Initial Experiences using Robot-assisted Distal Pancreatectomy: A Single Institution Study of 28 Patients

PURPOSE: Surgical procedures using robot-assisted surgery, including pancreatic surgery, have recently become popular. This study aimed to report our initial experiences with distal pancreatectomy procedures using the robot-assisted surgery system. METHODS: The clinical records of 28 patients who underwent robot-assisted distal pancreatectomy (RDP) between July 2012 and January 2016 were reviewed. RESULTS: Of the 28 patients, 5 (17.9%) were male and 23 (82.1%) were female. Their ages ranged from 11 to 78 years, with a median age of 44.5 years. The mean diameter of the pancreatic tumors was 3.6 cm. The median operative time was 192.5 (range, 100~390) minutes, and the median blood loss was 200 (range, 50~1,900) ml. All of the 28 RDPs were successfully completed. Spleen preservation was achieved in 16 (57.1%) patients. Clinically significant postoperative pancreatic fistula was detected in 4 (14.3%) patients. Postoperative complications were evident in 5 (17.9%) of the 28 patients. CONCLUSION: Our experiences suggest that RDP is feasible for patients with benign or borderline tumors at the body or tail of the pancreas. It may be considered as an effective surgical procedure for benign or borderline tumors of the pancreas in the future; however, further studies to confirm this are warranted.

Temporary Placement of a Newly Designed, Fully Covered, Self-Expandable Metal Stent for Refractory Bile Leaks

Bile leaks remain a significant cause of morbidity for patients undergoing laparoscopic cholecystectomy. Leakage from an injured duct of Luschka (subvesical duct) follows the cystic duct as the most common cause of postcholecystectomy bile leaks. Although endoscopic sphincterotomy, plastic-stent placement, or nasobiliary-drain placement are effective in healing biliary leaks, in patients in whom leakage persists and the symptoms worsen despite conventional endoscopic treatment, re-exploration with laparoscopy and ligation of the injured subvesical duct should be considered. We present herein the case of a 31-year-old woman with refractory bile leakage from a disrupted subvesical duct after cholecystectomy that could not be managed with endoscopic sphincterotomy and plastic-stent placement. A newly designed, fully covered, self-expandable metal stent (FC-SEMS) was successfully placed for the treatment of refractory bile leaks in this patient. It appears that temporary placement of an FC-SEMS is technically feasible and provides an effective alternative to surgical therapy for refractory bile leaks after cholecystectomy.

Therapeutic Plan for Traumatic Truncal Arterial Injury Associated with Truncal Organ Injury

PURPOSE: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study's objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions. Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed. RESULTS: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury. CONCLUSION: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional horacotomy.

The Outcome of Postoperative Radiation Therapy for Patients with Stage II Pancreatic Cancer (T3 or N1 Disease) / 대한방사선종양학회지

PURPOSE: To analyze retrospectively the outcome of postoperative radiation therapy with or without concurrent chemotherapy for curatively resected stage II pancreatic cancer with T3 or N1 disease. MATERIALS AND METHODS: Between January 1996 and December 2005, twenty-eight patients completed adjuvant radiation therapy at Ajou University Hospital. The patients had either pathologic T3 stage or N1 stage. The radiation target volume encompassed the initial tumor bed identified preoperatively, resection margin area and celiac nodal area. In the case of N1 patients, the radiation field extended to the lower margin of the L3 vertebra for covering both para-aortic lymph nodes bearing area. The median total radiation dose was 50 Gy. Ten patients received concurrent chemotherapy. RESULTS: Thirteen patients (46%) showed loco-regional recurrences. The celiac axis nodal area was the most frequent site (4 patients). Five patients showed both loco-regional recurrence and a distant metastasis. Patients with positive lymph nodes had a relatively high probability of a distant metastasis (57.1%). Patients that had a positive resection margin showed a relatively high local failure rate (57.1%). The median disease-free survival period of all patients was 6 months and the 1- and 2-year disease free survival rates were 27.4% and 8.2%, respectively. The median overall survival period was 9 months. The 2- and 3-year overall survival rates were 31.6% and 15.8%, respectively. CONCLUSION: The pancreatic cancer patients with stage II had a high risk of local failure and a high risk of a distant metastasis. We suggest the concurrent use of an effective radiation-sensitizing chemotherapeutic drug and adjuvant chemotherapy after postoperative radiation therapy for the treatment of patients with stage II pancreatic cancer.

