Purpose: This study aimed to evaluate the natural growth of subepithelial tumors of the small bowel detected on CT. Materials and Methods: Consecutive patients who were suspected of having subepithelial tumors of the small bowel between January 2005 and December 2020 were reviewed. Eligible patients with suspected small (< 30 mm) subepithelial tumors on at least two CT evaluations were included in the analysis. The patients’ data on demographic characteristics, tumoral characteristics, and tumoral size changes during the follow-up were collected. Results: This study included 64 patients with suspected small subepithelial tumors (n = 64) of the small bowel. After a median follow-up of 15.8 months, the diameter and volume growth rates were 0.02 mm/month and 1.5 mm3/month, respectively. A significant correlation was observed between the initial size and the growth rate of the small bowel subepithelial tumors. The group of large-sized tumors (initial diameter ≥ 10 mm) tended to show lobulated contours, heterogeneous enhancement, and necrotic changes more frequently than the group of small-sized tumors (initial diameter < 10 mm). Conclusion Small bowel subepithelial tumors measuring less than 10 mm grew more slowly than those measuring 10–30 mm.

Gastric type mucinous endocervical adenocarcinomas of the uterine cervix (GAC) are a newly classified mucinous subtype with morphologically in 2014, WHO. They have a much more aggressiveness and show unusual metastatic patterns compared to usual type endocervical adenocarcinoma. They tend to present at higher stage and even in stage I, they have worse survival. Therefore, differential diagnosis of GAC from the usual type of endocervical adenocarcinoma is very important because they are related to a significant risk of recurrence and decreased 5-year disease-specific survival. Besides, GACs are mostly not associated with human papillomavirus (HPV) infection and p16 immunohistochemistry is also typically negative in GAC that is HPV-unassociated tumor. We report a very rare and interesting case of stage IB1 GAC with negative HPV DNA and p16.
Adenocarcinoma ; Cervix Uteri ; Diagnosis, Differential ; DNA ; Female ; Humans ; Immunohistochemistry ; Mucins ; Recurrence

On 16 April 2014, the Sewol ferry, carrying 476 people, sank in the ocean off the south coast of South Korea. Two hundred and ninety five are confirmed dead and 9 remain missing. The Korean Neuropsychiatric Association (KNPA) set up a Disaster Mental Health Committee (KDMHC) for out-reach services and to provide general strategies for promoting mental health and resilience. Mem bers of KDMHC and Volunteering Psychiatrists of the KNPA had participated in disaster mental health services organized by Gyeonggi-Ansan disaster mental health support team. Their activities were composed of psychoeducation, supportive individual and familial counseling and referring service to professional institutes. This report has described the outline of the initial and acute mental health care responses by KDMHC and volunteers among KNPA members.
Academies and Institutes ; Counseling ; Disasters* ; Korea ; Mental Health Services ; Mental Health* ; Psychiatry ; Volunteers*

Prediction of malignancy or invasiveness of branch duct type intraductal papillary mucinous neoplasm (Br-IPMN) is difficult, and proper treatment strategy has not been well established. The authors investigated the characteristics of Br-IPMN and explored its malignancy or invasiveness predicting factors to suggest a scoring formula for predicting pathologic results. From 1994 to 2008, 237 patients who were diagnosed as Br-IPMN at 11 tertiary referral centers in Korea were retrospectively reviewed. The patients' mean age was 63.1 +/- 9.2 yr. One hundred ninty-eight (83.5%) patients had nonmalignant IPMN (81 adenoma, 117 borderline atypia), and 39 (16.5%) had malignant IPMN (13 carcinoma in situ, 26 invasive carcinoma). Cyst size and mural nodule were malignancy determining factors by multivariate analysis. Elevated CEA, cyst size and mural nodule were factors determining invasiveness by multivariate analysis. Using the regression coefficient for significant predictors on multivariate analysis, we constructed a malignancy-predicting scoring formula: 22.4 (mural nodule [0 or 1]) + 0.5 (cyst size [mm]). In invasive IPMN, the formula was expressed as invasiveness-predicting score = 36.6 (mural nodule [0 or 1]) + 32.2 (elevated serum CEA [0 or 1]) + 0.6 (cyst size [mm]). Here we present a scoring formula for prediction of malignancy or invasiveness of Br-IPMN which can be used to determine a proper treatment strategy.
Adenocarcinoma, Mucinous/*pathology ; Adult ; Aged ; Aged, 80 and over ; Carcinoembryonic Antigen/blood ; Carcinoma, Pancreatic Ductal/*pathology ; Carcinoma, Papillary/*pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Staging ; Pancreatic Neoplasms/*pathology ; Predictive Value of Tests ; ROC Curve ; Tomography, X-Ray Computed

