Gastric adenocarcinoma of fundic gland type is known to originate from the gastric mucosa of the fundic gland region without intestinal metaplasia. It is difficult to detect during endoscopy and diagnose histopathologically. The development of immunohistochemistry has enabled the diagnosis of gastric adenocarcinoma of fundic gland type by gastric phenotype. A 34-year-old man visited us for treatment of a 5 cm-sized low-grade dysplasia in the gastric fundus which was incidentally found during a health check-up endoscopy. Endoscopic submucosal dissection was performed successfully, and the final histopathology showed gastric adenocarcinoma of fundic gland type. Herein, we report a rare case of gastric adenocarcinoma of fundic gland type and its endoscopic and histopathologic findings.

Gastric adenocarcinoma of fundic gland type is known to originate from the gastric mucosa of the fundic gland region without intestinal metaplasia. It is difficult to detect during endoscopy and diagnose histopathologically. The development of immunohistochemistry has enabled the diagnosis of gastric adenocarcinoma of fundic gland type by gastric phenotype. A 34-year-old man visited us for treatment of a 5 cm-sized low-grade dysplasia in the gastric fundus which was incidentally found during a health check-up endoscopy. Endoscopic submucosal dissection was performed successfully, and the final histopathology showed gastric adenocarcinoma of fundic gland type. Herein, we report a rare case of gastric adenocarcinoma of fundic gland type and its endoscopic and histopathologic findings.

Acromegaly and hyperprolactinemia have been described in association with polyostotic fibrous dysplasia. The pathogenic mechanisms of this endocrinopathy are not clear. We experienced a 19-year-old male with hypersecretion of GH, hyperprolactinemia and fibrous dysplasia. He was referred for evaluation of suspected acromegaly. He had no skin pigmentation. Plasma GH, PRL, somatomedin-C, LH, FSH, testosterone, estradiol, progesterone, T3, T4, TSH and cortisol were measured. Among those, the levels of plasma GH, PRL and somatomedin-C were high. Serum alkaline phosphatase was increased. OGTT did not suppress plasma OH concentration and GH showed paradoxical response to TRH and LHRH. GH was suppressed after a test-dose of somatastatin and bromocriptine. Brain MRI demonstrated a mass lesion in sella turcica and another mass lesions in nasal cavity and posterior occipital bone. Whole body bone scan revealed increased uptake in skull, nasal bone, both 9th posterior rib, both femurs, both tibias, left scapular and pelvic bone. These fmdings were consistent with bone tumor such as fibrous dysplasia. We report a case with incomplete MeCune-Albright syndrome including acromegaly, hyperprolactinemia and polyostotic fibrous dysplasia.
Acromegaly ; Alkaline Phosphatase ; Brain ; Bromocriptine ; Estradiol ; Femur ; Fibrous Dysplasia, Polyostotic ; Glucose Tolerance Test ; Gonadotropin-Releasing Hormone ; Humans ; Hydrocortisone ; Hyperprolactinemia ; Magnetic Resonance Imaging ; Male ; Nasal Bone ; Nasal Cavity ; Occipital Bone ; Pelvic Bones ; Plasma ; Progesterone ; Ribs ; Sella Turcica ; Skin Pigmentation ; Skull ; Testosterone ; Tibia ; Young Adult

Objective: The use of a high flow nasal cannula (HFNC) might cover the gap between conventional oxygen therapy andmechanical ventilation in the management of acute respiratory failure patients and could be a significant factor in determiningpatient outcomes. Early predictors of HFNC failure may help a clinician decide whether to shift the patient to amechanical ventilator. We aimed at identifying the predictors associated with HFNC failure and the application of amechanical ventilator using arterial blood gas analysis (ABGA). Methods: We retrospectively analyzed patients who were admitted to the emergency room at a single center with respiratorydistress and a PaO2/FiO2 ratio (ratio of arterial partial pressure of oxygen to fraction of inspired oxygen) of less than300. Comparing keeping and weaning HFNC groups with the escalation group, we sought to identify a few discriminatingfactors. Initial ABGA was done when the patients entered the emergency room and this was followed up within 2 hoursafter HFNC therapy. Results: Two hundred and eighteen patients were enrolled and of these HFNC therapy succeeded in 153 and failed in65. At baseline Glasgow Coma Scale, follow-up (F/U) pH, ΔpH, and F/U respiratory rate-oxygenation index were lowerand pro-brain natriuretic peptide, initial lactate, F/U lactate, ΔPCO2, heart rate, acidosis, consciousness, oxygenation,respiratory rate score, Acute Physiology And Chronic Health Evaluation score, Simplified Acute Physiology Score, andSequential Organ Failure Assessment score were significantly higher in the HFNC failure group. The results of the multivariateanalysis indicated that initial lactate (odds ratio [OR], 1.215; 95% confidence interval [CI], 1.081-1.366; P=0.001)and ΔpH (OR, 0.000; 95% CI, 0.000-0.018; P<0.001) were independently associated with the prediction of application ofthe mechanical ventilator. Conclusion Patients who had higher initial lactate levels and insufficiently corrected pH after HFNC therapy may needto be monitored carefully and escalation of oxygen therapy may need to be considered.