Pancreaticogastrostomy as a Beneficial Alternative to a Pancreaticojejunostomy

Pancreaticogastrostomy (PG) has been used as an alternative procedure for pancreaticojejunostomy (PJ) for reconstruction after a pancreaticoduodenectomy (PD). Leakage at the pancreatoenteric anastomosis is still a major cause of morbidity and mortality after a PD. Therefore the major goal of technical modifications should be elimination or at least a reduction of pancreatic leakage. A number of published studies have shown that PG is associated with a low rate of anastomotic leakage. PG is easier to perform due to the thick posterior wall of the stomach and its excellent blood supply being proximal to the remaining pancreas. Furthermore, the pancreatic juice appears to be neutralized by the gastric juice, resulting in a reduction in the morbidity and mortality associated with anastomotic leakage. PG also results in a straight alignment of the digestive tract without an A-loop. PG and PJ showed an impaired exocrine and endocrine pancreatic function with a similar extent. The activity of the pancreatic enzymes is inhibited in the stomach after a PG. The enzymes become activated when gastric pH exceeds 3.1, which normally occurs after the ingestion of a meal. In conclusion, we recommend duct-to-mucosa PG as a beneficial alternative to a PJ, even in the hands of an inexperienced surgeon.

The Expression of Estrogen Receptors in Hepatocellular Carcinoma in Korean Patients

Expression of estrogen receptors (ER)-alpha and -beta, as well as androgen receptor (AR), in hepatocellular carcinoma (HCC) is thought to be correlated with prognosis, survival, and male prevalence of HCC. These hypotheses are based on investigations of European patients; however the expression patterns of these receptors in Asian patients are largely unknown. In this study, we collected liver carcinoma and peritumor tissues from 32 patients (9 females and 23 males) in South Korea. The expression of ERs and ARs was studied using RT-PCR. Wild-type ER-alpha and AR were expressed in all of the samples investigated, and their expression was independent of the causal virus or patient sex. Expression of the ER-alpha variant was independent of sex (100% female vs. 91.3% male) and HCV and HBV status (91.3% vs. 100%). Wild-type ER-beta was expressed more often in HCV patients than in HBV patients (95.7% vs. 44.4%; p < 0.05). In conclusion, the stronger ER-alpha variant expression in HCC tissues implies that this variant has an important role in HCC development. However, at least in Korean patients, expression of the ER-alpha variant (vER-alpha) is not related to male HCC prevalence. In addition, the predominant expression of ER-beta in HCV patients suggests that it plays an important role in HCV-induced liver disease.

Expression of the RERG Gene is Gender-Dependent in Hepatocellular Carcinoma and Regulated by Histone Deacetyltransferases

Ras-related, estrogen-regulated, and growth-inhibitory gene (RERG) is a novel gene that was first reported in breast cancer. However, the functions of RERG are largely unknown in other tumor types. In this study, RERG expression was analyzed in hepatocellular carcinomas of human patients using reverse transcriptase PCR analysis. In addition, the possible regulation of RERG expression by histone deacetyltransferases (HDACs) was studied in several cell lines. Interestingly, the expression of RERG gene was increased in hepatocellular carcinoma (HCC) of male patients (57.9%) but decreased in HCC of females (87.5%) comparison with paired peri-tumoral tissues. Moreover, RERG gene expression was increased in murine hepatoma Hepa1-6 cells, human breast tumor MDA-MB-231 cells, and mouse normal fibroblast NIH3T3 cells after treated by HDAC inhibitor, trichostatin A. Our results suggest that RERG may function in a gender-dependent manner in hepatic tumorigenesis and that the expression of this gene may be regulated by an HDAC-related signaling pathway.

New Surgical Technique for Hepatolithiasis: Ventral Hilar Exposure Method

PURPOSE: Various treatments have recently been applied for hepatolithiasis and their results also have been reported. We introduce herein a new surgical technique, the Ventral Hilar Exposure Method, for hepatolithiasis. This method has been performed for the last ten years at our hospital, and we now report the results of this procedure. METHODS: We evaluated the outcomes of 128 patients among 153 patients who had received hepatectomy with the method of ventral hilar exposure for hepatolithiasis at our hospital from June 1994 to June 2004. We analyzed the rates of residual and recurrent stone, the risk of the treatment and the rate of concomitant cholangiocarcinoma. With these results, we evaluated the utility of the ventral hilar exposure method for hepatolithiasis. RESULTS: There was no post-operative mortality and severe complications in the 128 patients who had received hepatectomy by the ventral hilar exposure method. Among those patients, the rate of residual stone and recurrent stone were 5.4% and 4.2%, respectively. The rate of concomitant cholangiocarcinoma was 11%. CONCLUSION: The ventral hilar exposure method hepatectomy is safe and it shows a more improved treatment result for hepatolithiasis. We think that the direct exploration of intra-hepatic hilar bile duct structure during hepatectomy resulted in the improved outcomes. Therefore, we recommend this procedure of hepatectomy as a standardized surgical treatment method for hepatolithiasis.

