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Acute cholecystitis (AC), defined as inflammation of the gallbladder, is mainly caused by gallstones. Over 90% of AC results from obstruction of the cystic duct by stones or sludge, which subsequently increases the intraluminal pressure within the gallbladder and, in conjunction with the presence of bile supersaturated with cholesterol, activates an acute inflammatory cascade. Clinical features play an important role in the diagnosis of AC. The Tokyo Guidelines 2018 for acute cholecystitis designates the presence of local inflammatory signs and systemic inflammatory signs for a suspected diagnosis. It requires confirmation by radiological imaging along with these two factors for a definitive diagnosis. Thanks to less invasiveness, easy availability, ease of use, and cost-effectiveness, ultrasound (US) is usually accepted as the first choice in suspicious AC patients. A meta-analysis comparing methods of diagnosis for AC reported that the US has 81% of sensitivity and 83% of specificity. Abdominal computed tomography is recommended for diagnosing emphysematous or gangrenous cholecystitis. Meanwhile, acute acalculous cholecystitis (AAC) is a life-threatening disease mainly in severely ill patients. It usually affects the patients hospitalized for multiple trauma, burns, cardiopulmonary bypass surgery, long-term total parenteral nutrition or sepsis. The diagnosis of AAC is quite challenging and requires a high index of suspicion. Currently, cholecystectomy is the treatment of choice for AC, although the optimal time for surgery is still controversial. Due to high morbidity and mortality in high surgical risk groups, percutaneous gallbladder drainage can be a safe and feasible alternative to cholecystectomy, particularly for patients unfit for the surgery.
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Background/Aims@#Recently, the European Society of Gastrointestinal Endoscopy (ESGE) proposed criteria for “difficult biliary cannulation” during endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to investigate the clinical relevance of the ESGE criteria from the perspective of post-ERCP pancreatitis (PEP). @*Methods@#An ERCP database was prospectively maintained between November 2014 and December 2015 across six teaching hospitals in South Korea. The ESGE criteria (biliary cannulation time, the number of cannulation attempts, and inadvertent pancreatic duct [PD] manipulation) were recorded in this database as well as other technical factors. Logistic regression analysis was used to identify risk factors for PEP. Then, the PEP prediction model was investigated using decision tree analysis. @*Results@#We analyzed 1,067 consecutive patients with naïve papilla. The overall rate of PEP was 6.6%. Multivariate analysis revealed that female sex (odds ratio [OR], 1.860; 95% confidence interval [CI], 1.124 to 3.078), a selective biliary cannulation duration >5 minutes (OR, 3.282; 95% CI, 1.641 to 6.566), and inadvertent PD manipulation (OR, 2.614; 95% CI, 1.480 to 4.617) were significant factors affecting PEP. Decision tree analysis revealed that biliary cannulation time (χ2 =49.857, p5 minutes, and >5 minutes with inadvertent PD manipulation, respectively. @*Conclusions@#Biliary cannulation time and inadvertent PD manipulation could be relevant indicators of PEP, and 5 minutes might be used as a cutoff value for the implementation of the rescue cannulation technique.
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Background/Aims@#Recently, the European Society of Gastrointestinal Endoscopy (ESGE) proposed criteria for “difficult biliary cannulation” during endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to investigate the clinical relevance of the ESGE criteria from the perspective of post-ERCP pancreatitis (PEP). @*Methods@#An ERCP database was prospectively maintained between November 2014 and December 2015 across six teaching hospitals in South Korea. The ESGE criteria (biliary cannulation time, the number of cannulation attempts, and inadvertent pancreatic duct [PD] manipulation) were recorded in this database as well as other technical factors. Logistic regression analysis was used to identify risk factors for PEP. Then, the PEP prediction model was investigated using decision tree analysis. @*Results@#We analyzed 1,067 consecutive patients with naïve papilla. The overall rate of PEP was 6.6%. Multivariate analysis revealed that female sex (odds ratio [OR], 1.860; 95% confidence interval [CI], 1.124 to 3.078), a selective biliary cannulation duration >5 minutes (OR, 3.282; 95% CI, 1.641 to 6.566), and inadvertent PD manipulation (OR, 2.614; 95% CI, 1.480 to 4.617) were significant factors affecting PEP. Decision tree analysis revealed that biliary cannulation time (χ2 =49.857, p5 minutes, and >5 minutes with inadvertent PD manipulation, respectively. @*Conclusions@#Biliary cannulation time and inadvertent PD manipulation could be relevant indicators of PEP, and 5 minutes might be used as a cutoff value for the implementation of the rescue cannulation technique.