Objective: The use of a high flow nasal cannula (HFNC) might cover the gap between conventional oxygen therapy andmechanical ventilation in the management of acute respiratory failure patients and could be a significant factor in determiningpatient outcomes. Early predictors of HFNC failure may help a clinician decide whether to shift the patient to amechanical ventilator. We aimed at identifying the predictors associated with HFNC failure and the application of amechanical ventilator using arterial blood gas analysis (ABGA). Methods: We retrospectively analyzed patients who were admitted to the emergency room at a single center with respiratorydistress and a PaO2/FiO2 ratio (ratio of arterial partial pressure of oxygen to fraction of inspired oxygen) of less than300. Comparing keeping and weaning HFNC groups with the escalation group, we sought to identify a few discriminatingfactors. Initial ABGA was done when the patients entered the emergency room and this was followed up within 2 hoursafter HFNC therapy. Results: Two hundred and eighteen patients were enrolled and of these HFNC therapy succeeded in 153 and failed in65. At baseline Glasgow Coma Scale, follow-up (F/U) pH, ΔpH, and F/U respiratory rate-oxygenation index were lowerand pro-brain natriuretic peptide, initial lactate, F/U lactate, ΔPCO2, heart rate, acidosis, consciousness, oxygenation,respiratory rate score, Acute Physiology And Chronic Health Evaluation score, Simplified Acute Physiology Score, andSequential Organ Failure Assessment score were significantly higher in the HFNC failure group. The results of the multivariateanalysis indicated that initial lactate (odds ratio [OR], 1.215; 95% confidence interval [CI], 1.081-1.366; P=0.001)and ΔpH (OR, 0.000; 95% CI, 0.000-0.018; P<0.001) were independently associated with the prediction of application ofthe mechanical ventilator. Conclusion Patients who had higher initial lactate levels and insufficiently corrected pH after HFNC therapy may needto be monitored carefully and escalation of oxygen therapy may need to be considered.

Glomus tumor is a benign tumor derived from the vascular wall of the arteriovenous anastomosis complex. Glomus tumors in the gastrointestinal tract are rare, especially those in the duodenum. Most gastrointestinal glomus tumors are found incidentally on endoscopy during routine health checkup and sometimes because of bleeding. We experienced a case of duodenal glomus tumor diagnosed after surgical resection of an incidental subepithelial tumor in the duodenum. Herein, we report the characteristic endoscopic ultrasonography, contrast-enhanced CT, and histopathological findings of duodenal glomus tumor.

Glomus tumor is a benign tumor derived from the vascular wall of the arteriovenous anastomosis complex. Glomus tumors in the gastrointestinal tract are rare, especially those in the duodenum. Most gastrointestinal glomus tumors are found incidentally on endoscopy during routine health checkup and sometimes because of bleeding. We experienced a case of duodenal glomus tumor diagnosed after surgical resection of an incidental subepithelial tumor in the duodenum. Herein, we report the characteristic endoscopic ultrasonography, contrast-enhanced CT, and histopathological findings of duodenal glomus tumor.