Influence of Preoperative Portal Vein Branch Ligation in Regeneration of Remaining Rat Liver with or without Jaundice

Purpose: The goal of this study is to define whether or not preoperative portal vein embolization has any additional role in the total amounts of liver regeneration and functional improvement after major hepatectomy in rat model. In addition, this study is to define obstructive jaundice has any positive or negative effect on it. METHODS: There were a total of 650 rats, divided into three experimental groups. Experiment A was done under the normal liver status, experiment B was done under the obstructive jaundice status, experiment C was done under the external biliary drainaged status. Each experimental group was divided into three groups that had been made by different surgery. One was 70% partial hepatectomy, another was 70% portal vein branch ligation, and the other was 70% portal vein ligation followed by 70% hepatectomy. Each operational group required over 60 rats for serial data collection which was taken at the operation and 6, 12, 24, 48, 72 hours after operation. RESULTS: We finally observed that there was no additional regeneration of remaining liver by doing preoperative portal vein embolization. It was same in obstructive jaundice group and external biliary drainaged group. And also, there was no significant fucntional improvement or deterioration by existence of obstructive jaundice. Conclusion: We conclude it is no worth doing preoperative portal vein embolization for getting additional liver regeneration and obstructive jaundice does not has significant positive or negative effect on liver regeneration and hepatic function in itself.

Presence of autocrine hepatocyte growth factor-Met signaling and its role in proliferation and migration of SNU-484 gastric cancer cell line

Autocrine stimulation via coexpression of hepatocyte growth factor (HGF) and its receptor (Met) has been reported in many human sarcomas, but few in carcinomas. In this report, we found that one gastric cancer cell line, SNU-484, among 11 gastric cell lines tested has an autocrine HGF- Met stimulation. RT-PCR, ELISA and scattering assay using MDCK cells revealed that SNU-484 cells secreted a significant amount of active HGF (about 1.25 +/- 0.41 ng/24 h/106 cells) into conditioned medium. Resultantly, Met in this cell line was constitutively phosphorylated. Neutralizing antibodies against HGF reduced the tyrosine phosphorylation of Met, resulting in the inhibition of cell proliferation and migration (P <0.005). To the best of our knowledge, this is the first report on autocrine HGF-Met signaling in a gastric cancer cell line. Our observations with SNU-484 cells suggest that HGF is involved in the development and/or progression of some gastric carcinoma through an autocrine mechanism.

Analysis of Clinical Features and Factors Predictive of Malignancy in Intraductal Papillary Mucinous Tumor of the Pancreas: Multi-center Analysis in Korea / 한국간담췌외과학회지

BACKGROUND/AIMS: Despite of increasing numbers of reports on intraductal papillary mucinous tumor (IPMT), there is still difficulty in its' diagnosis, treatment and prediction of prognosis. The purpose of this multicenter study was to evaluate the clinico-pathological features of IPMT in Korea and suggest the prediction criteria of malignancy in IPMT. METHODS: We retrospectively reviewed the clinico-pathological data of 208 patients who underwent operations with IPMT between 1993 and 2002 at 28 institutes in Korea. RESULTS: Of the 208 patients with a mean age of 60.5+/-9.7 years, 147 were men and 61 were women. 124 patients underwent pancreatoduodenectomy, 42 distal pancreatectomy, 17 total pancreatectomy, 25 limited pancreas resection. Benign cases were 128 (adenoma (n=62), borderline (n=66)) and malignant cases were 80 (non-invasive (n=29), invasive (n=51)). A significant difference in 5-year survival was observed between benign and malignant group (92.6% vs. 65.3%; p=0.006). Of the 6 factors (age, location, duct dilatation, tumor appearance, main duct type, and tumor size) that showed the statistical difference in univariate analysis between benign and malignant group, we found three significant factors (tumor appearance (p=0.009), tumor size (p=0.023), and dilated duct size (p=0.010)) by multivariate analysis. CONCLUSION: Although overall prognosis of IPMT is superior to ordinary pancreatic cancer, more curative surgery is recommended in malignant IPMT. Tumor appearance (papillary), tumor size (> or =30 mm) and dilated duct size (> or = 12 mm) can be used as preoperative indicators of malig-nancy in IPMT.

