Development and External Validation of a Deep Learning Algorithm for Prognostication of Cardiovascular Outcomes

BACKGROUND AND OBJECTIVES: We aim to explore the additional discriminative accuracy of a deep learning (DL) algorithm using repeated-measures data for identifying people at high risk for cardiovascular disease (CVD), compared to Cox hazard regression.METHODS: Two CVD prediction models were developed from National Health Insurance Service-Health Screening Cohort (NHIS-HEALS): a Cox regression model and a DL model. Performance of each model was assessed in the internal and 2 external validation cohorts in Koreans (National Health Insurance Service-National Sample Cohort; NHIS-NSC) and in Europeans (Rotterdam Study). A total of 412,030 adults in the NHIS-HEALS; 178,875 adults in the NHIS-NSC; and the 4,296 adults in Rotterdam Study were included.RESULTS: Mean ages was 52 years (46% women) and there were 25,777 events (6.3%) in NHIS-HEALS during the follow-up. In internal validation, the DL approach demonstrated a C-statistic of 0.896 (95% confidence interval, 0.886–0.907) in men and 0.921 (0.908–0.934) in women and improved reclassification compared with Cox regression (net reclassification index [NRI], 24.8% in men, 29.0% in women). In external validation with NHIS-NSC, DL demonstrated a C-statistic of 0.868 (0.860–0.876) in men and 0.889 (0.876–0.898) in women, and improved reclassification compared with Cox regression (NRI, 24.9% in men, 26.2% in women). In external validation applied to the Rotterdam Study, DL demonstrated a C-statistic of 0.860 (0.824–0.897) in men and 0.867 (0.830–0.903) in women, and improved reclassification compared with Cox regression (NRI, 36.9% in men, 31.8% in women).CONCLUSIONS: A DL algorithm exhibited greater discriminative accuracy than Cox model approaches.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02931500

Development and External Validation of a Deep Learning Algorithm for Prognostication of Cardiovascular Outcomes

BACKGROUND AND OBJECTIVES@#We aim to explore the additional discriminative accuracy of a deep learning (DL) algorithm using repeated-measures data for identifying people at high risk for cardiovascular disease (CVD), compared to Cox hazard regression.@*METHODS@#Two CVD prediction models were developed from National Health Insurance Service-Health Screening Cohort (NHIS-HEALS): a Cox regression model and a DL model. Performance of each model was assessed in the internal and 2 external validation cohorts in Koreans (National Health Insurance Service-National Sample Cohort; NHIS-NSC) and in Europeans (Rotterdam Study). A total of 412,030 adults in the NHIS-HEALS; 178,875 adults in the NHIS-NSC; and the 4,296 adults in Rotterdam Study were included.@*RESULTS@#Mean ages was 52 years (46% women) and there were 25,777 events (6.3%) in NHIS-HEALS during the follow-up. In internal validation, the DL approach demonstrated a C-statistic of 0.896 (95% confidence interval, 0.886–0.907) in men and 0.921 (0.908–0.934) in women and improved reclassification compared with Cox regression (net reclassification index [NRI], 24.8% in men, 29.0% in women). In external validation with NHIS-NSC, DL demonstrated a C-statistic of 0.868 (0.860–0.876) in men and 0.889 (0.876–0.898) in women, and improved reclassification compared with Cox regression (NRI, 24.9% in men, 26.2% in women). In external validation applied to the Rotterdam Study, DL demonstrated a C-statistic of 0.860 (0.824–0.897) in men and 0.867 (0.830–0.903) in women, and improved reclassification compared with Cox regression (NRI, 36.9% in men, 31.8% in women).@*CONCLUSIONS@#A DL algorithm exhibited greater discriminative accuracy than Cox model approaches.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02931500

Colon Transit Time May Predict Inadequate Bowel Preparation in Patients With Chronic Constipation

BACKGROUND/AIMS: We evaluated whether colonic transit time (CTT) can predict the degree of bowel preparation in patients with chronic constipation undergoing scheduled colonoscopy in order to assist in the development of better bowel preparation strategies for these patients. METHODS: We analyzed the records of 160 patients with chronic constipation from March 2007 to November 2012. We enrolled patients who had undergone a CTT test followed by colonoscopy. We defined patients with a CTT > or =30 hours as the slow transit time (STT) group, and patients with a CTT 30 hours were at risk for inadequate bowel preparation. CTT measured prior to colonoscopy could be useful for developing individualized strategies for bowel preparation in patients with slow CTT, as these patients are likely to have inadequate bowel preparation.

