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*

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*

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

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.

The 5-year survival rate of pancreatic cancer is extremely low till now, because resectable cases are less than 20% and 5-year survival rate after surgical resection is only 10-20%. Early detection and curative surgery are important to prolong the survival which was well proved by colon cancer screening test in general population. However, screening test for general population can not prove the survival benefit in pancreatic cancer. So, many studies were performed for the development of screening strategies in high-risk groups of pancreatic cancer. The following were current candidates for screening: first-degree relatives of patients with pancreatic cancer from a familial pancreatic cancer kindred with at least two affected first-degree relatives; patients with Peutz-Jeghers syndrome; and p16, BRCA2 and hereditary non-polyposis colorectal cancer mutation carriers with > or = 1 affected first-degree relative. The recommended screening tests are endoscopic ultrasonography and magnetic resonance cholangiopancreatography. Screening is recommended at age 50 or 10 year earlier than the onset age of pancreatic cancer among family. However, the screening interval is not established and there is great disagreement as to which screening abnormalities were of sufficient concern to for surgery to be recommended.
Age of Onset ; Cholangiopancreatography, Magnetic Resonance ; Colonic Neoplasms ; Colorectal Neoplasms ; Early Detection of Cancer ; Early Diagnosis ; Endosonography ; Humans ; Mass Screening ; Pancreatic Neoplasms* ; Peutz-Jeghers Syndrome ; Survival Rate

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

BACKGROUND: It has been suggested that chronic hepatitis C virus (HCV) infection is associated with diabetes. The aim of this study was to establish a potential relationship between chronic HCV infection and diabetes mellitus in Korean patients. METHODS: We performed a prospective analysis of 404 patients with chronic viral hepatitis or liver cirrhosis who visited our hospital and analyzed whether age, sex, body mass index, alcohol consumption, hepatitis B virus (HBV) infection, HCV infection and cirrhosis were associated with diabetes. We also enrolled 627 diabetic patients and the seroprevalence of HBV surface antigen (HBsAg) and anti-HCV was determined. RESULTS: Diabetes was observed more frequently in individuals with HCV infected chronic liver disease (24.0%) than in those with HBV infected (10.4%) (p<0.05). Univariate analyses revealed that age, alcohol consumption and HCV infection were significant independent predictors for diabetes. The mean age of the patients with HCV infected chronic liver disease was higher than that of HBV infected (56+/-16 vs 44+/-13, p<0.05). The prevalence of diabetes in HCV infected group was higher than that in HBV infected group in the age of 41~60 (p<0.05). In diabetic group, the seroprevalence of HBsAg positivity was 4.5% and that of anti-HCV was 2.1%. CONCLUSION: Our study demonstrates an association between diabetes and chronic HCV infection in Korean patients. The prevalence of diabetes in patients with HCV infected chronic liver disease is higher than that in those with HBV infected. Age and alcohol consumption are another risk factor for diabetes in patients with chronic viral liver disease.
Adult ; Age Distribution ; Aged ; Analysis of Variance ; Comorbidity ; Comparative Study ; Cross-Sectional Studies ; Diabetes Mellitus/epidemiology* ; Diabetes Mellitus/diagnosis ; Female ; Hepatitis C, Chronic/epidemiology* ; Hepatitis C, Chronic/diagnosis ; Human ; Korea/epidemiology ; Male ; Middle Age ; Prevalence ; Probability ; Prospective Studies ; Risk Assessment ; Risk Factors ; Sex Distribution

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