No abstract available.
Colorectal Neoplasms*

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

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

Vascular malformations are known by several names, such as angiodysplasia, vascular ectasia, arteriovenous malformation, and telangictasia. Arteriovenous malformations may occur anywhere in the gastrointestinal tract. The large intestine is the most commonly involved location, usually on the right side. Arteriovenous malformations, which consist of enlarged, tortuous and dilated, often thin-walled blood vessels, usually occur in the submucosa or mucosa. Occasionally, they can cause recurrent and even massive hemorrhage. The authors treated a case of angiodysplasia in the upper jejunum, which caused massive bleeding. A 67-year-old female patient was admitted because of massive lower gastrointestinal bleeding. The bleeding point was found by angiography, injection of methylene-blue dye, and intraoperative endoscopy. The bleeding lesion in jejunal segment was resected, and end-to-end anastomosis was performed. The postoperative course was uneventful, and the patient was discharged on the 10th postoperative day.
Aged ; Angiodysplasia ; Angiography ; Arteriovenous Malformations ; Blood Vessels ; Dilatation, Pathologic ; Endoscopy ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Intestine, Large ; Jejunum* ; Mucous Membrane ; Vascular Malformations*

Appendicitis is the most common acute abdominal condition that requires an operation during pregnancy. Variable clinical presentations in pregnant women make the diagnosis of acute appendicitis difficult, delay operative intervention, and cause many fetal or maternal complications. From January 1990 through December 1996, 36 appendectomies were performed on pregnant women at our hospital. This is a retrospective analysis of our cases compared to control group. 1. Thirty six pregnant women (0.1 %) from all labor cases during this period underwent appendectomies, representing 10.3 % of all appendectomies in women of childbearing age. 2. The age distribution was 21-25 (38.9 %), 26-30 (55.6 %) and 31-35 (5.5 %) years, which was similar to the age distribution of the non-pregnant group. 3. Acute appendicitis during pregnancy was most common in the spring. 4. No significant difference in the occurrences of various symptoms between the pregnant and the non-pregnant groups was observed. 5. The pregnant patients visited our hospital earlier, but underwent operations later, than the non-pregnant women. (p < 0.05) 6. An increase in the WBC count to above 15,000/mm3 was more common in the pregnant patients with appendicitis.(p < 0.05) 7. The appendix was normal in 22.2 % of the appendectomy cases during pregnancy; however, no significant difference in diagnostic accuracy was observed between pregnant and non-pregnant groups. (p > 0.05) 8. No significant differences between the pregnant and the non-pregnant groups were noticed in terms of operation time and types of anesthesia. (p > 0.05) 9. The wound infection rates were similar for the pregnant (16.7 %) and the non-pregnant (17.4 %)groups, but there were 3 fetal losses (8.3 %)from pregnant patients after their appendectomies. 10. The mean hospital stay was longer for the pregnant patients (7.6 days) than for the non-pregnant group (6.2 days).
Age Distribution ; Anesthesia ; Appendectomy* ; Appendicitis ; Appendix ; Diagnosis ; Female ; Humans ; Length of Stay ; Pregnancy ; Pregnant Women* ; Retrospective Studies ; Wound Infection

A patient with mucin hypersecreting papillary adenocarcinoma of intrahepatic bile duct had jaundice and symptoms of cholangitis. Radiologic evaluations-ultrasonography and computerized tomographyrevealed passage disturbance of bile at the level of the distal common bile duct or ampulla of Vater. But, primary lesion was located at left intrahepatic duct proximal to the ductal dilatation. This peculiar phenomenon confused clinicians. A 59-year-old man was referred to our hospital for evaluation of recurrent cholangitis. Ultrasonogram, computerized tomogram and endoscopic retrograde cholangiography disclosed dilatation and amorphous filling defect extending from left intrahepatic bile duct to common bile duct suggesting choledochal cyst(type IVa). Preoperative endoscopic examination showed spillage of mucin through duodenal papilla. Abdominal exploration revealed mucin hypersecreting papillary adenocarcinoma of left intrahepatic duct and dilated distal common bile duct filled with tenacious mucin. Left hepatic lobectomy and Roux-en-Y hepaticojejunostomy were performed.
Adenocarcinoma ; Adenocarcinoma, Papillary* ; Ampulla of Vater ; Bile ; Bile Ducts, Intrahepatic ; Cholangiography ; Cholangitis ; Common Bile Duct ; Dilatation ; Humans ; Jaundice ; Middle Aged ; Mucins* ; Ultrasonography

BACKGROUND: The aim of present study is to define the relationship of microvessel density to clinicopathologic data, the recurrence rate and the overall survival in patients with gastric carcinomas. METHODS: Sixty-two patients with gastric carcinomas who underwent a gastrectomy at Yeungnam University Hospital during one year (January to December 1991) were evaluated. Immunohistochemical staining with the factor VIII-related antigen (Dako, USA) was used to assess of angiogenesis. RESULTS: Microvessel counts increased in proportion to lymph-node metastases, perineural invasion, and lymphatic invasion. Histologic type, primary tumor invasion, stage and distant metastasis did not correlate statistically with microvessel counts. The microvessel counts increased with higher pathologic stages, but the difference was not statistically significant. The microvessel counts were significantly higher in the group with LN metastasis than in those without LN metastasis (p<0.05). In advanced gastric cancer patients, the microvessel counts were significantly increased (p<0.05). In patients with high microvessel counts (> or =62), the overall 5-year survival rate was shorter than in those with low microvessel counts (<62), but the difference was not statistically significant. The microvessel counts were higher in the group with recurrence than in those without recurrence. CONCLUSIONS: On the basis of these results, microvessel count may be a prognostic indicator of gastric carcinomas.
Adenocarcinoma ; Gastrectomy ; Humans ; Microvessels ; Neoplasm Metastasis ; Recurrence ; Stomach ; Stomach Neoplasms ; Survival Rate ; von Willebrand Factor

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*