Relationship between Tetrahydrobiopterin and Portal Hypertension in Patients with Chronic Liver Disease

Tetrahydrobiopterin (BH4) is an essential cofactor in NO synthesis by endothelial nitric oxide synthase (eNOS) enzymes. It has been previously suggested that reduced intrahepatic BH4 results in a decrease in intrahepatic NO and contributes to increased hepatic vascular resistance and portal pressure in animal models of cirrhosis. The main aim of the present study was to evaluate the relationship between BH4 and portal hypertension (PHT). One hundred ninety-three consecutive patients with chronic liver disease were included in the study. Liver biopsy, measurement of BH4 and hepatic venous pressure gradient (HVPG) were performed. Hepatic fibrosis was classified using the Laennec fibrosis scoring system. BH4 levels were determined in homogenized liver tissues of patients using a high performance liquid chromatography (HPLC) system. Statistical analysis was performed to evaluate the relationship between BH4 and HVPG, grade of hepatic fibrosis, clinical stage of cirrhosis, Child-Pugh class. A positive relationship between HVPG and hepatic fibrosis grade, clinical stage of cirrhosis and Child-Pugh class was observed. However, the BH4 level showed no significant correlation with HVPG or clinical features of cirrhosis. BH4 concentration in liver tissue has little relation to the severity of portal hypertension in patients with chronic liver disease.

A Case of Psoas Abscess Caused by Staphylococcus lugdunensis / 대한내과학회지

Staphylococcus lugdunensis is a member of coagulase-negative staphylococci (CoNS), an uncommon microbial culture isolate with virulent potency. Although CoNS are common skin commensals, and often regarded as contaminants or colonizers when isolated from clinical specimen cultures, the clinical course and microbiological characteristics of Staphylococcus lugdunensis may resemble those of Staphylococcus aureus rather than other CoNS. Invasive infectious diseases such as infective endocarditis, peritonitis, skin and soft tissue infection, vascular prosthetic infection, septicemia, and osteomyelitis have been found to be associated with Staphylococcus lugdunensis. Here we report the first case of psoas abscess caused by methicillin-sensitive Staphylococcus lugdunensis in Korea.

A Case of Gastric Cancer Manifesting as a Solitary Brain Metastasis in the Cerebellopontine Angle That Mimicked Acoustic Neuroma / 전남의대학술지

At the time of diagnosis, about 20% of patients with gastric cancer have stage IV disease involving the liver, lung, and bone. Brain metastasis from gastric cancer is exceedingly rare, with an incidence of <1% of clinical cases. A 59-year-old man was admitted with hearing loss in the left ear and left facial palsy for 1 month. A magnetic resonance imaging scan revealed a tumor in the cerebellopontine angle that extended to the inner auditory canal and that was clinically diagnosed as acoustic neuroma. After complete resection, histological examination showed metastatic poorly differentiated carcinoma. Further investigation revealed advanced gastric cancer involving the antrum with no evidence of the involvement of other sites except the brain parenchyma. Palliative total gastrectomy was performed and the surgical specimen revealed a poorly cohesive carcinoma that was histopathologically identical to that of the resected brain tumor. Here we report this rare case of gastric cancer that initially presented as a solitary brain metastasis mimicking acoustic neuroma.

A Case of Vivax Malaria Complicated by Adult Respiratory Distress Syndrome and Successful Management with Extracorporeal Membrane Oxygenation

Complicated malaria is mainly caused by Plasmodium falciparum, but, increasingly, Plasmodium vivax is also being reported as a cause. Since the reemergence of indigenous vivax malaria in 1993, cases of severe malaria have been steadily reported in Korea. Herein, we report a case of vivax malaria complicated by adult respiratory distress syndrome (ARDS) that was successfully managed with extracorporeal membrane oxygenation (ECMO). A 59-year-old man presented at our hospital with fever and abdominal pain, which had persisted for 10 days. On admission, the patient had impaired consciousness, shock, hypoxia and haziness in both lungs, jaundice, thrombocytopenia and disseminated intravascular coagulation, metabolic acidosis, and acute kidney injury. A peripheral blood smear and a rapid diagnostic test verified P. vivax mono-infection. Ten hours after admission, hypoxia became more severe, despite providing maximal ventilatory support. The administration of antimalarial agents, ECMO, and continuous venovenous hemofiltration resulted in an improvement of his vital signs and laboratory findings. He was discharged from the hospital 7 weeks later, without any sequelae.

