Usefulness of endoscopic resection using the band ligation method for rectal neuroendocrine tumors

BACKGROUND/AIMS: Rectal neuroendocrine tumors (NETs) are among the most common of gastrointestinal NETs. Due to recent advances in endoscopy, various methods of complete endoscopic resection have been introduced for small (≤10 mm) rectal NETs. However, there is a debate about the optimal treatment for rectal NETs. In our study, we aimed to evaluate the efficacy and feasibility of endoscopic resection using pneumoband and elastic band (ER-BL) for rectal NETs smaller than 10 mm in diameter. METHODS: A total of 55 patients who were diagnosed with rectal NET from January 2004 to December 2011 at Gil Medical Center were analyzed retrospectively. Sixteen patients underwent ER-BL. For comparison, 39 patients underwent conventional endoscopic mucosal resection (EMR). RESULTS: There was a markedly lower deep margin positive rate for ER-BL than for conventional EMR (6% [1/16] vs. 46% [18/39], P=0.029). Four patients who underwent conventional EMR experienced perforation or bleeding. However, they recovered within a few days. On the other hand, patients whounderwent endoscopic resection using a pneumoband did not experience any complications. In multivariate analysis, ER-BL (P=0.021) was independently associated with complete resection. CONCLUSIONS: ER-BL is an effective endoscopic treatment with regards to deep margin resection for rectal NET smaller than 10 mm.

Survey of perinatal hepatitis B virus transmission after Korean National Prevention Program in a tertiary hospital

BACKGROUND/AIMS: The Ministry of Health and Welfare and the Korea Centers for Disease Control and Prevention in South Korea have been organizing hepatitis B virus (HBV) vertical infection prevention projects since July 2002. In this single-institute study, the results of surveys conducted in target mothers who delivered babies in a tertiary hospital were investigated and analyzed. METHODS: Of the 9,281 mothers and their 9,824 neonates born between July 2002 and December 2012, 308 hepatitis B surface antigen (HBsAg)-positive mothers and their 319 neonates were selected for this study, and their records were analyzed retrospectively. RESULTS: A total of 308 mothers were HBsAg-positive, with an HBV prevalence of 3.32% (308/9,281). There were 319 neonates born to these HBsAg-positive mothers, and 252 were confirmed to as either HBsAg-positive or -negative. Four were confirmed as HBsAg-positive, with a 1.59% (4/252) HBV vertical infection rate. All the mothers of neonates who had an HBV vertical infection were hepatitis B e antigen (HBeAg)-positive. Among the HBsAg-positive neonates, three were HBeAg-positive and had an HBV DNA titer of 1.0 x 10(8) copies/mL. CONCLUSIONS: The HBV prevalence of mothers was 3.32% (308/9,281), and their vertical infection rate was 1.59% (4/252). Thus, the South Korean HBV vertical infection prevention projects are effective, and, accordingly, HBV prevalence in South Korea is expected to decrease continuously.

Clinical Features of Non-alcoholic Fatty Liver Disease in Cryptogenic Hepatocellular Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) may be one of the important causes of cryptogenic hepatocellular carcinoma (HCC). The aim of this study was to evaluate whether patients with cryptogenic HCC share clinical features similar to that of NAFLD. METHODS: Cryptogenic HCC was defined as HCC that occurs in patients with the following conditions: HBsAg(-), anti-HCV(-), and alcohol ingestion of less than 20 g/day. All patients diagnosed with cryptogenic HCC from 2005 to 2012 (cryptogenic HCC group), and all patients diagnosed with HBV associated HCC between 2008 and 2012 (HBV-HCC group) were enrolled in the present study. Clinical features, BMI, lipid profiles, presence of diabetes mellitus, hypertension, and metabolic syndrome were compared between the two groups. RESULTS: Cryptogenic HCC group was composed of 35 patients (19 males and 16 females) with a mean age of 70+/-11 years. HBV-HCC group was composed of 406 patients (318 males and 88 females) with a mean age of 56+/-7 years. Patients in the cryptogenic HCC group were older (p=0.001) and female dominant (p=0.042) than those in the HBV-HCC group. There were no differences in the laboratory test results including lipid profiles and Child-Turcotte-Pugh class between the two groups. Patients in the cryptogenic HCC group had higher prevalence of diabetes (37% vs. 17%, p=0.015), hypertension (49% vs. 27%, p=0.051), metabolic syndrome (37% vs. 16%, p=0.001), and higher BMI (25.3 kg/m2 vs. 24.1 kg/m2, p=0.042) than those in the HBV-HCC group. The tumor stage was more advanced (stage III and IV) at diagnosis in the cryptogenic HCC group than in the HBV-HCC group (60% vs. 37%, p=0.007). CONCLUSIONS: Cryptogenic HCC has clinical features similar to that of NAFLD and is diagnosed at a more advanced tumor stage.