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Gallbladder (GB) polyp is a mucosal projection into the GB lumen. With increasing health awareness, GB polyps are frequently found using ultrasonography during health screening. The prevalence of GB polyps ranges between 1.3% and 9.5%. Most patients are asymptomatic and have benign characteristics. Of the nonneoplastic polyps, cholesterol polyps are most common, accounting for 60%–70% of lesions. However, a few polyps have malignant potential. Currently, the guidelines recommend laparoscopic cholecystectomy for polyps larger than 1 cm in diameter due to their malignan potential. The treatment algorithm can be influenced by the size, shape, and numbers of polyps, old age (>50 years), the presence of primary sclerosing cholangitis, and gallstones. This review summarizes the commonly recognized concepts on GB polyps from diagnosis to an algorithm of treatment.
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Oxaliplatin is a new generation of platinum derivatives used frequently to treat solid organ malignancies, including colorectal and ovarian cancer. Recently, an oxaliplatin-based chemotherapeutic regimen was adopted for advanced pancreatic cancer. Although oxaliplatin has extensive therapeutic potential, its use can be limited by significant adverse effects, particularly ototoxicity. This paper reports a rare case of irreversible unilateral hearing loss in a 48-year-old female that developed after the intravenous infusion of oxaliplatin during pancreatic cancer treatment. To the best of the authors’ knowledge, this is the second reported case of oxaliplatin-related ototoxicity in pancreatic cancer.
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Background/Aims@#Few studies have addressed the relationship between the occurrence of adverse events (AEs) in endoscopic retrograde cholangiopancreatography (ERCP) and hospital case volume or endoscopist’s experience with inconsistent results. The aim of our study was to investigate the impact of hospital case volume and endoscopist’s experience on the AEs associated with ERCP and to analyze patient- and procedure-related risk factors for post-ERCP AEs. @*Methods@#From January 2015 to December 2015, we prospectively enrolled patients with naïve papilla who underwent ERCP at six centers. Patient- and procedure-related variables were recorded on data collection sheets at the time of and after ERCP. @*Results@#A total of 1,191 patients (median age, 71 years) were consecutively enrolled. The overall success rate of biliary cannulation was 96.6%. Overall, 244 patients (20.5%) experienced post-ERCP AEs, including pancreatitis (9.0%), bleeding (11.8%), perforation (0.4%), cholangitis (1.2%), and others (0.9%). While post-ERCP pancreatitis (PEP) was more common when the procedure was performed by less experienced endoscopists, bleeding was more common in high-volume centers and by less experienced endoscopists. Multivariate analysis showed that a less experience in ERCP was significantly associated with PEP (odds ratio [OR], 1.630; 95% confidence interval [CI], 1.050 to 2.531; p=0.030) and post-ERCP bleeding (OR, 1.439; 95% CI, 1.003 to 2.062; p=0.048). @*Conclusions@#Our study demonstrated that overall AEs following ERCP were associated with the experience of the endoscopist. To minimize post-ERCP AEs, rigorous training with a sufficient case volume is required, and treatment strategies should be modified according to the endoscopist’s expertise.
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Following the coronavirus disease 2019 outbreak in China, more than 10,765 patients tested positive for severe acute respiratory syndrome coronavirus 2 from February 18, 2020 to April 30, 2020 in South Korea. Performing emergency endoscopy is extremely challenging from the clinicians’ viewpoint during the viral outbreak. There are no available guidelines for emergency endoscopy in tertiary hospitals during this pandemic. We set up an algorithm as a guide for emergency endoscopy in patients presenting to the emergency room with bleeding, foreign body, or impending cholangitis. From February 18, 2020 to April 30, 2020 of outbreak, 130 patients underwent emergency endoscopy in our center. Owing to the simple and streamlined algorithm for performing emergency endoscopy, no endoscopy-related infection to other patients or medical workers was reported in our center.
