BACKGROUND/AIMS: Endoscopic sphincterotomy (EST) is a common therapeutic technique for biliary and pancreatic disease, but it can cause several complications. Although the literature suggests that there is no need for patients to stop taking aspirin before undergoing EST, there are no definite guidelines on this in Korea. Consequently, we compared the frequency of bleeding and safety between aspirin users and nonusers undergoing EST. METHODS: This retrospective study recruited 1003 patients who underwent EST at our hospital between 1 February 2005 and 30 September 2008. Thirteen patients continued to take aspirin until the day of the sphincterotomy (group 1), and 990 patients had not taken aspirin before the sphincterotomy (group 2). The incidence of post-sphincterotomy bleeding was compared between the two groups retrospectively. RESULTS: There was no significant difference in age or gender between the two groups. The indications for EST included common bile duct stones in 12 patients (92.3%, 12/13) in group 1 and 706 patients (71.3%, 706/990) in group 2 (p = 0.124). Regarding combined disease, cholangitis was observed in 11 patients (84.6%, 11/13) in group 1 and 815 patients (82.3%, 815/990) in group 2 (p = 0.974). Clinically significant post-sphincterotomy bleeding was observed in three patients in group 2 (0.3%, 3/990) versus none in group 1. CONCLUSIONS: Taking aspirin does not appear to clinically increase bleeding after EST. Therefore, there is no definite need to stop aspirin before undergoing EST.
Aspirin ; Cholangitis ; Common Bile Duct ; Hemorrhage ; Humans ; Incidence ; Korea ; Morinda ; Pancreatic Diseases ; Retrospective Studies ; Sphincterotomy, Endoscopic

OBJECTIVE: The purpose of this study was to assess the validity of CAGE (cut down, annoyed, guilty feeling, eye-opener) for older adults in community METHODS: Randomly selected alcohol drinking 182 older adults over 65 years of age in Incheon-Chungu participated in this study. We assessed alcohol use disorder by Korean Composite International Diagnostic Interview (K-CIDI) and interviewed by CAGE. The CAGE questionnaire is a brief alcohol screening questionnaire that can be interviewer or self-administered. Sensitivity, specificity, positive predictive value and receiver operating characteristics (ROC) curve for CAGE scores of 1-4 for older adults over 65 years of age was calculated. RESULTS: The mean age of 182 people was 71.3 (+/-5.2) years old and the number of male and female was 142 (78.0%) and 40 (22.0%) respectively. In 239 alcohol drinking older adults, 182 (76.2%) people answered in CAGE and CIDI. Among 182 people, 58 was Alcohol Use Disorder (AUD) and 124 was non-AUD. There was no age and educational differences between 182 people (case group) and 57 people (exclusion group). The sensitivity and specificity for a cut-off score of two was 72.5% and 85.5% respectively. The calculation of area under curve (AUC) by Receiver Operating Characteristics (ROC) was 0.806. CONCLUSION: The CAGE can easily discriminate older adults with alcohol use disorder from those without such a history. We suggest a score of '2' as the optimal cut-off score of CAGE.
Adult* ; Alcohol Drinking ; Area Under Curve ; Female ; Humans ; Male ; Mass Screening ; Surveys and Questionnaires ; ROC Curve ; Sensitivity and Specificity

No abstract available.
Migraine Disorders

We reviewed data of 64 patients who underwent reoperation because of prosthetic valve malfunction from January 1991 to December 1995. The indications for reoperation were prosthetic valve failure(primary tissue failure: 53 patients, 82.8%), prosthetic valve thrombosis(6 patients, 9.4%), paravalvular leak(3 patients, 4.7%), prosthetic valve endocarditis(2 patients, 3.6%). Prosthetic valve failure developed most frequently in mitral portion(40 patients, 75%), prosthetic valve thrombosis also in mitral portion(4 patients, 67%), paravalvular leak significantly in aortic portion(3 patients, 100%). Explant period was longest in prosthetic valve failure(mean 107.4+/-24.6 months), shortest in prosthetic valve endocarditis with prosthetic valve thrombosis(1 patient, 1 month). Mean explant period, defined as from first valve replacement operation to redo-valve replacement operatopn, was 109.2+/-10.7 months in mitral portion, 97.8+/-10.4 months in aortic portion, 109.5+/-10.4 months in total. Overall hospital mortality was 9.38%. The most common cause of death was the low cardiac output(4 patients), other causes were bleeding(1 patient), CNS injury(1 patient). Preoperative NYHA class IV(P=0.011), emergency operation(P=0.011), prosthetic valve endocarditis(P=0.001) were the independent risk factors, but age, sex, explant period, ACC time, double valve replacement, valve position, second reoperation did not appear to be significant risk factors. Mean follow up period was 28.8+/-17.8 months. Actuarial survival at 3 year was 92.0+/-6.2%, 2 year event-free survival was 84.3+/-6.1%. We propose that patients undergoing reoperation because of prosthetic valve failure are carfully controlled and selected in regarding to above mentioned risk factors - NYHA class IV, emergency operation, prosthetic valve endocarditis in preoperative state. About other risk factors possible, there is necessary of following study.
Cause of Death ; Disease-Free Survival ; Emergencies ; Endocarditis ; Follow-Up Studies ; Heart Valve Prosthesis* ; Heart Valves* ; Heart* ; Hospital Mortality ; Humans ; Reoperation* ; Risk Factors ; Thrombosis

