Clinical Features of Neuroendocrine Tumor of the Pancreas: Single Center Study / 대한소화기학회지

BACKGROUND/AIMS: Pancreatic neuroendocrine tumors (PNET) are rare and manifest as functioning tumor (FT) or non-functioning tumor (NFT). Although malignant changes are observed in some cases, its prognosis is better than pancreatic cancer. We evaluated clinicoradiologic features and prognosis of FT and NFT. In addition, we tried to find the predictive factors for the recurrence of NFT after resection. METHODS: Between October 1994 and June 2004, we retrospectively evaluated the clinicopathologic features and prognosis of 12 cases of FT and 31 cases of NFT diagnosed by surgical pathology at single medical center in Korea. RESULTS: PNET included 6 insulinomas, 4 gastrinomas, 1 glucagonoma, 1 somatostatinoma and 31 NFT. The major clinical manifestations were neuroglycopenic symptoms (100%) in insulinoma, abdominal ulcer symptoms (75%) in gastrinoma, dermatitis (100%) in glucagonoma, steatorrhea (100%) in somatostatinoma, and abdominal discomfort or pain (45%) in NFT. NFT was located more proximally when compared to FT (p=0.023). NFT showed more malignant (64.5%) behavior compared to FT (41.7%) despite the lack of statistical significance. Curative resections were done without postoperative death in 38 cases. Six cases of NFT (21.4%) and 1 case of FT (10%) recurred with an average of 26.5 months. In the recurrent NFT, the findings of diabetes mellitus (p=0.010), abnormal pancreatic duct (p=0.026), Whipple's operation (p=0.013) and tumor emboli (p=0.03) were more common than in non-recurrent NFT. CONCLUSIONS: FT and NFT showed different clinicoradiologic features. In addition, NFT should be monitored more carefully because of frequent recurrence.

Prospective Randomized Trial of Intravenous Ciprofloxacin for Prevention of Bacterial Infection in Cirrhotic Patients with Esophageal Variceal Bleeding / 대한간학회지

BACKGROUND/AIMS: In cirrhotic patients with esophageal variceal bleeding, bacterial infections are a frequent complication. Oral antibiotic prophylaxis decreases the incidence of bacterial infections. The administration of oral antibiotics, however, may be difficult in some cirrhotic patients with active bleeding.The purpose of this study was to assess the efficacy of prophylactic intravenous antibiotics for the prevention of bacterial infections in cirrhotic patients with esophageal variceal bleeding. METHODS: From December 1998 to September 2001, a total of 40 consecutive cirrhotic patients with Child-Pugh class B or C were enrolled after emergent endoscopic esophageal variceal ligation (EVL) was taken because of esophageal variceal bleeding. Enrolled patients were randomized into a treatment group and a control group. The treatment group (n=20) received the intravenous ciprofloxacin 200mg IV q 12 hours for 3 days while the control group(n=20) didn,t. RESULTS: Bacterial infection developed in nine patients (45%) of the control group and only two patients (10%) in the treatment group. The incidence of bacterial infections was significantly lower in the treatment group than the control group (p < 0.005). The hospital cost and length of hospital stay decreased in the treatment group compared with the control group (p < 0.001). There were no differences in the hospital course and mortality within 30 days between the two groups. CONCLUSIONS: In cirrhotic patients with variceal bleeding and with Child-Pugh class B or C, the use of intravenous ciprofloxacin for 3 days after EVL was not only effective in the prevention of bacterial infections but also cost-effective.

