Chang-Duck Kim

7180 Incomplete pancreas divisum: is it merely a normal anatomic variant without clinical implication?

Background and Study Aims: Incomplete pancreas divisum (PD) has been generallyregarded as a mere normal anatomic variant without clinical implication. In thisstudy, we compared the prevalence, symptom occurrence rate, clinical presentationand the response to the endoscopic treatment of incomplete PD with those of completePD. Patients and Methods: The study population consisted of 56 (1.25%)patients (complete PD: 27, incomplete PD: 29) of 4,473 new ERCPs. Twenty-fivesymptomatic patients with pancreas divisum, which was suspected to be a cause ofassociated pancreatic diseases (acute recurrent pancreatitis;ARP, chronic pancreatitis; CP, and pancreatic type pain; PP), underwent endoscopic treatment (minor papillasphincterortomy with stents or nasopancreatic drainage tube insertion). Mean follow- up period was 17 months (range 9 to 49 months). Results: In twelve (44%) of 27patients with complete PD, it was suspected that PD was a cause of associated pancreaticdisease:ARP;6 (6/27, 22%),CP;5 (5/27, 18%), PP 1 (1/27, 4%).Ten of 12 symptomaticcomplete PD patients underwent successful endoscopic treatment and seven(70%) of 10 patients benefited from endoscopic treatment. In fourteen (48%) of 29patients with incomplete PD, it was suspected that pancreas divisum was a cause ofassociated pancreatic disease:ARP; 8 (8/29, 28%), CP: 5 (5/29, 17%), PP: 1 (1/29 3%). Thirteen of 14 symptomatic incomplete patients underwent successful endoscopic treatment and eight (62%) of 13 patients had a clinical improvement. Conclusions: The prevalence, symptom occurrence rate, clinical presentation and response to endoscopic treatment were similar between the patients with complete PD and with incomplete PD.Incomplete PD,therefore,may have same clinical implication as complete PD.

Effects of Levosulpiride in Patients with Functional Dyspepsia Accompanied by Delayed Gastric Emptying

Objectives Levosulpiride is the levo-enantiomer of sulpiride, a well-known antiemetic, antidyspeptic and antipsychotic drug. This study was undertaken to investigate the effects of levosulpiride on dyspeptic symptoms and gastric motor function in a group of patients with functional dyspepsia showing delayed gastric emptying. Method Forty two eligible patients were entered into a 3 week, double-blind randomized comparison of 25mg of levosulpiride or placebo t.i.d.. Symptom assessment and gastric scintigraphy following the intake of scrambled egg sandwich, were performed in each patient before and after treatment. Results The improvement of symptom score in levosulpiride group was higher than the placebo group (p<0.05). We assessed global efficacy, which was excellent in 1 (6%), good 11 (65%), fair 4 (24%), nil 1 (6%) of those receiving levosulpiride, and fair 9(60%), nil 5 (33%), poor 1 (6%) of those receiving placebo. Levosulpiride tended to be more effective than placebo in relieving the dyspeptic symptoms especially in the subgroups of dysmotility-like (p<0.05) and nonspecific (p<0.05) as compared to other subgroups (p=0.16). The reduction of gastric emptying time after levosulpiride treatment was more marked than Placebo group (p<0.05). We found a significant correlation between changes of symptom score and gastric emptying time (r=0.47, p=0.01. No serious adverse effects were reported after administration of either levosulpiride or placebo. Only two patients reported mild somnolence during levosulpiride administration. Conclusions Levosulpiride is effective and well tolerated in patients with functional dyspepsia accompanied by delayed gastric emptying. Its efficacy may be related to its action on the gastric motor function by improving the delayed gastric emptying.

Potentiation of cholecystokinin and secretin-induced pancreatic exocrine secretion by endogenous insulin in humans.

To investigate the effects of endogenous insulin on pancreatic exocrine secretion in humans, we evaluated the pure pancreatic juice obtained by endoscopic cannulation of the main pancreatic duct in 21 healthy subjects (14 men and seven women). Samples of pancreatic juices were collected after intravenous injection of either glucose (50%, 40 ml), secretin (0.25 CU/kg), and cholecystokinin-8 (CCK) (40 ng/kg), or a combination of glucose, secretin, and CCK in six 5-min periods. The responses of plasma glucose, insulin, and C-peptide to intravenous administration of glucose were measured. After infusion of glucose, the plasma insulin and C-peptide levels were significantly increased and remained at high levels during 30-min experiments, intravenous administration of secretin and CCK resulted in significant increases of pancreatic secretion including volume, bicarbonate, and protein output. When glucose was simultaneously administered with secretin and CCK, pancreatic secretion was significantly increased, more than the effects achieved by the secretin and CCK. However, glucose alone did not increase basal pancreatic secretion. These observations suggest that endogenous insulin intensifies pancreatic secretion stimulated by secretin and CCK in humans.

