PURPOSE: Endoscopic papillectomy (EP) is currently employed for the treatment of ampullary adenoma. This study aimed to evaluate the clinical, endoscopic, and histologic characteristics related to complications and long-term outcomes of EP. MATERIALS AND METHODS: Thirty-nine patients underwent EP for ampullary adenoma. Patients were grouped according to the occurrence of procedure-related complications: no complication group (n=28) and complication group (n=11). RESULTS: The overall complication rate was 28.2%. The most common complication was EP-related pancreatitis (n=7). Amylase (p=0.006) and lipase levels (p=0.007), 24 hours after EP, were significantly higher in the complication group, however, these levels did not differ at earlier times. As the tumor progressed from adenoma to cancer, the complete resection was significantly lessened (p=0.032). The duration of antiprotease injection during the hospital stay was significantly longer (p=0.017) and the transfusion requirements were significantly higher (p=0.018) in the complication group. During a median follow-up of 15 months, three lesions (10.3%) recurred among patients with complete resection (n=29) and five lesions (12.8%) recurred among enrolled patients. One patient with progressive recurrence from low-grade dysplasia to adenocarcinoma was noted during a follow-up of 22 months. CONCLUSION: If symptoms are present, amylase and lipase levels, 24 hours after EP, could help predict possible EP-related pancreatitis. Histologic diagnosis through resected specimens may result in complete resection. Patients with complications need a longer duration of antiprotease injection during their hospital stay and more transfusions. The recurrence rate was not significantly high in completely resected cases, however, there was a possibility of progressive recurrence.
Adenoma/*surgery ; Adult ; Aged ; Aged, 80 and over ; Common Bile Duct Neoplasms/*surgery ; Endoscopy/*methods ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies

Congenital anomalies or normal variants of the pancreatic duct are in most cases asymptomatic and are found incidentally while conducting imaging studies (such as a MRCP and a CT scan) for other reasons. The frequency of pancreatic duct variants has been reported to be about 9% of the general population; the most common type is a bifid configuration of the major and minor pancreatic ducts. Though most patients with pancreatic duct variants do not have any symptoms, a small number may develop jaundice or gallstones. By reporting the case of a patient with a variant pancreatic duct who developed acute pancreatitis after undergoing screening endoscopy and biopsy, this study aims to warn of the possible risks of screening endoscopy or biopsy in the second portion of the duodenum.
Biopsy ; Duodenum ; Endoscopy ; Endoscopy, Digestive System ; Gallstones ; Humans ; Jaundice ; Mass Screening ; Pancreatic Ducts ; Pancreatitis

Tuberculosis is an opportunistic infection that causes significant morbidity and mortality in recipients of renal transplants. Although tuberculous peritonitis is easily diagnosed by paracentesis, it is difficult to diagnosis in the absence of ascites. Laparotomy and laparoscopic biopsies are needed for the diagnosis of tuberculous peritonitis. According to recent reports, the latter has a better outcome because of fewer associated complications. A case of tuberculous peritonitis in a renal transplant patient is reported that was diagnosed by laparoscopic peritoneal biopsy
Ascites ; Biopsy ; Humans ; Kidney Transplantation ; Laparotomy ; Opportunistic Infections ; Paracentesis ; Peritonitis, Tuberculous ; Renal Dialysis ; Transplants ; Tuberculosis

Infection of hepatic cyst is a serious complication of autosomal dominant polycystic kidney disease (ADPKD). Early diagnosis of infected cyst is crucial and usually requires conventional modalities, including ultrasound and computed tomography. However, their contribution is limited because of nonspecific results. We report a case of hepatic cyst infection for which 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) scan allowed the exact localization of the infected cyst and the precise drainage procedure. A 48-year-old woman with ADPKD presented with fever and RUQ pain. Contrast enhanced computed tomography did not show any evidence of complicated or infected cysts in both kidneys and liver. Though she had been treated by antibiotics for 7 days, patient's symptoms were not improved. However, 18F-FDG PET-CT scan revealed infected cyst in the left lobe of liver exactly. After percutaneous drainage based on 18F-FDG PET-CT imaging, the hepatic cyst infection was controlled. Therefore, 18F-FDG PET-CT imaging could be a valuable tool to identify the exact localization of cyst infection, which may contribute to drain the infected cyst. We report this case with a brief review of relevant literature.
Anti-Bacterial Agents ; Drainage ; Early Diagnosis ; Electrons ; Female ; Fever ; Fluorodeoxyglucose F18 ; Humans ; Kidney ; Liver ; Middle Aged ; Polycystic Kidney Diseases ; Polycystic Kidney, Autosomal Dominant ; Positron-Emission Tomography

