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1.
Article de Coréen | WPRIM | ID: wpr-80214

RÉSUMÉ

Aortoenteric fistula (AEF) developed after treatment for an abdominal aortic aneurysm (AAA) is a rare but usually fatal complication. We report a rare case of AEF bleeding after endovascular stent grafting for AAA which was managed angiographically. An 81-year-old man presented with hematochezia and acute abdominal pain for 1 day ago. Four years ago, an aortic stent was implanted in the infrarenal aorta for AAA. Endoscopies were performed to evaluate the hematochezia. Evidence of gastrointestinal bleeding was observed, but a clear bleeding point was not detected on upper endoscopy and colonoscopy. Contrast-enhanced computed tomography performed subsequently showed that the bleeding point was located in the fourth portion of the duodenum as an AEF caused by an inflammatory process in the stent-graft. Intra-arterial angiography showed a massive contrast leakage into the bowel via a small fistula from around the aortic stent graft site. Embolization was successfully performed by injecting a mixture of glue and lipiodol into the AEF tract. The patient was discharged with no evidence of gastrointestinal bleeding after the embolization.


Sujet(s)
Sujet âgé de 80 ans ou plus , Humains , Mâle , Angiographie , Anévrysme de l'aorte abdominale/thérapie , Maladies de l'aorte/étiologie , Embolisation thérapeutique , Endoscopie gastrointestinale , Fistule/étiologie , Hémorragie gastro-intestinale/thérapie , Endoprothèses/effets indésirables , Tomodensitométrie
2.
Korean Journal of Medicine ; : 226-231, 2012.
Article de Coréen | WPRIM | ID: wpr-96838

RÉSUMÉ

Anaplastic carcinoma of the pancreas is an extremely rare but aggressive, rapidly progressive tumor. It often presents with invasion of adjacent organs and distant metastases. Most cases are inoperable and confirmed by autopsy. A correct diagnosis of stomach invasion by anaplastic carcinoma of the pancreas is important due to the risk of bleeding, perforation by rapid tumor growth, and a poor prognosis. However, an accurate diagnosis is difficult as a result of the various clinical presentations, symptoms, and radiological findings. We herein report a case of anaplastic carcinoma of the pancreas in a 78-year-old woman who presented with stomach invasion mimicking a gastrointestinal stromal tumor.


Sujet(s)
Sujet âgé , Femelle , Humains , Autopsie , Carcinomes , Tumeurs stromales gastro-intestinales , Hémorragie , Métastase tumorale , Pancréas , Pronostic , Estomac
3.
Article de Anglais | WPRIM | ID: wpr-184133

RÉSUMÉ

Primary ovarian lymphoma is a rare malignancy whose symptoms or signs are usually nonspecific. In this article, we report a very rare case initially presenting as a rectal submucosal-tumor-like lesion with a defecation disturbance caused by primary ovarian lymphoma with bilateral involvement. A 42-year-old woman visited chungnam national university hospital complaining of persistent defecation disturbance for 6 months. Colonoscopy demonstrated compression of the rectum by an extrinsic mass mimicking a rectal submucosal tumor. Magnetic resonance imaging detected bilateral ovarian tumors, 9.3 cm and 5.4 cm each in diameter, compressing the rectum without enlarged lymph nodes. The diagnosis was established following a bilateral adnexectomy and histological studies of the excised tissue. The tumor was classified as a diffuse large B-cell lymphoma. The patient was prescribed six cycles of standard CHOP (cyclophosphamide, hydroxydaunorubicin, vincristine, prednisolone) regimen and is presently on treatment.


Sujet(s)
Adulte , Femelle , Humains , Coloscopie , Défécation , Noeuds lymphatiques , Lymphomes , Lymphome B , Imagerie par résonance magnétique , Rectum , Vincristine
4.
Gut and Liver ; : 446-451, 2012.
Article de Anglais | WPRIM | ID: wpr-58004

RÉSUMÉ

BACKGROUND/AIMS: The rate of diagnosis of gastric adenoma has increased because esophagogastroduodenoscopy is being performed at an increasingly greater frequency. However, there are no treatment guidelines for low-grade dysplasia (LGD). To determine the appropriate treatment for LGD, we evaluated the risk factors associated with the categorical upgrade from LGD to high grade dysplasia (HGD)/early gastric cancer (EGC) and the risk factors for recurrence after endoscopic treatment. METHODS: We compared the complication rates, recurrence rates, and remnant lesions in 196 and 56 patients treated with endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR), respectively, by histologically confi rming low-grade gastric epithelial dysplasia. RESULTS: The en bloc resection rate was significantly lower in the EMR group (31.1%) compared with the ESD group (75.0%) (p1 cm with surface redness and depressions. CONCLUSIONS: For the treatment of LGD, EMR resulted in a higher incidence of uncertain resection margins and a lower en bloc resection rate than ESD. However, there was no signifi cant difference in recurrence rate.


