Outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms in patients with liver cirrhosis

Background/Aims@#The treatment of superficial esophageal neoplasms (SENs) in cirrhotic patients is challenging and rarely investigated. We evaluated the outcomes of endoscopic submucosal dissection (ESD) to determine the efficacy and safety of treating SENs in patients with liver cirrhosis. @*Methods@#The baseline characteristics and treatment outcomes of patients who underwent ESD for SENs between November 2005 and December 2017 were retrospectively reviewed. @*Results@#ESD was performed in 437 patients with 481 SENs, including 15 cirrhotic patients with 17 SENs. En bloc resection (88.2% vs. 97.0%) and curative resection (64.7% vs. 78.9%) rates were not different between the cirrhosis and non-cirrhosis groups (p=0.105 and p=0.224, respectively). Bleeding was more common in cirrhotic patients (p=0.054), and all cases were successfully controlled endoscopically. The median procedure and hospitalization duration did not differ between the groups. Overall survival was lower in cirrhotic patients (p=0.003), while disease-specific survival did not differ between the groups (p=0.85). @*Conclusions@#ESD could be a safe and effective treatment option for SENs in patients with cirrhosis. Detailed preprocedural assessments are needed, including determination of liver function, esophageal varix status, and remaining life expectancy, to identify patients who will obtain the greatest benefit.

Clinical Usefulness of Bile Cytology Obtained from Biliary Drainage Tube for Diagnosing Cholangiocarcinoma / 대한소화기학회지

BACKGROUND/AIMS: Biliary drainage is performed in many patients with cholangiocarcinoma (CCA) to relieve obstructive jaundice. For those who have undergone biliary drainage, bile cytology can be easily performed since the access is already achieved. This study aims to determine the clinical usefulness of bile cytology for the diagnosis of CCA and to evaluate factors affecting its diagnostic yield. METHODS: A total of 766 consecutive patients with CCA underwent bile cytology via endoscopic nasobiliary drainage or percutaneous transhepatic biliary drainage from January 2000 to June 2012. Data were collected by retrospectively reviewing the medical records. We evaluated the diagnostic yield of bile cytology with/without other sampling methods including brush cytology and endobiliary forcep biopsy, and the optimal number of repeated bile sampling. Several factors affecting diagnostic yield were then analyzed. RESULTS: The sensitivity of bile cytology, endobiliary forceps biopsy, and a combination of both sampling methods were 24.7% (189/766), 74.4% (259/348), and 77.9% (271/348), respectively. The cumulative positive rate of bile sampling increased from 40.7% (77/189) at first sampling to 93.1% (176/189) at third sampling. On multivariate analysis, factors associated with positive bile cytology were perihilar tumor location, intraductal growing tumor type, tumor extent > or =20 mm, poorly differentiated grade tumor, and three or more samplings. CONCLUSIONS: Although bile cytology itself has a low sensitivity in diagnosing CCA, it has an additive role when combined with endobiliary forceps biopsy. Due to the relative ease and low cost, bile cytology can be considered a reasonable complementary diagnostic tool for diagnosing CCA.

A Case of Delayed Recovery from Antibody-Mediated Rejection / 대한내과학회지

Antibody-mediated rejection (ABMR) in kidney transplant recipients is mediated by donor-specific antibodies. It is the major cause of graft failure in noncompliant patients and is associated with reduced long-term graft survival. We present a case of delayed recovery of renal function despite aggressive therapy after acute ABMR. A 49-year-old male on triple-drug maintenance immunosuppression (prednisolone, cyclosporine, and azathioprine), who underwent cadaveric donor renal transplantation 14 years earlier, visited our clinic with a serum creatinine level (SCr) of 1.9 mg/dL. The kidney biopsy revealed acute ABMR with diffuse C4d immunopositivity. We started steroid pulse therapy and bortezomib with plasmapheresis. Nevertheless, the SCr increased. Consequently, antithymocyte globulin (ATG) and intravenous immunoglobulin were administered. The SCr increased further to 4.1 mg/dL. Therefore, we performed a second kidney biopsy, which showed no change. Finally, we used rituximab. Fortunately, the SCr decreased gradually and returned to baseline.

