A Case of a Pancreatic Intraductal Papillary Mucinous Neoplasm Forming Multiple Fistulas and Manifesting as Duodenal Ulcer Bleeding / 대한소화기내시경학회지

An intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an uncommon tumor characterized by the production of mucin in the pancreatic duct that occasionally involves the formation of fistulas with surrounding organs, including the stomach, duodenum and common bile duct. The mechanism underlying the formation of such fistulas is direct invasion by a tumor or a combination of high pressure in the main pancreatic duct and inflammatory stimulation. A 73-year-old man was referred to our hospital due to the presence of a gastric ulcer detected on screening gastroscopy. Endoscopic findings showed the presence of a whitish thick mucin coated ulcerative lesion that appeared as a perforation or fistula opening. Abdominal computed tomography and magnetic resonance cholangiopancreatography demonstrated the presence of an IPMN of the pancreas and multiple fistula formation with the neighboring organs. An endoscopic biopsy was carried out to obtain pancreatic tumor tissue through the pancreatogastric fistula and the mass was confirmed as a mucinous adenocarcinoma. To the best of our knowledge, this is the first case of an IPMN associated with a pancreatojejunal fistula and duodenal ulcer bleeding due to fistula formation.

Appendiceal Mucocele-Induced Intussusception That Presented as a Huge Mass on the Hepatic Flexure Area / 대한소화기내시경학회지

Appendiceal intussusception is a rare disease entity and appendiceal mucocele is one of the causes of this disease. Although computed tomography, ultrasonography, barium enema and colonoscopy can be performed to make a preoperative diagnosis, only a few cases of appendiceal mucocele-induced intussusception have been precisely diagnosed by these diaggnostic tools. Most of all, few such cases have been confirmed by colonoscopic examination. Colonoscopic examination has a supplementary role for the differential diagnosis of acute or chronic appendicitis, tumor or abscess in the ascending colon and cecum that is caused by appendiceal intussusception. We report here on a case of intussusception that was caused by an appendiceal mucocele, and this showed a target appearing structure in the hepatic flexure and a cystic mass inside the intussusceptive lumen on abdominal CT, and a huge mass was discovered on the colonoscopic examination.

A Case of Successful Closure using Endoscopic Hemostatic Clips with a Detachable Snare and Fibrin Glue Injection for a Gastro-Cutaneous Fistula following Buried Bumper Syndrome / 대한소화기내시경학회지

The buried bumper syndrome is a well-recognized long-term complication of a percutaneous endoscopic gastrostomy (PEG). Most of the buried bumpers are removed by making an external incision over the PEG site under local anesthesia or during a laparotomy. Recently, endoscopic removal is usually attempted. While the removal of the PEG tube is usually followed by spontaneous closure of the gastrostomy tract, a non-healing gastro-cutaneous fistula is difficult to manage. The fistula is generally treated with bowel rest and total parenteral nutritional support, suppression of gastric acid secretion, and occasionally, surgical exploration and wedge excision of the fistula site are performed. However, in debilitated patients, surgical management is accompanied with high morbidity and mortality. Recently, the use of nonsurgical alternative methods, such as endoscopic therapy using tissue adhesives or hemostatic clips, has emerged with recent advances in endoscopic technology. We report a case of successful closure using endoscopic hemostatic clips with a detachable snare and fibrin glue injection for a gastro-cutaneous fistula following buried bumper syndrome.

Differences in Overall Survival When Colorectal Cancer Patients are Stratified into New TNM Staging Strategy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to determine whether the prognosis can be more precisely gauged by the revised 6th AJCC staging system and if this is suitable for Korean colorectal cancer patients, and especially for those patients in the Youngdong district. MATERIALS AND METHODS: Between September 1996 and December 2003, 365 patients with histologically confirmed colorectal cancer were analyzed. Kaplan-Meier analyses were used to compare the overall and stage-specific 5-year survival. All the statistical tests were two-sided. RESULTS: The overall 5-year survival for the entire cohort was 62%. According to the stages defined by the AJCC fifth edition system, the 5-year stage-specific survival was 91% for stage I, 82% for stage II, 51% for stage III and 4% for stage IV. According to the stages defined by the AJCC sixth edition system, the 5-year stage-specific survival was 91% for stage I, 81% forstage IIa, 83% for stage IIb, 100% for stage IIIa, 64% for stage IIIb, 37% for stage IIIc and 4% for stage IV. The 5-year survival was significantly better for the patients with stage IIIb (64%) than those patients with stage IIIc (37%) (p<.001). CONCLUSION: It is widely known that the AJCC sixth edition system for colorectal cancer stratifies survival more distinctly than does the fifth edition system by providing more substages. Our study showed that stage IIIb disease had better survival than stage IIIc disease, but we couldn't confirm that this new staging system is relevant in our Korean clinical practice due to the small study population. Therefore, further study is required in a larger population.

Insidious Onset of Amiodarone Pulmonary Toxicity Presented with Hemoptysis / 결핵및호흡기질환

Amiodarone is widely used to control fatal arrhythmia. However, amiodarone therapy is associated with a relatively high incidence of pulmonary toxicity, up to 5 to 10%. Typical symptoms are nonspecific and often manifest as nonproductive cough, dyspnea and interstitial infiltrates in patients with acute pneumonitis or chronic fibrosis. However, hemoptysis is a very rare symptom of amiodarone pulmonary toxicity. We report a case of amiodarone pulmonary toxicity, who presented with hemoptysis and was successfully treated with the cessation of amiodarone, with review of the relevant literature.

The Comparative Study Of Cancer Incidence Between Urban And Rural Area In Gangneung: Gastric Cancer, Hepatoma And Lung Cancer / 대한내과학회지

BACKGROUND: Since most of epidemiologic studies of cancer disease in Korea are on the basis of data from large hospitals in metropolitan area, they neither represent the separate district, nor reflect the characters of rural area. We aimed to help prevent cancer and present control strategies in good accordance with regional features by evaluating the epidemiologic characters of cancers and performing a comparative study between urban and rural area. METHODS: We retrospectively reviewed the medical records of newly diagnosed cancer patients from January 1997 to December 2000 in Gangneung Asan Hospital, who resided in Gangneung city on diagnosis and investigated their pathologic results, radiologic findings, risk factors, stages, treatment modalities, etc. On the basis of them, we estimated incidence rates including crude rates and age standardized rates and compaed the differences between urban and rural area. RESULTS: The numbers of newly diagnosed cancer patients during this period were 367 in gastric cancer, 186 in hepatoma and 177 in lung cancer. The age standardized annual incidence rates of gastric cancer were estimated to be 49.7/17.8 (M/F) in urban area and 52.7/25.9 (M/F) in rural area per 100,000 persons. In hepatoma, the rates were 28.4/6.3 in urban and 36.3/6.5 in rural area and in the case of lung cancer, 23.5/6. 1 in urban and 32.0/7.4 in rural area. As a consequence, the age standardized annual incidence rates of rural area were higher than those of urban area in all the three cancers and the diffences were statistically significant except female hepatoma and lung cancer. However, risk factor survey among cancer patients revealed only difference in the amount of alcohol consumption associated with hepatoma, between urban and rural area. CONCLUSION: In rural area, the age standardized incidence rates were significantly higher than those of urban area in Gangneung city except female hepatoma and lung cancer. Moreover, in rural area, cancers were detected as more advanced state. Hence, preventive measures fit for these features were required urgently. In addition, more investigations about risk factors were needed to discover the cause of difference, including environmental and host factors which were not covered in this study.