Pathologic View of Intraductal Papillary Mucinous Neoplasm / 대한췌담도학회지

Among pancreatic cystic lesions, mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasm (IPMN) of the pancreas are precursor lesions of pancreatic adenocarcinoma. IPMN is characterized by intraductal papillary proliferation of mucin-producing epithelial cells that exhibit various degrees of dysplasia. IPMN is classified as the main duct type (MD-IPMN), mixed type and the branch duct type (BD-IPMN) according to the location of involvement, and into four histological subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) according to the histomorphological and immunohistochemical characteristics. Most patients with MD-IPMN undergo tumor resection due to moderate to high risk of malignancy. Patients with BD-IPMN who do not undergo resection may develop malignant change, and concomitant separate pancreatic cancer occurs in 2-10% of patients with IPMN. Patients with BD-IPMN who do not undergo resection should do careful surveillance including endoscopic ultrasound sonography for the early detection of malignant change and separate pancreatic cancer.

Standardization of the pathologic diagnosis of appendiceal mucinous neoplasms

Although the understanding of appendiceal mucinous neoplasms (AMNs) and their relationship with disseminated peritoneal mucinous disease have advanced, the diagnosis, classification, and treatment of AMNs are still confusing for pathologists and clinicians. The Gastrointestinal Pathology Study Group of the Korean Society of Pathologists (GPSG-KSP) proposed a multicenter study and held a workshop for the “Standardization of the Pathologic Diagnosis of the Appendiceal Mucinous Neoplasm” to overcome the controversy and potential conflicts. The present article is focused on the diagnostic criteria, terminologies, tumor grading, pathologic staging, biologic behavior, treatment, and prognosis of AMNs and disseminated peritoneal mucinous disease. In addition, GPSG-KSP proposes a checklist of standard data elements of appendiceal epithelial neoplasms to standardize pathologic diagnosis. We hope the present article will provide pathologists with updated knowledge on how to handle and diagnose AMNs and disseminated peritoneal mucinous disease.

Standardization of the pathologic diagnosis of appendiceal mucinous neoplasms

Although the understanding of appendiceal mucinous neoplasms (AMNs) and their relationship with disseminated peritoneal mucinous disease have advanced, the diagnosis, classification, and treatment of AMNs are still confusing for pathologists and clinicians. The Gastrointestinal Pathology Study Group of the Korean Society of Pathologists (GPSG-KSP) proposed a multicenter study and held a workshop for the “Standardization of the Pathologic Diagnosis of the Appendiceal Mucinous Neoplasm” to overcome the controversy and potential conflicts. The present article is focused on the diagnostic criteria, terminologies, tumor grading, pathologic staging, biologic behavior, treatment, and prognosis of AMNs and disseminated peritoneal mucinous disease. In addition, GPSG-KSP proposes a checklist of standard data elements of appendiceal epithelial neoplasms to standardize pathologic diagnosis. We hope the present article will provide pathologists with updated knowledge on how to handle and diagnose AMNs and disseminated peritoneal mucinous disease.

Incidence and clinical course of HELLP syndrome in pregnant women / 대한내과학회지

BACKGROUND: Although HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a serious medical complications including coagulopathy, hypertension, hepatic and renal failures, and pulmonary edema in pregnant women, the data about HELLP syndrome were rarely reported in the medical journal in Korea. METHODS: Nineteen cases of HELLP syndrome were retrospectively studied out of 16,910 pregnant women from January 1998 to March 2004 at Uijongbu St. Mary's Hospital. We analyzed incidence, clinical symptoms, laboratory findings, maternal and clinical complications and clinical course of HELLP syndrome. RESULTS: The incidence of HELLP syndrome was 0.27% (19/16,910) in total pregnant women and 4.15% (19/458) in women with preeclampsia. All patients had evidence of hemolysis and serum aspartate aminotransferase level >or= 70 IU/L, and platelet counts

Ten-Year Study of Bacteremia in Hemodialysis Patients in a Single Center / 대한신장학회잡지

BACKGROUND: The incidence of infection in patients on chronic hemodialysis in higher than that of the general population. Infection is known to be a major cause of morbidity and mortality in these patients. The vascular access is important for hemodialysis, but infection through this route is the most common source of bacteremia and can be lethal to the patients. Despite the high morbidity and mortality of bacteremia in patients on chronic hemodialysis, the clinical characteristics of bacteremia in hemodialysis patients is rarely reported yet in Korea. METHODS: We included 696 hemodialysis patients from January 1993 to December 2003 at Uijongbu St. Mary's Hospital. We investigated incidence, source, causative organisms, clinical manifestations, complication and mortality of bacteremia. We compared clinical factors, morbidity and mortality between arteriovenous fistula and central venous catheter groups. RESULTS: Total 52 cases of bacteremia occurred in 43 patients. The major source of infection was vascular access (48%) and staphylococcus aureus was most common. Major complications were septic shock (9.6%), pneumonia (9.6%), infective endocarditis (3.8%), aortic pseudoaneurysm (1.9%). Nine patients died from septic shock (n=4), aspiration pneumonia (n=2), hypoxic brain injury (n=1), gastrointestinal bleeding (n=1), and rupture of aortic pseudoaneurysm. Central venous catheter group (n= 22) had higher incidences of vascular access as a source of infection (81.8% vs 23.3%, p<0.001) and staphylococcus as a causative organism (77.2% vs 50.0%, p=0.042) than arteriovenous group. CONCLUSION: This data showed that bacteremia caused high incidence of fatal complications and mortality. Therefore, careful management of vascular access as well as early detection of bacteremia is an important factor for the prevention of infection and proper antibiotic therapy should be started early.