Appropriateness of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans to measure preoperative anxiety and the effect of preoperative anxiety on postoperative quality of recovery

Background@#The reliability and validity of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans (K-HADS-A) has not been studied in Korean surgical patients. This study aimed to validate the usefulness of K-HADS-A for measuring preoperative anxiety in Korean surgical patients. Additionally, the effect of preoperative anxiety on postoperative quality of recovery was evaluated. @*Methods@#Preoperative anxiety in 126 inpatients with planned elective surgery was measured using the K-HADS-A. The postoperative quality of recovery was measured using the Korean version of the Quality of Recovery-15. The validity and reliability of the K-HADS-A were evaluated. The differences in quality of recovery on the first and seventh day postoperatively were then compared between the anxious and non-anxious groups. @*Results@#There was a statistical correlation between the K-HADS-A and Anxiety Likert Scale. The goodness-of-fit indices of the structural equation model showed how well the data from the K-HADS-A match their concept. The Kaiser-Meyer-Olkin value was 0.848, and the P value of Bartlett’s test of sphericity was < 0.001. Cronbach’s alpha was high at 0.872. The K-HADS-A had an acceptable level of validity and reliability. Postoperative quality of recovery was significantly lower in the anxious group (postoperative day 1: t = 2.058, P = 0.042; postoperative day 7: t = 3.430, P = 0.002). @*Conclusions@#The K-HADS-A is an acceptable tool for appropriately assessing preoperative anxiety in Korean surgical patients. Assessing preoperative anxiety is valuable, because preoperative anxiety affects the postoperative quality of mental and physical recovery.

Validity and reliability of the Korean version of the Quality of Recovery-15 questionnaire / 대한마취과학회지

Background@# The qulity of recovery-40 questionnaire (QoR-40) has been widely used to assess quality of recovery after surgery, but it is too lengthy for clinical use. The short form of QoR-40, QoR-15, has been validated in many languages; however, an official Korean version of the QoR-15 (QoR-15K) has not yet been established. This study aimed to develop and validate QoR-15K. @*Methods@# Based on the previously-validated Korean QoR-40, we selected 15 items; the QoR-15K was patterned on the original QoR-15. We analyzed 210 subjects who had been scheduled for elective surgery under general anesthesia. The patients completed the questionnaire before surgery and on postoperative days one and two. The validity, reliability, and responsiveness of the QoR-15K were evaluated. @*Results@# We obtained excellent convergent validity on visual analog scale for recovery (VAS) (ρ = 0.88, P < 0.001). The duration of anesthesia, post-anesthesia care unit, and overall hospital stay with the QoR-15K showed a significant negative correlation (ρ = -0.183, -0.151, and -0.185, respectively). Cronbach’s α was 0.909. Cohen’s effect size and standardized response mean were 0.819 and 0.721. The recruitment and completion rate were 92.9% and 100%, respectively. We based the above calculations on the results obtained on the first day following surgery. @*Conclusions@# The validity and reliability of the QoR-15K are comparable to those of the English version. The QoR-15K would be a good instrument to assess the quality of recovery in Korean patients after surgery.

Clinical Features and Treatment Considerations When Switching Biologics in Korean Patients with Severe Psoriasis: A Retrospective Single-Centered Study / 대한피부과학회지

Background@#Since the advent of biologics, they have been an efficient treatment for severe psoriasis vulgaris. Psoriasis that is refractory to biologics is associated with factors, such as old age, a high initial psoriasis area and severity index, a high body mass index (BMI), and nail involvement. @*Objective@#We evaluated the clinical characteristics and differences in laboratory parameters in patients with severe psoriasis who switched biologics at least once. @*Methods@#We analyzed the demographics, medical records, and laboratory data of 29 Korean patients who had switched biologics. Patients were classified into two groups based on the number of times they switched to biologics. @*Results@#The reasons for switching biologics in the 29 patients were primary failure (37.9%), secondary failure (58.6%), and occurrence of adverse events (3.5%). The multiple switching group showed higher mean values than the single switching group for the factors associated with low efficacy of biologics, such as age at initial presentation (43.4±9.6 years vs. 42.1±12.1 years), an initial psoriasis area severity index (15.3±6.3 vs. 12.9±4.4), and a BMI (27.4±4.0 kg/m2 and 26.3±3.4 kg/m2 ), respectively. @*Conclusion@#In this single-centered study, secondary failure was the most common reason for switching biologics. Higher mean values for factors affecting the efficacy of biologics were noted in the multiple switching group; however, the difference was not statistically significant. When choosing biologics for patients, dermatologists should be mindful of this as they select the second-line biologics.