Risk Factors for Local Recurrence of Early Gastric Cancer after Endoscopic Submucosal Dissection / 대한내과학회지

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is a widely accepted method of treatment for early gastric cancer (EGC) without lymph node metastasis. However, there have been few studies about factors associated with local recurrence. The aim of our study was to evaluate the risk factors for local recurrence in patients with EGC after ESD. METHODS: We retrospectively analyzed medical records of patients who underwent ESD of EGC at Gachon University Gil Medical Center. From February 2008 to July 2011, ESD for EGC was performed in 222 cases involving 214 patients. Patients with additional treatment after ESD, patients with recurred EGC, and patients with endoscopic follow-up of < 12 months were excluded. After exclusions, a total of 150 cases were included. RESULTS: The mean age of the patients was 63.9 +/- 9.8 years, and 74.3% were male. The en bloc resection rate was 139/150 (92.7%), and the complete resection rate was 131/150 (87.3%). Local recurrence at the ESD site was found in 5 cases (5/150, 3.3%) during a mean follow-up period of 24 months. In multivariate analysis, tumor involvement at the lateral resection margin [HR: 13.12 (1.19 - 145.10); p = 0.036], piecemeal resection [HR: 25.31 (1.24 - 517.57); p = 0.036], and lymphovascular invasion [HR: 485.06 (2.30 - 102449.79); p = 0.024] were associated with local recurrence after ESD. CONCLUSIONS: Local recurrence after ESD was significantly associated with involvement of the lateral resection margin, piecemeal resection, and lymphovascular invasion. Therefore, patients who have these risk factors should be followed up more carefully to detect local recurrence.

The Impact of Inosine Triphosphatase Variants on Hemoglobin Level and Sustained Virologic Response of Chronic Hepatitis C in Korean

Two variants of the inosine triphosphatase (ITPA: rs1127354, rs7270101) gene cause ITPA deficiency and protect against the hemolytic toxicity of ribavirin. We investigated the clinical significance of ITPA variants in Korean patients treated with pegylated interferon (PEG-IFN) plus ribavirin. Of the 133 patients, 108 were CC and 25 were non-CC at rs1127354 (groups A and B, respectively). On the other hand, at rs7270101 all 133 were AA. The mean values of Hemoglobin (Hgb) after 4, 8, and 12 weeks of treatment in groups A and B were 12.2 and 14.0, 11.8 and 13.2, and 11.5 and 12.9, respectively (P=0.001, 0.036, 0.036). Sustained virologic response (SVR) was achieved in 67.8% (40/59) of genotype 1 patients and in 75% (27/36) of non-genotype 1 patients. Regarding ITPA variants, SVR was achieved by 66% and 80% of genotype 1 (P=0.282), and by 78% and 71% (P=0.726) of non-genotype 1. SVR was not significantly different in groups A and B. In conclusion, non-CC at rs1127354 without involvement of rs7270101 is strongly associated with protection from ribavirin-induced anemia, however, ITPA genotype is not associated with SVR.

A Case of Post-Operative Intra-Abdominal Infection Caused by Corynebacterium Striatum / 대한내과학회지

Corynebacterium striatum is an aerobic, Gram-positive bacillus that is part of the resident flora of skin and mucosal membranes. C. striatum is usually considered a non-pathogenic contaminant, although infective endocarditis and respiratory infection, and less frequently arthritis and meningitis, due to C. striatum have been reported. C. striatum has been particularly associated with catheter-related infections and infections following conditions that resulted in disruption of the skin barrier in both immunocompromised and immunocompetent hosts. We describe a case of post-operative intra-abdominal infection caused by the rare pathogen, C. striatum.

A case of emphysematous hepatitis with spontaneous pneumoperitoneum in a patient with hilar cholangiocarcinoma / 대한간학회지

An 80-year-old woman with hilar cholangiocarcinoma was hospitalized due to sudden-onset abdominal pain. Computed tomography revealed hepatic necrosis accompanied with emphysematous change in the superior segment of the right liver (S7/S8), implying spontaneous rupture, based on the presence of perihepatic free air. Although urgent percutaneous drainage was performed, neither pus nor fluids were drained. These findings suggest emphysematous hepatitis with a hepatic mass. Despite the application of intensive care, the patient's condition deteriorated rapidly, and she died 3 days after admission to hospital. Liver gas has been reported in some clinical diseases (e.g., liver abscess) to be caused by gas-forming organisms; however, emphysematous hepatitis simulating emphysematous pyelonephritis is very rare. The case reported here was of fatal emphysematous hepatitis in a patient with hilar cholangiocarcinoma.

