Background: s/Aims: This study evaluated the feasibility and outcomes of surgical treatment for metachronous periampullary carcinoma following curative resection of primary extrahepatic bile duct cancer. Methods: A retrospective review was conducted of seven patients who underwent pancreaticoduodenectomy (PD) for metachronous periampullary cancer after prior curative surgery for extrahepatic bile duct cancer. Results: The mean age at the second surgery was 66.7 years (range, 43–81 years). Initial malignancies included three hilar cholangiocarcinomas, one middle bile duct cancer, and three gallbladder cancers. Subsequent primary tumors consisted of three distal bile duct cancers, three pancreatic head cancers, and one duodenal cancer. The mean interval between the first and second cancers was 47 months (range, 13–121 months). No perioperative deaths occurred. Postoperative complications developed in three patients (42.9%):chyle leakage (Clavien–Dindo grade II) in two (28.6%) and a grade C postoperative pancreatic fistula requiring reoperation (grade IIIb) in one (14.3%). Both chyle leaks were managed conservatively. During follow-up, four patients died of recurrence at 5, 12, 19, and 24 months postoperatively. One patient underwent video-assisted thoracoscopic surgery for pulmonary metastasis 2 months after PD and remains alive 22 months later without recurrence. Two patients are disease-free at 38 and 92 months of follow-up. Conclusions PD for second primary periampullary cancer after resection of extrahepatic bile duct cancer appears feasible and potentially effective. Although no perioperative mortality occurred, major complications were observed. Larger studies are needed to confirm these preliminary findings.

Immunoglobulin G4 (IgG4)-related disease is a fibroinflammatory condition that can involve multiple organs. Isolated involvement of the gallbladder is exceptionally uncommon and often radiologically indistinguishable from gallbladder carcinoma, resulting in diagnostic uncertainty before surgery. A 77-year-old man presented with right upper abdominal discomfort lasting 1 month. Cross-sectional imaging revealed irregular gallbladder wall thickening with contrast enhancement, raising suspicion for resectable gallbladder cancer. The patient underwent a radical cholecystectomy with partial hepatectomy. Histopathological analysis demonstrated dense lymphoplasmacytic infiltration, storiform fibrosis, and marked infiltration of IgG4-positive plasma cells exceeding established diagnostic thresholds, consistent with IgG4-related cholecystitis. The postoperative course was uneventful, and no additional treatment was required. IgG4-related cholecystitis should be considered in the differential diagnosis of gallbladder malignancy, particularly in atypical or indeterminate cases. However, when imaging findings strongly suggest carcinoma, radical surgical resection remains an appropriate oncologic approach.

Inflammatory myofibroblastic tumors (IMTs) of the duodenum are exceptionally uncommon, and their epidemiologic and clinical characteristics remain poorly defined because of the limited number of reported cases. We previously reported a case of duodenal IMT in the Korean Journal of Gastroenterology in 2018, with follow-up data available only up to 12 months. IMTs typically behave in a benign manner, but they may occasionally demonstrate local invasiveness and recurrence; therefore, achieving complete surgical excision is crucial, followed by long-term surveillance. In the present manuscript, we provide a subsequent long-term follow-up report of the same patient, offering an extended 88-month postoperative course and additional radiologic and pathologic details not included in the earlier publication. This follow-up report highlights the long-term benign behavior of the tumor despite positive surgical margins and anaplastic lymphoma kinase (ALK)-negative immunohistochemistry, contributing meaningful information to the scarce literature on adult duodenal IMTs.

Background/Aims: High-sensitivity cardiac troponin (hs-TnT) assays detect very low levels of cardiac troponin. This study examined the interval change between initial and subsequent hs-TnT levels and evaluated its ability to predict significant coronary stenosis. Methods: The study analyzed 163 patients who presented with acute coronary syndrome (ACS) and underwent coronary angiography (CAG) between April 2014 and May 2018. The 0 and 3-hour hs-TnT were checked. The patients were subdivided into positive (n = 32) and negative (n = 131) interval change groups. The presence of significant coronary artery stenosis on CAG in the two groups was compared. Results: The positive interval change group was older and had higher 0 and 3-hour hs-TnT and blood glucose levels than the negative interval change group. Significant coronary stenosis was more common in the positive interval change group than in the negative interval change group (68.8% vs. 23.7%, p = 0.001). However, vasospasm was more common in the negative interval change group (6.3% vs. 31.3%, p = 0.003). The positive interval change group had higher rates of bifurcation lesions and received more percutaneous coronary intervention. In multivariate analysis, age, interval change of serial hs-TnT and diabetes mellitus were independent predictors of significant coronary artery stenosis. Conclusions This study identified a relationship between the serial change in cardiac biomarkers and the presence of significant coronary stenosis in patients with ACS. Serial hs-TnT change was associated with real angiographic stenosis in patients with ACS.

