No abstract available.
Colorectal Neoplasms*

Infantile hypertrophic pyloric stenosis (IHPS) a common childhood disorders characterized by nonbilious projectile vomiting, an olive shaped mass in the right upper quadrant of the abdomen and visible gastric peristaltic wave in the upper abdomen. Its etiology and pathogenesis are not clear but abnormal nerve distribution of the pylorus has been postulated2-6. We performed immunocytochemical staning to the pyloric muscle from 10 IHPS and 3 controls patients, utilizing specific monoclonal antibody to NCAM(neural cell adhesion molecule). In IHPS patients, the number of NCAM protein immunoreactive nerve fibers were less than that in normal subjects. Auerbach myenteric plexuse was well developed and interbundle nerve plexuse was present but nerve fibers supplying individual muscle cells in smooth muscle bundles were poorly developed. These results indicate reduction of innervation in smooth muscles in IHPS patients that possibly contributes to the pathogenesis of IHPS.
Abdomen ; Cell Adhesion ; Humans ; Muscle Cells ; Muscle, Smooth ; Myenteric Plexus ; Nerve Fibers ; Neural Cell Adhesion Molecules ; Olea ; Pyloric Stenosis, Hypertrophic* ; Pylorus* ; Vomiting

Microcystic adenoma, also known a glycogen rich or serous cystadenoma is very rare and usually presents grossly a large multiloculated mass, and the individual cystic cavities being small and filled with a clear(serous) fluid. The cut surface is spongy in appearance. Microscopically, cysts are composed of multiple small cysts lined by small, flat or cuboidal cells containing abundant glycogen but only an insignificant amount of mucin. The microcystic cystadenoma is benign, but mucinous cystadenoma is potentially malignant,so the two cysts should be differentiated, and should never be treated by-pass sugery in the case of mucinous cystadenoma. A 43-year-old female was admitted to this hospital with the palpable epigastric mass, postprandial nausea and weight loss for the preceeding 2 years, and increase in size in the past recent 8 months. Upper G.I series and ultrasonographic studies revealed a huge mass in the pancreatic head portion. Exploratory laparotomy was performed, which disclosed a round adult fist sized multicystic mass in the pancreatic head. Pancreaticoduodenectomy was performed. In gross specimen examination, the mass was 9x7.5x7 cm in size, the outer surface was smooth and grayish white, the cut surface was sponge- like with multiple small cysts. The content of cysts was serous fluid. Microscopically, the cystic mass was composed of small cysts, in which the lining of the cell shows flat and mild secretory activity. There was no malignant evidence. The patient was discharged uneventfully on the 22nd postoperative days.
Adenoma* ; Adult ; Cystadenoma ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Female ; Glycogen ; Head ; Humans ; Laparotomy ; Mucins ; Nausea ; Pancreas* ; Pancreaticoduodenectomy ; Weight Loss

BACKGROUND: Almost all cholecystectomies these days are performed using laparoscopic equipment. Recently, this has been applied in all possible pathologies of the gallbladder by many surgeons. However, we occasionally have had bitter experiences, difficult operations and long operative times, when doing laparoscopic cholecystectomies. The aim of this study was to detect the factors causing long operative times, conversions to open surgery, and higher postoperative complication rates, when difficult laparoscopic cholecystectomies are encountered. METHODS: From among the 250 patients who had undergone laparoscopic cholecystectomies during the recent 5 years (from November 1992 to January 1998), the clinical data of the 58 patients who had undergone laparoscopic cholecystectomies with operative times over 120 minutes (a long operative time) were compared with those of 45 patients with operative times of 60 minutes or less (short operative time). RESULTS: Clinical data for the patients with long operative times showed a higher incidence of steady pain (29.3 versus 0%), fever (36.2 versus 4.4%), previous history of upper abdominal surgery (6.9 versus 4.4%), tenderness (48.3 versus 4.4%), rebound tenderness (20.0 versus 0%), palpable tender mass (12.1 versus 0%), thick abdominal wall (13.8 versus 4.4%), leukocytosis (36.2 versus 8.9%), elevated bilirubin level (10.3 versus 0%), wall thickening of the gallbladder (34.5 versus 6.7%), fibrous adhesion after gastric surgery (5.1 versus 0%), inflammatory adhesion (39.7 versus 2.2%), and contracted gallbladder (1.2 versus 0%), as well as a higher required level of surgical experience (5.2 versus 2.2%). The surgical complication rate was 13.8% in the long-operation group and 0% in the short-operation group. Laparoscopic cholecystectomy was completed successfully in 250 of the 258 patients and the overall conversion rate to open surgery was 3.1%; that of the long-operation group was 7.9%. CONCLUSIONS: A laparoscopic cholecystectomy with a long operative time is inevitable in patients with acute severe inflammation of the gallbladder, previous history of gastric surgery, and a contracted gall-bladder. Also, the surgeon needs a learning period to be able to overcome the long operation. In spite of the higher rates complications and conversions to open surgery in the long-operation group, a difficult laparoscopic cholecystectomy with a long operative time is a clinically acceptable procedure in patients who need a cholecystectomy.
Abdominal Wall ; Bilirubin ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Fever ; Gallbladder ; Humans ; Incidence ; Inflammation ; Learning ; Leukocytosis ; Operative Time* ; Pathology ; Postoperative Complications

