Hemosuccus pancreaticus is an unusual gastrointestinal hemorrhage through the main pancreatic duct. We report a rare case of hemosuccus pancreaticus due to a simple mucinous cyst of the pancreas. A 52-year-old man who had been followed-up for a suspected branch duct intraductal papillary mucinous neoplasm (IPMN) visited the emergency room due to hematochezia. Endoscopy showed active bleeding from the ampulla. Computed tomography revealed hemorrhage in a 2.0-cm cystic mass in the pancreatic body. The patient was diagnosed with hemosuccus pancreaticus caused by bleeding into the main pancreatic duct from suspected IPMN. Elective laparoscopic distal pancreatectomy was performed. The histopathological diagnosis was a simple mucinous cyst with squamous metaplasia based upon the pathological finding involving the absence of ovarian-type stroma. In conclusion, it should be recognized that a pancreatic cyst including simple mucinous cyst may cause hemosuccus pancreaticus, and these cysts should be viewed as neoplastic and approached similarly as other mucinous pancreatic neoplasms.
Diagnosis ; Emergency Service, Hospital ; Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Metaplasia ; Middle Aged ; Mucins* ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Pancreatic Ducts ; Pancreatic Neoplasms

Angiogenesis, the formation of new blood vessels, is critical for tumor growth and metastasis. Notably, tumors themselves can lead to angiogenesis by inducing vascular endothelial growth factor (VEGF), which is one of the most potent angiogenic factors. Inhibition of angiogenesis is currently perceived as one of the most promising strategies for the blockage of tumor growth. In this study, we investigated the effects of Acer tegmentosum maxim water extract (ATME) on angiogenesis and its underlying signal mechanism. We studied the antiangiogenic activity of ATME by using human umbilical vein endothelial cells (HUVECs). ATME strongly inhibited VEGF-induced endothelial cell proliferation, migration, invasion, and tube formation, as well as vessel sprouting in a rat aortic ring sprouting assay. Moreover, we found that the p44/42 mitogen activated protein (MAP) kinase signaling pathway is involved in the inhibition of angiogenesis by ATME. Moreover, when we performed the in vivo matrigel plug assay, VEGF-induced angiogenesis was potently reduced when compared to that for the control group. Taken together, these results suggest that ATME exhibits potent antiangiogenic activity in vivo and in vitro and that these effects are regulated by the extracellular regulated kinase (ERK) pathway.
Acer/*metabolism ; Angiogenesis Inhibitors/*pharmacology ; Animals ; Cell Line, Tumor ; Cell Movement/drug effects ; Cell Proliferation/drug effects ; Cell Survival ; Extracellular Signal-Regulated MAP Kinases/*metabolism ; Hep G2 Cells ; Human Umbilical Vein Endothelial Cells/*drug effects ; Humans ; MAP Kinase Signaling System/drug effects ; Mice ; Mice, Inbred C57BL ; Mitogen-Activated Protein Kinase 1/metabolism ; Neoplasm Invasiveness/pathology ; Neovascularization, Pathologic/*drug therapy/prevention & control ; Nitric Oxide Synthase Type III/metabolism ; Phosphorylation/drug effects ; Plant Extracts/pharmacology ; Rats ; Rats, Sprague-Dawley ; Transcription Factors/metabolism ; Vascular Endothelial Growth Factor A/antagonists & inhibitors/metabolism

PURPOSE: To investigate the prognostic factors for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy. METHODS: In the present study we retrospectively reviewed intraindividual and interocular differences in 14 patients (28 eyes) who underwent pars plana vitrectomy for proliferative retinopathy with vitreous hemorrhage and having only 1 eye neovascular glaucoma. The patients underwent vitrectomy between March 2008 and July 2014 at Maryknoll Hospital. The patient clinical data on preoperative, intraoperative and postoperative factors were compared. Statistical analysis was performed using the Wilcoxon matched-pairs signed-rank (Mann-Whitney) test and chi-square test to evaluate the significance of differences within the patient groups. RESULTS: The decrease of photopic b-wave amplitudes on the preoperative electroretinogram significantly correlated with the development of neovascular glaucoma after vitrectomy for proliferative retinopathy with vitreous hemorrhage (p > 0.05). CONCLUSIONS: Based on the results from the present study, decreased photopic b-wave amplitudes on preoperative electroretinogram is an effective prognostic factor for the development of neovascular glaucoma after vitrectomy for proliferative retinopathy with vitreous hemorrhage.
Diabetic Retinopathy* ; Glaucoma, Neovascular* ; Humans ; Retrospective Studies ; Vitrectomy* ; Vitreous Hemorrhage

