The double pylorus-is a fistulous communication between the gastric antrum and duodenal bulb, usually extending from the lesser curvature of the stomach to the superior aspect of the duodenal bulb, and seperated by septum or bridge of normal mucosa. Although its incidence is rare, reports concerning double pylorus are increasing with the recent development of upper gastrointestinal endoscopy and more awareness of this abnormality. We recently experienced two cases of double pylorus; an aquired one in 72-year old male who had an another opening with healing ulcer at the superior aspect of the original pyloric channel, central erosion with clubbing and fusion of mucosal folds at the greater curvature of the lower body and a 3 x 4 cm sized ulcer at the lesser curvature of the lower body, and the other congenital one in 53-year old male who had an another opening at the superior aspect of the original pyloric channel with histologically intact muscularis mucosa in the pyloric septum with no evidence of chronic peptic ulcer scarring. We report here two cases of double pylorus, one-acquired, and the other-congenital, with a review of the literature.
Aged ; Cicatrix ; Endoscopy, Gastrointestinal ; Humans ; Incidence ; Male ; Middle Aged ; Mucous Membrane ; Peptic Ulcer ; Pyloric Antrum ; Pylorus ; Stomach ; Stomach Ulcer ; Ulcer

Posterior urethral valve is a cause of obstructive uropathy in infants and children. But there also have been a few descriptions in adults. We report a case of posterior urethral valve in a 57year-old adult with wonder that upper urinary tract is intact despite so late a diagnosis of the disease.
Adult* ; Child ; Diagnosis ; Humans ; Infant ; Urinary Tract

PURPOSE: In the pediatric population, Rathke's cleft cysts (RCCs) are known to be an infrequent cause of headaches, visual disturbances, and pituitary dysfunction. We investigated the clinical characteristics of children in whom RCCs were incidentally discovered and evaluated whether RCCs influence the treatment response of patients with proven endocrinopathy. METHODS: A retrospective analysis was conducted in 34 patients with RCCs who were diagnosed between 2006 and 2013 at Hallym University Medical Center. Their clinical, hormonal, and imaging findings were reviewed. We evaluated the clinical outcomes of the patients with concomitant RCCs and endocrinopathy compared to matched controls. RESULTS: Twenty-six of 34 patients with radiologically proven RCCs had endocrine disorders. They were 9 boys and 17 girls, with ages ranging from 4.8 to 17.4 years at the time of the diagnosis. Of these, 7 (27%) had idiopathic short stature, 7 (27%) had growth hormone deficiency (GHD), and 12 (46%) had central precocious puberty (CPP). Nineteen of 26 patients (73.1%) showed low signal intensities on T1-weighted images (T1WI) and high signal intensities on T2-weighted images. The incidence of hypointensity on T1WI was higher in the patients with RCCs accompanied by endocrinopathy than in those without endocrinopathy (P=0.033). The treatment outcomes of the patients with CPP and GHD with and without RCCs were similar. CONCLUSION: CPP and GHD patients with a small RCC (less than 20 mm) expressing cystic magnetic resonance intensity can be managed with medical treatment, although the RCCs need to be closely monitored in radiological studies to observe their growth.
Academic Medical Centers ; Adolescent* ; Central Nervous System Cysts* ; Child* ; Diagnosis ; Dwarfism, Pituitary ; Female ; Growth Hormone ; Headache ; Humans ; Incidence ; Puberty, Precocious ; Retrospective Studies

A 16-month-old male with mouth breathing due to intranasal mass and obstruction from birth is the subject of this report. CT (computerizd tomography) scan and MCTC (metrizamide CT cisternography) showed only a mass forming a cyst in the left nasal cavity, but magnetic resonance imaging (MRI) demonstrated the connection between the cranial content and the intranasal mass. The mass was concluded to be a congenital intranasal meningocele of a transethmoidal type, and dural plasty by bifrontal craniotomy was initially performed. The remaining herniated sac was removed by intranasal endoscopic resection. MRI has numerous advantages over CT. With MRI's multiplanar capability, there is no need for artificial dilution of the image of surrounding bone, and thus makes it the most valuable image technique for skull base lesions, making the diagnosis of intranasal meningocele much easier than it would be using conventional methods.
Craniotomy ; Diagnosis ; Humans ; Infant ; Magnetic Resonance Imaging* ; Male ; Meningocele* ; Mouth Breathing ; Nasal Cavity ; Parturition ; Skull Base

No abstract available.