A Case of Gastric Cancer Manifesting as a Solitary Brain Metastasis in the Cerebellopontine Angle That Mimicked Acoustic Neuroma / 전남의대학술지

At the time of diagnosis, about 20% of patients with gastric cancer have stage IV disease involving the liver, lung, and bone. Brain metastasis from gastric cancer is exceedingly rare, with an incidence of <1% of clinical cases. A 59-year-old man was admitted with hearing loss in the left ear and left facial palsy for 1 month. A magnetic resonance imaging scan revealed a tumor in the cerebellopontine angle that extended to the inner auditory canal and that was clinically diagnosed as acoustic neuroma. After complete resection, histological examination showed metastatic poorly differentiated carcinoma. Further investigation revealed advanced gastric cancer involving the antrum with no evidence of the involvement of other sites except the brain parenchyma. Palliative total gastrectomy was performed and the surgical specimen revealed a poorly cohesive carcinoma that was histopathologically identical to that of the resected brain tumor. Here we report this rare case of gastric cancer that initially presented as a solitary brain metastasis mimicking acoustic neuroma.

The usefulness of non-invasive liver stiffness measurements in predicting clinically significant portal hypertension in cirrhotic patients: Korean data

BACKGROUND/AIMS: Liver stiffness measurement (LSM) has been proposed as a non-invasive method for estimating the severity of fibrosis and the complications of cirrhosis. Measurement of the hepatic venous pressure gradient (HVPG) is the gold standard for assessing the presence of portal hypertension, but its invasiveness limits its clinical application. In this study we evaluated the relationship between LSM and HVPG, and the predictive value of LSM for clinically significant portal hypertension (CSPH) and severe portal hypertension in cirrhosis. METHODS: LSM was performed with transient elastography in 59 consecutive cirrhotic patients who underwent hemodynamic HVPG investigations. CSPH and severe portal hypertension were defined as HVPG > or =10 and > or =12 mmHg, respectively. Linear regression analysis was performed to evaluate the relationship between LSM and HVPG. Diagnostic values were analyzed based on receiver operating characteristic (ROC) curves. RESULTS: A strong positive correlation between LSM and HVPG was observed in the overall population (r2=0.496, P or =10 mmHg) was 0.851, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for an LSM cutoff value of 21.95 kPa were 82.5%, 73.7%, 86.8%, and 66.7%, respectively. The AUROC at prediction of severe portal hypertension (HVPG > or =12 mmHg) was 0.877, and the sensitivity, specificity, PPV, and NPV at LSM cutoff value of 24.25 kPa were 82.9%, 70.8%, 80.6%, and 73.9%, respectively. CONCLUSIONS: LSM exhibited a significant correlation with HVPG in patients with cirrhosis. LSM could be a non-invasive method for predicting CSPH and severe portal hypertension in Korean patients with liver cirrhosis.

Complete Endoscopic Resection of Very Early Stage Gastric Plasmacytoma

Gastric plasmacytomas are very rare, and most are not detected until the disease has progressed to an advanced stage. However, there have been recent reports of cases of early-stage gastric plasmacytoma, in which neoplastic cells are confined to the mucosa or submucosa. Here we report a case of a very early stage gastric plasmacytoma that was confined to the lamina propria of the gastric mucosa. The lesion was successfully and completely removed by endoscopic submucosal dissection, and the surveillance endoscopy showed no recurrence during the follow-up of 40 months. This report appears to be the first documented case of complete endoscopic removal of a primary gastric plasmacytoma.

A Case of a Pancreatic Intraductal Papillary Mucinous Neoplasm Forming Multiple Fistulas and Manifesting as Duodenal Ulcer Bleeding / 대한소화기내시경학회지

An intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an uncommon tumor characterized by the production of mucin in the pancreatic duct that occasionally involves the formation of fistulas with surrounding organs, including the stomach, duodenum and common bile duct. The mechanism underlying the formation of such fistulas is direct invasion by a tumor or a combination of high pressure in the main pancreatic duct and inflammatory stimulation. A 73-year-old man was referred to our hospital due to the presence of a gastric ulcer detected on screening gastroscopy. Endoscopic findings showed the presence of a whitish thick mucin coated ulcerative lesion that appeared as a perforation or fistula opening. Abdominal computed tomography and magnetic resonance cholangiopancreatography demonstrated the presence of an IPMN of the pancreas and multiple fistula formation with the neighboring organs. An endoscopic biopsy was carried out to obtain pancreatic tumor tissue through the pancreatogastric fistula and the mass was confirmed as a mucinous adenocarcinoma. To the best of our knowledge, this is the first case of an IPMN associated with a pancreatojejunal fistula and duodenal ulcer bleeding due to fistula formation.