BACKGROUND: Sleep is an essential restorative physiologic phenomenon. Impaired sleep results in significant negative effect to the health. Symptoms like sleep initiation difficulty, frequent awakening, severe snoring have related to poor sleep quality. We studied frequency and compared the characteristics of common sleep disorders at family practice. METHODS: We surveyed patients over 18 years of age and their guardians who visited 16 familial practices for 6 days. We investigated sleep characteristics, frequency of sleep disorder and associated factors by questionnaires and analyzed by frequency analysis, Spearman's correlation coefficient, multiple logistic regression. RESULTS: We enrolled 1,117 participants. Older participants were more likely to report early sleep onset and off time, short sleep duration. Mean number of awakening during a typical night is 1.69. Female complained difficulties in initiation and maintenance of sleep more than male. A total of 32.5% had these insomnia symptoms and related to hypertension, stroke, stress, arthralgia, depression, urological disorder. 31.1% had excessive daytime sleepiness, related to stress, arthralgia, depression. Loud snoring and gasp for breath showed positive correlation between male, high BMI. Disrupted sleep over 3 times was related to old age, female, diabetes, hypertension, stroke, stress, arthralgia, depression. Restless leg syndrome were high in elderly, high BMI, stress, arthralgia and depression. CONCLUSION: About one in three who visit in primary medical practice have sleep disorder symptoms like insomnia, daytime fatigue, snoring. 3% of them have gasp for breath, 8% have restless leg syndrome.
Aged ; Arthralgia ; Depression ; Family Practice ; Fatigue ; Female ; Humans ; Hypertension ; Leg ; Male ; Prevalence ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Snoring ; Stroke

PURPOSE: The risk factors of pseudomembranous colitis (PMC) are well known. However, there have been no studies of PMC after gastrointestinal operation. The aim of this study was to evaluate the risk factors and to establish the guiding principles for PMC after gastrointestinal operation. METHODS: We performed a retrospective study of 39 PMC patients after gastrointestinal operation from January 2004 to December 2008. A control group of one hundred and seventeen matched to a PMC group by date of operation was chosen in a random fashion. Preoperative, operative, and postoperative factors of PMC were evaluated. RESULTS: The incidence of PMC after gastrointestinal operation was 0.63%. On univariate analysis, among preoperative factors, albumin, PT-INR and neutropenia were significant risk factors for PMC. There was no difference in the operative factors. Among postoperative factors, duration of cephalosporin, aminoglycoside, H2 blocker administration were significant risk factors for PMC after gastrointestinal operation. And transfusion, duration of NPO, length of stay in intensive care unit (ICU) and postoperative intraabddominal abscess, pneumonia were also significant risk factors. On multivariate analysis, the independent risk factors for PMC after gastrointestinal operation were duration of aminoglycoside administration, transfusion volume and length of stay in ICU. When period of study was divided by three months, incidence of PMC at a specific period was high. After limiting of prophylactic antibiotics, incidence of PMC fell to 0.36%. CONCLUSION: To prevent PMC after gastrointestinal operation, we need sustained efforts to establish stricter guidelines about prophylactic antibiotics and transfusion, and to minimize length of stay in ICU.
Abscess ; Anti-Bacterial Agents ; Enterocolitis, Pseudomembranous ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Multivariate Analysis ; Neutropenia ; Pneumonia ; Retrospective Studies ; Risk Factors

The collision tumors have been reported in various organs and represent the coexistence of two adjacent but histologically distinct tumors in an organ without any histological admixture. A gastric collision tumor is rare and most gastric collision tumors involve an adenocarcinoma colliding with a lymphoma. A 48-year-old man was referred to our hospital for an evaluation of dyspepsia and upper abdominal discomfort. Endoscopy demonstrated the presence of an ulcerative lesion in the gastric antrum. The biopsy specimens confirmed a pathological diagnosis of an adenocarcinoma. After a radical subtotal gastrectomy, a thorough Histopathological examination revealed a collision tumor: a well-differentiated adenocarcinoma in the superficial layer (mucosa, submucosa) and a poorly differentiated neuroendocrine carcinoma in the deeper layer (muscularis propria, serosa). The patient received combination chemotherapy with cisplatin and etoposide. Para-aortic lymph node enlargement was observed on the abdominal computed tomography scanning, 3 years after surgery. The patient underwent chemotherapy with TS-1, and the size of lymph nodes was reduced. The patient continues to do well after a follow up period of 5 years 3 months. We report this case of gastric collision tumor (adenocarcinoma and neuroendocrine carcinoma) with a brief review of the relevant literature.
Adenocarcinoma ; Biopsy ; Carcinoma, Neuroendocrine ; Cisplatin ; Diagnosis ; Drug Therapy ; Drug Therapy, Combination ; Dyspepsia ; Endoscopy ; Etoposide ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Nodes ; Lymphoma ; Middle Aged ; Pyloric Antrum ; Stomach ; Stomach Neoplasms* ; Ulcer

