Ho-Soon Choi

Clinical Features of Chronic Pancreatitis in Korea: A Multicenter Nationwide Study

Background/Aims: No reliable nationwide clinical data about chronic pancreatitis (CP) was available in Korea. The etiology and clinical features of CP were investigated using a multicenter nationwide study. Methods: 814 cases of CP were enrolled retrospectively over the past 4 years at 13 hospitals. The following data were obtained from all patients: etiology, symptoms, complications, and surgery. Result: Alcohol (64.3%) was the major cause of CP and idiopathic CP (20.8%) was the second most common form. Mean patient age was 50.6 years and the male:female ratio was 6:1 (24:1 for alcoholic CP vs. 2:1 in idiopathic CP, p < 0.001). Diabetes (31.6%), pseudocysts (28.4%), biliary stricture (13.9%), and pancreatic ascites (6.6%) were the main complications. Of these, diabetes (35 vs. 26%) and pseudocyst (33.7 vs. 21.9%) were more frequent in alcoholic than in idiopathic CP. Pancreatic cancer developed in 25 patients (3.1%) during follow-up and their mean age was 59.1 years. Conclusions: In Korea, alcohol is the most common etiology of CP. Moreover, diabetes and pseudocysts are frequent complications, especially in alcoholic CP, and pancreatic cancer development is not infrequent.

Infarction of intestine with massive amyloid deposition in two patients on long-term hemodialysis

Two patients undergoing hemodialysis for 19 and 13 yr, respectively, developed intestinal infarction with extensive amyloid deposits in the muscle layer and blood vessels. In 1 patient the deposit reacted positively with antiserum to beta 2-microglobulin by immunohistochemical stain, and therefore was classified as beta 2-microglobulin in origin. The amyloid protein of the other patient remains unclassified. In patients with gastrointestinal symptoms who have been undergoing hemodialysis for long periods of time, amyloidosis of the intestine should be considered.

Metastatic meningioma. Hemangiopericytoma or angioblastic meningioma

The question of whether meningeal hemangiopericytoma is a variant of meningioma (“angioblastic meningioma”) or a nosologically distinct entity remains controversial. We present the case histories of an intracranial meningioma and of a meningeal hemangiopericytoma, both of which developed extracranial metastases. The metastatic lesions in both cases were studied by electron microscopy, which demonstrated pericytomatous differentiation in one instance and meningothelial differentiation in the other. This report supports the opinion that meningeal hemangiopericytomas and meningiomas of the CNS are distinct pathological entities.

Pancreatic choriocarcinoma presenting as inflammatory pseudocyst.

A primary pancreatic choriocarcinoma was discovered at surgery in a patient with a clinical diagnosis of pancreatic inflammatory pseudocyst. To our knowledge, this is the first example of an extragonadal choriocarcinoma reported as a primary at this site. We consider this neoplasm to be another example of a visceral choriocarcinoma arising from a primary carcinoma through a process of metaplasia. This case illustrates the inherent difficulties in the preoperative evaluation of cystic lesions of the pancreas, and the importance of recognizing endocrinologic manifestations of malignant disease.

Combination chemotherapy of heptaplatin, paclitaxel and 5-fluorouracil in patients with advanced gastric cancer: a pilot study.

PURPOSE To evaluate the efficacy and toxicity of heptaplatin, paclitaxel, and 5-fluorouracil combination chemotherapy in patients with advanced gastric cancer. MATERIALS AND METHODS Between July 2002 and September 2003, nineteen patients were enrolled in this study. Paclitaxel 135 mg/m(2) iv on day 1, heptaplatin 400 mg/m(2) iv on day 2 and 5-fluorouracil 800 mg/m(2) on day 2 approximately 4 were administered and the regimen was repeated every 3 weeks. RESULTS The median age of the patients was 60 years (range: 32 approximately 74) and the most common sites of metastasis were liver and lymph nodes. In the 16 evaluated patients, the overall response rate was 43.8%, but this was without any complete response. The median time to disease progression was 3.93 months (range: 0.26 approximately 8.1) and the median response duration for the 7 responding patients was 3.83 months (range: 1.48 approximately 6.07). The median overall survival for 19 patients was 7.01 months (range: 0.26 approximately 17.44). A median of 3 cycles (range: 1 approximately 7) and a total of 65 cycles were administered and evaluated for toxicity. The most common hematologic toxicities were NCI grade I/II anemia (47.7%), neutropenia (9.2%) and thrombocytopenia (6.2%). The most common non-hematologic toxicities more than grade II were nausea/vomiting (30.8%/9.2%). One elderly patient with ECOG 2 had a life-threatening complication of pneumonia. CONCLUSION The combination of heptaplatin, paclitaxel, and 5-fluorouracil showed significant activity and favorable toxicity profiles in patients with advanced gastric cancer. However, one elderly patient who had poor performance experienced a life-threatening toxicity/complication. Our results suggest that the efficacy of this combination chemotherapy can be maximized when administered to the patients with good performance status. Further studies with large numbers of patients and long-term follow-up study will be needed.

