Causes of Under-staging in Patients with Gastric Cancer That was Proven to be Unresectable after a Laparotomy: Correlation with CT Findings

PURPOSE: The aim of this study was to investigate the causes of under-staging in patients with advanced gastric cancer that was proven to be unresectable after a laparotomy. MATERIALS AND METHODS: We retrospectively analyzed 25 gastric cancer patients who had undergone a diagnostic laparotomy between 2001 and 2005. For the preoperative evaluation, spiral CT and multidetector-row CT were performed. We analyzed the clinicopathologic features of patients and compared the image findings and the results of surgery. The causes of under-staging were divided into 3 groups; patient factor, CT factor, and interpretation factor. RESULTS: Grossly, there were 12 cases of Borrmann type-III tumors and 13 cases of Borrmann type-IV tumors. The most frequent histologic type was poorly differentiated adenocarcinomas (8 cases) and signet ring cell carcinomas (7 cases). There were 13 cases of adjacent organ invasion, and the pancreas was the most frequently invaded organ (9 cases). There were 17 cases of peritoneal metastasis, and 3 cases of distant lymph node metastasis. For the cause of under-staging, there were four cases of patient factor, 19 cases of interpretation factor, and 9 cases of CT factor. In three cases, the cause of under-staging could not be identified. CONCLUSION: CT interpretation factor was the most frequent cause of under-staging in the preoperative diagnosis with gastric cancer patients. Therefore, more cautious CT interpretation is necessary to avoid unnecessary laparotomies in gastric cancer patients.

Acute Renal Failure, a Sequela of the Neuroleptic Malignant Syndrome / 대한신장학회잡지

Neuroleptic malignant syndrome is a rare, idiosyncratic and potentially lethal side effect that occurs patients receiving neuroleptic drugs. Characteristic sings and symtoms include muscle rigidity, fever, altered consciousness, and autonomic dysfuction. The most common serious complication is rhabdomyolysis, which produces acute myoglobiuric renal failure. We present a case of 32-year-old man in whom had NMS and acute renal failure after he had received a combination of chloropromazine and haloperidol. The patients recorvered after treatment by immediate hydration, diuretics and other conservative measure.

Two cases of pheochromocytoma associated with acute myocardial infarction / 대한내과학회지

Pheochromocytoma was usually derived from adrenal medulla or chromaffin cells in or about sympathetic ganglia, and manifested several symptoms and signs by producing, storing, secreting catecholamine. This tumor frequently presented various symptoms such as paroxysmal or persistent hypertension, headache, sweating, palpitation. EKG abnormalities, myocarditis, cardiomyopathy, angina pectoris and myocardial infarction have been reported in cardiovascular systems. We experienced two cases of pheochromocytoma associated with myocardial infarction Two patients presented typical cardiac enzyme patterns and regional wall motion abnormalities on ehcocardiography which was compatible with acute myocardial infarction. However, these patients showed normal coronary artery on coronary angiograpy. Urinary excretion of catecholamine metabolites were elevated and pheochromocytoma was found on right adrenal gland. After the removal of pheochromocytoma, urinary excretion of catecholamine metabolities, regional wall motion abnormalities on echocardiography and blood pressure were normalized.

A Case of Cystic Myxoma in the Left Atriym

Cardiac myxomas are the most common type of primary cardiac tumor. Approximately 86% of myxoma occur in the left atrium, and over 90% are solitary. Most myxoma are gelatinous and solid, although central hemorrhage or infarction may occur in some case. Rarely is the myxoma calcified. We experienced the case of a 52-year-old man transthoracic echocardiography revealed central echolucency within large mass. At operation, a globular, smooth surfaced mass was found attached to the interatrial septum of left atrium. The cut-surface shows central cystic degeneration within extensive patch hemorrhage and multiple small cysts.