Validity and reliability of the Korean version of the Quality of Recovery-15 questionnaire / 대한마취과학회지

Background@# The qulity of recovery-40 questionnaire (QoR-40) has been widely used to assess quality of recovery after surgery, but it is too lengthy for clinical use. The short form of QoR-40, QoR-15, has been validated in many languages; however, an official Korean version of the QoR-15 (QoR-15K) has not yet been established. This study aimed to develop and validate QoR-15K. @*Methods@# Based on the previously-validated Korean QoR-40, we selected 15 items; the QoR-15K was patterned on the original QoR-15. We analyzed 210 subjects who had been scheduled for elective surgery under general anesthesia. The patients completed the questionnaire before surgery and on postoperative days one and two. The validity, reliability, and responsiveness of the QoR-15K were evaluated. @*Results@# We obtained excellent convergent validity on visual analog scale for recovery (VAS) (ρ = 0.88, P < 0.001). The duration of anesthesia, post-anesthesia care unit, and overall hospital stay with the QoR-15K showed a significant negative correlation (ρ = -0.183, -0.151, and -0.185, respectively). Cronbach’s α was 0.909. Cohen’s effect size and standardized response mean were 0.819 and 0.721. The recruitment and completion rate were 92.9% and 100%, respectively. We based the above calculations on the results obtained on the first day following surgery. @*Conclusions@# The validity and reliability of the QoR-15K are comparable to those of the English version. The QoR-15K would be a good instrument to assess the quality of recovery in Korean patients after surgery.

The effect of the type of anesthesia on the quality of postoperative recovery after orthopedic forearm surgery / 대한마취과학회지

Background@#Although the quality of postoperative recovery may be affected by factors, there are few investigations whether the type of anesthesia also affects it. In this single-blinded, prospective, observational study, we compared the quality of postoperative recovery in patients undergoing orthopedic forearm surgery under general or regional anesthesia (brachial plexus block). @*Methods@# Ninety-seven subjects, aged 18–65 years and American Society of Anesthesiologists physical status I or II, undergoing orthopedic forearm surgery, were allocated to general or regional anesthesia group. The quality of postoperative recovery was assessed using a validated Korean version of Quality of Recovery-40 (QoR-40K) questionnaire. Patients were surveyed three times, the day before surgery (baseline) and 1st and 7th day after the surgery, and the scores of both groups were compared. @*Results@# We analyzed 47 and 50 patients in general and regional anesthesia, respectively. The global QoR-40K score and those of each of its five dimensions were not significantly different between the two groups at baseline, 1st and 7th day postoperatively. In two-way RM ANOVA, the global QoR-40K score at postoperative 1st day was significantly lower than that of baseline (P < 0.001) and postoperative 7th day (P < 0.001), respectively, in both general and regional anesthesia groups. However, there was no significant difference at each timepoint between the two groups. @*Conclusions@# The present study suggests that brachial plexus block with intravenous dexmedetomidine infusion does not improve the quality of postoperative recovery compared to sevoflurane inhalation anesthesia with remifentanil infusion in patients undergoing orthopedic forearm surgery.

Extranodal Malignant Lymphoma Concurrent Involving Female Urethra and Cervix: a Case Report

Extranodal lymphoma presents in almost one-third of all non-Hodgkin lymphoma cases. The gastrointestinal tract, skin, and central nervous system are common sites of involvement, whereas the urethra and cervix are very rare. To the best of our knowledge, this is the first report on concurrent extranodal involvement of the uterine cervix and urethra. We report imaging findings of malignant lymphoma involving urethra and cervix concurrently in a 79-year-old female patient with literature review. The magnetic resonance imaging showed huge intermediate to high signal intensity mass on T2 weighted images and strong homogeneous enhancement in uterine cervix and periurethral area, but no surrounding architectural disruption.

Dynamic Contrast-Enhanced MR Imaging of Tietze’s Syndrome: a Case Report

Tietze's syndrome is an inflammatory condition associated with painful swelling of the costochondral, costosternal, and sternoclavicular joints. Tietze's syndrome has been mostly attributed to microtrauma until now; however, this etiology is currently disputed. The diagnosis is based on clinical findings, although a few studies suggest the advantages of imaging. We report a case of Tietze's syndrome with a review of radiological findings, especially magnetic resonance imaging (MRI) with dynamic contrast enhancement.

