Clinical Efficacy and Safety of Endoscopic Treatment of Gastrointestinal Stromal Tumors in the Stomach

Background/Aims@#Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the stomach. We evaluated the clinical outcomes of endoscopic treatment for gastric GISTs. @*Methods@#This is a single center, retrospective study that enrolled 135 cases of gastric subepithelial tumors (SETs) resected by endoscopic procedures and confirmed as GISTs by histopathology from March 2005 to July 2019. The immediate and long-term clinical outcomes were analyzed retrospectively. @*Results@#The mean patient age was 57.9 years, and the mean tumor size was 2.1 cm. Of the tumors, 43.0% were located in the body, followed by the fundus (26.7%) and cardia (17.0%). Most tumors (85.2%) were resected by endoscopic submucosal dissection, followed by endoscopic mucosal resection (6.7%), submucosal tunneling endoscopic resection (5.9%), and endoscopic full-thickness resection (2.2%). Macroperforation occurred in 4.4% and microperforation in 6.7% of the cases. The R0 resection rate was 15.6%. However, the rate of complete resection by the endoscopic view was 90.4%, of which 54.8% of cases were in the very-low-risk group, followed by the low-risk group (28.1%), intermediate-risk group (11.9%), and high-risk group (5.2%). During 36.5 months of follow-up, recurrence was found in four (3.4%) of the 118 patients who were monitored for more than 6 months (low-risk group, 1/37 [2.7%]; intermediate-risk group, 2/11 [18.2%]; high-risk group, 1/6 [16.7%]). @*Conclusions@#Endoscopic treatment of a GIST appears to be a feasible procedure in selected cases. However, additional surgery should be considered if the pathologic results correspond to intermediate- or high-risk groups.

Inverted Hyperplastic Polyp in Stomach: A Case Report and Literature Review / 대한소화기학회지

An inverted hyperplastic polyp (IHP) found in stomach is rare and characterized by downward growth of hyperplastic mucosal component into the submucosa. Because of such characteristic, IHP can be misdiagnosed as subepithelial tumor or malignant tumor. In fact, adenocarcinoma was reported to have coexisted with gastric IHP in several previous reports. Because only 18 cases on gastric IHP have been reported in English and Korean literature until now, pathogenesis and clinical features of gastric IHP and correlation with adenocarcinoma have not been clearly established. Herein, we report a case of gastric IHP which was initially misdiagnosed as gastrointestinal stromal tumor and resected using endoscopic submucosal dissection. Literature review of previously published case reports on gastric IHP is also presented.

Good Response of a Salivary Duct Carcinoma to Androgen Deprivation Therapy / 대한내과학회지

Salivary duct carcinoma (SDC) is a rare, aggressive tumor. Androgen deprivation therapy (ADT) has been shown to have beneficial effects on SDC-expressing androgen receptors (ARs). A 69-year-old male with a right neck mass presented to our clinic. Computed tomography (CT) of the neck revealed a mass (6 cm diameter) on the right parotid gland, and enlarged lymph nodes. Examination of a needle biopsy sample identified SDC-expressing ARs. We performed total parotidectomy with bilateral neck dissection and concurrent postoperative chemoradiotherapy (total 66 Gy) with cisplatin (35 mg/m2), followed by another two cycles of chemotherapy (cisplatin 60 mg/m2, 5 FU 750 mg/m2). Post-treatment neck CT indicated that no residual tumor tissue remained; however, chest CT indicated recurrence in the right axilla. We initiated ADT with bicalutamide and leuprolide. Five months later, the axillar tumor tissue had almost disappeared. Our case demonstrates that ADT is effective for SDC of ARs. Therefore, clinicians should consider ADT in recurrent or metastatic SDC of ARs.

Nasogastric Tube Syndrome: Why Is It Important in the Intensive Care Unit? / 대한중환자의학회지

Although the nasogastric tube (NGT) is widely used in critically ill patients, most intensivists do not give much thought to it or its possible complications. NGT syndrome is a rare but fatal complication characterized by throat pain and vocal cord paralysis in the presence of NGT. Recently, we experienced a case of NGT syndrome developed in an 86-year-old female twelve days after NGT insertion. We immediately removed the NGT and secured the airway by tracheostomy. She was treated successfully with an intravenous antibiotic, steroid and proton pump inhibitor and the syndrome did not recur after reinsertion of the NGT.

