No abstract available.
Pancreatic Pseudocyst*

Acute appendicitis is a common disease, in general, but is rare in the elderly. This report is a clinical review of 148 patients over the age of 60 who, due to acute appendicitis, underwent appendectomies at the Department of General Surgery of Saint Columban Hospital from January 1993 to December 1995. The results are as follows: 1) The overall percentage of the patients over the age of 60 was about 16.4%. 2) The male to female ratio was 1:1.6. 3) The perforation rate was 33.1%. 4) The mean duration of symptoms were 2 days in non-perforated and 4.5 days in perforated appendicitis. 5) The chief complaints were pain (86.5%) and tenderness (88.5%) on right lower quadrant. 6) This disease occurred most frequently in spring and summer. 7) The highest incidence of leukocyte count was 10,000~15,000 per cubic mm of blood (50%). 8) The most frequent postoperative complication was wound infection as 14.2%. 9) sixty-seven cases (45.3%) were accompanied by concomitant disease, the most frequent being hypertention (14.9%). 10) The mean numbers of hospital days were 7.5 in non-perforated and 14 in perforated appendicitis.
Aged ; Appendectomy ; Appendicitis* ; Female ; Humans ; Incidence ; Leukocyte Count ; Male ; Postoperative Complications ; Saints ; Wound Infection

BACKGROUND/AIMS: Intrahepatic cholangiocarcinoma, which has been defined as a primary adenocarcinoma from the intrahepatic bile ducts distal to the second-order branch of the main hepatic ducts, has a poor prognosis against various treatment modalities. We analyzed the clinical characteristics of intrahepatic cholangiocarcinomas and evaluated the outcomes of surgical treatment. METHODS: Forty five cases of microscopically-proven intrahepatic cholangiocarcinoma during 8 and a half year period from January 1993 to june 2001 were reviewed. RESULTS: They comprised 29 men and 16 women with an average age of 54.3 years (range: 34 to 76 years). The overall incidence of intrahepatic cholangiocarcinoma in association with hepatolithiasis was 4~% and in this sutdy 17 out of 45 cases (37.8%) of intrahepatic cholangiocarcinoma was combined with intrahepatic stones. The incidence of accurate preoperative diagnosis was 56% due to low index of suspicion. The growth pattern of intrahepatic cholangiocarcinoma was mass-forming type in 32 cases, periductal infiltrative type in 9 cases, and intraductal growth type in 4 cases. CONCLUSION: Careful preoperative evaluation using computed tomography, ultrasonography, and angiography and a study of tumor markers for the possibility of a intrahepatic cholangiocarcinoma is necessary in risk groups with hepatolithiasis or clonorchiasis. Hepatric resection should be used in hepatolithiasis patients to improve the chance of survival.
Adenocarcinoma ; Angiography ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma* ; Clonorchiasis ; Diagnosis ; Female ; Hepatic Duct, Common ; Humans ; Incidence ; Male ; Prognosis ; Biomarkers, Tumor ; Ultrasonography

Sparganosis is a rare tissue-parasitic infestation caused by a plerocercoid tapeworm larva(sparganum), genus Spirometra. The most common clinical presentation of sparganosis is a palpable subcutaneous mass or masses. Fifteen simple radiographs and 10 ultrasonograms of 17 patients with operatively verified subcutaneous sparganosis were retrospectively analyzed to find its radiologic characteristics for preoperative diagnosis of sparganosis. The locations of the subcutaneous sparganosis were lower extremity, abdominal wall, breast, inguinal region and scrotum in order of frequency. The simple radiographs showed linear or elongated calcification with or without nodular elongated shaped soft tissue mass shadows in 8 patients, soft tissue mass shadow only in 2 patients and lateral abdominal wall thickening in 1 patient. But no specific findings was noted in 4 patients with small abdominal and inguinal masses. We could classify the subcutaneous sparganosis by ultrasound into 2 types: one is long band-like hypoechoic structures, corresponding to the subcutaneous tunnel-like tracks formed by migration of sparganum larva and the other is elongated or ovoid hypoechoic nodules, representing granulomas. Long band-like hypoechoic structures within or associated with mixed echoic granulomatous masses were noted in 6 patients and elongated or ovoid hypoechoic mass or masses were noted in 4 patients. In conclusion, sparganosis should be considered when these radiologic findings-irregular linear calcifications on simple radiograph and long ban-like hypoechoic structures on ultrasonography, corresponding to the subcutaneous tunnel-like tracks formed by migration of sparganum larva-are noted in the patients who have subcutaneous palpable mass or masses. And radiologic examination especially ultrasonography is very helpful to diagnose sparganosis.
Abdominal Wall ; Breast ; Cestoda ; Diagnosis ; Granuloma ; Humans ; Larva ; Lower Extremity ; Retrospective Studies ; Scrotum ; Sparganosis* ; Sparganum ; Spirometra ; Ultrasonography