The change of stroke volume variation during thoracotomy or one lung ventilation

BACKGROUND: Stroke volume variation (SVV) is based on cyclic changes of intrathoracic pressure during respiratory cycle. Thoracotomy and one-lung ventilation (OLV) can lead to changes in airway and intrathoracic pressure. The aim of this study was to determine whether thoracotomy and converting from two lung ventilation to OLV could affect SVV values. METHODS: Thirty patients who were scheduled for pulmonary lobectomy or pneumonectomy requiring OLV were enrolled. Induction and maintenance of anesthesia were performed with propofol and remifentanil via total intravenous anesthesia. Hemodynamic variables including mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), and SVV were measured at intervals of 1 min for 10 min after thoracotomy and OLV, respectively. RESULTS: MAP and HR increased from baseline at intervals between 3 and 10 min and between 4 and 10 min after thoracotomy, respectively (P < 0.001). CI increased between 4 and 10 min (P < 0.001). SVV did not change for 10 min after thoracotomy. After OLV, MAP decreased between 4 and 10 min (P = 0.112). SVV was the highest at 1 min after OLV. It returned to the baseline value at 7 min (P < 0.001). CI decreased between 8 and 10 min after OLV (P < 0.001). CONCLUSIONS: SVV can increase after OLV temporarily. Transient increase of SVV may be considered when fluid responsiveness is predicted by SVV during early period after OLV.

Validity and reliability of the Korean version of the Quality of Recovery-40 questionnaire / 대한마취과학회지

BACKGROUND: The Quality of Recovery-40 (QoR-40) is a widely-used, self-rated, and self-completed questionnaire for postoperative patients. The questionnaire is intended to elicit information from each patient regarding the quality of recovery during the postoperative period. It is noteworthy, however, that an official Korean version of the QoR-40 (QoR-40K) has not been established. The purpose of this study was to develop the QoR-40K by translation and cultural adaptation process and to evaluate the validity and reliability of the QoR-40K. METHODS: After pre-authorization from the original author of the QoR-40, the translation procedure was established and carried out based upon Beaton’s recommendation to create a QoR-40K model comparable to the original English QoR-40. Two hundred surgical patients were enrolled, and each completed the questionnaire during the preoperative period, on the third day, and 1 month after surgery. The QoR-40K was compared with the visual analogue scale (VAS) and another health-related questionnaire, the Short-form Health Survery-36 (SF-36). The method of validation for QoR-40K included test-retest reliability, internal consistency, and level of responsiveness. RESULTS: Spearman’s correlation coefficient for test-retest reliability was 0.895 (P < 0.001), and Cronbach’s alpha of the global QoR-40K on the third day after surgery was 0.956. A positive correlation was obtained between the QoR-40K and the mental component summary of SF-36 (ρ = 0.474, P < 0.001), and a negative correlation was observed between QoR-40K and VAS (ρ = −0.341, P < 0.001). The standardized responsive mean of the total QoR-40K was 0.71. CONCLUSIONS: The QoR-40K was found to be as acceptable and reliable as the original English QoR-40 for Korean patients after surgery, despite the apparent differences in the respective patients’ cultural backgrounds.

Effects of preoperative oral carbohydrate administration on patient well-being and satisfaction in thyroid surgery / 대한마취과학회지

BACKGROUND: Although the positive effects of preoperative oral carbohydrate administration on clinical outcomes followingmajor surgery have been reported continuously, there are few investigations of them in minor surgical patients. Thepresent study was designed to examine the effects of preoperative oral carbohydrate administration on patient well-beingand satisfaction in patients undergoing thyroidectomy. METHODS: Fifty adults aged 20–65 years and scheduled for elective thyroidectomy in first schedule in the morning wereallocated to one of two groups. The Control group (n = 25) was requested to obey traditional preoperative fasting aftermidnight prior to the day of surgery. The Carbohydrate group (n = 25) also fasted overnight but drank 400 ml of carbohydrate-richdrink 2 hours before induction of anesthesia. Patient well-being (thirst, hunger, mouth dryness, nauseaand vomiting, fatigue, anxiety and sleep quality) and satisfaction were assessed just before the operating room admission(preoperative) and 6 hours following surgery (postoperative). Other secondary outcomes including oral Schirmer’s testand plasma glucose concentrations were also evaluated. RESULTS: The two groups were homogenous in patient characteristics. Seven parameters representing patient well-beingevaluated on NRS (0–10) and patient satisfaction scored on a 5-point scale were not statistically different between thetwo groups preoperatively and postoperatively. There were no statistically significant differences in secondary outcomes. CONCLUSIONS: Preoperative oral carbohydrate administration does not appear to improve patient well-being and satisfactioncompared with midnight fasting in patients undergoing thyroidectomy in first schedule in the morning.