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Background/Aims@#Coronavirus disease 2019 (COVID-19) can reportedly cause gastrointestinal symptoms. Therefore, we investigated the clinical characteristics of COVID-19 patients with diarrhea. @*Methods@#We included 118 COVID-19 patients admitted to a single hospital from February 20 to March 31, 2020. Medical records with clinical characteristics, laboratory data, treatment course, and clinical outcomes were compared based on the presence or absence of diarrhea. Prognostic factors for disease severity and mortality in COVID-19 were also assessed. @*Results@#Among patients, 54 (45.8%) had diarrhea, whereas seven (5.9%) had only diarrhea. The median age of patients with diarrhea was 59 years (44 to 64), and 22 (40.7%) were male. Systemic steroid use, intensive care unit admission, septic shock, and acute respiratory distress syndrome were less frequent in the diarrhea group than in the non-diarrhea group. No significant differences were observed in total hospital stay and mortality between groups. On multivariate analysis, age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01 to 1.12; p = 0.044), diabetes (OR, 3.00; 95% CI, 1.25 to 20.47; p = 0.042), and dyspnea (OR, 41.19; 95% CI, 6.60 to 823.16; p < 0.001) were independent risk factors for septic shock. On Cox regression analysis, diabetes (hazard ratio [HR], 4.82; 95% CI, 0.89 to 26.03; p = 0.043) and chronic obstructive pulmonary disease (HR, 16.58; 95% CI, 3.10 to 88.70; p = 0.044) were risk factors for mortality. @*Conclusions@#Diarrhea was present in 45.8% of patients and was a common symptom of COVID-19. Although patients with diarrhea showed less severe clinical features, diarrhea was not associated with disease severity or mortality.
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In rhinoplasty, osteotomy is becoming more and more frequent as a way to achieve aesthetically pleasing and functional results, as well as patient satisfaction. In procedures to correct a deviated nose, osteotomy to correct the bone plays an essential role in addition to correction of the septum and cartilage, and osteotomy can reduce the wide nose bridge and give a slightly higher appearance in Asian rhinoplasty. However, osteotomy is relatively invasive, and the nasal bones of Asians are often low and thick, so bleeding or swelling during surgery can be somewhat more severe, and a stuffy nose can occur after surgery if osteotomy is performed incorrectly. Since side effects are possible, it is necessary to have a precise understanding of the relevant anatomy and technique. Several articles have described nasal bone osteotomy in rhinoplasty, and this review article introduces the methods presented in various articles, describes indications and limitations, and reviews the relevant anatomical structures and techniques in an accurate manner. We introduce a method that can increase patients’ satisfaction and the completeness of surgery through accurate osteotomy, as well as reducing the risk of side effects.
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No abstract available.
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Bile , Cistadenoma Seroso , Dilatação , Pâncreas , Ductos PancreáticosRESUMO
No abstract available.
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Bile , Cistadenoma Seroso , Dilatação , Pâncreas , Ductos PancreáticosRESUMO
A 43-year-old male was admitted to our hospital via emergency room with epigastric pain for 3 days. Abdominal computed tomography revealed pneumobilia in the biliary tree. Endoscopic retrograde cholangiopancreatography showed an atypical location of ampulla of Vater (AOV) with duodenal deformity. The plastic stent was placed through the fistular opening at the upper mound of AOV for biliary decompression. He was rehospitalized due to aggravation of jaundice two weeks later. The previous stent was changed into the nasobiliary catheter and biopsy was done around the ectopic opening. He underwent Whipple's operation due to the high grade dysplasia on biopsy. This is the report of aberrant opening of the common bile duct (CBD) into the duodenal bulb with precancerous conditions. Therefore, endoscopic biopsy is recommended in patients with mucosal abnormality around the ectopic opening of the CBD.
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Adulto , Humanos , Masculino , Ampola Hepatopancreática , Sistema Biliar , Biópsia , Catéteres , Colangiopancreatografia Retrógrada Endoscópica , Ducto Colédoco , Anormalidades Congênitas , Descompressão , Duodeno , Serviço Hospitalar de Emergência , Icterícia , Plásticos , Lesões Pré-Cancerosas , StentsRESUMO
Accurate diagnosis of biliary strictures is challenging and it commonly necessitates a multidisciplinary approach. There has been a great advancement of endoscopic techniques in tissue acquisition, laboratory tests, and imaging studies. Indeterminate biliary strictures are defined as strictures of no identifiable etiology despite extensive evaluation. Imaging modalities such as magnetic resonance imaging, magnetic resonance cholangiopancreatography, multi-detector computed tomography play a great role in evaluating the level, degree, length of biliary strictures and presence of a mass. Early and accurate diagnosis as malignant stricture can determine not only optimal timing of surgery, but also potential timely chemotherapy. No assertive diagnostic modalities to distinguish benign from malignant strictures is yet established. This article reviews various etiologies of biliary strictures and discusses the laboratory evaluation, imaging modalities and promising endoscopic work-up with biopsy to improve the diagnostic sensitivity.
