Cholangiocarcinoma has been associated with various fibrocystic diseases of liver and biliary tract, but cholangiocarcinoma in polycystic liver disease (PLD) was extremely rare. It was reported that the prognosis of cholangiocarcinoma associated PLD was very poor and distant metastases were common. We report a rare case of intrahepatic cholangiocarcinoma associated with PLD in 58- year- old female who presented vague abdominal pain. She had also polycystic kidneys with normal renal function. MRI showed well demonstrated tumor with central scar and a adjacent large cyst in the left lobe of the liver. She underwent extended left lobectomy. On microscopic examination, the tumor was moderately differentiated cholangiocarcinoma having abundant fibrous stroma and necrosis and the adjacent cyst showed focal in situ carcinomatous changes in the lining epithelium.
Abdominal Pain ; Biliary Tract ; Cholangiocarcinoma* ; Cicatrix ; Epithelium ; Female ; Humans ; Liver Diseases* ; Liver* ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Polycystic Kidney Diseases ; Prognosis ; Cholangiocarcinoma

PURPOSE: To evaluate changes in the MRI findings of pituitary adenoma after gamma-knife radiosurgery, and tocorrelate these with the clinical outcome. MATERIALS AND METHODS: We evaluated the MRI findings of 27 patientswith pituitary adenoma before and after gamma-knife radiosurgery. Their ages ranged from 16 to 69 years(M:F =8:19), and there were seven cases of microadenoma and 20 of macroadenoma. In 11 cases, the tumor was partiallyremoved before radiosurgery. The follow-up period ranged from three to 43 months. RESULTS: In two cases ofmicroadenoma, complete regression was seen after three and 12 months, respectively, with normalization of hormonelevels and the improvement of symptoms. Among the remaining cases, in which no volume change was noted, hormonelevels normalized in four. Among 20 cases of macroadenoma, volume reduction was seen in 18 patients and completeregression, in two. In cases in which the volume was reduced by 20%, the mean follow-up period was 6.6 months, andin cases in which this was 50%, the period was 15.3 months. On postenhanced T1W images, the most frequent patternswere rim enhancement (n=10;50%) and homogneous enhancement changed to rim enhancement (n=4;20%). In six of ninecases(66.7%) of hyperfunctioning macroadenomas, hormone levels normalized, and in nine of 11 cases (81.8%) ofnonfunctioning macroadenomas, symptom improvement was noted. In six of 20 cases in which the enhancement patternchanged after gamma knife radiosurgery, there was clinical improvement. Among 14 cases in which there was nochange in the enhancement pattern, nine showed clinical improvement but five did not. The former showed a meanvolume reduction of 62.5% and the latter, 16.5%. CONCLUSIONS: After gamma-knife radiosurgery, clinicalimprovement in microadenomas can be expected, regardless of volume change. The volume of macroadenomas decreasedand a rim enhancement pattern was observed after gamma-knife radiosurgery. A marked reduction in the volume of atumor, or a change in its enhancement pattern may indicate clinical improvement.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Pituitary Neoplasms* ; Radiosurgery

Eosinophilic abscess is a rare disease of stomach that consists of many eosinophils in submucosa and muscle layers of stomach. Eosinophilic abscess is usually observed in liver after parasite infestation such as hepatic fascioliasis or in intradermal lesion of pemphigus. A 67-year-old female was admitted due to epigastric pain and indigestion. Endoscopic finding suggested early gastric cancer type IIc with the depth of invasion to mucosal layer at the lesser curvature of lower body. Histologic examination of endoscopic biopsy proved to be signet ring cell type adenocarcinoma. On endoscopic ultrasonography, the tumor was imaged as a slightly elevated mass with 15 mm in diameter. The lesion was localized from the first layer to the fourth layer which correspond to the mucosa and the proper muscle layer, The lesion consisted of low echoic and isoechoic densities. The lower echoic lesion ranging from the third layer to the fourth layer was thought to be necrotic or hemorrhagic portion within the tumor. Subtotal gasterectomy was performed. We compared the endoscopic and endosonographic features with the histologic findings of the resected stomach. Histologic examination showed signet ring cell carcinoma in mucosal layer and eosinophilic abscess in submucosal and proper muscle layer. We concluded that the endosonographic depth of invasion was overestimated because of the eosinophilic abscess.
Abscess* ; Adenocarcinoma ; Aged ; Biopsy ; Carcinoma, Signet Ring Cell ; Dyspepsia ; Endosonography* ; Eosinophils* ; Fascioliasis ; Female ; Humans ; Liver ; Mucous Membrane ; Parasites ; Pemphigus ; Rare Diseases ; Stomach ; Stomach Neoplasms*

