No abstract available.
Colorectal Neoplasms* ; Humans

No abstract available.
Pancreas*

Intraductal papillary tumors of the breast exhibit bloody discharge with often no evidence of a palpable tumor, making discrimination between benign and malignant lesions sometimes difficult for pathologists and surgeons. So the technique used in removing the offending ductal system should be fully diagnostic, adequately therapeutic and cosmetically. Microdochectomy has been accepted treatment for intraductal papilloma of the breast. We performed dye-injection microdochectomy on intraductal papilloma of the breast in 15 patients. This procedure utilizes lacrimal probe and 24-gauge medicut that are gently advanced into the offending duct and methylene blue dye is injected to outline the involved duct for easy dissection through a circumareolar incision. Because we could perform dye-injection microdochectomy safely, rapidly and effectively, we think that this procedure is standard treatment of intraductal papilloma of the breast.
Breast* ; Discrimination (Psychology) ; Humans ; Methylene Blue ; Papilloma, Intraductal*

BACKGROUND: Intraductal papillary tumors of the breast exhibit bloody discharge, often with no evidence of a palpable tumor, making discrimination between benign and malignant lesions sometimes difficult for pathologists and surgeons. Thus the technique used in removing the offending ductal system should be fully diagnostic, adequately therapeutic and cosmetically. Microdochectomy has been the accepted treatment for intraductal papillomas of the breast. METHODS: We performed dye-injection microdochectomy on intraductal papillomas of the breast in 15 patients. This procedure utilize a lacrimal probe and 24-gauge medicut that were gently advanced into the offending duct, and methylene blue dye was injected to outline the involved duct for easy dissection through a circumareolar incision. Also a visual check was made as the duct filled with eye. With careful dissection as far as the base of the nipple and good hemostasis, the suspicious duct was easily isolated and then dissected along its entire length and removed with a small cone of the breast tissue surrounding the duct. RESULTS: The peak incidence was in the 3rd and the 4th decades (67%). Among the 15 patients operated on for an intraductal papilloma, 7 (47%) had bloody discharge, 2 (13%) were serous, 2 (13%) were yellowish and 4 (26.7%) had both bloody dischrage and mass. Microdochectomy was performed under general anesthesia in 12 (80%). There were single papillomas in 9 (60%) and multiple papillomas in 6 (40%). Postoperative complication was seroma in the wound in 1case (7%). CONCLUSIONS: Because we could perform dye-injection microdochectomy safely, rapidly, and effectively, we think that this procedure should be a standard treatment for intraductal papilloma of the breast.
Anesthesia, General ; Breast* ; Discrimination (Psychology) ; Hemostasis ; Humans ; Incidence ; Methylene Blue ; Nipples ; Papilloma ; Papilloma, Intraductal* ; Postoperative Complications ; Seroma ; Wounds and Injuries

PURPOSE: To correlate the atypical sonographic patterns of fibroadenoma of the breast with the pathologicfindings. MATERIALS AND METHODS: Among 203 surgically proven 43 which were sonographi-cally atypicalfibroadenomas, were retrospectively reviewed. The diagnostic criteria for atypical va riety, as seen onsonography, were an ill-defined margin, microlobulated or irregular shape, heterogeneous internal echo-pattern,posterior shadowing, micro-calcification, and clefts. The atypical sonographic patterns of these 43 fibroadenomaswere analysed and compared with the pathologic findings. RESULTS: Among 43 lesions, ill-defined margins orirregular shapes were seen in 15 c a s e s, heterogeneous internal echo-patterns in 27, posterior attenuation innine, and clefts in seven. Thirty-seven (86%) of the 43 were predominantly ductal or hada mixed ductal and stromalcomponent. Eleven (73.3%) of fifteen ill-defined margin or irregular shaped lesions were caused by interdigitationof surrounding normal breast parenchyma and mass. Twenty two (81.5%) of 27 heterogeneous internal echo-pat-ternswere related to dilated ducts, phyllodes features, collagen bundles, adenosis, mi-crocalcification, or fatvacuoles. Eight (88.9%) of nine posterior attenuations were caused by collagen bundles, microcalcification, ductalproliferation or dilatation. All seven cases showing clefts revealed phyllodes features and dilated ducts. CONCLUSIONS: Most atypical fibroadenomas had a redominantly ductal or mixed component. Ill-defined margin orirregular shape was mainly due to interdigitation of normal surrounding parenchyma. Variable histologic featureswere related to the het-erogeneous internal echo-pattern, posterior shadowing, and the clefts revealed by atypicalsonographic findings.
Breast Neoplasms ; Breast* ; Collagen ; Dilatation ; Fibroadenoma* ; Retrospective Studies ; Shadowing (Histology) ; Ultrasonography*

