BACKGROUND/AIMS: Gallbladder polyps (GBP) are a common clinical finding and may possess malignant potential. We conducted this study to determine whether visceral obesity is a risk factor for GBP. METHODS: We retrospectively reviewed records of subjects who received both ultrasonography and computed tomography with measurements of the areas of visceral adipose tissue and total adipose tissue (TAT) on the same day as health checkups. RESULTS: Ninety-three of 1,615 subjects (5.8%) had GBP and were compared with 186 age- and sex-matched controls. VAT (odds ratio [OR], 2.941; 95% confidence interval [CI], 1.325 to 6.529; p=0.008 for the highest quartile vs the lowest quartile) and TAT (OR, 3.568; 95% CI, 1.625 to 7.833; p=0.002 for the highest quartile vs the lowest quartile) were independent risk factors together with hypertension (OR, 2.512; 95% CI, 1.381 to 4.569; p=0.003), diabetes mellitus (OR, 2.942; 95% CI, 1.061 to 8.158; p=0.038), hepatitis B virus positivity (OR, 3.548; 95% CI, 1.295 to 9.716; p=0.014), and a higher level of total cholesterol (OR, 2.232; 95% CI, 1.043 to 4.778; p=0.039 for <200 mg/dL vs > or =240 mg/dL). Body mass index and waist circumference were not meaningful variables. CONCLUSIONS: Visceral obesity measured by VAT and TAT was associated with GBP irrespective of body mass index or waist circumference.
Adipose Tissue/ultrasonography ; Adult ; Case-Control Studies ; Cholesterol/blood ; Diabetes Complications ; Female ; Gallbladder Diseases/blood/epidemiology/*etiology ; Hepatitis B/complications ; Humans ; Hypertension/complications ; Intra-Abdominal Fat/ultrasonography ; Male ; Middle Aged ; Obesity, Abdominal/blood/*complications/ultrasonography ; Odds Ratio ; Polyps/blood/epidemiology/*etiology ; Prevalence ; Retrospective Studies ; Risk Factors

No abstract available.
Adult ; Colon, Transverse/radiography ; Colonoscopy ; Fibrosis/pathology ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Mucosa/pathology/*surgery ; Male ; Pneumatosis Cystoides Intestinalis/*diagnosis/surgery ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Proton pump inhibitor (PPI) is generally prescribed to prevent post endoscopic submucosal dissection (ESD) bleeding. However, there was no consensus about the effectiveness of intravenous (IV) or oral PPI. We conducted this investigation to evaluate whether oral PPI can be also safely and effectively used to prevent post-ESD bleeding by measurement of intragastric pH. MATERIALS AND METHODS: Patients were assigned in the fixed order to IV pantoprazole by 40 mg every 12 hours and oral lansoprazole fast disintegrating tablet (LFDT) by 30 mg every 8 hours. We checked intragastric pH and hemoglobin (Hb) levels at pre and post-ESD procedure. RESULTS: A total of 10 patients (LFDT group: 6 patients, IV pantoprazole group: 4 patients) were included. There was no difference of baseline Hb level between two groups (LFDT, 14.38+/-0.46 mg/dL; IV pantoprazole, 13.85+/-0.83 mg/dL; P=0.18). After 24 hours, change of Hb level was not different between LFDT (0.95+/-0.30 mg/dL) and IV pantoprazole group (0.98+/-0.45 mg/dL; P=0.96). Baseline intragastric pH was 3.72+/-0.19 with LFDT and 4.31+/-0.41 with IV pantoprazole group (P=0.18). After 24 hours, there was no significant difference of the extent of pH increase between LFDT (2.38+/-0.28) and IV pantoprazole group (2.17+/-0.21; P=0.60). CONCLUSIONS: There was no difference in both the increase of post-24 hour intragastric pH and decrease of post-24 hour Hb between LFDT and IV pantoprazole group. Oral PPI regimen may be able to replace IV PPI therapy for the prevention of post-ESD bleeding and LFDT might be superior to IV PPIs in the aspect of cost-effectiveness.
Consensus ; Hemorrhage* ; Humans ; Hydrogen-Ion Concentration ; Lansoprazole* ; Proton Pump Inhibitors ; Proton Pumps

