Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

Objectives: . Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). Methods: . We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. Results: . Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). Conclusion . A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

Objectives: . Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). Methods: . We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. Results: . Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). Conclusion . A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

BACKGROUND/AIMS: Protein-calorie malnutrition is a common complication in cirrhosis. Protein restriction for the treatment of hepatic encephalopathy (HE) may cause disease progression and poor prognosis. Therefore, we evaluated important clinical parameters for nutritional state in cirrhotic patients with or without HE to predict the development of HE. METHODS: Twenty-two cirrhotic patients were divided into two groups; group A-13 patients without HE and group B-9 patients with HE. Clinical and biochemical parameters, serum proteins {serum albumin, insulin-like growth factor-1 (IGF-1), transferrin, leptin, etc}, immunologic parameters and anthropometry were measured. RESULTS: Child-Pugh score and Model for End-stage Liver Disease (MELD) scale were higher in group B (p<0.01). After correction of various factors affecting nutritional assessment, especially of Child-Pugh score and MELD scale, leptin was higher in group B (p<0.05). There was no difference in anthropometric measurements. Transferrin correlated inversely with MELD scale in group A (p<0.01). IGF-1 correlated inversely with total lymphocyte count in group B (p<0.05). Leptin correlated with Child-Pugh scores, total lymphocyte count and mid-arm muscle cirumference in group A (p<0.05, p<0.05 and p<0.05, respectively), and correlated inversely with CD8 in group B (p<0.05). CONCLUSIONS: Leptin level is higher in patients with HE, and further studies for parameters of nutrition to predict HE in many cirrhotic patients will be needed.
Aged ; Anthropometry ; Biological Markers/*blood ; Female ; Hepatic Encephalopathy/blood/diagnosis/*etiology ; Humans ; Insulin-Like Growth Factor I/analysis ; Leptin/blood ; Liver Cirrhosis/blood/*complications ; Male ; Middle Aged ; *Nutritional Status ; Transferrin/analysis

PURPOSE: There have been controversies about the management of small abdominal aortic aneurysm (AAA). This prospective study was performed to analyze the annual expansion rates and the clinical courses of small AAAs, and to we wanted to suggest some guidelines for the proper management of small AAAs in Koreans. METHOD: From 1991 to 2003, thirty-five patients who had an initial diagnosis of small AAA were enrolled into the study group. All the patients were assigned to undergo regular imaging studies with either ultrasonography or CT angiography every 6 months. At the end of the study, the twenty four patients who were followed up with at least three successive visits were included in the statistical analysis. The clinical symptoms and the size of their aneurysms were documented on each visit. Symptomatic aneurysms and aneurysms with a size greater than 5.5 cm were considered as candidates for surgical repair. The annual expansion rate, rupture rate and the requirements for aneurysm repair were analyzed. The overall aneurysm expansion rate was 0.33+/-0.22 cm/year. RESULT: The expansion rate of the aneurysms smaller than 4.0 cm (12 cases) was 0.32+/-0.26 cm/year and that of aneurysms between 4.0 cm and 5.0 cm in size (12 cases) were 0.34+/-0.19 cm/year (P=0.55). Only the presence of iliac artery involvement was significantly related with a higher aneurysm expansion rate (0.47+/-0.2 cm/year vs. 0.19+/-0.13 cm/year, respectively, P=0.001). There was no rupture of aneurysm during the study. 10 cases undergone aneurysm repair and there was no morbidity or mortality after the aneurysm repair. CONCLUSION: Small AAAs in Koreans can be safely managed with regular follow-up. Closer follow-up is recommended as the aneurysm size increases and for small aneurysms that involve the iliac artery.
Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal* ; Diagnosis ; Follow-Up Studies ; Humans ; Iliac Artery ; Mortality ; Prospective Studies ; Rupture ; Ultrasonography

BACKGROUND: It has been known that Asians are more likely to develop atherosclerosis of the intracranial arteries while Caucasians have more extracranial arterial diseases. Angiographic distribution and frequency of the carotid artery stenosis have not been well known in Korean patients with acute ischemic stroke. METHODS: From the Yonsei Stroke Registry, a total of 300 acute ischemic stroke patients, who were evaluated by a conventional cerebral angiography from July 1997 to September 2000, were enrolled for this study. Patients were divided into three groups: isolated intracranial internal carotid artery (ICA) stenosis (IICA group); isolated extracranial ICA stenosis (EICA group); and combined stenosis of intracranial and extracranial ICAs (combined group). The clinical and angiographical characteristics were investigated and compared among them. RESULTS: A total of 107 patients had stenotic lesions in the ICA. They were 45 patients with lesions in the intracranial ICA (IICA group), 42 in the extracranial ICA (EICA group), and 20 patients in the both intracranial and extracranial ICAs (combined group). No significant differences were found among the three groups in terms of the degree of stenosis (50.2%, 49.6%, 56.8% each: p= 0.34), risk factors of ischemic stroke, and frequency of combined stenosis in the other intracranial arteries. CONCLUSIONS: ICA stenosis was common in patients with acute ischemic stroke. Significant differences of the frequency and risk factors between intracranial and extracranial ICA stenosis were not found. ICA stenosis at the extracranial portion as well as at the intracranial portion should be considered as a common cause of ischemic stroke occurring in the carotid artery system.
Arteries ; Asian Continental Ancestry Group ; Atherosclerosis ; Carotid Arteries ; Carotid Artery, Internal* ; Carotid Stenosis* ; Cerebral Angiography ; Constriction, Pathologic ; Humans ; Risk Factors ; Stroke*

