Purpose: This study aimed to assess combined effects of early oral feeding after Cesarean section (C/S) under regional anesthesia on bowel function, gastrointestinal complications and surgical recovery. Methods: A systematic literature search was conducted using KISS, RISS, PubMed, CINAHL, EMBASE, CENTRAL and Google Scholar to identify randomized clinical trials comparing early oral feeding (EOF) with delayed oral feeding (DOF) after C/S. Outcome variables were bowel function and gastrointestinal complications and surgical recovery. Effect size was calculated using weighted mean differences (WMDs) and relative risks (RRs), with 95% confidence intervals (CIs). Results: Seven studies involving 1,911 patients from 568 studies, 7 studies were included in meta-analysis. EOF was significantly associated with shorter time to recover bowel movement compared with DOF (WMD, - 2.50; CI, - 3.50~- 1.50). EOF was not associated with nausea (RR, 1.15; CI, 0.87~1.53) and vomiting (RR, 0.96; CI, 0.65~1.42), but lower incidence of abdominal distension (RR, 0.70; CI, 0.50~0.98). EOF was significantly associated with shorter time to discontinuation of intravenous fluids (WMD, - 8.88; 95% CI, - 16.65~- 1.11) and removal of urinary catheter (WMD, - 15.23; CI, - 25.62~- 4.85). Conclusion This meta-analysis provides evidence that EOF after C/S under regional anesthesia not only accelerates return of bowel function and surgical recovery but also reduces gastrointestinal complications. These results suggest that EOF should be offered to women who have undergone C/S to improve the recovery experience and reduce overall medical costs.

Purpose: The prevalence and incidence of eosinophilic esophagitis (EoE) are increasing worldwide. Despite increased understanding of inflammatory pathogenesis, changes in endoscopic features after treatment of EoE have not been clearly described.We aimed to investigate the reversibility of endoscopic features of EoE after treatment. Materials and Methods: Out of 58 adult subjects who were diagnosed with EoE at the Yonsei University Health System from July 2006 to August 2019, we recruited 33 subjects (30 males; mean age: 42 years) whose pre-treatment and post-treatment endoscopic images were available. Endoscopic features included both inflammatory and fibrostenotic features. Exudate, edema, furrow, and crepe paper-like mucosa were classified as inflammatory features. Ring and stricture were classified as fibrostenotic features. We compared changes in endoscopic features after treatment for EoE. Results: After treatment, clinical symptoms improved in all patients. The following endoscopic features were observed before treatment: furrow (81.8%), edema (90.9%), exudate (42.4%), ring (27.3%), crepe paper-like mucosa (15.2%), and stricture (3.0%).Endoscopic remission was achieved in 21 patients (63.6%). Inflammatory features were reversible (72.7%, p<0.001), whereas fibrostenotic features were not (10%, p=0.160). Exudate had resolved in 92.9% of patients, edema in 70% and furrow in 88.9%. Ring and stricture persisted in almost all of the patients (9/10) who had these endoscopic features before treatment. Conclusion We outlined the reversibility of endoscopic inflammatory features of EoE. Fibrostenotic features were irreversible after esophageal remodeling in patients with EoE. However, further validation studies with long-term follow-up are needed.

Purpose: The prevalence and incidence of eosinophilic esophagitis (EoE) are increasing worldwide. Despite increased understanding of inflammatory pathogenesis, changes in endoscopic features after treatment of EoE have not been clearly described.We aimed to investigate the reversibility of endoscopic features of EoE after treatment. Materials and Methods: Out of 58 adult subjects who were diagnosed with EoE at the Yonsei University Health System from July 2006 to August 2019, we recruited 33 subjects (30 males; mean age: 42 years) whose pre-treatment and post-treatment endoscopic images were available. Endoscopic features included both inflammatory and fibrostenotic features. Exudate, edema, furrow, and crepe paper-like mucosa were classified as inflammatory features. Ring and stricture were classified as fibrostenotic features. We compared changes in endoscopic features after treatment for EoE. Results: After treatment, clinical symptoms improved in all patients. The following endoscopic features were observed before treatment: furrow (81.8%), edema (90.9%), exudate (42.4%), ring (27.3%), crepe paper-like mucosa (15.2%), and stricture (3.0%).Endoscopic remission was achieved in 21 patients (63.6%). Inflammatory features were reversible (72.7%, p<0.001), whereas fibrostenotic features were not (10%, p=0.160). Exudate had resolved in 92.9% of patients, edema in 70% and furrow in 88.9%. Ring and stricture persisted in almost all of the patients (9/10) who had these endoscopic features before treatment. Conclusion We outlined the reversibility of endoscopic inflammatory features of EoE. Fibrostenotic features were irreversible after esophageal remodeling in patients with EoE. However, further validation studies with long-term follow-up are needed.

