Journal Detail Information

1

Cite

Share

Nesidioblastosis with Hyperinsulinemic Hypoglycemia in Adult.

Young Bin LEE ; Chul Nam KIM ; Tae Gil HUR ; Gi Hong KIM ; Myoung Soo LEE ; Surg Hyo CHANG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2004;8(3):202-205.

Nesidioblastosis is a term that describes the prolonged differentiation of islets of Langerhan's cells from the epithelium of the pancreatic duct. Nesidioblastosis is a primarily childhood disease, which is often associated with hyperinsulinemic hypoglycemia, but rarely found in adults. A 62-year-old man with hyperinsulinemic hypoglycemia complained of general weakness and mental change while fasting. Abdominopelvic CT, celiac angiography, intra-arterial calcium stimulation test and endoscopic ultrasonography did not reveal any tumor in the pancreas. A subtotal pancreatectomy (nearly 80% of pancreas was removed) was then carried out. He was diagnosed with nesidioblastosis inform the pathology after the operation. Herein, our experience of a 62-year-old Nesidioblastosis patient is reported.
Adult* ; Angiography ; Calcium ; Endosonography ; Epithelium ; Fasting ; Humans ; Hypoglycemia* ; Middle Aged ; Nesidioblastosis* ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pathology

2

Cite

Share

A Case of Metastatic Malignant Melanoma of the Gallbladder.

Tae Hoon KIM ; Jin Young JANG ; Min Gew CHOI ; Yoo Seok YOON ; Sun Whe KIM ; Yong Hyun PARK

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2004;8(3):198-201.

A metastatic melanoma is a ubiquitous tumor that spares no organ from metastases. Gastrointestinal involvement is a common occurrence in patients with a metastatic melanoma, and post mortem records have shown gallbladder involvement in about 15% of all gastrointestinal metastatic localizations. However, metastasis to the gallbladder as an isolated site is rare. Herein, an unusual case of a young man in whom a single metastatic gallbladder melanoma was the first and only metastatic site of the disease is reported. The clinical presentation, diagnosis, histopathology, prognosis and treatment of metastatic melanomas of the gallbladder are also reviewed.
Diagnosis ; Gallbladder* ; Humans ; Melanoma* ; Neoplasm Metastasis ; Prognosis

3

Cite

Share

Malignant Extragastrointestinal Stromal Tumor of the Gallbladder.

Chan Young KIM ; Kyu Yun JANG ; In Hee KIM ; Baik Hwan CHO

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2004;8(3):195-197.

The demonstration of CD 117 (KIT) expression in extragastrointestinal lesions has helped to validate extra-gastrointestinal stromal tumors. We report here on an exceedingly rare case of a malignant extragastrointestinal stromal tumor of the gallbladder. A 68-year-old male patient presented with a palpable and nontender mass occupying the entire right upper quadrant of his abdomen. The patient underwent open cholecystectomy. On gross examination, a firm, polypoid, 10x6 cm tumor protruded from the lumen of the gallbladder. Histologically, there were 88 mitotic figures per 10 high-power fields. The tumor cells were immunoreactive for CD 117, vimentin and CD 34. Immunostaining for CD 117 showed a dot-like staining pattern in about 20% of the tumor cell. The present case was an exceedingly rare entity occurring in the gallbladder, Currently, the patient is under follow-up for 6 months with no abnormal findings such as recurrence.
Abdomen ; Aged ; Cholecystectomy ; Follow-Up Studies ; Gallbladder* ; Gastrointestinal Neoplasms ; Humans ; Male ; Recurrence ; Vimentin

4

Cite

Share

A Case of Long-Term Survivor after Surgical Resection for Undifferentiated Embryonal Sarcoma of the Liver in Adult.

Young Min CHOI ; Dong Wook CHOI ; Sang Beom KIM ; Yoo Chul KIM ; Sun Hoo PARK

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2004;8(3):190-194.

An undifferentiated (embryonal) sarcoma of the liver (USL) is a rare and highly malignant hepatic neoplasm of mesenchymal origin. This tumor almost exclusively affects pediatric patients, with a poor prognosis. The highest incidence is noted in pediatric patients, usually from 5~10 years of age, but only 43 cases of USL have been reported in adults worldwide since it was first as a clinicopathological entity. With a USL in adults, most patients are known to have died within 1 year of diagnosis. The absence of specific symptoms, rapid tumor growth, normality of common tumor markers and the consequential delay in diagnosis often result in significant enlargement of the tumor, with a poor prognosis. Various therapeutic modalities have been attempted in adult patients, but only a few long-term survivors have been reported. Herein, our experience of a 42-year-old female patient who is still alive, 55 months after the first resection for a USL is reported.
Adult* ; Diagnosis ; Female ; Humans ; Incidence ; Liver Neoplasms ; Liver* ; Prognosis ; Sarcoma* ; Survivors* ; Biomarkers, Tumor

5

Cite

Share

Laparoscopic Cholecystectomy in Elderly Patients.