PURPOSE: To report a rare case of a patient with diplopia due to a mass in the sphenoidal sinus, histologically diagnosed as carcinoma. CASE SUMMARY: A 57-year-old male visited our clinic complaining of diplopia and ptosis for 10 days. He had esotropia 45 prism diopters in the primary position, markedly limited abduction, and a 4 mm dilated pupil in the right eye compared with a 2 mm pupil in the left eye. Enhanced magnetic resonance imaging revealed a sphenoidal sinus mass extended into the pituitary gland and sella turcica with homogeneous intense enhancement. Metastatic workups, including CT of the head, neck, chest, and abdomen were unremarkable. He underwent a transsphenoidal approach mass debulking surgery followed by radiotherapy for 6 weeks. Histological findings were compatible with carcinoma. Six weeks after radiotherapy he had esotropia of 20 prism diopters in the primary position. Abduction limitation was partially recovered postoperatively. CONCLUSIONS: Diplopia may develop as a result of multiple cranial nerve palsy due to carcinoma in the sphenoidal sinus and may be improved by debulking surgery and radiation treatment.
Abdomen ; Abducens Nerve Diseases* ; Cranial Nerve Diseases ; Diplopia ; Esotropia ; Head ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck ; Pituitary Gland ; Pupil ; Radiotherapy ; Sella Turcica ; Thorax

PURPOSE: To evaluate the risk factors for the development of posterior capsule opacification (PCO) after cataract surgery or combined cataract and vitreoretinal surgery. METHODS: In the present study all surgical procedures were performed by the same surgeon. We retrospectively reviewed 272 consecutive eyes that received cataract surgery or combined cataract and vitreoretinal surgery. The risk factors including gender, age, diabetes, continuous curvilinear capsulorhexis (CCC) size, intraocular lens shape, intraoperative intravitreal bevacizumab, gas, and silicone oil injections were evaluated using multiple logistic regression analysis. RESULTS: PCO developed in 55 (20.2%) out of 272 eyes. The mean age was 63.3 +/- 12.1 years (range 23-85 years) and mean follow-up period was 17.3 +/- 3 months. A correlation existed between the development of the PCO and age (p < 0.05), CCC size (p = 0.009), vitreoretinal surgery (p = 0.014), intraoperative intravitreal gas (p = 0.009) and silicone oil injections (p = 0.005). However, no statistical correlation with gender, diabetes, intraocular lens shape, or intraoperative intravitreal bevacizumab injection was observed (p > 0.05). CONCLUSIONS: The risk factors associated with PCO included young age, large CCC size, combined cataract and vitreoretinal surgery, intraoperative intravitreal gas and silicone oil injections.
Capsule Opacification* ; Capsulorhexis ; Cataract* ; Follow-Up Studies ; Lenses, Intraocular ; Logistic Models ; Retrospective Studies ; Risk Factors* ; Silicone Oils ; Vitreoretinal Surgery* ; Bevacizumab

PURPOSE: In this study we evaluated the changes in tear film after primary pterygium operation in patients with pterygium. METHODS: We investigated 43 eyes of 42 subjects who showed successful results 3 months after pterygium operation performed by one surgeon. The changes in tear film thickness, tear break-up time (BUT), Schirmer I test, and ocular surface disease index (OSDI) were evaluated. All values were compared before and after surgery. RESULTS: The mean age was 58.0 +/- 11.1 years (34-81 years). Preoperative tear film thickness, tear BUT, and Schirmer I test in eyes which underwent pterygium operation were 21.53 +/- 5.93 microm, 4.84 +/- 2.21 seconds, and 11.67 +/- 6.75 mm, respectively. Three months after the operation, the respective values were 24.23 +/- 4.19 microm (p < 0.05), 5.81 +/- 1.89 seconds (p < 0.05), and 13.02 +/- 7.54 mm (p = 0.094). Tear film thickness and BUT score increased significantly after pterygium operation. There was no statistically significant difference in Schirmer I test, before and 3 months after pterygium operation. The subjective parameter (OSDI) improved 3 months after pterygium operation (p = 0.015). CONCLUSIONS: Pterygium operation can partially restore the tear film function into a normal state by improving tear film thickness and tear BUT after pterygium operation.
Humans ; Pterygium* ; Tears*

PURPOSE: Laparoscopy-assisted distal gastrectomy for early gastric cancer has gained acceptance and popularity worldwide. However, laparoscopy-assisted distal gastrectomy for advanced gastric cancer is still controversial. Therefore, we propose this prospective randomized controlled multi-center trial in order to evaluate the safety and feasibility of laparoscopy assisted D2-gastrectomy for advanced stage gastric cancer. MATERIALS AND METHODS: Patients undergoing distal gastrectomy for advanced gastric cancer staged cT2/3/4 cN0/1/2/3a cM0 by endoscopy and computed tomography are eligible for enrollment after giving their informed consent. Patients will be randomized either to laparoscopy-assisted distal gastrectomy or open distal gastrectomy. Sample size calculation revealed that 102 patients are to be included per treatment arm. The primary endpoint is the non-compliance rate of D2 dissection; relevant secondary endpoints are three-year disease free survival, surgical and postoperative complications, hospital stay and unanimity rate of D2 dissection evaluated by reviewing the intraoperative video documentation. DISCUSSION: Oncologic safety is the major concern regarding laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Therefore, the non-compliance rate of clearing the N2 area was chosen as the most important parameter for the technical feasibility of the laparoscopic procedure. Furthermore, surgical quality will be carefully reviewed, that is, three independent experts will review the video records and score with a check list. For a long-term result, disease free survival is considered a secondary endpoint for this trial. This study will offer promising evidence of the feasibility and safety of Laparoscopy-assisted distal gastrectomy for advanced gastric cancer.Trial Registration: NCT01088204 (international), NCCCTS-09-448 (Korea).
Arm ; Disease-Free Survival ; Endoscopy ; Gastrectomy ; Humans ; Informed Consent ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Postoperative Complications ; Prospective Studies ; Sample Size ; Stomach Neoplasms

