PURPOSE: We investigated the role of radiotherapy (RT) for pancreatobiliary neuroendocrine tumors (PB-NETs). MATERIALS AND METHODS: We identified 9 patients with PB-NETs who received RT between January 2005 and March 2012. Of these 9 patients, 4 were diagnosed with NETs in the pancreas and 5 were diagnosed with NETs in the gallbladder. All patients received RT to the primary tumor or resection bed with a median total irradiation dose of 50.4 Gy, with or without chemotherapy. RESULTS: The tumor response rate and tumor control rate in the RT field were 60% and 100 %, respectively. All 4 patients who underwent surgery had no evidence of disease in the RT field. Of the 5 patients who received RT to the primary gross tumor, 1 had complete response, 2 had partial response, and 2 had stable disease in the RT field. The median time to progression was 11 months. Of the 9 patients, four patients had no progression, and 5 patients had progression of disease (locoregional, 2; distant, 2; locoregional/distant, 1). Of the 4 patients without progression, 3 were treated with RT in adjuvant or neoadjuvant setting, and one received RT to primary tumor. One patient experienced radiation-induced duodenitis at 3 months after concurrent chemoradiation without treatment-related mortality. CONCLUSION: RT can yield local control for advanced PB-NETs. RT should be considered an essential part of multimodality treatment in management of advanced PB-NETs.
Duodenitis ; Gallbladder ; Humans ; Neuroendocrine Tumors ; Pancreas ; Treatment Outcome

Henoch-Schönlein purpura (HSP) is a systemic vasculitis involving the small vessels with distinct clinical features. The etiology of HSP is diverse, and viral infection is one of the many predisposing factors. Cytomegalovirus (CMV) infection mostly affects immune-suppressed patients, but rarely patients with normal immunity can also be affected. Authors experienced a case of HSP patient, with underlying small-cell lung cancer (SCLC) with CMV duodenitis. This is a rare case of HSP diagnosed in SCLC patient with predisposing factor of CMV infection.
Causality ; Cytomegalovirus* ; Duodenitis* ; Humans ; Lung Neoplasms ; Purpura* ; Systemic Vasculitis

Cytomegalovirus(CMV) disease is a major cause of morbidity and mortality in immunocompromised patients. CMV enteritis should be considered when nausea and vomiting continue 3 to 4 weeks after bone marrow transplantation(BMT). The treatment of CMV enteritis is not well established. We report a CMV duodenitis patient following allogenic bone marrow transplantation. The patient had prolonged nausea and vomiting for 5 weeks after bone marrow transplantation and CMV duodenitis was diagnosed by the gastroduodenoscopic mucosal biopsy which showed cytomegalic cells. Ganciclovir treatment for 3 weeks resulted in the resolution of symptoms and promoted healing of the lesion. The patient was free of CMV infection until 288 days after allogenic BMT without maintenance ganciclovir treatment.
Adult ; Antiviral Agents/therapeutic use* ; Bone Marrow Transplantation/adverse effects ; Case Report ; Cytomegalovirus Infections/etiology ; Cytomegalovirus Infections/drug therapy* ; Cytomegalovirus Infections/diagnosis ; Duodenitis/etiology ; Duodenitis/drug therapy* ; Duodenitis/diagnosis ; Ganciclovir/therapeutic use* ; Human ; Male ; Transplantation, Homologous

BACKGROUND/AIMS: It has been suggested that gastric metaplasia in the duodenum is prerequisite for duodenal ulcer. The aim of this study was to investigate the role of clinicopathologic parameters of the duodenum such as endoscopic diagnosis, pathologic findings and Helicobacter pylori (H. pylori) infection on the development of gastric metaplasia. METHODS: Endoscopic records as well as pathologic findings of 390 patients were reviewed. The degree of gastric metaplasia in duodenum was evaluated. H. pylori infection was determined by immunohistochemical staining. RESULTS: The degree of gastric metaplasia was higher in duodenal ulcers and hyperplastic duodenal polyps than in chronic duodenitis. The degree of gastric metaplasia was closely related to severe acute inflammation, mild chronic inflammation and H. pylori infection in duodenum. Duodenal ulcers showed higher acute inflammation and a higher incidence of H. pylori infection than hyperplastic polyps and chronic duodenitis. CONCLUSIONS: Gastric metaplasia in duodenal ulcers may be related to duodenal inflammation and H. pylori infection, whereas in hyperplastic polyps gastric metaplasia may occur by another mechanism.
Duodenal Ulcer ; Duodenitis ; Duodenum ; Helicobacter pylori ; Humans ; Incidence ; Inflammation ; Metaplasia ; Polyps