Comparative Results of Trabeculectomy with Mitomycin C in Uveitic Glaucoma versus Primary Open-Angle Glaucoma

PURPOSE: In this study we evaluated the long-term outcomes and prognostic factors of trabeculectomy with mitomycin C (MMC) in eyes with uveitic glaucoma (UG) compared with primary open-angle glaucoma (POAG). METHODS: We performed a retrospective chart review of 60 eyes with UG and 402 eyes with POAG that were followed up for at least 1 year after trabeculectomy with MMC between June 2000 and December 2012. The review included intraocular pressure (IOP), number of anti-glaucoma medications, and postoperative complications. Surgical success was analyzed using the Kaplan-Meier life-table method based on 2 definitions of successful IOP control with topical anti-glaucoma medications: Definition A (IOP < or = 15 mm Hg) and Definition B (IOP < or = 18 mm Hg). Risk factors for surgical failure of trabeculectomy were analyzed using the Cox proportional hazards model. RESULTS: Success rate at 5 years after trabeculectomy was lower in UG than in POAG (65.8% vs. 76.4%, Definition B), but without significant difference. However, UG had a significantly lower cumulative probability of success than POAG based on Kaplan-Meier survival curves (p = 0.049 and 0.044, respectively). Postoperative hypotony and hypotony maculopathy was more frequent in UG (p = 0.044 and 0.044, respectively). In UG, the Cox proportional hazards model showed postoperative shallow anterior chamber was associated with surgical failure in both Definition A and B. CONCLUSIONS: Long-term results of trabeculectomy with MMC in eyes with UG showed successful IOP control similar to POAG. Trabeculectomy with MMC is a reasonable surgical option for the management of UG.

Surgical Outcomes of Transconjunctival 25-Gauge Plus Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

PURPOSE: To evaluate anatomical and visual results of transconjunctival 25-gauge plus pars plana vitrectomy (PPV) in the management of primary rhegmatogenous retinal detachment (RRD). METHODS: A retrospective analysis of 46 eyes of 46 patients who underwent transconjunctival 25-gauge plus PPV for primary RRD repair between January 2013 and May 2013 with a minimum of 3-month follow-up was performed. Data collected for the study included patient demographics, lens status, preoperative visual acuity, macular status, and location and number of primary breaks. Main outcome measures were anatomical reattachment rate, postoperative visual acuity, operation time, and postoperative complications. RESULTS: The study included 30 men and 16 women. The mean age of the patients was 54.3 years. The locations of retinal breaks were 24 (52.2%) eyes in the superior half, 15 (32.6%) eyes in the inferior half, and 7 (15.2%) eyes on both sides. The macula-on RRD was present preoperatively in 21 (45.7%) of 46 eyes. Of the 33 (71.7%) phakic eyes, 18 (39.1%) underwent combined phacoemulsification, intraocular lens implantation, and PPV. Two different tamponades, C3F8 gas and silicone oil were used in this study. C3F8 gas was injected in the 33 (71.7%) eyes, and the remaining eyes were filled with silicone oil (1,300 centistokes for 11 eyes, 5,700 centistokes for 2 eyes). Mean operation time was 48.8 +/- 13.2 minutes. Retinal reattachment was achieved in 45 (97.8%) of 46 eyes at 3 months. Mean best-corrected visual acuity improved from 1.33 +/- 1.20 log MAR preoperatively to 0.68 +/- 0.94 log MAR postoperatively (p < 0.001). Postoperative complications included transient intraocular pressure elevation in 6 (13.1%) eyes and posterior capsular opacity in 3 (6.5%) eyes. CONCLUSIONS: It seems that transconjunctival 25-gauge plus PPV can be a safe and effective option for surgical management of RRD.

