BACKGROUND: While the effect of the flashlamp pumped dye laser in the treatment of telangiectasia and other vascular disease has been reported by many authors, there have been a few reports on the therapeutic effect of the copper vapor laser(CVL) on telangiectasia and other vascular lesions. OBJECTIVE: Our purpose was to assess the clinical results in Korean patients who had cutaneous vascular disorders that were treated with the CVL at 578 nm. METHODS: A total of 23 patients with vascular lesions such as telangiectasia were involved. The effect of the laser treatment was evaluated 3 months after the last treatment. RESULTS: Of the 15 patients with telangiectasia, 12 patients showed good or excellent responses. 2 out of 3 patients with strawberry hemangioma showed good results. As for the other lesions, 2 out of the remaining patients 5 showed excellent results. CONCLUSION: The CVL has a beneficial effect and is a good alternative treatment modality for vascular lesions.
Copper* ; Hemangioma, Cavernous ; Humans ; Lasers, Dye ; Lasers, Gas* ; Telangiectasis ; Vascular Diseases

Purpose: Three years of adjuvant imatinib is the standard treatment for resected gastrointestinal stromal tumors (GISTs) with rupture, but the recurrence rate is prominently high. We aimed to investigate the efficacy and safety of 5-year adjuvant imatinib compared with 3-year treatment in patients with a ruptured GIST following surgical resection. Materials and Methods: A total of 51 patients were included in the analysis. The assessment of GIST rupture was based on Nishida’s classification. Twenty patients who were diagnosed before November 2013 were treated with 5 years of imatinib, and 31 patients who were diagnosed after November 2013 were treated with 3 years of imatinib. We retrospectively compared the clinical outcomes of the two groups. Results: Baseline characteristics and the incidence of the adverse events were generally comparable between the two groups. During a median follow-up duration of 43.8 months and 104.2 months in the 3- and 5-year group, 8 and 9 patients had a disease recurrence, respectively. The 5-year group showed better recurrence-free survival (RFS) than the 3-year group. In multivariate analysis, low mitotic index was a significant independent favorable prognostic factor for RFS, while 5-year imatinib treatment was marginally associated with a favorable RFS. Conclusion Five years of adjuvant imatinib treatment in patients with ruptured GIST was associated with favorable survival outcomes with manageable toxicity profiles. Our findings warrant validation and confirmation in future studies.

Cutaneous metastasis from renal cell carcinoma is unusual and have been reported infrequently. We report a case of metastatic renal cell carcinoma in a 33-year-old man who presented with a 3.5X2.0 cm-sized round, brightly red colored nodule on the scalp for 1 month. A skin biopsy revealed the typical clear cell adenocarcinoma with clear cytoplasm and oval hyperchromatic nuclei arranged in glandular pattern consistent with metastatic renal cell carcinoma. In most instances, once cutaneous involvement is manifested the disease is widespread and has a poor prognosis. But, our case presented only a single cutaneous nodule, and workup showed no evidence of further metastasis for 1 year.
Adenocarcinoma, Clear Cell ; Adult ; Biopsy ; Carcinoma, Renal Cell* ; Cytoplasm ; Humans ; Neoplasm Metastasis ; Prognosis ; Scalp* ; Skin

BACKGROUND/AIMS: Preoperative diagnosis of peritoneal metastasis is extremely important to select the appropriate treatment strategy and predict the prognosis for patients with gastrointestinal cancer. However, imaging techniques have a limited capacity for detecting peritoneal metastasis. We therefore evaluated the feasibility of percutaneous ultrathin flexible peritoneoscopy in an animal model. MATERIALS AND METHODS: Percutanous ultrathin flexible peritoneoscopy was performed on two mini-pigs under general anesthesia. We punctured the abdominal wall at the anti-Mcburney and umbilical regions using a 16-gauge angiocatheter. Guidewire was inserted through the angiocatheter and we then enlarged the puncture using a biliary dilation catheter and a 6- to 8-mm balloon dilator catheter. After track formation, we inserted a 4.9-mm ultrathin endoscope into the abdominal cavity. The peritoneal cavity was examined, and peritoneal and liver biopsy was performed. The puncture was closed with a single suture. After the procedure, we monitored the general condition of the pigs for 2 weeks. RESULTS: Percutaneous ultrathin flexible peritoneoscopy was successfully performed regardless of the puncture site location. Peritoneal and liver biopsy was also successfully executed. The mean procedure time was 20 minutes. Formation of the abdominal track was not easily accomplished with standard endoscopic equipment. Nevertheless, none of the abdominal organs were injured. The post-procedure course was uneventful. Minor scarring was observed at the incision site 2 weeks after the procedure. CONCLUSIONS: Percutanous ultrathin flexible peritoneoscopy is a relatively simple and technically feasible method. However, dedicated accessories for fascial dilation should be developed to ensure the safety of human patients undergoing this procedure.
Abdominal Cavity ; Abdominal Wall ; Anesthesia, General ; Animals ; Biopsy ; Catheters ; Cicatrix ; Endoscopes ; Feasibility Studies ; Gastrointestinal Neoplasms ; Laparoscopy ; Liver ; Neoplasm Metastasis ; Peritoneal Cavity ; Peritoneum ; Prognosis ; Punctures ; Sutures ; Swine

