Background/Aims: This study aimed to review the indications, methods, cooperation, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG). Methods: Questionnaires were sent to 200 hospitals, of which 62 returned their questionnaires, with a response rate of approximately 30%. Descriptive statistics were calculated to analyze the responses to the questionnaires. Results: In 2019, a total of 1,052 PEGs were performed in 1,017 patients at 62 hospitals. The main group who underwent PEG was older adult patients with brain disease, particularly stroke.Nutritional supply was an important purpose of the PEG procedure. “The pull method” was the most commonly used for initial PEG insertion. The complications related to PEG were mostly mild, with leakage being the most common. Patients who underwent PEG procedures were primarily educated regarding the post-procedure management and complications related to PEG.Preoperative meetings were skipped at >50% of the institutions. Regarding the cooperation between the nutrition support team (NST) and the physician performing PEG, few endoscopists answered that they cooperated with NST before and after PEG. Moreover, the rate of NST certification obtained by physicians performing PEG and the frequency of attendance at NST-related conferences were relatively low. Conclusions This study shows a similar trend to that found in the previous PEG guidelines.However, it covers new aspects, including team-based work for PEG procedure, nutrition support, and education for patients and guardians. Therefore, each medical institution needs to select an appropriate method considering the medical environment and doctor’s abilities.

In November 2021, 14 international travel-related severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.1.529 (omicron) variant of concern (VOC) patients were detected in South Korea. Epidemiologic investigation revealed community transmission of the omicron VOC. A total of 80 SARS-CoV-2 omicron VOC-positive patients were identified until December 10, 2021 and 66 of them reported no relation to the international travel.There may be more transmissions with this VOC in Korea than reported.

BACKGROUND/AIMS: In patients with occlusive colorectal cancers, a complete preoperative evaluation of the colon proximal to the obstruction is often impossible. We aimed to evaluate the feasibility of preoperative colonoscopy after stent placement and to determine whether the success rate of colonoscopy differs between covered and uncovered stents. METHODS: Seventy-three patients with malignant colorectal obstruction were enrolled prospectively. In patients with a resectable cancer, a preoperative colonoscopy was performed after insertion of a self-expandable metal stent (SEMS). The success rate of complete preoperative colonoscopy was compared between covered and uncovered stents. RESULTS: Forty-five of 73 patients who underwent stent placement had a resectable cancer (61.6%). A complete preoperative colonoscopy was possible in 40 of 45 patients (88.9%). The success rate of complete preoperative colonoscopy was significantly lower in the covered-stent group when the obstructing mass lesion was located in the sigmoid colon (p=0.024). Synchronous cancer was detected in one patient (2.2%). Stent migration was observed in four patients with a covered stent. CONCLUSIONS: A preoperative complete colonoscopy after SEMS placement was feasible and safe in most patients with malignant colorectal obstruction. Uncovered stents seem to have more advantages than covered stents in preoperative colonoscopy proximal to the obstruction.
Colon ; Colon, Sigmoid ; Colonoscopy ; Colorectal Neoplasms ; Humans ; Neoplasms, Multiple Primary ; Prospective Studies ; Stents

Self expandable metal stent can be used both as palliative treatment for malignant colorectal obstruction and as a bridge to surgery in patients with potentially resectable colorectal cancer. Here, we report a case of successful relief of malignant stomal obstruction using a metal stent. A 56-year-old man underwent loop ileostomy and was given palliative chemotherapy for ascending colon cancer with peritoneal carcinomatosis. Eight months after the surgery, he complained of abdominal pain and decreased fecal output. Computed tomography and endoscopy revealed malignant stomal obstruction. Due to his poor clinical condition, we inserted the stent at the stomal orifice, instead of additional surgery, and his obstructive symptoms were successfully relieved. Stent insertion is thought to be a good alternative treatment for malignant stomal obstruction, instead of surgery.
Abdominal Pain ; Carcinoma ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colorectal Neoplasms ; Endoscopy ; Humans ; Ileostomy ; Middle Aged ; Palliative Care ; Stents

