1.Is Chemoprevention of Pancreatic Cancer Possible by Aspirin Consumption?.
Yong Seok KIM ; Young Woo CHOI
The Korean Journal of Gastroenterology 2014;63(4):262-264
No abstract available.
2.Metastatic Recurrence of Small Bowel Cancer in Crohn's Disease.
Ji Min CHOI ; Changhyun LEE ; Jong Pil IM
The Korean Journal of Gastroenterology 2014;63(4):258-261
No abstract available.
Adenocarcinoma, Mucinous/diagnosis
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Colonoscopy
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Crohn Disease/complications/*pathology
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Humans
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Intestinal Neoplasms/*diagnosis/pathology/radiography
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Lymphatic Metastasis
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Male
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Middle Aged
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Neoplasm Recurrence, Local
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Positron-Emission Tomography
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Tomography, X-Ray Computed
3.A Case of Alpha-cell Nesidioblastosis and Hyperplasia with Multiple Glucagon-producing Endocrine Cell Tumor of the Pancreas.
Huapyong KANG ; Sewha KIM ; Tae Seop LIM ; Hye Won LEE ; Heun CHOI ; Chang Moo KANG ; Ho Guen KIM ; Seungmin BANG
The Korean Journal of Gastroenterology 2014;63(4):253-257
Nesidioblastosis is a term used to describe pathologic overgrowth of pancreatic islet cells. It also means maldistribution of islet cells within the ductules of exocrine pancreas. Generally, nesidioblastosis occurs in beta-cell and causes neonatal hyperinsulinemic hypoglycemia or adult noninsulinoma pancreatogenous hypoglycemia syndrome. Alpha-cell nesidioblastosis and hyperplasia is an extremely rare disorder. It often accompanies glucagon-producing marco- and mircoadenoma without typical glucagonoma syndrome. A 35-year-old female was referred to our hospital with recurrent acute pancreatitis. On radiologic studies, 1.5 cm sized mass was noted in pancreas tail. Cytological evaluation with EUS-fine-needle aspiration suggested serous cystadenoma. She received distal pancreatectomy. The histologic examination revealed a 1.7 cm sized neuroendocrine tumor positive for immunohistochemical staining with glucagon antibody. Multiple glucagon-producing micro endocrine cell tumors were scattered next to the main tumor. Additionally, diffuse hyperplasia of pancreatic islets and ectopic proliferation of islet cells in centroacinar area, findings compatible to nesidioblastosis, were seen. These hyperplasia and almost all nesidioblastic cells were positive for glucagon immunochemistry. Even though serum glucagon level still remained higher than the reference value, she has been followed-up without any evidence of recurrence or hormone related symptoms. Herein, we report a case of alpha-cell nesidioblastosis and hyperplasia combined with glucagon-producing neuroendocrine tumor with literature review.
Adult
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Chromogranin A/blood
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Female
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Glucagon/*metabolism
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Glucagon-Secreting Cells/metabolism
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Humans
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Hyperplasia/complications/*diagnosis
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Islets of Langerhans/metabolism/ultrasonography
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Nesidioblastosis/complications/*diagnosis
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Neuroendocrine Tumors/complications/*diagnosis/pathology
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Pancreas/*pathology
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Tomography, X-Ray Computed
4.Long-term Successful Treatment of Massive Distal Duodenal Variceal Bleeding with Balloon-occluded Retrograde Transvenous Obliteration.