Sujet(s)
Humains , Adénomes , Endoscopie digestive , Incidence , Prévalence , Récidive , Facteurs de risque , Tumeurs de l'estomac
5.
Article de Coréen | WPRIM | ID: wpr-175646

RÉSUMÉ

Schwannoma is a benign neoplasm of the Schwann cells of the neural sheath. Most schwannomas occur in the head and neck, and extremities and rarely in the retroperitoneal space. The differentiation of a schwannoma from other malignant tumor or benign tumor is very difficult on a preoperative examination with ultrasonography, computed tomography or magnetic resonance imaging. Furthermore, the lesion with increased fluorodeoxyglucose uptake in PET-CT cannot exclude malignant tumor. Therefore, this lesion needs surgical excision and a histological examination with immunohistochemical staining. We report a case of schwannoma occuring in the retroperitoneal space that incidentally discovered by PET-CT for health-check up. Pathologic confirmation by laparoscopic excision was done.


Sujet(s)
Sujet âgé , Humains , Mâle , Diagnostic différentiel , Fluorodésoxyglucose F18 , Neurinome/diagnostic , Tomographie par émission de positons , Tumeurs du rétropéritoine/diagnostic , Tomodensitométrie
6.
Article de Anglais | WPRIM | ID: wpr-35139

RÉSUMÉ

BACKGROUND/AIMS: This study was conducted to investigate the assessment of treatment efficacy of radiotherapy (RT) and other therapeutic modalities compared with palliative care only for treatment with advanced hepatocellular carcinoma (HCC). METHODS: From 2002 to 2010, based on the case of 47 patients with advanced HCC, we have investigated each patients' Child-Pugh's class, ECOG performance, serum level of alpha fetoprotein and other baseline characteristics that is considered to be predictive variables and values for prognosis of HCC. Out of overall patients, the 29 patients who had received RT were selected for one group and the 18 patients who had received only palliative care were classified for the other. The analysis in survival between the two groups was done to investigate the efficacy of RT. RESULTS: Under the analysis in survival, the mean survival time of total patients group was revealed between 30.1 months and 45.9 months in RT group, while it was 4.8 months in palliative care group, respectively. In the univariate analysis for overall patients, there were significant factors which affected survival rate like as follows: ECOG performance, Child-Pugh's class, the tumor size, the type of tumor, alpha fetoprotein, transarterial chemoembolization, and RT. The regressive analysis in multivariate Cox for total patients. No treatment under radiotherapy and high level of Child-Pugh's class grade were independent predictors of worse overall survival rate in patients. In contrast, for the subset analysis of the twenty-nine patients treated with radiotherapy, the higher serum level of alpha fetoprotein was an independent predictors of worse overall survival rate in patients. CONCLUSIONS: We found that the survival of patients with advanced HCC was better with radiotherapy than with palliative care. Therefore, radiotherapy could be a good option for in patients with advanced HCC.


Sujet(s)
Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Carcinome hépatocellulaire/mortalité , Chimioembolisation thérapeutique , Études de cohortes , Tumeurs du foie/mortalité , Soins palliatifs , Pronostic , Études rétrospectives , Indice de gravité de la maladie , Analyse de survie , Alphafoetoprotéines/analyse
7.
Korean Journal of Medicine ; : 578-582, 2011.
Article de Coréen | WPRIM | ID: wpr-68586

RÉSUMÉ

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin lesion) is rare multisystem disease of unknown cause with varying clinical manifestations. Although there is no established definition for this syndrome, the common classical features are considered to be secondary to the plasma cell dyscrasia with the production of a monoclonal component. Anasarca, including ascites, peripheral edema, and pleural effusion, occurs frequently in POEMS syndrome, but cases with idiopathic liver cirrhosis are rarely reported. We experienced a 73-year-old female with POEMS syndrome whose main problem was massive ascites. It is the first report of idiopathic liver cirrhosis in a patient with POEMS syndrome in Korea.