Background: Angiolipoma is a disorder characterized by the development of distinct, encapsulated subcutaneous tumors. Unlike lipoma, angiolipoma is distinctively accompanied by tenderness, which does not respond to general painkillers. Additionally, the reason for the pain has not been elucidated yet. Objective: This study aims to investigate platelet aggregation as the potential cause of tenderness in angiolipoma. Methods: Twenty-three patients diagnosed with angiolipoma and lipoma were enrolled. Platelet aggregation was visualized by CD61 immunohistochemical staining. The area of platelet aggregation and vessel lumen in a high power field were measured with the QuPath software. The ratio between the area of platelet aggregation and vessel lumen (p/v ratio) was calculated from the captured images. Results: Eleven of 46 patients complained of tenderness (9/23 angiolipoma [39.1%], 2/23 lipoma [8.7%]).Angiolipoma demonstrated a higher p/v ratio than that observed in lipoma (0.27 vs. 0.09, p＜0.001). Furthermore, the mean p/v ratio was high in patients with tenderness (0.44 vs. 0.09, p＜0.01). Patients were divided into three groups according to the aggregation pattern, highly clustered, mixed, and particulated. Nine patients with angiolipoma presented a highly clustered pattern, meanwhile, only three patients with lipoma exhibited a highly clustered pattern. Moreover, the number of patients with tenderness was significant in the highly clustered group (63.6%). Additionally, among the highly clustered group, the mean p/v ratio was higher in patients with tenderness (0.52 vs. 0.24, p＜0.01). Conclusion As clustered platelet aggregation with a high p/v ratio demonstrated relevance to tenderness, medications inhibiting platelet aggregation could mitigate tenderness in patients with angiolipoma.

Background: Angiolipoma is a disorder characterized by the development of distinct, encapsulated subcutaneous tumors. Unlike lipoma, angiolipoma is distinctively accompanied by tenderness, which does not respond to general painkillers. Additionally, the reason for the pain has not been elucidated yet. Objective: This study aims to investigate platelet aggregation as the potential cause of tenderness in angiolipoma. Methods: Twenty-three patients diagnosed with angiolipoma and lipoma were enrolled. Platelet aggregation was visualized by CD61 immunohistochemical staining. The area of platelet aggregation and vessel lumen in a high power field were measured with the QuPath software. The ratio between the area of platelet aggregation and vessel lumen (p/v ratio) was calculated from the captured images. Results: Eleven of 46 patients complained of tenderness (9/23 angiolipoma [39.1%], 2/23 lipoma [8.7%]).Angiolipoma demonstrated a higher p/v ratio than that observed in lipoma (0.27 vs. 0.09, p＜0.001). Furthermore, the mean p/v ratio was high in patients with tenderness (0.44 vs. 0.09, p＜0.01). Patients were divided into three groups according to the aggregation pattern, highly clustered, mixed, and particulated. Nine patients with angiolipoma presented a highly clustered pattern, meanwhile, only three patients with lipoma exhibited a highly clustered pattern. Moreover, the number of patients with tenderness was significant in the highly clustered group (63.6%). Additionally, among the highly clustered group, the mean p/v ratio was higher in patients with tenderness (0.52 vs. 0.24, p＜0.01). Conclusion As clustered platelet aggregation with a high p/v ratio demonstrated relevance to tenderness, medications inhibiting platelet aggregation could mitigate tenderness in patients with angiolipoma.

Background: Angiolipoma is a disorder characterized by the development of distinct, encapsulated subcutaneous tumors. Unlike lipoma, angiolipoma is distinctively accompanied by tenderness, which does not respond to general painkillers. Additionally, the reason for the pain has not been elucidated yet. Objective: This study aims to investigate platelet aggregation as the potential cause of tenderness in angiolipoma. Methods: Twenty-three patients diagnosed with angiolipoma and lipoma were enrolled. Platelet aggregation was visualized by CD61 immunohistochemical staining. The area of platelet aggregation and vessel lumen in a high power field were measured with the QuPath software. The ratio between the area of platelet aggregation and vessel lumen (p/v ratio) was calculated from the captured images. Results: Eleven of 46 patients complained of tenderness (9/23 angiolipoma [39.1%], 2/23 lipoma [8.7%]).Angiolipoma demonstrated a higher p/v ratio than that observed in lipoma (0.27 vs. 0.09, p＜0.001). Furthermore, the mean p/v ratio was high in patients with tenderness (0.44 vs. 0.09, p＜0.01). Patients were divided into three groups according to the aggregation pattern, highly clustered, mixed, and particulated. Nine patients with angiolipoma presented a highly clustered pattern, meanwhile, only three patients with lipoma exhibited a highly clustered pattern. Moreover, the number of patients with tenderness was significant in the highly clustered group (63.6%). Additionally, among the highly clustered group, the mean p/v ratio was higher in patients with tenderness (0.52 vs. 0.24, p＜0.01). Conclusion As clustered platelet aggregation with a high p/v ratio demonstrated relevance to tenderness, medications inhibiting platelet aggregation could mitigate tenderness in patients with angiolipoma.