Acute Necrotizing Pancreatitis during L-asparaginase Treatment in a Patient with Acute Lymphoblastic Leukemia / 대한췌담도학회지

L-asparaginase is an important component of antileukemic therapy in patients with acute lymphoblastic leukemia. The degree of L-asparaginase toxicity is variable. Several cases of L-asparaginase related pancreatitis have been reported in the literature. However, necrotizing pancreatitis in adult has not been reported yet. Herein, we present a case of necrotizing pancreatitis caused by L-asparaginase that was complicated by pancreatic duct leakage and pseudocyst formation, but successfully treated with percutaneous drainage and octreotide treatment.

Nasogastric Tube Syndrome: Why Is It Important in the Intensive Care Unit? / 대한구급학회지

Although the nasogastric tube (NGT) is widely used in critically ill patients, most intensivists do not give much thought to it or its possible complications. NGT syndrome is a rare but fatal complication characterized by throat pain and vocal cord paralysis in the presence of NGT. Recently, we experienced a case of NGT syndrome developed in an 86-year-old female twelve days after NGT insertion. We immediately removed the NGT and secured the airway by tracheostomy. She was treated successfully with an intravenous antibiotic, steroid and proton pump inhibitor and the syndrome did not recur after reinsertion of the NGT.

A Case of Intralesional Cidofovir Injection for Recurrent Lacrimal Sac Squamous Papilloma

PURPOSE: To report a case of treating a patient with intralesional cidofovir injection who had frequently recurring lacrimal sac squamous papilloma after several excision surgeries. CASE SUMMARY: A 59-year-old man who had mass excision surgery at a different clinic nine months previously, visited our clinic to treat a recurring erythematous protruding mass near his left medial canthus that developed two months prior. Orbit CT showed a 15 x 25 mm-sized large mass located on the lacrimal sac adherent to medial orbital wall. An excision biopsy was performed and the histopathologic examination showed typical findings of squamous papilloma. Because the tumor recurred six months after the second surgery, we decided to perform adjuvant therapy using the antiviral agent cidofovir. The patient was treated with a 5 mg/mL intralesional cidofovir injection every three weeks. A transient recurrence presented on the upper lid at the third intralesional cidofovir injection site two months after the surgery, but the recurrent lesion improved after repeated injections. During the 12 months of follow-up, there were no complications and no evidence of recurrence. CONCLUSIONS: Intralesional cidofovir injections can be a safe and effective treatment for the management of recurrent squamous papilloma of the orbit, especially after total excision.

Frequency of Instant Noodle (Ramyeon) Intake and Food Value Recognition, and their Relationship to Blood Lipid Levels of Male Adolescents in Rural Area / 대한지역사회영양학회지

In order to investigate the ramyeon intake patterns, food value recognition, and their effects on blood pressure and blood lipid levels, a total of 385 male students aged 13-15 years living in rural area were sampled randomly, and they were surveyed using questionnaire. Blood pressure and fasting serum lipids levels of 123 subjects selected among the total were determined. Of the total subjects 80.3% either liked or liked very much ramyeon and 42.2% of them were eating ramyeon from 1 to 2 times a week,21.1% 5-6 times a week, while 11.7% more than once a day, and 13.1% less than once a month. They took ramyeon from one (56.8%) to two (25.4%) packs each time. Two-third of subjects consumed entire ramyeon soup or more than half of it. Mostly they added egg or onion to ramyeon and took along with kimchi, cooked rice, danmuji, or dried laver. The food value recognition score about ramyeon was 41.33 out of 100 full grade. Comparing to underweight or normal weight subjects, overweight students tended to take ramyeon more frequently when playing with friends and tended to consume less soup of ramyeon. There was a significant negative correlation between ramyeon intake frequencies and HDL-cholesterol levels (r=-.223 p < .05). Moreover, among the normal body weight students (n=72) adjusted with relative weight, ramyeon intake frequencies showed not only a significant negative correlation with HDL-cholesterol level (r=-.244 p < .05), but also significant positive correlations with atherogenic index (r: .249 p < .05) and systolic blood pressure (r: .259 p < .05) . These results suggested that frequent intake of ramyeon with limited sidedishes as a whole meal might have negative influences on blood pressure and serum lipid levels. Nutrition education is needed to have correct food value recognition and proper consumption of ramyeon along with the balanced diet.