PURPOSE: Recent studies have shown that cyclooxygenase (COX)-2 may be involved in colorectal carcinogenesis. In this study, we evaluate the differences of COX-2 expression in patients with synchronous and metachronous hepatic metastasis of colorectal cancer. In addition, the expression of COX-1 and E-cadherin were also evaluated. METHODS: Paraffin embedded blocks were obtained from 41 patients who underwent surgery for colorectal cancer with hepatic metastasis. Samples from primary colorectal cancer, synchronous and metachronous hepatic lesions were stained by immunohistochemistry for monoclonal antibody against COX-1, COX-2, and E-cadherin. RESULTS: In colonic COX-1 expression, there was no significant difference in the degree of COX-1 expression between primary colorectal cancer with synchronous hepatic metastasis and that of metachronous hepatic metastasis (P=0.507). In colonic COX-2 and E-cadherin expression, the degree of COX-2 expression was not different between the two groups. But, the patient survival rate in the positive group of COX-1 and COX-2 expression was lower than in the negative group, respectively (P=0.023, P=0.006). CONCLUSION: The degree of colonic COX-1 and COX-2 expression has an impact on prognosis in synchronous and metachronous hepatic metastasis. Further large-scale study is necessary to determine the meaning of COX-2 expression in colorectal cancer.
Cadherins ; Colon ; Colorectal Neoplasms ; Humans ; Immunohistochemistry ; Neoplasm Metastasis ; Paraffin ; Prognosis ; Prostaglandin-Endoperoxide Synthases ; Survival Rate

BACKGROUND: The Korean Medical Association intends to determine the relative value of physician's work separately from the total relative value scale for each medical or surgical procedure. This study was designed by the Korean Society for Laboratory Medicine to determine the relative value of laboratory physician's work (LPW) in each diagnostic test. The LPW was clearly defined first and then its relative value was measured quantitatively on the basis of time and intensity of work. METHODS: LPW in the laboratory test was categorized into three parts, pre-service, intra-service, and post-service. The relative value of physician's work was measured using Rasch paired comparisons. RESULTS: Practice characteristics of LPW were clearly defined according to the pre-service, intraservice, and post-service. However, any laboratory physician's effort to improve the quality of laboratory work, which could not be measured in each test, had to be comprised in a pre-service designated separately as `comprehensive pre-service'. Rasch analysis based on the rating survey for LPW taken by a diverse group of laboratory medicine and other medical specialists revealed higher values than those assigned previously in many routine diagnostic tests (e.g., Gram stain, hemoglobin, anti-HBs, ABO cell type). The results obtained by applying Rasch regression analysis showed that the diagnostic tests that had been given a low relative value of LPW tended to be measured with more improved relative valuation. CONCLUSIONS: LPW for quality control and quality improvement was acknowledged with an improved relative valuation, even in the routine diagnostic test, as the results of Rasch analysis based on the rating survey. LPW might be further equated across the specialties, considering the practice characteristics of LPW.
Diagnostic Tests, Routine ; Matched-Pair Analysis ; Quality Control ; Quality Improvement ; Relative Value Scales ; Specialization

A choledochal cyst is relatively rare lesion in the biliary system, and a carcinoma arising from such a cyst is rarely reported. Until now, a case of a hepatocellular carcinoma combined with a choledochal cyst had not been reported. A 45-year-old woman was recently admitted due to abdominal pain. An abdominal computed tomography revealed a 5 cm-sized low attenuative mass involving the right anterior and left medial segment of the liver and gallbladder fossa. An endoscopic retrograde cholangiopancreatogram showed fusiform dilatation of the common bile duct, but anomalous union of pancreaticobiliary duct was not observed. Fine-needle aspiration of the liver was conducted and yielded a hepatocellular carcinoma. On celiac arteriography, a hypervascular hepatic mass was also found. Transarterial chemoembolization was performed. It is believed this may be the first case of a choledochal cyst combined with a hepatocellular carcinoma in the literature. Hence, this case is herein reported with a review of related literatures.
Abdominal Pain ; Angiography ; Biliary Tract ; Biopsy, Fine-Needle ; Carcinoma, Hepatocellular* ; Choledochal Cyst* ; Common Bile Duct ; Dilatation ; Female ; Gallbladder ; Humans ; Liver ; Middle Aged

