ABSTRACT
Foreign bodies with a sharp margin in the esophagus are often associated with serious complications, such as bleeding, perforation and mediastinitis in the middle of endoscopic removal, as well as impaction in the esophagus wall. Therefore, safe extraction for such patients is essential. The techniques that are performed with an endoscope have been designed with using a protector hood and overtube. Yet the former is not available in Korea, and the later is uncomfortable and limited in diameter. Press-through-packs (PTPs) are commonly used as a package for drugs and they also usually cause esophageal impaction because they have sharp edges. We report here on a case of an impacted PTP in the upper esophagus, and this was successfully extracted endoscopically with using a surgical glove, which is a better safe alternative to above mentioned removal items.
Subject(s)
Humans , Endoscopes , Esophagus , Foreign Bodies , Gloves, Surgical , Hemorrhage , Korea , MediastinitisABSTRACT
BACKGROUND/AIMS: Colonoscopy is the most effective method to detect and remove colonic polyps and for colorectal cancer screening and prevention. However, polyps are frequently missed during colonoscopy. The aim of this study was to determine the miss rates of polyps by colonoscopy and to evaluate the factors that affect the miss rates. METHODS: Within sixty days after a first-time colonoscopy, consecutive polypectomies were performed in 317 patients who had one or more colon polyps. RESULTS: The overall miss rate for polyps was 26.6%. As the withdrawal time increased, the number of polyps detected on the first colonoscopy decreased, and the miss rate decreased significantly (respectively p=0.000, p=0.028). The withdrawal time for an expert operator was shorter than the withdrawal time for a beginner operator (p=0.001). The miss rate for a beginner operator and expert operator was not different (p=0.271) due to interference with withdrawal time. The most frequent location of a polyp was the ascending colon and the most frequent size of a polyp was < or =5 mm. CONCLUSIONS: Although colonoscopy is the gold standard for colorectal polyp detection, it is imperfect even when meticulously performed. To reduce the miss rates of polyps, it is important that a careful examination with sufficient withdrawal time is performed, the colonoscopy is complete to the cecum, and that the bowel preparation is adequate.
Subject(s)
Humans , Cecum , Colon , Colon, Ascending , Colonic Polyps , Colonoscopy , Colorectal Neoplasms , Mass Screening , PolypsABSTRACT
An association of carcinoid tumors with another primary neoplasm has been reported in 17~53% of cases, with an especially high incidence of adenocarcinomas. However, simultaneous association of a gastric carcinoid tumor with a gastric adenocarcinoma as a synchronous double primary cancer is extremely rare. We report a case of a synchronous double primary cancer associated with a gastric carcinoid and early gastric cancer in a 63-year-old male patient.
Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma , Carcinoid Tumor , Incidence , Neoplasms, Multiple Primary , Stomach NeoplasmsABSTRACT
The pancreas with the complete absence of its body and tail is the result of underdevelopment or agenesis of the dorsal pancreatic bud during embryogenesis, and this is a rare anomaly. We report here on a case of a 38-year-old man who had a pancreas with the total absence of the body and tail. On the abdominal computed tomography (CT), only a pancreatic head portion with speckled calcifications was seen, and the pancreatic body and tail were not visualized at all. Endoscopic retrograde cholangiopancreatography (ERCP) showed only a short major pancreatic duct with smooth tapering and terminal arborization. The Ampulla of Vater had a normal appearance and it was located at the medial side of the second portion of the duodenum. There was no difficulty to perform cannulation. Any minor papilla was not found. On magnetic resonance cholangiopancreatography (MRCP), the duct of Santorini and the duct in the body and tail were not visualized.
Subject(s)
Adult , Female , Humans , Pregnancy , Ampulla of Vater , Catheterization , Cholangiopancreatography, Endoscopic Retrograde , Cholangiopancreatography, Magnetic Resonance , Congenital Abnormalities , Duodenum , Embryonic Development , Head , Pancreas , Pancreatic DuctsABSTRACT
Esophageal submucosal dissection is a rare condition, resulting in the separation of the submucosa and muscle layer by mucosal laceration and bleeding. Possible causes are external trauma, foreign body entrapment, endoscopic instrumentation and even spontaneous dissection. Typical endoscopic findings show a false lumen from the torn mucosa and a muscle layer in the false lumen. Esophagography shows a "double barrelled" appearance. A dissection can be resolved with conservative management. We experienced a case of a submucosal dissection of the esophagus with perforation, an unusual complication of conscious sedation endoscopy.
Subject(s)
Conscious Sedation , Endoscopy , Esophagus , Foreign Bodies , Hemorrhage , Lacerations , Mucous MembraneABSTRACT
There are few reports of gastrointestinal stromal tumors (GISTs) in the esophagus. The authors report a patient with an esophageal GIST that was found incidentally during an endoscopy. The endoscopy revealed a 1 cm sized mass with a granular surface at the 32 cm site from the upper incisor. Endoscopic ultrasonography revealed the tumor to be located in the muscularis mucosa of the esophageal wall. Histologically, the tumor consisted of spindle cells, with no mitotic index, that were immunoreactive for KIT and S-100. The tumor was diagnosed as a gastrointestinal stromal tumor with neural differentiation (GINT). An endoscopic mucosal resection was performed and the patient has been on routine follow up at the out patient department for three months.
