When ultrasound or computed tomographic (CT) scans demonstrate a focal mass within the pancreas, the radiologist or gastroenterologist assumes that it is carcinoma. Statistically this is the correct diagnosis. However, distinguishing pancreatitis from carcinoma by ultrasound and CT is occassionally impossible. Similarly, abnormalities seen on ERCP, such as simultaneous obstruction of both the common bile duct and adjacent pancreatic duct (double duct sign), has been shown to occur in pancreatitis as well as in the more commonly diagnosed pancreatic carcinoma. We experienced 3 cases af focal pancreatic masses that mistaken a carcinoma. And so, knowledge that such a mass can be benign in a clinical setting sbould result in an organiged approach to the correct diagnosis and avoidance of any unnecessary operations.
Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Diagnosis ; Inflammation* ; Pancreas ; Pancreatic Ducts ; Pancreatitis* ; Ultrasonography

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

Purpose: Precise estimation of the standard liver volume (SLV) is crucial in decision making regarding major hepatectomy and living donor liver transplantation. This study aimed to propose an accurate and efficient formula for estimating the SLV in the Korean population. Methods: We created a regression model for SLV estimation using a data set of 230 Korean patients with healthy livers. The proposed model was cross validated using a different data set of 37 patients with healthy livers. The total liver volume (TLV), except for the volume of liver blood vessels, was measured through computed tomography volumetry as the dependent variable. Various anthropometric variables, liver height (LH), thoracic width (TW), age, and sex (0, female and 1, male) were considered as candidates for independent variables. We conducted stepwise regression analysis to identify variables to be included in the proposed model. Results: A new formula was established; SLV = −1,275 + 9.85 × body weight (BW, kg) + 19.95 × TW (cm) + 7.401 × LH (mm). The proposed formula showed the best performance among existing formulas over the cross-validation data set. Conclusion The proposed formula derived using BW, TW, and LH estimated the TLV in the cross-validation data set more accurately than existing formulas.f

BACKGROUND AND OBJECTIVES: Although the usefulness of various endoscopic thyroid surgery techniques has been reviewed, little specific information is available regarding ENT surgeons who maybe unfamiliar with laparoscopic surgery and must performing endoscopic thyroidectomy. We examined the feasibility and safety of endoscopic thyroid surgery via a novel approach without gas insufflation. SUBJECTS AND METHOD: Forty-one patients undergoing endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation were enrolled in this study. Our indications for endoscopic thyroid surgery were as follows: 1) benign nodules less than 6 cm in diameter, 2) follicular neoplasm less than 6 cm in diameter, and 3) only unilateral thyroid lesions. The following variables were examined: perioperative complications, operation time, diameter of resected thyroid nodule, permanent pathology, time of hospital discharge after operation, duration of drain placement, and total amount of drainage. RESULTS: Postoperative pathology revealed 8 follicular adenomas, 31 nodular hyperplasias, and 2 lymphocytic thyroiditis. The operating time in the first 10 hemithyroidectomies was 154.0+/-64.88 min, which was 38.07 min longer than in the last 31 hemithyroidectomies (115.93+/-32.64 min; p=0.1426). The amount and duration of postoperative drainage were 249.34+/-118.47 mL in 4.01+/-1.31 days, respectively. The postoperative hospital stay was 6.12+/-1.99 days. Overall, perioperative complications occurred in seven patients (7/41, 17.1%), including one transient recurrent laryngeal nerve palsies (2.4%), five seromas (12.2%), and one hematoma (2.4%), which arose from a subplatysmal skin flap. CONCLUSION: These results suggest that endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation is safe and effective in selective unilateral benign thyroid lesions and appears to provide better cosmetic results and a shorter operation time than other endoscopic thyroidectomy methods. However, more invasiveness due to significant dissection aimed at obtaining an adequate working space and longer operation time needed than with either traditional open surgery or the minimally invasive video assisted technique should be overcome through accumulation of experience.
Adenoma ; Axilla ; Breast ; Cosmetics ; Drainage ; Endoscopy ; Hematoma ; Humans ; Hyperplasia ; Insufflation ; Laparoscopy ; Length of Stay ; Paralysis ; Recurrent Laryngeal Nerve ; Seroma ; Skin ; Thyroid Gland ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis, Autoimmune

