BACKGROUND/AIMS: Endoscopic sphincterotomy (EST) has become a well-established therapeutic modality for common bile duct stone (s). EST and subsequent stone extraction, including mechanical lithotripsy, can clear bile duct in 85% to 95% of patients. Other therapeutic modalities which have been developed to enhance bile duct clearance including extracorporeal shock-wave lithotripsy, electrohydraulic or laser lithotripsy, and chemical dissolution are high cost, not yet widely available especially in community hospital, yet to be perfected, or still under clinical evaluation. The use of biliary stenting has been proposed as an alternative therapy for patients at high risk for surgery. We carried out this prospective, controlled study to evaluate the long-term effect of biliary stenting for endoscopically unextractable common bile duct stone (s). METHODS: Of the 233 patients with common bile duct stone (s) admitted at Gil Hospital from Jan. 1995 to Dec. 1996, the stent group were 14 patients with retained comrnon bile duct stone (s) in which 7Fr polyethylene biliary stent was placed with the proximal end above the stone and the distal end in the duodenum. The control group were 6 patients with common bile duct stone (s) not treated, because of patients refusal of surgical or endoscopic management. Follow-up was achieved by direct interview and telephone, and consisted of prospective analysis of all complications that occured during long-term follow-up period. Complication rates in the both groups were compared using chi-square test and cumulative complication-free rates were calculated by Kaplan-Meier analysis.
Bile Ducts ; Common Bile Duct* ; Disulfiram ; Duodenum ; Follow-Up Studies ; Hospitals, Community ; Humans ; Kaplan-Meier Estimate ; Lithotripsy ; Lithotripsy, Laser ; Polyethylene ; Prospective Studies ; Sphincterotomy, Endoscopic ; Stents* ; Telephone

Ciliated hepatic foregut cysts are uncommon lesions of the liver. They arise from remnants of the embryonic foregut, and are usually asymptomatic and benign. They are lined with a layer of ciliated columnar cells and contain mucoid material and debris. Ciliated hepatic foregut cysts are not malignant neoplasms and must be differentiated from cystic neoplasms and hypovascular solid tumors. We experienced a case of ciliated hepatic foregut cyst, which was successfully removed by laparoscopic excision, so we report the case with review of the literature.
Laparoscopy ; Liver

Adenoid basal carcinoma and adenoid cystic carcinoma of the uterine cervix are rare tumors that have often been regarded as a single entity. But adenoid basal and adenoid cystic carcinomas of the cervix differ from each other in their histology, treatment, and prognosis. We experienced 2 cases of these neoplasms, with 1 case in each category. Whereas adenoid basal carcinoma is a slow-growing, locally invasive lesion amenable to simply hysterectomy, adenoid cystic carcinoma is an aggressive tumor associated with regional lymph node involvement and late distant metastases. This study reviews the literature and formulates a program for the management of these rare lesions.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Cervix Uteri* ; Female ; Hysterectomy ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

Adenomatous polyps of the duodenum is uncommon in general population, but duodenal adenomas are found in the majority of patients with both familial adenomatous polypasis and Gardner's syndrome. These polyps are usually small, multiple and most commonly found in the second portion of the duodenum, and may involve ampulla of Vater. They also have malignant potential so that routine surveillance of the duodenum including ampulla of Vater has been recommended in patients with adenomatous polyposis coli. The adenoma of ampulla of Vater can be found in approximately 50% of patients with familial adenomatous polyposis and usually is asymptomatic, but sometimes, especially villous adenoma, may exhibit clinical problems including partial gastric outlet obstruction, pancreatitis, bleeding, obstructive jaundice, in addition to a high incidence of malignancy. Among the non-malignant complications of the ampullary tumor, there are only a few case reports of acute pancreatitis as the presenting manifestation of an ampullary adenoma or carcinoma in patients with familial adenomatous polyposis in the English literature, but no cases have been reported in Korea. We present here a case of symptomatic adenoma of the ampulla of Vater presenting as acute pancreatitis in a patient with familial adenomatous polyposis.
Adenoma* ; Adenoma, Villous ; Adenomatous Polyposis Coli* ; Adenomatous Polyps ; Ampulla of Vater ; Duodenum ; Gardner Syndrome ; Gastric Outlet Obstruction ; Hemorrhage ; Humans ; Incidence ; Jaundice, Obstructive ; Korea ; Pancreatitis* ; Polyps

PURPOSE: Nevus comedonicus is a rare disease involving abnormal development of the pilosebaceous unit, clinically appearing confluent clusters of open comedones. It is characterized by follicular epidermic invaginations filled with keratin, with atrophic pilose or sebaceous structures which are open to the lower pole of the invagination. We report a child with inflammatory pustules and cysts correlated to the nevus comedonicus. METHODS: A 15-month-old girl was referred for treatment of a nevus comedonicus that has been developed since birth. There were periodic episodes of erythema and swelling of the plaque. The patient had treated previously with retinoid cream for 2 weeks without obvious benefit at dermatology clinic. We excised the nevus comedonicus with Y-shape leaving some lesions. RESULTS: When we incised skin, we could see multiple large whitish cysts beneath the nevus comedonicus. Histopathologic findings showed deep invagination of epidermis filled with keratin plugs, keratinous cyst in the dermis, rudimentary hair follicle. CONCLUSION: We treated rare nevus comedonicus with multiple large cysts as surgical excision.
Child ; Dermatology ; Dermis ; Epidermis ; Erythema ; Hair Follicle ; Humans ; Infant ; Keratins ; Nevus ; Parturition ; Rare Diseases ; Skin

