Neuroendocrine Tumor with Metachronous Gastrointestinal Stromal Tumor in a Patient:A Case Report / 대한소화기학회지

Neuroendocrine tumors (NETs) that arise from neuroendocrine cells can develop in most organs; however, it is rarely found in the duodenal papilla. Conversely, gastrointestinal stromal tumors (GISTs), which are mostly asymptomatic and detected incidentally, are usually found in the stomach and very rarely occur metachronously with NETs. A 42-year-old female with no specific underlying disease underwent gastroscopy due to epigastric pain. Biopsy of enlarged major and minor duodenal papilla confirmed the diagnosis of a NET. Endoscopic papillectomy of the major and minor papillae was performed. Multiple duodenal and jejunal submucosal nodules were seen on biliary CT performed at the 30 months follow-up. Pylorus-preserving pancreaticoduodenectomy was performed due to the suspicion of multiple recurrent NETs and muscularis propria involvement on endoscopic ultrasound. Surgical specimen biopsy confirmed the diagnosis of multiple duodenal and jejunal GIST lesions and a metastatic NET in the duodenal lymph node. We report a rare case of a GIST detected in the duodenum during follow-up after the diagnosis and papillectomy of duodenal papilla NET.

Pancreatic Acinar Cell Cystadenoma Mimicking Pancreatic Serous Cystadenoma / 대한소화기학회지

Acinar cell cystadenoma, also known as an acinar cystic transformation of the pancreas, is an exceedingly rare but benign pancreatic lesion. A 51-year-old woman was transferred to Inje University Busan Paik Hospital because of an 8 cm-sized calcified, multiseptated, and multilocular cystic mass in the pancreatic tail observed during abdominal CT performed at another hospital. The patient did not complain of abdominal pain or other symptoms, and her laboratory findings were normal. MRI showed that the cyst was not connected to the main pancreatic duct. A pancreatic serous cystadenoma was suspected, and a laparoscopic distal pancreatectomy was performed. The resected mass was composed of variable sized multilocular cysts with incomplete septa and focally lined by epithelium with acinar differentiation. The patient was diagnosed with acinar cell cystadenoma and is currently being followed up regularly. No complications or recurrences have been observed.

Pancreatic Acinar Cell Cystadenoma Mimicking Pancreatic Serous Cystadenoma / 대한소화기학회지

Acinar cell cystadenoma, also known as an acinar cystic transformation of the pancreas, is an exceedingly rare but benign pancreatic lesion. A 51-year-old woman was transferred to Inje University Busan Paik Hospital because of an 8 cm-sized calcified, multiseptated, and multilocular cystic mass in the pancreatic tail observed during abdominal CT performed at another hospital. The patient did not complain of abdominal pain or other symptoms, and her laboratory findings were normal. MRI showed that the cyst was not connected to the main pancreatic duct. A pancreatic serous cystadenoma was suspected, and a laparoscopic distal pancreatectomy was performed. The resected mass was composed of variable sized multilocular cysts with incomplete septa and focally lined by epithelium with acinar differentiation. The patient was diagnosed with acinar cell cystadenoma and is currently being followed up regularly. No complications or recurrences have been observed.

Percutaneous Trans-splenic Obliteration for Duodenal Variceal bleeding: A Case Report / 대한소화기학회지

Duodenal varices are a serious complication of portal hypertension. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). The patient no longer complained of melena after treatment. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding.

Percutaneous Trans-splenic Obliteration for Duodenal Variceal bleeding: A Case Report / 대한소화기학회지

Duodenal varices are a serious complication of portal hypertension. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). The patient no longer complained of melena after treatment. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding.

Post-ERCP Bleeding in the Era of Multiple Antiplatelet Agents

BACKGROUND/AIMS: This study aimed to determine the risk of post-endoscopic retrograde cholangiopancreatography (post-ERCP) bleeding among patients taking antiplatelet agents (APAs), particularly in the era of multiple APAs. METHODS: The primary outcomes were the frequency, type, and severity of ERCP-related bleeding according to the use of APAs. RESULTS: The frequencies of post-ERCP bleeding among the four different groups were 16 of 2,083 (0.8%) in the no drug group, 12 of 256 (4.7%) in the aspirin group, 3 of 48 (6.3%) in the single APA group, and 4 of 48 (8.3%) in the multiple APA group (p<0.001). In the univariate analysis, post-ERCP bleeding was associated with age, pull-type sphincterotomy, and APA and was inversely associated with balloon dilation of the biliary orifice. In the multivariate analysis, pull-type sphincterotomy (odds ratio [OR], 7.829; 95% confidence interval [CI], 1.411 to 43.453; p=0.019) and country (Korea: OR, 0.124; 95% CI, 0.042 to 0.361; p<0.001) were associated with post-ERCP bleeding. CONCLUSIONS: The frequency of post-ERCP bleeding was statistically higher in patients on any APA within 6 days prior to ERCP. However, in the multivariate analysis, APA use was not associated with post-ERCP bleeding. Until a large, adequately powered study to detect differences is performed, caution is recommended when considering invasive procedures during ERCP in patients on APAs.