Pancreatoblastoma is a rarely occurring malignant tumor in childhood, which has been reported less 60cases in the world. which is a kind of adenocarcinoma exhibiting solid encapsulating tumor. Its prognosis is better favorable than typical pancreatic cancer. We were experienced one case of pancreatoblastoma, the patient was a 8 years-old boy who was incidentally found by his parent because of left upper quadrant mass during having a bath without any previous medical history. His preoperative AFP level was elevated and his preoperative diagnosis was pancreatoblastoma by abdominal computed tomography. During laparotomy, the tumor was located between body and tail of pancreas, adhered to hilum of spleen and also surrounded by transverse mesocolon, displacing the arcade of mesocolic vessels. When dissecting the mesocolon from pancreatic tumor, superior mesenteric artery and gastroduodenal artery were embeded in the tumor. The patient underwent distal pancreatectomy and splenectomy after ligature and dividing of mid-colic vessel. After surgery, he was received six-cycle of combined chemotherapy. There is no evidence of recurrence and metastasis for nineteen months after surgery.
Adenocarcinoma ; Arteries ; Baths ; Child ; Diagnosis ; Drug Therapy ; Humans ; Laparotomy ; Ligation ; Male ; Mesenteric Artery, Superior ; Mesocolon ; Neoplasm Metastasis ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms ; Parents ; Prognosis ; Recurrence ; Spleen ; Splenectomy

PURPOSE: Intrauterine inflammation (IUI) is a leading cause of preterm delivery. Although matrix metalloproteinase-8 (MMP-8) and intercellular adhesion molecule-1 (ICAM-1) are known to be related with IUI, it has not been fully elucidated whether MMP-9 or ICAM-3 is associated with IUI. We performed this study to determine whether the levels of tumor necrosis factor-alpha (TNF-alpha), MMP-9 and ICAM-3 in umbilical cord blood of preterm infants are associated with chorioamnionitis, funisitis or bronchopulmonary dysplasia. METHODS: Eighty-two pairs of pregnant women and their preterm newborns <35 weeks gestation were enrolled. Levels of TNF-alpha, MMP-9 and ICAM-3 in umbilical cord blood were measured using immunoassays and compared with results of histological examination of placenta and clinical data of the study participants. RESULTS: The level of MMP-9 in umbilical cord blood was significantly associated with the presence of funisitis (P =0.007). The level of TNF-alpha in umbilical cord blood was significantly associated with the development of bronchopulmonary dysplasia (P =0.030). However, presence of chorioamnionitis or funisitis was not associated with development of bronchopulmonary dysplasia. With the establishment of receiver operating characteristic (ROC) curve, the best cut-off value for umbilical blood MMP-9 was 99.42 pg/mL in identification of funisitis. The area under a constructed ROC curve for prediction of funisitis was 0.847 (standard error, 0.112; 95% confidence interval, 0.750-0.917). CONCLUSION: Measurement of MMP-9 concentration in umbilical cord blood may be an alternative way to predict whether a preterm infant has been exposed to IUI. Further study with larger numbers of subjects will be necessary to elucidate the association between the presence of IUI and neonatal adverse outcome.
Bronchopulmonary Dysplasia ; Chorioamnionitis* ; Female ; Fetal Blood* ; Humans ; Immunoassay ; Infant, Newborn ; Infant, Premature ; Inflammation ; Intercellular Adhesion Molecule-1 ; Matrix Metalloproteinase 8 ; Matrix Metalloproteinase 9* ; Placenta ; Pregnancy ; Pregnant Women ; ROC Curve ; Tumor Necrosis Factor-alpha

