Guillain-Barre Syndrome After Two COVID-19 Vaccinations: Two Case Reports With Follow-up Electrodiagnostic Study

Guillain-Barre syndrome (GBS) is an immune-mediated acute polyradiculoneuropathy and commonly occurs after a preceding infection or immunization sequalae. Following the severe acute respiratory syndrome-coronavirus-2 virus pandemic with co-introduction of massive vaccinations, several GBS cases associated with coronavirus disease 2019 (COVID-19) infection per se or after vaccination for COVID-19 were reported internationally. Herein, we report two cases of Korean GBS presenting with tetraplegia after two different COVID-19 vaccinations (42-year old man by AstraZeneca and 48-year woman by Pfizer vaccines) within four weeks after vaccination. The patients were diagnosed with clinical examination, serial electromyography, and compatible laboratory results and improved after comprehensive rehabilitative treatment and intravenous immunoglobulin therapy. Furthermore, we performed an electrodiagnostic follow-up study of each case to examine their unique characteristics.

Hemodynamic Depression of Early Carotid Revascularization on Ischemic Stroke Patients with Symptomatic Carotid Stenosis

BACKGROUND: Carotid revascularization is frequently complicated by hemodynamic depression (HD), which can increase the risk of stroke or vascular death. However, no studies yet exist describing the correlation between the timing of carotid revascularization and HD. The present study investigated whether carotid revascularization in the early phase of a stroke had an impact on the incidence of HD. METHODS: A retrospective study of consecutive ischemic stroke patients who underwent carotid revascularization was designed to compare the incidence of HD between early and late carotid revascularization. Early carotid revascularization was defined as carotid artery stenting or endarterectomy within two weeks of stroke onset. HD was defined as hypotension or bradycardia within five days of carotid revascularization. RESULTS: Of 69 carotid revascularizations, HD occurred in 29 (42.0%). The incidence of HD did not differ significantly between the early and late phase groups (48.0% vs. 38.6%, respectively, P =0.449). Patients with HD had undergone more carotid artery stenting than those without HD (79.3% vs. 35%, respectively, P < 0.001). Age, sex, hypertension, diabetes, heart disease, antihypertensive medication, and severity of carotid stenosis did not differ between patients with and without HD. CONCLUSION: The present research suggests that early carotid revascularization is as safe as late carotid revascularization with regard to HD.

The cutoff values of indirect indices for measuring insulin resistance for metabolic syndrome in Korean children and adolescents

PURPOSE: The prevalence rates of metabolic syndrome (MetS) and percentile distribution of insulin resistance (IR) among Korean children and adolescents were investigated. The cutoff values of IR were calculated to identify high-risk MetS groups. METHODS: Data from 3,313 Korean subjects (1,756 boys and 1,557 girls, aged 10–18 years) were included from the Korean National Health and Nutrition Examination Survey conducted during 2007–2010. Three different sets of criteria for MetS were used. Indirect measures of IR were homeostasis model assessment (HOMA-IR) and triglyceride and glucose (TyG) index. The cutoff values of the HOMA-IR and TyG index were obtained from the receiver operation characteristic curves. RESULTS: According to the MetS criteria of de Ferranti el al., Cook et al., and the International Diabetes Federation, the prevalence rates in males and females were 13.9% and 12.3%, 4.6% and 3.6%, and 1.4% and 1.8%, respectively. Uses these 3 criteria, the cutoff values of the HOMA-IR and TyG index were 2.94 and 8.41, 3.29 and 8.38, and 3.54 and 8.66, respectively. The cutoff values using each of the 3 criteria approximately corresponds to the 50th–75th, 75th, and 75th–90th percentiles of normal HOMA-IR and TyG index levels. CONCLUSION: This study describes the prevalence rates of MetS in Korean children and adolescents, an index of IR, and the cutoff values for MetS with the aim of detecting high-risk groups. The usefulness of these criteria needs to be verified by further evaluation.