BACKGROUND/AIMS: Proton pump inhibitor (PPI) is generally prescribed to prevent post endoscopic submucosal dissection (ESD) bleeding. However, there was no consensus about the effectiveness of intravenous (IV) or oral PPI. We conducted this investigation to evaluate whether oral PPI can be also safely and effectively used to prevent post-ESD bleeding by measurement of intragastric pH. MATERIALS AND METHODS: Patients were assigned in the fixed order to IV pantoprazole by 40 mg every 12 hours and oral lansoprazole fast disintegrating tablet (LFDT) by 30 mg every 8 hours. We checked intragastric pH and hemoglobin (Hb) levels at pre and post-ESD procedure. RESULTS: A total of 10 patients (LFDT group: 6 patients, IV pantoprazole group: 4 patients) were included. There was no difference of baseline Hb level between two groups (LFDT, 14.38+/-0.46 mg/dL; IV pantoprazole, 13.85+/-0.83 mg/dL; P=0.18). After 24 hours, change of Hb level was not different between LFDT (0.95+/-0.30 mg/dL) and IV pantoprazole group (0.98+/-0.45 mg/dL; P=0.96). Baseline intragastric pH was 3.72+/-0.19 with LFDT and 4.31+/-0.41 with IV pantoprazole group (P=0.18). After 24 hours, there was no significant difference of the extent of pH increase between LFDT (2.38+/-0.28) and IV pantoprazole group (2.17+/-0.21; P=0.60). CONCLUSIONS: There was no difference in both the increase of post-24 hour intragastric pH and decrease of post-24 hour Hb between LFDT and IV pantoprazole group. Oral PPI regimen may be able to replace IV PPI therapy for the prevention of post-ESD bleeding and LFDT might be superior to IV PPIs in the aspect of cost-effectiveness.
Consensus ; Hemorrhage* ; Humans ; Hydrogen-Ion Concentration ; Lansoprazole* ; Proton Pump Inhibitors ; Proton Pumps

We report a case of primary mucosa-associated lymphoid tissue (MALT) lymphoma in the esophagus that manifested as a large submucosal tumor (SMT). Primary esophageal lymphoma is very rare, occurring in less than 1% of all patients with gastrointestinal lymphoma. Only a few cases of MALT lymphoma in the esophagus have been reported in the English literature. A 53-year-old man was referred to Dongguk University Ilsan Hospital (Goyang, Korea) in July 2012 for further evaluation and treatment of an esophageal SMT. Endoscopy showed a cylindrically elongated submucosal mass with normal overlying mucosa in the mid esophagus, 25-30 cm from the incisor teeth. He underwent surgery to confirm the diagnosis. Pathologic findings showed diffuse small atypical lymphoid cells which were stained with Bcl-2, CD20, but not with CD3, CD5, CD23, Bcl-6, or cyclin D1. These cells showed a positive monoclonal band for immunoglobulin heavy chain gene rearrangement. Based on the pathological, immunohistochemical, and molecular biological features, the esophageal mass was diagnosed as extranodal marginal zone B-cell lymphoma of the MALT type.
Antigens, CD20/metabolism ; Bone Marrow/pathology ; Esophageal Neoplasms/*diagnosis/pathology/surgery ; Gastroscopy ; Humans ; Immunohistochemistry ; Lymphoma, B-Cell, Marginal Zone/*diagnosis/pathology/surgery ; Male ; Middle Aged ; Mucous Membrane/pathology ; Proto-Oncogene Proteins c-bcl-2/metabolism ; Tomography, X-Ray Computed

Substantial ACL ruptures are not common in adolescence or childhood. During this period, ACL tibia avulsion fractures are more common than substantial ACL ruptures are. However, recent advancements in MRI and increases in adolescent sports activity have led to increased diagnosis of substantial ACL ruptures. Many physeal-sparing ACL reconstruction methods have been reported. However, some physeal-sparing ACL reconstructions are associated with poor outcomes because of laxity in the reconstructed ligament and discordance in the isometric point. We report a 14-year-old male patient with a chronic substantial ACL rupture and a longitudinal medial meniscus tear who was treated with ACL reconstruction and all-inside meniscal repair, which spares the femoral physis and reduces tibia physeal injury with an Achilles allograft.
Adolescent ; Anterior Cruciate Ligament Reconstruction ; Humans ; Ligaments ; Male ; Menisci, Tibial ; Rupture ; Sports ; Tibia ; Transplantation, Homologous