PURPOSE: Nevus comedonicus is a rare disease involving abnormal development of the pilosebaceous unit, clinically appearing confluent clusters of open comedones. It is characterized by follicular epidermic invaginations filled with keratin, with atrophic pilose or sebaceous structures which are open to the lower pole of the invagination. We report a child with inflammatory pustules and cysts correlated to the nevus comedonicus. METHODS: A 15-month-old girl was referred for treatment of a nevus comedonicus that has been developed since birth. There were periodic episodes of erythema and swelling of the plaque. The patient had treated previously with retinoid cream for 2 weeks without obvious benefit at dermatology clinic. We excised the nevus comedonicus with Y-shape leaving some lesions. RESULTS: When we incised skin, we could see multiple large whitish cysts beneath the nevus comedonicus. Histopathologic findings showed deep invagination of epidermis filled with keratin plugs, keratinous cyst in the dermis, rudimentary hair follicle. CONCLUSION: We treated rare nevus comedonicus with multiple large cysts as surgical excision.
Child ; Dermatology ; Dermis ; Epidermis ; Erythema ; Hair Follicle ; Humans ; Infant ; Keratins ; Nevus ; Parturition ; Rare Diseases ; Skin

Purpose: The aim of this study was to compare the diameter and volume of liver metastases on CT images in relation to overall survival and tumor response in patients with gastric cancer liver metastases (GCLM) treated with chemotherapy. Materials and Methods: We recruited 43 patients with GCLM who underwent chemotherapy as a first-line treatment. We performed a three-dimensional quantification of the metastases for each patient. An independent survival analysis using the Response Evaluation Criteria in Solid Tumors (RECIST) was performed and compared to volumetric measurements. Overall survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios following univariate analyses. Results: When patients were classified as responders or non-responders based on volumetric criteria, the median overall survival was 23.6 months [95% confidence interval (CI), 8.63–38.57] and 7.6 months (95% CI, 3.78–11.42), respectively (p = 0.039). The volumetric analysis and RECIST of the non-progressing and progressing groups showed similar results based on the Kaplan-Meier method (p = 0.006) and the Cox proportional hazard model (p = 0.008). Conclusion Volumetric assessment of liver metastases could be an alternative predictor of overall survival for patients with GCLM treated with chemotherapy.

Purpose: The aim of this study was to compare the diameter and volume of liver metastases on CT images in relation to overall survival and tumor response in patients with gastric cancer liver metastases (GCLM) treated with chemotherapy. Materials and Methods: We recruited 43 patients with GCLM who underwent chemotherapy as a first-line treatment. We performed a three-dimensional quantification of the metastases for each patient. An independent survival analysis using the Response Evaluation Criteria in Solid Tumors (RECIST) was performed and compared to volumetric measurements. Overall survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios following univariate analyses. Results: When patients were classified as responders or non-responders based on volumetric criteria, the median overall survival was 23.6 months [95% confidence interval (CI), 8.63–38.57] and 7.6 months (95% CI, 3.78–11.42), respectively (p = 0.039). The volumetric analysis and RECIST of the non-progressing and progressing groups showed similar results based on the Kaplan-Meier method (p = 0.006) and the Cox proportional hazard model (p = 0.008). Conclusion Volumetric assessment of liver metastases could be an alternative predictor of overall survival for patients with GCLM treated with chemotherapy.

Purpose: To confirm that the phaco chop method using an illuminated chopper (iChopper; Oculight, Seongnam, Korea) can reduce cataract surgery complications, and that even beginners can safely and effectively perform phaco chop. Methods: We retrospectively analyzed the medical records of the first 30 phaco chop cases using illuminated chopper of four cataract surgeons. Four ophthalmologists had a variety of empirical backgrounds, from those who have experienced more than 10,000 cataract surgery, to beginners who have experienced 20 cataract surgery. Results: Of the total 120 eyes, two eyes (1.67%) had posterior capsule rupture. The chopping method was changed from phaco chop to stop and chop in three eyes (2.5%) including one eye with brown cataract with pseudoexofoliation syndrome and two eyes with nuclear opacity grade ≥5. Conclusions The rates of posterior capsule rupture of phaco chop using an illuminated chopper were very low in four surgeons with various experiences and who became proficient shortly in phaco chop.

A central venous port catheter is widely used to administer fluids, chemotherapeutic agents, and parenteral nutrition; however, similar to other invasive procedures, it has numerous potential complications. Among them, distal migration of a fractured central venous port catheter is a rare complication. A 66-year-old man had a central venous port catheter implanted into the right subclavian vein for adjuvant stomach cancer chemotherapy and presented with an ulceration at the chemoport insertion site. While removing the port catheter, it fractured and the distal tip and migrated and impacted the annulus of the right atrium. The impacted port catheter was successfully removed through a femoral vein approach using a radiofrequency ablation catheter and a multi snare.
Aged ; Catheterization, Central Venous ; Catheters ; Femoral Vein ; Fractures, Spontaneous ; Heart Atria ; Humans ; SNARE Proteins ; Stomach ; Stomach Neoplasms ; Subclavian Vein ; Ulcer ; Vascular Access Devices