Prevalence of Toxocariasis and Its Risk Factors in Patients with Eosinophilia in Korea

Eosinophilia occurs commonly in many diseases including allergic diseases and helminthic infections. Toxocariasis has been suggested as one cause of eosinophilia. The present study was undertaken to examine the prevalence of toxocariasis in patients with eosinophilia and to identify the risk factors for toxocariasis. This prospective cohort study recruited a total of 81 patients with eosinophilia (34 males and 47 females) who visited the outpatient clinic at Seoul National University Hospital from January 2017 to February 2018 and agreed to participate in this study. The prevalence of toxocariasis was examined by T. canis-specific ELISA, and the various risk factors for toxocariasis were evaluated by a questionnaire survey. Among 81 patients with eosinophilia, 18 were positive for anti-T. canis antibodies (22.2%); 88.9% were male (16/18) and 11.1% were female (2/18). Multivariate statistical analysis revealed that males (OR 21.876, 95% CI: 1.667-287.144) with a history of consuming the raw meat or livers of animals (OR 5.899, 95% CI: 1.004-34.669) and a heavy alcohol-drinking habit (OR 8.767, 95% CI: 1.018-75.497) were at higher risk of toxocariasis in patients with eosinophilia. Toxocariasis should be considered a potential cause of eosinophilia when the patient has a history of eating the raw meat or livers of animals in Korea. A single course of albendazole is recommended to reduce the migration of Toxocara larvae in serologically positive cases with eosinophilia.

Natural Course and Risk of Cholangiocarcinoma in Patients with Recurrent Pyogenic Cholangitis: A Retrospective Cohort Study

BACKGROUND/AIMS: Recurrent pyogenic cholangitis (RPC) is a chronic progressive disease frequently accompanied by cholangiocarcinoma (CCA). This study aimed to investigate the natural course of RPC and identify factors associated with CCA. METHODS: From January 2005 to December 2016, 310 patients diagnosed with RPC at Seoul National University Hospital were included. Complications and management during follow-up were recorded. CCA-free probability was estimated by Kaplan-Meier method, and risk factors associated with CCA were analyzed using log-rank test and Cox’s proportional hazard regression model. RESULTS: Mean age at diagnosis was 59.1±10.9 years and mean follow-up duration was 84.0±64.1 months. An intrahepatic duct stone was found in 253 patients (81.6%). Liver atrophy was identified in 185 patients (59.7%) and most commonly located at the left lobe (65.4%). Acute cholangitis, liver abscesses, cirrhotic complications, and CCA developed in 41.3%, 19.4%, 9.7%, and 7.4%, respectively. During follow-up, complete resolution rate after hepatectomy, biliary bypass surgery, and choledocholithotomy with T-tube insertion reached 82.3%, 55.2%, and 42.1%, respectively. None of the patients who maintained complete resolution by the last follow-up day developed CCA. In univariate analysis, female, both-sided intrahepatic duct stones, and liver atrophy at any location were associated with increased risk of CCA. Multivariate analysis revealed that both-sided atrophy significantly increased risk of CCA (hazard ratio, 4.56; 95% confidence interval, 1.48 to 14.09; p=0.008). In 21 patients who developed intrahepatic CCA, tumor was located mostly in the atrophied lobe (p=0.023). CONCLUSIONS: In RPC patients, acute cholangitis, liver abscess, cirrhotic complications, and CCA frequently developed. Both-sided liver atrophy was a significant risk factor for developing CCA.

Metastatic Gallbladder Cancer Treated with Curative Surgery after Cyclic Chemotherapy and Biliary Drainage / 대한췌담도학회지

Gallbladder cancer is the most common malignancy of the biliary tract and carries very poor prognosis. Surgery is an only curative modality of treatment in the gallbladder cancer. However, as most of the gallbladder cancers are diagnosed at advanced stages, surgery can be attempted in a very limited number of patients. In advanced stage, treatment option is confined to a palliative systemic chemotherapy, and biliary decompression is needed when cholangitis is suspected. We report a case of 49-year-old patient with metastatic gallbladder cancer treated with successful curative resection after several courses of palliative chemotherapy and biliary decompression.

A novel c.563 T>G, p.L189R lamin A/C mutation in identical twins with dilated cardiomyopathy

No abstract available.

Acute Emphysematous Pancreatitis with Fulminant Multi-organ Failure / 대한췌담도학회지

An emphysematous pancreatitis is a rare, but fatal subtype of acute pancreatitis. Gas-forming bacteria from the bowel may penetrate the pancreas to cause emphysematous pancreatitis. It is characterized by the presence of gas within pancreas bed or retroperitoneal cavity at computed tomographic image and carries a high mortality rate. It requires fluid resuscitation and anti-bacterial therapy to control infection, and needs to consider percutaneous drainage or surgical management depending on the clinical condition. We report a case of 73-year-old patient presented with an emphysematous pancreatitis which developed fulminant multi-organ failure in spite of intensive medical treatment along with a review of the related literatures.

Multiple Polypoid Angiodysplasia with Obscure Overt Bleeding

Angiodysplasia (AD) is increasingly being recognized as a major cause of gastrointestinal bleeding. Morphologically flat lesions are common types of AD, whereas the polypoid types are rare. We report a case of multiple polypoid AD in the small bowel causing severe anemia and requiring surgical treatment. A 60-year-old male patient visited our hospital with dyspnea and hematochezia. He had a history of myocardial infarction and was taking both aspirin and clopidogrel. Capsule endoscopy, enteroscopy, computed tomography, and angiography revealed multifocal vascular lesions with a polypoid shape in the jejunum. Surgical resection was performed because endoscopic treatment was considered impossible with the number and the location of lesions. The risk of recurrent bleeding related to the use of antiplatelet agents also contributed to the decision to perform surgery. AD was histologically diagnosed from the surgical specimen. He resumed taking both aspirin and clopidogrel after surgery. He fully recovered and has been doing well during the several months of follow-up.

Intraductal Papillary Mucinous Neoplasm with an Associated Invasive Carcinoma Manifested by Acute Pancreatitis / 대한췌담도학회지

Idiopathic acute pancreatitis (IAP) is defined as acute pancreatitis for which the standard initial evaluation has failed to reveal the etiology. Although a tumor is a rare cause of IAP, it is important to consider it in advance, because prognosis is poor if diagnosis is delayed. We describe a case of presumed IAP at the index presentation that was finally diagnosed as intraductal papillary mucinous neoplasm with an associated invasive carcinoma in a 70-year-old woman after surgery to remove a mass identified during follow-up endoscopic ultrasonography. Therefore, this is a case in which suspicion of malignancy and follow-up endoscopic ultrasonography helped to appropriately diagnose and treat the tumor.

A Case of Xanthogranulomatous Cholecystitis Decreased in Size after Steroid Treatment and Avoided Extended Resection / 대한췌담도학회지

Xanthogranulomatous cholecystitis is an uncommon destructive inflammatory disease with accumulation of lipid-laden macrophages, fibrous tissue, and inflammatory cells. It is often mistaken for gallbladder cancer due to diffuse wall thickening of gallbladder and infiltration into neighboring organs. And it is usually difficult to distinguish xanthogranulomatous cholecystitis from gallbladder cancer based on clinical, radiographic, or laboratory testing. Patients with xanthogranulomatous cholecystitis often undergo cholecystectomy to confirm the diagnosis, and to exclude gallbladder cancers. We report a case of 69-year-old woman with xanthogranulomatous cholecystitis who had been treated with steroid and avoided extended resection.