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Biópsia , Colangiopancreatografia por Ressonância Magnética , Constrição Patológica , Diagnóstico , Tratamento Farmacológico , Imageamento por Ressonância MagnéticaRESUMO
A gastric subepithelial tumor (SET) is commonly detected during a diagnostic endoscopic examination. Gastric tuberculosis (TB), in particular, can present as a SET of the gastric wall. A few cases of gastric TB mimicking a SET have recently been reported. Radiological imaging combined with endoscopic biopsy can aid in the early diagnosis of TB without surgical intervention. A 41-year-old man visited our health promotion center for a regular check-up. Esophagogastroduodenoscopy (EGD) revealed a round and smooth, bulging mucosal lesion suggesting a gastric SET in the upper body of the stomach. Endoscopic ultrasound (EUS) demonstrated a hypoechoic lesion measuring 18 mm, with an obscure layer of origin, and EUS-guided fine-needle aspiration was performed. Microscopic examination of the sample showed chronic granulomatous inflammation. Histopathologically, the aspirated sample showed positive Ziehl-Neelsen staining, confirming a diagnosis of tuberculous lymphadenitis. We describe a case of a patient who presented with tuberculous lymphadenitis mimicking a SET of the stomach. The lesion was found on EGD and confirmed using EUS-guided fine-needle aspiration.
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Adulto , Humanos , Biópsia , Biópsia por Agulha Fina , Diagnóstico , Diagnóstico Precoce , Endoscopia do Sistema Digestório , Promoção da Saúde , Inflamação , Estômago , Tuberculose , Tuberculose dos Linfonodos , UltrassonografiaRESUMO
Endoscopic Retrograde Cholangiopancreatography (ERCP) is an essential endoscopic technique in diagnosis and treatment of pancreatobiliary diseases. Although its diagnostic role is decreasing because of less invasive modalities such as magnetic resonance cholangiopancreatography or endoscopic ultrasound, it is still very important in treatment of pancreatobiliary diseases. However, there is a trend of hesitation to learn ERCP by the fellows in Korea because of following reasons; concentration of ERCP in a few high volume centers, high risk of post-procedural complications, and long training courses. In this background, the education committee of Korean Pancreatobiliary Association has prepared for ERCP educational guidelines for fellows in Korea. This guideline should be helpful to fellows who are currently under the training.
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Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Diagnóstico , Educação , Bolsas de Estudo , Coreia (Geográfico) , UltrassonografiaRESUMO
Endoscopic Retrograde Cholangiopancreatography (ERCP) is an essential endoscopic technique in diagnosis and treatment of pancreatobiliary diseases. Although its diagnostic role is decreasing because of less invasive modalities such as magnetic resonance cholangiopancreatography or endoscopic ultrasound, it is still very important in treatment of pancreatobiliary diseases. However, there is a trend of hesitation to learn ERCP by the fellows in Korea because of following reasons; concentration of ERCP in a few high volume centers, high risk of post-procedural complications, and long training courses. In this background, the education committee of Korean Pancreatobiliary Association has prepared for ERCP educational guidelines for fellows in Korea. This guideline should be helpful to fellows who are currently under the training.
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Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Diagnóstico , Educação , Bolsas de Estudo , Coreia (Geográfico) , UltrassonografiaRESUMO
BACKGROUND: A face is considered beautiful if the forehead is presented with a width and proportion similar to the golden ratio or so called Cannon ratio. The most previously performed plastic surgeries on the forehead was a procedure to fill depressed parts so as to make the appearance of a smooth but convex three-dimensional forehead. However, this study focused on making a beautiful facial contour from the creation of a forehead adequately proportional to the overall ratio through a method of correcting the large forehead. METHODS: Based on the measurement by gliding test, start the designing in a zig-zag form along the hair line. Flap is dissected as designed between the galea aponeurotica and above the periosteum. In order to reposition and fix the scalp flap to the desired place, Endotine forehead® is used. RESULTS: The amount of forehead reduction ranged from 12 to 23 mm, the average being 15.9 mm. The post-operative scar was matured 5 to 6 months after the surgery, and became faded and invisible in most of the patients. CONCLUSIONS: The method used by the authors may be referred to as a surgical method with an emphasis on reducing the area on the forehead directly. This was done by lowering the location of the trichion, shortening the length of the forehead, and consequently reducing the size of a broad forehead. Satisfactory results were obtained from the tension-minimized forehead reduction procedure used in this study.