Journal of Yeungnam Medical Science

Review

The roles of endoscopic ultrasound in the diagnosis of pancreatobiliary cancer.: Kook Hyun Kim; Yeungnam Univ J Med. 2016;33(2):77-84. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.77

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Abstract PDF: Pancreatic cancer, the 4th leading cause of cancer-related death in the United States, has a very poor prognosis. Cholangiocarcinoma originates from either intrahepatic or extrahepatic bile duct, and its incidence is gradually increasing worldwide. Endoscopic retrograde cholangiopancreatography with brush cytology has a high false-negative rate for the diagnosis of biliary malignancy. Recently, endoscopic ultrasonography (EUS) has emerged as the potential modality to detect pancreatic cancer. EUS-guided fine needle aspiration for cytologic analysis made it possible to overcome the obstacle in differentiating between benign and malignant lesions in the pancreatobiliary lesion, and it has been well established as a safe and effective procedure. Herein, the clinical application of EUS in the diagnosis of pancreatobiliary cancer was reviewed.

Case Reports

Massive barium sulfate aspiration during upper gastrointestinal contrast material study in an elderly patient with dysphagia.: Hae Ryong Yun, Chang Gon Kim, Jihye Park, Yong Eun Park, Yong Il lee, Byung Woo Yoo, Kyung Soo Chung, Young Sam Kim, Joo Han Song; Yeungnam Univ J Med. 2016;33(2):162-165. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.162

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Abstract PDF: Barium sulfate is an inert material used as a radiographic contrast medium during upper gastrointestinal contrast studies for evaluation of patients with dysphagia. Oral barium aspiration is an uncommon but well-reported complication of this procedure. While barium aspiration of small amounts may not cause any symptoms, massive barium aspiration can be life-threatening, particularly in elderly patients with multiple comorbidities. In this case report, we describe an elderly patient with multiple comorbidities who presented with thyrotoxicosis and dysphagia, and then died after massive barium aspiration. Despite administration of intensive medical care with ventilator support and therapeutic bronchoalveolar lavage to remove the aspirated barium, the patient died of multiple organ failure 9 days after barium aspiration. Clinicians should pay attention to elderly patients with predisposing factors for aspiration in whom upper gastrointestinal barium contrast studies are indicated, and should consider other diagnostic tools for evaluation of dysphagia in this population.

Aspiration Pneumonia after General Anesthesia Using Laryngeal Mask Airway: A case report.: Deok Hee Lee, Ki Ho Park; Yeungnam Univ J Med. 2004;21(1):127-131. Published online June 30, 2004; DOI: https://doi.org/10.12701/yujm.2004.21.1.127

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Abstract PDF: A laryngeal mask airway (LMA) has many advantages in the management of airway emergencies or the treatment of patients in whom intubation is difficult, but the use of LMA during positive ventilation may seem inappropriate to protect the airway because of the risk of pulmonary aspiration of regurgitated gastric contents. We experienced aspiration pneumonia after general anesthesia using LMA in patient who suffered from panperitonitis. It is considered that the main reason for aspiration pneumonia was a leakage of gastric content through the space surrounding the nasogastric tube while under high airway inflation pressure. We concluded that when LMA or the Proseal laryngeal mask airway (PLMA) is chosen for the use in difficult intubations, careful patient-suitability selection and the correct knowledge of LMA and PLMA are needed to protect the airway against aspiration.

Original Articles

Indication of Bone Marrow Aspiration in Acute Idiopathic Thrombocytopenic Purpura in Children.: Won Duck Kim, Jeong Ok Hah; Yeungnam Univ J Med. 2001;18(2):239-245. Published online December 31, 2001; DOI: https://doi.org/10.12701/yujm.2001.18.2.239

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Abstract PDF: BACKGROUND
Acute idiopathic thrombocytopenic purpura(ITP) is one of the common hematologic disorders in children. Bone marrow aspiration(BMA) is often performed in children with acute ITP to rule out leukemia, aplastic anemia or other hematologic diseases. However, whether BMA is needed in children with typical clinical and hematological features of acute ITP have been questioned. This study was performed to examine the proper indication of BMA in acute childhood ITP. MATERIALS AND METHODS: The medical records and BMA reports of children with the provisional diagnosis of acute ITP were reviewed from January 1984 to December 2000. Patients were divided into two groups, one with typical and another with atypical clinical and hematological features of acute ITP. Typical acute ITP group was characterized by the history of previous viral infection, well being appearance, no hepatosplenomegaly, no lymphadenopathy, normal Hb, WBC, neutrophil count and peripheral blood smear except thrombocytopenia. A platelet count of 50x109/L or lower was the cutoff level. RESULTS: Total 120 children with the provisional diagnosis of acute ITP were included. One hundred eighteen of them were confirmed to have acute ITP by BMAs. Of these, 66 had typical and 54 had atypical features. All of typical features and 52 of 54 with atypical features of acute ITP were confirmed to have acute ITP by BMAs. Two patients with atypical features of acute ITP were diagnosed as aplastic anemia and myelodyspalstic syndrome, respectively, by BMAs. CONCLUSION: This study concludes that BMA is not needed for the children with typical features of acute ITP but it is needed for the children with atypical features of acute ITP to rule out other hematologic disorders.

Analysis of the result and merit of computed tomography guided percutaneous needle aspiration biopsy of focal lung lesion.: You Song Chang, Kil Ho Cho, Woo Mock Byun, Mi Soo Hwang, Bok Hwan Prk; Yeungnam Univ J Med. 1993;10(1):127-134. Published online June 30, 1993; DOI: https://doi.org/10.12701/yujm.1993.10.1.127

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Abstract PDF: Percutaneous needle biopsy of pulmonary lesion with use of fluoroscopic guidance is well estabilished as a diagnostic tool but limited by the small size and inaccessibility of certain lesions. However, percutaneous needle biopsy'has been used increasingly in relation to advance and the salty of smaller biopsy needle and new imaging modalities such as ultrasound and CT. CT, because of its characteristics of high resolution, allows tissue sampling with considerable safty from area that heretofore could not be visualized under fluoroscopy. The authors summarized 44 pulmonary lesions that underwent CT-guided transthoracic biopsy with fine-needle over a 14 month period and analyzed the sensitivity of PTNB. -CT-guided PTNB was done with 20 gauge or 22 gauge Westcott biopoy needle (Mann medical products, USA). A diagnosis was made in 27 of 44 cases (61%) including malignany in 19 of 24 cases and benignancy in 8 of 20 cases. The pulmonary mass lesions were located at the peripheral zone of the lung field in 33 cases and at the central zone in 11 cases. Complications were observed in 2 cases which were pneumothorax and hemoptysis each but specific therapy was not required The sensitivity of PTNB by one session was 61% (27/44). The sensitivity of malignancy was 79% (19/24) and benignancy was 40% (8/20). These results suggest the usefulness of PTNB using fine needles be increased in eariler diagnosis and improved staging of pulmonary nodular lesions without significant complications.

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