Soon Woo HWANG ; Joo Hyun SOHN ; Tae Yeob KIM ; Ji Yeoun KIM ; Jiyoung YHI ; Dong Shin KWAK ; Hae Su KIM ; Soon Young SONG
The Korean Journal of Gastroenterology 2014;63(4):248-252
Duodenal variceal bleeding in patients with portal hypertension due to cirrhosis or other causes is uncommon. We report on a case of a 55-year-old male with an ectopic variceal rupture at the distal fourth part of the duodenum who presented with massive hematochezia and shock. Shortly after achievement of hemodynamic stability, due to the limitation of an endoscopic procedure, we initially attempted to find the bleeding focus by abdominal computed tomography, which showed tortuous duodenal varices that drained into the left gonadal vein. He was treated with first-line balloon-occluded retrograde transvenous obliteration (BRTO), resulting in a favorable long-term outcome without rebleeding three years later. This case suggests that BRTO may be a first-line therapeutic option for control of ruptured duodenal varices, especially at a distal location.
Balloon Occlusion
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Duodenal Diseases/*diagnosis/radiography/therapy
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Embolization, Therapeutic
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Gastrointestinal Hemorrhage/therapy
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Humans
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Male
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Middle Aged
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Tomography, X-Ray Computed
5.A Case of Plummer-Vinson Syndrome Associated with Crohn's Disease.
Joon Mo PARK ; Kyeong Ok KIM ; Chan Seo PARK ; Byung Ik JANG
The Korean Journal of Gastroenterology 2014;63(4):244-247
Plummer-Vinson syndrome manifests as cervical dysphagia, iron deficiency anemia, an upper esophageal web, and atrophic glossitis. The cause of the esophageal web is thought to be iron deficiency anemia; however, the cause of Plummer-Vinson syndrome has not been established. Crohn's disease is usually accompanied by malnutrition and iron deficiency anemia; however, no case of concomitant Crohn's disease and Plummer-Vinson syndrome with aggravated malnutrition and anemia has been previously reported. Here, we report on a rare case of Plummer-Vinson syndrome in a Crohn's disease patient, which caused malnutrition and constipation.
Adult
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Cobblestone Lissencephaly/diagnosis
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Colon, Sigmoid/surgery
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Crohn Disease/complications/*diagnosis
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Esophageal Sphincter, Upper/radiography
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Humans
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Male
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Plummer-Vinson Syndrome/*diagnosis/etiology
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Sigmoidoscopy
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Sphincterotomy, Endoscopic
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Tomography, X-Ray Computed
6.Primary Aortoenteric Fistula to the Sigmoid Colon in Association with Intra-abdominal Abscess.
Wonho LEE ; Chul Min JUNG ; Eun Hee CHO ; Dong Ryeol RYU ; Daehee CHOI ; Jaihwan KIM
The Korean Journal of Gastroenterology 2014;63(4):239-243
Primary aortoenteric fistula (PAEF) is a rare but catastrophic cause of massive gastrointestinal bleeding. Diagnosis of PAEF is difficult to make and is frequently delayed without strong clinical suspicion. Timely surgical intervention is essential for patient's survival. We report on a case of an 86-year-old woman with no history of abdominal surgery, who presented with abdominal pain. Initially, computed tomography scan showed an intra-abdominal abscess, located anterior to the aortic bifurcation. However, she was discharged without treatment because of spontaneous improvement on a follow-up computed tomography scan, which showed a newly developed right common iliac artery aneurysm. One week later, she was readmitted due to recurrent abdominal pain. On the second day of admission, sudden onset of gastrointestinal bleeding occurred for the first time. After several endoscopic examinations, an aortoenteric fistula bleeding site was found in the sigmoid colon, and aortography showed progression of a right common iliac artery aneurysm. We finally concluded that intra-abdominal abscess induced an infected aortic aneurysm and enteric fistula to the sigmoid colon. This case demonstrated an extremely rare type of PAEF to the sigmoid colon caused by an infected abdominal aortic aneurysm, which has rarely been reported.
Abdominal Abscess/*diagnosis/microbiology
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Aged, 80 and over
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Aorta, Abdominal/radiography
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Aortic Aneurysm, Abdominal/*diagnosis/etiology
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Bacteroides/isolation & purification
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Bacteroides fragilis/isolation & purification
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Colon, Sigmoid/radiography
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Colonoscopy
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Enterococcus/isolation & purification
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Female
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Fistula/*diagnosis
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Humans
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Tomography, X-Ray Computed
7.Safety and Effectiveness of Successive Extracorporeal Shock Wave Lithotripsy for Pancreatolithiasis under Intravenous Bolus Pethidine Administration Alone.