BACKGROUNDS/AIMS: The therapeutic requirements of patients with non-erosive reflux disease (NERD) are similar to those with erosive esophagitis. The pharmacological action mechanism of prokinetics is quite different; domperidone is a peripheral dopamine D2-antagonist and cisapride is a HT4-agonist. This study was performed to evaluate the therapeutic effect of these two different prokinetics in patients with NERD. METHODS: 178 patients, with heartburn and/or regurgitation, without reflux esophagitis were enrolled and divided into 2 groups by randomization code. In this prospective multicenter trial, 178 patients (93 patients in cisapride group, 85 patients in domperidone group) received 10 mg of cisapride three times a day or 10 mg of domperidone three time a day for 2 or 4 weeks. Symptom assessment was performed in each patients before treatments, 2 and 4 weeks after treatment. RESULTS: Of the 133 patients available for final analysis, 65 were allocated to the cisapride group and 68 to the domperidone group. After 2 weeks treatment, heartburn was reduced in 81.1% of cisapride group, 56.7% of domperidone group (p < 0.05) and regurgitation was reduced in 89.7% of cisapride group, 77.7% of domperidone group. After 4 weeks treatment, heartburn was reduced in 94.3% of cisapride group, 88.7% of domperidone group and this difference was not significant. The proportion of adverse events in cisapride group was 9.4% and was 5.5% in domperidone group. CONCLUSIONS: Cisapride tartrate was more effective in relieving heartburn in NERD patients than domperidone maleate after 2 week treatment. However, this superior effect dose not persist longer than 2 weeks.
Cisapride* ; Domperidone* ; Dopamine ; Esophagitis ; Esophagitis, Peptic ; Heartburn ; Humans ; Prospective Studies ; Random Allocation ; Symptom Assessment

Antibiotics associated colitis due to Clostridium difficile is a common nosocomial infection associated with significant morbidity. In severe cases, pseudomembraneous colitis may be associated with intraperitoneal fluid accumulation. However, the characteristics of the fluid are seldom described. This case report describes pseudomembraneous colitis patient who was presented with low serum-ascites albumin gradients and lymphocytic ascites, without the evidence of infection, malignancy, or inflammatory peritoneal disease.
Anti-Bacterial Agents ; Ascites* ; Clostridium difficile ; Colitis* ; Cross Infection ; Humans ; Peritoneal Diseases

Lower gastrointestinal bleeding is difficult to localize despite advanced diagnostic procedures such as colonoscopy, small bowel series, mesenteric angiography and radionuclide scan. We had experienced a case of mantle cell lymphoma of small bowel. In this case, the cause of recurrent lower gastrointestinal bleeding and abdominal pain was not defined despite extensive preoperative evaluation. We diagnosed this case as mantle cell lymphoma after exploratory laparotomy.
Abdominal Pain ; Angiography ; Colonoscopy ; Hemorrhage* ; Laparotomy ; Lymphoma ; Lymphoma, Mantle-Cell*

Focal nodular hyperplasia (FNH) is a rare benign hepatic tumor occurring predominantly in women of childbearing age. Generally oral contraceptive is not associated with FNH but might accentuate the vascular abnormalities which may cause the lesion to enlarge and, very rarely, to rupture. FNH is typically asymptomatic and seldom bleeds. Often it is incidentally observed during imaging procedures performed for some other reasons. The histologic feature of FNH is characterized by areas of localized growth of mature hepatocytes and septal fibrosis. Surgical resection is seldom required because of the benign nature of the lesion and its lack of significant complication. We experienced a case of focal nodular hyperplasia without liver cirrhosis confirmed by surgical resection and histologic examination. in a 47-year-old man.
Female ; Fibrosis ; Focal Nodular Hyperplasia* ; Hepatocytes ; Humans ; Liver Cirrhosis ; Liver* ; Middle Aged ; Rupture