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the outcome of the surgical treatment for lumbar spinal stenosis with fracture in multiple osteoporotic vertebral body compression fractures. SUMMARY OF LITERATURE REVIEW: An osteoporotic vertebral compression fracture, without neurological symptom, has mainly been treated with conservative care. Sometimes, vertebroplasty or kyphoplasty has been used as a surgical treatment. In the case of a single thoracolumbar fracture with neurological symptoms, not improved by conservative care, decompression, fusion and instrumentation through an anterior or a posterior approach has been attempted. MATERIALS AND METHODS: 10 patients, who had received surgical treatment for symptomatic lumbar spinal stenosis with fracture out of those with multiple osteoporotic vertebral body compression fractures, and over the age of 60, were assessed. The surgical treatment was performed on the patient with all of the following five criteria; (1) severe back pain caused by fractures, (2) neurological symptoms of lumbar spinal stenosis, (3) radiological evidences of stenosis by lumbar fracture, (4) no response to conservative treatment for over 3 months, and (5) adequate physical ability for daily living without a severe medical condition. The surgical procedure included: decompressive laminectomy, posterior instrumentation using pedicle screw fixation, and fusion in situ. The pedicle screws were located 2-3 above and below the most cephalad and caudad fractured vertebral bodies. RESULTS: Clinically, favorable results were obtained in 8 of the 10 patients. In the roentgenographic assessment, the operated states were well maintained, without the metallic failure or instability. Halos around the pedicle screws were seen in 4 patients, but there was no significant evidence of loosening. There were no serious medical and systemic complications in the peri- and postoperative periods. Additional vertebral body fractures and pain were seen in 5 patients, but they had been well managed, conservatively. CONCLUSION: Favorable clinical results could be expected for the surgical treatment of lumbar spinal stenosis, with fracture, in the patients with multiple osteoporotic vertebral fractures, as long as the surgical treatment was indicated exactly and carefully.
Back Pain ; Constriction, Pathologic ; Decompression ; Fractures, Compression* ; Humans ; Kyphoplasty ; Laminectomy ; Postoperative Period ; Retrospective Studies ; Spinal Stenosis* ; Vertebroplasty

Hemolytic uremic syndrome (HUS) is characterized clinically by classic triad of microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The illness is uncommon and various agents have been associated with HUS, such as infectious, genetic, environmental and phamacological factor. We experienced a case of hemolytic uremic syndrome in a eighty-year old man with a evidence for recent Epstein-barr virus infection. He developed hemolytic anemia, thrombocytopenia, hypertension and azotemia. His renal dysfunction was recovered by hemodialysis, plasmapheresis, warfarin and dypiridamole. We present this case with a review of the literature.
Acute Kidney Injury ; Anemia, Hemolytic ; Azotemia ; Disseminated Intravascular Coagulation ; Hemolytic-Uremic Syndrome* ; Herpesvirus 4, Human ; Hypertension ; Plasmapheresis ; Renal Dialysis ; Thrombocytopenia ; Warfarin

Although advances in imaging technology have allowed for earlier detection of disease, hepatocellular carcinoma is usually asymptomatic and discovered at an advanced stage with metastasis. The most common sites of metastasis include lung, peritoneum, adrenal gland, and bone, but rarely, the nasal cavity, orbit, gallbladder, and ovary can be metastatic sites. We experienced a case of metastatic hepatocellular carcinoma of the ovary in a living patient. The differential diagnosis includes hepatoid yolk sac tumor of the ovary, primary or metastatic hepatoid carcinoma and primary or metastatic oxyphil cell tumor of the ovary. To the best of our knowledge, there have been eight cases of metastatic hepatocellular carcinoma of the ovary in the English literature and only six cases discovered in living patients. This is the first report of a metastatic hepatocellular carcinoma of the ovary in Korea.
Adult ; Carcinoma, Hepatocellular/*secondary ; Diagnosis, Differential ; English Abstract ; Female ; Humans ; Liver Neoplasms/*pathology ; Ovarian Neoplasms/diagnosis/*secondary

Epithelioid hemangioendothelioma is a rare vascular tumor, which occurs in the lung, liver, bone, and soft tissue. Hypertrophic osteoarthropathy is a syndrome characterized by subperiosteal new bone formation, joint effusion and clubbing, and may be associated with cyanotic heart disease, chronic pulmonary disease, liver disease, and other miscellaneous diseases. The activation of endothelium and platelets has been suggested to be involved in the development of hypertrophic osteoarthropathy. We report a rare case of hypertrophic osteoarthropathy, which developed in association with hepatic epithelioid hemangioendothelioma with pulmonary metastasis. We also discuss the role of vascular endothelial growth factor in its pathogenesis.
Adult ; Biopsy ; Blood Platelets/metabolism ; Endothelium/metabolism ; Femur/radiography ; Hemangioendothelioma, Epithelioid/*complications/*pathology ; Human ; Lung/pathology ; Lung Neoplasms/*complications/pathology ; Male ; Osteoarthropathy, Secondary Hypertrophic/*complications/*pathology ; Vascular Endothelial Growth Factor A/metabolism ; Vascular Neoplasms/*diagnosis/pathology