Background/Aims: High-sensitivity cardiac troponin (hs-TnT) assays detect very low levels of cardiac troponin. This study examined the interval change between initial and subsequent hs-TnT levels and evaluated its ability to predict significant coronary stenosis. Methods: The study analyzed 163 patients who presented with acute coronary syndrome (ACS) and underwent coronary angiography (CAG) between April 2014 and May 2018. The 0 and 3-hour hs-TnT were checked. The patients were subdivided into positive (n = 32) and negative (n = 131) interval change groups. The presence of significant coronary artery stenosis on CAG in the two groups was compared. Results: The positive interval change group was older and had higher 0 and 3-hour hs-TnT and blood glucose levels than the negative interval change group. Significant coronary stenosis was more common in the positive interval change group than in the negative interval change group (68.8% vs. 23.7%, p = 0.001). However, vasospasm was more common in the negative interval change group (6.3% vs. 31.3%, p = 0.003). The positive interval change group had higher rates of bifurcation lesions and received more percutaneous coronary intervention. In multivariate analysis, age, interval change of serial hs-TnT and diabetes mellitus were independent predictors of significant coronary artery stenosis. Conclusions This study identified a relationship between the serial change in cardiac biomarkers and the presence of significant coronary stenosis in patients with ACS. Serial hs-TnT change was associated with real angiographic stenosis in patients with ACS.

We report a patient with severe neurological deterioration due to leptomeningeal metastases involving brain and spinal cord from anaplastic lymphoma kinase (ALK)-positive lung adenocarcinoma, managed rapidly and successfully with lorlatinib therapy. A 48-year-old male patient presented with acute mental deterioration, severe headache, and weakness of both legs. The patient’s previous medical history included cerebral metastases from ALK-positive lung adenocarcinoma, which had been successfully managed via whole brain radiation therapy and gamma knife radiosurgery one year and three months before, respectively. Physical examination revealed neck stiffness and paraparesis with motor grade I.Gadolinium-enhanced brain MRI showed newly developed leptomeningeal enhancement along cerebellar folia, and whole spine MRI revealed similar leptomeningeal metastasis along the whole spinal axis. Lorlatinib was started orally with a dose of 100 mg/day. The patient showed rapid clinical improvement after one week. The patient was alert and the headache disappeared, while the paraparesis improved to normal ambulatory status. Two months of lorlatinib treatment resulted in almost complete disappearance of previous leptomeningeal enhancement of brain and spinal cord, and absence of newly developed metastatic lesions in the central nervous system, based on MRI results. The patient had been regularly followed with ongoing lorlatinib therapy for 5 months without any systemic complications or neurological abnormality. Conclusively, lorlatinib could be a rapid and effective treatment for patients with central nervous system leptomeningeal metastases arising from ALK-positive lung cancer.

OBJECTIVE: Patients with low acuity who need hospitalization may be at risk if they do not receive proper treatment in overcrowded emergency rooms. This study was conducted to investigate factors affecting the hospitalization of patients with low acuity of Korean Triage and Acuity Scale (KTAS). METHODS: This study was a retrospective chart review analysis of patients aged 15 years or older who had triaged as KTAS 4 and 5 grades when visiting a local emergency medical center from January 1, 2016 to December 31, 2017. Multivariate logistic analysis was performed to analyze the effects of age, sex, reasons for visiting, visiting route, ambulance utilization, KTAS grade and major category on patient admission. RESULTS: A total of 10,540 patients were enrolled and the odds ratio (OR) increased with age from those aged over 34 years (P < 0.001). Patients that triaged as KTAS grade 5 (adjusted OR, 1.57; 95% confidence interval [CI], 1.36–1.82), had a condition caused by disease (adjusted OR, 2.31; 95% CI, 2.00–2.68), and visited by using an ambulance (public: adjusted OR, 1.05; 95% CI, 0.91–1.22; private: adjusted OR, 4.60; 95% CI, 3.85–5.49) were more likely to be hospitalized. Individuals in the “general” major category were more likely to be hospitalized than those falling into other major categories (P < 0.001). CONCLUSION: The factors influencing the hospitalization of patients with low acuity were age, reasons for visiting, visiting route, ambulance utilization, KTAS grade and major category on patient admission.
Accidental Falls ; Ambulances ; Emergencies* ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Odds Ratio ; Patient Admission ; Retrospective Studies ; Risk Factors ; Triage