PURPOSE: Total gastrectomy is followed by weight loss in the majority of patients, but the reason for this is not clear. Ghrelin, a novely isolated gastric hormone, exerts orexigenic activity. If a circulating ghrelin participates in the adaptive response to weight loss, the weight loss induced by total gastrectomy may be accompanied by impaired ghrelin secretion. METHODS: The blood was collected from gastric cancer patients who have undergone gastric resection, preoperatively and immediately after resection, on the 1st, 3rd and 7th postoperative day. The correlation of the preoperative plasma ghrelin concentration with gender, age and BMI were analyzed. The concentration changes of plasma ghrelin were observed serially after dividing gastrectomized patients into the subtotal gastrectomy group, the total gastrectomy group, and the proximal gastrectomy group. RESULTS: Although statistically not significant, the plasma ghrelin concentration was negatively correlated with age and BMI. In the subtotal gastrectomy group, nadir ghrelin was 48.4 +/- 23.6% of the preoperative value after gastric resection and then gradually increased to 82.4 +/- 19.9% on the 7th postoperative day. In the total gastrectomy group, nadir ghrelin was 36.9 +/- 10.4% of the preoperative value after gastric resection and remained 20.9 +/- 10.9% on the 7th postoperative day. In the proximal gastrectomy group, nadir ghrelin was 29.4 +/- 4.6% after gastric resection, which was followed by a gradual recovery. However, the recovery rate was steadier than compare to the subtotal gastrectomy group, as the concentration was 41.8 +/- 23.1% even on 7th postoperative day. CONCLUSION: The principal site of the ghrelin synthesis is stomach which contributes 60~70% to the circulating concentration of ghrelin. In the case of subtotal gastrectomy, ghrelin production is compensated by the remnant stomach. For this reason total gastrectomy is associated with suppressed ghrelin levels and it possibly contribute to the weight loss.
Gastrectomy ; Gastric Stump ; Ghrelin* ; Humans ; Plasma* ; Stomach ; Stomach Neoplasms ; Weight Loss

Extramammary Paget's disease (EMPD) is a rare intraepithel ial neoplasm arising in apocrine gland-bearing skin. EMPD may be regarded as a skin marker of associated malignancy because it tends to combine a variety of underlying malignancies in up to 50% of cases. Herein a case of gastric cancer diagnosed in a patient with extramammary Paget's disease of the scrotum is reported. The patient was a 65-year-old man whose chief complaint was exanthema of the right scrotum of 3 years duration. Biopsy samples taken from patient showed large, round cells with clear cytoplasm in the epidermis. The final diagnosis was EMPD of the scrotum. The extensive workups, including tumor marker, imaging studies and endoscopy to exclude associated malignancy were performed. Examination of the endoscopic gastric biopsy specimen revealed an adenocarcinoma of the stomach. On the basis of this result, a radical subtotal gastrectomy was successfully performed. This case suggests that, in cases of EMPD, the clinicians should consider the possibility of underlying malignancies and thoroughly examine not only the urogenital tract and lower gastrointestinal tract, but also the visceral organs, such as the stomach, even if there are no clinical symptoms of malignancy.
Adenocarcinoma ; Aged ; Biopsy ; Cytoplasm ; Diagnosis ; Endoscopy ; Epidermis ; Exanthema ; Gastrectomy ; Humans ; Lower Gastrointestinal Tract ; Paget Disease, Extramammary* ; Scrotum ; Skin ; Stomach ; Stomach Neoplasms*

BACKGROUND/AIMS: Despite of increasing numbers of reports on intraductal papillary mucinous tumor (IPMT), there is still difficulty in its' diagnosis, treatment and prediction of prognosis. The purpose of this multicenter study was to evaluate the clinico-pathological features of IPMT in Korea and suggest the prediction criteria of malignancy in IPMT. METHODS: We retrospectively reviewed the clinico-pathological data of 208 patients who underwent operations with IPMT between 1993 and 2002 at 28 institutes in Korea. RESULTS: Of the 208 patients with a mean age of 60.5+/-9.7 years, 147 were men and 61 were women. 124 patients underwent pancreatoduodenectomy, 42 distal pancreatectomy, 17 total pancreatectomy, 25 limited pancreas resection. Benign cases were 128 (adenoma (n=62), borderline (n=66)) and malignant cases were 80 (non-invasive (n=29), invasive (n=51)). A significant difference in 5-year survival was observed between benign and malignant group (92.6% vs. 65.3%; p=0.006). Of the 6 factors (age, location, duct dilatation, tumor appearance, main duct type, and tumor size) that showed the statistical difference in univariate analysis between benign and malignant group, we found three significant factors (tumor appearance (p=0.009), tumor size (p=0.023), and dilated duct size (p=0.010)) by multivariate analysis. CONCLUSION: Although overall prognosis of IPMT is superior to ordinary pancreatic cancer, more curative surgery is recommended in malignant IPMT. Tumor appearance (papillary), tumor size (> or =30 mm) and dilated duct size (> or = 12 mm) can be used as preoperative indicators of malig-nancy in IPMT.
Academies and Institutes ; Diagnosis ; Dilatation ; Female ; Humans ; Korea* ; Male ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Prognosis ; Retrospective Studies