PURPOSE: To report a case of Pott's puffy tumor from a recurrent upper eyelid abscess. CASE SUMMARY: A 73-year-old male visited our clinic with recurrent upper eyelid abscess over the previous 3 months. The patient did not have any evidence of external injuries, systemic inflammations, or any other specific findings. The best corrected visual acuity was 0.9 in the right and 0.5 in the left eye with normal IOP. Enhanced CT revealed a focal low density mass (11.3 x 12.6 x 10 mm) with peripheral enhancement. An excisional biopsy was performed. Histopathologic examination revealed chronic inflammation and granulation tissue formation and the patient was diagnosed with Pott's puffy tumor. The patient experienced no discomfort after the excision biopsy. At the 14-month follow-up, there were no signs of recurrence. CONCLUSIONS: Although rare, Pott' puffy tumor should be considered in the differential diagnosis of upper eyelid mass.
Abscess ; Biopsy ; Diagnosis, Differential ; Eye ; Eyelids ; Follow-Up Studies ; Granulation Tissue ; Humans ; Inflammation ; Male ; Pott Puffy Tumor ; Visual Acuity

PURPOSE: The aim of the present study was to assess the association between the pre-operative plasma fibrinogen level and the adjacent organ involvement in advanced gastric cancer. MATERIALS AND METHODS: A total of 923 pre-operative plasma samples were obtained from 923 patients diagnosed clinically as having advanced gastric cancer, and fibrinogen levels were measured by immunoassay. Associations between fibrinogen levels and clinicopathologic findings (depth of tumor, adjacent organ involvement, and lymph node metastasis), along with survival were examined by univariate and multivariate analyses. RESULTS: Tumor size, tumor depth, and the presence of lymph node metastasis were found to be positively correlated with the preoperative plasma fibrinogen levels (P<0.001). Fifty (5.4%) patients had adjacent organ involvement. Lymphatic invasion (P<0.001), tumor size (P<0.001), clinical T (depth of invasion) stage (P<0.001), and clinical nodal stage (P=0.018) were found to be associated with adjacent organ involvement. Univariate and multivariate regression analyses showed that a preoperatively elevated plasma fibrinogen level was associated with adjacent organ involvement (P<0.001, 0.028), and Kaplan-Meier analysis showed that it was associated with poorer survival (P<0.001). CONCLUSIONS: Plasma fibrinogen was found to be a clinically useful marker of adjacent organ involvement and overall survival. When a high fibrinogen level is encountered, preoperatively, adjacent organ involvement should be suspected in clinically advanced gastric cancer.
Fibrinogen ; Gastrectomy ; Humans ; Immunoassay ; Kaplan-Meier Estimate ; Lymph Nodes ; Neoplasm Metastasis ; Plasma ; Stomach Neoplasms

OBJECTIVE: To evaluate the usefulness of infrared thermography in the diagnosis of unilateral carpal tunnel syndrome (CTS). METHOD: Thirty six patients confirmed electrodiagnostically as CTS and fifteen adults with normal electrodiagnostic study were included in this study. For the thermographic diagnosis, we measured the skin temperature of the palmar area of all 5 fingers, thenar area, hypothenar area and volar area of forearm bilaterally. We compared the interside peak temperature difference between median nerve innervated area and noninnervated area in three different groups (normal control, mild CTS and moderate to severe CTS groups). RESULTS: Thermography of the CTS patients showed significant temperature differences in more than one area of the median vasomotor nerve territory, and no significant temperature difference in all the areas that were not innervated by the median vasomotor nerve. When we considered interside temperature differences of more than 0.3 degrees C as abnormal findings, the sensitivity of thermography was 2.7% and the specificity was 86.6%. With more than 0.6 degrees C as abnormal, the sensitivity was 25% and the specificity was 66.6%. With more than 1.0 degrees C, the sensitivity was 8.3% and the specificity was 73.3%. There was no significant interside peak temperature difference in all groups. CONCLUSION: This study suggests that infrared thermography has low sensitivity and specificity, which implies that it is not useful for the diagnosis of CTS.
Adult ; Carpal Tunnel Syndrome ; Electrodiagnosis ; Fingers ; Forearm ; Humans ; Median Nerve ; Sensitivity and Specificity ; Skin Temperature ; Thermography