Secretory carcinoma is an uncommon type of carcinoma and the only well-documented type that may arise in children and adults of both sexes. Secretory carcinomas do not occur with any particular frequency in any part of the breast. Usually, the primary symptom is a painless mass that may be present for years before biopsy. We encountered a case of a secretory carcinoma of the breast. The patient was a 34-year-old woman. She visited our hospital due to a painless mass located in the upper portion of the left breast in the direction of 11 o,clock and at a distance of 1 cm from the areola. On palpation, it showed a firm and fixed tumor mass. A secretory carcinoma was diagnosed based on excisional biopsy. The patient underwent an Auchincloss, modified radical mastectomy. Multistep cross sections showed an ill-defined brownish, white tumor mass with a gritty sensation and measuring 2.0 1.4 cm in size. Metastasis was found in 1 of 8 axillary lymph nodes. Compared with typical breast cancer, the prognosis is better, but a similar therapeutic strategy may be necessary.
Adult ; Biopsy ; Breast Neoplasms ; Breast* ; Child ; Female ; Humans ; Lymph Nodes ; Mastectomy, Modified Radical ; Neoplasm Metastasis ; Palpation ; Prognosis ; Sensation

PURPOSE: We performed this study to determine (1) whether the levels of inflammatory mediators, including matrix metalloproteinase-9 (MMP-9) and intercellular adhesion molecule-3 (ICAM-3), in gastric fluid (GF) in premature newborns are associated with those in amniotic fluid (AF) in their mothers and (2) whether the levels of the inflammatory mediators in newborn GF are associated with the presence of intrauterine inflammation (IUI). METHODS: Sixty-two pairs of pregnant women and their premature newborns born at <35 weeks' gestation by cesarean delivery were enrolled in this study. AF and newborn GFs were obtained during cesarean section procedures. Levels of MMP-9, ICAM-3, interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha) were measured and compared between the AF and newborn GFs in each dyad, according to the presence or absence of chorioamnionitis (CA), preterm prelabor rupture of membranes (PPROM), and preterm labor (PTL). RESULTS: The levels of MMP-9, ICAM-3, IL-6, IL-8, and TNF-alpha in newborn GF were significantly correlated with those in AF in each dyad. The premature newborns and their mothers with CA had significantly higher GF MMP-9, IL-8, and TNF-alpha levels than those without CA. Those with PPROM or PTL showed similar findings in terms of GF MMP-9, IL-8, and TNF-alpha levels. CONCLUSION: The newborn GF immediately after birth can be a useful alternative source of information on whether a premature infant has been exposed to IUI at the time of delivery.
Amniotic Fluid ; Cesarean Section ; Chorioamnionitis ; Female ; Humans ; Infant, Newborn* ; Infant, Premature ; Inflammation ; Interleukin-6 ; Interleukin-8 ; Matrix Metalloproteinase 9 ; Membranes ; Mothers ; Obstetric Labor, Premature ; Parturition ; Pregnancy ; Pregnant Women ; Rupture ; Tumor Necrosis Factor-alpha

Recently, a combination of a partial mastectomy, axillary dissection, and radiation has been accepted as therapy for early-stage breast cancer because various significant trials have demonstrated that the combination therapy and the radical mastectomy produce comparable actuarial survival rates. The authors reviewed the cases of 62 patients who were treated for stage I and II breast cancer, 22 with breast-preserving surgery (quadrantectomy, axillary dissection and latissimus dorsi myocutaneous flap) and 40 with a modified radical mastectomy at Pusan National University Hospital during the period of 2.5 years from January 1994 to June 1996. The results are as follows: 1) The mean age of the breast-preserving group was 44.8 years, and that of the modified radical mastectmy group was 51.2 years. 2) The mean size of tumor mass was 2.1 cm and 2.5 cm, respectively. The most frequent site was the upper outer quadrant in both groups. 3) According to TNM classification, 8 patients (36.4%) had stage I tumors and 12 patients (54.5%) had stage II tumors in the breast-preserving group. The respective numbers of patients were 8 (20.0%) and 31 (77.5%) in the modified radical mastectomy group. 4) In the breast-preserving group, the number of axillary lymph-node metastasis was 0 in 16 cases (72.7%), 1~3 in 5 cases (22.7%), and 4 in 1 case (4.6%). In the modified radical mastectomy group, the number was 0 in 23 cases (57.5%), 1~3 in 13 cases (32.5%), and 4 in 4 cases (10.0%). 5) In the breast-preserving group, a local recurrence developed in one case at 12 months after the operation, and a salvage mastectomy was done. In the modified radical mastectomy group, a local recurrence developed in two cases, one at 14 months and the other at 16 months after the operation, and a wide excision was done. 6) Complications associated with axillary dissection were impaired arm mobility, arm edema, seroma, and skin necrosis. However, complications were well treated with no difficulty. 7) The overall subjective cosmetic results in the breast-preserving group were excellent in 7 cases (31.8%), good in 12 cases (54.1%), fair in 3 cases (13.7%), and poor in 0 cases. Postoperative asymmetry of the nipple is a problem to be solved. 8) The fear of recurrence was observed in 10 cases (45.5%) in the breast-preserving group and in 18 cases (45.0%) in the modified radical mastectomy group. 9) The complications associated with radiotherapy in the breast-preserving group were transient radiation dermatitis, breast fibrosis, radiation pneumonitis, and limited motion of shoulder. Our review shows a high loco-regional control rate (95.5%) and a satisfactory cosmetic result (86.3%) in the breast-preserving group for early-stage breast cancer. Thus breast-preserving procedures seem to be acceptable alternatives to a modified radical mastectomy in highly selective group of patients with early-stage breast cancer.
Arm ; Breast Neoplasms* ; Breast* ; Busan ; Classification ; Dermatitis ; Edema ; Humans ; Mastectomy ; Mastectomy, Modified Radical* ; Mastectomy, Radical ; Mastectomy, Segmental ; Necrosis ; Neoplasm Metastasis ; Nipples ; Pneumonia ; Radiation Pneumonitis ; Radiotherapy ; Recurrence ; Seroma ; Shoulder ; Skin ; Superficial Back Muscles ; Survival Rate

