Cholangiocarcinoma is a devastating cancer originating from the epithelial cell lining of the bile duct, whose prognosis is poor due to suboptimal response to therapy despite the fact that the incidence is increasing. Hence surgery still remains the only curative treatment option for cholangiocarcinoma. Recent investigations into the underlying biochemical and molecular mechanisms in biliary carcinogenesis and tumor growth, may illuminate new therapeutic modalities and suggest some new serum and bile markers that could be useful for the diagnosis of cholangiocarcinoma. In this review, we discuss the molecular mechanisms of pathogenesis in cholangiocarcinoma and the role of new tumor makers for the diagnosis of cholangiocarcinoma.
Bile ; Bile Ducts ; Cholangiocarcinoma ; Epithelial Cells ; Incidence ; Prognosis ; Biomarkers, Tumor

Periventricular-intraventricular hemorrhage (PV-IVH)is one of the most important neurologic lesion of the low birth weight infants. Serial neurosonographic exeaminations were performed in 113 low birth weight infants who were admitted to the neonatal intensive care unit of Presbyterian Medical Center from November 1, 1990to July 31, 1991. The results were summarized as follows: 1) The incidence of PV-IVH in the study was 54% 2) According to Papile's grading system of PV-IVH, grade I was 32.8%, grade II was 45.9%, grade IIIwas 11.5% and grade IV was 9.8%. 3) The onset of PV-IVH was within the first 7 days of life in 82%. 4) Poor activity, apnea, bradycardia and hypotension were statistically significant clinical findings associated with PV-IVH(P<0.05). 5) The risk factors associated with PV-IVH were gestational age, birth weight, hyaling membrane disease, patent ductus arteriosus and artifical ventilation. 6) The mortality of PV-IVH was 0% for grade I, 10.7% for grade II,42.9% for grade III and 83.3% for gradeIV.
Apnea ; Birth Weight ; Bradycardia ; Diagnosis* ; Ductus Arteriosus, Patent ; Gestational Age ; Hemorrhage* ; Humans ; Hypotension ; Incidence ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Intensive Care, Neonatal ; Membranes ; Mortality ; Protestantism ; Risk Factors ; Ventilation

In the initial genetic studies about pancreatitis in Korea, gene mutations were thought to be rare. However, the recent findings of PRSS1, SPINK1, and CFTR mutations in patients with idiopathic chronic pancreatitis or inherited cases of chronic pancreatitis are much more common than originally predicted. Therefore, it is important to identify underlying genetic background in idiopathic chronic pancreatitis to avoid progression and development of complications. In addition, concentrated and strict follow-up must be given to the patients because of very high risk of pancreatic cancer. However, it is also true that studies about genetics in pancreatitis were not enough to compare with Western studies. Accordingly, further large scale studies are necessary to find other unknown possible genes that could be related to the chronic and hereditary pancreatitis.
Genetics* ; Humans ; Korea ; Pancreatic Neoplasms ; Pancreatitis* ; Pancreatitis, Chronic

No abstract available.
Churg-Strauss Syndrome* ; Cyclophosphamide*

Pancreatic cancer is one of the most lethal malignancies. Despite the availability of newer and better antineoplastic combinations, the 5-year survival rate for all stages of pancreatic cancer remains only 6%. Palliative care represents an important aspect of care in patient with pancreatic cancer. Thus, optimal palliation of symptoms to maximize remaining quality of life is of primary importance to most patients. This review discusses highlights the most significant problems faced when caring for patients with advanced pancreatic cancer. Common problems include pain, pancreatic insufficiency, anorexia-cachexia and depression. To provide optimal and meaningful supportive care for patients with advanced pancreatic cancer is complex and requires ongoing close monitoring of the physical and emotional aspects of the patient. Prompt management of the many symptoms and problems associated with pancreatic cancer is essential to minimize distress and improve quality of life for patients with this fatal disease. Recognizing end-of-life concerns and patient preferences during the dying process helps clinicians find ways to alleviate suffering for patients and families.
Depression ; Exocrine Pancreatic Insufficiency ; Humans ; Palliative Care ; Pancreatic Neoplasms ; Patient Preference ; Quality of Life ; Survival Rate