Antral web is a very rare cause of vomiting in child, known to be a congenital disorder caused by incomplete recanalization of embryonic foregut, and in almost cases treated surgically. Author experienced a case of antral web in a 4-year-old boy who had suffered from severe abdominal pain for 2 months, in whom erosive duodenitis was noted on endoscopic examination. The patient became symptomfree after 1 week of conservative treatment for duodenitis. No specific therapy was not required for the antral web. Author concluded that surgical treatment is indicated for the clinically severe cases.
Abdominal Pain ; Child* ; Child, Preschool ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Duodenitis ; Humans ; Male ; Vomiting

PURPOSE: Nodular duodenitis is defined as two or more erythematous nodules in the duodenum, with surrounding inflammation and with or without apical erosions. But the clinical features and natural history of nodular duodenitis remain largely undefined, therefore we examined clinical, endoscopic and pathologic features of nodular duodenitis in children to find about its natural history, relationship between endoscopic and pathologic findings, relationship between Helicobacter pylori and nodular duodenitis as well as clinical response to antisecretory therapy. METHODS: Forty-nine children presented with chronic abdominal pain, chronic diarrhea, vomiting and indigestion showed nodular duodenitis on gastroduodenoscopic examinations at the Department of pediatrics of Hangyang University Hospital from January 1995 to August 1997. Endoscopic and pathologic findings were graded and the correlation coefficient between endoscopic and pathologic grades were analyzed. Clinical responses to therapy were compared between Helicobacter pylori (H. pylori)-associated and non H. pylori-associated children. RESULTS: The chief most common complaint was chronic abdominal pain and this disease was most commonly developed in females and in school-aged children. In endoscopic examinations, Grade 1 was the most commonly noted, while in pathologic examinations, Grade 2 was most common. The correlation coefficient between endoscopic and pathologic findings was 0.278 (P= 0.053). Clinical symptoms were improved by H2-blocker or anti-H. pylori therapy in most patients. CONCLUSION: There was no significant correlation between endoscopic and pathologic grades. H. pylori infection may be an etiologic factor of nodular duodenitis in some cases.
Abdominal Pain ; Child* ; Diarrhea ; Duodenitis* ; Duodenum ; Dyspepsia ; Female ; Helicobacter pylori ; Humans ; Inflammation ; Natural History ; Pediatrics ; Vomiting

A gangliocytic paraganglioma (GP) is a rare benign neuroendocrine tumor. However, its origin remains unclear. It is seen most frequently in the second portion of the duodenum. At endoscopy, a GP characteristically appears as a pedunculated nodular submucosal tumor with erosions and surface ulcers. The histological diagnosis is usually made from endoscopic biopsies showing the presence of epithelioid, spindle, and ganglion cells. We experienced a case of GP in a 38-year-old female who was referred because of a possible ampullary tumor. The endoscopic images showed a 1.5-cm, oval ampullary tumor covered with normal mucosa. An endoscopic biopsy showed chronic duodenitis. The tumor was removed by an endoscopic papillectomy. We report a case of duodenal GP that presented as a submucosal tumor that was treated with a papillectomy and review the literature.
Adult ; Biopsy ; Diagnosis ; Duodenitis ; Duodenum ; Endoscopy ; Female ; Ganglion Cysts ; Humans ; Mucous Membrane ; Neuroendocrine Tumors ; Paraganglioma* ; Ulcer

Ulcerative colitis (UC) is a chronic inflammatory disorder of the colonic mucosa that characteristically affects the rectum and involves the large bowel in a contiguous distribution. Upper gastrointestinal inflammation was not believed to be present in UC, but a few recent studies have reported a high incidence of gastroduodenal inflammation in patients with UC, although such occurrences are apparently rare and the stomach and duodenum are not generally considered target organs in UC. Here, we present the case of a 29.year.old man with UC who was found to have diffuse ulcerative duodenitis with endoscopic and histologic features identical to UC
Colitis, Ulcerative ; Colon ; Duodenitis ; Duodenum ; Humans ; Incidence ; Inflammation ; Mucous Membrane ; Rectum ; Stomach ; Ulcer

