Obstructive jaundice by vascular compression is rare. The causative arteries were identified as the right hepatic artery, gastroduodenal artery, cystic artery, proper hepatic artery, and an unspecified branch of the common hepatic artery. Also the venous system, such as enlarging collateral veins in cases of portal hypertension was a causative vessel. Herein, we describe a case of a proximal choledocholithiasis due to compression of the common bile duct by right hepatic artery originated from gastroduodenal artery. Final diagnosis and treatment were achieved through an operation.
Cholangiography ; Common Bile Duct/blood supply/*pathology/surgery ; Diagnosis, Differential ; *Hepatic Artery ; Humans ; Jaundice, Obstructive/*diagnosis/etiology/radiography ; Male ; Middle Aged ; Tomography, X-Ray Computed

A double pylorus, a fistulous communication between the gastric antrum and duodenal bulb, is a very rare anomaly. It appears as an acquired lesion in the majority of cases and mainly occurs in males with chronic obstructive pulmonary disease, chronic renal failure, chronic rheumatism, systemic lupus erythematosus, or diabetes. However, there are no previous reports of a double pylorus combined with diabetes mellitus in Korea. Recently we experienced a case of double pylorus caused by a peptic ulcer in 74-year-old man who had diabetes mellitus with complications. We report this case with a review of the literature.
Aged ; Diabetes Mellitus ; Humans ; Kidney Failure, Chronic ; Korea ; Lupus Erythematosus, Systemic ; Male ; Peptic Ulcer ; Pulmonary Disease, Chronic Obstructive ; Pyloric Antrum ; Pylorus ; Rheumatic Diseases

Granular cell tumor (GCT) is a relatively rare benign tumor that can be located anywhere throughout the body, but it is uncommon in the gastrointestinal tract, and especially in the colon and rectum. A 41-year-old man visited our hospital with a three-month history of intermittent abdominal discomfort at the left lower quadrant area. Colonoscopic examination revealed a hemispheric, submucosal lesion, about 1.5 x 1.2 cm in size, on the opposite side of the ileocecal valve in the proximal ascending colon. The tumor was removed by an endoscopic snare without any immediate complication. The pathologic findings revealed spindled or polygonal large cells that were positive for S-100, neuron-specific enolase and vimentin, and they were negative for smooth muscle actin and desmin, which was consistent with granular cell tumor. We report here on a case of granular cell tumor of the colon that was successfully treated with endoscopic polypectomy.
Actins ; Adult ; Colon* ; Colon, Ascending ; Colonoscopy* ; Desmin ; Gastrointestinal Tract ; Granular Cell Tumor* ; Humans ; Ileocecal Valve ; Muscle, Smooth ; Phosphopyruvate Hydratase ; Rectum ; SNARE Proteins ; Vimentin

Many reports have shown that endoscopic polypectomy or endoscopic mucosal resection can successfully remove tumor less than 1.0 cm in size. However, most carcinoid tumors in the rectum occur in the submucosal layer so that the entire tumor cannot be completely removed via endoscopic polypectomy or endoscopic mucosal resection. Endoscopic mucosal resection can also cause perforation of the intestinal wall and bleeding. Due to these reasons, instead of these two conventional methods, endoscopic mucosal resection using a ligation device is currently being used for the treatment of rectal carcinoid tumor. Recent studies that used this method have reported that endoscopic mucosal resection of rectal carcinoid tumor by band ligation and the snare resection technique is safe with minimal complications and this is quite useful to completely remove rectal carcinoid tumor.
Carcinoid Tumor ; Hemorrhage ; Ligation ; Rectum ; SNARE Proteins

Objective: This study aimed to validate the risk stratification system (RSS) and biopsy criteria for cervical lymph nodes (LNs) proposed by the Korean Society of Thyroid Radiology (KSThR). Materials and Methods: This retrospective study included a consecutive series of preoperative patients with thyroid cancer who underwent LN biopsy, ultrasound (US), and computed tomography (CT) between December 2006 and June 2015. LNs were categorized as probably benign, indeterminate, or suspicious according to the current US- and CT-based RSS and the size thresholds for cervical LN biopsy as suggested by the KSThR. The diagnostic performance and unnecessary biopsy rates were calculated. Results: A total of 277 LNs (53.1% metastatic) in 228 patients (mean age ± standard deviation, 47.4 years ± 14) were analyzed. In US, the malignancy risks were significantly different among the three categories (all P < 0.001); however, CTdetected probably benign and indeterminate LNs showed similarly low malignancy risks (P = 0.468). The combined US + CT criteria stratified the malignancy risks among the three categories (all P < 0.001) and reduced the proportion of indeterminate LNs (from 20.6% to 14.4%) and the malignancy risk in the indeterminate LNs (from 31.6% to 12.5%) compared with US alone. In all image-based classifications, nodal size did not affect the malignancy risks (short diameter [SD] ≤ 5 mm LNs vs. SD > 5 mm LNs, P ≥ 0.177). The criteria covering only suspicious LNs showed higher specificity and lower unnecessary biopsy rates than the current criteria, while maintaining sensitivity in all imaging modalities. Conclusion Integrative evaluation of US and CT helps in reducing the proportion of indeterminate LNs and the malignancy risk among them. Nodal size did not affect the malignancy risk of LNs, and the addition of indeterminate LNs to biopsy candidates did not have an advantage in detecting LN metastases in all imaging modalities.

