BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is a difficult procedure to perform on patients who have undergone a Billroth II gastrectomy, Whipple's operation or Roux-en-Y gastrobypass surgery. Our study was designed to evaluate the clinical usefulness of cap-assisted ERCP for beginner endoscopists in cases of surgically altered anatomy. METHODS: From April 2008 to March 2010, 16 patients with biliary diseases and who had previously undergone abdominal surgery such as Billroth II gastrectomy or Roux-en-Y operation were analyzed. A single endoscopist performed all the procedures using a cap-assisted gastroscope, after ERCP training. RESULTS: Cap-assisted ERCP was attempted in 24 sessions of 16 patients. Afferent loop intubation and selective bile duct cannulation was successfully achieved in 19 sessions (79.1%). Among the patients who had undergone a Billroth II gastrectomy, 19 out of 20 sessions were successfully conducted. Only 4 patients who had undergone a previous Roux-en-Y operation failed afferent loop intubation. Duodenal free wall perforation developed in one case. There were no cases of mortality. CONCLUSIONS: Therapeutic cap-assisted ERCP was useful in patients who had previously undergone a Billroth II gastrectomy and this may be helpful for inexperienced endoscopists.
Anastomosis, Roux-en-Y ; Bile Ducts ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Gastrectomy ; Gastroenterostomy ; Gastroscopes ; Humans ; Intubation

Duodenal perforations caused by biliary prostheses are uncommon, but they are potentially life threatening and require immediate treatment. Here we describe an unusual case of duodenal perforation induced by a plastic biliary stent. It masqueraded as a case of cholecystitis and combined systemic upset with a localized peritonitis and fever. Primary endoscopic closure by hemoclips was difficult due to the position of the lateral wall and the complexity of aligning the perforation with the endoscope. To approximate the perforated hole and adherent hemoclips, glue injection and sprayings were successfully performed under cap-fitted endoscopy. The patient recovered without additional complications.
Adhesives ; Cholecystitis ; Endoscopes ; Endoscopy ; Fever ; Fibrin ; Fibrin Tissue Adhesive ; Humans ; Intestinal Perforation ; Peritonitis ; Plastics ; Prostheses and Implants ; Stents

The potential hepatotoxicity of herbal remedies and/or health foods is usually ignored in daily life. There have been cases showing the toxic hepatitis and renal failure associated with the ingestion of raw carp bile. We experienced a case of toxic hepatitis without any evidence of renal failure that was associated with carp juice ingestion. The clinical manifestations were characterized by nausea and vomiting after the ingestion of carp juice for 3 months. The diagnosis of toxic hepatitis was made on the basis of the patient's history, laboratory data, RUCAM (Russel Uclaf Causality Assessment) and the results of ultrasonography guided liver biopsy. The patient showed rapid improvement after instituting supportive therapy.
Male ; Korea ; Humans ; Hepatitis, Toxic/*etiology ; *Carps ; *Bile ; Animals ; Adult

Psoas abscesses are rare clinical entities complicating Crohn's disease (CD). However, psoas abscesses can cause poor outcomes because the diagnosis is frequently delayed due to the non-specific clinical features. Recently, we managed a case of a huge iliopsoas abscess in a 21-year-old man with a 4-year history of CD who presented with a limping gait and flexion contractures of the sacroiliac joint. Notably, the iliopsoas abscess developed during induction treatment with infliximab. The patient was successfully treated with antibiotics, surgical drainage, and a right hemicolectomy. Herein we present the case with a brief review of the literature.
Anti-Bacterial Agents ; Antibodies, Monoclonal ; Contracture ; Crohn Disease ; Drainage ; Gait ; Humans ; Infliximab ; Psoas Abscess ; Sacroiliac Joint ; Young Adult

Psoas abscesses are rare clinical entities complicating Crohn's disease (CD). However, psoas abscesses can cause poor outcomes because the diagnosis is frequently delayed due to the non-specific clinical features. Recently, we managed a case of a huge iliopsoas abscess in a 21-year-old man with a 4-year history of CD who presented with a limping gait and flexion contractures of the sacroiliac joint. Notably, the iliopsoas abscess developed during induction treatment with infliximab. The patient was successfully treated with antibiotics, surgical drainage, and a right hemicolectomy. Herein we present the case with a brief review of the literature.
Anti-Bacterial Agents ; Antibodies, Monoclonal ; Contracture ; Crohn Disease ; Drainage ; Gait ; Humans ; Infliximab ; Psoas Abscess ; Sacroiliac Joint ; Young Adult

Phytophotodermatitis is a condition caused by sequential exposure to photosensitizing substances present in plants followed by ultraviolet light. Several plants (e.g., limes, celery, fig, and wild parsnip) contain furocoumarin compounds (psoralens). It is important for dermatologists to be aware of phytophotodermatitis because it may be misdiagnosed as cellulitis, tinea, or allergic contact dermatitis. We present five patients with a sharply defined erythematous swollen patch with bullae on both feet. They described soaking their feet in a fig leaves decoction to treat their underlying dermatologic diseases. Within 24 hours, all patients had a burning sensation in their feet, and erythema and edema had developed on the feet dorsa with exception of the portion of the skin covered by the sandals. Histopathologic examinations revealed sub-epithelial blisters with intensive epidermal necrosis. Phytophotodermatitis was ultimately diagnosed and, after several days, the patients' skin lesions began to recover upon treatment with systemic and topical corticosteroids. Unfortunately, since there are no studies providing sufficient evidence on the benefits of fig leaves, they should be used with caution.
Adrenal Cortex Hormones ; Apium graveolens ; Blister ; Burns ; Cellulitis ; Citrus aurantiifolia ; Dermatitis, Allergic Contact ; Edema ; Erythema ; Ficus ; Foot ; Humans ; Necrosis ; Photosensitivity Disorders ; Sensation ; Skin ; Tinea ; Ultraviolet Rays

