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Background/Aims@#Most guidelines recommend surgical resection of all main duct (MD) and mixed-type (MT) intraductal papillary mucinous neoplasms (IPMNs) in suitable patients. However, there is little evidence regarding the malignancy risk of enhancing mural nodules (EMNs) that are present only in the main pancreatic duct (MPD) in patients with MD- and MT-IPMNs.Therefore, this study aimed to identify the clinical and morphological features associated with malignancy in MD- and MT-IPMNs with EMNs only in the MPD. @*Methods@#We retrospectively enrolled 50 patients with MD- and MT-IPMNs with EMNs only in the MPD on contrast-enhanced magnetic resonance imaging. We evaluated the clinical characteristics and preoperative radiologic imaging results of MPD morphology and EMN size and analyzed the risk factors associated with malignancy. @*Results@#Histological findings of EMNs were low-grade dysplasia (38%), malignant lesions (62%), high-grade dysplasia (34%), and invasive carcinoma (28%). On the receiver operating characteristic curve, the cutoff value of EMN size on magnetic resonance imaging for best predicting malignancy was 5 mm (sensitivity, 93.5%; specificity, 52.6%; area under the curve, 0.753).Multivariate analysis showed that only EMN >5 mm (odds ratio, 27.69; confidence interval, 2.75 to 278.73; p=0.050) was an independent risk factor for malignancy. @*Conclusions@#EMNs of >5 mm are associated with malignancy in patients with MD- and MTIPMNs with EMNs that are present only in the MPD, in accordance with the international consensus guidelines.
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Background/Aims@#Steatohepatitis related to metabolic syndrome is a chronic liver disease prevalent in patients not only with non-alcoholic steatohepatitis but also with alcoholic liver disease and chronic viral hepatitis. On the other hand, there is limited data on the effects of hepatotonic agents in these patients. Therefore, this study evaluated the efficacy of a combined hepatotonic agent in this population. @*Methods@#Thirty-three adults with chronic hepatitis and one or more components of metabolic syndrome were assigned randomly to receive biphenyl dimethyl dicarboxylate/ursodeoxycholic acid or a placebo for 24 weeks. The primary outcome was the normalization of ALT (≤40 U/L). The secondary outcomes were the change in controlled attenuation parameter, transient elastography, and Chronic Liver Disease Questionnaire score. @*Results@#The 33 patients were assigned randomly to two groups. Eight (50%) of 16 patients who received the intervention drug showed the normalization of ALT, whereas only one (6%) of 17 patients in the placebo group did so. In contrast, the change in controlled attenuation, transient elastography, and Chronic Liver Disease Questionnaire were similar in the two groups. ALT was changed significantly during the four assessment periods, and this change was affected by the group. The interaction between the group and time was also significant. AST was changed significantly during the same period. This change was not affected by the group. @*Conclusions@#Biphenyl dimethyl dicarboxylate/ursodeoxycholic acid combination reduced ALT in chronic liver disease related to metabolic syndrome. On the other hand, there is no evidence that this leads to improved hepatic steatosis and fibrosis within 6 months.
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Since Endoscopic ultrasound (EUS) was introduced in the 1980s, EUS has evolved from a diagnostic tool to a therapeutic modality for patients with pancreatic neoplasms. Traditionally, treatment policy of pancreatic benign neoplasms (PBN) has been a dichotomous approach to observation or surgery. However, EUS guided treatment provides an alternative option with minimally invasiveness for patients with PBN. This review aimed to provide the role of EUS guided treatment for PBN.
ABSTRACT
Since Endoscopic ultrasound (EUS) was introduced in the 1980s, EUS has evolved from a diagnostic tool to a therapeutic modality for patients with pancreatic neoplasms. Traditionally, treatment policy of pancreatic benign neoplasms (PBN) has been a dichotomous approach to observation or surgery. However, EUS guided treatment provides an alternative option with minimally invasiveness for patients with PBN. This review aimed to provide the role of EUS guided treatment for PBN.
