Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: adenoma ≥10 mm in size; 3 to 5 (or more) adenomas; tubulovillous or villous adenoma; adenoma containing high-grade dysplasia; traditional serrated adenoma; sessile serrated lesion containing any grade of dysplasia; serrated polyp of at least 10 mm in size; and 3 to 5 (or more) sessile serrated lesions. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: 1) adenoma ≥10 mm in size; 2) 3-5 (or more) adenomas; 3) tubulovillous or villous adenoma; 4) adenoma containing high-grade dysplasia; 5) traditional serrated adenoma; 6) sessile serrated lesion (SSL) containing any grade of dysplasia; 7) serrated polyp of at least 10 mm in size; and 8) 3-5 (or more) SSLs. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for the management of advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: (1) adenoma ≥10 mm in size; (2) 3 to 5 (or more) adenomas; (3) tubulovillous or villous adenoma; (4) adenoma containing high-grade dysplasia; (5) traditional serrated adenoma; (6) sessile serrated lesion (SSL) containing any grade of dysplasia; (7) serrated polyp of at least 10 mm in size; and (8) 3 to 5 (or more) SSLs. More studies are needed to fully comprehend the patients most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

BACKGROUND/AIMS: Mechanical lithotripsy is generally used when it is difficult to endoscopically remove common bile duct (CBD) stones. However, this procedure not only requires extensive experience, but it is also time consuming. Medium endoscopic sphincterotomy (medium EST) combined with endoscopic papillary large balloon dilation (EPLBD) is recently being increasingly used; therefore, the aim of this study was to evaluate the safety and effects of medium EST with EPLBD for patients with CBD stones that are difficult to remove. METHODS: 41 patients with CBD stones that were difficult to remove by conventional endoscopic methods were enrolled in this study. EPLBD was performed after medium EST. The size of the stones, the procedure time, complications and the total number of sessions needed for stone removal were analyzed. RESULTS: The mean size of the CBD stones was 18.2 +/- 7.7 mm, and the mean number of stones was 2.7. Additional mechanical lithotripsy for complete removal was required in 9.7% (4/41) of the patients. Procedure related complications occurred in 7% (3/41): bleeding in 1 case and acute pancreatitis in 2 cases. CONCLUSIONS: Medium EST with EPLBD was a safe and effective treatment modality for CBD stones that were difficult to remove. Further prospective randomized studies are needed for comparing the effectiveness and safety between conventional EST and medium EST with EPLBD for removing difficult CBD stones.
Common Bile Duct* ; Hemorrhage ; Humans ; Lithotripsy ; Pancreatitis ; Sphincterotomy, Endoscopic*

BACKGROUND/AIMS: Mechanical lithotripsy is generally used when it is difficult to endoscopically remove common bile duct (CBD) stones. However, this procedure not only requires extensive experience, but it is also time consuming. Medium endoscopic sphincterotomy (medium EST) combined with endoscopic papillary large balloon dilation (EPLBD) is recently being increasingly used; therefore, the aim of this study was to evaluate the safety and effects of medium EST with EPLBD for patients with CBD stones that are difficult to remove. METHODS: 41 patients with CBD stones that were difficult to remove by conventional endoscopic methods were enrolled in this study. EPLBD was performed after medium EST. The size of the stones, the procedure time, complications and the total number of sessions needed for stone removal were analyzed. RESULTS: The mean size of the CBD stones was 18.2 +/- 7.7 mm, and the mean number of stones was 2.7. Additional mechanical lithotripsy for complete removal was required in 9.7% (4/41) of the patients. Procedure related complications occurred in 7% (3/41): bleeding in 1 case and acute pancreatitis in 2 cases. CONCLUSIONS: Medium EST with EPLBD was a safe and effective treatment modality for CBD stones that were difficult to remove. Further prospective randomized studies are needed for comparing the effectiveness and safety between conventional EST and medium EST with EPLBD for removing difficult CBD stones.
Common Bile Duct* ; Hemorrhage ; Humans ; Lithotripsy ; Pancreatitis ; Sphincterotomy, Endoscopic*