A Study for Mechanism of Biliary Ductal Injury in Patients with Anomalous Pancreaticobiliary Ductal Union: A Study for Mechanism of Biliary Injury in APBDU / 한국간담췌외과학회지

PURPOSE: It has been known that clinical features of anomalous pancreaticobiliary ductal union (APBDU) are thought to result from cholestasis and regurgitation of pancreatic juice. The purpose of our study is to clarify the relationship of clinicopathological factors and to get information on mechanism of biliary ductal injury in APBDU. METHODS: A total of 23 patients who underwent operation for APBDU from March 1995 to March 2003 were examined. The results of patients were analyzed for their relevance to the clinicopathological factors such as age, sex, age at onset, size of cyst, grade of inflammation, type of APBDU, level of pancreatic enzymes sampled from biliary ductal system, and Ki67 labeling index. RESULTS: Level of amylase in biliary ductal system was decreased with age, especially after 20 years. The grade of hyperplasia in gallbladder was increased with level of amylase in gallbladder. The grade of inflammation in gallbladder was increased with age, but inflammation of gallbladder decreased with the level of amylase in gallbladder, and the size of cyst was increased with grade of inflammation and age. CONCLUSION: Level of amylase in the bile of biliary ductal system was decreased with age, especially after 20 years, which suggests that reflux of pancreatic amylase is closely related with onset of symptom in adult with APBDU. As far as mechanism of biliary ductal injury in APBDU is concerned, inflammation of biliary ductal system is increased with age and size of cyst. And hyperplasia of gallbladder is increased with the degree of regurgitation of pancreatic juice.

Effect of Hepatocyte Growth Factor on the Expression of E-cadherin in Gastric Carcinoma Cell Lines / 대한암학회지

PURPOSE: Previously, we reported that the expression of E-cadherin was significantly decreased according to the increase of the level of hepatocyte growth factor (HGF) in gastric cancer tissue. In this work, the effect of HGF on the cell-cell adhesion and intracellular distribution of E-cadherin in the gastric carcinoma cell lines were studied. MATERIALS AND METHODS: Western blot analysis was performed to confirm the presence or abscence of c-Met and E-cadherin in SNU-1, 5, and 16 cells. Tyrosine phosphorylation of c-Met, E-cadherin, alpha-, beta-, gamma-catenins was checked by immunoprecipitation. The morphologic changes induced by HGF were studied with immunocytochemical staining. Functional proportion of E-cadherin was estimated by cell fractionation. The effect of HGF on cell proliferation and invasion was also assessed. RESULTS: Among SNU-1, 5, and 16 cell lines, only SNU-16 cells expressed both E-cadherin and c-Met. A morphological change from epithelial shape to fibroblastic one was observed in the SNU-16 cells after treatment with HGF. In addition, E-cadherin expression of the SNU-16 cells was shifted from the membrane and to the cytoplasm, and the functional fraction of E-cadherin was decreased in the SNU-16 cells treated with HGF. On the other hand, HGF increased the proliferation and invasion of the SNU-16 cells. CONCLUSION: These results suggest that HGF may regulate cell adhesion in gastric carcinomas via the cellular redistribution and functional change of E-cadherin.

The Influence of Preoperative Fasting on the Survival of Rats Induced by 90% Hepatectomy / 한국간담췌외과학회지