The influence of vaccination on the clinical features of hemorrhagic fever with renal syndrome in the last 5 years / 대한내과학회지

BACKGROUND/AIMS: Hemorrhagic fever with renal syndrome (HFRS) caused by Hantaan virus is an endemic febrile disease in Korea. Although inactivated Hantaan virus vaccine has been introduced, the effect of vaccination is not clear. We evaluated the effect of vaccination on the incidence rate and clinical features of HFRS based on our clinical experience. METHODS: Group I consisted of the patients with confirmed HFRS from a total of 131 patients who were seropositive for Hantaan virus at one tertiary teaching hospital from January 2002 to December 2006. Group II contained 100 patients treated as HFRS at the same hospital from January 1986 to December 1990, before the introduction of the vaccine. Then, we compared the clinical features of the two groups. We confirmed whether the patients had been vaccinated by reviewing their medical records and from telephone interviews. RESULTS: Only 16 (12.2%) of the 131 patients who were seropositive for Hantaan virus were confirmed to have overt HFRS during the most recent 5 years. The incidence of overt HFRS was significantly lower in vaccinees (5%, 3 of 56) than in non-vaccinees (20%, 10 of 50) (p=0.025). The prevalence of renal failure (62.5 vs. 95%, p<0.001) and oliguria (6.25 vs. 46%, p=0.002) was significantly lower in group I than in group II. Three patients were treated with dialysis and none died in group I, versus 17 and 8, respectively, in group II. CONCLUSIONS: It appears that Hantaan virus vaccine has helped to reduce the amount of serious illness and the occurrence of HFRS.

A Case of Salmonella Infection in the Terminal Ileum That Was Initially Misdiagnosed as Lymphoma / 대한소화기내시경학회지

Salmonella usually invades the Peyer's patch of the terminal ileum or ascending colon. A 55-year old female was referred to our hospital for general weakness and sustained fever. On the abdominal contrast computed tomography (CT) scan, we found symmetric circular hypertrophy of the intestinal wall and multiple hypertrophied lymph nodes in the terminal ileum. The positron emission tomography computed tomography (PET-CT) scan showed skipped areas of wall thickening and intense fluorodeoxyglucose (FDG) uptake in the terminal ileum and the ileocecal valve with adjacent lymphadenopathies. On the colonoscopy, multiple mass forming variable-sized ulcers on the terminal ileum were found, so a biopsy specimen and the colonic luminal fluid were obtained, and we made a diagnosis of lymphoma. However, the blood and colonic luminal fluid culture for Salmonella paratyphi-A was reported as positive, and therefore we corrected the diagnosis to Salmonella infection. We report here on a case of Salmonella infection in the terminal ileum, which looked like malignant lymphoma on the baseline radiologic image studies, including the CT and PET-CT.

Expression of Alpha-catenin/E-cadherin and Clinical Significance of Metastatic Factors in Stage III Advanced Colon Cancer

PURPOSE: Among the cell adhesion molecules, alpha-catenin and E-cadherin play an important part in maintaining normal cell structure. The change in expression of cell adhesion molecules affects the invasion and metastasis of a tumor and the prognosis for patients. In this study, we evaluated the relationship between the expression of cell adhesion molecules and the histopathologic characteristics of stage III colon cancer. METHODS: The relationship between the immunohistochemical expression of cell adhesion molecules and tumor progression were statistically analyzed in 40 patients with stage III colon cancer. RESULTS: There were no statistically significant correlations between loss of membranous alpha-catenin and E-cadherin expressions and such variables as histologic differentiation and lymph node disease based on the criteria of the American Joint Committee on Cancer (AJCC). A significant correlation, however, existed between depth of mural invasion and loss of expressions of both alpha-catenin and E-cadherin (P=0.001 and P=0.002, respectively). Expressions of both alpha-catenin and E-cadherin were also significantly decreased in patients showing liver metastases during follow-up (P=0.019 and P=0.015, respectively). CONCLUSION: Immunohistochemical analyses of alpha-catenin and E-cadherin expressions may be available as predictors for distant metastasis, especially in stage III colon cancer. Such analyses may also help to identify appropriate therapeutic strategies and the need for intensive follow-up in patients with stage III colon cancer.