The cutoff values of indirect indices for measuring insulin resistance for metabolic syndrome in Korean children and adolescents

PURPOSE: The prevalence rates of metabolic syndrome (MetS) and percentile distribution of insulin resistance (IR) among Korean children and adolescents were investigated. The cutoff values of IR were calculated to identify high-risk MetS groups. METHODS: Data from 3,313 Korean subjects (1,756 boys and 1,557 girls, aged 10–18 years) were included from the Korean National Health and Nutrition Examination Survey conducted during 2007–2010. Three different sets of criteria for MetS were used. Indirect measures of IR were homeostasis model assessment (HOMA-IR) and triglyceride and glucose (TyG) index. The cutoff values of the HOMA-IR and TyG index were obtained from the receiver operation characteristic curves. RESULTS: According to the MetS criteria of de Ferranti el al., Cook et al., and the International Diabetes Federation, the prevalence rates in males and females were 13.9% and 12.3%, 4.6% and 3.6%, and 1.4% and 1.8%, respectively. Uses these 3 criteria, the cutoff values of the HOMA-IR and TyG index were 2.94 and 8.41, 3.29 and 8.38, and 3.54 and 8.66, respectively. The cutoff values using each of the 3 criteria approximately corresponds to the 50th–75th, 75th, and 75th–90th percentiles of normal HOMA-IR and TyG index levels. CONCLUSION: This study describes the prevalence rates of MetS in Korean children and adolescents, an index of IR, and the cutoff values for MetS with the aim of detecting high-risk groups. The usefulness of these criteria needs to be verified by further evaluation.

Minimal systems analysis of mitochondria-dependent apoptosis induced by cisplatin

Recently, it was reported that the role of mitochondria-reactive oxygen species (ROS) generating pathway in cisplatin-induced apoptosis is remarkable. Since a variety of molecules are involved in the pathway, a comprehensive approach to delineate the biological interactions of the molecules is required. However, quantitative modeling of the mitochondria-ROS generating pathway based on experiment and systemic analysis using the model have not been attempted so far. Thus, we conducted experiments to measure the concentration changes of critical molecules associated with mitochondrial apoptosis in both human mesothelioma H2052 and their ρ0 cells lacking mitochondrial DNA (mtDNA). Based on the experiments, a novel mathematical model that can represent the essential dynamics of the mitochondrial apoptotic pathway induced by cisplatin was developed. The kinetic parameter values of the mathematical model were estimated from the experimental data. Then, we have investigated the dynamical properties of this model and predicted the apoptosis levels for various concentrations of cisplatin beyond the range of experiments. From parametric perturbation analysis, we further found that apoptosis will reach its saturation level beyond a certain critical cisplatin concentration.

Japanese B Encephalitis with Favorable Recovery; Clinical Course, Brain Imaging, and Neuropsychological Findings

No abstract available.

A Comparison of Apolipoprotein E Polymorphism in Alzheimer's Disease and Subcortical Vascular Dementia in Koreans

BACKGROUND AND PURPOSE: The apolipoprotein E (Apo E) epsilon4 allele is known to be a risk factor for Alzheimer's disease (AD). However, there are debates about the relationship between Apo E epsilon4 frequency and subcortical vascular dementia (SVaD). We compared the frequency of the Apo E epsilon4 allele in AD and SVaD in Koreans. METHODS: The study was comprised of 400 subjects who visited the Dementia Clinic at Daegu Catholic University from July 2007 to December 2011. Neuropsychological tests, a brain MRI, and blood laboratory tests were performed on all subjects. Two hundred and ninety subjects were AD, 32 subjects were SVaD and 78 subjects were normal. The diagnosis for SVaD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and Erkinjuntti criteria, and the diagnosis for AD was based on the DSM-IV and National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's disease and Related Disorders Association criteria. Apo E polymorphism was genotyped in all subjects. RESULTS: The Apo E epsilon4 allele frequency was 17.4% in AD, 10.9% in SVaD and 8.3% in the normal group (p=0.03). The odds ratio (OR) after age adjustment for AD conferred to the Apo E epsilon4 was 2.04 (p=0.04). But, the OR for SVaD conferred to the Apo E epsilon4 allele was 1.34 (p=0.62), indicating that the Apo E epsilon4 allele does not significantly confer the risk of SVaD. CONCLUSIONS: Apo E epsilon4 is a reliable predictor of AD but has modest efficacy for predicting SVaD in Koreans.

