Influence of Obesity on the Severity and Clinical Outcome of Acute Pancreatitis

BACKGROUND/AIMS: Obesity tends to be associated with increased mortality and morbidity in acute pancreatitis. However, in Asian populations, higher morbidity and mortality have been reported in patients with low body mass indexes (BMIs). This study was undertaken to evaluate the relation between obesity and outcome, and to investigate the occurrence of complications by overweightedness in acute pancreatitis. METHODS: The medical records of 403 patients with acute pancreatitis were reviewed retrospectively, and Ranson's scores, modified Glasgow scores, Acute Physiology and Chronic Health Evaluation (APACHE) II scores and computed tomography severity indexes were calculated. Patients were categorized by BMI for the analysis. RESULTS: When compared with normal patients (BMI 18.5 to 22.9), all categories with a BMI > or =23 had an increased risk of developing a severe form of acute pancreatitis (p=0.003) and all categories with a BMI > or =25 significantly predicted severity (p<0.001). Patients with class 1 obesity (BMI 25 to 29.9) developed significantly more systemic and metabolic complications. CONCLUSIONS: Overweightedness and obesity were found to be associated with a higher risk of developing severe pancreatitis. Further studies are needed to establish the precise prognostic value of obesity in members of the population with low BMIs.

Four cases of multiple biliary hamartoma in the liver / 대한내과학회지

Biliary hamartoma is a benign neoplasm that normally measures < 1 cm in diameter and can occur throughout the liver. It is composed of dilated bile ducts embedded in a fibrous stroma and is a congenital fibrocystic disease derived from incomplete remodeling of the ductal plates in the embryonic development of intrahepatic bile ducts. Incidentally found in imaging studies without clinical symptoms, it is known to be infrequently accompanied by cholangiocarcinoma. However, biliary hamartoma must be differentiated from other cystic lesions that are similar to metastatic tumors or abscesses. We describe four cases of biliary hamartoma.

Clinical characteristics of right versus left colonic diverticulitis / 대한내과학회지

BACKGROUND/AIMS: Left colonic diverticulitis is relatively common in western nations. Although the incidence of colonic diverticulitis is increasing in Korea, very little is known regarding its clinical characteristics in korean patients. METHODS: We compared the clinical characteristics of right versus left colonic diverticulitis via the retrospective review of 37 cases treated at the Kyungpook National University Hospital, Korea, from July 1998 to December 2006. Diagnosis was confirmed via computed tomography (CT), barium study, colonoscopy, and/or surgery. RESULTS: Eighteen men and 19 women (median age, 45.0 years; range, 21~75 years) were included. The ratio of right to left colonic diverticulitis was 30:7. The male to female ratio for right colonic diverticulitis was 16:14 and the median age was 38.5 years (range, 21~72 years). The male to female ratio for left colonic diverticulitis was 2:5 and the mean age was 57.0 years (range, 45~75 years). Left colonic diverticulitis was more frequently associated with intestinal perforation (p=0.001) and old age (p=0.005). Surgical intervention was more common in left versus right colonic diverticulitis (p=0.009). CONCLUSIONS: These results indicate that although left colonic diverticulitis is relatively rare among koreans, it develops later in life and is more frequently complicated than right colonic diverticulitis.

A Case with Rotor Syndrome in Hyperbilirubinemic Family / 대한소화기학회지

Rotor syndrome is a rare, benign familial disorder characterized by chronic fluctuating, nonhemolytic and predominantly conjugated hyperbilirubinemia with normal hepatic histology. In contrast to Dubin-Johnson syndrome, there is no liver pigmentation in Rotor syndrome. A 36-year-old man was admitted due to asymptomatic persistent jaundice. His siblings had jaundice with direct hyperbilirubinemia. Physical examination revealed icteric sclerae without hepatosplenomegaly. Laboratory findings showed increased serum bilirubin with direct bilirubinmia. Hepatic uptake and storage capacity of indocyanine green was markedly reduced, while excretion into bile was slightly suppressed. Markedly decreased hepatic uptake and poor visualization of the gallbladder and biliary tract were shown in 99mTc-DISIDA scan. Histology of the liver showed mild steatosis without pigmentation. We report a case with the review of literature.

Acute Myeloid Leukemia Presenting as Obstructive Jaundice Caused by Granulocytic Sarcoma

We report a rare case of granulocytic sarcoma infiltrating the bile duct in a patient with acute myeloid leukemia. A 23-year-old man presented with jaundice and weight loss. A peripheral blood smear revealed blast cells, and the results of an examination of bone marrow aspirate were consistent with acute myeloid leukemia. The bilirubin level increased gradually after induction chemotherapy with cytarabine. Magnetic resonance cholangiopancreatography (MRCP) revealed dilatation of the intrahepatic bile ducts and smooth tapering off at the level of the common hepatic bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) also revealed diffuse narrowing of the proximal common hepatic bile duct. Obstructive jaundice resolved after endoscopic nasobiliary drainage. Remission induction chemotherapy with cytarabine and idarubicin was administered, and the patient remained complete hematological remission with normal liver function tests.