Phytophotodermatitis is a condition caused by sequential exposure to photosensitizing substances present in plants followed by ultraviolet light. Several plants (e.g., limes, celery, fig, and wild parsnip) contain furocoumarin compounds (psoralens). It is important for dermatologists to be aware of phytophotodermatitis because it may be misdiagnosed as cellulitis, tinea, or allergic contact dermatitis. We present five patients with a sharply defined erythematous swollen patch with bullae on both feet. They described soaking their feet in a fig leaves decoction to treat their underlying dermatologic diseases. Within 24 hours, all patients had a burning sensation in their feet, and erythema and edema had developed on the feet dorsa with exception of the portion of the skin covered by the sandals. Histopathologic examinations revealed sub-epithelial blisters with intensive epidermal necrosis. Phytophotodermatitis was ultimately diagnosed and, after several days, the patients' skin lesions began to recover upon treatment with systemic and topical corticosteroids. Unfortunately, since there are no studies providing sufficient evidence on the benefits of fig leaves, they should be used with caution.
Adrenal Cortex Hormones ; Apium graveolens ; Blister ; Burns ; Cellulitis ; Citrus aurantiifolia ; Dermatitis, Allergic Contact ; Edema ; Erythema ; Ficus ; Foot ; Humans ; Necrosis ; Photosensitivity Disorders ; Sensation ; Skin ; Tinea ; Ultraviolet Rays

Endometriosis occurs most frequently in the intestine. In the pelvic organs intestinal endometriosis presents with various symptoms and endoscopic findings. If an asymptomatic submucosal lesion is found in the sigmoid colon or rectum of reproductive women, a differential diagnosis should be done. Owing to advancements in endoscopic therapy, endoscopic excision has been attempted for various subepithelial lesions. To successfully do an endoscopic excision, accurate diagnosis should be obtained through diagnostic tests such as endoscopic ultrasonography prior to excision. Here the authors report a case of rectal endometriosis in an asymptomatic woman of reproductive age. They attempted endoscopic resection based on the endoscopic finding that the subepithelial lesion was limited to the submucosal layer in endoscopic ultrasonography. This conclusion turned out to be a mistaken one. Because of tumor adhesion to the proper muscular layer, we failed to successfully conduct an endoscopic excision. Ultimately, we did surgery and diagnosed rectal endometriosis.
Colon, Sigmoid ; Diagnosis, Differential ; Diagnostic Tests, Routine ; Endometriosis ; Endosonography ; Female ; Humans ; Intestines ; Rectum

PURPOSE : E-cadherin is a tumor suppressor adhesion molecule that has an anti-invasive role and it is often considered as a useful marker for differentiating the lobular types from the ductal types of breast cancer. Yet the biological functions of E-cadherin in the invasive ductal types of breast cancers are unclear. METHODS : The E-cadherin expression was assessed immunohistochemically in 84 case of surgically resected invasive ductal carcinoma. Only the membranous expression of E-cadherin was considered and its expression was categorized as positive (>95% stained) or negative (<95% stained). The relationship between the E-cadherin expression and tumor size, the lymph node status, the histologic grade, the ER and PR status, The HER2/neu and p53 expressions was studied by performing prospective aspect. RESULTS : We analyzed 84 invasive ductal carcinomas for the E-cadherin expressions. Variable degrees of E-cadherin expression were noted in 79 cases and the complete absence of its expression was noted in 5 cases(5.9%) which showed all HER2/neu positive and p53 negative. Positive expression of E-cadherin was noted in 66cases(78.5%). Significant associations were found between the E-cadherin expression and the tumor size and the estrogen receptor status. The expression of E-cadherin was not found to be related to the lymph node status, histologic grade, the progesteron receptor status, the HER2/neu and p53 expressions. CONCLUSION: We confirmed that there was a strong correlation between the negative membrane expressions of E-cadherin and the T-stages and a negative estrogen receptor status. E-cadherin immunostaining appears to have a minimal prognostic value and it can be efficiently used for determining tumor progression of invasive ductal carcinomas of the breast.
Breast Neoplasms ; Breast* ; Cadherins* ; Carcinoma, Ductal* ; Estrogens ; Immunohistochemistry ; Lymph Nodes ; Membranes ; Prospective Studies

Even though percutaneous transhepatic gallbladder drainage (PTGBD) is performed prior to ERCP or following ERCP because of the patients' medical condition or failed bile duct cannulation, there are no definite endoscopic landmarks that are useful for successful bile duct cannulation in some cases. We report here on 4 patients in whom selective bile duct cannulation, as guided by the endoscopic landmarks, was successful following indigocarmine injection via PTGBD.
Bile ; Bile Ducts ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Gallbladder ; Humans