OBJECTIVE: To evaluate the clinical significance of fetal choroid plexus cysts (CPCs) in the second trimester, especially an association with trisomy 18. METHODS: From March 1998 through June 1999, second trimester screening ultrasonography was performed on 4,948 unselected single-ton pregnancies. CPCs were noted in 132 fetuses. Among them, detailed ultrasonography and follow-up was possible in 119 cases and they were recruited into the study. There were 91 cases of isolated CPCs and 28 cases of CPCs in high-risk population. "Isolated CPCs" were defined as: mother did not have any risk factors requiring amniocentesis and there were no other sonographic abnormalities on detailed ultrasound. "CPCs in high-risk population" were defined as: mother had any risk factor requiring karyotyping or there were any other sonographic abnormalities although she was general population. Amniocentesis was performed in 39 cases. We compared gestational age at time of detection, size, bilaterally, multiplicity, and complexity of CPCs in the group of isolated CPCs and CPCs in high-risk population (t-test, chi-square test; P<0.05). We evaluated the findings of detailed and follow-up ultrasonography, karyotypes, and final outcomes of pregnancy. RESULTS: Gestational age at time of detection was not different in both groups of isolated CPCs and CPCs in high-risk population (19+/-2 vs 18+/-1 wk, p>0.05). Mean size (6.4 vs 6.2 mm), bilaterality (60% vs 57%), multiplicity (66% vs 57%), and complexity (8% vs 14%) of CPCs were also similar. All CPCs were disappeared irrespective of size and mean time of disappearance was 25+/-3 and 26+/-3 week, respectively (p>0.05). All cases of isolated CPCs resulted in phenotypically-normal neonates. It was confirmed by either amniocentesis or postnatal examination by the pediatrician. Among fetuses having CPCs in high-risk population, two trisomy 18 and one trisomy 21 were detected. All of them had positive result of maternal serum marker test and/or sonographic abnormalities. Remaining cases were proved normal. CONCLUSION: The risk of chromosome abnormalities is very high when CPCs are associated with other abnormalities on detailed ultrasound, indicating a clear need to offering genetic amniocentesis. As contrast, the risk of chromosome abnormalities for a case of isolated CPCs is very low, and in this series there was no trisomy 18. Therefore isolated CPCs should be considered as the indication of detailed ultrasound examination, but not routine karyotyping.
Amniocentesis ; Biomarkers ; Choroid Plexus* ; Choroid* ; Chromosome Aberrations ; Down Syndrome ; Female ; Fetus ; Follow-Up Studies* ; Gestational Age ; Humans ; Infant, Newborn ; Karyotype ; Karyotyping ; Mass Screening ; Mothers ; Pregnancy ; Pregnancy Trimester, Second* ; Prenatal Diagnosis ; Risk Factors ; Trisomy* ; Ultrasonography

Sarcomatoid carcinoma or carcinosarcoma is a very rare biphasic tumor characterized by a combination of malignant epithelial and mesenchymal cells. The pathogenesis of sarcomatoid carcinoma is not fully elucidated and the guideline of treatment has not been established yet. Although the upper aerodigestive tract, lung and female urogenital system are known to be the most frequently affected, this tumor also can occur in various sites, including the digestive tract. Since sarcomatoid carcinoma in colon was firstly reported in 1986, 24 cases have been reported to date. We report a rare case with sarcomatoid carcinoma of appendix. Interesting histologic feature of our case was the presence of mucinous cystadenocarcinoma with morphological "transition" between carcinomatous and sarcomatous tissue. To our knowledge, this is the first case of sarcomatoid carcinoma arising from mucinous cystadenocarcinoma of the appendix.
Appendix ; Carcinosarcoma ; Colon ; Cystadenocarcinoma, Mucinous ; Female ; Gastrointestinal Tract ; Humans ; Lung ; Mucins ; Urogenital System