A clinieal Observation was done on the 110 cases (male; 52 cases, female; 58 cases) of duodenitis under the gastroduodenoscopic examination among the patients who were performed endoscopic examination because of seeking for the cause of dyspepsia period from Aug. 1981 to Sep. 1981 at Department of lnteral Medicine of BNUH. The results were summerized as follow 1) Normal finding(Grade 0) was highest as 40% in the incidence according to grade of duodenits. Next was moderate (Grade II & II) as 24. 5%, the 3rd was mild(Grade I) as 20% and lowest in severe(Grade IV) duadenitis as 15.5%, 2) Sex distribution of duodenitis showed 37 cases in male and 29 cases in female. And male was slightly higher in incidence than female. 3) Age distribution of duodenitis revealeii 3rd decade and 4th decade were highest in incidence, 30 cases and 28 cases respectively. The order of frequency was 5th decade, 6th decade, 1st decade and 7th decade. 4) Duodenitis was slightly higher in after 4th decade than before 4th decade. 5) The 56 cases of duodenitis except for 1 case were aasociated with gastroduodenal diseases such as gastritis, peptic ulcer or gastric carcinoma. Association of gastritis is highest as 79. 4%. 6) Acurracy of diagnosis in duodenitis on X-ray study was 3 cases in 20 cases. Generally X-ray study was little value in diagnosis of duodenitis.
Age Distribution ; Diagnosis ; Duodenitis* ; Dyspepsia ; Female ; Gastritis ; Humans ; Incidence ; Male ; Peptic Ulcer ; Sex Distribution

This study was conducted to assess the effects of implementation of the patient referral system started July 1st, 1989. A comparison on the pattern of outpatient services of the Departments of Internal Medicine, General Surgery, and Pediatrics at the Yeungnam University Hospital was conducted for each one year period before and after implementation of the patient referral system. The pre-implementation period was from July 1. 1988 to June 30, 1989 and the post-implementation period was from July 1. 1989 to June 30, 1990. The information used for this study was obtained from official forms, prepared by the Yeungnam University Hospital, and submitted to the Korean Medical Insurance Cooperatives. After implementation of the patient referral system, the number of outpatient cases in the Department of Internal Medicine decreased 36.1% from 9,669 cases to 6,181 cases a year. Cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of Pediatrics decreased 36.9% from 3,372 cases to 2,128 cases a year. After implementation of the patient referral system, the average age of cases in the Departments of Internal Medicine and General Surgery was 52.5 and 49.7 years old, respcetively. This was a significant increase in comparison with the pre-implementation period. After implementation of patient referral system, the proportion of new outpatients in the Department of Internal Medicine decreased form 24.1% to 14.6%, the Department of General Surgery from 36.0% to 23.4%, and the Department of Pediatrics from 15.5% to 8.3%. The number of visits per case decreased significantly in the Department of Internal Medicine(from 1.74 to 1.61), but there was no significant change in the Department of General Surgery and Pediatrics. The length of treatment per case increased significantly in all three departments (form 16.1 days to 19.3 days in the Department of Internal Medicine, from 12.0 days to 15.2 days in the Department General Surgery, and 8.9 days to 11.2 days in the Department of Pediatrics). The number of clinical tests per case increased significantly in the Department of Internal Medicine (from 22. to 2.5), in the Department of Pediatrics(from 0.8 to 1.1) and increased in the Department of General Surgery(from 6.4 to 6.6). The average medical cost per case decreased form 43,900 Won to 42,500 Won in the Department of Internal Medicine, while the cost increased from 75,900 Won to 78,500 Won in the Department of General Surgery and from 12,700 Won to 13,500 Won in the Department of Pediatrics. In case-mix, the chronic degenerative disease(i. e. hypertension, diabetes mellitus, angina pectoris, malignant neoplasm, and pulmonary tuberculosis) ranked higher and acute infectious diseases and simple cases(i. e. gastritis and duodenitis, haemorrhoids, anal fissure, carbuncle, acute URI, and bronchitis) ranked lower after implementation of the patient referral system compared to before implementation.
Angina Pectoris ; Carbuncle ; Communicable Diseases ; Diabetes Mellitus ; Duodenitis ; Fissure in Ano ; Gastritis ; Humans ; Hypertension ; Insurance ; Internal Medicine ; Outpatients* ; Pediatrics ; Referral and Consultation*