Breastfeeding increases the risk of food sensitization but not affect food allergy symptoms in young children with atopic dermatitis

PURPOSE: Breast-feeding is recommended to prevent allergies, particularly in high-risk infants, but the evidence of protective effects that breast-feeding has on food allergy (FA) remains elusive. The aim of this study was to investigate risk factors of FA and the association between breast-feeding and FA symptoms/food sensitization (FS) in children with atopic dermatitis under 2 years of age. METHODS: We reviewed the medical records of 384 children with atopic dermatitis under 2 years of age who visited our pediatric allergy clinic from March 1, 2009 through December 31, 2014. Symptoms of FA, feeding type, and family history of allergic disease were assessed. Laboratory tests were conducted, including serum total IgE, eosinophil (%), serum 25-hydroxyvitamin D, and specific IgE to egg white, milk, soy, peanut, and wheat. RESULTS: Subjects were divided into 3 groups based on FA symptoms and evidence of sensitization: The FA symptom group (n=240), no symptom group (n=53) and no FS group (n=91). The FA symptom group had a higher log total IgE level (2.0 vs. 1.3, P<0.001) and eosinophil (%) (7.0% vs. 4.7%, P=0.001) than the no FA symptom group. In multivariate analysis, breast-feeding was associated with FS (adjusted odds ratio [aOR], 2.43; 95% confidence intervals [CI], 1.03-5.74) but was not associated with FA symptoms (aOR, 0.65; 95% CI, 0.23-1.83). CONCLUSION: Breast-feeding may increase the risk of FS, but not immediate-type FA symptoms in children with atopic dermatitis.

Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey / 대한중환자의학회지

BACKGROUND: Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea. METHODS: An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS). RESULTS: Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues. CONCLUSIONS: Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist's role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.

Accidental ingestion of E-cigarette liquid nicotine in a 15-month-old child: an infant mortality case of nicotine intoxication / 소아과

Electronic cigarettes are novel tobacco products that are frequently used these days. The cartridge contains liquid nicotine and accidental poisoning, even with a small oral dose, endangers children. We present here a mortality case of a 15-month-old child who ingested liquid nicotine mistaking it for cold medicine. When the emergency medical technicians arrived, she was found to have pulseless electrical activity. Spontaneous circulation was restored after approximately 40 minutes of cardiopulmonary resuscitation. The cotinine level in her urine was 1,716 ng/mL. Despite intensive supportive care, severe anoxic brain injury was found on computed tomography and the child ultimately died. This fatality highlights the need for public health efforts to minimize such accidents.

Erratum: Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey / 대한중환자의학회지

We found an error in this article. The author's name should be corrected as following: from "Younsuk Koh" to "Younsuck Koh".

Effects of intraoperative single bolus fentanyl administration and remifentanil infusion on postoperative nausea and vomiting / 대한마취과학회지

BACKGROUND: Although the use of postoperative opioids is a well-known risk factor for postoperative nausea and vomiting (PONV), few studies have been performed on the effects of intraoperative opioids on PONV. We examined the effects of a single bolus administration of fentanyl during anesthesia induction and the intraoperative infusion of remifentanil on PONV. METHODS: Two hundred and fifty women, aged 20 to 65 years and scheduled for thyroidectomy, were allocated to a control group (Group C), a single bolus administration of fentanyl 2 microg/kg during anesthesia induction (Group F), or 2 ng/ ml of effect-site concentration-controlled intraoperative infusion of remifentanil (Group R) groups. Anesthesia was maintained with sevoflurane and 50% N2O. The incidence and severity of PONV and use of rescue antiemetics were recorded at 2, 6, and 24 h postoperatively. RESULTS: Group F showed higher incidences of nausea (60/82, 73% vs. 38/77, 49%; P = 0.008), vomiting (40/82, 49% vs. 23/77 30%; P = 0.041) and the use of rescue antiemetics (47/82, 57% vs. 29/77, 38%; P = 0.044) compared with Group C at postoperative 24 h. However, there were no significant differences in the incidence of PONV between Groups C and R. The overall incidences of PONV for postoperative 24 h were 49%, 73%, and 59% in Groups C, F, and R, respectively (P = 0.008). CONCLUSIONS: A single bolus administration of fentanyl 2 microg/kg during anesthesia induction increases the incidence of PONV, but intraoperative remifentanil infusion with 2 ng/ml effect-site concentration did not affect the incidence of PONV.