PURPOSE: To define and correlate characteristic sonographic and pathologic findings in men with gynecomastia. MATERIALS AND METHODS: We reviewed medical records and sonographic findings of 26 patients with pathologically proven gynecomastia. All of the chief symptoms, physical findings and causes were categorized. Characteristic sonographic patterns of gynecomastia were analyzed and compared with pathologic findings. RESULTS: Gynecomastia was most common in the 20- to 40-year-old age group (50%) 6;palpable mass was found in 62% of all those cases. Gynecomastia was unilateral or asymmetrical in 22 men (85%), and was caused idiopathically in 21 (81%). The characteristic sonographic patterns correlated with pathologic findings were as follows : (1) focal subareolar smooth oval (or triangular) indistinct margined homogeneous hypoechoic(or isoechoic) patterns were found in 14cases (54%). Eight of these (57%) were of the florid type of gynecomastia (67%) ; (2) diffuse homogeneous hyperechoic (or isoechoic) patterns were found in five cases (19%) ; four of these (80%) were of the intermediate or fibrotic type : (3) involuting female breast parenchymal patterns were found in seven cases (27%), of which six(86%) were of the intermediate or fibrotic type. CONCLUSION: The characteristic sonographic patterns of gynecomastia correlate closely with pathologic types related to the duration of the condition. Ultrasonography isa useful primary diagnostic modality for the evaluation of gynecomastia.
Adult ; Breast ; Female ; Gynecomastia* ; Humans ; Male ; Medical Records ; Ultrasonography

PURPOSE: Endoscopic surgery is becoming more widely used because of its low invasiveness and cosmetic effect. However reports on its use in thyroid surgery are scarce particularly with regard to exploiting the advantage of eliminating the unattractive scars that are sometimes encountered in con ventional operations on the exposed anterior part of the neck. Thus, we applied this to thyroidectomy. METHODS: This clinical trial was conducted on a total of 29 patients hospitalized in our Department from December 1998 to August 1999. Our operation method was as follows. Three trochars were inserted, one at each circumareolar area on the breast (5 mm) and one in the skin between these (15 mm). Subplatysmal and subcutaneous operative space was created with CO2 insufflation at 6-7 mmHg from straight-line between two nipples to just below the thyroid gland. The thyroidal vessels and the parenchyma of the gland were dissected and divided using an ultrasonic scalpel and commonly used-laparoscopic instruments. RESULTS: The patients consisted of 25 females and 4 males. The anesthesia and operation time was 220 10.4 minutes and 165.7 9.4 minutes respectively. We had 4 cases of conversion to a conventional thyroidectomy because of uncontrolled intraoperative bleeding (1 case), technical failure (1 case) and thyroid carcinoma (2 cases). Postoperative complications occurred in 2 cases, injury of recurrent laryngeal nerve and severe anterior chest discomfort for 3 months. The average length of postoperative stay was 6.7 days. Operative scars were completely covered by clothes, and cosmetic results were excellent. CONCLUSION: With these results, the cosmetic effect may be regarded as the only strength of an endoscopic thyroidectomy but by going through more cases, this technique could be performed safely with the other advantages of endoscopic surgery such as shortened operation time and hospital stay, et al. We hope an endoscopic thyroidectomy will be another surgery of choice for most patients with thyroid disease.
Anesthesia ; Breast ; Cicatrix ; Female ; Hemorrhage ; Hope ; Humans ; Insufflation ; Length of Stay ; Male ; Neck ; Nipples ; Postoperative Complications ; Recurrent Laryngeal Nerve ; Skin ; Thorax ; Thyroid Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Ultrasonics

