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*

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: 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*

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: 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: Although there is an increasing incidence of upper third gastric cancers, the appropriate extent of resection for upper third gastric cancer is not known. This study was performed to analyze a 9-year experience with upper third gastric adenocarcinomas from one institution treated by either total gastrectomy (TG) or proximal gastrectomy (PG). METHODS: The records and survival data of 158 upper third gastric cancer patients who underwent curative TG (n=106) or PG (n=52) through an exclusively abdominal approach were retrospectively analyzed. RESULTS: There was no significant difference in age, sex, tumor gross type, tumor differentiation, and stage between the groups who underwent TG and those who underwent PG. In addition, there were no significant differences in hospital mortality, overall 5-year survival, and disease-free survival rates between PG and TG group. However, PG group showed higher rates of postoperative reflux esophagitis and anastomosis stricture than TG group. Regarding the main patterns of recurrence, local recurrence was dominant in PG group, whereas distant recurrence was dominant in TG group. CONCLUSION: The extent of resection for upper third gastric cancer does not affect long-term outcome, and both procedures can be accomplished safely. When the cancer is confined to upper third of the stomach without serosal invasion, PG combined with antireflux procedures can be indicated.
Adenocarcinoma ; Constriction, Pathologic ; Disease-Free Survival ; Esophagitis, Peptic ; Gastrectomy ; Hospital Mortality ; Humans ; Incidence ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach ; Stomach Neoplasms*

This study was undertaken to identify the causative factors that predispose to early postoperative intestinal obstructions after the radical resection due to colorectal cancer, and to determine their preventive operative techniques. The records of 722 patients that had undergone radical resection due to colorectal cancer at the Department of General Surgery, Kangbuk Samsung Hospital, between January 1, 1986 and December 31, 1995, were reviewed. Among them, operative treatments due to early postoperative intestinal obstructions were performed in 39 patients(5.4%). The most common cause of intestinal obstruction in early postoperative period was bowel adhesion, that was developed in 20 cases(51.3%), and next common cause was internal herniation of bowel into the space between colostomy loop and lateral peritoneal wall(3 cases, 7.7%), incarcerated herniation of small bowel into the reperitonealized pelvic cavity(3 cases, 7.7%), pelvic abscess(1 case, 2.6%), and unknown causes(9 cases, 23.1%) in descending frequency. Use of closed suction drains was responsible to development of the 3rd and 4th causes. As a result, during the radical resection due to colorectal cancer, meticulous manupulation of bowels not to injure the bowel serosa, reperitonealization of pelvic floor at narrow interval with inversion of its dissected edge, complete closure of the space between colostomy loop and lateral wall of peritoneum, and adequate alternative use of closed suction drain and natural drain according to the operative condition, should be considered. In conclusion, surgeons should pay more attention to the operating procedures to lower the incidence of early postoperative intestinal obstruction.
Colorectal Neoplasms ; Colostomy ; Humans ; Incidence ; Intestinal Obstruction* ; Pelvic Floor ; Peritoneum ; Postoperative Period ; Serous Membrane ; Suction