The carcinoid tumor of the ampulla of Vater is extremely rare. We report a case of 57-year old male with carcinoid tumor of ampulla of Vater. This patient had been presented with bronchial asthma for one year. Abdominal CT finding revealed diffuse dilatation of common bile duct and pancreatic duct, and also ampullary soft mass protruded into duodenal lumen. The correct diagnosis was made preoperatively by endoscopic retrograde cholangiography with biopsy. Pancreatico- duodenectomy with lymph nodes dissection was performed. Malignant carcinoid tumor originating from ampulla of Vater was diagnosed with pericholedochal lymphatic metastasis. Surgical removal led to complete resolution of asthmatic symptoms.
Ampulla of Vater* ; Asthma ; Biopsy ; Carcinoid Tumor* ; Cholangiography ; Common Bile Duct ; Diabetes Mellitus ; Diagnosis ; Dilatation ; Humans ; Insulin Resistance ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Middle Aged ; Obesity ; Pancreatic Ducts ; Polymerase Chain Reaction ; PPAR gamma ; Tomography, X-Ray Computed

PURPOSE: This descriptive study was conducted to identify the use of complementary and alternative therapies, and the perception and attitudes toward CAT in Korean adults. METHODS: The 1,010 study subjects were recruited from ten regions in South Korea. Data were collected from July to September, 2004. RESULTS: The 43.2% of the sample(n=436) had an experience of using CAT. The subjects using CAT was more likely to have high score in the CAT perception compared to the subjects with no experience of CAT(p=.001). The primary source of information about CAT was mass media(59.7%). The 52.4% of the sample answered that CAT was supplementary and the 27.7% answered CAT was applicable to chronic pain or musculoskeletal disorders. Subjects(34.8%) pointed out that the greatest problem was no scientific informant in the use of CAT. The primary reason of using CAT was to maintain their health or to prevent disease(44.0%), and the 59.0% of the subjects responded that CAT was effective. Majority of subjects were satisfied with CAT(63.3%) and experienced no side effects of CAT(90.6%). CONCLUSION: This study suggests that professional counseling and education for CAT is needed for Korean public as well as the research approach to test the effects of CAT.
Adult* ; Animals ; Cats ; Chronic Pain ; Complementary Therapies* ; Counseling ; Education ; Humans ; Korea

BACKGROUND: We measured plasma vancomycin concentrations as a part of therapeutic drug monitoring (TDM) consultation and compared and analyzed the estimated plasma steady-state therapeutic drug levels of vancomycin obtained on the basis of measured concentrations and by population PK parameters using a PK simulation software in Korean patients to find the factors influencing the discrepancies that lie between these estimates. MATERIALS AND METHODS: We analyzed the PK parameters of the 188 patients for whom vancomycin TDM was done for 239 episodes between March, 2001 and September, 2002. The trough vancomycin plasma concentrations were measured from plasma samples that were drawn 30 minutes before a vancomycin dose. Based on the measured concentrations, we estimated the steady-state therapeutic levels (ECm) and PK parameters (apparent volumes of distribution, Vdm; clearance, Clm; and half life, T1/2m) using the single-point linear method utilized in CAPCIL (Simkin, Inc.) software program. We compared these with the steady-state levels and PK parameters estimated based on population PK database supplied by the software (ECp, Vdp, Clp, and T1/2p). We stratified and compared the values based on the patients' renal functions, body weights relative to ideal body weights, the magnitude of differences between ECm and ECp. Multiple logistic regression using SAS software package was done to analyze factors that significantly influence the discrepancies. RESULTS: One hundred and eleven were males, and 77 were females. The mean ECm were significantly lower than the mean ECp (11.9+/-9.9 microgram/ml vs. 19.2+/-19.5 microgram/ml). Clm and Vdm were higher than Clp and Vdp, respectively. The same patterns could be applied to the subclasses of patients based on renal functions and body weights. The factors that contribute to the differences in ECm and ECp were body weight, age, height, IBW, BUN, and Clcr, of which age, body weight, and BUN were found to be most significant by multiple regression analysis. CONCLUSIONS: Significant sizes of discrepancies between the estimated plasma steady-state therapeutic drug levels of vancomycin obtained on the basis of measured concentrations and by population PK parameters using a PK simulation software in Korean patients necessitate adjustment of dosage and confirmation of steady-state levels by follow-up TDM. We emphasize the need for obtaining vancomycin population PK database in Korean patients.
Body Weight ; Drug Monitoring* ; Female ; Follow-Up Studies ; Half-Life ; Humans ; Ideal Body Weight ; Logistic Models ; Male ; Pharmacokinetics ; Plasma ; Vancomycin*

BACKGROUND: We measured plasma vancomycin concentrations as a part of therapeutic drug monitoring (TDM) consultation and compared and analyzed the estimated plasma steady-state therapeutic drug levels of vancomycin obtained on the basis of measured concentrations and by population PK parameters using a PK simulation software in Korean patients to find the factors influencing the discrepancies that lie between these estimates. MATERIALS AND METHODS: We analyzed the PK parameters of the 188 patients for whom vancomycin TDM was done for 239 episodes between March, 2001 and September, 2002. The trough vancomycin plasma concentrations were measured from plasma samples that were drawn 30 minutes before a vancomycin dose. Based on the measured concentrations, we estimated the steady-state therapeutic levels (ECm) and PK parameters (apparent volumes of distribution, Vdm; clearance, Clm; and half life, T1/2m) using the single-point linear method utilized in CAPCIL (Simkin, Inc.) software program. We compared these with the steady-state levels and PK parameters estimated based on population PK database supplied by the software (ECp, Vdp, Clp, and T1/2p). We stratified and compared the values based on the patients' renal functions, body weights relative to ideal body weights, the magnitude of differences between ECm and ECp. Multiple logistic regression using SAS software package was done to analyze factors that significantly influence the discrepancies. RESULTS: One hundred and eleven were males, and 77 were females. The mean ECm were significantly lower than the mean ECp (11.9+/-9.9 microgram/ml vs. 19.2+/-19.5 microgram/ml). Clm and Vdm were higher than Clp and Vdp, respectively. The same patterns could be applied to the subclasses of patients based on renal functions and body weights. The factors that contribute to the differences in ECm and ECp were body weight, age, height, IBW, BUN, and Clcr, of which age, body weight, and BUN were found to be most significant by multiple regression analysis. CONCLUSIONS: Significant sizes of discrepancies between the estimated plasma steady-state therapeutic drug levels of vancomycin obtained on the basis of measured concentrations and by population PK parameters using a PK simulation software in Korean patients necessitate adjustment of dosage and confirmation of steady-state levels by follow-up TDM. We emphasize the need for obtaining vancomycin population PK database in Korean patients.
Body Weight ; Drug Monitoring* ; Female ; Follow-Up Studies ; Half-Life ; Humans ; Ideal Body Weight ; Logistic Models ; Male ; Pharmacokinetics ; Plasma ; Vancomycin*