 1) In assessing the depth of tumor invasion, EUS accuracy on depth of invasion was 76.0% and overstaging and understaging were 14.7% and 9.3%, respectively. 2) In assessing the lymph node metastasis, the accuracy rate of EUS was 65.3%. A rate of false-positive diagnosis was 27.3%, and a rate of false-negative diagnosis was 24.5%.3) In assessing the incidence of lymph node metastasis for each T stage, the involve rate was 10.5% in pT1, 36.4% in pT2, 95.7% in pT3, 100% in pT4. CONCLUSIONS: EUS is the most accurate diagnostic methods presently available to determine tumor infiltration depth and lymph node metastasis.
Biopsy ; Diagnosis ; Digestive System Diseases ; Endoscopy ; Endosonography* ; Esophagus* ; Female ; Humans ; Incidence ; Intestines* ; Lymph Nodes ; Neoplasm Metastasis ; Stomach* ; Ultrasonography

The orbital blowout fracture has been increasingly noticed due to trauma and traffic accidents. The diagnostic confirmation is early established by CT scan, but indication for surgical treatment, the technique for repair, and timing of repair are still controversial. The main symptoms of orbital fracture include diplopia, enophthalmos and hypesthesia in distributions of the infraorbital nerve. These are usually accompained by other symptoms such as emphysema of the eyelids, ptosis, epistaxis and ocular injury. Among these diplopia and enophthalmos are considered as main surgical indications. Especially operation is performed when the contractibility of extraocular muscle(EOM) is changed due to incarceration of EOM and persistent diplopia at straight forward gaze or downward gaze. Many theories for sugical repiar timing are insisted but at present the accepted timing for operation is posttraumatic 1-2 weeks. To prevent the fibrosis and atrophy of extraocular muscle from the incarceration of EoM due to orbital fracture is the indication of surgery. To estimate the optimal time to perform the operation, we checked the EOM contractivilty by electromyography before and after artificial muscle incareceration in the rabbit. The results were as follows. The differences in RMS(root mean square) and MRV(mean rectified voltage) were not shown before or after the artivicial incarceration of extraocular muscle until the 5th day of the surgery. But the RMS and MRV measurements performed on the 7th day decreased significantly and these decreases were sustained. According to the results of this experiment. if the incarceration of the extraocular muscle due to the orbital fracture is diagnosed, relieving the incarceration by surgery before the 7th day can prevent the change of EOM contractibility. It will provide significant benefit, in maintaining the normal functioin of the extraocualr muscle.
Accidents, Traffic ; Atrophy ; Diplopia ; Electromyography ; Emphysema ; Enophthalmos ; Epistaxis ; Eyelids ; Fibrosis ; Hypesthesia ; Orbit ; Orbital Fractures ; Tomography, X-Ray Computed

Adenosquamous carcinomas of the intestine are rare tumors, especially when they occur in the small bowel. We report a case of primary adenosquamous carcinoma of the proximal jejunum in a 66 year old woman with no underlying pathologic condition. The tumor mainly consisted of well differentiated squamous cell carcinoma showing keratin pearl and conspicuous intercellular bridges, and minor portion revealed well differentiated adenocarcinoma. The tumor seemed to have originated from the mucosal epithelium, invading the entire wall and metastasizing to the regional lymph nodes. Previous reports of adenosquamous carcinoma of the small intestine have been associated with metastatic disease from distant sites or intestinal duplication. In the colon, squamous cell differentiation have been seen in about 0.05% of adenocarcinomas and in 0.4% of adenomata. The pathogenesis of squamous cell carcinoma of the intestine is unknown, but some possible mechanisms are proposed. :1)malignant transformation of squamous cell epithelium in the submucosa, 2)aberrant differentiation of stem cells to squamous cell with subsequent malignant change, 3)squamous metaplasia of glandular cells with subsequent malignant change, 4)transformation of an adenosquamous into an epidermoid carcinoma.
Adenocarcinoma ; Aged ; Carcinoma, Adenosquamous* ; Carcinoma, Squamous Cell ; Cell Differentiation ; Colon ; Epithelium ; Female ; Humans ; Intestine, Small ; Intestines ; Jejunum* ; Lymph Nodes ; Metaplasia ; Stem Cells

BACKGROUND/AIMS: Electrohydraulic lithotrypsy(EHL) under cholangioscopic control has been performed for difficult bile duct stones. The percutaneous transhepatic approach is technically easy and useful in diagnosis and treatment of bile duct obstruction and stones. Biliary stenting with self expanding metal stent is gaining increasingly wider acceptance as a palliative treatment of bile duct obstruction. METHODS: Between Sep. 1994 and Sep. 1996, EHL under choledochoscopy by percutaneous transhepatic approach was performed in 30 cases(Male: 13, Female: 17). After PTBD with 7F pig tail catheter, the percutaneous transhepatic passage was dilated over guide wire with dilaters of increasing size up to 16Fr in 3-Sdays. In one week, after fistula had been estabilished, choledochoscopy was performed. RESULTS: (1) Mean age was 61.3 years. Mean stone number was 2.5. And mean stone size was 1.6 X 2.3 cm. (2) Com.plete removal of the stone was achieved in all patients(100%). (3) There were no serious complications. (4) In six cases, Endocoils were implanted with successful decompression of obstructions and simultaneous removal of biliary stones located at both side of stricutre. CONCLUSIONS: Percutaneous transhepatic choledochoscopy is easy and safe and assists in the diagnosis and treatment of biliary stricture and the management of difficult CBD stone.
Bile Ducts ; Catheters ; Cholestasis ; Common Bile Duct* ; Constriction, Pathologic ; Decompression ; Diagnosis ; Female ; Fistula ; Humans ; Palliative Care ; Stents

No abstract available.
Cartilage* ; Transplants*

Lung volume reduction surgery, resecting the most severely affected regions of emphysema, was designed to improve quality of life for selected patients with severe emphysema. We report a case of a 72 year old severe emphysema patient who received bilateral lung volume reduction surgery and showed marked improvement of quality of life and lung function.
Aged ; Emphysema* ; Humans ; Lung* ; Pneumonectomy* ; Quality of Life

Pathologic findings of scrub typhus have been characterized by vasculitis of the microvasculature of the involved organ resulting from a direct invasion by Orientia tsutsugamushi. We experienced a case of acute respiratory distress syndrome (ARDS) associated with scrub typhus. The case was proven by eschar and high titer of serum IgM antibody (positive at 1:1280). Open lung biopsy showed diffuse alveolar damage (DAD) in the organizing stage without evidence of vasculitis. Immunofluorescent antibody staining and polymerase chain reaction for O. tsutsugamushi failed to demonstrate the organism in the lung tissue. The patient expired due to progressive respiratory failure despite doxycycline therapy. Immunologic mechanism, without direct invasion of the organism, may participate in the pathogenesis of ARDS associated with scrub typhus.
Acute Disease ; Aged ; Case Report ; Fatal Outcome ; Female ; Human ; Infant, Newborn ; Pulmonary Alveoli/pathology ; Pulmonary Alveoli/injuries ; Respiratory Distress Syndrome/physiopathology ; Respiratory Distress Syndrome/pathology ; Respiratory Distress Syndrome/immunology ; Respiratory Distress Syndrome/complications* ; Scrub Typhus/physiopathology ; Scrub Typhus/pathology ; Scrub Typhus/immunology ; Scrub Typhus/complications* ; Vasculitis