BACKGROUND/AIMS: Endoscopic papillary balloon dilation (EPBD) is a safe and effective method for the treatment of choledocholithiasis, but previous studies have rarely reported the appropriate ballooning time (BT). We prospectively evaluated the safety and efficacy of EPBD according to BT in patients undergoing bile duct stone removal. METHODS: Seventy consecutive patients with bile duct stones were randomly assigned to receive EPBD with either conventional (n = 35, 60 seconds) or short (n = 35, 20 seconds) BT. RESULTS: EPBD alone achieved complete bile duct clearance in 67 patients (long BT, n = 33, 94.3%; short BT, n = 34, 97.1%; p = 0.808). We also found no significant difference in the rate of complete duct clearance, including procedures that used mechanical lithotripsy, between the long and short BT groups (97.1% vs. 100%; p = 0.811). Mild pancreatitis was noted in four (11.4%) patients in the long BT group and two (5.7%) patients in the short BT group, but this incidence was not significantly different. CONCLUSIONS: The study showed that EPBD using both 20-sec and 60-sec BTs is safe and effective for the treatment of bile duct stones. Short and long BTs produced comparable outcomes.
Aged ; Aged, 80 and over ; Balloon Dilatation/adverse effects/*methods ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis/radiography/*therapy ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Time Factors ; Treatment Outcome

Adenoid cystic carcinoma of the breast is a rare histologic type of breast cancer. Prognosis is favorable with rare recurrence or metastasis. We report a case of metastatic adenoid cystic carcinoma of the breast in a 50-year-old woman who presented with a 0.8 X 0.9 X 0.5 cm-sized dome shaped pink colored smooth surfaced partially eroded nodule on the scalp for 1 month. A skin biopsy revealed mainly solid malignant cell nests in the upper dermis, but in the lower dermis, tumor cell showed cylindromatous and adenoid pattern consistent with metastatic adenoid cystic carcinoma of the breast.
Adenoids* ; Biopsy ; Breast Neoplasms ; Breast* ; Carcinoma, Adenoid Cystic* ; Cytochrome P-450 CYP1A1 ; Dermis ; Female ; Humans ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Scalp* ; Skin

Large-cell neuroendocrine carcinoma of the colon is a rare entity with a prognosis that is usually poor due to the high likelihood of early metastasis. A 61-year-old man had surgery for colon cancer of the transverse colon and cecum. Microscopic examination of the tumor showed that the location was the proximal transverse colon, with small nests containing rosettes and palisading patterns of large tumor cells with faintly granular cytoplasm. The immunohistochemistry was positive for synaptophysin and chromogranins. The tumors were diagnosed as a large-cell neuroendocrine carcinoma of the colon. In addition, the tumor of the cecum showed microscopic findings consistent with a well-differentiated adenocarcinoma. The immunohistochemical panel showed that the tumor was negative for neuroendocrine markers. There were no clinical findings suggestive of hormone hypersecretion. Cancer metastasis was found in the peritoneum section of the small bowel. Postoperative chemotherapy was applied. The patient was alive with good performance after, and there was no sign of tumor progression. This is the first case of a synchronous large-cell neuroendocrine carcinoma and adenocarcinoma of the colon. The patient was treated successfully with debulking surgery and systemic chemotherapy.
Adenocarcinoma ; Carcinoma, Neuroendocrine ; Cecum ; Chromogranins ; Colon ; Colon, Transverse ; Colonic Neoplasms ; Cytoplasm ; Humans ; Immunohistochemistry ; Middle Aged ; Neoplasm Metastasis ; Neoplasms, Multiple Primary ; Peritoneum ; Prognosis ; Synaptophysin

