Multiple primary cancer is defined as the multiple occurrence of malignant neoplasm in the same individual. Synchronous cancers are usually defined as finding the second cancer at the same time or within a 6-month period after the diagnosis of the primary lesion, and metachronous cancers are found at more than 6 months after the initial diagnosis. Multiple primary cancers have been increasing reported on due to prolonged lifespans and the improvement of diagnostic techniques. Nevertheless, triple synchronous cancers have been regarded as a relatively rare finding. We report here on an unusual case of triple synchronous cancer of early gastric cancer, carcinoid tumor of the ampulla of Vater and renal cell carcinoma.
Adenocarcinoma* ; Ampulla of Vater* ; Carcinoid Tumor* ; Carcinoma, Renal Cell* ; Diagnosis ; Neoplasms, Second Primary ; Stomach Neoplasms

To examine diseases of the small intestines, the use of different methods including a small bowel series and push type enteroscopy have been employed, but these procedures are restrictive and have a low diagnostic accuracy rate. Recently, the use of double balloon enteroscopy has been introduced, and it is expected that this procedure will be of great value for research of diseases of the small intestine as it enables one to obtain a biopsy tissue sample and to perform diagnostic and therapeutic endoscopy while examining small intestine visually. We report as case of a patient that visited our institution complaining of abdominal pain, and the patient was diagnosed as suffereing from an intestinal obstruction due to a bezoar. The patient was treated by surgery after an investigation with the aid of a double balloon enteroscope.
Abdominal Pain ; Bezoars ; Biopsy ; Double-Balloon Enteroscopy ; Endoscopy ; Humans ; Intestinal Obstruction ; Intestine, Small

Adenocarcinoma of the appendix is a rare neoplasm. Metastatic adenocarcinoma of the appendix from stomach adenocarcinoma is also a very rare finding. A 72-year-old man complained of right lower quadrant abdominal pain for 10 days, and he was diagnosed with acute appendicitis. Appendectomy was performed by a general surgeon. Adenocarcinoma was found on the postoperative biopsy. Subsequently, gastric adenocarcinoma was diagnosed on the gastroscopy with biopsy, and this was proven to be the original site of the appendiceal adenocarcinoma.
Abdominal Pain ; Adenocarcinoma* ; Aged ; Appendectomy ; Appendicitis ; Appendix* ; Biopsy ; Gastroscopy ; Humans ; Stomach*

Dieulafoy's lesion is an unusual cause of gastrointestinal hemorrhage that results from the erosion of an abnormally large submucosal artery. In most cases, the lesion is encountered in the proximal stomach within 6 cm of the gastroesophageal junction. However, similar lesions have been reported in the antrum, duodenum, colon, and rectum. In particular, jejunal Dieulafoy's lesion Dieulafoy's lesion is an unusual cause of gastrointestinal hemorrhage that results from the erosion of an abnormally large submucosal artery. In most cases, the lesion is encountered in the proximal stomach within 6 cm of the gastroesophageal junction. However, similar lesions have been reported in the antrum, duodenum, colon, and rectum. In particular, jejunal Dieulafoy's lesion is extremely rare. We report a case of jejunal Dieulafoy's lesion with recurrent and massive bleeding, which was diagnosed and treated with the double-balloon enteroscopy.
Arteries ; Colon ; Double-Balloon Enteroscopy* ; Duodenum ; Esophagogastric Junction ; Gastrointestinal Hemorrhage ; Hemorrhage ; Jejunum* ; Rectum ; Stomach

Dieulafoy's lesion is an unusual cause of gastrointestinal hemorrhage that results from the erosion of an abnormally large submucosal artery. In most cases, the lesion is encountered in the proximal stomach within 6 cm of the gastroesophageal junction. However, similar lesions have been reported in the antrum, duodenum, colon, and rectum. In particular, jejunal Dieulafoy's lesion Dieulafoy's lesion is an unusual cause of gastrointestinal hemorrhage that results from the erosion of an abnormally large submucosal artery. In most cases, the lesion is encountered in the proximal stomach within 6 cm of the gastroesophageal junction. However, similar lesions have been reported in the antrum, duodenum, colon, and rectum. In particular, jejunal Dieulafoy's lesion is extremely rare. We report a case of jejunal Dieulafoy's lesion with recurrent and massive bleeding, which was diagnosed and treated with the double-balloon enteroscopy.
Arteries ; Colon ; Double-Balloon Enteroscopy* ; Duodenum ; Esophagogastric Junction ; Gastrointestinal Hemorrhage ; Hemorrhage ; Jejunum* ; Rectum ; Stomach

Caroli's disease is defined as a communication between congenital cystic dilatation of the bile duct and the biliary system. Caroli's disease accompanied with autosomal dominant polycystic kidney disease is a very rare finding and the differential diagnosis between Caroli's disease with polycystic kidney disease and a polycystic liver is very important. A 67-year-old male patient was admitted to our hospital for hematochezia, and he underwent hemodialysis for chronic renal failure due to his autosomal dominant polycystic kidney disease. On colonoscopy, ulcero-infiltrative tumor was observed in the sigmoid colon. It was diagnosed as adenocarcinoma on tissue biopsy. On abdominal computerized tomography and magnetic resonance cholangiopancreatography, a number of simple cysts was observed in both kidneys and we were able to identify the communication between the dilated intrahepatic ducts and the intrahepatic cystic lesions, and so we diagnosed this patient as having Caroli's disease.
Adenocarcinoma ; Aged ; Bile Ducts ; Biliary Tract ; Biopsy ; Caroli Disease* ; Cholangiopancreatography, Magnetic Resonance ; Colon* ; Colon, Sigmoid ; Colonic Neoplasms* ; Colonoscopy ; Diagnosis, Differential ; Dilatation ; Gastrointestinal Hemorrhage ; Humans ; Kidney ; Kidney Failure, Chronic ; Liver ; Male ; Polycystic Kidney Diseases* ; Polycystic Kidney, Autosomal Dominant ; Renal Dialysis

BACKGROUND AND OBJECTIVES: This study was done to evaluate the safety of Gore-Tex as a nasal implant. Materials and METHOD: A retrospective multicenter study was carried out on 15 surgeons from 11 general hospitals and 4 private practice clinics regarding the safety of the Gore-Tex as a nasal implant. The study involved 853 patients, of whom 656 received primary surgery and 197 revision surgery. Gore-Tex was mainly used as a dorsal implant in a form of sheet or as a reinforced nasal implant. RESULTS: The overall complication rate associated with Gore-Tex was 2.5% (21 cases). Infection was the most common complication (18 cases ; 2.1%) followed by 2 cases of seroma and 1 case of persistent nasal swelling. In 19 out of 21 complication cases, the graft needed removal to control the infection or seroma (91% removal rate). Nine cases of infection developed in both primary cases (1.37%) and in revision cases (4.57%), which suggests a higher association rate between infection and revision cases (p=0.0062). Infection developed within 1 month in 5 cases while 9 cases developed infection after 6 months of operation. Other complications such as aesthetic problems (malpositioning of the implant or dorsal irregularities) were found in 15 cases (1.8%) and hematoma in 1 case. CONCLUSION: The infection rate of Gore-Tex used in rhinoplasty was about 2% and it rose significantly in the revision cases. If infected, almost all of the implanted Gore-Tex needs removal; therefore, we suggest judicious use of Gore-Tex in rhinoplasty.
Hematoma ; Hospitals, General ; Humans ; Polytetrafluoroethylene* ; Private Practice ; Retrospective Studies ; Rhinoplasty* ; Seroma ; Transplants

Background: Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. Methods: From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. Results: Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). Conclusion In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.