Man Sup LIM ; Sun Hyung JOO ; Samuel LEE ; Chan Heun PARK ; Joo Seop KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2004;8(3):185-189.

PURPOSE: Open cholecystectomy is preferred to a laparoscopic approach in elderly patients with gallstones, because acute inflammation is more frequent in this age group than in younger patients. However, the surgical morbidity and mortality of an open cholecystectomy are known to be higher than for a laparoscopic cholecystectomy. The aim of this study was to analyze the outcome of laparoscopic cholecystectomy in elderly patients, and to assess its safety and feasibility. METHODS: 289 laparoscopic cholecystectomy cases were enrolled with regard to their clinical parameters. There were 49 patients older and 240 younger than 70 years of age; Groups A and B, respectively. RESULTS: There were no demographic differences between the two groups. The preoperative presentation of acute cholecystitis was higher in Group A (53.1 versus 37.1%, p< 0.05). The average times interval from the initial symptoms to the operation were 36.3 and 50.2 days in Groups A and B, respectively. The rate of combined choledocholithiasis was higher in Group A (20.4 versus 9.2%, p< 0.05). The average operation time was similar in both groups (83.7+/-29.5 versus 83.0+/-29.3minute). The conversion rate from a laparoscopic to an open cholecystectomy was higher in group A (8.2% versus 2.9%, p=0.08). There were no differences in hospital stays and postoperative complications between the two groups. CONCLUSION: From this study, a laparoscopic cholecystectomy is suggested as a safe and effective treatment in elderly patients. Therefore, a laparoscopic cholecystectomy should be initially and actively performed, rather than an open cholecystectomy in elderly patients.
Aged* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Choledocholithiasis ; Gallstones ; Humans ; Inflammation ; Length of Stay ; Mortality ; Postoperative Complications

6

Cite

Share

The Surgical Therapeutic Options for Polypoid Lesion of Gallbladder.

Sang Hyun BAIK ; Hyung Seok PARK ; Seon Woo KIM ; Jae Young CHOI ; Yong Jin PARK ; Myung Hee YOON ; Dong Hoon SHIN ; Chung Han LEE

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2004;8(3):180-184.

PURPOSE: Gallbladder polyps have malignant potentials and there are no definitive treatment criteria. Therefore, to establish the appropriate treatment for gallbladder polyps, the gross and microscopic appearance of gallbladder polyps were studied and the clinical findings analyzed. METHODS: Between January 1990 and December 1999, 1108 subjects underwent open and laparoscopic cholecystectomy at our institute. Seventy nine subjects, confirmed to have gallbladder polyps by pathology, were analyzed. To establish the surgical indications of polyps with malignancy potential, gender, age, clinical symptoms, polyp size, numbers, shape, coexistence of stones and the pathological findings were analyzed. RESULTS: The mean age of the subjects with benign and malignant polyps were 44.2 and 55.2 years old, respectively (p=0.034). The mean maximum diameter in benign and malignant polyps were 6.4 and 19.8 mm, respectively (p= 0.029). There were single polyps in 52.6 (30/57) and 86.3% (19/22) of the benign and malignant lesions, respectively (p= 0.046). Comparing the clinical symptoms (abdominal discomfort. etc) between the two groups, benign polyps had 26.3% (15/57), malignant polyps had 86.3% (19/22) (p= 0.0032). Cholesterol polyps were found in 29 (36.7%), inflammatory or hyperplastic polyps in 11 (13.9%) adenomas in 17 (21.5%) and adenocarcinomas in 22 (27.9%) cases. There were no differences in the presence of stones or in the shape of the polyps. CONCLUSION: On the basis of our analysis, when the polyp is of the single type, over 15 mm in diameter and the patient was 50 years old or over, surgical intervention should be considered due to the high risk of malignancy. If surgical intervention is not appropriated, a close follow-up is generally recommended to monitor the changes in the polyp size and shape.
Adenocarcinoma ; Adenoma ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholesterol ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Middle Aged ; Pathology ; Polyps

7

Cite

Share

Cyclooxygenase-2 Expression in Bile Duct Cancer.

