Annular pancreas is a rare congenital abnormality characterized by a ring of pancreatic tissue encircling the descending part of the duodenum. It is considered to originate from incomplete ventral pancreatic bud rotation. A 39-year-old male with refractory nausea and vomiting despite receiving appropriate medical treatment underwent contrast-enhanced computed tomography; it revealed an annular pancreas encircling the descending part of the duodenum. We found that surgical resection of the annular pancreas relieved nausea and vomiting due to duodenal obstruction.

Annular pancreas is a rare congenital abnormality characterized by a ring of pancreatic tissue encircling the descending part of the duodenum. It is considered to originate from incomplete ventral pancreatic bud rotation. A 39-year-old male with refractory nausea and vomiting despite receiving appropriate medical treatment underwent contrast-enhanced computed tomography; it revealed an annular pancreas encircling the descending part of the duodenum. We found that surgical resection of the annular pancreas relieved nausea and vomiting due to duodenal obstruction.

Annular pancreas is a rare congenital abnormality characterized by a ring of pancreatic tissue encircling the descending part of the duodenum. It is considered to originate from incomplete ventral pancreatic bud rotation. A 39-year-old male with refractory nausea and vomiting despite receiving appropriate medical treatment underwent contrast-enhanced computed tomography; it revealed an annular pancreas encircling the descending part of the duodenum. We found that surgical resection of the annular pancreas relieved nausea and vomiting due to duodenal obstruction.

Annular pancreas is a rare congenital abnormality characterized by a ring of pancreatic tissue encircling the descending part of the duodenum. It is considered to originate from incomplete ventral pancreatic bud rotation. A 39-year-old male with refractory nausea and vomiting despite receiving appropriate medical treatment underwent contrast-enhanced computed tomography; it revealed an annular pancreas encircling the descending part of the duodenum. We found that surgical resection of the annular pancreas relieved nausea and vomiting due to duodenal obstruction.

The percutaneous endoscopic gastrostomy is used for nutritional support in patients requiring prolonged tubal feeding. Unfortunately, numerous complications, such as infection, stomal leak, fever, local pain, ileus and tube occlusion, have been reported since its introduction. The buried bumper syndrome is a rare but well-recognized long-term complication. The tight anchorage between the internal and external bumpers leads to gastric mucosal erosion and embedding of the internal bumper into the gastric wall, obstructing feeding. Our case involves an elderly patient with a buried bumper syndrome complicated by an abdominal wall abscess. A similar case has not been reported in Korea before. This article reports our findings and management with a review of the literature.
Abdominal Wall ; Abscess ; Aged ; Fever ; Gastrostomy ; Humans ; Ileus ; Korea ; Nutritional Support

BACKGROUND AND OBJECTIVES: An anatomic variant of left anterior descending coronary artery (LAD), termed "dual LAD", consists of early bifurcation of the proximal LAD into one early terminating branch (short LAD) which remains in the anterior interventricular sulcus (AIVS) and doesn't reach the apex, and the second (long LAD), which has a variable course outside the AIVS but returns to the distal sulcus and continues to the apex. Its incidence, angiographic features and clinical significance are investigated. MATERIALS AND METHOD: Consecutive 696 coronary angiograms during October 1997 through August 1998 were analyzed. RESULTS: A dual LAD variant was noted in 45 patients (6%) of the 696 patients. Type I, in which the long LAD descends on the left ventricular side of the AIVS before reentering the AIVS, was noted in 24 patients (53%) and type II, in which the long LAD descends on the right ventricular side of the AIVS before reentering the AIVS, in 21(47%). First septal branch was commonly originated from LAD proper in both type (54% vs 52%), but first diagonal branch from LAD proper (63%) in type I, from short LAD (71%) in type II. Presence of dual LAD was recognized before percutaneous coronary intervention (10) or bypass surgery (2) in 12 (63%) of 19 patients. Regional wall motion abnormalities (RWMA) were localized in distal septum or anterolateral wall in 2 patients with short or long LAD obstruction, respectively. CONCLUSION: Recognition of dual LAD is essential to prevent errors of interpretation of the coronary angiogram, to plan optimal strategy for percutaneous coronary intervention or bypass surgery, especially in case of total occlusion, and to understand localized septal or anterolateral RWMA.
Coronary Vessels* ; Humans ; Incidence* ; Percutaneous Coronary Intervention