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Background/Aims@#Steatohepatitis related to metabolic syndrome is a chronic liver disease prevalent in patients not only with non-alcoholic steatohepatitis but also with alcoholic liver disease and chronic viral hepatitis. On the other hand, there is limited data on the effects of hepatotonic agents in these patients. Therefore, this study evaluated the efficacy of a combined hepatotonic agent in this population. @*Methods@#Thirty-three adults with chronic hepatitis and one or more components of metabolic syndrome were assigned randomly to receive biphenyl dimethyl dicarboxylate/ursodeoxycholic acid or a placebo for 24 weeks. The primary outcome was the normalization of ALT (≤40 U/L). The secondary outcomes were the change in controlled attenuation parameter, transient elastography, and Chronic Liver Disease Questionnaire score. @*Results@#The 33 patients were assigned randomly to two groups. Eight (50%) of 16 patients who received the intervention drug showed the normalization of ALT, whereas only one (6%) of 17 patients in the placebo group did so. In contrast, the change in controlled attenuation, transient elastography, and Chronic Liver Disease Questionnaire were similar in the two groups. ALT was changed significantly during the four assessment periods, and this change was affected by the group. The interaction between the group and time was also significant. AST was changed significantly during the same period. This change was not affected by the group. @*Conclusions@#Biphenyl dimethyl dicarboxylate/ursodeoxycholic acid combination reduced ALT in chronic liver disease related to metabolic syndrome. On the other hand, there is no evidence that this leads to improved hepatic steatosis and fibrosis within 6 months.
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Pancreatic adenocarcinoma is one of the cancers with the poorest prognosis, and its incidence has gradually increased to become the 9th most common cancer in Korea in 2016. Surgical resection is the only treatment option to improve the cure and longterm survival rate. Unfortunately, only 10% to 20% of all pancreatic cancer patients present with resectable disease, because of common symptoms are rarely noticeable in its early stages and disease progress very quickly. Unresectable pancreatic cancer can be divided into locally advanced pancreatic cancer (LAPC) and metastatic disease. Pancreatic cancer with distant metastasis accounts for about 40–60% of the total pancreatic cancer and systemic chemotherapy is considered as standard treatment. LAPC is observed in 30–40%, defined as the tumor surrounding major blood vessels (especially, celiac artery and superior mesenteric artery) more than 180° without distant metastasis which cannot be completely removed by surgery. Standard treatment for LAPC has not yet been established, and chemotherapy and radiotherapy have mainly been used, but in most cases, response to these therapeutic options has been limited. As imaging techniques, endoscopic devices and procedures have recently been developed and the role of local endoscopic therapies for LAPC has expanded. This article provides an overview of local endoscopic treatment for LAPC such as injection therapy, radiofrequency ablation (RFA), irreversible electroporation (IRE), radiotherapy and drug-delivery stent insertion.
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Serous cystic neoplasm (SCN) represents 10–16% of cystic pancreatic lesions, first classified by Compagno and Oertel at 1978. In contrast to mucinous cystic neoplasm or intraductal papillary mucinous neoplasm of pancreas which have malignant potential, SCN is thought to be exclusively benign as solitary lesion in nearly all cases. There has been rare reported association between the SCN and pancreatic ductal adenocarcinoma, and few cases were documented their coexistence. In this report, we present the case of SCN of the pancreas with literature review in which synchronous pancreatic ductal adenocarcinoma and pancreatic intraepithelial neoplasm coexist together.
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Background/Aims@#With the improvement of hygiene, the incidence of amebic liver abscess is decreasing in South Korea. On the other hand, there is little data on the status of amebic liver abscess compared to pyogenic liver abscess. @*Methods@#Patients with an amebic liver abscess, in whom Entamoeba histolytica (E. histolytica) IgG was positive, were identified retrospectively in a university hospital. The clinical, laboratory, and radiological characteristics of amebic liver abscess were compared with those of pyogenic liver abscess in the same period. @*Results@#Between March 2010 and October 2016, 413 patients with a liver abscess were identified. Among them, the serologic test for E. histolytica was performed in 209 patients. Fifteen (7.2%) were classified as an amebic liver abscess, and the remainder were diagnosed with a pyogenic liver abscess. The age, gender, white blood cell, and CRP was comparable between the two groups. Procalcitonin was lower in amebic liver abscess than the pyogenic one. On CT, peripheral rim enhancement was more frequent, but cluster signs were not observed in amebic liver abscess compared to pyogenic liver abscess. None of the patients with amebic liver abscess died. In contrast, the mortality of pyogenic liver abscess was 4.7%. @*Conclusions@#Amebic liver abscess should still be considered as one of the causes of liver abscess in Korea. It is difficult to discriminate an amebic liver abscess from a pyogenic liver abscess only according to the clinical, laboratory, and radiologic findings. Therefore, it is necessary to perform a serologic test for E. histolytica for a precise evaluation of liver abscess in a high-risk group.
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Surgical resection is considered the only treatment option for pancreatic cancer and other pancreatic neoplasms with malignant potential, such as neuroendocrine tumors, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. However, only 10%–20% of all patients with pancreatic cancer present with resectable forms of the disease as the symptoms are rarely manifested during the early stages, and the disease tends to progress rapidly. Furthermore, pancreatic surgery is associated with high rates of morbidity and mortality. The development of linear-array endoscopic ultrasound (EUS) techniques has increased the indications of EUS-guided local therapy for pancreatic neoplasms. We assessed the studies that investigated various treatment modalities, such as fine-needle injection, radiofrequency ablation, irreversible electroporation, and radiotherapy, under EUS guidance to better understand the usefulness of these techniques with respect to the efficacy and associated complications.
