Carcinoma of the cystic duct remnant is a rare disease. We report a case of a remnant cystic duct carcinoma in a male patient who had undergone cholecystectomy for cholecystolithiasis 20 years previously. A 53-yr-old man visited our hospital for the evaluation of a submucosal tumor on the duodenum. During the evaluation, we detected a mass in the cystic duct remnant by the use of endoscopic ultrasonography. Based on the pathology, the mass was confirmed as a carcinoma of the cystic duct remnant by intraductal ultrasonography and an intraductal biopsy.
Biopsy ; Cholecystectomy ; Cholecystolithiasis ; Cystic Duct ; Duodenum ; Endosonography ; Humans ; Male ; Rare Diseases

PURPOSE: To evaluate the feasibility of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for preoperative concurrent chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC), by comparing with 3-dimensional conformal radiotherapy (3D-CRT). MATERIALS AND METHODS: Patients who were treated with PCRT for LARC from 2015 January to 2016 December were retrospectively enrolled. Total doses of 45 Gy to 50.4 Gy with 3D-CRT or SIB-IMRT were administered concomitantly with 5-fluorouracil plus leucovorin or capecitabine. Surgery was performed 8 weeks after PCRT. Between PCRT and surgery, one cycle of additional chemotherapy was administered. Pathologic tumor responses were compared between SIB-IMRT and 3D-CRT groups. Acute gastrointestinal, genitourinary, hematologic, and skin toxicities were compared between the two groups based on the RTOG toxicity criteria. RESULTS: SIB-IMRT was used in 53 patients, and 3D-CRT in 41 patients. After PCRT, no significant differences were noted in tumor responses, pathologic complete response (9% vs. 7%; p = 1.000), pathologic tumor regression Grade 3 or higher (85% vs. 71%; p = 0.096), and R0 resection (87% vs. 85%; p = 0.843). Grade 2 genitourinary toxicities were significantly lesser in the SIB-IMRT group (8% vs. 24%; p = 0.023), but gastrointestinal toxicities were not different across the two groups. CONCLUSION: SIB-IMRT showed lower GU toxicity and similar tumor responses when compared with 3D-CRT in PCRT for LARC.
Capecitabine ; Chemoradiotherapy* ; Drug Therapy ; Fluorouracil ; Humans ; Leucovorin ; Neoadjuvant Therapy ; Radiotherapy, Conformal* ; Radiotherapy, Intensity-Modulated* ; Rectal Neoplasms* ; Retrospective Studies ; Skin

PURPOSE: To evaluate the feasibility of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for preoperative concurrent chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC), by comparing with 3-dimensional conformal radiotherapy (3D-CRT). MATERIALS AND METHODS: Patients who were treated with PCRT for LARC from 2015 January to 2016 December were retrospectively enrolled. Total doses of 45 Gy to 50.4 Gy with 3D-CRT or SIB-IMRT were administered concomitantly with 5-fluorouracil plus leucovorin or capecitabine. Surgery was performed 8 weeks after PCRT. Between PCRT and surgery, one cycle of additional chemotherapy was administered. Pathologic tumor responses were compared between SIB-IMRT and 3D-CRT groups. Acute gastrointestinal, genitourinary, hematologic, and skin toxicities were compared between the two groups based on the RTOG toxicity criteria. RESULTS: SIB-IMRT was used in 53 patients, and 3D-CRT in 41 patients. After PCRT, no significant differences were noted in tumor responses, pathologic complete response (9% vs. 7%; p = 1.000), pathologic tumor regression Grade 3 or higher (85% vs. 71%; p = 0.096), and R0 resection (87% vs. 85%; p = 0.843). Grade 2 genitourinary toxicities were significantly lesser in the SIB-IMRT group (8% vs. 24%; p = 0.023), but gastrointestinal toxicities were not different across the two groups. CONCLUSION: SIB-IMRT showed lower GU toxicity and similar tumor responses when compared with 3D-CRT in PCRT for LARC.
Capecitabine ; Chemoradiotherapy* ; Drug Therapy ; Fluorouracil ; Humans ; Leucovorin ; Neoadjuvant Therapy ; Radiotherapy, Conformal* ; Radiotherapy, Intensity-Modulated* ; Rectal Neoplasms* ; Retrospective Studies ; Skin