Byung Uk LEE ; Myung Hwan KIM ; Joon Hyuk CHOI ; Jun Ho CHOI ; Hyo Jung KIM ; Do Hyun PARK ; Sang Soo LEE ; Dong Wan SEO ; Sung Koo LEE
The Korean Journal of Gastroenterology 2014;63(4):231-238
BACKGROUND/AIMS: A retrospective analysis was performed to evaluate the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) for pancreatolithiasis on successive days under intravenous bolus of pethidine alone. METHODS: Ninety patients with calcified pancreatic stones (> or =5 mm) presenting with abdominal pain were selected for ESWL. ESWL was performed with an electroconductive lithotripter under fluoroscopic target systems. Fragmented calculi after ESWL were removed by endotherapy. RESULTS: A mean of 4.2 ESWL sessions were performed for each patient, with a mean of 2,984 shocks at a mean power setting of 12.8 kV. Eighty-four (89.3%) patients underwent ESWL for three or more days in a row. Fragmentation of the stones were achieved in 83/90 (92.2%) patients. Complete clearance of the main pancreatic duct was achieved in 54/90 (60.0%) patients, and partial clearance was achieved in 27 (30.0%) patients. The mean dose of pethidine used during ESWL was 53.5+/-20.7 mg per session. As ESWL-related complications, four (4.3%) patients developed mild acute pancreatitis. CONCLUSIONS: In case of endoscopically difficult-to-treat pancreatic duct stones, combined therapy with ESWL is an effective method, and treatment with multiple sessions of ESWL on successive days under intravenous bolus of pethidine alone is safe and well tolerated.
Acute Disease
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Adult
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Aged
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Aged, 80 and over
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Calculi/*therapy
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Female
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Fluoroscopy
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Humans
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Injections, Intravenous
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*Lithotripsy
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Male
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Meperidine/*administration & dosage
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Middle Aged
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Pancreatic Ducts
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Pancreatitis/therapy
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Retrospective Studies
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Tomography, X-Ray Computed
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Treatment Outcome
8.Diagnostic Accuracy of Brush Cytology with Direct Smear and Cell-block Techniques according to Preparation Order and Tumor Characteristics in Biliary Strictures.
Yeong Geol JO ; Tae Hoon LEE ; Hyun Deuk CHO ; Sang Heum PARK ; Jae Man PARK ; Young Sin CHO ; Yunho JUNG ; Il Kwun CHUNG ; Hyun Jong CHOI ; Jong Ho MOON ; Sang Woo CHA ; Young Deok CHO ; Sun Joo KIM
The Korean Journal of Gastroenterology 2014;63(4):223-230
BACKGROUND/AIMS: There are few data supporting the diagnostic yield of brush cytology depending on the order of cytologic preparation method or the location or shape of tumors in biliary strictures. We investigated diagnostic yields and variations in brush cytology with direct smear and cell-block preparations according to sampling preparation sequence and tumor location and shape in biliary strictures. METHODS: Patients who had undergone ERCP with tissue sampling between August 2009 and April 2013 were analyzed retrospectively. Group A was examined using brush cytology with direct smear followed by cell-block with or without biopsy, while the reverse order was performed for group B. RESULTS: Among 138 enrolled patients, 92 patients (A: 36, B: 56) underwent both brush cytology with direct smear and cell-block preparations. No differences in sensitivity, specificity, or accuracy were observed according to the sampling preparation method and the location or shape of tumors in biliary strictures. The cellularity observed from brush cytology with direct smear was better than that from cell-block according to the location of the tumor (p<0.01). The diagnostic yield was increased in both groups with addition of an endobiliary biopsy. CONCLUSIONS: No difference in diagnostic accuracy was observed between the sequences of preparation for brush cytology with direct smear and cell-block techniques. Brush cytology showed better cellularity for diagnosis.