Cervical vagal schwannomas with cystic degeneration changes are extremely rare. These tumors are typically benign and slow growing. A 44-year-old woman underwent complete resection of a tumor measuring 4x3.5 cm in the right neck using the endoscopic approach, instead of the conventional transcervical approach. We applied the new scarless neck surgery technique with an endoscopic unilateral axillo-breast approach. The tumor originated from the right vagus nerve, and was confirmed to be a vagal schwannoma pathologically. The patient has been followed up for 18 months postoperatively with no evidence of tumor recurrence or neurological deficit. We report an extremely rare vagal schwannoma with cystic degeneration that was removed by an endoscopic approach, along with a review of the relevant literature.
Adult ; Female ; Humans ; Neck ; Neurilemmoma* ; Recurrence ; Vagus Nerve

Background: and Purpose To identify sex differences in daytime sleepiness associated with apnea severity and periodic limb movements during sleep (PLMS) in subjects with obstructive sleep apnea (OSA). Methods: This study used the Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Sleep Hygiene Index (SHI) in logistic regression analyses with interaction terms. Severe OSA, excessive daytime sleepiness (EDS), and PLMS were defined as an apnea-hypopnea index of ≥30, an ESS score of ≥11, and a periodic limb movements index of >15, respectively. Results: The 1,624 subjects with OSA (males, 79.1%) comprised 45.3%, 38.2%, and 16.4% with severe OSA, EDS, and PLMS, respectively. Multiple logistic regression without interaction terms showed that sex, severe OSA, and PLMS were not significantly associated with EDS. However, significant interactions were noted between sex and severe OSA and PLMS in EDS in both crude and adjusted models (all p values<0.05). In the adjusted model, severe OSA was associated with EDS in males (p=0.009) but not in females. PLMS were more likely to be associated with EDS in females (p=0.013), whereas PLMS were less likely to be associated with EDS in males (p=0.041). The models were adjusted by the BDI score, SHI, and presence of medical comorbidities. Conclusions There are significant sex differences in subjective daytime sleepiness in subjects with severe OSA and PLMS. Severe OSA and PLMS may influence daytime sleepiness more in males and females, respectively.

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) has been widely used for patients with swallowing dysfunction. However, its beneficial effects in the treatment of gastroesophageal reflux (GER) are controversial. The aim of this study was to evaluate the effect of PEG on the prevention of GER in patients with nasogastric tube (NGT) feeding. METHODS: Continuous 24-hour pH monitoring was performed prospectively in 21 patients receiving NGT feeding before and 7.3+/-2.2 days after PEG placement to compare the severity of GER. RESULTS: We studied 21 patients with a mean age of 59.8+/-14.1 years. The mean duration of NGT placement was 5.8+/-5.4 months. The causes of swallowing dysfunction included cerebral infarction, cerebral hemorrhage and other central nervous system (CNS) lesions. When all of the patients were considered, there were no significant differences in reflux parameters after PEG placement compared to before PEG placement. However, all seven patients who had preexisting GER showed significant improvement (p<0.05) of the reflux parameters, including the frequency of acid reflux, duration of acid reflux, total time with a pH below 4.0 and the fraction of time with a pH below 4.0, after PEG placement. CONCLUSIONS: PEG might prevent GER in patients receiving NGT feeding, especially in those patients with GER.
Central Nervous System ; Cerebral Hemorrhage ; Cerebral Infarction ; Deglutition ; Gastroesophageal Reflux ; Gastrostomy ; Humans ; Hydrogen-Ion Concentration ; Prospective Studies