A Case of Fitz-Hugh-Curtis syndrome in a male patient / 고신대학교의과대학학술지

Fitz-Hugh-Curtis syndrome has been described as perihepatitis associated with pelvic inflammatory disease (PID). It is classically seen in premenopausal young women who have right upper quadrant pain, usually but not always accompanied by symptoms of PID, and is frequently confused with biliary tract disease. However, the syndrome has rarely been reported in males. The predominant symptom is right upper quadrant pain, but PID may not be present in male patients. Here, we report a case of Fitz-Hugh-Curtis syndrome in a young male patient, which was diagnosed by serological tests and computed tomography. Fitz-Hugh-Curtis syndrome should be considered as a possible cause of pain in the right upper quadrant in male patients, although such a case is very rare.

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.

Usefulness of Percutaneous Puncture in Insertion of Totally Implantable Venous Access Devices in Pediatric Patients

PURPOSE: Totally implantable venous access devices (TIVADs) are commonly used in pediatrics for the administration of chemotherapy, antibiotics, or parenteral nutrition. TIVADs can be implanted using various techniques, including surgical cutdown (SC) and percutaneous puncture (PP). Recently, percutaneous TIVAD became popular in adults, but studies comparing between PP and SC group in pediatric patients are rare. MATERIALS AND METHODS: Data were collected and analyzed retrospectively from 23 patients who underwent TIVAD at a single institution between January 2013 and December 2015. We examined the clinical characteristics, insertion techniques, and clinical outcome. We divided the patients into 2 groups and compared PP with ultrasonography and SC using the insertion technique. We compared success rate, procedural time, and the patency rate between the 2 groups. RESULTS: Eleven TIVADS were inserted using PP, and 12 TIVADs were inserted using SC. No statistically significant difference in characteristics was found between the 2 groups. The procedural time in the PP group was shorter than that in the SC group, but the difference was not statistically significant (P=0.685). During follow-up, 1 patient in the SC group had an occlusion, and 1 patient in the PP group had an infection. CONCLUSION: PP of the internal jugular vein with ultrasonography appears to be the method of choice for TIVAD insertion owing to its similar success rate in terms of implantation and complication rate to that in SC, with shorter procedural times in pediatric patients.

Diagnostic accuracy of 22/25-gauge core needle in endoscopic ultrasound-guided sampling: systematic review and meta-analysis

BACKGROUND/AIMS: To compare the diagnostic accuracy of endoscopic ultrasound-guided core needle aspiration with that of standard fine-needle aspiration by systematic review and meta-analysis. METHODS: Studies using 22/25-gauge core needles, irrespective of comparison with standard fine needles, were comprehensively reviewed. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic curves for the diagnosis of malignancy were used to estimate the overall diagnostic efficiency. RESULTS: The pooled sensitivity, specificity, and DOR of the core needle for the diagnosis of malignancy were 0.88 (95% confidence interval [CI], 0.84 to 0.90), 0.99 (95% CI, 0.96 to 1), and 167.37 (95% CI, 65.77 to 425.91), respectively. The pooled sensitivity, specificity, and DOR of the standard needle were 0.84 (95% CI, 0.79 to 0.88), 1 (95% CI, 0.97 to 1), and 130.14 (95% CI, 34.00 to 495.35), respectively. The area under the curve of core and standard needle in the diagnosis of malignancy was 0.974 and 0.955, respectively. The core and standard needle were comparable in terms of pancreatic malignancy diagnosis. There was no significant difference in procurement of optimal histologic cores between core and standard needles (risk ratio [RR], 0.545; 95% CI, 0.187 to 1.589). The number of needle passes for diagnosis was significantly lower with the core needle (standardized mean difference, -0.72; 95% CI, -1.02 to -0.41). There were no significant differences in overall complications (RR, 1.26; 95% CI, 0.34 to 4.62) and technical failure (RR, 5.07; 95% CI, 0.68 to 37.64). CONCLUSIONS: Core and standard needles were comparable in terms of diagnostic accuracy, technical performance, and safety profile.