Kyu Hee HER ; Sun Whe KIM ; Jin Young JANG ; Yoo Seok YOON ; Kwang Sik KIM ; Hye Seung LEE ; Yong Bum YOON ; Yong Hyun PARK

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2004;8(3):172-179.

PURPOSE: Epidemiological studies have shown that regular ingestion of a nonsteroidal anti-inflammatory drug reduces the risk of fatality from colon cancer. Cyclooxygenase-2 (COX-2) has been found to be overexpressed in various types of tumor, including colorectal cancer. It has been suggested that the COX-2 enzyme may play an important role in carcinogenesis and tumor progression. The aims of this study were to find the relationship between COX-2 expression and bile duct carcinogenesis and its clinical significance in bile duct cancer. METHODS: The COX-2 expression was determined using three methods, reverse transcription polymerase chain reaction (RT-PCR), Western blotting and immunohistochemical staining. mRNA and proteins were extracted from the tissue specimens of 22 bile duct cancer patients. RESULTS: RT-PCR and western blotting found COX-2 expressions in all the cancers and their paired noncancerous tissues. Immunohistochemistry revealed the highest levels of COX-2 expressed in bile duct carcinoma cells, mainly in the cytoplasm, and a weak reactivity of the COX-2 protein was observed in noncancerous bile duct epithelial cells. CONCLUSION: Based on this study, it is postulated that the carcinogenesis mechanism of COX-2 expression may be initiated from a noncancerous condition, such as chronic inflammation, and may advance to bile duct cancer progression.
Bile Duct Neoplasms* ; Bile Ducts* ; Bile* ; Blotting, Western ; Carcinogenesis ; Colonic Neoplasms ; Colorectal Neoplasms ; Cyclooxygenase 2* ; Cytoplasm ; Eating ; Epithelial Cells ; Humans ; Immunohistochemistry ; Inflammation ; Polymerase Chain Reaction ; Prostaglandin-Endoperoxide Synthases ; Reverse Transcription ; RNA, Messenger

8

Cite

Share

Nonoperative Treatment for Grade IV Liver Injury.

Sang Hwi KWON ; Seon Ki LEE ; Jin Young PARK ; Yun Jin HWANG ; Sang Geol KIM ; Young Kook YUN

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2004;8(3):166-171.

PURPOSE: Though the nonoperative management of liver injury (NOMLI) has frequently been employed for traumatic liver injuries, the indications for NOMLI for grade IV liver injuries are still controversial. To determine the usefulness of the NOMLI in grade IV liver injuries, the clinical features of an operative management (n=26) and a NOMLI group (n=20) were compared. METHODS: For the 10 years up until Feb. 2004, 46 grade IV liver injury cases, according to the AAST liver injury scale, at the Kyung Pook National University Hospital, were selected for this study. The clinical features, grade of liver injury and outcomes of treatments were reviewed retrospectively. RESULTS: Of the 46 cases 40 (87%) and 6 (13%) were male and female, respectively. The mean ages of the male and female cases were 37.6 (15.2 and 34.5 (16.7 years, respectively. The causes of liver trauma were vehicle accident (71.7%, 33/46), industry accident (26.1%, 12/46) and violence (2.2%, 1/46). The accompanying abdominal injury was not present in the NOMLI group compared to 30.8% (8/26) in the operative management group. NOMLI was more than 2 times more frequently indicated after Feb. 1999. The mortality in operative management group was 11.5% (3/26) compared with none in the NOMLI group. 20% (4/20) of NOMLI group failed due to delayed bleeding and eventually had to undergo operations and the 80% (16/20) of NOMLI group was successful. The morbidity in successful NOMLI group was bile collection (6.25%, 1/16) and empyema (6.25%, 1/16). CONCLUSION: Nonoperative management for grade IV liver injury in hemodynamically stable patients without accompanying abdominal injury was successful. However, continuous monitoring and immediate operative management should be prepared for the delayed bleeding.
Abdominal Injuries ; Bile ; Empyema ; Female ; Hemorrhage ; Humans ; Liver* ; Male ; Mortality ; Retrospective Studies ; Violence ; Wounds and Injuries

9

Cite

Share

Clinical Review of the Hepatic Resection for Hepatolithiasis: Factors Affecting Postoperative Complications.