Atypical epidermoid cyst containing multiple nail plates at a finger amputation stump.

Fingertip injury is the most common problem in upper extremity trauma (Panattoni et al., 2015). The multiple treatment options are a source of great controversy, and there are also many complications after treatment. Among the complications associated with fingertip injury, cyst formation at the fingertip is rare but some different cases have been reported based on the histopathological findings (Bukhari and Al-Mugharbel, 2004). We report an atypical epidermoid cyst containing multiple nail plates at a finger amputation stump. A 53-year-old male patient presented with a painful mass on the dorsum of the amputated stump of the right ring finger. The patient had a past history of several operations after traumatic amputation of the ring finger 23 years previously, including a tubular groin flap that was applied to cover the fingertip. At the tip of the stump, there was no visible nail, but a 2 × 2 cm tender hard mass was palpated. On radiographs there was a rounded mass containing many amorphous radiopaque shadows. Further images showed a round, thick cystic wall containing multiple, radiopaque, and irregular-shaped rectangular masses. At operation there was a thick walled cyst with many dark, yellow, rectangular fragments with a rubbery hard consistency. Histopathology revealed a stratified,

4718 Clinical studies of 13c-urea breath test in korea.

Backgrounds/Aims: 13C-urea breath test(UBT) has been an useful test for the diagnosis of H. pylori infection. However, the results of UBT were variable according to country, age, race and test methods such as feeding, sampling time, and test meal. The aim of study was to improve standardization of UBT in Korea by determining the cut-off value for the initial diagnosis of H. pylori infection and evaluating the effect of meal and the timing of breath sample collection. Materials and Methods: Two different studies were performed. First, 159 patients with dyspepsia were studied by means of endoscopy, histology(H-E and Giemsa stain), anti- H.pylori IgG ELISA and UBT. UBT was performed with HelikitTM(pre-mixed with 75 mg of 13C-urea and 750 mg of citrate) and isotope-ratio mass spectrometer (IRMS). H. pylori infection was established when histology was positive or more than two of the tests positive. Cut-off value was analyzed. Second, 25 healthy volunteers, for whom the results on H. pylori both by histology and fasting UBT were concordant, were enrolled. Fasting UBT were done after 4-hour fast and nonfasting UBT within 1 hour after square meal respectively on the same subjects at a week interval. The breath sample collected just before and at 5,10,15,20,25,30 minutes after Helikit TM ingestion. Results: Optimal cut-off value was 3. 8 per mili with sensitivity of 94.7% and specificity of 100% by receiver operating characteristic (ROC) curve analysis. At second study, δ 13 CO 2 was significantly decreased at nonfasting state than fasting, but nonfasting did not interfere with the results in H. pylori infected subjects. One subject with H. pylori infected showed false negative at 5 minutes. In H. pylori negative subjects, test results were not influenced by nonfasting and no early peak of δ 13 CO 2 within 10 minutes was found. Conclusion: 13C-UBT in Korea can be simplified using 10- minute breath samples and a cutoff of 3.8 per mili under the conditions of 75 mg of 13C-urea,citric acid,IRMS,initial diagnosis and adults. Furthermore, nonfasting state does not alter the accuracy of the test, making the test more profitable.

4497 Cyclooxygenase-2 expression in colorectal polyp.

Backgrounds/Aim:Recent studies have shown that cyclooxygenase(COX)-2 involves in the tumorigenesis in colorectal neoplasia. However, the timing of COX-2 expression during adenoma-carcinoma sequence is not completely established. The aim of this study was to evaluate COX-2 expression in colorectal polyp according to histologic type. Materials and Methods:52 patients with colorectal polyp from endoscopic polypectomy or surgical resection were enrolled. Polyps were divided histologically as follows;12 hyperplastic polyps(HP), 13 adenomas with low grade dysplasia(LGD), 12 adenomas with high grade dysplasia(HGD) and 15 malignant polyps(MP, carcinoma arising from adenoma). They were stained for COX-2 by avidinbiotin immunohistochemical technique using polyclonal IgG antibody. The intensity and extent of staining were semi-quantitatively accessed by two pathologists, blinded to outcome. Results:COX-2 was stained in varying intensity in tumor cells of 7 per 12 HGDs and 11 per 15 MPs, though was not in those of all LGDs and HPs. Percentage of COX-2 expression in tumor epithelial cells was 20 to 40% in 6 HGDs and above 50% in 10 MPs. Strong COX-2 staining was also observed in stromal components such as mononuclear cells, endothelial cells of all adenomas and carcinomas. Conclusion: The frequency and intensity of COX-2 expression was increased in both adenoma with high grade dysplasia and carcinoma. These results suggest that up-regulation of COX-2 has an important role in tumor progression from the late stage of colorectal adenoma.