Clinical investigations of Crohn's disease in Korea / 대한내과학회지

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disease that has difficulty in treatment due to various complications and frequent recurrence. There have been many studies on the clinical aspects of CD in western countries, however there have been few studies in Korea. We try to perform this study to elucidate the clinical features of CD in Korea. METHODS: We retrospectively reviewed the medical records of 62 patients diagnosed as CD in Samsung Medical Center from October 1994 to July 1999 and investigated their clinical features. RESULTS: Male to female ratio was 1.7:1 and the mean age at diagnosis was 29.6 years. The most common symptom was abdominal pain (58%), followed by diarrhea. Perianal lesions were observed in 27 cases (44%) of 62 patients. Fistula was the most common (60%) among the perianal lesions, followed by abscess, fissure, and stricture. Extraintestinal manifestations were observed in 23 cases (37%) of 62 patients. Arthritis was the most common (44%), followed by oral, skin, and ocular lesions. All patients were classified into three groups on the basis of disease extent by the radiologic and endoscopic findings; combined type (66%), colitis alone (23%), and small bowel disease alone (11%). Empirical anti-tuberculous medications were administered to 28 cases (45%) of 62 patients before CD was diagnosed. The presenting features were classified into inflammatory (71%), fistulizing (14.5%), and fibrostenotic (14.5%) type. Operation was performed in 31 cases (50%) of 62 patients during clinical course. The causes of operation were fistulizing complication (48%), fibrostenotic obstruction (32%), and indefinite diagnosis (20%). CONCLUSION: We noticed little difference in the clinical features of CD in Korea compared to those of western countries. And, intestinal tuberculosis should be considered in differential diagnosis of CD in endemic areas of tuberculosis like Korea.

Analysis of Clinical, Biochemical and Pathologic Factors According to the Response to Initial Steroid Therapy in Active Crohn's Disease / 대한소화기내시경학회지

BACKGROUND/AIMS: The predictory factors of the response to initial steroid therapy in active Crohn's disease has been controversial in numerous literature reviews. We evaluated any predictory factor of the response to initial steroid therapy in active Crohn's disease patients. METHODS: The medical records of 32 patients with active Crohn's disease who clinically responded to oral steroid therapy were retrospectively reviewed. The steroid responsive group was defined as the one showing maintenance of response for more than one month from steroid withdrawal and the steroid dependent group as the one showing relapse or exacerbation during steroid tapering or within 30 days from steroid withdrawal. The clinical, biochemical, and pathologic factors were evaluated. RESULTS: There were 22 male and 10 female patients. The mean age was 28.9 years. The number of steroid responsive and dependent group was 22 (68.8%) and 10 (31.2%), respectively. There were no significant differences between these two groups in age, sex, time to diagnosis, perianal lesion, extent of disease, extraintestinal manifestations, presence of granuloma, presenting features, hemoglobin, ESR, and CRP, except serum albumin level. CONCLUSIONS: Serum albumin level was significantly lower in steroid dependent group than steroid responsive group, reflecting severe inflammation in steroid dependent group.

Recurrent gastrointestinal hemorrhage from a jejunal duplication cyst in an adult / 대한내과학회지

Duplication of the alimentary tract is an unusual congenital anomaly which may occur at any level, from the oral cavity to the rectum. Jejunal duplication cyst is quite rare and most of them are presented in infancy with the symptoms of abdominal mass, obstruction, hemorrhage and perforation. But some cases has not been diagnosed till adult if duplication cyst was too small enough to cause symptoms. We report a case of a 28-year-old woman who presented with recurrent gastrointestinal hemorrhage as a result of an ulceration without ectopic mucosa in jejunal duplication cyst and was successfully treated with surgery.

A case of primary solitary tuberculoma of the liver treated with antituberculosis chemotherapy and surgical excision / 대한내과학회지

The solitary form of primary hepatic tuberculosis is a rare disease. We report an unusual case of primary solitary hepatic tuberculosis treated with surgical resection and second-line antituberculosis chemotherapy due to the recurrence after first-line antituberculosis chemotherapy alone. A 36-year-old man was presented with right upper abdominal discomfort, chills and weight loss for 2 months. Computerized tomography demonstrated the solitary space occupying lesion on the left lobe of liver suggesting a malignant disease. The open biopsy revealed chronic granulomatous inflammation with multinucleated giant cells and caseous necrosis. The patient was treated with antituberculosis chemotherapy for nine months and eighteen months respectively with the interval of eighteen months. But the hepatic lesion had become larger and symptoms were aggravated after the discontinuation of therapy. He underwent surgical excision of the lesioin. With second-line antituberculosis chemotherapy, the symptoms improved in postoperative days. Twenty four months later, no evidence of recurrence was noted in symptoms, laboratory findings and imaging studies.