Choledochal cyst may be defined as cystic dilatation of biliary tree, and prone to complications such as recurrent cholangitis, pancreatitis, choledocholithiasis, biliary cirrhosis, portal hypertension, cystic rupture and carcinoma. It is found usually in childhood(more than 60%). The clinical symptoms are characterized by abdominal pain, jaundice and a palpable abdominal mass. It can be diagnosed with abdominal US, abdominal CT, ERCP but the usefullness of ERCP is limited by its invasiveness. In 1977, Todani classified choledochal cyst to 5 types and many clinicians use this classification in these days. Principle of treatment is surgical excision due to its complication, so excision of the cyst with Roux-en- Y hepaticojejunostomy is common procedure. We retrospectivly reviewed 18 patients who were finally diagnosed as choledochal cyst from Jan, 1993 to June, 1998 at PNUH(Pusan National University Hospital). The ratio of female to male was 5 : 1, and their age distribution range from 3-day to 77-year old(less than 10-year old in 61.1%). Their chief complaints were abdominal pain(50.0%), jaundice( 38.9%), fever & chill(33.3%), palpable abdominal mass(22.2%) and symptomatic duration was less than 1 month in 72.2%. In laboratory findings; serum ALT level was elevated in 61.1%, ALP in 50.5%, Bilirubin in 38.9%. Almost all patients were diagnosed with US & CT, and preoperative diagnostic rate was 83.3%. According to Todani's classification; Type I was found in 11 patients(61.1%), Type II in 1(5.6%), Type IVa in 6(33.3%). Associated disease with choledochal cyst was found in nine patients; choledocholithiasis in four patients, cholangitis in two patients, pancreatitis in two patients, hepatitis in one patient. All patients were managed by operation; Cyst excision with Roux-en-Y hepaticojejunostomy in sixteen patients(88.8%), Cyst excision with Roux-en-Y choledochojejunostomy in one case(5.6%), Cyst excision with Roux-en-Y hepaticojejunostomy & T-tube choledochostomy in one case(5.6%). There was no anastomotic leakage and operative mortality, but pancreatitis(16.7%), cholangitis(11.1%), wound infection(5.6%) were complicated in the postoperative period. It is significant to have early diagnosis and early management such that we can expect better prognosis.
Abdominal Pain ; Age Distribution ; Anastomotic Leak ; Biliary Tract ; Bilirubin ; Child ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledochal Cyst* ; Choledocholithiasis ; Choledochostomy ; Classification ; Dilatation ; Early Diagnosis ; Female ; Fever ; Hepatitis ; Humans ; Hypertension, Portal ; Jaundice ; Liver Cirrhosis, Biliary ; Male ; Mortality ; Pancreatitis ; Postoperative Period ; Prognosis ; Rupture ; Tomography, X-Ray Computed ; Wounds and Injuries