Efficacy of Peginterferon and Ribavirin Combination Therapy of Chronic Hepatitis C: A Pooled Analysis / 대한소화기학회지

BACKGROUND/AIMS: A combination of peginterferon and ribavirin is the standard therapy for chronic hepatitis C (CHC). However, the respective study has not been carried out in a large scale in Korea. The purpose of this study was to collect the studies that have been reported in Korea in order to analyze the therapeutic effect of combination therapy and compare to find racial difference. METHODS: Twenty-eight papers related to the therapeutic effect of combination therapy in CHC patients were analyzed based on pooled analysis. RESULTS: Based on the analysis for genotype 1 in Korea, early virologic response (EVR), end of treatment response (ETR), and sustained virologic response (SVR) were 79.6% (125/157), 80.1% (166/207), and 62.7% (341/543). The EVR, ETR, and SVR for genotype 2 and 3 were 89.4% (119/133), 92.2% (203/220), and 84.1% (434/516). Data from other Asians showed that EVR and SVR for genotype 1 were 88.9% (290/326) and 64.4% (491/762) respectively and 88.8% (135/152), and 79.4% (151/190) for genotype 2 and 3 respectively. In Western, EVR and SVR for genotype 1 were 51.3% (1,981/3,860) and 42.4% (1,798/4,231) respectively, and for genotype 2 and 3 were 87.7% (350/399) and 77.8% (533/685) respectively. Based on the comparative analysis, no statistical difference in SVR between Koreans and other Asians (p=0.955) was observed; However, the SVR of Koreans was higher with significance than that of Westerns (p<0.001) On the other hand, there was no difference what so ever, in SVR for genotype 2 amongst the different races. CONCLUSIONS: The SVR of combination therapy for the Korean chronic hepatitis C patients was similar to other Asians but higher than Westerns.

A Case of Post-Operative Intra-Abdominal Infection Caused by Corynebacterium Striatum / 대한내과학회지

Corynebacterium striatum is an aerobic, Gram-positive bacillus that is part of the resident flora of skin and mucosal membranes. C. striatum is usually considered a non-pathogenic contaminant, although infective endocarditis and respiratory infection, and less frequently arthritis and meningitis, due to C. striatum have been reported. C. striatum has been particularly associated with catheter-related infections and infections following conditions that resulted in disruption of the skin barrier in both immunocompromised and immunocompetent hosts. We describe a case of post-operative intra-abdominal infection caused by the rare pathogen, C. striatum.

The Effect of Periampullary Diverticulum on the Outcome of Bile Duct Stone Treatment with Endoscopic Papillary Large Balloon Dilation / 대한소화기학회지

BACKGROUND/AIMS: Periampullary diverticulum (PAD) causes difficulty in the extraction of common bile duct (CBD) stones with conventional endoscopic therapy. Our study was designed to evaluate the effect of PAD on endoscopic large balloon dilation (EPLBD) with/without limited endoscopic sphincterotomy (EST) for CBD stone treatment. METHODS: We retrospectively reviewed cases of 141 patients treated CBD stones by EPLBD with/without limited EST at Gachon Gil Medical Center from September 2008 to February 2010. PAD were classified into three groups according to the location of the papilla and diverticulum. Clinical parameters, endoscopic parameters, and procedure outcomes were analyzed. RESULTS: PAD were identified in 46.1% (65/141), with 23 male (35.4%) and 42 female (64.6%) and a mean age of 72.9+/-11.1 years. Mean diameter of the stones was 14.8+/-6.0 mm and mean diameter of CBD was 21.6+/-7.7 mm. PAD group was significantly older than control group (72.9 vs. 68.6, p=0.043) and the incidence of large stone (> or =15 mm) was higher in PAD group (60.0% vs. 42.1%, p=0.034). Success rate of complete removal of stones in the first session was 32/65 patients (49.2%) and overall successful complete stone removal rates was 63/65 (96.9%). There was no significant difference between the PAD and control groups in success rate. Major complications were similar between two groups. CONCLUSIONS: PAD is associated with an increased incidence of large bile duct stones and older age. PAD seems to not increase technical failure rate or complication risk on EPLBD with/without limited EST.

A case of amoxicillin-induced hepatocellular liver injury with bile-duct damage / 대한간학회지

Amoxicillin, an antibiotic that is widely prescribed for various infections, is associated with a very low rate of drug-induced liver injury; hepatitis and cholestasis are rare complications. Here we present a case of a 39-year-old woman who was diagnosed with abdominal actinomycosis and received amoxicillin treatment. The patient displayed hepatocellular and bile-duct injury, in addition to elevated levels of liver enzymes. The patient was diagnosed with amoxicillin-induced cholestatic hepatitis. When amoxicillin was discontinued, the patient's symptoms improved and her liver enzyme levels reduced to near to the normal range.

Posterior Transvertebral Extension Osteotomy: A Case Report

No abstract available.

A Case of Fenestrated Basilar Artery Associated with Multiple Aneurysms

Fenestrated basilar artery is a uncommon congenital anomaly. It is seen in approximately 0.3 to 5.26% of autopsy series, but only in 0.1 to 1.9% of angiography series. Because the fenestrated basilar artery is a defect or weakness of muscular and internal elastic lamina, incidence of fenestration of the basilar artery when a vertebrobasilar artery aneurysm is present is reported to be 35.5%. We experienced one case of fenestrated basilar artery associated with multiple aneurysms(fenestrated basilar artery, basilar tip, left posterior communicating artery). We operated the basilar tip aneurysm and the posterior communicating artery aneurysm. Although we didn't operate the fenestrated basilar artery aneurysm, we report one case with review of literature in order to improve the operative result of the fenestrated basilar artery aneurysm.