Proton magnetic rcsonance spectroscopy (1H MRS) has demontrated its abilities to detect an increase of choline containing compounds (Cho) in various brain tumors and prostatic cancer tissues. Based on preclinical works done by other authors using multinuclei MRS, it is reasonable to assume malignant breast tumors will have elevated level of Cho compared to that of normal tissues and benign breast lesions. Several challenges must be met to obtain clinically useful 1H breast spectrum. Good water and fat suppression, Bo homogeneity are required to detect low level metabolic signals like choline if any. In this study, we investigated the clinical utility of 1H MRS with simultaneous suppression of water and fat signals, using breast imaging surface coil for evaluating breast cancer with small lesions. All studies were performed using a GE signa MRI unit (1.5 T, Ver 5.5) and 2-channel breast coil (GE). Water suppression was achieved by chemical selective saturation, and fat signal was attenuated using inversion recovery sequence. Spectroscopic data were acquired with PRESS sequence. Twenty-three patients, age 14-75, were examined. Eleven of these patients presented with invasive ductal carcinoma. The remaining patients presented with benign processes including fibroadenoma, fibrocystic change, galactocele, adenosis, ductal ectasia and dystrophic calcification. The size of lesions were variable (8-90 mm in diameter). Choline at 3.25 ppm was visible in the spectra of all cancer patients, while invisible in the spectra of all benign lesions except a lesion of dystrophic calcification. We concluded that in vivo detection of choline containing compounds in breast carcinomas using proton magnetic resonance spectroscopy demonstrated its potential as a noninvasive tool for differential diagnosis of malignant and benign breast lesions larger than 7 mm in diameter.
Brain Neoplasms ; Breast Diseases* ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Choline ; Diagnosis, Differential* ; Dilatation, Pathologic ; Fibroadenoma ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Prostatic Neoplasms ; Protons* ; Spectrum Analysis ; Water

A case of a small cell carcinoma of the stomach is reported. A small cell carcinoma of the stomach is a very rare disease. Preoperative diagnosis is very difficut. The prognosis of this disease is very poor compared with the common type of gastric carcinoma. Considering the poor prognosis of this particular disease, adjuvant chemotherapy might be mandatory in all cases even when a surgically curative resection is perfomed. A 63-year-old male was referred to our hospital for elective surgery for gastric cancer, which is located in the cardia. A total gastrectomy and splenectomy with D4 systematic lymph node dissection were perfomed. The serosal layer was invaded. The metastases were found in the number 1, 7, 8, and 12 lymph node. Thirteen of the 62 dissected nodes were positive. Other organs were grossly intact. The tumor cells were show small-sized cells with hyperchromatic nuclei and scanty cytoplasms, and were arranged in solid nests. No glandular differentiation was observed in the tumor itself. Postoperative adjuvant chemotherapy was perfomed with etoposide and carboplatin. The patient has been followed up for 10 months he appears to be relatively healthy and is doing well, but the prognosis is expected to be poor.
Carboplatin ; Carcinoma, Neuroendocrine ; Carcinoma, Small Cell* ; Cardia ; Chemotherapy, Adjuvant ; Cytoplasm ; Diagnosis ; Etoposide ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Rare Diseases ; Splenectomy ; Stomach Neoplasms ; Stomach*

BACKGROUND : There are plenty of documented observations of gastric cancer patients having suppressed cellular immunity, and this immunity may be correlated to recurrence. We studied the changes in the peripheral T-lymphocyte subpopulations in gastric cancer patients and their predictive roles for recurrence. METHODS : Lymphocyte subpopulations in peripheral blood from thirty-eight gastric cancer patients who were operated on at Taegu Catholic Medical Center from September 1995 to February 1997 were measured by 3-color direct immunofluorescence analysis with a Coulter S-plus IV automatic counter. RESULTS : CD4 significantly increased with tumor size and depth of invasion although other immune parameters, such as CD8, CD19, the CD4/CD8 ratio, and total lymphocyte count did not changed. In the patients with lymph-node metastasis, increases in CD3 and CD4 and a decrease in CD19 were observed. CD19 and the B lymphocyte count also decreased in advanced gastric cancer patients. However, T-lymphocytes subpopulations did not significantly change with stage. There were significant decreases in CD8 and in the T- & B-lymphocyte counts, without changes in CD4 and the CD4/CD8 ratio in the postoperative immune parameters.The preoperative values of the T- & B-lymphocyte counts and CD8 and CD19 were lower in patients who had recurrences during six months to two years of follow up, compared to recurrence-free patients. CONCLUSIONS : On the basis of these results, we found changes of T-lymphocyte subpopulations with size, depth of invasion, and regional lymph node metastasis, but not with stage. Postoperatively, there were significant decreases in the T- & B-lymphocyte counts. Suppressed immunity correlated with recurrence, and preoperative evaluation of peripheral T-cell subpopulations may be helpful for predict recurrence and for postoperative prognosis.
B-Lymphocytes ; Daegu ; Fluorescent Antibody Technique, Direct ; Follow-Up Studies ; Humans ; Immunity, Cellular ; Lymph Nodes ; Lymphocyte Count ; Lymphocyte Subsets* ; Lymphocytes* ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Stomach Neoplasms* ; T-Lymphocytes