Sujet(s)
Sujet âgé , Femelle , Humains , Ascites , Oedème , Corée , Foie , Cirrhose du foie , Paraprotéinémies , Épanchement pleural , Syndrome POEMS , Peau
8.
Korean Journal of Medicine ; : 457-465, 2010.
Article de Coréen | WPRIM | ID: wpr-227581

RÉSUMÉ

BACKGROUND/AIMS: The aim of this study was to investigate the clinical features of acutely toxic hepatitis associated with ingesting Dictamnus dasycarpus (D. dasycarpus). METHODS: Between January 2004 and July 2009, 28 patients were enrolled in this study. We reviewed the medical records retrospectively. Acutely toxic hepatitis associated with D. dasycarpus was diagnosed by a Roussel Uclaf Causality Assessment Method Values (RUCAM) score of 6 or above. All patients were tested for viral hepatitis A, B, C, cytomegalovirus, and Epstein-Barr virus. Other tests included anti-nuclear antibody, anti-mitochondrial antibody, and anti-smooth muscle antibody. Abdominal pelvic computed tomography was performed. RESULTS: The incidence was female predominant (64% vs. 36%). The mean patient age was 53.0+/-11 years. The symptoms were jaundice (68%), fatigue (57%), nausea (43%), anorexia (43%), and abdominal pain (24%). The mean RUCAM score was 7.0+/-0.8. The biochemical patterns of hepatotoxicity were hepatocellular (n=23, 82%) and mixed types (n=5, 18%). Radiologic findings were as follows: normal findings (29%), lymphadenopathy (50%), edema of the gall bladder wall (46%), periportal edema (43%), splenomegaly (11%), fatty liver (11%), and ascites (7%). The mean hospitalization period was 21.6+/-11.6 days. The mean duration of recovery from hepatitis was 56.6+/-30.4 days, and all patients recovered completely from the toxic hepatitis. One patient who had severe jaundice developed a complication of pure red cell aplasia during the hospitalization period. CONCLUSIONS: The biochemical pattern of liver injury was hepatocellular predominant. Although the initial manifestations and clinical course were variable, all patients completely recovered with supportive care or steroid treatment. Toxic hepatitis was accompanied by pure red cell aplasia in one patient.


Sujet(s)
Femelle , Humains , Douleur abdominale , Anorexie , Ascites , Cytomegalovirus , Dictamnus , Lésions hépatiques dues aux substances , Oedème , Fatigue , Stéatose hépatique , Hépatite , Hépatite A , Herpèsvirus humain de type 4 , Hospitalisation , Incidence , Ictère , Foie , Maladies lymphatiques , Dossiers médicaux , Muscles , Nausée , Érythroblastopénie chronique acquise , Études rétrospectives , Splénomégalie , Vessie urinaire
9.
Korean Journal of Medicine ; : 194-201, 2008.
Article de Coréen | WPRIM | ID: wpr-209229

RÉSUMÉ

BACKGROUND/AIMS: To evaluate the effect and prognostic factors related to curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer. METHODS: The authors performed a retrospective analysis of 53 patients with extrahepatic bile duct cancer who were treated at Chungnam National University Hospital between 1998 and 2005. 18 patients (Group 1) were managed with percutaneous bile drainage (n=13) or endoscopic bile drainage (n=5), 17 patients (Group 2) underwent only curative resection, and 18 patients (Group 3) received radiotherapy after curative resection. The radio-sensitizer used in these patients was 5-FU. RESULTS: Three-year overall survival was 5.6% in group 1, 64.7% in group 2, and 61.1% in group 3, with no significant difference noted between group 2 and group 3. The disease-free survival rate was 64.7% in group 2 and 66.7% in group 3, with no significant difference noted between the two groups. We evaluated age, sex, differentiation, tumor location, perineural invasion, operative method, lymphovascular tumor emboli, T stage, and N stage as possible prognostic factors. T stage, N stage, and operative method were significant factors in group 2, but age was the only significant factor in group 3. Group 2 patients had longer overall survival than did group 3 patients with well-differentiated cancer, but group 3 patients had longer survival than did group 2 patients with lymph node metastasis. The recurrence rate was 34.3% (mean value) and was no different between group 2 and group 3. Recurrence sites included local tissue, such as liver, and regional lymph nodes. There were no serious complications during radiotherapy. CONCLUSIONS: Patients who underwent curative surgical resection and adjuvant radiotherapy after surgery had no statistically significant difference in survival or recurrent rates. However, curative surgery is considered to be the only method to improve survival. Our results suggest that radiotherapy after curative resection may improve survival in patients with lymph node metastasis.


Sujet(s)
Humains , Bile , Conduits biliaires extrahépatiques , Survie sans rechute , Drainage , Foie , Noeuds lymphatiques , Métastase tumorale , Radiothérapie adjuvante , Récidive , Études rétrospectives
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