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

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*

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

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

Laparoscopic cholecystectomy is now the treatment of choice for the surgical treatment of uncomplicated cholelithiasis. Application of this rule in acute cholecystitis is still controversal, in spite of the eagerness of the experts in the field of laparoscopic surgery.The role of a laparoscopic cholecystectomy in patients with acute cholecystitis was evaluated by comparing clinical data from a laparoscopic cholecystectomy group with those from an open cholecystectomy group.Clinical data for 24 patients with acute cholecystitis who underwent a laparoscopic cholecystectomy in the mid 1990, were compared with data for 31 patients with acute cholecystitis who went through an open cholecystectomy in the early 1990s. Preoperative clinical data showed no statistical difference between the laparoscopic cholecystectomy group and the open cholecystectomy group. The operating time, the postoperative hospitalization, the duration of drainage, and the returning time of intestinal motility were shorter in laparoscopic cholecystectomy group, and the incidence of wound infection was lower. However, the incidence of bile duct or bowel injury was larger in the laparoscopic cholecystectomy group. Laparoscopic cholecystectomy can be performed safely in most patients with acute cholecystitis, in spite of the difficulties in observation, traction and dissection, which can be overcome with complete understanding, confirmation of the biliary anatomy, and sufficient experience.
Bile Ducts ; Cholecystectomy* ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute* ; Cholelithiasis ; Drainage ; Gastrointestinal Motility ; Hospitalization ; Humans ; Incidence ; Traction ; Wound Infection

PURPOSE: The purpose of this study is to measure the diameter of saphenofemoral junction (SFJ) by using duplex scan and to assess the different anatomic characteristics of SFJ according to the clinical manifestation. METHODS: 100 Limbs of 77 patients with varicose veins due to greater saphenous vein (GSV) were assessed prospectively about sex, symptom, disease duration, morphology of varicose vein. The diameter of GSV (GSVD), SFJ, femoral vein (FVD) and the ratio of each value-GSV/FV (GFDR) and SFJ/FV (JFDR)-were measured by color-flow duplex scanning. Findings were compared with clinically normal 20 control limbs. RESULTS: The mean value of GSVD, FVD, SFJ, GFDR, JFDR in patients group were different from that of control group with statistical significance except FVD. There were statistically significant differences in the mean value of GSVD, FVD, GFDR, JFDR between men and women. The mean value of GSVD, FVD, SFJ, GFDR, JFDR between symptomatic and asymptomatic group were not different statistically. The result of comparison according to the disease duration showed statistically significant difference, which the more duration of disease were longer, the more the mean value of SFJ were increased. In comparison of the findings according to the morphologic classification, there were no statistically significant differences in the mean value of GSVD, FVD, SFJ, GFDR, JFDR. CONCLUSION: Dilatation of SFJ may be related to the cause of varicose veins from the result that the mean value of SFJ was more increased in patients group than control group.
Classification ; Dilatation ; Extremities ; Female ; Femoral Vein ; Humans ; Male ; Prospective Studies ; Saphenous Vein ; Varicose Veins*

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

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