Subject(s)
Humans , Endoscopy , Endosonography , Esophagus , Follow-Up Studies , Gastrointestinal Stromal Tumors , Incisor , Mitotic Index , Mucous MembraneABSTRACT
Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone and insulin like growth factor 1, generally from pituitary adenoma. Although there have been several reports suggesting the possible association of hematologic malignancies with acromegaly, myelofibrosis with acromegaly is very rare. Here we report 54-year-old male patient with myelofibrosis accompanied with acromegaly. We treated this patient with low dose thalidomide (50 mg/day) and prednisone (30 mg/day). We reported this case with literature review.
Subject(s)
Humans , Male , Middle Aged , Acromegaly , Growth Hormone , Hematologic Neoplasms , Insulin , Pituitary Neoplasms , Prednisone , Primary Myelofibrosis , ThalidomideABSTRACT
BACKGROUND: Excision repair cross complementing gene 1 (ERCC1) not only has a protective role against carcinogens, but plays an important role in cisplatin-resistance via the repair of cisplatin-DNA adducts. This study investigated the association between the ERCC1 expression levels in sputum and survival after cisplatin-based chemotherapy in patients with inoperable non-small cell lung cancer (NSCLC). METHODS: Using the sputum collected from 67 inoperable (stage IIIa-IV) NSCLC patients treated with either taxanes (33 cases) or gemcitabine (34 cases) plus cisplatin, the relative expression levels of ERCC1 and the expression of the tumor specific antigen, MAGE, were examined by the quantitative RT-PCR and RT-PCR, respectively. The response and survival were compared with the relative level of ERCC1 or MAGE expression and the treatment modality. RESULTS: In the sputum, ERCC1 and MAGE was detected in 74.6% and 40.2% of patients, respectively. Using the median ERCC1 level, the patients were classified as having high or low ERCC1 expression. The median overall survival (MST) was significantly longer in patients with a high ERCC1 expression level than those with a low expression level (84 weeks vs. 44 weeks respectively, P=0.017). In the taxene-based treatment group, the MST was longer than the gemcitabine group (79 weeks vs. 47 weeks, respectively, P=0.03). The levels of ERCC1 were significantly higher in patients who were MAGE-positive (P=0.003). In the MAGE-negative patients, the MST was longer in the high ERCC1 group (103 weeks vs. 43 weeks, P=0.008), but not in the MAGE-positive patients (62 weeks vs. 44 weeks, P=0.348). CONCLUSION: ERCC1 expression in the sputum can be a prognostic factor for survival after chemotherapy in patients with inoperable NSCLC.
Subject(s)
Humans , Carcinogens , Carcinoma, Non-Small-Cell Lung , Cisplatin , Complement System Proteins , DNA Repair , Drug Therapy , Sputum , TaxoidsABSTRACT
Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone and insulin like growth factor 1, generally from pituitary adenoma. Although there have been several reports suggesting the possible association of hematologic malignancies with acromegaly, myelofibrosis with acromegaly is very rare. Here we report 54-year-old male patient with myelofibrosis accompanied with acromegaly. We treated this patient with low dose thalidomide (50 mg/day) and prednisone (30 mg/day). We reported this case with literature review.
Subject(s)
Humans , Male , Middle Aged , Acromegaly , Growth Hormone , Hematologic Neoplasms , Insulin , Pituitary Neoplasms , Prednisone , Primary Myelofibrosis , ThalidomideABSTRACT
BACKGROUND: Endobronchial tumors cause?life-threatening dyspnea and can lower the quality of life due to central airway obstruction.?In those cases with an intraluminal tumor, various bronchoscopic techniques are available for tumor debulking. The therapeutic effect of bronchoscopic electrocautery for palliation in patients with a symptomatic tumor obstruction was studied. METHOD: Nineteen patients with bronchogenic carcinomas (n=15) and metastatic tumors affecting the bronchi (n=4), between March 2002 and March 2005, were enrolled in this study. Electrocautery was performed under local anesthesia using an electroprobe and diathermic snare. Using flexible bronchoscopy, a follow-up bronchoscopic examination was performed 3-4 days later. Symptom improvement was evaluated by FEV1, FVC and dyspnea score (Modified Borg Category Scale (0~10)), both before and after the electrocautery. RESULTS: The success rate of electrocautery on the follow up examination was 84%. Patients with endoluminal airway lesions had a mean overall decrease in the size of the obstruction to 47.8+/-15.7%. The mean Improvement in the dyspnea score immediately after the endobronchial tumor debulking was 2.78+/-1.42.The average improvements in the FEV1 and FVC after electrocautery were 0.32+/-0.19L and 0.5+/-0.22L, respectively. There were 2 cases of complications related with electrocautery (one each of pneumothorax and pneumonia). CONCLUSION: Electrocautery using an electroprobe and diathermic snare was an effective and safe palliative treatment for a symptomatic endoluminal airway obstruction in lung cancer.