Mucosa-associated lymphoid tissue lymphoma mainly arises in the stomach, with fewer than 30% arising in the small intestine. We describe here two cases of primary duodenal mucosa-associated lymphoid tissue lymphoma which were evaluated by endoscopic ultrasonography. A 52-year-old man underwent endoscopy due to abdominal pain, which demonstrated a depressed lesion on duodenal bulb. Endoscopic ultrasonographic finding was hypoechoic lesion invading the submucosa. The other case was a previously healthy 51-year-old man. Endoscopy showed a whitish granular lesion on duodenum third portion. Endoscopic ultrasonography image was similar to the first case, whereas abdominal computed tomography revealed enlargement of multiple lymph nodes. The first case was treated with eradication of Helicobacter pylori, after which the mucosal change and endoscopic ultrasound finding were normalized in 7 months. The second case was treated with cyclophosphamide, vincristine, prednisolone, and rituximab every 3 weeks. After 6 courses of chemotherapy, the patient achieved complete remission.
Abdominal Pain ; Antibodies, Monoclonal, Murine-Derived ; Cyclophosphamide ; Duodenum ; Endoscopy ; Endosonography ; Helicobacter pylori ; Humans ; Intestine, Small ; Lymph Nodes ; Lymphoid Tissue ; Lymphoma, B-Cell, Marginal Zone ; Middle Aged ; Prednisolone ; Stomach ; Vincristine ; Rituximab

Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis characterized by an autoimmune inflammatory process. This is the first case report of AIP, not otherwise specified, accompanied by pericardial effusion. A 52-year-old female visited our hospital due to dyspnea. Echocardiography showed a large amount of pericardial thickening. Abdominal computed tomography revealed diffuse enlargement of the pancreas body and tail with a sausage-shaped appearance, surrounded by a thick hypodense rim. Endoscopic retrograde cholangiopancreatography could not identify the tail portion of the pancreas, despite forceful contrast injection. Serology was positive for antinuclear antibody and IgG4 was normal. Endoscopic ultrasound-guided core biopsy of the pancreas was performed. Histologic examination revealed a fibrous connective tissue with inflammatory infiltration. The patient was treated with steroids. In the follow-up images, abnormal findings of pericardial effusion were improved, although an irregular long stricture of the pancreas tail portion remained.
Antibodies, Antinuclear ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Connective Tissue ; Constriction, Pathologic ; Dyspnea ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Immunoglobulin G ; Middle Aged ; Pancreas ; Pancreatitis* ; Pancreatitis, Chronic ; Pericardial Effusion* ; Steroids

As a rare complication of percutaneous endoscopic gastroscopy (PEG), a gastrocolocutaneous fistula may occur after PEG placement. This paper reports an interesting case which PEG tube unintentionally penetrated transverse colon during PEG. A 72-year-old female patient who suffered from medullary infarction underwent PEG procedure for enteral nutrition, and fecal materials were observed 6 days after the procedure. Transverse colon located in antero-superior site of stomach was observed through abdominal computed tomography, and also the wrong inserted tube was found through gastroscopy and colonoscopy. Endoscopic treatment for the fistula was performed by the use of hemo-clip and detachable snare, closure of the fistula was finally confirmed 6 days after the endoscopic procedure. Therefore, the gastrocolocutaneous fistula should be considered as one of the complications of PEG when fecal material is observed through PEG tube in a few days after PEG procedure and endoscopic treatment can be feasible in this case.
Aged ; Colon, Transverse ; Colonoscopy ; Enteral Nutrition ; Female ; Fistula ; Gastroscopy ; Gastrostomy ; Humans ; Infarction ; SNARE Proteins ; Stomach

BACKGROUND: Radioiodine treatment is effective for the removal of remnant thyroid tissues after thyroidectomy in patients with differentiated thyroid carcinoma. To induce the elevation of serum TSH level which facilitates the uptake of radioiodine into remnants, a 4 to 6 week interval between thyroidectomy and radioiodine administration has been established. During the period of preparation, most patients have experienced overt symptoms of hypothyroidism which have led to the development of alternative strategies. Some reports have suggested that the interval could be reduced to about 3 weeks with less symptoms. We reevaluated the adequate time needed for the elevation of serum TSH level above 30microU/mL after thyroidectomy. METHODS: Forty five patients who had undergone total thyroidectomy for differentiated thyroid carcinoma were investigated. Serum TSH and free T4 levels were measured one or more times within 3 weeks after operation(total 97 blood samples). Eighty nine blood samples were obtained within 15 days. RESULTS: In 41 patients (91.1%) serum TSH levels increased to 30 microU/mL until 15 days after operation. Until postoperative 21 days, serum TSH levels in all the other patients reached 30microU/mL. In linear equation, the daily increment of serum TSH levels was 2.62microU/mL for the first 8 days after operation and 5.34micorU/mL for the next 7 days. The half-life of serum free T4 levels showed marked individual variations. CONCLUSION: Measurement of serum TSH level at about 15 days after total thyroidectomy for differentiated thyroid carcinoma may be useful in determining the time of radioiodine administration.
Half-Life ; Humans ; Hypothyroidism ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin