Factors affecting long-term survival after surgical resection of pancreatic ductal adenocarcinoma / 대한외과학회지

PURPOSE: Some patients who undergo surgical resection of pancreatic cancer survive longer than other patients. The purpose of this study was to identify the factors that affect long-term survival after resection of histopathologically confirmed pancreatic ductal adenocarcinoma. METHODS: A single-center, retrospective study was conducted among 164 patients who underwent surgical resection of pancreatic cancer, between May 1995 and December 2004. The patient follow-up process was conducted via telephone survey and review of electronic medical records for at least 5 years or until death. RESULTS: We compared patients with long-term (> or =60 months, n = 19) and short-term survival (<60 months, n = 145). Resection margin status, differentiation of the tumor, tumor stage, pre-operative serum level of albumin, total bilirubin and carbohydrate antigen (CA) 19-9 level are related with survival difference (all factors, P < 0.05). Multivariate analysis revealed that a pre-operative serum total bilirubin level <7 mg/dL and a pre-operative serum CA19-9 level <37 U/mL is a statistically significant prognostic factor for long-term survival. CONCLUSION: The preoperative serum total bilirubin and serum CA19-9 levels are associated with long-term survival after surgical resection of pancreatic cancer.

Intraductal Tubular Carcinoma of the Pancreas: a Case Report with the Imaging Findings

We describe here a case of intraductal tubular carcinoma of the main pancreatic duct. Gadolinium-enhanced pancreas magnetic resonance (MR) imaging showed an enhancing mass that was confined in the dilated main pancreatic duct of the pancreatic body, along with dilatation of the upstream main pancreatic duct and chronic pancreatitis that was due to obstruction. MR cholangiopancreatography and an endoscopic retrograde pancreatogram showed a filling defect that was due to an intraductal mass of the pancreatic body, along with dilatation of the upstream main pancreatic duct and no dilatation of the downstream main pancreatic duct. The pathological findings demonstrated an intraductal nodular appearance without papillary projection or mucin hypersecretion.

Adenomyoma of Ampulla of Vater or the Common Bile Duct: A Report of Three Cases

Adenomyoma is a rare non-neoplastic lesion of the biliary tract. Here we report on three cases of adenomyoma; one located in the ampulla of Vater and two located in the common bile duct. Although preoperative endoscopic and radiological evaluations could not determine whether lesions were benign or malignant, intra-operative frozen section histologic examinations aided the differential diagnosis. Microscopic features of a lobular gland architecture with basally located nuclei and the absence of desmoplastic stromal reaction were found to be characteristic in frozen and paraffin sections.

A Case of Familial Writer's Cramp

Writer's cramp is one of the most frequent type of task-related dystonia. It is primarily defined by the appearance of involuntary muscle contractions soon after one begins to write and often co-exists with postural tremor. The cause of writer's cramp as well as other focal dystonia is still a matter of debate. Although the genetic background of some dys-tonia was well known, there have been few cases of writer's cramp that involve other family members. We experienced one family with writer's cramp and postural tremor. A 42-year-old man noted handwriting difficulty of gradual onset which began with postural tremor at the age of 25. When he wrote certain letters or numbers, he automatically had to press hard or hold the pen tightly, experiencing tremor as well as dystonia. His mother and four siblings also had simi-lar disabilities. All were right-handed, and had a postural tremor, prominent in their right hands. They noted the onset of symptoms between the age of 20 and 40. The symptoms had slowly progressed over a period of years and no patient described a remission of symptoms. Two of them eventually no longer attempted to write due to writer's cramp. Two members could write but barely readable and the other two had minimal distress. Alcohol somewhat relieved the cramp in only one of them. Levodopa was no beneficial to the cramp and baclofen relieved the cramp minimally. We report this rare case with familial writer's cramp and postural tremor that suggests autosomal dominant inheritance.

ERCP Findings In Hepatic Clonorchiasis / 대한소화기내시경학회지

An endoscopic retrograde cholangiographic study of 25 consecutive cases of hepatic clonorchiasis was performed during the period from Aug. 1986 to Sep. 1991 Hepatic clonorchiasis was confirmed by stool of examination for Clonorchis sinensis. The findings consist of characteristic filling defects and changes in the intrahepatic and extrahepatic bile ducts. The filling defects due to adult worms are significant diagnostic criteria of clonorchiasis. Its appearance is elliptical and/or round. The change in the intrahepatic bile ducts consisits of dilatation, irregularity(tortousity and elongation) and blunting of termieal branches of bile tree, irregular stenosis, fuzziness and raggedness. The characteristic changes in the extrahepatic bile ducts in clonorchiasis are duct wall irregularities and mild dilatation of bile duct. ERCP is an excellent method to evaluate biliary tree in patient with clonorchiasis because it reveals not only its characteristic findings of clonorchiasis but also its severity and associated lesions.

ERCP Findings In Hepatic Clonorchiasis / 대한소화기내시경학회지

An endoscopic retrograde cholangiographic study of 25 consecutive cases of hepatic clonorchiasis was performed during the period from Aug. 1986 to Sep. 1991 Hepatic clonorchiasis was confirmed by stool of examination for Clonorchis sinensis. The findings consist of characteristic filling defects and changes in the intrahepatic and extrahepatic bile ducts. The filling defects due to adult worms are significant diagnostic criteria of clonorchiasis. Its appearance is elliptical and/or round. The change in the intrahepatic bile ducts consisits of dilatation, irregularity(tortousity and elongation) and blunting of termieal branches of bile tree, irregular stenosis, fuzziness and raggedness. The characteristic changes in the extrahepatic bile ducts in clonorchiasis are duct wall irregularities and mild dilatation of bile duct. ERCP is an excellent method to evaluate biliary tree in patient with clonorchiasis because it reveals not only its characteristic findings of clonorchiasis but also its severity and associated lesions.