PURPOSE: To study whether preoperative fasting would influence postoperative prognosis and to measure the variation of the ketone body amount and ketone body ratio, kidney function during the postoperative period in the model of 90% hepatectomy. MATERIALS AND METHODS: Total of 180, seven weeks old, male, specific pathogen free Sprague-Dawley rats, divided into two groups of the fasted and the fed. First, 80 rats were divided into two groups of 40 each; 40 of that were denied food for 48 hours before the operation, other 40 were fed. Following 90% hepatectomy they were investigated by Kaplan-Meier method, drawing a survival curve. Secondly, 100 rats were divided into two groups of 50 each, 50 of that were denied food for 48 hours before the operation, and the other 50 were fed. Following 90% hepatectomy, they were investigated by the method of Student's T-test and Mann-Whitney test on the following: the amount of arterial ketone body in the blood in the blood sampled from abdominal aorta, reading at preoperative 48 hours, at the time of operation, postoperative 6 hours, 12 hours, 24 hours, 48 hours periods. RESULTS: The mean survival time after operation: the fasted group was 53.0+/-3.7 hours and the fed group was 34+/-1.7 hours and it had the statistical significance(p=0.0008). Rats which had long term survival over 72 hours were 14(35%) in fasted group, but only 2(5%) in fed group. In preoperative fasted group arterial ketone body ratio was recovered earlier than fed group and ketone body amount elevated, but in preoperative fed group, there was no significant change in ketone body amount. Blood glucose level lowered in both groups. Blood ammonia was severely increased in preoperative fed group, suggested bad liver function and destruction of muscle. BUN and blood creatinine was elevated in preoperative fed group, suggested lowered kidney function. CONCLUSION: Preoperative fasting has a positive influence on survival of the rats which has acute liver failure induced by 90% hepatectomy, because it could be caused by increased ketone body amount by preoperative fasting.

Expression of Vascular Endothelial Growth Factor in Hepatocellular Carcinomas

BACKGROUND: A tumor must continuously stimulate the growth of new capillary blood vessels for the tumor itself to grow and metastasize. Vascular endothelial growth factor (VEGF) promotes vascular permeability and endothelial cell growth. A hepatocellular carcinoma (HCC) is a typical hypervascular tumor. METHODS: We evaluated the expression of VEGF in 36 cases of HCC by using immunohistochemical staining in order to define its prognostic value. RESULTS: The expression rate of VEGF was 44.4% (16/36) in tumor cells and 0% (0/36) in non- tumorous liver parenchyme. VEGF expression did not correlate with any clinicopathological characteristics. And patients with expression of VEGF in tumor cells had no survival difference in comparison to those without VEGF expression. CONCLUSIONS: These results suggest that the expression of VEGF in HCC cells by itself may not be a significant factor in the prognosis of HCC.

The Effects of Intrasplenic Transplantation of Hepatocytes on Rats with Acute Liver Failure Induced by a 90% Hepatectomy

BACKGROUND: Acute liver failure either after liver resection or as part of underlying liver disease is still associated with high mortality. Various treatments have been tried to improve liver function during acute liver failure, including metabolic and nutritional support, hemodialysis, hemoperfusion, plasmapheresis, and hepatocyte and liver transplantation. Hepatocyte transplantation in various forms has attracted attention recently. We investigated whether allogeneic isolated hepatocytes transplanted in the spleen would prolong survival, facilitate liver regeneration, and improve biochemical parameters in rats with acute liver failure induced by a 90% hepatectomy. METHODS: Allogeneic male Sprague-Dawley rats were used. Group I rats (n=26) received an intrasplenic injection of 2 107 hepatocytes in 0.3 ml of Dulbecco's modified Eagle's medium (DMEM), and 1 days later acute liver failure was induced. Group II acute-liver-failure rats (n=24) received an intrasplenic injection of DMEM. The survival time was determined for 22 rats in Group I and for 20 rats in Group II. The remaining 8 (4/each group) acute liver failure rats were used to assess the liver function and regeneration. RESULTS: The survival was longer and the number of long-term survivors was greater for Group I rats than for the Group II controls. At 24 hour after the hepatectomy, Group I rats had lower ammonia, lower total bilirubin, lower activities of liver enzymes, and higher glucose levels than did Group II rats. In Group I, there was significant increase in the ratio of the weight of the remnant liver lobes to the body weight. CONCLUSION: Compared with the Control group intrasplenic hepatocyte transplantation in acute liver failure rats acts as a bridge to support experimental rats in going from acute or fulminant liver failureto liver regeneration or compensation, prolongs survival in rats with acute liver failure induced by a 90% hepatectomy, and improves the biochemical parameters, except for the albumin levels and prothrombin time. Transplantation of hepatocytes may be beneficial in supporting a liver which has been acutely devastated by a 90% hepatectomy.