Optimized Internal Control and Gene Expression Analysis in Epstein-Barr Virus-Transformed Lymphoblastoid Cell Lines

The Epstein-Barr virus-transformed lymphoblastoid cell line (LCL) is one of the major genomic resources for human genetics and immunological studies. Use of LCLs is currently extended to pharmacogenetic studies to investigate variations in human gene expression as well as drug responses between individuals. We evaluated four common internal controls for gene expression analysis of selected hematopoietic transcriptional regulatory genes between B cells and LCLs. In this study, the expression pattern analyses showed that TBP (TATA box-binding protein) is a suitable internal control for normalization, whereas GAPDH (glyceraldehyde-3-phosphate dehydrogenase) is not a good internal control for gene expression analyses of hematopoiesis-related genes between B cells and LCLs at different subculture passages. Using the TBP normalizer, we found significant gene expression changes in selected hematopoietic transcriptional regulatory genes (downregulation of RUNX1 , RUNX3 , CBFB , TLE1, and NOTCH2; upregulation of MSC and PLAGL2) between B cells and LCLs at different passage numbers. These results suggest that these hematopoietic transcriptional regulatory genes are potential cellular targets of EBV infection, contributing to EBV-mediated B-cell transformation and LCL immortalization.

Clinical Characteristics of Nutritional Rickets in Korean Infants / 대한소아내분비학회지

PURPOSE: The prevalence of nutritional rickets in developed countries appears to be rising. We studied cases of recently diagnosed nutritional rickets in Korean infants to investigate the clinical characteristics of this condition. METHODS: We studied the medical records of 15 patients (10.5 +/- 10.5 mo) with clinical and subclinical nutritional rickets diagnosed between January 2007 and June 2009 and grouped them according to their clinical presentation. Group I (n = 6, 4.5 +/- 5.2 mo) included patients who were asymptomatic and had increased levels of serum alkaline phosphatase (ALP); group II (n = 5, 21.7 +/- 10.1 mo), patients with skeletal abnormalities; and group III (n = 4, 5.7 +/- 4.5 mo), patients with hypocalcemic seizure. These groups were compared for age and serum levels of calcium, phosphorus, ALP, 25-hydroxy vitamin D (25OHD), and parathyroid hormone (PTH). RESULTS: The serum 25OHD level was 16.5 +/- 9.9 ng/mL. All but 2 patients were being breast-fed or had been breast-fed for more than 6 months. Infants in group I were relatively young, with 2 small for gestational age (SGA) infants, and showed the highest serum levels of ALP with low serum levels of 25OHD (15.3 +/- 6.2 ng/mL), but mild radiologic changes. Group II infants (including 4 with bow leg and 1 with short stature) were significantly older (P = 0.018) with relatively higher levels of 25OHD (23.0 +/- 11.6 ng/mL) but worse radiologic findings as compared to other groups. Group III infants were relatively young including 2 SGA and had the lowest 25OHD levels (10.3 +/- 9.4 ng/mL) and significant hypocalcemia (P = 0.016, 5.7 +/- 4.5 mg/dL), but mild radiologic changes. The fact that group I and III were very young implies that not only were these infants supplied with inadequate amounts of vitamin D, but many began life with small stores of vitamin D as a result of maternal vitamin D deficiency. CONCLUSION: Nutritional rickets manifested in 3 different clinical forms, and vitamin D should be supplemented in breast-feeding infants as well as pregnant women.

Clinical Characteristics of Nutritional Rickets in Korean Infants / 대한소아내분비학회지

PURPOSE: The prevalence of nutritional rickets in developed countries appears to be rising. We studied cases of recently diagnosed nutritional rickets in Korean infants to investigate the clinical characteristics of this condition. METHODS: We studied the medical records of 15 patients (10.5 +/- 10.5 mo) with clinical and subclinical nutritional rickets diagnosed between January 2007 and June 2009 and grouped them according to their clinical presentation. Group I (n = 6, 4.5 +/- 5.2 mo) included patients who were asymptomatic and had increased levels of serum alkaline phosphatase (ALP); group II (n = 5, 21.7 +/- 10.1 mo), patients with skeletal abnormalities; and group III (n = 4, 5.7 +/- 4.5 mo), patients with hypocalcemic seizure. These groups were compared for age and serum levels of calcium, phosphorus, ALP, 25-hydroxy vitamin D (25OHD), and parathyroid hormone (PTH). RESULTS: The serum 25OHD level was 16.5 +/- 9.9 ng/mL. All but 2 patients were being breast-fed or had been breast-fed for more than 6 months. Infants in group I were relatively young, with 2 small for gestational age (SGA) infants, and showed the highest serum levels of ALP with low serum levels of 25OHD (15.3 +/- 6.2 ng/mL), but mild radiologic changes. Group II infants (including 4 with bow leg and 1 with short stature) were significantly older (P = 0.018) with relatively higher levels of 25OHD (23.0 +/- 11.6 ng/mL) but worse radiologic findings as compared to other groups. Group III infants were relatively young including 2 SGA and had the lowest 25OHD levels (10.3 +/- 9.4 ng/mL) and significant hypocalcemia (P = 0.016, 5.7 +/- 4.5 mg/dL), but mild radiologic changes. The fact that group I and III were very young implies that not only were these infants supplied with inadequate amounts of vitamin D, but many began life with small stores of vitamin D as a result of maternal vitamin D deficiency. CONCLUSION: Nutritional rickets manifested in 3 different clinical forms, and vitamin D should be supplemented in breast-feeding infants as well as pregnant women.