A carcinoid tumor is a slow growing, rare neoplasm arising from enterochromaffin cells with a malignant potential. A primary carcinoid tumor of the stomach and duodenum is uncommon. However, their prevalence has been increasing due to the widespread use of endoscopy. Recently, the use of endoscopic resection for the treatment of small carcinoid tumors is gradually increasing. To our knowledge, this is the first case report of synchronous carcinoid tumors in the stomach and duodenum. We report a case of small, multiple carcinoid tumors of the stomach and duodenum in a 58-year-old man that was endoscopically removed with a snare.
Carcinoid Tumor* ; Duodenum* ; Endoscopy* ; Enterochromaffin Cells ; Humans ; Middle Aged ; Prevalence ; SNARE Proteins ; Stomach*

Truncal contrapulsion in association with pretectal syndrome has not been described previously. We report a patient with vertical-gaze palsy and severe truncal contrapulsion due to an infarction in the mesodiencephalic junction. Truncal contrapulsion in this patient may have resulted from the disruption of the ascending fibers in the crossed cerebellothalamic tract.
Humans ; Infarction ; Mesencephalon ; Paralysis

BACKGROUND/AIMS: The aim of the study was to evaluate the efficacy of i-scans for the diagnosis of gastroesophageal reflux disease, especially where only minimal change is involved. METHODS: The esophageal mucosa was inspected using an i-scan following conventional white light endoscopy. The examination with iscan was performed under tone enhancement (TE) esophagus (e) mode. Patients with subtle distal esophageal mucosal changes without definite mucosal breaks, such as blurring of Z-line (B), mucosal coarseness (C), hyperemic or purplish discoloration (D), erythema (E), ectopic gastric mucosal islet (I) and mixed type were classified as minimal change. RESULTS: A total of 156 patients were included. Using i-scan endoscopy, the number of minimal change was found to further increase from 94 (conventional endoscopy; 19B, 9C, 29D, 13E, 5I, 19 mixed type) to 109 (i-scan; 15B, 8C, 29D, 16E, 5I, 36 mixed type). And 14 patients who had single type by conventional endoscopy were converted to mixed type after i-scan. Therefore, 29 of 156 patients were upgraded after i-scan, they were account for 19% (p<0.0001; 95% confidence interval, 0.13 to 0.25). CONCLUSIONS: The use of i-scan endoscopy significantly improves the identification of minimal change and helps to identify more precisely the type of minimal change.
Endoscopy ; Erythema ; Esophagus ; Gastroesophageal Reflux ; Humans ; Light ; Mucous Membrane

BACKGROUND/AIMS: The aim of the study was to evaluate the efficacy of i-scans for the diagnosis of gastroesophageal reflux disease, especially where only minimal change is involved. METHODS: The esophageal mucosa was inspected using an i-scan following conventional white light endoscopy. The examination with iscan was performed under tone enhancement (TE) esophagus (e) mode. Patients with subtle distal esophageal mucosal changes without definite mucosal breaks, such as blurring of Z-line (B), mucosal coarseness (C), hyperemic or purplish discoloration (D), erythema (E), ectopic gastric mucosal islet (I) and mixed type were classified as minimal change. RESULTS: A total of 156 patients were included. Using i-scan endoscopy, the number of minimal change was found to further increase from 94 (conventional endoscopy; 19B, 9C, 29D, 13E, 5I, 19 mixed type) to 109 (i-scan; 15B, 8C, 29D, 16E, 5I, 36 mixed type). And 14 patients who had single type by conventional endoscopy were converted to mixed type after i-scan. Therefore, 29 of 156 patients were upgraded after i-scan, they were account for 19% (p<0.0001; 95% confidence interval, 0.13 to 0.25). CONCLUSIONS: The use of i-scan endoscopy significantly improves the identification of minimal change and helps to identify more precisely the type of minimal change.
Endoscopy ; Erythema ; Esophagus ; Gastroesophageal Reflux ; Humans ; Light ; Mucous Membrane

A 47-year-old patient with diabetes mellitus was admitted with the complaints of sore throat and dysphagia. We performed an esophagogastroduodenoscopy and found esophageal ulcers. Histological examination of the esophageal biopsy revealed sulphur granules, and immunological findings ruled out viral infection. Thus, we diagnosed an isolated actinomycotic infection of the esophagus and treated the infection with oral amoxicillin. This case illustrates that actinomycotic infection of the esophagus can occur in immunocompetent patients. Therefore, when evaluating dysphagia, the probability of actinomycotic infection must be considered not only in immunocompromised patients, but in immunocompetent individualswith diabetes mellitus.
Actinomycosis ; Amoxicillin ; Biopsy ; Deglutition Disorders ; Diabetes Mellitus ; Endoscopy, Digestive System ; Esophagitis ; Esophagus ; Humans ; Immunocompromised Host ; Middle Aged ; Pharyngitis ; Ulcer