A Case of Biliary Obstruction Caused by Liver Cyst / 대한소화기학회지

Most cystic lesions of the liver are found incidentally in imaging studies because they are not symptomatic, and generally do not require treatment. Rarely, however, symptomatic hepatic cysts may develop complications and require treatment. Here, we describe a case of a 77-year-old woman who developed biliary obstruction with abdominal pain due to compression of the bile duct by a simple hepatic cyst. We confirmed the diagnosis based on symptoms and imaging studies. The patient's symptoms improved after simple cyst ablation by sclerotherapy.

Oral udenafil and aceclofenac for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients: a randomized multicenter study

BACKGROUND/AIMS: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Combination therapy w ith ora l udenafil and aceclofenac may reduce the occurrence of post-ERCP pancreatitis by targeting different pathophysiological mechanisms. We investigated whether combining udenafil and aceclofenac reduced the rates of post-ERCP pancreatitis. METHODS: A prospective, randomized, double-blind, placebo-controlled, multicenter study was conducted in four academic medical centers. Between January 2012 and June 2013, a total of 216 patients who underwent ERCP were analyzed for the occurrence of post-ERCP pancreatitis. Patients were determined to be at high risk for pancreatitis based on validated patient and procedure-related risk factors. RESULTS: Demographic features, indications for ERCP, and therapeutic procedures were similar in each group. There were no significant differences in the rate (15.8% [17/107] vs. 16.5% [18/109], p = 0.901) and severity of post-ERCP pancreatitis between the udenafil/aceclofenac and placebo groups. One patient in each group developed severe pancreatitis. Multivariate analyses indicated that suspected dysfunction of the sphincter of Oddi and endoscopic papillary balloon dilation without sphincterotomy were associated with post-ERCP pancreatitis. CONCLUSIONS: Combination therapy with udenafil and aceclofenac is not effective for the prevention of post-ERCP pancreatitis.

A Case of Biliary Fascioliasis Mimicking Neoplasia of the Common Hepatic Duct / 대한내과학회지

Fascioliasis is a rare zoonotic disease caused by Fasciola hepatica, the liver fluke. Humans can become accidental hosts of this parasite by ingesting contaminated drinking water or plants containing viable metacercariae. There are two disease stages: the hepatic (acute) and biliary (chronic) stages. The biliary stage of this zoonotic infection is often misdiagnosed because the symptoms are subclinical, with intermittent cholangitis as the only sign. Endoscopic retrograde cholangiopancreatography (ERCP) has been described in the diagnosis of a few cases of fascioliasis. We used this modality to diagnose biliary fascioliasis in a 39-year-old woman with chronic hepatitis B who had intermittent abdominal pain for three years with irregular wall thickening and luminal narrowing of the common hepatic duct (CHD), which resembled neoplasia of the CHD. Following the correct diagnosis, the adult worm was removed using endoluminal forceps via endoscopic sphincterotomy. This case report confirms the diagnostic and therapeutic value of ERCP in patients with biliary fascioliasis that may mimic neoplasia of the CHD.

Intermuscular Lipoma in the Posterior Triangle of the Neck

No abstract available.

Foreign-Body Granuloma after Metacarpal Fracture Treatment with Absorbable Implants

No abstract available.

Risk Factors for the Presence of Residual Bile Duct Stones after Endoscopic Treatment of Stones of the Common Bile Duct / 대한내과학회지

BACKGROUND/AIMS: Stones remaining after endoscopic treatment of common bile duct (CBD) stones may evolve into recurrent CBD stones or serve as nuclei for the growth of new CBD stones. The aim of the present study was to identify risk factors for the presence of residual stones after endoscopic treatment of CBD stones. METHODS: We performed a retrospective case-control study; 55 patients with residual stones were enrolled as the case group and 281 patients without such stones served as a control group. We collected information on age, sex, stone characteristics, laboratory findings, the presence/absence of a periampullary diverticulum, use of mechanical lithotripsy, use of (single-procedure) endoscopic papillary balloon dilatation (EPBD), presence/absence of multiple CBD stones, CBD stone size, CBD stone diameter, whether CBDs were associated with gall bladder stones, and histories of prior cholecystectomy and cholecystectomy performed after endoscopic treatment. RESULTS: Upon univariate analysis, mechanical lithotripsy, single-procedure EPBD, the presence of multiple CBD stones (more than four), and CBD stone diameter greater than 1 cm were risk factors for the presence of residual stones. Upon multivariate analysis, single-procedure EPBD (odds ratio [OR], 3.174; 95% confidence interval [CI], 1.68-6.00; p = 0.000), and more than four CBD stones (OR, 2.459; 95% CI, 1.24-4.86; p = 0.010), were significant risk factors for the presence of residual stones. CONCLUSIONS: Single-procedure EPBD and the presence of more than four CBD stones were independent risk factors for the presence of residual stones. Particular care, featuring meticulous inspection, is necessary when treating patients with these risk factors. A second procedure, endoscopic retrograde cholangiopancreatography, may be required.