Endoscopic Treatment for Pain Relief in Chronic Pancreatitis: A Cross-Sectional Analysis by Korean Multicenter Study Group on Chronic Pancreatitis

Endoscopic Treatment for Pain Relief in Chronic Pancreatitis: A Cross-Sectional Analysis by Korean Multicenter Study Group on Chronic Pancreatitis Dong Wan Seo, Ho-Soon Choi, Dong Ki Lee, Jin Lee, Kyu Taek Lee, Woo Jin Lee, Jong Ho Moon, Young-Soo Moon, Ho Gak Kim, Jae Seon Kim, Tae Nyeun Kim, Myung Hwan Roh, Ji Kon Ryu, Byung Moo Yoo Background: Endoscopic treatment has become one of the treatment options for chronic pancreatitis. However, there are some groups of patients who are refractory to this treatment. It is not clear which subgroup could be benefited by pancreatic endotherapy. The purpose of this study is to analyze the result of endoscopic treatment of chronic pancreatitis in Korea and to identify a subgroup in which pancreatic endotherapy is helpful for the relief of pain. Method: From 14 different academic centers, 432 patients with chronic pancreatitis were screened and 137 patients who received endoscopic treatment were enrolled in this study. Using structured questionnaires, following data were collected: demographic data, response to pain medication, type of endoscopic treatment, and response to endoscopic treatment. Results: The patients were categorized into 3 different groups depending on their ductal pathology: ductal stones (23.4%), dominant strictures (46.8%), stones with strictures (29.8%). The types of endoscopic treatment were endoscopic pancreatic sphincterotomy(EPST) alone (10.5%), EPSTCstent placement(68.6%), or EPSTCstent placementCextracorporeal shock wave lithotripsy (ESWL)(20.9%). There was no significant difference in pain response rate according to the type of treatment. The diameter of stents, duration of pancreatic stenting and etiology of pancreatitis did not affect the response rate. However, the response rate was significantly lower in the patients with predominant ductal strictures (70.5%) than those in patients with stones (81.8%) or stones and stricures (85.7%) (p!0.05). Conclusions: Endoscopic treatment can be offered as a reasonable alternative to surgery for pain relief in chronic pancreatitis. However, careful patient selection seems to be important to improve the response rate, especially in patients with predominant strictures.

Prevalence and impact of upper gastrointestinal symptoms in Korean population-A population-based survey using ROME II criteria

Background & Aims: Various reports on the prevalence of gastroesophageal reflux disease (GERD) and functional dyspepsia have been conducted according to countries, survey methods and diagnosis criteria. However, detailed population-based data in Korea are lacking. The aim of this study was to determine the prevalence of upper gastrointestinal (GI) symptoms such as GERD and dyspeptic symptoms in Korea, as well as the impact of these symptoms on quality of life. Methods: The telephone survey, conducted by Galhip Korea, targeted a stratified probability random sample of the Republic of Korea. A reliable and valid questionnaire was asked about upper GI symptoms according to ROME II criteria, soeiodemographic association, physician visit and quality of life. In measuring quality of life, the Korean version o[ the EQ-SD, which underwent cross-cultural adaptation and validation, was used. Results: A total of 3,600 people were selected, and among them, 1,044 people responded to all questions. The response rate was 29%. 3.5% of the responders experienced heartburn more than twice a week, 3.4% once a week, 5.8% once a month, and 12.3% once in two momhs. And 2.6% of the responders experienced acid regurgitation more than twice a week, 1.9% once a week, 5.5% once a month, and 14.3% once in two months. A statistically significant difference was found in the quality of life according to the frequency of heartburn and acid regurgitation (p<0.001). As frequency of heartburn and acid regurgitation increased, quality of life significantly decreased. 12.2% of the respondents experienced abdominal discomfort and pain at least for three months during the past one year, and prevalence of functional dyspepsia based on the Rome II criteria was estimated 8.4% (95% confidence imerval, 6.710.1). Of the subjects presumed to have functional dyspepsia, dysmotility-like dyspepsia (56.8%) was the most common subtype, and 61.4% of subjects visit a clinic or hospital due to abdominal discomfort and pain. Quality of life did not show a significant difference between individuals presumed to have dyspepsia and individuals who do not manifest any symptom. Conclusions: This is the population-based survey on prevalence of upper GI symptoms such as GERD and dyspepsia in Korea. Upper GI symptoms are very prevalent in general Korean population. The most common subtype of functional dyspepsia was dysmotfiity-like type. As frequency of GERD symptoms increased, quality of life significantly decreased.