A Case of Congenital Laryngeal Atresia with Diaphragmatic Hernia / 대한주산의학회잡지

Congenital laryngeal atresia is a rare cause of airway obstruction that is almost always lethal within short period of time after birth unless diagnosed prenatally and emergency tracheostomy was performed. Other life-threatening anomalies such as tracheoesophageal fistula, gastrointestinal or urinary anomalies, and VATER syndrome are often associated with laryngeal atresia. Recently, we experienced a case of congenital laryngeal atresia with diaphragmatic hernia, ear and skull anomalies, not diagnosed prenatally, died of asphyxia due to intubation failure, and confirmed by autopsy. We report this case with a brief review of the literatures.

Clinical study of urinary tract infection, natural courses, and prenatal ultrasonographic results according to the grades of hydronephrosis / 소아과

PURPOSE: Although renal ultrasonography (USG) has improved the detection rate of hydronephrosis (HN), its clinical courses and postnatal management remains controversial. Here, we reviewed the clinical features of patients with HN according to the grades. METHODS: We retrospectively studied 207 patients who were regularly followed-up among 367 patients with HN detected by renal USG postnatally between April 1998 and December 2007. These patients were grouped into four groups, grades 1-4, according to renal pelvic diameter (RPD). For analysis, each group was merged into two categories (mild: grade 1, 2; severe: grade 3, 4). RESULTS: During follow-up, 128 episodes of urinary tract infection (UTI) occurred in 91 patients. According to grades from 1 to 4, 35/89 (39.3%), 41/88 (46.5%), 11/22 (50%), and 4/8 (50%), respectively, had UTI, without any significance between the mild and severe groups. However, the severe group presented a higher risk in cumulative episodes of UTI per year (P=0.041). The spontaneous resolution of HN was observed in 103 (58.8%) of the 175 mild group patients and in 3 (10.7%) of the 28 severe group patients (P<0.001). Furthermore, the detection rate of prenatal HN by prenatal USG was much higher in patients with severe RPD (P<0.001). CONCLUSION: We found that the severer the grade of HN, the lower was the rate of spontaneous resolution and higher was the frequency of UTI. Therefore, the establishment of guidelines for managing treatments such as antibiotic prophylaxis for patients with HN is needed to improve renal prognosis.

Ultrasound-Guided Sciatic Nerve Block for the Treatment of Radiation Therapy Induced Sciatic Neuritis: A case report

Sciatic nerve block is frequently used for anesthesia or analgesia during lower leg surgery or chronic lower leg pain syndrome. Recently, a lot of ultrasound-guided peripheral nerve block has been reported because there are several benefits compared to blind technique. We performed ultrasound-guided right sciatic nerve block successfully to the patient who has been suffering from right buttock pain after previous radiation therapy.

The Effects of Lidocaine, Fentanyl, Nicardipine, and Esmolol on Hemodynamic and Bispectral Index Responses during Induction with Thiopental Sodium / 대한마취과학회지

BACKGROUND: The laryngoscopy and tracheal intubation may accompany with undesirable side effects such as hypertension, tachycardia, arrhythmia, and awareness. The aim of this study was to investigate whether the correlation between the hemodynamics and bispectral index (BIS) changes after tracheal intubation following the administration of various adjuvants to attenuate tracheal response exists or not. METHODS: The patients were randomly assigned to one of five groups (control, lidocaine, fentanyl, nicardipine, or esmolol) and the drugs were administered at preselected time before tracheal intubation. The heart rate (HR), blood pressure, rate-pressure product (RPP), BIS and the episode of BIS more than 65 (BIS > or = 65) were measured. RESULTS: There were significant differences in the mean arterial pressure and RPP between control group and other groups. The HR was the most attenuated in esmolol group. The HR and RPP was the most increased in nicardipine group except control group. There was no significant difference in the maximal BIS among the five groups. The BIS > or = 65 were 50% in control group and 0.3% in nicardipine group. CONCLUSIONS: All the adjuvant drugs in the study attenuated with a various degree of the tracheal responses. However, there was no correlation between the changes of hemodynamics and BIS after the administration of various adjuvants following tracheal intubation.