Selective cannulation into the intrahepatic duct during ERCP can occasionally be difficult and time-consuming depending on the GI tract anatomy and the presence of biliary tree anomalies or pathology. A variety of techniques or devices have been used to enhance the success rate of selective cannulation in these situations. The balloon occluded method for selective cannulation of the LHD (left hepatic duct) with using an inflated balloon catheter to occlude the RHD (right hepatic duct) has also been reported. We report here a case of successful selective cannulation of the RHD with using an inflated balloon catheter to occlude the LHD in a patient who had a GB cancer with liver metastasis. After this maneuver, a guidewire is advanced; it deflects off the inflated balloon and then proceeds to the RHD.
Biliary Tract ; Catheterization ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Gastrointestinal Tract ; Humans ; Liver ; Neoplasm Metastasis

BACKGROUND AND OBJECTIVES: Dual blood supply to the anterior interventricular septum (IVS), derived from the septal branches of the left anterior descending artery (LAD) and the conal branch of the right coronary artery (RCA), may prevent ST segment elevation in lead V1 during an anterior acute myocardial infarction (AMI), and predict a favorable in-hospital clinical course. SUBJECTS AND METHODS: The admission 12-lead electrocardiogram (ECG), and the coronary angiograms performed within 10 days of hospital admission, were evaluated in 67 patients with anterior wall AMI, as defined by a ST segment elevation > or =2mm in at least 2 of the V1 to 4 leads. The patients were divided into two groups according to the magnitude of the ST segment elevation in V1 lead: group 1 (ST <1.5 mm, n=22) and group 2 (ST > or =1.5 mm, n=45). The conal branch types were classified into small (a diameter <0.5 mm), not reaching the IVS, and large (a diameter >0.5 mm), reaching the IVS. RESULTS: A large conal branch was found in 11 patients of each group 50 and 24%, respectively (p=0.04). There was no significant relation between the sites of the LAD lesion, whether proximal or distal to the first septal branch, and the presence of ST segment elevation in lead V1. The serum cardiac enzymes, Killip class and the incidence of in-hospital congestive heart failure, were not significantly different. CONCLUSION: The absence of ST segment elevation in lead V1 during an anterior AMI suggested that the IVS is protected by a large conal branch, in addition to the septal branch of the LAD, but this did not influence the in-hospital clinical course.
Anterior Wall Myocardial Infarction* ; Arteries ; Coronary Vessels* ; Electrocardiography ; Heart Failure ; Humans ; Incidence ; Myocardial Infarction ; Prognosis

PURPOSE: This study was conducted to evaluate the results of internal fixation for stable femoral neck fractures occurring in patients over 65 years old. MATERIALS AND METHODS: Between 2008 and 2014, we evaluated 25 patients over 65 years old with Garden type 1 and 2 femoral neck fractures that were treated with internal fixation after a minimum follow up of 1 year. There were 5 males and 20 females and the average age was 72.3 years (range, 65-84 years) at the time of surgery. Fracture site union, horizontal shortening and complications were evaluated as radiographic parameters and change of walking ability (as measured using Koval walking ability score) was investigated as a clinical parameter. RESULTS: Union of fracture site was achieved in 24 out of the 25 cases (96.0%). The average length of horizontal shortening was 6.5 mm (range, 0.2-19.7 mm). At final follow up, 3 cases experienced complications: nonunion (n=1), avascular necrosis (n=1), and subtrochanteric fracture after minor trauma (n=1). Walking ability decreased an average of 1 step at the final follow up. CONCLUSION: Internal fixation for stable femoral neck fractures occurring in patients over 65 years showed satisfactory union rates. However, care should be taken with this technique given the possibility of decreased walking ability resulting from horizontal shortening.
Aged* ; Female ; Femoral Neck Fractures* ; Femur ; Femur Neck* ; Follow-Up Studies ; Fracture Fixation, Internal ; Humans ; Male ; Necrosis ; Walking

BACKGROUND/AIMS: It can be difficult to differentiate an extraluminal compression from a true submucosal tumor (SMT) in the stomach. The best method for differentiating an extraluminal compression from a true SMT is endoscopic ultrasonography (EUS). Extragastric compression is frequently observed, but its clinical significance has rarely been reported on. We evaluated the clinical findings of extraluminal compression according to the site of the stomach. METHODS: Ninety-one patients were diagnosed by EUS as having extragastric compressions from January 2006 to July 2008. Abdominal sonography or computed tomography was performed in some cases. RESULTS: The causes of normal structures (64 cases) were the vessels, spleen, intestine, gallbladder, liver, mesentery, pancreas and kidney. The causes of pathologic lesions (27 cases) were hepatic cyst, distended gallbladder with sludge, splenic cyst, hepatic hemangioma, polycystic hepatic and renal disease, pancreatic cyst, renal cyst, calcified lymph node and hepatocelluar carcinoma. The great curvature of the fundus was the most frequent site of extraluminal compressions. The lesions in the anterior wall of the body showed a higher frequency of pathologic lesions than did those lesions in other sites. CONCLUSIONS: EUS is useful for finding the causes of extragastric compression. Careful evaluation is needed because many lesions in the anterior wall of the body of the stomach were due to pathologic causes.
Endosonography ; Gallbladder ; Hemangioma ; Humans ; Intestines ; Kidney ; Liver ; Lymph Nodes ; Mesentery ; Pancreas ; Pancreatic Diseases ; Sewage ; Spleen ; Stomach

