The Use of Pancreatic Exocrine Insufficiency-Questionnaire (PEI-Q) / 대한췌담도학회지

Chronic pancreatitis is a non-reversible, progressive inflammatory disease of the pancreas that is caused by repeated inflammation. It is characterized by morphological changes in the parenchyma and main pancreatic duct as pancreatic tissue is damaged and fibrosis progresses. These changes can lead to exocrine and endocrine dysfunction in patients with chronic pancreatitis, with major complications including pain, endocrine or exocrine insufficiency, and increased risk of pancreatic cancer. Of these, pancreatic exocrine insufficiency (PEI) is a state of malabsorption in which more than 15 g of fat is excreted per day. It can be diagnosed and assessed using several methods, but these methods are currently difficult to use in Korea and have low compliance, making them low utility. Recently, the PEI-questionnaire (PEI-Q) was developed to diagnose and assess patients’ exocrine insufficiency. It has been validated in foreign countries and has the potential to be used as a tool for diagnosing exocrine insufficiency with simple questions. This paper will review the diagnostic methods for existing exocrine insufficiency and the usefulness and utilization of the PEI-Q.

Recent Update of Targeted Therapy in Cholangiocarcinoma / 대한췌담도학회지

Cholangiocarcinoma (CCA) is one of the cancers with the worst prognosis. Its incidence and mortality have increased in recent years, but treatment options are limited. Although various clinical trials have been conducted, there is no effective therapeutic agent yet. As molecular genetic profiling is progressing in CCA, the interest in targeted therapies is growing. To realize targeted therapy in practice, various clinical requirements must be met. A molecular biological test should be performed on a patient’s tissue or blood, a target should be determined using an appropriate analysis method, and there should be a targeted agent. Regarding CCA, genetic variation occupies an intermediate level. Accordingly, many new agents have been recently developed for molecular biological targets. The most common genetic aberrations show almost similar patterns in intrahepatic and extrahepatic CCA. However, HER2 gene amplification is more often observed in extrahepatic CCA, and FGFR2 fusion, IDH1 mutation, and RAS-RAF-MEK-ERK signaling system mutations are more frequently found in intrahepatic CCA. Phase 2 or 3 clinical trials are being conducted with zanidatamab for HER2 amplification, pemigatinib/infigratinib for FGFR fusion, ivosidenib for IDH1 mutation, and dabrafenib for BRAFV600E mutation. In addition, clinical trials for agents targeting the NTRK, BRCA, and ARID1A gene mutations are ongoing. These targeted therapies are expected to have a bright future as a new treatment for CCA.

Treatment of Difficult Pancreatic Duct Strictures Using a Cystotome: A Single-Center Experience / 대한췌담도학회지

Background@#/Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is one of the useful treatment for treating diseases that cause pancreatic duct stenosis. However, if the stenosis is severe, accessories other than the guide wire cannot pass through. This makes the ERCP procedure difficult. At this time, cystotome, a type of diathermic dilator seems to be an option. In this paper, we would like to discuss the experience of treatment procedures using cystotome. @*Methods@#Patients who underwent ERCP at a single tertiary hospital from November 2019 to October 2022 were analyzed retrospectively. Among them, cystotome was used in eight procedures in seven patients who passed the guide wire but failed to pass the stenosis. @*Results@#Technical success was achieved in all eight times. All the balloon catheter smoothly passed through the stenosis after cystotome was performed. In the second ERCP, it was a functional success for the balloon catheter to pass through stenosis without further treatment. This was achieved in 6 out of 8 (75.0%). In the case of complications, only one of the total successful procedures developed mild pancreatitis, which led to additional hospitalization for about two days after the procedure, and improved after conservative treatment. @*Conclusions@#Based on this, cystotome seems to be a good option as an alternative treatment to severe stenosis of the pancreatic duct.