BACKGROUND/AIMS: Flumazenil was administered after the completion of endoscopy under sedation to reduce recovery time and increase patient safety. We evaluated patient satisfaction after endoscopy under sedation according to the timing of a postprocedural flumazenil injection. METHODS: In total, 200 subjects undergoing concurrent colonoscopy and upper endoscopy while sedated with midazolam and meperidine were enrolled in our investigation. We randomly administered 0.3 mg of flumazenil either immediately or 15 minutes after the endoscopic procedure. A postprocedural questionnaire and next day telephone interview were conducted to assess patient satisfaction. RESULTS: Flumazenil injection timing did not affect the time spent in the recovery room when comparing the two groups of patients. However, the subjects in the 15 minutes injection group were more satisfied with undergoing endoscopy under sedation than the patients in the immediate injection group according to the postprocedural survey (p=0.019). However, no difference in overall satisfaction, memory, or willingness to undergo a future endoscopy was observed between the two groups when the telephone survey was conducted on the following day. CONCLUSIONS: This study demonstrated that a delayed flumazenil injection after endoscopic sedation increased patient satisfaction without prolonging recovery time, even though the benefit of the delayed flumazenil injection did not persist into the following day.
Adult ; Anesthesia Recovery Period ; Endoscopy/adverse effects ; Female ; Flumazenil/*administration & dosage ; GABA Modulators/*administration & dosage ; Humans ; Male ; Memory/drug effects ; Middle Aged ; Pain/epidemiology ; *Patient Satisfaction ; Prospective Studies ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: Laparoscopic Heller myotomy with antireflux procedure is considered to be a standard treatment for achalasia. Recently, peroral endoscopic myotomy (POEM) was developed and performed on patients with achalasia. However, there is no report on POEM use in South Korea. The aim of this study was to evaluate the technical feasibility of POEM in a porcine model. METHODS: POEM was performed on two mini pigs. We performed upper endoscopy under general anesthesia. A submucosal tunnel was created and the circular muscle layer was incised using several knives. The mucosal entry was closed using resolution clips. We performed a follow-up endoscopy and sacrificed the pigs 2 weeks after the POEM. The myotomy site was evaluated grossly and histologically. RESULTS: POEM was successfully performed on the two mini pigs. No injuries to any abdominal or mediastinal structures occurred. Two weeks after the POEM, the esophageal mucosa healed without any endoscopic evidence of complications. Necropsy revealed that the circular muscle layer was completely lost and replaced with fibrotic tissue. CONCLUSIONS: We found that POEM is a technically feasible method which can be performed on an animal model. However, to ensure safe use on patients with achalasia, further studies on technical methods and long-term follow-up examinations are required.
Anesthesia, General ; Animals ; Dietary Sucrose ; Endoscopy ; Esophageal Achalasia ; Esophagus ; Feasibility Studies ; Follow-Up Studies ; Humans ; Models, Animal ; Mucous Membrane ; Muscles ; Republic of Korea ; Swine

A ganglioneuroma is a benign tumor composed of ganglion cells, nerve fibers, and supporting cells that originates from the neural crest. An occurrence of a ganglioneuroma is mainly along the pathway of the sympathetic chain. However, it is rare to find the lesion in the gastrointestinal tract. A ganglioneuroma of the gastrointestinal tract appears to involve predominantly the colon and rectum, but rarely involves the upper gastrointestinal tract. An intestinal ganglioneuroma is divided into three subgroups: a polypoid ganglioneuroma, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis. A polypoid ganglioneuroma is not associated with systemic disease. However, ganglioneuromatous polyposis and diffuse ganglioneuromatosis are highly associated with systemic diseases. A 33-year-old woman who had no specific family history visited our institution with a complaint of abdominal discomfort. A single polyp was found incidentally in the descending colon during a colonoscopy and it was treated by snare polypectomy. The patient had no associated systemic disease and histology of the polyp revealed a ganglioneuroma. We report a patient with a polypoid ganglioneuroma of the colon.
Adult ; Colon ; Colon, Descending ; Colonoscopy ; Female ; Ganglion Cysts ; Ganglioneuroma ; Gastrointestinal Tract ; Humans ; Neural Crest ; Neurons ; Polyps ; Rectum ; SNARE Proteins ; Upper Gastrointestinal Tract