Endoscopic Versus Mini.open Carpal Tunnel Release in Patients with Bilateral Carpal Tunnel Syndrome

OBJECTIVE: The purpose of this study was to determine any differences in outcome and patient satisfaction between endoscopic release (ECTR) and open carpal tunnel release (OCTR) in patients with bilateral carpal tunnel syndrome who underwent both techniques. METHODS: Seven patients with confirmed bilateral idiopathic carpal tunnel syndrome were randomized to undergo endoscopic release using a single portal Agee technique to one hand and a minimal open release to the other. Subsequent assessments were made at 0, 3, and 12 months after operation using a modified Levin scale. We also analyzed subjective and objective outcomes retrospectively, including the time to return to full activity, patient preference, cosmetic satisfaction, scar tenderness, and pillar pain. The pain was assessed using a visual analogue scale from 1 to 10. RESULTS: Based on the Levin scale, there were no significant differences between hands at any follow-up interval. At the three-month follow up, mean scale scores were lower in the ECTR group; however, the differences did not reach statistical significance. Cosmetically, all patients were satisfied with their scar irrespective of the technique. There were no statistical differences in terms of scar tenderness and pillar pain. CONCLUSION:ECTR did not show any significant advantage over short-incision OCTR. Therefore, the operator's experience and skill in using a certain method is important, regardless of which technique is used.

Efficacy and safety of lamivudine therapy in patients with liver cirrhosis associated with chronic hepatitis B / 대한내과학회지

BACKGROUND: Lamivudine has been reported to be effective and safe in the treatment of chronic hepatitis B. However, in patients with advanced liver cirrhosis (LC) who have less hepatic reserve function and so higher chances of serious complications, its outcomes remained to be clarified. We evaluated the effectiveness and safety of lamivudine in patients with LC caused by hepatitis B. METHODS: Twenty four patients with HBV-associated LC who had clinical evidence of hepatic dysfunction (Child-Pugh Class A:B:C = 13:7:4) as well as 76 patients with biopsy-proven chronic hepatitis B (CH) as controls were administered with 150 mg of lamivudine orally everyday for at least more than 6 months. Serum HBeAg and HBV-DNA (liquid phase hybridization assay) as well as CBC, prothrombin time and biochemistry were tested sequentially during the follow-up period. RESULTS: All patients in both groups became negative for HBV-DNA in their sera during the treatment. Five out of 24 LC (21%) and 33 (43%) of 76 CH patients were relapsed within the follow-up periods of median 19 and 22 months, respectively (p=0.42). HBeAg seroconversion was observed in 7 of 19 LC (37%) and 25 of 69 CH (36%) patients with positive HBeAg (p=0.52). The hemoglobin, white blood cell and platelet counts were not changed significantly in both groups during the follow-up periods. The prothrombin time, serum cholesterol and bilirubin levels were also not changed significantly during the treatment. All of 76 CH patients had not presented any fatal complication during the follow-up periods. In contrast, 3 out of 4 LC patients in Child-Pugh class C died of serious complications (1 out of 5 relapsers, 2 of 19 persistent responders, p=NS; 1 died of sepsis, 2 of variceal bleeding). CONCLUSION: Lamivudine therapy may be as effective in patients with LC as in those with CH in terms of the clearance of serum HBV-DNA and the seroconversion of HBeAg. Our data also suggest that the lamivudine therapy is as safe even in decompensated LC as in CH.

A Villous Adenoma with Foci of Adenocarcinoma Arising in the Common Hepatic Duct / 대한소화기내시경학회지

Villous adenoma of the extrahepatic duct is a rare disease. Even though it is benign, it has malignant potential and is considered a premalignant lesion. We here report one case of villous adenoma with foci of adenocarcinoma arising in the common hepatic duct. A 60-year-old male was admitted to our hospital because of epigastric pain. The cholangiogram revealed a large filling defect in the right intrahepatic and common hepatic duct with intrahepatic bile duct dilatation. The patient underwent right lobectomy. Grossly, stalked papillay tumor originated in the common hepatic duct was overriding the right intrahepatic duct. Microscopically, the tumor was composed of stratified tall columnar cells with various dysplasia and there were foci of invasive adenocarcinoma.

A Case of Mucin-Hypersecreting Intrahepatic Bile Duct Tumor Combined with Pancreatic Intraductal Papillary Mucinous Tomor (IPMT) / 대한소화기내시경학회지

Intraductal papillary mucinous tumor (IPMT) of the pancreas is a recently understood unique clinicopathologic disease entity comprising approximately 1% of all exocrine pancreatic tumors and 11% of cystic neoplasms of pancreas. It has been reported worldwide, mostly in Japan. It is generally characterized by recurrent pancreatitis, mucin oozing from the papilla of Vater, and dilated pancreatic duct with intraductal filling defects. Microscopically, the mucin-producing columnar epithelium forms papillary proliferation into the dilated pancreatic duct and this feature differentiates IPMT of the pancreas from the more common mucinous cystic neoplasms of the pancreas which usually do not communicate with the pancreatic duct. On the other hand, mucin-hypersecreting bile duct tumors have been rarely reported in the English literature. We herein present the first case of mucin-hypersecreting bile duct tumor combied with IPMT of the pancreas with a review of the related literature.

Clinical usefulness of serum isocitrate dehydrognase as a marker of centrilobular hepatic necrosis in patients with hyperthyroidism / 대한내과학회지

BACKGROUND: The zonal differentiation of hepatic necrosis is important in the aspect of treatment, follow-up and prognosis of patients. The purpose of this study was evaluating the clinical usefulness of serum isocitrate dehydrogenase (ICDH) as a marker of centrilobular hepatic necrosis in patients with hyperthyroidism. METHODS: We determined the serum ICDH and alanine aminotransferase (ALT) activities in 56 patients with hyperthyroidism, 16 patients with chronic viral hepatitis, and 17 normal controls. RESULTS: The activities of serum ICDH were significantly higher in patients with hyperthyroidism than those of patients with chronic viral hepatitis or normal control (p< 0.01), even though those of serum ALT were higher in patients with chronic viral hepatitis (p< 0.01). The ratio of serum ICDH and ALT activities were markedly different between the patients with hyperthyroidism and chronic viral hepatitis (p< 0.001). There was a significant correlation between the serum ICDH and ALT activities in patients with hyperthyroidism as well as in those with chronic viral hepatitis (p< 0.05). In patients with hyperthyroidism, the serum ICDH levels were more significantly correlated with serum triiodothyronine (T3) than thyroxine (T4) levels. In a patients with hyperthyroidism and elevated ALT levels, the serum ICDH activity decreased progressively and was normalized ultimately, as serum ALT level and thyroid function were normalized with antithyroid medication. CONCLUSION: The serum ICDH or ratio of serum ICDH and ALT activities might be useful clinically in differentiating the centrilobular from periportal hepatic necrosis, and following up the degree of hepatic necrosis in patients with hyperthyroidism.