A 71-year-old man was admitted due to abdominal distension and periumbilical pain. He was diagnosed as having mucinous ductal ectasia (MDE) of the pancreas three months prior, but refused an operation. Three months later, an abdominal computed tomography revealed more dilated pancreatic duct, newly developed liver metastasis and ascites in comparison with previous findings. Fine-needle aspiration cytology of the cystic lesion in the pancreatic head was conducted and yielded adenocarcinoma. Also, an ascitic fluid cytology determined adenocarcinoma. This patient was diagnosed to be inoperable and received palliative chemotherapy and pain control. The patient expired 5 months after the initial diagnosis.
Adenocarcinoma ; Aged ; Ascites* ; Ascitic Fluid ; Biopsy, Fine-Needle ; Diagnosis ; Dilatation, Pathologic* ; Drug Therapy ; Head ; Humans ; Liver* ; Mucins* ; Neoplasm Metastasis* ; Pancreas* ; Pancreatic Ducts

OBJECTIVE: The objective of this study was to compare perinatal outcomes of pregnancy-induced hypertensive and normotensive women experiencing abruptio placentae, Our hypothesis is that pregnancy-induced hypertensive women have a less favorable perinatal outcome than do normotensive women. METHODS: Women with the diagnosis of abruptio placentae delivered between August 1, 1989 and December 1, 1996, composed the study group (n=92) in this case-control study. The women with abruptio placentae were divided according to their hypertensive (n=37) or normotensive (n=55) status. Maternal and neonatal medical records were reviewed and abstracted for demographic variables, antepartum complications, delivery route, abruptio placentae grade, neonatal gender, birth weight, Apgar score and perinatal mortality. We compared these perinatal outcome variables between the pregnancy-induced hypertensive and normotensive pregnant women. RESULTS: The incidence of abruptio placentae was 0.35%. The two groups of woman wne similar with regard to age and parity. Abruptio placentae grades 2 occurred more often in hypertensive women (P=0.0053). Pregnancy-inducedhypertensive women were similar to normotensive women with regard to antenatal complications. The mean gestational age of delivery, delivery route, neonatal weight and sex were similar between two groups of women. Neonates from pregnancy-induced hypertensive women were no more likely to have low 1 and 5-minute Apgar score or to die than those from normotensive women. Statistical analysis was performed with two-tailed independent t-test and Kruskal-Wallis analysis. CONCLUSION: Although pregnancy-induced hypertensive women experiencing abruptio placentae are more likely to have grade 2 abruptio placentae with fetal distress, the overall perinatal outcome was not significantly different from that of normotensive women experiencing abruptio placentae.
Abruptio Placentae ; Apgar Score ; Birth Weight ; Case-Control Studies ; Diagnosis ; Female ; Fetal Distress ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Infant, Newborn ; Medical Records ; Parity ; Perinatal Mortality ; Placenta* ; Pregnancy ; Pregnant Women*

Dermatofibrosarcoma protuberans(DFSP) is a rare, distinctive cutsneous tumor originating in the dermis that appears as a raised uninodular or multinodular lesion on the trunk or the proximal extremities. In about 10% of the cases, DFSP arises in childhood and it is rarely evident already at birth. Histopathologically, DFSP shows the chsracteristic storiform and cartwheel patterns, with the fibroblasts arranged radially about a small central hub of fibrous tissue. We report herein a case of childhood DFSP in a 7-year-old boy.
Child ; Dermatofibrosarcoma* ; Dermis ; Extremities ; Fibroblasts ; Humans ; Male ; Parturition