BACKGROUND/AIMS: Since the laparoscopic cholecystectomy has been introduced, minimally invasive techniques have been applied to the management of various intraabdominal lesions. Laparoscopic resection of benign gastric tumor has several advantages compared to open surgery; such as reduced postoperative discomfort, early hospital discharge and less complications. METHODS: We performed laparoscopic gastric resection for 6 benign gastric leiomyomas and 3 heterotropic gastric pancreases diagnosed by gastric endoscopy and did endoscopic ultrasonography routinely to find out the exact location of mass and depth of invasion. RESULTS: 1) Male to female ratio was 2: 7 and mean age was 48 years. 2) The masses were located at posterior wall of body in 5 cases, fundus in 2 cases, anterior wall of antrum in 1 case, and enterior wall of body, lesser curvature in 1 case. 3) Resection of benign gastric tumors were readily achieved laparoscopically, aided by disposable stapling instruments. 4) Mean operation time was 120 minutes and mean hospital stay was 5.1 days. CONCLUSIONS: The benign gastric tumors can be managed laparoscopically with good results and this procedure provides another choice for the resection of them.
Cholecystectomy, Laparoscopic ; Endoscopy ; Endosonography ; Female ; Humans ; Leiomyoma ; Length of Stay ; Male ; Pancreas

PURPOSE: Little is known about local recurrence following proximal gastrectomy in patients with upper third gastric cancer. We performed this study to evaluate the long-term results of a proximal gastrectomy, and to analyze the risk factors of local recurrence affecting survival in these patients. MATERIALS AND METHODS: We undertook a retrospective study of 63 patients who underwent potentially curative proximal gastrectomy between 1990 and 1999, with special reference to local recurrence. RESULTS: During a median follow-up period of 37 months, 25 of the 63 patients (39.7%) developed a recurrence of cancer, with local recurrence in 15 patients (23.8%), the majority of these occurring at the remnant stomach or anastomosis. The median time to local recurrence was 38 months (8~78 months). Univariate analysis of risk factors for local recurrence revealed an infiltrative or diffuse gross type, with a tumor sizes>5 cm, a distal resection margin Diagnosis ; Follow-Up Studies ; Gastrectomy* ; Gastric Stump ; Humans ; Prognosis ; Recurrence* ; Reoperation ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms*

PURPOSE: The choice of surgical strategy for patients with adenocarcinoma of the upper one third of the stomach is controversial. This study was performed to analyze the surgical results of a 11-year experience with these lesions. MATERIALS AND METHODS: From January 1990 to December 2000, 259 patients with upper third gastric cancer underwent proximal gastrectomy (n=74) or total gastrectomy (n=185) through an abdominal approach. Morbidity, mortality, recurrence patterns, and survival were compared between these two groups retrospectively. RESULTS: There were no significant differences in general complication and mortality rates between the two groups. However, the incidences of reflux esophagitis (16.2%) and anastomotic stricture (35.1%) were more common in the proximal gastrectomy group compared with the total gastrectomy group (0.5 and 8.1%). Regarding the main patterns of recurrence, local recurrence was dominant in the proximal gastrectomy group, whereas distant recurrence was dominant in the total gastrectomy group. Five-year overall survival (54.8 versus 47.8%) and survival according to tumor stage were no different between the groups. Multivariate analysis showed that the extent of resection was not an independent prognostic factor. CONCLUSION: The extent of resection for upper third gastric cancer did not appear to affect long-term outcome. However, proximal gastrectomy is associated with an increased risk of reflux esophagitis, anastomotic stricture, and local recurrence.
Adenocarcinoma* ; Constriction, Pathologic ; Esophagitis, Peptic ; Gastrectomy* ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms ; Stomach*