PURPOSE: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system. The pathogenesis is not well known, but it is thought to be an immune-mediated disease and may follow a viral infection or vaccinations. MRI demonstrates decreased signal on T1 weighting and increased signal on T2-weighted image. We report clinical features and characteristic MRI findings in seven patients with ADEM who confirmed the preceding infections serologically. METHODS: Patients admitted to the Department of Pediatrics at Asan Medical Center as having ADEM were evaluated for the preceding infections : CSF findings, MRI findings, effects of high-dose steroids and follow-up on changes of neurological symtoms and MRI findings. RESULTS: The onset of neurological symptoms from preceding infection was between 1-3 weeks. The etiologies were Epstein-Barr virus in two, mycoplasma pneumoniae in three, and measles virus in two cases. All lesions found in MRI were cerebral white matter lesions of which there were subcortical white matter in three, corpus callosum in three, deep white matter in two, periventricular white matter in one, internal capsule in one, and cerebral peduncle in one case. There were a total of 3 cases with gray matter lesions. Two cases were treated with high- dose methyl prednisolone, one which showed a good clinical response with much improved lesions on follow-up T2-weighted image, but no clinical response in the other with aggravated MRI lesions. There was 1 patient with gadolinium enhancement lesion in acute phase and the lesion was completely resolved after steroid treatment. CONCLUSION: MRI shows various features in ADEM and may be useful in diagnosis and evaluation of clinical course.
Central Nervous System ; Chungcheongnam-do ; Corpus Callosum ; Demyelinating Diseases ; Diagnosis ; Encephalomyelitis, Acute Disseminated* ; Follow-Up Studies ; Gadolinium ; Herpesvirus 4, Human ; Humans ; Internal Capsule ; Magnetic Resonance Imaging* ; Measles virus ; Mycoplasma pneumoniae ; Pediatrics ; Pneumonia, Mycoplasma ; Prednisolone ; Steroids ; Tegmentum Mesencephali ; Vaccination

BACKGROUND: Left ventricular remodeling after acute myocardial infarction has been identified as an important prognostic factor because it leads to ventricular enlargement, ventricular aneurysm, and increased mortality. However predictors of left ventricular remodeling are not clearly defined. This study was perforrned to evaluate the efficacy of dobutamine echocardiography in the prediction of left ventricular remodeling in patients with acute myocardial infarction. METHODS: Forty-five patients(39 males, age 56.9+/-10.2 years) with acute myocardial infarction(AMI) and patent infarct-related artery(no significant narrowing with/without revascularization) underwent dobutamine echocardiography at 2 7 days after AMI. The stages of dobutamine infusion were baseline, 5, 10, 20ug/kg/min, and images at each stage were directly compared and analyzed with the use of 16-segment model(by American Society of Echocardiography) and scoring system(1: normal, 2: mild to moderate hypokinesia, 3: severe hypokinesia, 4: akinesia, 5: dyskinesia). The viability of infarct zone was defined as improvement of wall motion score in more than 2 contiguous segments during dobutamine infusion in areas of resting asynergy. Coronary angiography was performed at 7~10 days after AMI and revascularization of infarct-related artery was done, if severe stenosis was present. Follow-up(F/ U) echocardiography was performed more than 3 months after AMI. We have measured left ventricular end-diastolic and end-systolic volume at baseline, dobutamine(peak dose) and follow-up echocardiography by modified Simpsons method. RESULTS: 1) Dobutamine echocardiography was performed at 5.5+3.9 days after acute myocardial infarction, and follow-up echocardiography was performed at 7.5+3.4 months after dobutamine echocardiography. 2) We assessed left ventricular end-diastolic volume(LVEDV) at follow-up echocardiography compared to LVEDV at baseline echocardiography, and patients were divided into 2 groups. Group 1(n=14) with increase in LVEDV during F/U period(mean change 13.9+14.2ml); Group 2(n=31) with no increase in LVEDV volume during F/U period(mean change 27.4+22.1). Between two groups, clinical parameters such as age, sex, incidence of anterior myocardial infarction, incidence of non-Q myocardial infarction, peak CK, peak CKMB, pre-infarction angina, incidence of reperfusion therapy, follow-up duration, were not significantly different. 3) Between group 1 and group 2, there were no singnificant differences in baseline echocardiographic parameters such as ejection fraction, wall motion score index, LVEDV, LV enddiastolic dimension. 4) In group 1, the incidence of patients with infarct zone viability assessed by dobutamine echocardiography was significantly snialler than the one in group 2(5 of 14 and 21 of 31, respectively, p <0.05). 5) Beween group 1 and group 2, the change of LVEDV at dobutamine echocardiography compared to LVEDV at baseline echocardiography was significantly different( -1.3+/-17.7 and -17.1+/-26.2, respectively, p<0.05). 6) Linear regression analysis indicated that the change of LVEDV during follow-up period was predicted by the change of LVEDV during dobutamine echocardiography. LVEDV(F/U) LVEDV(baseline) = 0.726[LVEDV(dobutamine) LVEDV(baseline) ] 5.648(r=0.65, p<0.05) CONCLUSION: The viability of infarct zone assessed by dobutamine echocardiography was predictive of left ventricular remodeling at F/U of acute myocardial infarction and the change in LVEDV during dobutamine echocardiography correlated with the change in LVEDV at follow-up of acute myocardial infarction. Dobutamine echocardiography can be an useful tool for the prediction of LV remodeling after acute myocardial infarction.
Aneurysm ; Arteries ; Constriction, Pathologic ; Coronary Angiography ; Dobutamine* ; Echocardiography* ; Follow-Up Studies ; Humans ; Hypokinesia ; Incidence ; Linear Models ; Male ; Mortality ; Myocardial Infarction* ; Reperfusion ; Ventricular Remodeling*