A case of an aortoesophageal fistula presenting as a Dieulafoy-like lesion / 대한내과학회지

A 68-year-old woman visited our emergency center because of hematemesis. An emergency endoscopy showed an exposed vessel with blood flowing into the upper esophagus. Angiography revealed the presence of extravasation of contrast at the level of the aortic arch and a tortuous fistula between the aortic arch and esophagus. Chest computerized tomography demonstrated the presence of an aortoesophageal fistula and air bubbles inside the fistula. The patient had emergency surgery and the intraoperative findings revealed an aortoesophageal fistula and necrotic materials with a foul odor at the upper esophagus. Primary closure and wrapping of the aorta were performed, but primary closure of the esophagus was impossible because of necrosis. An aortoesophageal fistula is a rare but life-threatening disease. As shown for this patient, an exposed vessel without ulceration at the upper esophagus should raise suspicion of an aortoesophageal fistula and a CT scan or angiography should be performed before endoscopic intervention.

The Usefulness of Endoscopic Ultrasonography in the Diagnosis of Diseases of Liver, Biliary Tree, Gallbladder and around Distal Common Bile Duct / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) is now accepted as an essential tool for the diagnosis and the therapy of various gastrointestinal diseases. With regard to the biliary system, its high diagnostic sensitivity and specificity were reported recently. We assessed the clinical usefulness of EUS for the diagnosis of diseases of the liver, biliary tree, gallbladder and distal common bile duct. METHODS: We sent questionnaires about the clinical usefulness of EUS to the doctors who requested EUS examination for 32 patients with suspected diseases of the liver, gallbladder and around extrahepatic biliary tree from Aug. 2001 to Aug. 2002. We evaluated the answers and clinical characteristics of the patients. RESULTS: Patients were 17 males and 15 females with mean age of 61.8 years old. All received abdominal computed tomography (CT) before EUS and some had abdominal ultrasonography (USG) or endoscopic retrograde cholangiopancreatography (ERCP). EUS was more accurate and informative than other imaging modalities and gave definite final diagnosis for 31.2%. In 40.6%, EUS was helpful as an additional diagnostic tool. CONCLUSIONS: EUS was useful in 71.8% of the cases for the diagnosis of diseases of the liver, biliary tree, gallbladder and around distal common bile duct. EUS can be used as an important adjunct to USG, CT and ERCP.

Oxaliplatin and UFT, leucovorin combination chemotherapy in patients with advanced colorectal cancer / 대한내과학회지

BACKGROUND: UFT/oral leucovorin (LV) provided a safer, more convenient oral alternative to bolus i.v. 5-Fluorouracil/LV regimen for advanced colorectal cancer while producing equivalent survival. We evaluated the efficacy and safety of a combination of oxaliplatin and UFT/LV in patients with advanced colorectal cancer. METHODS: From January 1999 to December 2001, a total 28 patient with metastatic or relapsed colorectal cancer were enrolled in this study. Treatment was consisted of oxaliplatin 130 mg/m2 i.v. for 2 hours on day 1, and UFT 300 mg/m2 p.o. and LV 30 mg p.o. on day 1-21. Chemotherapy repeated every three weeks until disease progression. RESULTS: Of the 28 patients, 1 complete response and 10 partial responses were observed. The overall response rate was 39.3%. The estimated median time to progression and survival were 6.0 months and 18.2 months, respectively. Peripheral neuropathy was the most common adverse effect. But, peripheral neuropathy was mild (grade 1, 2) and reversible. From the 129 cycles analyzed, grade 3, 4 adverse effects were observed only 3% included neutropenia (1.5%), and thrombocytopenia (1.5%). There were no treatment-related deaths. CONCLUSION: This combination of oxaliplatin and UFT/oral leucovorin is active and feasible in patients with advanced colorectal cancer. The regimen deserve further evaluation in a phase III prospective study.

Non small cell lung cancer diagnosed by EUS guided fine needle aspiration / 대한내과학회지

No abstract available.

A Case of Amiodarone-Induced Pulmonary Toxicity After a Long Course of a Low Dose Therapy / 결핵

Amidarone is one of the most commonly prescribed anti-arrythmic agents for almost all arrythmias, whether atrial or ventricular in origin. There are several side effects associated with amiodarone therapy. These include corneal deposits, abnormal liver function tests, hyper and hypothyroidism, bluish discolorations of the skin, bone marrow suppression, coagulopathies, peripheral neuropathies, and pulmonary toxicity. Amiodarone-induced pulmonary toxicity(APT), which was first described in 1980, is potentially serious side effects that are believed to develop in 5% of patients. Doctors often assume that APT occurs only when high amiodarone doses are used for a long time, but in practice a low maintenance dose of amiodarone may also be toxic. In this report, a case of amiodarone-induced pulmonary toxicity after a long course of a low dose therapy for refractory supraventricular arrythmia is described.