A Large Neuroendocrine Tumor of the Major Duodenal Papilla Removed by Endoscopic Papillectomy / 대한내과학회지

Neuroendocrine tumors (NET) of the major duodenal papilla are rare and the natural history of this disease is not clear. We experienced a case in a 31-year-old male. Duodenoscopy revealed an enlarged major duodenal papilla with central umbilication and nodularity. Endoscopic ultrasonography (EUS) demonstrated a 3-cm hypoechoic mass that was confined to the submucosa. A biopsy led to the diagnosis of a grade 1 NET. The patient refused surgery, so we performed an endoscopic papillectomy. The tumor was removed completely. The resected specimen confirmed the diagnosis of a well-differentiated NET and all resection margins were negative. Surgical resection is currently considered to be the gold standard for the treatment of a large NET of the major duodenal papilla; however, endoscopic resection is a possible treatment modality for patients at high surgical risk or who are reluctant to undergo surgery.

A Case of Inferior Mesenteric Arterial Thrombosis with Bowel Infarction Successfully Treated by Conservative Treatment / 대한내과학회지

Acute mesenteric thrombosis accounts for 25-30% of acute mesenteric ischemia and occurs usually alongside severe atherosclerotic disease. Acute mesenteric thrombosis primarily affects the superior mesenteric artery; thus, inferior mesenteric arterial thrombosis is an extremely rare form of the condition. Surgical treatment is mandatory to resolve impending or overt bowel infarction in acute mesenteric ischemia patients. However, here we report a case of colonic infarction caused by acute inferior mesenteric thrombosis successfully treated by conservative management.

A Case of Acute Poststreptococcal Glomerulonephritis Accompanied with Acute Pyelonephritis

Acute poststreptococcal glomerulonephritis(APSGN) is the most common form of postinfectious glomerulonephritis, and acute pyelonephritis(APN) is the most severe form of urinary tract infection in childhood. However, the concurrence of two diseases is uncommon in the literature. We describe a case of APSGN accompanied with APN in a 5-year-old female who presented with fever, left flank pain, headache and facial edema. Urinalysis showed pyuria, microscopic hematuria, and mild proteinuira. Serial urine cultures grew Escherichia coli. (99m)Tc-DMSA renal scan revealed a cortical defect in the upper pole of left kidney. She had a history of preceding pharyngitis, in addition, showed high blood pressure, high anti-streptolysin O titer, and low serum complement levels. The patient improved completely with supportive treatment, including antibiotic and antihypertensive therapy. These findings suggested that APSGN and APN could be manifested simultaneously or be superimposed on each other.

Plantar Pressure Reducing Effect of Diabetic Shoes with Different Rigid Rockers

OBJECTIVE: To determine the most effective type of rigid rocker bottom for prevention of diabetic foot complications according to the different rocker angles and axes of diabetic shoes. METHOD: Thirteen healthy volunteers participated in this study and the plantar peak pressure and pressure time integrals were measured by insole plantar pressure system for subjects either barefoot and wearing rigid rocker shoes with 12 kinds of different rocking angles and rocking points (15, 20, 25, 30degrees and 60, 65, 70% of shoe length). Evaluation was analyzed at M1 (hindfoot), M2 (midfoot), M3 (medial forefoot area), M4 (central forefoot area), M5 (lateral forefoot area), M6 (1st toe area), M7 (lesser toes area) zones respectively. RESULTS: Reduced pressure was observed in all kinds of rockers at central-metatarsal area (p<0.05). But pressure was not significantly changed at lateral metatarsal area in almost all types of rocker. With rocking point at 65 and 70%, pressure was increased at first and lesser toe area in all rocking angles. With rocking point at 60 and 70%, pressure was increased at midfoot area. CONCLUSION: Most effectively reduced pressure was observed with shoe of rocking point at 65% and rocking angle 30degress.

The Effect of Intrathecal Baclofen Injection on Muscle Stretch Reflex in Spinal Cord Injured Rabbit

OBJECTIVE: To develop an experimental model that is useful to evaluate the effect of antispastic medication administered intrathecally and to titrate the intrathecal baclofen effect quantitatively by using muscle stretch reflex. METHOD: Ten rabbits were laminectomized posteriorly and intrathecal catheter was inserted. Then the spinal cords were contused by 12.5 gx20 cm weight drop around 12th thoracic vertebra. After 8~12 days, muscle stretch reflex was measured before intrathecal baclofen injection (ITBI) and after ITBI 30 minutes, 60 minutes, and 120 minutes. Rabbits' triceps surae were dissected and stretched 5 mm at the rate of 2 mm/sec using a step motor. The change of muscle tension was graphed into the time (length)-tension curve. The slope in the time (length)-tension curve was defined as stiffness index (SI). RESULTS: The measurement of muscle stretch reflex was available in 5 of 10 spinal cord injured rabbits. The proportion of SI reduced significantly at 60 minutes and 120 minutes compared to baseline (p=0.005, p<0.001). CONCLUSION: Our data proved the antispastic effect of ITBI quantitatively by using muscle stretch reflex. We concluded that the quantitative measurement method of the antispastic effect of ITBI will be useful in evaluating antispastic effect by intrathecal administration of the other antispastic medications.