A comparison of the temperature difference according to the placement of a nasopharyngeal temperature probe / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare temperatures measured at three different sites where a nasopharyngeal temperature probe is commonly placed. METHODS: Eighty elective abdominal surgical patients were enrolled. After anesthesia induction, four temperature probes were placed at the nasal cavity, upper portion of the nasopharynx, oropharynx, and the esophagus. The placement of the nasopharyngeal temperature probes was evaluated using a flexible nasendoscope, and the depth from the nares was measured. The four temperatures were simultaneously recorded at 10-minute intervals for 60 minutes. RESULTS: The average depths of the probes that were placed in the nasal cavity, upper nasopharynx, and the oropharynx were respectively 5.7 ± 0.9 cm, 9.9 ± 0.7 cm, and 13.6 ± 1.7 cm from the nares. In the baseline temperatures, the temperature differences were significantly greater in the nasal cavity 0.32 (95% CI; 0.27-0.37)℃ than in the nasopharynx 0.02 (0.01-0.04)℃, and oropharynx 0.02 (−0.01 to 0.05)℃ compared with the esophagus (P < 0.001). These differences were maintained for 60 minutes. Twenty patients showed a 0.5℃ or greater temperature difference between the nasal cavity and the esophagus, but no patient showed such a difference at the nasopharynx and oropharynx. CONCLUSIONS: During general anesthesia, the temperatures measured at the upper nasopharynx and the oropharynx, but not the nasal cavity, reflected the core temperature. Therefore, the authors recommend that a probe should be placed at the nasopharynx (≈ 10 cm) or oropharynx (≈ 14 cm) with mucosal attachment for accurate core temperature measurement.

Erratum: Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey / 대한구급학회지

We found an error in this article. The author's name should be corrected as following: from "Younsuk Koh" to "Younsuck Koh".

Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey / 대한구급학회지

BACKGROUND: Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea. METHODS: An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS). RESULTS: Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues. CONCLUSIONS: Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist's role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.

Marfan syndrome and symptomatic dural ectasia: A case report and literature review

Dural ectasia refers to the widening or ballooning of the dural sac surrounding the spinal cord. It can affect any plane of the spinal canal, but occurs primarily in the lumbosacral region. Dural ectasia is present in 63-92% patients who have Marfan syndrome, and is related to Ehlers-Danlos syndrome, neurofibromatosis type I, and ankylosing spondylitis. The most common symptoms are low back pain, headache, weakness, numbness above and below the affected limb, and occasional rectal and genital pain. However, in most patients, dural ectasia is usually asymptomatic. We report the case of a 5-year-old boy who presented with a severe headache who had been diagnosed with Marfan syndrome. During the evaluation, magnetic resonance imaging of the lumbar and sacral spine revealed dural ectasia. To our knowledge, this is the first report on Marfan syndrome with symptomatic dural ectasia in Korea. We concluded that dural ectasia should be suspected in patients diagnosed with Marfan syndrome who have a severe headache.

A Case of Multiple Tumors Located in Structures Other than the Colon in a Patient with Familial Adenomatous Polyposis / 대한내과학회지

Most patients with familial adenomatous polyposis (FAP) undergo prophylactic colectomy. As a result, extracolonic manifestations including benign and malignant tumors are more common in patients with FAP, and duodenal cancer is now the main cause of death. However, duodenal adenomas and carcinomas are detected less frequently in Korea and Japan than in Western countries, and gastric cancer is more prevalent than in Western countries. In the present case, a 63-year-old man, who had undergone a total colectomy and an ileostomy 14 years previously, presented at our outpatient clinic complaining of discomfort at the ileostomy site. The patient had adenomas in the gallbladder and ileum, and adenocarcinomas in the duodenum and stomach. The interval between development of duodenal cancer and stomach cancer was only 4 months. Therefore, we suggest that more frequent endoscopic surveillance may be needed for these cases.