Endoscopic Papillectomy for Synchronous Major and Minor Duodenal Papilla Neuroendocrine Tumors / 대한소화기학회지

Neuroendocrine tumor (NET) of the major duodenal papilla is a rare occurrence. However, that of the minor duodenal papilla is even rarer. To date, only a few cases have been reported. Herein, we present a rare case of NETs detected at the major and minor duodenal papilla synchronously, which were successfully treated with endoscopic papillectomy without procedure-related complication. To the best of our knowledge, this is the first report of this kind in the world. Photomicrograph of the biopsy specimen stained immunohistochemically for synaptophysin showed a positive reaction of tumor cells. All resection margins were negative. Further experience with more cases will be needed to establish the exact indication of endoscopic papillectomy for duodenal papillary NETs.

A Case of Gastric Neuroendocrine Carcinoma Presenting as Early Gastric Cancer Diagnosed by Endoscopic Submucosal Dissection

Gastric neuroendocrine carcinomas are very rare, when compared with gastric adenocarinomas. In addition, it is difficult to distinguish between gastric adenocarcinoma and gastric neuroendocrine carcinoma histol-ogically without immunohistochemical staining. In most of the reported cases, neuroendocrine carcinomas were diagnosed at an advanced stage, confirmed postoperatively by histological examinations using immunohistochemical staining and associated with a poor prognosis. A 55-year-old woman was diagnosed as cellular atypia by screening endoscopy for her health check-up at a local clinic. Histological examination from the endoscopic specimen revealed suspicious early gastric cancer. Endoscopic submucosal dissection was performed for therapeutic and diagnostic purposes and the pathologic findings revealed neuroendocrine carcinoma. Herein, we report a case of gastric neuroendocrine carcinoma presenting as early gastric cancer that was diagnosed by endoscopic submucosal dissection.

A Case of Gastric Neuroendocrine Carcinoma Presenting as Early Gastric Cancer Diagnosed by Endoscopic Submucosal Dissection

Gastric neuroendocrine carcinomas are very rare, when compared with gastric adenocarinomas. In addition, it is difficult to distinguish between gastric adenocarcinoma and gastric neuroendocrine carcinoma histol-ogically without immunohistochemical staining. In most of the reported cases, neuroendocrine carcinomas were diagnosed at an advanced stage, confirmed postoperatively by histological examinations using immunohistochemical staining and associated with a poor prognosis. A 55-year-old woman was diagnosed as cellular atypia by screening endoscopy for her health check-up at a local clinic. Histological examination from the endoscopic specimen revealed suspicious early gastric cancer. Endoscopic submucosal dissection was performed for therapeutic and diagnostic purposes and the pathologic findings revealed neuroendocrine carcinoma. Herein, we report a case of gastric neuroendocrine carcinoma presenting as early gastric cancer that was diagnosed by endoscopic submucosal dissection.

Analysis of Treatment Patterns and Blood Pressure Changes According to Risk Stratification in Hypertensive Subjects / 대한내과학회지

BACKGROUND/AIMS: The aims of this study were to identify real world treatment patterns of hypertension according to cardiovascular risk stratification and to evaluate blood pressure changes with anti-hypertensive treatment in each risk group. METHODS: This study included patients who were newly-diagnosed with hypertension or known hypertensive patients with uncontrolled blood pressure (BP) at seven tertiary hospitals in Busan and Ulsan. World Health Organization/International Society of Hypertension (WHO/ISH) cardiovascular risk stratification was performed through retrospective chart review. RESULTS: Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers were the most frequently prescribed drugs. The higher WHO/ISH risk group received a greater number of drugs at the initial treatment, and one year after treatment. Target BP was achieved less frequently in the higher risk group (68.2% vs. 85.2% vs. 89.0%, p < 0.001). The rate of attaining target BP was lower (50.7% vs. 81.6%, p < 0.001), and the time to attaining target BP was longer (106.5 +/- 79.2 days vs. 82.1 +/- 75.3, p = 0.001), in patients with renal disease or diabetes. Initial systolic BP above 160 mmHg (OR: 4.91, 95% CI: 2.27~10.65), renal disease (3.42, 1.60~7.32), medium or high risk group status (2.27, 1.23~4.20), initial diastolic BP above 100 mmHg (2.11, 1.11~4.04), and diabetes (2.06, 1.29~3.25) were independent factors that predicted failure of attaining the target BP. CONCLUSIONS: BP control was relatively unsatisfactory in patients with higher initial BP, renal disease, higher WHO/ISH risk group status, and diabetes. Individualized approaches for such patients are needed to improve BP control in routine clinical practice.

Differences between Patients with TB-Destroyed Lung and Patients with COPD Admitted to the ICU / 결핵및호흡기질환

BACKGROUND: Although patients with tuberculous-destroyed lung (TDL) account for a significant proportion of those with chronic airflow obstruction, it is difficult to distinguish patients with airway obstruction due to TDL from patients with pure chronic obstructive pulmonary disease (COPD) on initial presentation with dyspnea. We investigated clinical features differing between (i) patients with TDL and airway obstruction and (ii) those with COPD admitted to the intensive care unit (ICU) due to dyspnea. METHODS: We reviewed the medical records of patients with TDL who had a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of <70% on a pulmonary function test (PFT; best value closest to admission) and patients with COPD without a history of pulmonary tuberculosis (TB) who were admitted to the ICU. Ultimately, 16 patients with TDL and 16 with COPD were compared, excluding patients with co-morbidities. RESULTS: The mean ages of the patients with TDL and COPD were 63.7 and 71.2 years, respectively. Mean FVC% (50.4% vs. 71.9%; p<0.01) and mean FEV1% (39.1% vs. 58.4%; p<0.01) were significantly lower in the TDL group than in the COPD group. More frequent consolidation with TB (68.8% vs. 31.3%; p=0.03) and more tracheostomies (50.0% vs. 0.0%; p=0.02) were observed in the TDL than in the COPD group. CONCLUSION: Upon ICU admission, patients with TDL had TB pneumonia more frequently, more diminished PFT results, and more tracheostomies than patients with COPD.