EUS currently plays an important role in the diagnosis and treatment of digestive diseases. In addition, EUS-guided sampling has been applied to pancreaticobiliary lesions for the accurate diagnosis of pancreaticobiliary lesions. Many new instruments and studies for EUS-guided sampling are being developed and attempted. This review introduces and summarizes the key recommendations made in the recent guideline for EUS-guided sampling developed by the European Society of Gastrointestinal Endoscopy.
Biliary Tract ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endoscopy, Gastrointestinal ; Pancreas ; Ultrasonography

The Education Board of Korean Society of Gastroenterology (KSG) has three missions: 1) to meet the needs of KSG members, 2) to provide educational opportunities for future members (fellows), and 3) to train world-class experts using latest knowledge. To achieve these objectives, the ‘Education Board’: 1) updates guidelines and provides academic information to KSG members, 2) provides quality education and training for gastroenterology fellows, and 3) offers opportunities to young gastroenterologists to participate in overseas training programs, such as the American Gastroenterology Association, Clinical Observation and Research Education program.
Education ; Fellowships and Scholarships ; Gastroenterology ; Religious Missions

EUS currently plays an important role in the diagnosis and treatment of digestive diseases. In addition, EUS-guided sampling has been applied to pancreaticobiliary lesions for the accurate diagnosis of pancreaticobiliary lesions. Many new instruments and studies for EUS-guided sampling are being developed and attempted. This review introduces and summarizes the key recommendations made in the recent guideline for EUS-guided sampling developed by the European Society of Gastrointestinal Endoscopy.
Biliary Tract ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endoscopy, Gastrointestinal ; Pancreas ; Ultrasonography

BACKGROUND: The endothelium is an important regulator of vascular tone via release of relaxing and constricting substances. The regulatory effect of the endothelium has been shown to be impaired in atherosclerotic arteries in human and animal models of hypertension. But there are some debates on extent and developing time of endothelium dysfunction in patients with hypertension, and the determining factors for endothelium dysfunction also were not defined. The objects of this study are to determine whether endothelial function is impaired in coronary and peripheral arteries, and to investigate the predicting factors for endothelial dysfunction in patients with essential hypertension. METHODS: The study patients comprised 14 patients with essential hypertension(M : 7, Mean age : 50+/-2 year) and 6 normal control (M :2, Mean age : 45+/-4 year). We assessed the vasomotor response to acetylcholine and nitroglycerin by change of arterial diameter during the infusion of acetylcholine, from 10(-9M) to 10(-6M) in coronary artery and 7.5, 15, and 25ug/min in left superficial femoral artery, and on intracoronary injection of 200ug nitroglycerin after acetylcholine infusion. RESULTS: 1) There were no significant differences in sex, age, body mass index and ventricular mass index, except systolic(174+/-5 vs 118+/-7mmHg, p<0.001) and distolic blood pressure(106+/-5 vs 75+/-5mmHg,p<0.001) between patients with hypertension and normal control. 2) There were no significant differences in laboratory date of total cholesterol, HDL-cho-lesterol, lipoprotein(a), microaluminuria and von-Willebrand Factor but Fibrinogen level was raised significantly in patients with hypertension than normal control(299+/-26 vs 192+/-23ng/dl, p=0.04). 3) The vasoconstrictor response to acetylcholine, 10-8 to 10-6 M concentration, at proximal, mid, and distal left anterior descending coronary artery were increased significantly in hypertensive patients than normal control(p<0.05). At rest superficial femoral artery, the vasodilator response to acetylcholine, only 25ug/min, was decreased in patients with hypertension(p<0.05). There was no signficant difference in the vasodilator response to nitroglycerin at coronary artery between two groups but in superficial femoral artery, the vasodilator response to nitroglycerin was decreased significantly in hypertensive patients(p<0.05). CONCLUSIONS: The results of this study suggest that endothelium dependent vascular relaxation is impaired in both coronary and superificial femoral artery and it remained to be investigated the predicting factors for endothelial dysfunction in patients with essential hypertension.
Acetylcholine ; Arteries ; Body Mass Index ; Cholesterol ; Coronary Vessels ; Endothelium ; Femoral Artery ; Fibrinogen ; Humans ; Hypertension* ; Lipoprotein(a) ; Models, Animal ; Nitroglycerin ; Relaxation