Approximately 10% of pheochromocytomas are malignant and its major criteria are tumor invasion of capsular blood vessel as well as metastatic invasion of other tissues. It is general rule that all resectable masses have to be removed surgically. However, there is no definite treatment modality about unresectable masses or microinvasive lesions. We experienced a case of 45 year-old male patient who was referred to our hospital for treatment of hypertension and headache. The plasma and urine catecholamine were increased above normal values and its metabolites also were increased. 131I-metaiodobenzylguanidine (MIBG) scan showed right adrenal mass and metastatic lesion of left iliac bone. This lesion was consistent with findings of the abdomen computed tomography (CT) and electron beam tomography (EBT) scan. We diagnosed this case as malignant pheochromocytoma. We removed primary tumor mass by wide excision and treated this patient with high dose 131I-MIBG. We report this case who shows good response to the high dose 131I-MIBG after surgery.
3-Iodobenzylguanidine ; Abdomen ; Blood Vessels ; Headache ; Humans ; Hypertension ; Male ; Middle Aged ; Neoplasm Metastasis ; Pheochromocytoma* ; Plasma ; Reference Values ; Tomography, X-Ray Computed

BACKGROUND: Patients have anxiety and fear of complications due to general anesthesia. Through new instruments and local anesthetic drugs, a variety of anesthetic methods have been introduced. These methods keep hospital costs down and save time for patients. In particular, the target-controlled infusion (TCI) system maintains a relatively accurate level of plasma concentration, so the depth of anesthesia can be adjusted more easily. We conducted this study to examine whether intravenous anesthesia using the TCI system with propofol and remifentanil would be an effective method of anesthesia in breast augmentation. METHODS: This study recruited 100 patients who underwent breast augmentation surgery from February to August 2011. Intravenous anesthesia was performed with 10 mg/mL propofol and 50 microg/mL remifentanil simultaneously administered using two separate modules of a continuous computer-assisted TCI system. The average target concentration was set at 2 microg/mL and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinical effect and vital signs. Oxygen saturation, electrocardiography, and respiratory status were continuously measured during surgery. Blood pressure was measured at 5-minute intervals. Information collected includes total duration of surgery, dose of drugs administered during surgery, memory about surgery, and side effects. RESULTS: Intraoperatively, there was transient hypotension in two cases and hypoxia in three cases. However, there were no serious complications due to anesthesia such as respiratory difficulty, deep vein thrombosis, or malignant hypertension, for which an endotracheal intubation or reversal agent would have been needed. All the patients were discharged on the day of surgery and able to ambulate normally. CONCLUSIONS: Our results indicate that anesthetic methods, where the TCI of propofol and remifentanil is used, might replace general anesthesia with endotracheal intubation in breast augmentation surgery.
Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthesia, Local ; Anesthetics ; Anoxia ; Anxiety ; Blood Pressure ; Breast ; Electrocardiography ; Female ; Hospital Costs ; Humans ; Hypertension, Malignant ; Hypotension ; Intubation, Intratracheal ; Mammaplasty ; Memory ; Oxygen ; Piperidines ; Plasma ; Propofol ; Venous Thrombosis ; Vital Signs

Despite the recent increase in the use of complementary and alternative medicine (CAM) among the general population and patients, little is known about Korean physicians' attitudes about and interest in CAM. We conducted a web-based survey of knowledge, attitude, and experience in CAM among primary care physicians (PCPs) and academic physicians (APs) in Korea. A total of 826 physicians (341 PCPs and 485 APs) responded. Respondents in both groups felt that they were not sufficiently knowledgeable about CAM. PCPs, however, had a significantly higher composite index score in CAM knowledge than that of APs. Although APs were more skeptical about the scientific evidence of CAM than PCPs, both groups had a positive attitude toward CAM. The level of experience in utilizing CAM in their practice was 23.2% among PCPs, which was much higher than that among APs (2.7%). Experience rates of referring patients to CAM were 11.7% in PCPs and 4.5% in APs (P<0.001). Despite the discrepant rates in CAM education between the two groups (58.7% in PCPs and 26.0% in APs, P<0.001), the majority of doctors in both groups (85.0% in PCPs and 70.0% in APs) expressed an intention to participate in authorized CAM coursework. In conclusion, despite the lack of scientific evidence, both PCPs and APs have an interest in incorporating CAM into their conventional medical practices. To meet physicians' increasing needs for CAM the Korean medical societies should promote education and research about CAM in the conventional medical system.
Complementary Therapies ; Humans ; Intention ; Korea ; Physicians, Primary Care ; Primary Health Care ; Societies, Medical ; Surveys and Questionnaires