We presented a case of Reiters syndrome consisting of conjunctivitis, arthritis and mucocutaneous lesions, occurring in 49 year-old Korean male. He had an pisode of dysentery 18 months before the onset of the syndrome and later followed by transient conjunctivitis but no history of venereal disease was revealed. He had the relatively well demarcated erythematous scaly patches on the scalp, face and back, and also the solitary or confluent thickened hyperkeratotic plaques on the dorsum of the feet and hands and lower extremities. Balanitis circinata as .a lesion of the mucous membrane, was seen but there were no lesions on the oral mucosa and palate. Arthritis of the knee and elbow joints were very scvere, accompanied by severe pain and limited motion, and severe wasting and weakness of the muscles of both lower extremities were noticed. He was treated with penicillin and corticosteroids systemically combined witb physiotherapy with some improvement of both skin lesions and joint pain but he died 3 months later probably of the far advanced pulmonary tuberculosis, gastrointestinal bleeding and cachexia.
Adrenal Cortex Hormones ; Arthralgia ; Arthritis ; Balanitis ; Cachexia ; Conjunctivitis ; Dysentery ; Elbow Joint ; Foot ; Hand ; Hemorrhage ; Humans ; Knee ; Lower Extremity ; Male ; Middle Aged ; Mouth Mucosa ; Mucous Membrane ; Muscles ; Palate ; Penicillins ; Scalp ; Sexually Transmitted Diseases ; Skin ; Tuberculosis, Pulmonary

A case of solitary painful glomus tumor occurring in a 36-year-old Korean rnale is reported. This tumor was a slightly elevated, bluish subcutaneous nodule about 1cm. in diameter on the left antecubital fossa. We performed a complete surgical excision of the nodule, which was histopathologically cnnfirmed as a typical solitary glomus tumor.
Adult ; Glomus Tumor* ; Humans

We reported a case of epidermodysplasia verruciformis which occurred in a 15 year-old girl. She had an extensive eruption of plane warts on the face, neck, upper trunk, and extremities, especially on the dorsa of the hands and feet, with symmetrical diatribution. The skin lesions appeared initially on the forehead and gradually generalized. all over the body for 10 years duration. Skin biopsy showed hyperkeratosis with basket-weave pattern, thickened granular layer, vacuolization of many celIs in the upper stratum malpighii and the granular layer and acanthosis.
Adolescent ; Biopsy ; Epidermodysplasia Verruciformis* ; Extremities ; Female ; Foot ; Forehead ; Hand ; Humans ; Neck ; Skin ; Warts

Pyoderma gangrenosum, as described by Brunsting and his aaaociates in 1930, is characterized by the rapid appearance of one or more bluish-black, boggy, undermined ulcers, most frequently on the legs of peraons with ulcerative colitis or rheumatoid arthritis. Its pathogenesis is often obscure. Present management of pyoderma gangrenosum consists of local treatment of the wound, systemic cortieosteroid therapy, and treatment of any underlying disease. In our 21 year-old male with pyoderma gangrenosum, hyperbaric oxygen therapy was performed. Treatment was given in the hyperbaric oxygen one-man chamber at 3.0 ATA for 30 minutes daily for 49 days. By 36 days, the ulcers on the face and neck was healed. Approximately one month after the patient was discharged, complete resolution of the 1esions on the back occurred.
Arthritis, Rheumatoid ; Colitis, Ulcerative ; Humans ; Hyperbaric Oxygenation* ; Leg ; Male ; Neck ; Oxygen ; Pyoderma Gangrenosum* ; Pyoderma* ; Ulcer ; Wounds and Injuries ; Young Adult

In one case of advanced systemic scleroderma hyperbaric oxygen therapy was performed. The treatrnent were given in an one-man pressure chamber (made in Korea) at a pressure of 2. 5 atmospheres absolute pressure (AT.A). The pressure was increased in 5-7 minutes, kept constant for 1.5 hours and lowered in 5--7 minutes. After 16 weeks of the treatment, regression of the skin contraction was achieved, together with improved mobility of the joints and healing of ulceration.
Atmosphere ; Hyperbaric Oxygenation* ; Joints ; Scleroderma, Systemic* ; Skin ; Ulcer