Chromosomal Information of 1,144 Korean BAC Clones

We sequenced 1,841 BAC clones by terminal sequencing, and 1,830 of these clones were characterized with regard to their human chromosomal location and gene content using Korean BAC library constructed at the Korean Science (KCGS). Sequence analyses of the 1,830 BAC clones was performed for chromosomal assignment: 1,144 clones were assigned to a single chromosome, 190 clones apparently assigned to more than one chromosome, and 496 clones to no chromosome. Evaluating gene content of the 1,144 BAC clones, we found that 706 clones represented 1,069 genes of which 415 genes existed in the BAC clones covering the full sequence of the gene, 180 genes covering a 50%~99%, and 474 genes covering less than 50% of the gene coverage. The estimated covering size of the KBAC clones was 73,379 kilobases (kb), in total corresponding to 2.3% of haploid human genome sequence. The identified BAC clones will be a public genomic resource for mapped clones for diagnostic and functional studies by Korean scientists and investigators worldwide.

Genetic Variants of IL-13 and IL-4 in the Korean Population: Polymorphisms, Haplotypes and Linkage Disequilibrium

Asthma is an inflammatory airways disease characterized by bronchial hyperresponsiveness and airways obstruction, which results from a complex interaction of genetic and environmental factors. Interleukin (IL)-13 and IL-4 are important in IgE synthesis and allergic inflammation, therefore genes encoding IL-13 and IL-4 are candidates for predisposition to asthma. In the present study, we screened single-nucleotide polymorphisms (SNPs) in IL-13 and IL-4 and examined whether they are risk factors for asthma. We resequenced all exons and the promoter region in 12 asthma patients and 12 normal controls, and identified 18 SNPs including 2 novel SNPs. The linkage disequilibrium(LD) pattern was evaluated with 16 common SNPs, and haplotypes were also estimated within the block. Although IL-13 and IL-4 are localized within 27 kb on chromosome 5q31 and share many biological profiles, this region was partitioned into 2 blocks. One SNP and three SNPs were determined as haplotype-taggingSNPs (htSNPs) within IL-13 and IL-4 haplotype-block, respectively. No significant associations were observed between any of the SNPs or haplotypes and development of asthma in small number of Korean subjects. However, the genetic variants of IL-13 and IL-4 would provide valuable strategies for the genotyping studies in large population.

Practical Choice and Knowledge of Korean Anesthesiologists for Fresh Gas Flow / 대한마취과학회지

BACKGROUND: The inhalational anesthesia is performed by the administration of inhalational agents and fresh gases. Low and high flows have their own advantages and disadvantages. In Korea, many anesthesiologists use more than 2 L/min of fresh gas flow (FGF). This study was performed to analyze the practice and knowledge of FGF use by Korean Anesthesiologists. METHODS: A questionaire was sent to 122 anesthesiologists (15 university hospitals and 16 general hospitals) who attended the 47th Annual Autumn Meeting of the Korean Society of Anesthesiology in 2002. The questionaire covered topics dealing with inhalational agents, FGF, and safety systems for inhalational anesthesia practice. RESULTS: The most preferred inhalational anesthetic was sevoflurane (65.6%). 88.5% of respondents used more than 2 L/min of FGF. The majority of the respondents, however, did not consider the reasons for using certain levels of FGF. Only 27% of hospitals had pulse oximetry, capnogram or muti-gas analysis, fail-safe device, and a scavenging system. CONCLUSIONS: Many anesthesiologists, especially trainees, failed to consider the use of FGF during inhalational anesthesia. Therefore, special consideration should be given to the training and education of trainees about the proper of FGF.