BACKGROUND: The exercise stress testing(Treadmill Test) is one of the preferred noninvasive methods of identifying patients with coronary artery disease. ST-segment elevation during or immediately after exercise is uncommon and in most patients, it was associated with prior infarction, left ventricular hypertrophy or left bundle branch block, Exercise-induced ST-segment elevation has been attributed to ventricular wall motion abnormalities, and ischemia due to either coronary vasospasm or ervere proximal coronary stenosis. We examined the clinical, angiographic, and prognostic significance of 16 patients with exercise induced ST-segment elevation. METHODS: 16 patients with exercise-induced ST-segment elevation were retrospectively reviewed. The symptom-limited exercis testing was performedn using a modified Bruce protocol and in patients with acute myocardial infarction(AMI), low level exercise testing(Myocardial infarction protocol) was used. The significant ST-segment elecation was defined as a > or =1mm change present in >1 lead measured at 0.08 sec after J point and in > or =3 consecutive beats. Coronary arteriogram and percutaneous transluminal coronary angioplasty(PTCA) was performed using standard techniques within 7 days of initial exercise testing and a luminal diameter stenosis of >50% was considered significant. RESULTS: 1) We have studied 2076 exercise tests and 16 patients(M/F:15/1, Mean age : 58 years) developed exercise-induced ST-segment elevation. The initial diagnosis were acute myoca rdial infarction(AMI) in 12, variant angina in 2, effort angina in 1 and unstable angina in 1 patient. 9 of 12 patients with AMI were treated with thrombolytic agent(Urokinase 2.5 to 3 million unit) within 6 hours from the onset of chest pain. 2) Mean maximal ST-segment elevation was 2.6mm(range 1-5mm). The leads which showed exercise-induced ST-segment elevation were corresponded to the location of severe coronary stenosis in typical effort angina, to spasm site in variant angina, and to infarction site in AMI. 11 Patients had follow-up exercise testing and showed abolition of exercise-induced ST-segment elevation in 4 of 5 patients with AMI and 1 patient with effort angina after PTCA, and 1 patient with variant angina and 3 of 4 patient with AMI after medication. 3) In 12 patients, coronary angiography was performed, and showed 95% and 90% stenosis at proximal LAD in 2 patients with effort angina and >80% stenosis at proximal or mid lesion of infarct-related artery in 7 patients with AMI. In variant angina, one patient showed normal coronary artery and another patient showed 60% stenosis at mid LAD. On LV angiogram, there were moderate to severe hypokinesia instead of akinesia or dyskinesia at infarction site in all patients with AMI and showed normal LV contractility in patients with effort or variant angina. PTCA were successfully performed in 7 patients(effort angina 2, AMI 5). 4) The clinical follow up for 16 patients were obtained for mean follow-up duration of 17 months and during the clinical follow-up, 1 variant angina patient with mild stenosis at proximal LAD was died with ventricular fibrillation after discontinution of medication. There were CABG due to restenosis in 1 patient and cerebrovascular accident in 1 patient. CONCLUSION: 1) The exercise-induced ST-segment elevation signifies severe ischemia due to either severe proximal coronary stenosis or coronary arterial spasm. In AMI, this findings suggests the residual ischemia(or residual viable myocardium) in addition to left ventricular dyssynergy or aneurysm. 2) Adverse cardiac events can be provented by revascularization in patients who had critical coronary stenosis and by medical therapy in those with coronary vasospasm or mild coronary stenosis.
Aneurysm ; Angina, Unstable ; Arteries ; Bundle-Branch Block ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vasospasm ; Coronary Vessels ; Diagnosis ; Dyskinesias ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertrophy, Left Ventricular ; Hypokinesia ; Infarction ; Ischemia ; Phenobarbital ; Retrospective Studies ; Spasm ; Stroke ; Ventricular Fibrillation