Hepatocellular carcinoma incidence is decreasing in Korea but increasing in the very elderly

Background/Aims@#A comprehensive analysis of trends in the incidence of hepatocellular carcinoma (HCC) is important for planning public health initiatives. We aimed to analyze the trends in HCC incidence in South Korea over 10 years and to predict the incidence for the year 2028. @*Methods@#Data from patients with newly diagnosed HCC between 2008 and 2018 were obtained from Korean National Health Insurance Service database. Age-standardized incidence rates (ASRs) were calculated to compare HCC incidence. A poisson regression model was used to predict the future incidence of HCC. @*Results@#The average crude incidence rate (CR) was 22.4 per 100,000 person-years, and the average ASR was 17.6 per 100,000 person-years between 2008 and 2018. The CR (from 23.9 to 21.2 per 100,000 person-years) and ASR (from 21.9 to 14.3 per 100,000 person-years) of HCC incidence decreased during the past ten years in all age groups, except in the elderly. The ASR of patients aged ≥80 years increased significantly (from 70.0 to 160.2/100,000 person-years; average annual percent change, +9.00%; P<0.001). The estimated CR (17.9 per 100,000 person-years) and ASR (9.7 per 100,000 person-years) of HCC incidence in 2028 was declined, but the number of HCC patients aged ≥80 years in 2028 will be quadruple greater than the number of HCC patients in 2008 (from 521 to 2,055), comprising 21.3% of all HCC patients in 2028. @*Conclusions@#The ASRs of HCC in Korea have gradually declined over the past 10 years, but the number, CR, and ASR are increasing in patients aged ≥80 years.

Endoscopic Ultrasound Images of Normal Anatomy of the Pancreas and Biliary Tree / 대한췌담도학회지

Since the development of endoscopic ultrasound (EUS), the importance in the using EUS in pancreas and biliary tree has gradually increased. In order to properly observe the pancreas and biliary tree in EUS, it is necessary to learn landmark structures at each location, such as the stomach and duodenum, and to learn the positional relationship between them and normal structures. In this article, we will deal with the examination method at each position of the linear and radial EUS and reveal the normal EUS image.

The Incidence and Care Cascade of the Hepatitis C Virus in Korea

Background/Aims@#The 2030 hepatitis C virus (HCV) elimination targets of the World Health Organization are an 80% reduction in incidence and 65% reduction in mortality compared to the 2015 rates. However, information on the nationwide incidence and treatment rates of HCV infection are limited. We aimed to investigate the nationwide incidence and status of the care cascade for HCV infection in Korea. @*Methods@#This study used data from the Korea Disease Control and Prevention Agency linked with the data of the Korea National Health Insurance Service. Linkage to care was defined as visiting hospitals twice or more due to HCV infection within 1.5 years of the index date. The treatment rate was the number who had been prescribed antiviral medication within 1.5 years from the index date out of patients newly diagnosed with HCV. @*Results@#The new HCV infection rate was 17.2 per 100,000 person-years (n=8,810) in 2019. The number of new HCV infections was the highest in patients aged 50 to 59 years (n=2,480), and the new HCV infection rate significantly increased with age (p<0.001). Among newly infected patients with HCV, the linkage to care rate was 78.2% (78.2% men, 78.2% women) and the treatment rate was 58.1% (56.8% men, 59.3% women) within 1.5 years. @*Conclusions@#The new HCV infection rate was 17.2 per 100,000 person-years in Korea. It is necessary to continuously monitor the incidence and care cascade of HCV to establish proper strategies to reach the goal of HCV elimination by 2030.

A Case Report of Thrombotic Thrombocytopenia After ChAdOx1 nCov-19 Vaccination and Heparin Use During Hemodialysis

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but life-threatening complication. VITT strongly mimics heparin-induced thrombocytopenia (HIT) and shares clinical features. Heparin is commonly used to prevent coagulation during hemodialysis.Therefore, nephrologists might encounter patients needing dialysis with a history of heparin exposure who developed thrombotic thrombocytopenia after vaccination. A 70-year-old male presented with acute kidney injury and altered mental status due to lithium intoxication. He needed consecutive hemodialysis using heparin. Deep vein thrombosis of left lower extremity and accompanying severe thrombocytopenia of 15,000/µL on 24 days after vaccination and at the same time, nine days after heparin use. Anti-platelet factor 4 antibody test was positive.Anticoagulation with apixaban and intravenous immunoglobulin (IVIG) infusion resolved swelling of his left calf and thrombocytopenia. There were no definitive diagnostic tools capable of differentiating between VITT and HIT in this patient. Although VITT and HIT share treatment with IVIG and non-heparin anticoagulation, distinguishing between VITT and HIT will make it possible to establish a follow-up vaccination plan in a person who has had a thrombocytopenic thrombotic event. Further research is needed to develop the tools to make a clear distinction between the clinical syndromes.