Effect of Small-dose Ketamine on Hemodynamic Changes during Lower Extremity Surgery Using a Tourniquet under General Anesthesia / 대한마취과학회지

BACKGORUND: A tourniquet is commonly used to achieve bloodless field in surgery of the extremities. However, use of tourniquet occasionally has been associated with intraoperative hypertension, but the mechanism of this tourniquet-induced hypertension is unknown. We investigated the effect of preoperative ketamine on tourniquet-induced changes of arterial blood pressure (BP), heart rate (HR), cardiac index (Ci), and systemic vascular resistance index (SVRi). METHODS: Twenty-two patients of ASA physical status class 1 and 2, scheduled for lower extremity surgery using a tourniquet, were randomly assigned into two groups. Anesthesia was maintained with 1.5-2.0 vol% enflurane and 50% N2O in O2 with endotracheal intubation. The changes of BP, HR, Ci, and SVRi were measured (1) at 10 minutes after induction, (2) at 10 minutes after injection of normal saline (control group) or ketamine 0.25 mg/kg, i.v. (ketamine group) before skin incision and tourniquet inflation, (3) at immediately and 5, 10, 15, 20, 30, and 40 minutes after inflation of tourniquet, and (4) immediately after deflation of tourniquet. RESULTS: During tourniquet inflation, BP and HR were not significantly changed in each group and there was no significant differences between the two groups. However, Ci decreased during inflation of the tourniquet in both groups, and it significantly decreased in the control group at the time of 5 and 40 minutes after inflation of tourniquet. SVRi significantly increased during inflation of the tourniquet, and decreased immediately after deflation of the tourniquet in the control group. CONCLUSiONS: We concluded that preoperative iV ketamine, 0.25 mg/kg can prevent tourniquet-induced hemodynamic changes in patients under general anesthesia.

Carpal Tunnel Decompression with Limited One-Incision Technique / 대한정형외과학회잡지

PURPOSE: Carpal tunnel decompression with limited one-incision technique has been reported that it is possible to achieve a sufficient decompression without significant complications. We evaluated the clinical effectiveness of this method. MATERIALS AND METHODS: Forty-two cases of twenty-eight patients of carpal tunnel syndrome were retrospectively evaluated, which were treated with limited one-incision technique less than 2 cm in length, from January 1997 to September 1999. RESULTS: According to Cseuz's criteria, 36 cases (85.7%) were excellent or good. CONCLUSION: Carpal tunnel decompression with limited one-incision technique can provide sufficient decompression with small skin incision. It is not necessary of special eqipment. It has less copmplications and no difference of clinical results comparing with classic open method or endoscopic method. Therefore, this method can be a good method in the surgical treatment of carpal tunnel syndrome. But this method can't be performed in the patient with abnormal anatomical structure or tumorous conditions in carpal tunnel and complication rates are not zero. Therefore operator should pay attention to the selection of patients and the technique.

Transduodenal Ampullectomy in Ampullary Neoplasm

PURPOSE: Periampullary malignant tumors become symptomatic at an early stage because of their particular location. For this reason, radical resection is possible in the majority of cases. Periampullary tumors can be removed either by a local resection, as performed by Halsted in 1899, or by a radical pancreaticoduodenectomy, as performed by Whipple et al. in 1935. Both techniques have been used, and their respective places in the treatment of benign or malignant periampullary tumors has been the subject of constant debate. Therefore, we reviewed the cases of four patients who had undergone a transduodenal ampullectomy for an ampullary tumor which was confined to the ampulla of Vater. METHODS: The clinical records of 4 patients who undergone a transduodenal ampullectomy were reviewed. All patients were diagnosed as having an ampullary mass based on gastroduodenoscopy, endoscopic retrograde cholangiopancreatography, or both. Clinical presentation, comparison of pathologic findings of preoperative endoscopic biopsy, operative frozen section, final pathologic examination, complications, follow-up period, and recurrence were reviewed. RESULTS: The two men and the two women studied had a median age of 59.3 (range, 49 to 64 years). Among the four patients who underwent a transduodenal ampullectomy, an adenocarcinoma was found at final pathologic examination in two patients with preoperative diagnoses of a villotubular adenoma and a villous adenoma, respectively. The other two cases were diagnosed as tubular adenomas at final pathologic examination as they had been at the preoperative diagnosis. No evidence of disease was observed in any of the four patients on follow-up at 29 months, 30 months36 months, and 4 months. None of these patients had major complications in the immediate postoperative period, transient hyperamylasemia without clinical significance developed in two patients. CONCLUSION: The transduodenal ampullectomy is a valuable tool in the treatment of ampullary lesions. The result of local excision of the Vater for ampullary tumors appears satisfactory, and this procedure may be particularly indicated for benign tumors, as well as for older or high-risk patients whose malignant lesions are confined to the ampulla of Vater. However, the selection of this procedure required judicious decision making and precise technique and should involve an experienced team of pathologists and surgeons. As a result, for patients in whom it is indicated, a transduodenal ampullectomy is an alternative to the pancreaticoduodenectomy and has good long-term results.