Two Cases of Benign and Malignant Lesion Caused Ileocolic Intussusception: Preoperative Colonoscopic Reduction was Attempted for These Patients / 대한소화기내시경학회지

In contrast to the idiopathic cause of intussusception in children, adult intussusception in most patients is associated with organic causes. The majority of these patients are brought to the operating room with the preoperative diagnosis of bowel obstruction, and the surgeon discovers an intussusception intraoperatively. But the increasing use of abdominal CT may improve the ability to diagnose intussusception. There is no universal agreement upon the correct treatment of adult intussusception, although most authors agree that surgical intervention is necessary. In the more recent reports, colonoscopic reduction of intussusception has been reported for selected patients. For patients in whom the involved ileum is extremely long, it is advisable to attempt an operative reduction or colonoscopic reduction selectively. Thus, we report here on two patients with benign and malignant lesion, respectively, that caused ileocolic intussusception; preoperative colonoscopic diagnosis and reduction were attempted for these patients, although the patients were not reduced by colonoscopic procedure.

The clinical feature of the muscle cramps and the effects of eperisone hydrochloride in treatment for the muscle cramps of the patients with liver cirrhosis / 대한내과학회지

BACKGROUND: Muscle cramps in cirrhotic patients are not serious symptoms but have frequently bad effect on their quality of life. We have evaluated the effectiveness of treatment with eperisone hydrochloride, an antispastic agent, on muscle cramps in cirrhotic patients. METHODS: Sixty five cirrhotic patients (cramps 35, no cramps 30) were included in our study. Thirty five patients with muscle cramps were questioned about the frequency and localization of muscle cramps. All patients were evaluated a physical findings and blood chemistry at the beginning of the study and after one month. Eperisone hydrochloride 50 mg per day were given orally to the patients with muscle cramps. RESULTS: There were significant differences for the number of diuretics use (p=0.019), hemoglobin (p=0.005), platelet (p=0.007), total bilirubin (p=0.003), albumin (p=0.000), total calcium (p=0.0001) and Na+ (p=0.001) between with and without muscle cramps. Muscle cramps were found to occur in calf muscles (60%) and hands (54%), to occur several times a week (76%), mainly during sleep (73%) and to last for several minutes (53%). After a month, muscle cramps completely disappeared in 7 patients (20%), decreased in frequency in 18 patients (51%) and were unaltered in 10 patients (29%). Side effects were observed in 7 patients (epigastric discomfort in five, fatigue in two) but any patients were not stopped. CONCLUSIONS: Eperisone hydrochloride was significantly effective in treatment for the muscle cramps of the patients with liver cirrhosis. In addition, this agents was well tolerated without any serious adverse effects in the majority of the patients.

The Clinical Values of CD44v6 Over-expression as a Prognostic Indicator in Colorectal Cancer

PURPOSE: The CD44 is a cell surface adhesion molecule that plays a role in lymphocyte homing, cell migration, and cancer metastasis. It has been reported that the expression of CD44v6, which is one of the CD44 variants, is related to tumor progression, recurrence and metastasis in colorectal cancer This study examined the relationship between CD44v6 over-expression and the depth of invasion, lymph node metastasis, and evaluated the clinical significance of CD44v6 as a prognostic factor of colorectal cancer. METHODS: Immunohistochemical staining of CD44v6 was performed on 72 patients who underwent radical surgery for colorectal cancer. Positive expression of more than half of the carcinoma cells was regarded as `over-expression', and that of less than half was regarded as being `low-expression'. The degree of CD44v6 expression according to depth of the invasion and lymph node metastasis was analyzed, and the 5-year survival rate of the patients was calculated. RESULTS: CD44v6 over expression was identified in 22 cases (30.6%). There was a significant correlation between CD44v6 over-expression and a lymph node metastasis, but not between CD44v6 over-expression and the depth of invasion. In addition, the 5-year survival rate was lower in the CD44v6 over expression cases (31.8%) than in the low-expression cases (90.0%)(P<0.001) Multivariate analysis, CD44v6 was regarded as a significant prognostic factor for survival in colorectal cancer patients. CONCLUSION: These results suggested that CD44v6 over- expression might be a useful prognostic indicator in colorectal cancer.