BACKGROUND : Fibronectins (FNs) are adhesive glycoproteins that have variable primary structures owing to cell type-specific splicing of the FN precursor mRNA. FNs can be classified as plasma (p-FN) and cellular (c-FN) types, and c-FN may play a role as a marker of malignancies. CEA and CA 125 have been reported as useful tumor markers, but FNs have not studied adequately in gastric cancers. METHODS : We evaluated the clinical significance of urinary and plasma c-FN in thirty-five patients who were operated on our department due to gastric cancer from January 1997 to August 1997. The c-FN level was determined by enzyme immunoassay using a FIBRONECTIN EIA kit (Takara Shuzo Co., Kyoto, Japan). RESULTS : The levels of urine c-FN in gastric cancer patients (215.6 470.2) were higher than those in the control groups (94.1 63.0 ng/mgCr) and also showed a tendency to increase with advancing of tumor growth. A higher rate of increased urine c-FN also was identified in patients with distant metastasis than in patients without distant metastasis (6/8 vs. 10/27, p=0.05). However, p-FN didn't showed any differences according to extent of tumor invasion and/or presence of distant metastasis. Other parameters, such as age, sex, preoperative tumor size, and depth of invasion, were not correlated with urine and plasma c-FN. CONCLUSIONS : Urine c-FN may be useful as a new tumor marker in gastric cancer and can be helpful in early detection of metastasis and peritoneal seeding, but further studies and follow up are needed for complete clinical application.
Adhesives ; Biomarkers, Tumor ; Fibronectins* ; Glycoproteins ; Humans ; Immunoenzyme Techniques ; Neoplasm Metastasis ; Plasma ; RNA, Messenger ; Stomach Neoplasms*

We report various causes of acute abdominal aortic occlusion, a condition which is infrequent but usually ends catastrophically. The three cases are embolic occlusion by myxoma, thrombotic occlusion of aortic aneurysm, and thrombosis of an atherosclerotic aorta; the first two causes are very rare clinical presentations. All patients showed leg paralysis, pain, and severe ischemic symptoms. Diagnosis was done by emergent-CT (computed tomography) scan and surgery was performed urgently. Nevertheless, all patients died in the early postoperative period. As acute aortic occlusion is infrequent, its diagnosis may be delayed. The mortality rates remains high even with urgent surgical care.
Aorta ; Aorta, Abdominal* ; Aortic Aneurysm ; Diagnosis ; Humans ; Leg ; Mortality ; Myxoma ; Paralysis ; Postoperative Period ; Thrombosis

PURPOSE: Free radicals are defined as any species capable of independent existence that contains one or more unpaired electrons and they have the effects on carcinogenesis and tumor progression by causing mutations on genetic structure or suppressing repair of mutated DNA. This study was aimed to identify changes of antioxidant capacity in carcinogenesis and tumor progression of colorectal cancer (CRC). METHODS: We studied the level of serum antioxidant capacity using ABTS technique for 34 CRC patients who were operated between July 1997 and January 1998 at department of surgery, Taegu Catholic Medical Center and compared with 38 persons who had normal value of liver function during the same period. RESULTS: CRC patients showed decreased serum antioxidant capacity level compared to that of control group (CRC male 1.23 0.15 mmol/L, CRC female 1.11 0.13 mmol/L, control male 1.40 0.15, control female 1.35 0.11 mmol/L). Changes of antioxidant capacity levels were not correlated with stages, even though the marginal difference between T-stages (T1/2 1.23 0.10 mmol/L, T3/4 1.16 0.15 mmol/L). CONCLUSIONS: Free radicals may be the causative agent of colorectal carcinogenesis and can be associated with early phase of carcinogenesis rather than tumor progression.
Carcinogenesis ; Colorectal Neoplasms* ; Daegu ; DNA ; Female ; Free Radicals ; Genetic Structures ; Humans ; Liver ; Male ; Reference Values