Jin Seok PARK ; Min Ku LEE ; Joo Seung PARK ; Yun Jung KANG ; Byung Sun JOE ; Chang Nam KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2004;8(3):160-165.

PURPOSE: The hepatolithiasis and associated cholangitis result in liver atropy, biliary stricture, liver abscess and intrahepatic malignancy, and a hepatic resection should be performed in such cases. The technical difficulty and accompanied inflammation with a hepatic resection frequently cause postoperative complications. Therefore, the factors affecting the postoperative complications were evaluated. METHODS: Twenty one patients, with hepatolithiasis that had received a hepatectomy at the Department of Surgery, Eulji University Hospital between March 2001 and January 2003, were reviewed. RESULTS: The postoperative complications were intraabdominal abscess (7 cases), pleural effusion (3 cases), wound complication (3 cases), T-tube site leakage (1 case), cardiac arrest (1 case), acute pancreatitis (1 case), hepatitis A (1 case) and delayed gastric emptying (1 case). The overall complication rate was 57% (12/21 patients) and the most common complication was an intraabdominal abscess (7 cases). The factors that may affect these complications were analyzed. Preoperative percutaneous transhepatic biliary drainage (PTBD) increased the postoperative complications, which was statistically significant (p=0.027). Especially, preoperative PTBD and hepaticojejunostomy increased the rate of an intraabdominal abscess, which was statistically significant (p=0.026, p=0.008). CONCLUSION: With hepatolithiasis requiring hepatic resection there is a need to avoid unnecessary preoperative PTBD and bypass surgery for the reduction of postoperative complications, including an intraabdominal abscess. Conversely, it is considered important to remove every stone and avoid needless bypass surgery under an operation and for a hepatic resection to be performed after removing PTBD, where possible.
Abscess ; Cholangitis ; Constriction, Pathologic ; Drainage ; Gastric Emptying ; Heart Arrest ; Hepatectomy ; Hepatitis A ; Humans ; Inflammation ; Liver ; Liver Abscess ; Pancreatitis ; Pleural Effusion ; Postoperative Complications* ; Wounds and Injuries

10

Cite

Share

Antioxidant Effects of Haematococcus Extracts for Ischemia-Reperfusion Injury on Liver of Mice.

Ik Jin YUN ; Moon Sang AHN ; Dong Chul KIM ; Byeung Il YOU ; Gun Kuk LEE ; Jongwon HA ; Sang Joon KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2004;8(3):152-159.

PURPOSE: An IRI (Ischemia-reperfusion injury) of the liver is one of the main problems in major liver surgery, liver transplantation and liver trauma, which can lead to liver failure. The mechanism of a liver IRI is supposed to be highly related to the oxygen free radicals (Should the read, "free oxygen radicals"?) made in the course of the damage process. Therefore, antioxidants must be one of the most effective therapeutic modalities for liver IRI. Haematococcus pluvialis contains a lot of astaxanthin, which is known of powerful antioxidant. Since the use of synthetic astaxanthin is not permitted to humans, only naturally produced astaxanthin, such as Haematococcus, is a candidate for use. In this report, the antioxidant effects of a Haematococcus extract has been studied and compared with other antioxidants and synthetic astaxanthin. METHODS: To evaluate the effect of the Haematococcus extract in a liver IRI, the mouse liver IRI model was employed. Following ischemia for 60 minutes, three reperfusion periods were used; 3, 24 and 48 hours. The MDA (malondialdehyde) values in the liver, lungs and serum were all evaluated, and two types of Haematococcus extract compared with other antioxidants and synthetic astaxanthin. RESULTS: In all tissues and serum, the antioxidants all produced lower levels of MDA than in the control. The oil- extracted Haematococcus group had much lower MDA levels compared to the biomass Haematococcus and other antioxidants groups. The effects of synthetic astaxanthin are similar to those of oil-extracted Haematococcus. CONCLUSION: The Haematococcus extract has very potent antioxidant effects compared with vitamin E and Superoxide dismutase (SOD) in protecting the liver from IRI. Oil-extracted Haematococcus is better than biomass Haematococcus, and was even comparable to the effects of synthetic astaxanthin.
Animals ; Antioxidants* ; Biomass ; Free Radicals ; Humans ; Ischemia ; Liver Failure ; Liver Transplantation ; Liver* ; Lung ; Mice* ; Oxygen ; Reperfusion ; Reperfusion Injury* ; Superoxide Dismutase ; Vitamin E ; Vitamins

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share