A hilar cholangiocarcinoma is a cholangiocarcinoma occurring at the confluence of the right and left hepatic bile ducts which is called as Klatskin tumor. Because hilar cholangiocarcinoma is the most common form of extrahepatic bile duct cancer (EBDC), the epidemiology and risk factors of hilar cholangiocarcinoma are similar to those of EBDC. In Korea, overall incidence of EBDC is 5.1/100,000 individuals without a significant change during past 10 years. Most of cases occur in patients over the age of 50 and the incidence is 1.78 times higher in men than women. The etiology of EBDC has not been clearly defined. A number of pathologic conditions, however, resulting in either acute or chronic biliary tract epithelial injury may predispose to malignant change. Chronic biliary tract parasitic infection, such as Clonorchis sinensis and Opisthorchis viverrini, has been identified as a risk factor of EBDC and hilar cholangiocarcinoma. Other clear risk factors of EBDC are primary sclerosing cholangitis and choledochal cyst. However, there are no enough evidences whether primary sclerosing cholangitis and choledochal cyst are the definite risk factors of hilar cholangiocarcinoma or not.
Bile Ducts ; Bile Ducts, Extrahepatic ; Biliary Tract ; Cholangiocarcinoma ; Cholangitis, Sclerosing ; Choledochal Cyst ; Clonorchis sinensis ; Female ; Humans ; Incidence ; Klatskin's Tumor ; Korea ; Male ; Opisthorchis ; Risk Factors

No abstract available.
Botulinum Toxins* ; Gastrointestinal Tract*

Pancreatic cancer is a devastating disease with a fatal prognosis due to late diagnosis. Current imaging studies are inadequate for early detection and CA 19-9, the best tumor marker thus far, has low sensitivity in small pancreatic cancer, so the use of new markers is our most promising approach. Activation of the proto-oncogene K-ras and inactivation of the tumor suppressor genes p53, p16 and SMAD4 are characteristics for pancreatic cancer. K-ras mutation can be detected from pancreatic juice in 55~79% of patients with pancreatic cancer but can occur in the setting of chronic pancreatitis up to 32%. Telomerase activity in pancreatic juice can be used to distinguish between cancer and pancreatitis. The progression model of pancreatic cancer proposes that pancreatic intraepithelial neoplasia is the pre-cancerous lesion and this model is important for developing screening tools to detect early curable cancer. Pancreatic cancer harbors aberrant methylation of many cancer-related genes and detection of DNA hypermethylation by methylation specific PCR is attractive new candidate suitable for early detection. Recent large- scale gene expression studies can be done using cDNA and oligonucleotide microarrays and serial analysis of gene expression. Hundreds of overexpressed genes were already identified in pancreatic cancer. Large-scale analysis of proteins in biologic samples is possible by proteomics which has been applied to discovery proteins that could be used as potential markers. It is hoped that the understanding of genetic alterations and development of high throughput technologies will lead to the rapid discovery of biomarkers that will save lives by enabling aggressive therapy at the early stage.
Biomarkers ; Carcinoma, Pancreatic Ductal ; Delayed Diagnosis ; Diagnosis* ; DNA ; DNA, Complementary ; Gene Expression ; Genes, Tumor Suppressor ; Hope ; Humans ; Mass Screening ; Methylation ; Molecular Biology ; Oligonucleotide Array Sequence Analysis ; Pancreatic Juice ; Pancreatic Neoplasms* ; Pancreatitis ; Pancreatitis, Chronic ; Polymerase Chain Reaction ; Prognosis ; Proteomics ; Proto-Oncogenes ; Telomerase ; Biomarkers, Tumor*

In the recently published paper, there was a typo in the affiliation of the author. The word Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea was incorrectly spelled as Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. We hereby publish the correct affiliation as follows: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

In the recently published paper, there was a typo in the affiliation of the author. The word Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea was incorrectly spelled as Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. We hereby publish the correct affiliation as follows: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

No abstract availble.
Autoimmune Diseases/*drug therapy ; Glucocorticoids/*therapeutic use ; Humans ; Pancreatitis, Chronic/*drug therapy/immunology

Pancreatic cancer remains one of the most deadly diseases, despite significant advances in medicine over the past decade. Patients with chronic pancreatitis are known to have an increased risk of pancreatic cancer compared with the general population. There are few studies about the clinical features of pancreatic cancer associated with chronic pancreatitis. A recent retrospective study by Choi et al. showed that pancreatic cancer with chronic pancreatitis patients were younger at the time of the diagnosis and computed tomography findings showed only pancreatic duct dilatation without a mass in some cases. However, there were no differences between the two groups regarding resectability and the preoperative stage. Recent data indicate that imaging tests can detect asymptomatic precursor benign lesions in individuals with an inherited predisposition or strong family history. However, there are no consensus data about screening program in patient with chronic pancreatitis.
Consensus ; Dilatation ; Humans ; Mass Screening ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatitis ; Pancreatitis, Chronic ; Retrospective Studies

The diagnosis of autoimmune pancreatitis (AIP) is clinically challenging because it is a rare disease, which closely mimics more common pancreaticobiliary malignancies in its presentation such as obstructive jaundice and pancreatic mass. The price of misdiagnosis is high because AIP diagnosed as pancreatic cancer can lead to unnecessary surgery for the benign disease, and cancer diagnosed as AIP can delay potentially curative surgery. There is no single ideal diagnostic test for AIP; hence one has to use a set of diagnostic criteria to distinguish it from other diseases. International consensus diagnostic criteria (ICDC) and algorithm for AIP have been proposed by a consensus of expert opinion in 2011. The concept of the Japan pancreas society (JPS) 2011 criteria took basic concepts of both the Japanese previous criteria and type 1 in the ICDC as much as possible. However, the ICDC are very complex to remember and definition of level 1 and 2 are not evidence based in some criteria. The revised JPS criteria are simpler than ICDC but further evaluation is necessary in other than Japan. So, further research is required to establish easy, ideal and practical diagnostic criteria.
Asian Continental Ancestry Group ; Consensus ; Diagnosis ; Diagnostic Errors ; Diagnostic Tests, Routine ; Expert Testimony ; Humans ; Japan ; Jaundice, Obstructive ; Pancreas ; Pancreatic Neoplasms ; Pancreatitis* ; Rare Diseases ; Unnecessary Procedures

No abstract available.
Constriction, Pathologic* ; Stents*

Acute pancreatitis has a variable etiology and natural history, and some patients have severe complications with a significant risk of death. The prediction of severe disease should be achieved by careful ongoing clinical assessment coupled with the use of a multiple factor scoring system and imaging studies. Over the past 30 years several scoring systems have been developed to predict the severity of acute pancreatitis. However, there are no complete scoring index with high sensitivity and specificity till now. The interest in new biological markers and predictive models for identifying severe acute pancreatitis testifies to the continued clinical importance of early severity prediction. Among them, IL-6, IL-10, procalcitonin, and trypsinogen activation peptide are most likely to be used in clinical practice as predictors of severity. Even if contrast-enhanced CT has been considered the gold standard for diagnosing pancreatic necrosis, early scanning for the prediction of severity is limited because the full extent of pancreatic necrosis may not develop within the first 48 hour of presentation.
APACHE ; Age Factors ; Blood Urea Nitrogen ; C-Reactive Protein/analysis ; Creatine/analysis ; Cytokines/metabolism ; Humans ; Pancreatitis, Acute Necrotizing/*diagnosis ; Prognosis ; *Severity of Illness Index ; Tomography, X-Ray Computed