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Pancreatic cancer was the 9th most common cancer in Korea in 2016, and the incidence is on the rise. Despite advances in diagnostic and therapeutic methods, 5-year survival rate of pancreatic cancer is about 11.7% in Korea, and its prognosis is very poor compared to other cancers. At present, although complete surgical resection is the most effective treatment, only less than 20% of patients are even candidates for resection because diagnosis is usually delayed. So early detection of pancreatic cancer is one of the main objective in the treatment of pancreatic cancer. Among imaging modalities, computed tomography-scan is the most widely available, and the most frequently used. However as endoscopic ultrasound (EUS) techniques have evolved and based on the results of researches that EUS is superior to computed tomography-scan in the diagnosis of small pancreatic tumor, the role of EUS in the early diagnosis of pancreatic cancer is attracting attention. Herein, the authors focused on the role of EUS in early pancreatic cancer.
Subject(s)
Humans , Diagnosis , Early Diagnosis , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Endosonography , Incidence , Korea , Pancreatic Neoplasms , Prognosis , Survival Rate , UltrasonographyABSTRACT
PURPOSE: The outcome of a tubularized incised plate (TIP) urethroplasty for hypospadias was reviewed retrospectively, and compared with other procedures with respected to the success rate, complications and satisfaction. MATERIALS AND METHODS: Between April, 1994 and July, 2001, 51 patients underwent a repair for hypospadias, by the same operator, using a transverse preputial island flap (TPIF; 7), an onlay island flap (OIF; 3), Mathieu (7) and tubularized incised plate (34) procedures. The operation time, period of catheterization, postoperative hospital days and complication rates for each procedure were also compared. RESULTS: The mean operation time in the TIP group was 140 minutes, compared to 230 220 and 160 minutes in the TPIF, OIF and Mathieu groups, respectively. The mean admission periods in the TPIF, OIF, Mathieu and TIP group, were 14, 17, 11 and 10 days, respectively. The mean operation time and admission period was shorter in the TIP group than those of the other procedures. The incidence rate of an urethrocutaneous fistula was lower in the TIP group (23%: 8/34) than in the TPIF (43%: 3/7), OIF (66%: 2/3) and Mathieu groups (57%: 4/7). Postoperative satisfaction for the penis and meatus shapes was highest in the TIP group. CONCLUSIONS: The TIP urethroplasty had better outcomes than the TPIF, OIF and Mathieu procedures with regard to the operation time, catheterization period, admission period and complication rates following the operations. TIP urethroplasty is thought to be the most economic method for the repair of hypospadias, and can be recommended as the first choice for its repair.
Subject(s)
Female , Humans , Male , Catheterization , Catheters , Fistula , Hypospadias , Incidence , Inlays , Penis , Retrospective Studies , UrethraABSTRACT
PURPOSE: Sclerotherapy is performed additionally to improve the outcome of aspiration in simple renal cyst. Ethanol has been used most commonly as a sclerosing agent, however, drainage is necessary which complicates the procedure. For this reason, we used minocycline HCl as a sclerosing agent without need to be drained and evaluated the results. MATERIALS AND METHODS: From June 1990 to May 1999, 140 patients who underwent percutaneous minocycline HCl sclerotherapy for simple renal cyst were evaluated. Among them, 10 patients were missed during follow-up and 7 patients had bilateral simple renal cysts. The simple renal cysts were aspirated under ultrasonography, and then minocycline HCl 100mg mixed with 5ml normal saline was injected into the cyst per 50ml of aspirated cyst fluid. The follow-up ultrasonography was performed at posttreatment 3, 6 and 12 months. The recurred cases were retreated with same procedure. RESULTS: Among 137 renal cysts of 130 patients who could be followed up, 70 renal cysts (51.1%) were totally collapsed and 53 renal cysts (38.7%) showed a 50% or more decrease in cyst volume after first treatment. All 14 persistent renal cysts (10.2%) showed a 50% or more decrease in cyst volume after second or third treatment. Catheterization for drainage of the sclerosing agent was not needed. There were only some minor complications such as nausea, vomitting and local pain that subsided within one day with only symptomatic treatment. CONCLUSIONS: These results shows that percutaneous minocycline HCl sclerotherapy is simple, safe and effective and can be a alternative first line therapy of simple renal cyst.