This study was performed to investigate the significance of gastric juice analysis (GJA) as a diagnostic criterion of a positive challenge in a standard oral cow's milk challenge (OCC) to confirm typical cow's milk protein-induced enterocolitis (CMPIE). Data from 16 CMPIE patients (aged 14 to 44 days) were analyzed. A standard OCC was openly executed using 0.15 g/kg of protein. Three symptoms (vomiting, lethargy, and bloody or pus-like stool), and four laboratory findings (GJA [3 hr], changes in peripheral blood absolute neutrophil count [ANC] [6 hr], C-reactive protein [6 hr], and stool smear test for occult blood or leukocytes) were observed after OCC. Before OCC, baseline studies were conducted; a stool smear test, blood sampling, and GJA. Positive OCC results were; vomiting (87.5%) (observed 1-3 hr after OCC), lethargy (62.5%) (1-3 hr), bloody or pus-like stool (43.8%) (6-10 hr), abnormal GJA (93.8%), an ANC rise >3,500 cells/microliter (93.8%), and an abnormal stool smear test (75.0%). A single GJA test after a standard OCC is a sensitive diagnostic criterion of a positive challenge, and may provide an early confirmatory diagnosis of CMPIE. An investigation of positive OCC outcomes helps to find out a diagnostic algorithm of criteria of a positive challenge in CMPIE.
Adolescent ; Adult ; Algorithms ; Animals ; Blood Cell Count ; C-Reactive Protein/analysis ; Cattle ; Enterocolitis/*diagnosis/*etiology ; Female ; *Gastric Juice ; Humans ; Male ; Milk Hypersensitivity/*diagnosis/*pathology ; Milk Proteins/*analysis ; Neutrophils/cytology

BACKGROUND/AIMS: The well-organized study to support that increased cholelithiasis and bile duct dilatation can occur after gastrectomy has not been reported. The aim of this study was to determine the incidence of cholelithiasis and the degree of common bile duct (CBD) dilatation in patients undergoing subtotal gastrectomy, compared to those undergoing endoscopic treatment for gastric cancer. METHODS: Patients who diagnosed with gastric cancer and received treatment at six academic referral centers were investigated for the incidence and time of cholelithiasis and the degree of CBD dilatation after treatment by analysis of 5-year follow-up CTs. The operation group underwent subtotal gastrectomy without vagotomy, while in the control group endoscopic treatment was administered for gastric cancer. RESULTS: A total of 802 patients were enrolled in 5-year analysis (735 patients in the operation group and 67 patients in the control group). Cholelithiasis occurred in 47 patients (6.39%) in the operation group and 3 patients (4.48%) in the control group (p=0.7909). The incidences of cholelithiasis were 4.28% in Billoth-I and 7.89% in Billoth-II (p=0.0487). The diameter of proximal CBD and distal CBD increased by 1.11 mm and 1.41 mm, respectively, in the operation group, compared to 0.4 mm and 0.38 mm, respectively, in the control group (p<0.05). Patients with increased CBD dilatation more than 5 mm showed statistically significant increases in alkaline phosphatase and gamma-glutamyltransferase. CONCLUSIONS: The incidence of cholelithiasis was not increased due to subtotal gastrectomy without vagotomy, but the incidence was higher after Billoth-II compared to Billoth-I. In addition, significant change in the CBD diameter was observed after subtotal gastrectomy.
Aged ; Alanine Transaminase/analysis ; Aspartate Aminotransferases/analysis ; Bilirubin/analysis ; Case-Control Studies ; Cholelithiasis/*diagnosis/epidemiology ; Common Bile Duct/diagnostic imaging/*physiopathology ; Endoscopy, Gastrointestinal ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Incidence ; Male ; Middle Aged ; Odds Ratio ; Stomach Neoplasms/*surgery ; Tertiary Care Centers ; Tomography, X-Ray Computed