Aged
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Aged, 80 and over
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Bile Duct Neoplasms/*pathology
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Cholangiocarcinoma/pathology
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Cholangiopancreatography, Endoscopic Retrograde
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*Cytodiagnosis
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Female
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Gallbladder Neoplasms/pathology
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Humans
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Male
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Middle Aged
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Neoplasm Staging
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Pancreatic Neoplasms/pathology
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Retrospective Studies
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Sensitivity and Specificity
9.Crohn's Disease in Association with IgA Nephropathy.
Ji Myoung LEE ; Kang Moon LEE ; Hyung Wook KIM ; Woo Chul CHUNG ; Chang Nyol PAIK ; Jeong Rok LEE ; Yeong Jin CHOI ; Jin Mo YANG
The Korean Journal of Gastroenterology 2008;52(2):115-119
Urological complications are not uncommon in Crohn's disease (CD). The most common manifestations are renal stones, enterovesical fistulas, and ureteral obstruction, but renal parenchymal disease has rarely been reported. IgA nephropathy, the most common form of primary glomerulonephritis, is usually isolated, but can be sometimes associated with chronic extrarenal disorders such as inflammatory bowel disease. We describe a case of 36 year-old man with CD associated with IgA nephropathy. He was diagnosed as CD 6 years ago and at that time, isolated proteinuria was observed. He presented recurrent proteinuria and elevation of creatinine level while he had been managed well with mesalamine and azathioprine. The renal biopsy was performed and IgA nephropathy (type IV) was diagnosed. Strict blood pressure control with angiotensin converting enzyme inhibitor and calcium channel blocker resulted in clinical improvement and normalization of serum creatinine level.
Adult
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Angiotensin-Converting Enzyme Inhibitors/therapeutic use
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Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
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Antimetabolites/therapeutic use
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Azathioprine/therapeutic use
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Blood Pressure
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Calcium Channel Blockers/therapeutic use
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Colonoscopy
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Crohn Disease/*diagnosis/drug therapy/etiology
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Glomerulonephritis, IGA/complications/*diagnosis/pathology
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Humans
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Male
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Mesalamine/therapeutic use
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Proteinuria/diagnosis/etiology
10.A Case of Sepsis and Acute Renal Failure Associated with Salmonella Enterocolitis.
Chul Han KIM ; Ki Tae SUK ; Jae Woo KIM
The Korean Journal of Gastroenterology 2008;52(2):110-114
Salmonella infection can cause an asymptomatic intestinal carrier state or clinical diseases such as enterocolitis presenting abdominal pain, fever, vomiting, or diarrhea. Salmonella usually invades Peyer's patch of terminal ileum or ascending colon. Sepsis is not common and acute renal failure secondary to rhabdomyolysis is rare. The causes of rhabdomyolysis are trauma, excessive exercise, alcohol, seizure, metabolic abnormality, and infection. Infections account for less than 5% of the reported causes of rhabdomyolysis and resulting acute renal failure. The mechanisms underlying rhabdomyolysis due to infection are direct muscle invasion, toxin production, and nonspecific effects that can occur with infections such as fever, dehydration, acidosis, and electrolyte imbalance. We report a case of sepsis and acute renal failure secondary to rhabdomyolysis associated with Salmonella infection.
Colonoscopy
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Enterocolitis/complications/*diagnosis
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Humans
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Kidney Failure, Acute/*diagnosis/etiology
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Male
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Middle Aged
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Rhabdomyolysis/diagnosis/etiology/microbiology
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Salmonella Infections/complications/*diagnosis
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Sepsis/*diagnosis/etiology
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Tomography, X-Ray Computed