BACKGROUND: Cord blood (CB), which has no HLA restriction, is an alternative to bone marrow for hematopoietic stem cell transplantation. The use of cord blood, however, is limited by the number of progenitor/stem cells necessary to reconstitute the older child or adult. Therefore, ex vivo expansion of CB could have tremendous impact on diverse clinical settings. We studied the ex vivo expansion of isolated population of CD34+ cells from cryopreserved CB cells. METHODS: CD34+ cells were isolated from cryopreserved CB mononuclear cells. Purified cells were cultured with various combinations of hematopoietic growth factors including erythropoietin (EPO), stem cell factor (SCF), granulocyte-colony-stimulating factor (G-CSF), granulocyte, macrophage-colony-stimulating factor (GM-CSF), interleukin-1beta (IL-1beta), IL-3, and IL-6. After 7, 10 or 14 days of culture, the fold increases of colony-forming unit- granulocyte, macrophage (CFU-GM), burst-forming unit-erythroid (BFU-E), colony-forming unit-mix (CFU-Mix), and high proliferative potential colony-forming cell (HPP-CFC) were evaluated. RESULTS: Ten-day culture with the combination of EPO, SCF, G-CSF, IL-1beta, and IL-3 resulted in a median of 60-fold increase of CFU-GM, which was greater than those with the combinations of less than 5 growth factors. The addition of IL-6 or GM-CSF to this combination did not enhance CFU-GM expansion. Ten-day culture was significantly superior to 7-day culture for CFU-GM expansion. Prolongation of culture to 14 days, however, revealed decreased expansion of CFU-GM compared to 10 days. BFU-E and CFU-Mix were expanded to 2~5 folds in 7-day culture with the combination of EPO, SCF, and G-CSF. Further expansion was not achieved in 10-day culture and colonies disappeared in 14-day culture. HPP-CFC was expanded to a median of 7.5 folds in 7-day culture with the combination of EPO, SCF, G-CSF, IL-1beta, IL-3, and IL-6. Neither 10-day or 14 day-culture enhanced expansion of HPP-CFU. CONCLUSION: Cryopreserved cord blood cells maintain ex vivo expansion potential. In our system, 10-day culture with the combination consisting of EPO, SCF, G-CSF, IL-1beta, and IL-3 seems to be adequate for hematopoietic progenitor/stem cell expansion from cryopreserved cord blood cells.
Adult ; Bone Marrow ; Child ; Erythroid Precursor Cells ; Erythropoietin ; Fetal Blood* ; Granulocyte Colony-Stimulating Factor ; Granulocyte-Macrophage Colony-Stimulating Factor ; Granulocyte-Macrophage Progenitor Cells ; Granulocytes ; Hematopoietic Stem Cell Transplantation ; Humans ; Intercellular Signaling Peptides and Proteins ; Interleukin-1beta ; Interleukin-3 ; Interleukin-6 ; Macrophages ; Stem Cell Factor

BACKGROUND/AIMS: The diagnostic and therapeutic utility of endoscopic retrograde cholangiopancreatography (ERCP) has been well demonstrated for biliary and pancreatic diseases. Biliary access can be allowed by infundibulotomy if failed by using the standard cannulation methods. However, no data are available regarding ERCP-related complications in patients taking antiplatelet agents who are undergoing infundibulotomy. Therefore, we aimed to assess the frequency of ERCP-related complications after infundibulotomy in patients taking antiplatelet agents. METHODS: We performed a retrospective study, and enrolled 835 patients who underwent ERCP at Pusan National University Hospital from January 2011 to December 2012. Seventy-two patients had been taking antiplatelet agents prior to the procedure. Patients were classified into two groups according to the utilization of infundibulotomy: 20 patients underwent infundibulotomy (group 1), and 52 patients did not undergo infundibulotomy (group 2). Complications after ERCP were defined as bleeding, post-ERCP pancreatitis, and perforation according to Cotton's criteria. RESULTS: Between group 1 and 2, there were no significant differences in baseline characteristics. ERCP was successfully performed in all cases. Clinically significant bleeding was observed in one patient in group 1 (5%, 1/20) versus none in group 2. Post-ERCP pancreatitis was observed in 2 patients (10.0%, 2/20) in group 1, and 7 patients (13.5%, 7/52) in group 2 (p=0.691). However, none of these differences were statistically significant. No perforation occurred in both groups. CONCLUSIONS: Considering the low incidence of bleeding after infundibulotomy in patients taking antiplatelet agents, infundibulotomy may be safely performed in this group of patients.
Aged ; *Cholangiopancreatography, Endoscopic Retrograde/adverse effects ; Female ; Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Pancreatitis/etiology ; Pituitary Gland/*surgery ; Platelet Aggregation Inhibitors/administration & dosage/*adverse effects ; Retrospective Studies ; Sphincterotomy, Endoscopic