Amyloidosis uncommonly presents with intestinal pseudo-obstruction. According to previous reports, patients with primary AL amyloidosis presented with a chronic process with symtom duration of more than 1 year, but patients with secondary AA amyloidosis presented as an acute illness, usually less than 10 weeks. Localized gastrointestinal amyloidosis limited to the jejunum, without involvement of stomach, duodenum, colon, or rectum, is very rare. Imaging studies in small intestinal amyloidosis generally show a symmetrical uniform appearance. AA amyloidosis with acute-phase reactant serum amyloid A protein is associated with inflammatory, infectious or neoplastic disorders. To our knowledge, no case of amyloidosis associated with latent syphilis has been reported to date. We present a case of a 56-year-old man who presented with clinical and radiographic features of a small bowel obstruction and obscure gastrointestinal bleeding. Investigations including laparoscopy and other laboratory dataled to a diagnosis of pseudo-obstruction of the jejunum due to AA amyloidosis associated with latent syphilis. After appropriate treatment for latent syphilis, abdominal symptoms had been disappeared, but jejunal dilatation was still present two years later.
Amyloidosis ; Colon ; Dilatation ; Duodenum ; Hemorrhage ; Humans ; Intestinal Pseudo-Obstruction ; Jejunum ; Laparoscopy ; Middle Aged ; Rectum ; Serum Amyloid A Protein ; Stomach ; Syphilis ; Syphilis, Latent

Self-expandable metallic stents are widely used to relieve acute colorectal obstruction that's secondary to malignancy. They are utilized for both palliation and preoperative decompression prior to colorectal surgery. Although stents have been documented as a relatively safe therapeutic modality, procedure-related complications such as perforation, bleeding, stent reobstruction and migration can occur during or after colonic stent placement. Therefore, clinicians must be aware of the various complications associated with colonic stent placement. We present here a very rare case of sigmoidorectal intussusception that developed after fluoroscopic placement of a self-expandable metallic stent for preoperative decompression of sigmoid colon cancer. We misdiagnosed the intussusception as a distal stent migration on the plain radiography. On the sigmoidoscopic examination to evaluate the unrelieved colonic obstruction, we diagnosed a sigmoidorectal intussusception of the stent-implanted malignant tumor. The patient was successfully treated by laparoscopic partial reduction, followed by a curative anterior resection. This case demonstrates that careful examination must be done in cases of unrelieved colonic obstruction with suspicious stent migration, and intussusception must be considered as a rare complication of self-expandable metallic stent placement in the colon.
Colon ; Colonic Neoplasms ; Colorectal Surgery ; Decompression ; Hemorrhage ; Humans ; Intussusception ; Sigmoid Neoplasms ; Stents

BACKGROUND: Human cells are almost never spontaneously immortalized in vitro. We tried to immortalize human fetal hepatocytes (h-FH) and evaluate the differentiational status and its change. METHODS: Hepatocytes were isolated from a liver fragment of 20 week old fetus and infected with amphotropic recombinant retrovirus containing a temperature- sensitive mutant of SV40 large T antigen and neomycin phosphotransferase gene. G418 resistant colonies were cloned and expanded. The cells which were able to divide more than 30 times were used to analyze various functions. RESULTS: The immortalization rate was 3.3 x 10-8 and two cell lines (C11, D21) were established. C11-60, C11-80, D21-30 and D21-60 (suffix number means the cell division counts) were evaluated. D21-30 was thougt to be imcompletely immortalized because a considerable portion of cells died during culture. The morphology was similar to that of epithelial cells except for D21-30 which looked like fibroblast. The cells grew rapidly at 33oC but stopped growing at 39oC. T antigen and p53 was expressed at 33oC but disappeared at 39oC, which suggest that T antigen binds to p53. Chromosomal changes were so marked that it was impossible to discriminate exact number. Albumin was secreted as about 1/10 as that of h-FH, but alpha-fetoprotein secretion stopped after immortalization. Telomerase was activated in both cell lines except for the incompletely immortalized cells D21-30. Telomere was elongated in competely immortalized cell lines, but it was rather shortened in D21-30 compared to that of h-FH. Macroscopic colonies did not develop in soft agar assay. CONCLUSIONS: We successfully immortalized human fetal hepatocytes. Although the cells are not likely to have oncogenicity, the functions are not so good, possibly due to marked chromosomal changes which are thought to occur before telomerase is activated during immortalization step.
Agar ; alpha-Fetoproteins ; Antigens, Viral, Tumor* ; Cell Division ; Cell Line ; Clone Cells ; Epithelial Cells ; Fetus ; Fibroblasts ; Hepatocytes* ; Humans* ; Kanamycin Kinase ; Liver ; Retroviridae* ; Telomerase ; Telomere