BACKGROUND/AIMS: The apolipoprotein B/A-I ratio (ApoB/A-I) is a powerful clinical indicator of atherosclerosis. Although numerous reports have shown the effect of non-alcoholic fatty liver disease (NAFLD) on cardiovascular disease, few reports have examined the relationship between NAFLD and the ApoB/A-I ratio. The aim of the study was to determine the association between NAFLD and the ApoB/A-I ratio in prediabetic patients. METHODS: This cross-sectional study was performed with data obtained from 701 patients (mean age, 47.9+/-9.6 years) diagnosed with prediabetes. Serum lipid profiles including lipoprotein, apolipoprotein, and calculated ApoB/A-I ratio as well as metabolic syndrome parameters such as fasting glucose and insulin were measured in each subject. RESULTS: Among the 701 patients, 340 (48%) had NAFLD. The number of male patients was 490 (NAFLD+, 276; and NAFLD-, 214). The odds ratios for the prevalence of NAFLD increased according to the quartiles of the ApoB/A-I ratio (1.886, 2.245, and 2.587) (p<0.001). CONCLUSIONS: The prevalence of NAFLD correlated with high ApoB/A-I ratio, suggesting that NAFLD increases the risk for atherosclerosis progression in male prediabetic patients.
Apolipoprotein A-I ; Apolipoproteins ; Atherosclerosis ; Cardiovascular Diseases ; Cross-Sectional Studies ; Fasting ; Fatty Liver ; Glucose ; Humans ; Insulin ; Lipoproteins ; Male ; Odds Ratio ; Prediabetic State ; Prevalence

In recent years, next-generation sequencing (NGS)–based genetic testing has become crucial in cancer care. While its primary objective is to identify actionable genetic alterations to guide treatment decisions, its scope has broadened to encompass aiding in pathological diagnosis and exploring resistance mechanisms. With the ongoing expansion in NGS application and reliance, a compelling necessity arises for expert consensus on its application in solid cancers. To address this demand, the forthcoming recommendations not only provide pragmatic guidance for the clinical use of NGS but also systematically classify actionable genes based on specific cancer types. Additionally, these recommendations will incorporate expert perspectives on crucial biomarkers, ensuring informed decisions regarding circulating tumor DNA panel testing.

In recent years, next-generation sequencing (NGS)–based genetic testing has become crucial in cancer care. While its primary objective is to identify actionable genetic alterations to guide treatment decisions, its scope has broadened to encompass aiding in pathological diagnosis and exploring resistance mechanisms. With the ongoing expansion in NGS application and reliance, a compelling necessity arises for expert consensus on its application in solid cancers. To address this demand, the forthcoming recommendations not only provide pragmatic guidance for the clinical use of NGS but also systematically classify actionable genes based on specific cancer types. Additionally, these recommendations will incorporate expert perspectives on crucial biomarkers, ensuring informed decisions regarding circulating tumor DNA panel testing.