BACKGROUND: The overexpression of transforming growth factor-beta 1 receptor II (TGF-beta1RII) and transforming growth factor-beta 1 (TGF-beta1) ligand may be involved in the formation of a bulla. In this study, we tested if serum TGF-beta1 ligand levels correlated with the expression level of TGF-beta1RII and TGF-beta1 in bullous tissues from patients with spontaneous pneumothorax. MATERIAL AND METHOD: Bullous lung tissues and blood samples were obtained from 19 patients with spontaneous pneumothorax, 18 males and 1 female, aged 17 to 35 years old. The bullous tissues were obtained by video-assisted thoracic surgery (VATS), fixed in formalin, embedded in paraffin, and cut into 5~6micrometer thick slices. Sections were immunohistochemically stained with primary antibodies against TGF-beta1 or TGF-beta1RII, and serum levels of TGF-beta1 in patients and normal controls was measured by enzyme-linked immunosorbent assay (ELISA). RESULT: Of the 19 patients, 16 were TGF-beta1 positive and 10 were TGF-beta1RII positive. Among the 16 TGF-beta1 positives, 9 were also TGF-beta1RII positive. As seen previously, strong immunohistochemical staining of TGF-beta1RII and TGF-beta was detected in the boundary region between the bullous and normal lung tissues. Average TGF-beta1 blood levels of both TGF-beta1 and TGF-beta1RII positive patients was 38.36+/-16.2 ng/mL, and that of five controls was 54.06+/-15 ng/mL. CONCLUSION: These results suggest that overexpression of TGF-beta1 and TGF-beta1RII expression may be involved in the formation of bullae. TGF-beta1 blood levels in patients with primary spontaneous pneumothorax is lower than normal people, suggesting that the high level of local TGF-beta1 expression in the bullous tissue region, but not in the whole blood, may contribute more in the formation of bullae.
Aged ; Antibodies ; Blister ; Enzyme-Linked Immunosorbent Assay ; Female ; Formaldehyde ; Humans ; Lung ; Male ; Paraffin ; Pneumothorax ; Thoracic Surgery, Video-Assisted ; Transforming Growth Factor beta ; Transforming Growth Factor beta1

BACKGROUND/AIMS: Colorectal cancer (CRC) is one of the major causes of death and poses a major public health concern. The National CRC Screening Programme (NCSP) provides annual CRC screening using a fecal occult blood test for individuals >50 years of age since 2004. The purpose of the current study was to determine the outcomes and efficacy of a fecal immunochemical test (FIT) based on the NCSP in a quality-controlled university hospital setting. METHODS: We retrospectively reviewed the medical records and a standardized questionnaire from the NCSP of 3,852 individuals who underwent a FIT between March and December 2009. All of the subjects submitted a stool specimen for a FIT, while a double-contrast barium enema or colonoscopy was performed as a confirmatory examination for FIT-positive individuals. The CRC screening rate and rate of detection colorectal adenomas, advanced adenomas, and colorectal cancers by FIT were evaluated. RESULTS: The CRC screening rate with FIT was very high (72.3%), but the positive rate of detection by FIT was only 1.3%. The rate of detection for colorectal cancers, adenomas, and advanced adenomas by FIT was 0.08%, 0.39%, and 0.13%, respectively. The quantitative values of FIT in individuals with colorectal adenomas and cancers were significantly higher than other colorectal diseases. Men (P=0.001) and elderly individuals (P=0.039) were significantly more common in the FIT-positive group than the FIT-negative group. Approximately 28% of the subjects with FIT-positive tests did not receive a confirmatory examination. CONCLUSIONS: Although the FIT had a low rate of detection, the FIT was a useful screening tool for detection of CRC in the NCSP. It will be important to increase CRC screening rates and confirmatory examination rates.
Adenoma ; Aged ; Barium ; Cause of Death ; Colonoscopy ; Colorectal Neoplasms ; Early Detection of Cancer ; Enema ; Humans ; Male ; Mass Screening ; Medical Records ; Occult Blood ; Public Health ; Retrospective Studies ; Surveys and Questionnaires

BACKGROUND/AIMS: Endoscopic papillary balloon dilation (EPBD) has been advocated as an alternative therapy to endoscopic sphincterotomy for the treatment of common bile duct (CBD) stones. However, there is no established consensus on the optimal balloon dilation duration (BDD). We prospectively evaluated the efficacy and post-endoscopic retrograde cholangiopancreatography (ERCP) complications between the 20- and 60-second EPBD groups. METHODS: A total of 228 patients with small CBD stones (< or =12 mm) were randomly assigned to undergo EPBD with a 20- or 60-second duration at six institutions. We evaluated baseline patient characteristics, endoscopic data, clinical outcomes, and procedure-related complications. In addition, we analyzed risk factors for postprocedural pancreatitis. RESULTS: CBD stones were removed successfully in 107 of 109 patients (98.1%) in the 20-second group and in 112 of 119 patients (94.1%) in the 60-second group (p=0.146). Post-ERCP pancreatitis developed in seven patients (6.4%) in the 20-second group and nine patients (7.5%) in the 60-second group (p=0.408). In multivariate analysis, contrast dye injection into the pancreatic duct is a significant risk factor for post-EPBD pancreatitis. CONCLUSIONS: Based on the data showing that there were no significant differences in safety and efficacy between the two BDD groups, 20 seconds of BDD may be adequate for treatment of small CBD stones with EPBD.
Choledocholithiasis ; Common Bile Duct* ; Consensus ; Humans ; Multivariate Analysis ; Pancreatic Ducts ; Pancreatitis ; Prospective Studies* ; Risk Factors ; Sphincterotomy, Endoscopic