We investigated predictors of major adverse cardiac events (MACE) with two years after medical treatment for lesions with angiographically intermediate lesions with intravascular ultrasound (IVUS) minimum lumen area (MLA) <4 mm² in non-proximal epicardial coronary artery. We retrospectively enrolled 104 patients (57 males, 62±10 years) with angiographically intermediate lesions (diameter stenosis 30–70%) with IVUS MLA <4 mm² in the non-proximal epicardial coronary artery with a reference lumen diameter between 2.25 and 3.0 mm. We evaluated the incidences of major adverse cardiovascular events (MACE including death, myocardial infarction, target lesion and target vessel revascularizations, and cerebrovascular accident) two years after medical therapy. During the two-year follow-up, 15 MACEs (14.4%) (including 1 death, 2 myocardial infarctions, 10 target vessel revascularizations, and 2 cerebrovascular accidents) occurred. Diabetes mellitus was more prevalent (46.7% vs. 18.0%, p=0.013) and statins were used less frequently in patients with MACE compared with those without MACE (40.0% vs. 71.9%, p=0.015). Independent predictors of MACEs with two years included diabetes mellitus (odds ratio [OR]=3.41; 95% CI=1.43–8.39, p=0.020) and non-statin therapy (OR=3.11; 95% CI=1.14–6.50, p=0.027). Long-term event rates are relatively low with only medical therapy without any intervention, so the cut-off of IVUS MLA 4 mm² might be too large to be applied for defining significant stenosis. The predictors of long-term MACE were diabetes mellitus and statin therapy in patients with angiographically intermediate lesions in non-proximal epicardial coronary artery.
Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels* ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Male ; Myocardial Infarction ; Plaque, Atherosclerotic ; Retrospective Studies ; Ultrasonography* ; Ultrasonography, Interventional

Metformin (1,1-dimethylbiguanide hydrochloride), derived from French lilac (Galega officinalis), is a first-line anti-diabetic drug prescribed for patients with type 2 diabetes. However, the role of metformin in odontoblastic cell differentiation is still unclear. This study therefore undertook to examine the effect of metformin on regulating odontoblast differentiation in MDPC-23 mouse odontoblastic cells derived from mouse dental papilla cells. As compared to controls, metformin significantly accelerated the mineralization, significantly increased and accelerated the expressions of ALP and Col I mRNAs, and significantly increased the accelerated expressions of DSPP and DMP-1 mRNAs, during differentiation of MDPC-23 cells. There was no alteration in cell proliferation of MDPC-23 cells, on exposure to metformin. These results suggest that the effect of metformin on MDPC-23 mouse odontoblastic cells derived from mouse dental papilla cells, facilitates the odontoblast differentiation and mineralization, without altering the cell proliferation.
Animals ; Cell Differentiation ; Cell Proliferation ; Dental Papilla ; Humans ; Metformin* ; Mice ; Miners ; Odontoblasts* ; RNA, Messenger

OBJECTIVES: The purpose of this study is to evaluate the treatment efficacy of enucleation after decompression. MATERIALS AND METHODS: A total of 17 patients with cystic lesion of the jaw were treated with decompression followed by enucleation. Pre- and postdecompression panoramic radiographs were analyzed. RESULTS: The mean percentage of reduction after decompression was 64%. The reaction was graded as good (>80%) in five patients (29.4%), moderate (50%-80%) in nine patients (52.9%), and poor (<50%) in three patients (17.6%). The reduction rate of larger cystic lesions was faster than that of smaller lesions. However, the reduction rate was not affected by age. The duration of follow-up ranged from one to eight years. There were no complications, and one case recurred. CONCLUSION: Decompression is an effective method for the initial treatment of jaw cysts.
Decompression* ; Follow-Up Studies ; Humans ; Jaw Cysts ; Jaw* ; Methods ; Odontogenic Cysts ; Retrospective Studies* ; Treatment Outcome