Role of Serum Hepatocyte Growth Factor in Gastric Cancer Patients

BACKGROUND: Hepatocyte growth factor (HGF) was first identified as a potent stimulator of hepatocyte growth. Later, it was shown that HGF can promote cell motility and cell proliferation in tumor cells as well as in endothelial cells. To look for the significance of HGF in patients with gastric cancer, we measured the serum levels of HGF in gastric cancer patients and followed the levels of HGF after resection of the tumors. METHODS: The serum levels of HGF were determined by using an Immunis HGF ELISA kit. The serum levels of CEA, CA125, and CA19-9 in the same serum sample were examined using the ELISA method. RESULTS: The mean levels of serum HGF in 212 healthy control subjects, 105 patients with primary gastric cancer, 54 patients after resections of the tumors, and 13 patients with recurrent gastric cancer were 0.20 +/- 0.07 ng/ml, 0.33 +/- 0.26 ng/ml, 0.20 +/- 0.19 ng/ml, and 0.58 +/- 0.26 ng/ml respectively. Of the 105 patients with primary gastric cancer, 35 (33.3%) showed an abnormal increase in the serum level of HGF. The increased HGF levels were significantly associated with the degree of tumor invasion, nodal metastasis, distant metastasis and stage. Also the HGF levels increased significantly with increasing tumor size. The HGF levels decreased to normal levels by one month after the resections of the tumors. The HGF levels in recurrent gastric cancer patients were significantly higher than those of nonrecurrent patients after resections of the tumors. Among several tumor markers including CEA, CA125, and CA19-9, HGF was revealed to be the one most correlated with the occurrence of gastric cancer. CONCLUSION: The serum levels of HGF were significantly correlated with the aggressiveness of the tumors, suggesting that HGF might play an important role in the tumor progression of gastric cancer. Furthermore, serum HGF levels should be studied as a tumor marker in patients with gastric cancer.

Glomus Tumor of the Stomach: 1 Case report

Glomus tumors are maturely organized proliferations of glomus cells and vascular channels. Such tumors are rare in the stomach, and only two cases have been reported in Korea. Because specific clinical or radiologic features are not associated with the glomus tumor, it can be recognized only by histologic characteristics. Although available data are inadequate for determining the histogenesis of this tumor, it may represent a hamartoma rather than a neoplastic disease. The treatment of choice is local resection. In frozen sections, it may be misidentified as a carcinoid tumor, leading to more extensive surgery than required for cure. We report a case of a glomus tumor of the stomach in a 30-year-old female patient who was operated on, and we present a review of the literature on this subject.

Glomus Tumor of the Stomach: 1 Case report

Glomus tumors are maturely organized proliferations of glomus cells and vascular channels. Such tumors are rare in the stomach, and only two cases have been reported in Korea. Because specific clinical or radiologic features are not associated with the glomus tumor, it can be recognized only by histologic characteristics. Although available data are inadequate for determining the histogenesis of this tumor, it may represent a hamartoma rather than a neoplastic disease. The treatment of choice is local resection. In frozen sections, it may be misidentified as a carcinoid tumor, leading to more extensive surgery than required for cure. We report a case of a glomus tumor of the stomach in a 30-year-old female patient who was operated on, and we present a review of the literature on this subject.

Biodistribution of Intrasplenically Transplanted Hepatocytes in the Rat

Liver failure still constitutes a major cause of morbidity and death in patients with liver disease. Various potential treatments have been discussed to reduce liver failure-induced deaths. Recently, interest in hepatocyte transplantation(HT) has markedly increased, and HT has been tried for the treatment of liver failure. Both experimental and clinical data indicate that HT may be beneficial both for the support of an acutely devastated liver and for the correction of genetic disorders resulting in states of metabolic deficiency. For this purpose, the location of the HT has been suggested as a critical point. Therefore, we tried to study the biodistribution of hepatocytes in acute and chronic liver failure model in rats at 2 hours and 24 hours after the injection of 125I-labeled hepatocytes into the spleen. A ninety percent partial hepatectomy model and a dimethylnitrosamine-induced liver-cirrhosis model were used as the acute and chronic liver-failure models respectively. An SV-40 T-transfected immotilized cell line named L2A2 was transplanted intrasplenically. The biodistribution of the transplanted hepatocytes was similar in both the acute and the chronic liver-failure groups. In both groups, the biodistribution studies at 2 hours and 24 hours after intrasplenic transplantation demonstrated that the hepatocytes were localized predominantly in the spleen. However, intrasplenic retention of the transplanted hepatocytes progressively decreased with time. We conclude that methods for preventing the progressive loss of intrasplenic transplanted hepatocytes should be investigated.