Prevention of Postsurgical Scars: Comparsion of Efficacy and Convenience between Silicone Gel Sheet and Topical Silicone Gel

To date, few studies have compared the effectiveness of topical silicone gels versus that of silicone gel sheets in preventing scars. In this prospective study, we compared the efficacy and the convenience of use of the 2 products. We enrolled 30 patients who had undergone a surgical procedure 2 weeks to 3 months before joining the study. These participants were randomly assigned to 2 treatment arms: one for treatment with a silicone gel sheet, and the other for treatment with a topical silicone gel. Vancouver Scar Scale (VSS) scores were obtained for all patients; in addition, participants completed scoring patient questionnaires 1 and 3 months after treatment onset. Our results reveal not only that no significant difference in efficacy exists between the 2 products but also that topical silicone gels are more convenient to use. While previous studies have advocated for silicone gel sheets as first-line therapies in postoperative scar management, we maintain that similar effects can be expected with topical silicone gel. The authors recommend that, when clinicians have a choice of silicone-based products for scar prevention, they should focus on each patient's scar location, lifestyle, and willingness to undergo scar prevention treatment.

A Case of Colonic Perforation after Acute Necrotizing Pancreatitis / 대한내과학회지

Colonic perforation after acute necrotizing pancreatitis is a very rare but critical complication. The mortality rate is greater than 50%. Therefore, a high index of suspicion is needed for early detection of the complication. We present a case of a 50-year-old man diagnosed as colonic perforation after acute necrotizing pancreatitis. During the treatment course, fecal material was drained via a pleural drainage tube. Colonic perforation was confirmed on CT scan. The pathogenesis of colonic perforation in this case involved direct spread of pancreatic enzymes and inflammatory exudate. He was treated successfully with colectomy, ileostomy, debridement of necrotic tissue, and drainage.

Development of Clinical Guideline for the Diagnosis and Evaluation of Depression: Focused on Diagnosis Guideline / 신경정신의학

OBJECTIVES: The aim of this study is to develop guideline for use in diagnosis of depression. METHODS: Development of this guideline was processed according to the ADAPTE manual, which was developed for adaptation of good clinical practice guidelines. Important key questions were determined, and a systematic review of clinical practice guidelines was performed. The contents of guidelines selected by comparison of the methodological quality and currency were evaluated with regard to the applicability and acceptability. Answers to key questions and clinical recommendations were established by peer review. RESULTS: There has been no evidence on strategies to improve the accuracy and rate of diagnosis of depression. The screening tools for depression were useful in diagnosis of depression in clinical practice. CONCLUSION: The results of this study may suggest the necessity of strategies to improve the validity and reliability of diagnosis of depression. In contrast, scales for screening depression can be useful in diagnosis of depression. This guideline did not include systematic reviews regarding useful scales for diagnosis of depression. In the future, amendment of this guideline might be needed in order to supplement limitations.

Development of Clinical Guideline for the Diagnosis and Evaluation of Depression: Focused on Evaluation Guideline / 신경정신의학

OBJECTIVES: The aim of this study is to develop guideline for evaluation of depression. METHODS: Development of this guideline was processed according to the ADAPTE manual, which was developed for adaptation of good clinical practice guidelines. Important key questions were determined, and a systematic review of clinical practice guidelines was performed. The contents of guidelines selected by comparison of the methodological quality and currency were evaluated with regard to the applicability and acceptability. Answers to key questions and clinical recommendations were established by peer review. RESULTS: Careful evaluations on the characteristics of depression, including subtype, severity, suicidality, and psychiatric and physical comorbidities were recommended because these factors can have an influence on course and prognosis in treatment of depression. CONCLUSION: The results of this study may contribute to the systematic evaluation of depression, based on clinical importance. However, this guideline did not include systematic reviews regarding useful scales for evaluation of depression. In the future, amendment of this guideline might be needed in order to supplement limitations.