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

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

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: Obesity not only does increase the incidence of breast cancer, but also affects the course of treatment, recurrence and mortality. This study aims to evaluate on the obesity status of Korean breast cancer survivors and their obesity-related lifestyles. METHODS: The study included 125 Korean female breast cancer survivors aged over 19 year old enrolled in the 2009-11 Korean National Health and Nutrition Examination Survey. Women who answered 'yes' to the question 'have you ever been diagnosed breast cancer by a physician?' was defined as a breast cancer survivors. Height, weight, and waist circumference were measured and Body mass index (BMI) was calculated. Body fat percent was assessed by dual X-ray absorptiometry (DXA). Standardized surveys by trained interviewers were used to investigate survivors' obesity-related lifestyles such as physical activities, sleeping hours and nutrients intake. RESULTS: 48.4% of Korean breast cancer survivors were obese. 44.7% had abdominal obesity and 89.2% had body fat percent over 30. Their physical activity level was generally low; only 22.5% maintained health-enhancing level of physical activities. Fat intake (14.4 [0.8] %) was as low and carbohydrate intake (74.2 [1.2] %) was high. However, daily dietary fiber intake was low (10.5 [1.1] g). Factors that were found to be significantly related with obesity in Korean breast cancer survivors were low education level (P=0.042), smoking (P<0.001), having chronic diseases (P=0.002) and short sleeping hours (P<0.001). CONCLUSIONS: It is mandatory for physician to evaluate obesity status of breast cancer survivors as soon as their diagnosis and give proper intervention to maintain healthy weight and healthy obesity related lifestyle.
Absorptiometry, Photon ; Adipose Tissue ; Body Mass Index ; Breast Neoplasms* ; Chronic Disease ; Diagnosis ; Dietary Fiber ; Education ; Female ; Humans ; Incidence ; Life Style* ; Metabolic Equivalent ; Mortality ; Motor Activity ; Nutrition Surveys ; Obesity* ; Obesity, Abdominal ; Recurrence ; Smoke ; Smoking ; Survivors* ; Waist Circumference

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

OBJECTIVES: We analyzed whether gender role stereotypes (GRS) and patriarchal attitudes are associated with cognitive function in an elderly community. METHODS: We analyzed data from 580 people enrolled in the Korean Social Life, Health, and Aging Project. The degrees to which respondents held stereotypical beliefs about gender roles and had patriarchal mindsets were measured using a questionnaire. Based on participants’ responses, we divided respondents into 2 groups—those with conservative mindsets and those with open mindsets—according to the median score for each of the 2 variables. Cognitive function was assessed using the Mini-Mental State Examination, Korean version (MMSE-K). Cognitive impairment was defined as an MMSE-K score ≤21 points. Multivariable logistic regression was performed, adjusting for gender, age, socio-demographic and lifestyle factors, and social network size. Age and lifestyle factors were stratified. RESULTS: Compared to those with open mindsets, those with conservative mindsets regarding gender roles and patriarchal norms had adjusted odds ratios of 1.88 (95% confidence interval [CI], 1.11 to 3.19) and 1.67 (95% CI, 1.00 to 2.79) for cognitive impairment, respectively. In the stratified analysis, subgroups with younger age and a good lifestyle maintained a protective association with cognitive impairment. CONCLUSIONS GRS and a patriarchal mindset were marginally significantly associated with cognitive impairment among women later in life.

OBJECTIVES: We analyzed whether gender role stereotypes (GRS) and patriarchal attitudes are associated with cognitive function in an elderly community. METHODS: We analyzed data from 580 people enrolled in the Korean Social Life, Health, and Aging Project. The degrees to which respondents held stereotypical beliefs about gender roles and had patriarchal mindsets were measured using a questionnaire. Based on participants’ responses, we divided respondents into 2 groups—those with conservative mindsets and those with open mindsets—according to the median score for each of the 2 variables. Cognitive function was assessed using the Mini-Mental State Examination, Korean version (MMSE-K). Cognitive impairment was defined as an MMSE-K score ≤21 points. Multivariable logistic regression was performed, adjusting for gender, age, socio-demographic and lifestyle factors, and social network size. Age and lifestyle factors were stratified. RESULTS: Compared to those with open mindsets, those with conservative mindsets regarding gender roles and patriarchal norms had adjusted odds ratios of 1.88 (95% confidence interval [CI], 1.11 to 3.19) and 1.67 (95% CI, 1.00 to 2.79) for cognitive impairment, respectively. In the stratified analysis, subgroups with younger age and a good lifestyle maintained a protective association with cognitive impairment. CONCLUSIONS GRS and a patriarchal mindset were marginally significantly associated with cognitive impairment among women later in life.

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