Distant metastasis of squamous cell carcinoma from the anal canal is an uncommon event. However, hematogenous spread to the vertebrae may occur in the course of this disease. The route of metastasis from the anal canal seems to be Batson's vertebral venous system. A 52-year-old female patient presented with lower back and right leg pain of one-week history. She has undergone radiotherapy and chemotherapy for squamous cell carcinoma of the anal canal and then was followed by surgical resection. Three months later, magnetic resonance images of the lumbar spine disclosed a well-enhanced mass of L5 vertebral body compressing the thecal sac. Surgical decompression and biopsy were performed. Histopathological study confirmed carcinoma of the squamous cell origin. We report a rare case of vertebral metastasis from squamous cell carcinoma of the anal canal with a pertinent review of literature.
Anal Canal* ; Anus Neoplasms ; Biopsy ; Carcinoma, Squamous Cell* ; Decompression, Surgical ; Drug Therapy ; Female ; Humans ; Leg ; Middle Aged ; Neoplasm Metastasis* ; Radiotherapy ; Spine

We present a case of a 7-year-old boy who had cholestasis after trimethoprim-sulfamethoxazole combination therapy. Liver biopsy was performed 36 days after the onset of jaundice because of no evidence of improving cholestasis. Liver histology revealed portal inflammation, bile plug, and biliary stasis around the central vein with the loss of the interlobular bile ducts. Immunohistochemical stains for cytokeratin 7 and 19 were negative. These findings were consistent with those of vanishing bile duct syndrome (VBDS). Chlestasis was progressively improved with dose increment of urosodeoxycholic acid from conventional to high dose. This is the first case report of trimethoprime-sulfamethoxazole associated VBDS in Korean children. The case suggests that differential diagnosis of VBDS should be considered in case of progressive cholestatic hepatitis with elevation of alkaline phosphatase and gamma-glutamyl transpeptidase after or during taking medicine to treat nonhepatobiliary diseases illness.
Alkaline Phosphatase ; Bile Ducts* ; Bile* ; Biopsy ; Child* ; Cholestasis ; Coloring Agents ; Diagnosis, Differential ; gamma-Glutamyltransferase ; Hepatitis ; Humans ; Inflammation ; Jaundice ; Keratin-7 ; Liver ; Male ; Trimethoprim, Sulfamethoxazole Drug Combination ; Veins

PURPOSE: The purpose of this study was to analyze the clinical results of patients with scaphoid nonunions treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation. METHODS: We retrospectively reviewed 20 patients with a scaphoid nonunions which was treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation from November 2008 to July 2012. Time from injury to treatment was 74 months (range, 3-480 months) in average. Functional outcome was evaluated using the modified Mayo wrist score and visual analogue scale (VAS) for pain, which were measured before operation and at the last follow up. RESULTS: All nonunions were healed successfully. The average radiologic union time was 9.7 weeks (range, 7-14 weeks). The average VAS score improved from 6.3 (range, 4-8) preoperatively to 1.6 (range, 0-3) at the last follow up. The average modified Mayo wrist score increased from 62.5 preoperatively to 85.7 at the last follow-up. CONCLUSION: Arthroscopically assisted bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion. It may provide more biological environment than open surgery as a minimally invasive procedure.
Arthroscopy ; Bone Transplantation* ; Follow-Up Studies ; Humans ; Retrospective Studies ; Wrist

PURPOSE: The purpose of our study is to evaluate the plain radiographic features of pulmonary tuberculosis in adult diabetic patients compared with those in patients without any underlying diseases. MATERIALS AND METHODS: We analyzed the chest PA and lateral views of 100 patients having active pulmonary tuberculosis;40 patients had diabetes mellitus and 60 patients had no other underlying diseases. images were assesed for anatomical distributions, extents of lesions, size and number of cavity and patterns radiographic findings. RESULTS: Diabetic tuberculosis had higher prevalence and wider involvement of unusual segments for the tuberculosis such as anterior segment, lingular segment of upper lobe and basal segment of the lower lobe, and they showed the tendency of having more cavities than those who had no other underlying diseases, but there were no meaningful differences in the cavity size between the two groups. CONCLUSION: Pulmonary tuberculosis in diabetic patients tends to have wider extent with unusual segmental involvement and multiple cavities than in the patients who had no other underlying diseases.
Adult* ; Diabetes Mellitus ; Equidae ; Humans ; Prevalence ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*