A Case of Choledochocele with Parapapillary Diverticulum Presenting as Pancreatitis / 대한소화기내시경학회지

Choledochocele, classified as choledochal cyst: type III, is a rare cystic or diverticular dilatation of the terminal biliary tree that causes abdominal pain, recurrent pancreatitis, and obstructive jaundice. It is the rarest of the choledochal cysts and has lower malignant potential than any other type of choledochal cyst. Although its anatomic structure does not fit the criteria for pancreatobiliary maljunction, pancreaticobiliary reflux may occur in patients with choledochocele. Herein, we report the case of a 63-year-old woman with recurrent episodes of acute pancreatitis that were caused by a choledochocele with two parapapillary diverticula. She was successfully treated by endoscopic needle-knife sphincterotomy without severe complications and remained asymptomatic at the 6-month follow-up.

The effects of growth hormone administration on the markers of cardiovascular disease in growth hormone deficient adults / 대한내과학회지

BACKGROUND: Subjects with growth hormone-deficiency (GHD) have increased cardiovascular mortality, and growth hormone (GH) replacement may modulate cardiovascular disease risk. Therefore, we evaluated the effects of GH administration on the markers of cardiovascular disease in subjects with GHD. METHODS: 37 subjects (12 men and 25 women) with GHD and 65 normal subjects were enrolled in this study. GH or placebo were given for 3 months at a dose adjusted for normal serum insulin-like growth factor-I (IGF-I) level. Height, weight, waist circumference, hip circumference, lean body mass, fat mass, blood pressure, fasting blood glucose, IGF-I, lipid profile, uric acid, C-reactive protein (CRP), plaminogen activator inhibitor-1 (PAI-1), apolipoprotein AI, and quality of life-assessment of growth hormone deficiency in adults (QoL-AGHDA) were measured at baseline and month 3. RESULTS: Subjects with GHD showed higher levels of triglyceride, CRP, and PAI-1, but lower level of fasting glucose than normal subjects. Fat mass, CRP, and PAI-1 levels decreased in GH recipients (fat mass; 21.9+/-6.6 to 21.3+/-6.7%, p<0.05, CRP; 2.73+/-2.11 to 1.47+/-1.29 mg/L, p<0.001, PAI-1; 48.9+/-33.2 to 31.6+/-28.5 ng/mL, p<0.05). Fasting blood glucose and total cholesterol levels increased in GH recipients (fasting blood glucose; 4.58+/-0.46 to 4.81+/-0.36 mmol/L, p<0.05, total cholesterol; 5.36+/-1.31 to 6.17+/-1.12 mmol/L, p<0.01). Placebo recipients showed decrease in waist-hip ratio (0.93+/-0.05 to 0.92+/-0.04, p<0.05) and increase in fasting blood glucsoe (4.63+/-0.38 to 4.89+/-0.45 mmol/L, p<0.05) and uric acid (319.6+/-89.2 to 335.6+/-89.2 micro mol/L, p<0.05). QoL-AGHDA score improved in both groups (GH recipients; 10.0+/-6.0 to 7.4+/-5.5, p<0.01, placebo recipients; 9.8+/-4.4 to 6.7+/-3.4, p<0.05). CONCLUSION: Our results demonstrated favourable effects of GH on cardiovascular disease through modulating CRP and PAI-1 plasma level in subjects with GHD.

Clinical Analysis of Laparoscopic Incidental Appendectomy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the safety and efficacy of the laparoscopic incidental appendectomy during gynecologic laparoscopic operation. Methods: This study was evaluated for the clinical analysis of 118 patients who underwent laparoscopic assisted vaginal hysterectomy(LAVH group, 65 cases) and LAVH with laparoscopic incidental appendectomy(LAVH + IA group, 53 cases) at the Wallace Memorial Baptist Hospital from Oct. 1996 to Nov. 1998. RESULTS: The following results were obtained: 1) There was no significant difference between two groups in regard to age. The mean age was 45.7 years in LAVH group and 43.8 years in LAVH + IA group. 2) There was no significant difference between two groups in mean operative time. The mean operative time was 90.4 minutes in LAVH group and 97.5 minutes in LAVH + IA group. 3) The mean appendectomy time was 7.1 minutes. 4) The mean time recovering normal bowel activity was 46.2 hours in LAVH group and 45.8 hours in LAVH + IA group. There was no significant difference between two groups. 5) The mean hospital stay was 6.4 days in LAVH group and 5.7 days in LAVH + IA group. There was no significant difference between two groups. 6) The postoperative complications occurred in 11 cases(9.3 %). The serious complications of appendectomy was not found. 7) Of the 53 appendices removed, 5(9.4 %) were abnormal pathologic findings. CONCLUSION: Laparoscopic incidental appendectomy during laparoscopic operation was not found to influence the operation time, hospital stay, gas passing time, but there is one case of wound infection due to incidental appendectomy. Therefore, a large number of study should be performed to evaluate the safety and efficacy of laparoscopic incidental appendectomy during laparoscopic operation.