BACKGROUND/AIMS: Presence of enhanced mural nodules, which can be visualized using computed tomography (CT), is one of high-risk stigmata in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs). Conversely, the absence of enhanced mural nodules on preoperative imaging does not exclude malignant risk. The present study aimed to investigate other morphological features as predictors of malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT. METHODS: This retrospective study included 180 patients with surgically confirmed “pure” BD-IPMNs of the pancreas and no enhanced mural nodules on preoperative CT. The study was conducted at 15 tertiary referral centers throughout South Korea. Univariate and multivariate analyses were used to identify significant predictors of malignancy. RESULTS: BD-IPMNs with low-grade (n=84) or moderate-grade (n=76) dysplasia were classified as benign; those with high-grade dysplasia (n=8) or invasive carcinoma (n=12) were classified as malignant. The multivariate analysis revealed that cyst size ≥30 mm (odds ratio, 8.6; p=0.001) and main pancreatic duct diameter ≥5 mm (odds ratio, 4.1; p=0.01) were independent risk factors for malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT. Endoscopic ultrasound detected enhanced mural nodules (6/82) that had been missed on CT, and two IPMNs with enhanced mural nodules were malignant. CONCLUSIONS: In patients with “pure” BD-IPMNs who have no enhanced mural nodules on CT, cyst size ≥30 mm and main pancreatic duct diameter ≥5 mm may be associated with malignancy.
Christianity ; Humans ; Korea ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatic Ducts ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Ultrasonography

We present a case of a 65-year-old man with psoriasis who developed autoimmune hepatitis (AIH) without receiving immunosuppressive therapy with either anti-tumor necrosis factor-α or methotrexate. The AIH had completely resolved at 2 months after prednisolone and azathioprine therapy. This case confirms the need to consider AIH in psoriasis patients who experience new elevations in liver enzymes. To our knowledge, this is first description of the development of AIH in an immunosuppressant-naïve patient with psoriasis.
Aged ; Azathioprine ; Hepatitis, Autoimmune* ; Humans ; Liver ; Methotrexate ; Necrosis ; Prednisolone ; Psoriasis*

BACKGROUND/AIMS: The diagnostic efficacy of current tissue sampling techniques for gastric subepithelial tumors (SETs) is limited. Better tissue sampling techniques are needed to improve pathological diagnosis. The aim of this study was to evaluate the safety and efficacy of a new technique, mucosal incision and forceps biopsy, for reliable tissue sampling of gastric SETs. METHODS: This study enrolled 12 consecutive patients who underwent mucosal incision and forceps biopsy of gastric SETs between November 2011 and September 2014 at Gangneung Asan Hospital. The medical records of patients were reviewed retrospectively. The safety and diagnostic yield of this method were evaluated. RESULTS: By performing mucosal incision and forceps biopsy, we were able to provide a definitive histological diagnosis for 11 out of 12 cases. The pathological diagnoses were leiomyoma (3/11), gastrointestinal stromal tumor (GIST; 2/11), lipoma (2/11), schwannoma (1/11), and ectopic pancreas (3/11). In cases of leiomyoma (n=3) and GIST (n=2), tissue samples were of sufficient size to allow immunohistochemical staining. In addition, the mitotic index was evaluated in two cases of GIST. There were no procedure-related complications. CONCLUSIONS: Mucosal incision and forceps biopsy can be used as one of several methods to obtain adequate tissue samples from gastric SETs.
Biopsy* ; Chungcheongnam-do ; Diagnosis ; Gangwon-do ; Gastrointestinal Stromal Tumors ; Gastroscopy ; Humans ; Leiomyoma ; Lipoma ; Medical Records ; Methods ; Mitotic Index ; Neurilemmoma ; Pancreas ; Retrospective Studies ; Stomach ; Surgical Instruments*

No abstract available.
Sweet Syndrome*

Endometriosis is a benign gynecologic disease, characterized by the presence and growth of functional endometrial-like tissue outside uterus. This ectopic endometrial tissue is most commonly found in the peritoneum, ovaries and uterosacral ligaments, but extremely rarely there is involvement of the appendix or cecum. Here we report a case of cecal endometriosis presenting as a subepithelial tumor diagnosed by surgical excision.
Appendix ; Cecum ; Colonic Neoplasms ; Endometriosis* ; Female ; Genital Diseases, Female ; Ligaments ; Ovary ; Peritoneum ; Uterus

PURPOSE: The aim of the present study was to investigate the risk factors for the development of coronary artery lesions (CALs) and to determine whether hyponatremia is associated with CALs in children with Kawasaki disease (KD). METHODS: We retrospectively analyzed the data of 105 children with KD who were admitted to Ilsan Hospital between January 2000 and July 2011. RESULTS: Erythrocyte sedimentation rate (P = 0.013), total bilirubin levels (P = 0.017) were higher and serum sodium levels (P = 0.027) were lower in KD children with CALs than those without. White blood cell (WBC) counts (P = 0.006), neutrophil counts (P = 0.003) were higher and albumin levels (P = 0.009) were lower in KD children with hyponatremia than those without. On multiple logistic regression analysis, hyponatremia (P = 0.024) and intravenous immunoglobulin??resistance (P = 0.024) were independent risk factors for CALs in KD. Furthermore, serum sodium levels were correlated negatively with WBC counts (P = 0.004), neutrophil counts (P < 0.001), total bilirubin levels (P = 0.005) and positively with albumin levels (P = 0.009). CONCLUSION: Our study indicates that hyponatremia may reflect severe inflammation in children with KD.
Bilirubin ; Blood Sedimentation ; Cardiovascular Abnormalities ; Child* ; Coronary Vessels ; Humans ; Hyponatremia* ; Inflammation* ; Leukocytes ; Logistic Models ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Retrospective Studies ; Risk Factors ; Sodium