Spontaneous Resolution of a Relapsed Right Neck Mass due to Sternocleidomastoid Hypertrophy in a Congenital Muscular Torticollis Infant

There was an episode of complete recovery of congenital muscular torticollis presenting an ipsilateral neck mass due to the right sternocleidomastoid muscle (SCM) with other symptoms such as contralateral rotation of the head and restricted motion following initial physiotherapy for 6 months in a male infant. Physical examination and neck ultrasonography in the neonate clinic at 6 months revealed that his neck mass had disappeared, so therapy was discontinued. After 12 months of the episode, there was a reoccurrence of congenital muscular torticollis with the only symptom of ipsilateral neck mass and subsequently recovered without restricted motion. After 26 months of the reoccurrence, with no treatment except for 2 months of the second physiotherapy which was proven to be ineffective, spontaneous resolution of the right neck mass was demonstrated on serial ultrasound. Recovery of relapse SCM hypertrophy is extremely rare; therefore, we report the case. We suggest that the case may help clinicians diagnose and treating patients with the recovery of relapse SCM hypertrophy without complications.

Spontaneous Resolution of a Relapsed Right Neck Mass due to Sternocleidomastoid Hypertrophy in a Congenital Muscular Torticollis Infant

There was an episode of complete recovery of congenital muscular torticollis presenting an ipsilateral neck mass due to the right sternocleidomastoid muscle (SCM) with other symptoms such as contralateral rotation of the head and restricted motion following initial physiotherapy for 6 months in a male infant. Physical examination and neck ultrasonography in the neonate clinic at 6 months revealed that his neck mass had disappeared, so therapy was discontinued. After 12 months of the episode, there was a reoccurrence of congenital muscular torticollis with the only symptom of ipsilateral neck mass and subsequently recovered without restricted motion. After 26 months of the reoccurrence, with no treatment except for 2 months of the second physiotherapy which was proven to be ineffective, spontaneous resolution of the right neck mass was demonstrated on serial ultrasound. Recovery of relapse SCM hypertrophy is extremely rare; therefore, we report the case. We suggest that the case may help clinicians diagnose and treating patients with the recovery of relapse SCM hypertrophy without complications.

A Rare Case of Eosinophilic Gastroenteritis in a Neonate with Fever

Eosinophilic gastroenteritis is a member of eosinophilic gastrointestinal (GI) diseases and is characterized by the accumulation of eosinophils within the GI tract. Common symptoms of eosinophilic gastroenteritis are vomiting, abdominal pain, dysphagia, and weight loss, but rare fever in neonate. This report describes a 10-day-old boy who developed fever, bloody mucoid stool, and bilious vomiting resulting from eosinophilic gastroenteritis, mimicking sepsis. Sigmoidoscopy and pathologic findings revealed mucosal edema, small hemorrhagic spot, and segmental erythemoid edema in the colon and increased number of eosinophils in the lamina propria with intraepithelial eosinophils. After breast milk feeding with restriction of milk from the mother for 6 months, specific immunoglobulin to milk was class 0 (class 3, previous). The boy restarted formula feeding, and he had no fever and GI symptoms.

Peripapillary Granuloma with Optic Nerve Head Involvement Associated with Sarcoidosis

No abstract available.

A Case of Spontaneous Common Iliac Atery Dissection / 고신대학교의과대학학술지

Spontaneous and isolated dissection of the limb arteries without involvement of the aorta is extremely rare, and has been reported previously in pregnant patients in association with collagen vascular disease, and in cases of high-energy trauma or intensive activity in athletes. There is no consensus yet on indications for medical or surgical therapeutic modality. Due to the rarity of spontaneous dissection of external iliac artery, its natural history has been poorly described. A healthy 50-year-old male with normotension was admitted with an acute onset of left flank pain. Left external iliac artery dissection was diagnosed by abdominal computed tomography.