Background: Angiolipoma is a disorder characterized by the development of distinct, encapsulated subcutaneous tumors. Unlike lipoma, angiolipoma is distinctively accompanied by tenderness, which does not respond to general painkillers. Additionally, the reason for the pain has not been elucidated yet. Objective: This study aims to investigate platelet aggregation as the potential cause of tenderness in angiolipoma. Methods: Twenty-three patients diagnosed with angiolipoma and lipoma were enrolled. Platelet aggregation was visualized by CD61 immunohistochemical staining. The area of platelet aggregation and vessel lumen in a high power field were measured with the QuPath software. The ratio between the area of platelet aggregation and vessel lumen (p/v ratio) was calculated from the captured images. Results: Eleven of 46 patients complained of tenderness (9/23 angiolipoma [39.1%], 2/23 lipoma [8.7%]).Angiolipoma demonstrated a higher p/v ratio than that observed in lipoma (0.27 vs. 0.09, p＜0.001). Furthermore, the mean p/v ratio was high in patients with tenderness (0.44 vs. 0.09, p＜0.01). Patients were divided into three groups according to the aggregation pattern, highly clustered, mixed, and particulated. Nine patients with angiolipoma presented a highly clustered pattern, meanwhile, only three patients with lipoma exhibited a highly clustered pattern. Moreover, the number of patients with tenderness was significant in the highly clustered group (63.6%). Additionally, among the highly clustered group, the mean p/v ratio was higher in patients with tenderness (0.52 vs. 0.24, p＜0.01). Conclusion As clustered platelet aggregation with a high p/v ratio demonstrated relevance to tenderness, medications inhibiting platelet aggregation could mitigate tenderness in patients with angiolipoma.

Gastrointestinal neuroendocrine tumors arise from cells of the diffuse neuroendocrine system and can take place almost anywhere within the gastrointestinal tract. A 40-year-old man admitted to evaluate a duodenal subepithelial lesion which was incidentally found at health check-up. The polypoid duodenal subepithelial lesion, measuring about 7 mm, was removed by the endoscopic mucosal resection and the pathology confirmed a neuroendocrine tumor. Abdominopelvic computed tomography, done for staging work up, revealed a mass in the pancreatic head and the patient received pylorus preserving pancreaticoduodenectomy. Mass at the pancreas also found out to be neuroendocrine tumor but showed different histopathologic traits under immunohistochemical staining. The patient was also diagnosed as hyperparathyroidism and pituitary microadenoma. Finally, multiple endocrine neoplasia type 1 was confirmed, which was accompanied by duodenal neuroendocrine tumor.
Adult ; Antigens, CD56/metabolism ; Duodenum/*pathology ; Endoscopy, Digestive System ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Neoplasms, Multiple Primary ; Neuroendocrine Tumors/*diagnosis/metabolism/surgery ; Pancreas/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

Gastrointestinal neuroendocrine tumors arise from cells of the diffuse neuroendocrine system and can take place almost anywhere within the gastrointestinal tract. A 40-year-old man admitted to evaluate a duodenal subepithelial lesion which was incidentally found at health check-up. The polypoid duodenal subepithelial lesion, measuring about 7 mm, was removed by the endoscopic mucosal resection and the pathology confirmed a neuroendocrine tumor. Abdominopelvic computed tomography, done for staging work up, revealed a mass in the pancreatic head and the patient received pylorus preserving pancreaticoduodenectomy. Mass at the pancreas also found out to be neuroendocrine tumor but showed different histopathologic traits under immunohistochemical staining. The patient was also diagnosed as hyperparathyroidism and pituitary microadenoma. Finally, multiple endocrine neoplasia type 1 was confirmed, which was accompanied by duodenal neuroendocrine tumor.
Adult ; Antigens, CD56/metabolism ; Duodenum/*pathology ; Endoscopy, Digestive System ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Neoplasms, Multiple Primary ; Neuroendocrine Tumors/*diagnosis/metabolism/surgery ; Pancreas/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

Medical treatment so far takes the major portion in the treatment of gastroesophageal reflux disease (GERD). Histamine-2 receptor antagonists, proton pump inhibitors and antacids, which are used in the medical treatment of GERD, decreases intragastric acidity, and therefore decreases acid reflux. However, recurrences are frequently observed after the cessation of medication. On the other hand, fundoplication, the surgical management of GERD, aims for physiologic reconstruction of esophagogastric junction, and for correcting the pathogenetic cause of GERD. But fundoplication is linked to risks related to surgery and general anesthesia. Laparoscopic funcoplication minimizes these risks. We recently experienced three cases of GERD improved by laparoscopic 270o fundoplication. One patient was intolerant of long-term proton pump inhibitor treatment, and two patients had hiatal hernia, and one of them showed failure to medical treatment. This report describes these three cases with a brief review of literatures survey.
Anesthesia, General ; Antacids ; Esophagogastric Junction ; Fundoplication* ; Gastroesophageal Reflux* ; Hand ; Hernia, Hiatal ; Humans ; Proton Pump Inhibitors ; Proton Pumps ; Recurrence