Clinical aspects of the cystic tumors of the pancreas confirmed by operation / 대한내과학회지

BACKGROUND: Cystic tumors of the pancreas are uncommon, and frequently mistaken for pancreatic pseudocysts. Recently if the patient is a good surgical candidate and is symptomatic, resection is the treatment of the choice without the cytological and chemical analysis by the fine needle aspiration. But, we have no data in Korean population. The aim of this study was to evaluate the subclassification of the cystic tumors of the pancreas and the differential points between pancreatic pseudocysts and cystic tumors of the pancreas which had to be operated. METHODS: fifty-nine patients with cystic lesions of the pancreas have been operated at the Samsung Seoul Hospital from 1994 to 1999 and evaluated about the subclassification, frequency and the difference between pseudocysts and cystic tumors retrogradely. RESULTS: There were 14 mucinous cystic neoplasms (mucinous cystadenomas : 11 cases, mucinous cyst-adenocarcinomas : 3 cases), 10 serous cystadenomas, 9 solid and papillary epithelial neoplasms, 8 intra-ductal papillary mucinous neoplasms, 5 pseudocysts, 4 retention cysts, 3 endocrine tumors, 1 pancreatic ductal adenocarcinoma with cystic change, 1 solid pseudopapillary tumor, 1 pancreatic ductal adenocarci-noma with pseudocyst, 1 cavernous lymphangioma, 1 lymphoepithelial cyst and 1 simple cyst. 57.6% of the patients were females and the mean age was 50.0 years (16 years-77 years). The characteristics between pseudocysts and cystic tumors of the pancreas (sex differentiation, mean age, previous history of alcohol drinking and pancreatitis, communication with the main duct on the pancreatogram and the sign of the pancreatitis on the radiologic study) had no differences. CONCLUSION: We conclude there were no other methods to differentiate accurately the pseudocyst from the cystic tumor of the pancreas other than the operation.

Etiology of Gastrointestinal Bleeding in Intensive Care Unit / 대한소화기내시경학회지

BACKGOUND/AIMS: Gastrointestinal (GI) bleeding remains a common medical problem, with morbidity and mortality rates of GI bleeding in intensive care unit (ICU) believed to have remained unchanged. There has been no report about the etiology and clinical manifestation of GI bleeding in ICU in Korea. Therefore, we performed this study to determine the frequency, etiology, risk factors, and outcome of clinically significant GI bleeding that occurred after admission to ICU. METHODS: We reviewed medical records of 1829 patients admitted to medical ICU in Samsung Medical Center from October 1994 to May 1999. Cases were enrolled the patients who developed GI bleeding more than 24 hours after admission to the medical ICU. The cases were compared with control populations: a set of ICU patients without GI bleeding matched with cases for age, gender, and length of ICU stay to evaluate the risk factors of GI bleeding. RESULTS: Clinically significant GI bleeding, confirmed by endoscopy, occurred in 71 patients of 1,829 patients (3.9%) after a mean ICU stay of 14+/-2.6 days. Gastric ulcer bleeding was the most common source of GI bleeding, accounting for 29.6% of cases overall. There were no statistical differences in underlying disease, mechanical ventilator use, heparin or steroid use, prothrombin time, prophylactic drug use such as H2 blocker and antacid use between cases and controls. However, thrombocytopenia (<50,000/mm3) was more common in cases who had GI bleeding than controls (P<0.05). CONCLUSIONS: Gastric ulcer was the most common cause of GI bleeding in ICU and careful attention was necessary to patients with thrombocytopenia (<50,000/mm3) in ICU.