A Case of Langerhans Cell Histiocytosis Preceding with Central Diabetes Insipidus / 대한소아내분비학회지

A 3-year-old girl presented with polydipsia and polyuria for last 2 years. Her fluid intake was 7~8 L/day, and urinalysis showed low osmolality and specific gravity. Central diabetes insipidus (DI) was diagnosed by a water deprivation test. Intranasal 1-desamino-8-D-arginine vasopressin relieved her symptoms and normalized urinary concentrations. A T1-weighted MRI scan revealed a symmetrical thickening of the central part of the pituitary stalk. Six months after the diagnosis of central DI, she developed papular skin lesions on her forehead. The lesions were surgically removed, and histologically classified as Langerhans cell histiocytosis (LCH). We concluded that thickening of the central part of the pituitary stalk might represent the first manifestation of LCH clinically presenting with central DI. In children with central DI, special attention should be paid to the appearance of the pituitary stalk using MRI for the various manifestations of LCH in the central nervous system.

Lipoma Arborescens with Unilateral Knee Extensor Weakness: A case report

Lipoma arborescens is a rare intra-articular lesion characterized by villous lipomatous proliferation of the synovial tissue, usually found in knee. Patients with this benign condition are seen with progressive, painless swelling of the joint. We presented a case of 35 year old man with 3 year history of painless swelling in right knee. The symptom waxed and waned having about 1 year interval. The swelling was not related to alcohol intake and walking. Physical examination revealed severe effusion in right knee. The active range of motion was full and patient explained some tenderness on lateral side of patello-femoral joint. There were no abnormalities in knee X-ray but magnetic resonance image revealed a villous proliferation in suprapatella pouch. There were no significant abnormalities in blood test. Joint fluid analysis did not reveal any cause of swelling and effusion. In evaluation of isokinetic exercise, there was significant weakness of knee extensors.

A clinical study on infants of diabetic mothers

Thirty one infants of diabetic mothers(IDM) who had been admitted in Neonatal Intensive Care Unit at Chonnam University Hospital from January 1987 to July 1991 were studied for evaluation of their perinatal outcome and prognosis. The results were as follows; 1) The distribution of diabetic mothers according to modified White's classification was GD & class A in 12 cases(38.7%), B in 16 cases(51.6%), C in one case, D4 in one case, and R in one case. 2) Of the 31 diabetic mothers, 8(25.8%) had a history of infertility or stillbirth, 20(64.5%) had prognostically bad signs of pregnancy (PBSP), and 12(38.7%) were treated with insulin and/or oral hypoglycemic agent during pregnancy. 3) C-section rate was 32.2%, and the rates of shoulder dystocia and birth asphyxia were 35.5% and 29.0%, respectively. 4) The rates of large for gestational age were 75.0% in class GD & A, 68.8% in class B, and the rates of small for gestational age were 8.3% and, 6.3% respectively, Characteristic face with body composition was noted in all babies, hepatosplenomegaly in 90.3%, heart murmur in 41.9%, respiratory distress syndrome in 12.9%, transient tachypnea of mewborn in 19.4%, hypertrophic cardiomyopathy in 40.0%, and seizure in 6.5%. 5) Laboratory abnormalities were hypoglycemia in 77.4%, hyperbilirubinemia in 83.9%, polycythemia in 16.1%, hyperinsulinemia in 45.5%, hypercalcemia in 22.6%, and hypomagnesemia in 23.1%. 6) Birth injuries were noted in 61.3%, The most common were caput succedaneum and/or cephal-hematoma, brachial palsy, and fracture. Congenital anomalies were noted in 16.1%. The most common were musculoskeletal, cardiovascular, and gastrointestinal anomalies. 7) In the short term follow up of 19 patients, there were mild developmental delay in 2 cases, cerebral palsy in 2 cases, and epilepsy in 1 case. These results suggested that infants of diabetic mothers had greater morbidity than infants of nondiabetic mothers. Therefore, long term follow up is recommended to achieve their normal growth and development.

Adverse factors of hepatic dysfunction during chemotherapy for childhood malignancy / 대한암학회지

No abstract available.