Esophageal and gastric varix, portal hypertensive gastropathy, Mallory-Weiss tear and gastric ulcer are common causes of bleeding in patients with liver cirrhosis. However, spontaneous arterial bleeding without a history of trauma is a rare cause of bleeding which can be fatal. We report a case of a 55-year-old woman with alcoholic liver cirrhosis who developed spontaneous bleeding of multiple right lumbar arteries and died in spite of repetitive transfusion and embolization.
Arteries ; Female ; Gastrointestinal Hemorrhage/*etiology/therapy ; Hematoma/diagnosis ; Humans ; Liver Cirrhosis/complications/*diagnosis ; Lung Injury/pathology ; Middle Aged ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to verify renal inflammation following Kawasaki disease (KD) using single photon emission computed tomography along with Technetium-99m dimercaptosuccinic acid scintigraphy (DMSA renal SPECT). METHODS: From March 2011 to October 2011, 15 patients diagnosed with KD at the National Health Insurance System Ilsan Hospital were enrolled in the study. All patients underwent DMSA renal SPECT to evaluate renal involvement during the acute phase of KD. Urine beta2-microglobulin (beta2-MG), a marker of renal proximal tubular dysfunction, was also measured to assess renal damage. RESULTS: All 15 patients had normal renal function test results. However, microscopic hematuria and pyuria were observed in 13% and 33% of the patients, respectively. Moreover, urine beta2-MG was elevated in 46% of the patients. In addition, patients were divided into two groups based on beta2-MG level: those with an increased beta2-MG level, and those with a normal beta2-MG level. No significant differences were found between these two groups in clinical characteristics, laboratory, sonography, and echocardiography findings. All patients' DMSA renal SPECT scans were normal. CONCLUSION: Our study showed that mild abnormalities in the urinalysis and elevated urine beta2-MG were the only findings of renal involvement in KD. However, no aggressive renal manifestations were detected on DMSA renal SPECT.
Echocardiography ; Hematuria ; Humans ; Inflammation ; Mucocutaneous Lymph Node Syndrome* ; National Health Programs ; Pyuria ; Radionuclide Imaging ; Succimer ; Tomography, Emission-Computed, Single-Photon ; Urinalysis

Gastrointestinal strongyloidiasis and Cytomegalovirus infection mostly occur in patients receiving cancer chemotherapy, undergoing immunosuppressive therapy after organ transplantation, and suffering from acquired immune deficiency syndrome. A 56-year-old man was admitted to the hospital because of abdominal pain and constipation. He had a 10-year history of chronic obstructive pulmonary disease and has been treated intermittently with systemic steroid. The gastroduodenoscopic examination showed a single ulcer on the duodenal bulb and microscopic finding of the biopsy specimens from the ulcer revealed Strongyloides stercoralis and cytomegalovirus immunohistochemical stain positive intranuclear inclusion body on the mucosal surface. The patient was successfully treated with albendazole and ganciclovir.
Abdominal Pain ; Acquired Immunodeficiency Syndrome ; Albendazole ; Biopsy ; Coinfection ; Constipation ; Cytomegalovirus ; Cytomegalovirus Infections ; Duodenal Ulcer ; Ganciclovir ; Humans ; Intranuclear Inclusion Bodies ; Middle Aged ; Organ Transplantation ; Pulmonary Disease, Chronic Obstructive ; Steroids ; Stress, Psychological ; Strongyloides ; Strongyloides stercoralis ; Strongyloidiasis ; Transplants ; Ulcer

Pyogenic liver abscess is a serious clinical disease with severe complication in about 10-20% of cases. Metastatic septic endophthalmitis and CNS infection are rare but their incidence is increasing in liver abscess patients, especially Klebsiella pneumoniae as etiologic bacteria. Despite appropriate treatment, the outcome is devastating. We experienced a case of septic endophthalmitis, CNS infection (meninigitis, ventriculitis) and infective spondylitis associated with K. pneumoniae liver abscess. The patient had no specific risk factor. After intensive treatement such as systemic intravenous antibiotics with percutaneous abscess drainage and intravitreal injection, liver abscess was resolved completely. But, sequelae were severe. Socket reconstruction after evisceration with debridement on both eye and ventriculo-peritoneal shunt due to hydrocephalus were done. Our experience suggests that attention should be paid to the possibility of septic metastatic lesions as soon as the treatment of K. pneumoniae liver abscess is initiated.
Abscess ; Anti-Bacterial Agents ; Bacteria ; Debridement ; Drainage ; Endophthalmitis ; Humans ; Hydrocephalus ; Incidence ; Intravitreal Injections ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Meningitis ; Pneumonia ; Risk Factors ; Spondylitis ; Ventriculoperitoneal Shunt