Cutaneous Fistula of Dental Origin, Case Report

Most common etiologic factor of supprative cutaneous fistula is the extension of chronic infection of dental origin. Skin opening is commonly located on chin and jaw, occasionally neck and chest. Because the skin opening may be remote from the infection origin, the physicians often incorrectly diagnose and also treat ineffectively. Rarely large necrotic defect is caused by ineffective treatment of cutaneous fistula. Recognition and treatment of the underlying dental infection is required to allow the resolution of the associated skin lesion. In the presence of a cutaneous fistula around the face and neck, it is always useful to perform routine dental examination and radiologic evaluation to exclude an odontogenic background. From March 2001 to April 2002, we were experienced 5 cases cutaneous fistula of dental orgin. We report the 3 patients, two are simple fistula and one is a complicated case which is developed necrotizing fascitis on chin and neck.

Duodenum-preserving pancreatic head resection / 한국간담췌외과학회지

BACKGROUND: Recently, partial pancreatectomy has been performed for treatment of benign pancreatic lesion with special attention to functional preservation of adjacent organs. In contrast to traditional pancreaticoduodenectomy( Whipple's procedure) and pylorus-preserving pancreaticoduodenectomy(PPPD), the duodenum-preserving pancreatic head resection(DPPHR) preserves stomach, duodenum, jejunum, extrahepatic bile duct, and this procedure is reported to preserve function of adjacent organs, to reduce morbidity and mortality rates. The indications of DPPHR are benign lesion of the head of the pancreas as well as complications of chronic pancreatitis, including distal common bile duct obstruction, duodenal obstruction, colonic stenosis, pseudocyst of the head of the pancreas, internal pancreatic fistula, portal or splenic vein stenosis. Also this procedure is indicated for the management of the pancreatic head injury. Reconstructive methods following resection of the pancreatic head are modified variously, this methods are end-to-end anastomosis of the pancreatic duct, Roux-en-Y pancreaticojejunostomy, pancreaticogastrostomy, pancreaticoduodenostomy. MATERIALS AND METHODS: The authors performed DPPHR in 4 patients; pseudocyst of the pancreatic head 1, pancreatic head injury 2, chronic pancreatitis 1. Two patients with pseudocyst of the pancreatic head and pancreatic head injury underwent end-to-end anastomosis of the pancreatic duct after resection of the head of the pancreas. This procedure involved insertion of feeding tube into the pancreatic duct and then end-to-end anastomosis of the pancreatic duct. Other two patients with pancreatic head injury and chronic pancreatitis underwent Roux-en-Y pancreaticojejunostomy after resection of the head of the pancreas. RESULTS: Two patients with end-to-end anastomosis of the pancreatic duct developed leakage of the anastomotic site of the pancreatic duct at 3rd and 8th postoperative days, respectively. So this patients were performed reoperation, Roux-en-Y pancreaticojejunostomy. But the peripancreatic abscess developed after reoperation and then performed drainage of the abscess. This patients were improved and discharged. Total hospital stay was 35days and 34days, respectively. Other two patients underwent Roux-en-Y pancreaticojejunostomy after resection of the head of the pancreas. This patients were improved without complications and discharged within 1 month. CONCLUSIONS: In our experiences, DPPHR can be appropriated in the treatment of complications of chronic pancreatitis, benign lesion of the head of the pancreas, pancreatic head injury. And we consider that the Roux-en-Y pancreaticojejunostomy is more safe reconstructive method, compare with the end-to-end anastomosis of the pancreatic duct.

A Case of Actinomycosis of the Greater Omentum

Actinomycosis is a chronic suppurative bacterial infection produced by Actinomyces israeli. The three major clinical presentation include the cervicofacial, thoracic, and abdominal regions. Abdominal actinomycosis is a rare entity which presents some difficulty in establishing a correct preoperative diagnosis. The diagnosis is usually based on histologic demonstration of sulfur granules in pus or surgically resected specimen. Recently, authors experienced a case of actinomycosis of the greater omentum in 38-years old woman. The patient underwent surgery under the impression of periappendiceal abscess. A 6cm sized firm mass was noted in the transverse colon. Histologically the mass was composed of fibroinflammatory mass with multiple actinomycosis granules.