Risk of Stent Stenosis after Implanting a First-Generation Drug-Eluting Stent and Drug Balloon Angioplasty / 대한내과학회지

In patients with coronary artery disease, coronary stenting with a drug-eluting stent (DES) is associated with lower rates of in-stent restenosis and re-surgery for the target lesion compared with a bare metal stent, while late stent thrombosis has emerged as a life-threatening complication in patients treated with a first-generation DES. As no treatment has been established for potentially fatal late stent thrombosis associated with a first-generation DES, we perform drug balloon angioplasty for patients with stent thrombosis and in-stent restenosis associated with DES. Here, we reported the cases with normal coronary artery flow after a 2-year follow-up.

Rapid and Sensitive Detection of KRAS Mutation by Peptide Nucleic Acid-based Real-time PCR Clamping: A Comparison with Direct Sequencing between Fresh Tissue and Formalin-fixed and Paraffin Embedded Tissue of Colorectal Cancer

BACKGROUND: Rapid and sensitive detection of KRAS mutation is needed to maximize the benefits for patients who are being treated with monoclonal antibodies to target the epidermal growth factor receptor in colorectal cancer. The aim of this study is to evaluate the efficacy of the peptide nucleic acid clamp real-time PCR (PCqPCR) as compared to that of direct sequencing (DS) between using fresh colorectal cancer tissue and the matched formalin-fixed and paraffin-embedded (FFPE) colorectal cancer tissue. METHODS: The efficacy of PCqPCR was evaluated and compared with that of DS using fresh tissue and matched FFPE tissue from 30 cases of colorectal cancer. RESULTS: PCqPCR is more sensitive than DS for detecting KRAS mutation. PCqPCR detected 1% of mutants in 1 ng DNA. PCqPCR detected mutation in 1% of mutant cells, while DS barely detected, by manual reading, that in 20-50% of mutant cells. In the clinical samples, PCqPCR detected KRAS mutation in 60.0% while DS detected KRAS mutation in 53.3% of the colorectal cancers. The two methods showed a 100% concordance rate for detecting KRAS mutation between the fresh tissue and FFPE tissue. CONCLUSIONS: The PCqPCR method is efficiently applicable for the detection of KRAS mutation in a clinical setting.

Implementation of Single Source Based Hospital Information System for the Catholic Medical Center Affiliated Hospitals / 대한의료정보학회지

OBJECTIVES: The objective of this research is to introduce the unique approach of the Catholic Medical Center (CMC) integrate network hospitals with organizational and technical methodologies adopted for seamless implementation. METHODS: The Catholic Medical Center has developed a new hospital information system to connect network hospitals and adopted new information technology architecture which uses single source for multiple distributed hospital systems. RESULTS: The hospital information system of the CMC was developed to integrate network hospitals adopting new system development principles; one source, one route and one management. This information architecture has reduced the cost for system development and operation, and has enhanced the efficiency of the management process. CONCLUSIONS: Integrating network hospital through information system was not simple; it was much more complicated than single organization implementation. We are still looking for more efficient communication channel and decision making process, and also believe that our new system architecture will be able to improve CMC health care system and provide much better quality of health care service to patients and customers.

Polypoidal Choroidal Vasculopathy in Korean Patients with Large Submacular Hemorrhage

PURPOSE: To determine and compare the clinical characteristics, visual prognosis and treatment of hemorrhagic polypoidal choroidal vasculopathy (HPCV) with those of hemorrhagic choroidal neovascularization (HCNV) due to age-related macular degeneration (ARMD). MATERIALS AND METHODS: Retrospective analysis of 44 consecutive eyes with a submacular hemorrhage comprising more than 50% of the neovascular lesion. Patients were diagnosed as having HPCV or HCNV on the basis of indocyanine green angiography. RESUTLS: Of the 44 eyes with submacular hemorrhage, 26 were classified as HPCV and 18 as HCNV. The baseline patient characteristics were similar for both groups. At the final follow-up the HPCV group had 17 eyes showing visual improvement, four showing maintained vision, and five showing visual deterioration. In contrast, the HCNV group had four eyes showing visual improvement, one showing maintained vision, and 13 showing visual deterioration. Visual acuity of 0.05). CONCLUSION: PCV accounts for the largest proportion of submacular hemorrhage in Koreans. PCV showed a better visual prognosis than CNV.