BACKGROUND/AIMS: It has been reported the placement of a double-layered pyloric combination stent can overcome the disadvantage of the increased ingrowth observed for an uncovered stent and the increased migration for a covered stent. But this did not satisfactorily prevent stent migration and it caused stent migration more frequently than with using the uncovered stent. This study evaluated the usefulness of applying a clip in an effort to reduce stent migration. METHODS: Fifteen patients with malignant gastric outlet obstruction were treated with endoscopic placement of a double-layered combination pyloric stent. Three endoscopic clips were then applied to fix the proximal end of the enteral stent to the gastric or duodenal mucosa. The clinical efficacy and especially the rate of migration were analyzed. RESULTS: The technical and clinical success rate was 100% (15/15) and 93.3% (14/15), respectively. No stent migration was observed in any of the patients. Three patients (20%) experienced complications such as stent collapse. The median stent patency period was 83.4 days. CONCLUSIONS: Endoscopic clipping for enteral stent placement is effective for preventing stent migration in patients with malignant gastric outlet obstruction.
Gastric Outlet Obstruction ; Humans ; Mucous Membrane ; Stents

Background: To evaluate workload in emergency rooms (ERs) among clinical specialties including neurology and investigate characteristics of neurological consultations in ER. Methods: A nationwide survey was conducted to evaluate the number of specialists, resident physicians/surgeons, and emergency consultations of each clinical specialty in Korean tertiary referral hospitals from 2018 to 2019. Characteristics of neurological emergency consultations during the same period were investigated in one of the hospitals that participated. Results: A total of 23 hospitals were included. Four irrelevant clinical specialties were excluded. The number of neurology specialists and resident physicians were 12.5/hospital (4.1% of all specialists) and 6.4/hospital (3.4% of all resident physicians/surgeons), respectively, while the mean numbers of specialists and resident physicians or surgeons per clinical specialty were 13.7/hospital and 8.6/hospital, respectively. Neurological consultations accounted for 11.0% of all ER consultations for severe patients (Korean Triage and Acuity Scale level 1-3). Annual ER consultations for severe patients per neurology specialist was 274.1, which was only second to pediatrics (290.0). Annual ER consultations for severe patients per resident physician was 406.6 which was 1.6 times higher than the second highest (internal medicine, 247.0). Frequent conditions for neurological ER consultation were dizziness (24.8%), motor weakness (23.9%), headache (10.6%), dysarthria (9.9%), and seizures (7.7%). Frequent primary diagnoses were cerebrovascular diseases (29.0%) and episodic and paroxysmal disorders (24.9%). Conclusions Workloads of neurology specialists for ER consultation were significantly heavy, and the workload of neurology resident physicians was the heaviest among all specialties. This should be considered in health care policies.

Background: Because Korea is the fastest aging country, the stroke incidence is increasing rapidly. We investigate the trend of the number of patients with acute stroke in recent years and estimate the burden of the neurologist to treat the acute stroke patient visited the emergency department. Methods: We requested a questionnaire survey to all teaching hospitals on the number of hospital beds, the number of stroke patients who visited the emergency department, the number of stroke patients in charge of the neurologist, and the number of days on duty of residents from 2016 to 2019. Results: Of 69 teaching hospitals, 41 hospitals answered the survey. The average hospital beds per hospital were increased annually from 909 to 916. The average patients who visited the emergency department with stroke and were in charged to neurologists were rapidly increased from 799 to 867 per hospital. In particular, the number of patients with hyperacute cerebral infarction requiring the thrombolytic administration or mechanical thrombectomy were rapidly increased from 105 to 131. On the other hand, the average number of residents per hospital was decreased from 5.1 to 4.8. Therefore, the days on duty per resident were increased from 74 to 77. Conclusions The number of acute stroke patients, especially, hyperacute stroke required the rapid cooperation and high labor were increasing rapidly in recent years. However, because the number of residents were decreased, the burden was increasing. To improve the quality of acute stroke treatment, it is necessary to increase the number of residents.