Changes in Sonographic Findings after Treatment of Patients with Clonorchiasis in a Heavy Endemic Area

We measured changes in sonographic findings of patients with clonorchiasis after a treatment in a highly endemic area. A total of 347 residents showed positive stool results for Clonorchis sinensis eggs in a village in northeastern China, and were treated with praziquantel. Of them, 132 patients underwent abdominal sonography both before and 1 year after treatment, and the changes in sonographic findings of 83 cured subjects were compared. Diffuse dilatation of intrahepatic bile ducts (DDIHD) was found in 82 patients (98.2%) before and 80 (96.4%) after treatment, which was improved in 3, aggravated in 1, and unchanged in 79 patients. Increased periductal echogenicity (IPDE) was observed in 42 patients (50.6%) before and 45 (54.2%) after treatment, which was improved in 5, aggravated in 8, and unchanged in 70 patients. Floating echogenic foci in the gallbladder (FEFGB) was detected in 32 patients (38.6%) before and 17 (20.5%) after treatment, which was improved in 20, aggravated in 5, and unchanged in 58 patients. Improvement of FEFGB only was statistically significantly (P = 0.004). The present results confirm that DDIHD and IPDE persist but FEFGB decreases significantly at 1 year after treatment. In a heavy endemic area, the sonographic finding of FEFGB may suggest active clonorchiasis 1 year after treatment.

A case of epiphrenic diverticulum with solitary mediastinal tumor / 대한내과학회지

Epiphrenic diverticulum(traction type) is such a rare disease. The case of this disease which is due to mediastinal tumor, not because of inflammatory adhesion or of motor disorder is especially hard to find. The patient was a 50-year-old male and admitted with the intermittent postprandial chest discomfort. The chest CT and esophagography showed epiphrenic diverticulum(traction type). The tumor was located at the left anterolateral of thoracic spine, adhered to the right wall of esophagus. We performed the diverticulectomy and extirpation of mediastinal tumor under left posterolateral thoracotomy. The tumor and the esophagus were well seperated without invasion to the esophagus. In the pathology of resected tissues, solitary neurofibroma was diagnosed. There was no complication or recurrence after surgical resection.

Transjugular Liver Biopsy: The Adequacy and Safety / 대한내과학회지

OBJECTIVES: Liver biopsy is an essential tool to confirm suspected diagnosis and to guide specific therapy in patients with liver disease. But, the standard percutaneous needle biopsy is contraindicated in patients with coagulopathy and large amount of ascites. The transjugular approach has been developed for these problem cases, but its efficacy and safety has not been adequately tested in korea. METHODS: We retrospectively analysed 21 transjugular liver biopsy cases, and the success rate of procedure, the adequacy of obtained specimen for diagnosis and procedure related complications were reviewed. RESULTS: The major reasons for trasjugular liver biopsy were coagulopathy(71%) and massive ascites(19%). Liver tissue was obtained successfully in 20 of 21 cases. The mean number of specimens was 3.4+/-1.1 per case and the mean size of specimen was 1.8+/-0.7mm. Pathologists reviewed and judged as adequate for diagnosis in 13 cases(65%), helpful in 6 cases(30%), and inadequate in 1 case. Minor complications such as neck pain, hematoma at puncture site, or transient fever occurred in 5 cases (23.8%) but there was no major complication or procedure-related mortality. CONCLUSION: Transjugular liver biopsy is a safe and valuable technique that provides adequate diagnostic informations in about two thirds of patients for whom conventional percutaneous biopsy is contraindicated.

Clinicopathologic Comparison between Autoimmune Cholangitis and Primary Biliary Cirrhosis

Primary biliary cirrhosis (PBC) is characterized by histological findings of an immunoinflammatory destruction of small- and medium-sized bile ducts with progressive portal fibrosis, and the presence of anti-mitochondrial antibody (AMA) with a laboratory evidence of chronic cholestasis. The term "autoimmune cholangitis" (AIC) is used for a disease with the clinical and pathologic features of primary biliary cirrhosis (PBC) but with negative AMA and positive anti-nuclear antibody (ANA) tests. Eight cases of AIC and ten cases of PBC were reviewed in order to determine whether there was any difference between two diseases in clinico-pathologic aspects. All of the patients were female and the mean ages of AIC and PBC patients were 48 and 47 years, respectively. ANA test was positive in six of ten PBC paients and their mean titer was lower than that of AIC patients. IgM level was significantly higher in PBC group than in AIC group. No significant difference was found between two groups with respect to biochemical and histopathological features. Since the only consistently distinguishing features between these two conditions are the autoantibody profile (AMA vs ANA) and immunoglobulin level (IgM), these two conditions might be part of a spectrum. PBC can be considered to be the same as AMA-positive AIC or alternatively AIC to be the same as AMA-negative PBC.

Distribution of hepatitis C virus genotypes determined by line probe assay in Korean patients with chronic HCV infection / 대한간학회지

BACKGROUND/AIMS: The hepat it is C virus (HCV) genotypes have been shown to be differently distributed among distinct geographic areas and as sociated with different clinical present at ions. The aut hors investigated the distribution of HCV genotypes in Korean patients with chronic HCV infection and the as sociation of HCV genotypes with age, sex, severity of the liver disease, and the possible mode of transmission. METHODS: The study population consisted of 143 patients with chronic HCV infect ion: 13 with normal ALT , 78 with chronic hepatitis , 35 with cirrhosis , 17 with hepat ocellular car cinoma (HCC). HCV genotypes were determined by line probe assay. RESULTS: The principal HCV genotype was 1b ( 56%) and followed by 2a/ c ( 32%), mixed (8%), 2b ( 3%), and 1a (1%). Patients infected with type 1b and 2a/ c were older than those with ot her genotypes (p< 0.05). Genotype 1b tended to be more prevalent among patients with HCC ( 76% compared with 53% for patients with other liver diseases ; p=0.07). There was no significant relations hip bet ween genotypes and sex or mode of transmission. CONCLUSION: The most common HCV genotype in Korea was type 1b and followed by 2a/ 2c. Although patients infected with type 1b and 2a/c were older than those with other genotypes, there was no correlation between genotypes and sex, severity of liver disease, or mode of transmission.

The Clinical Characteristics of 16 Patients with Sphincter of Oddi Dyskinesia / 대한소화기내시경학회지

We evaluated the clinical characteristics of patients with SO dyskinesia(n=16) who were confirmed by ERCP manometry during past 5 years. They were 14 male and 2 female and mean age was 52-year-old(range, 32-75). According to the criteria suggested by Hogan and Geenen, 13 patients were classified into biliary type and 3 patients into pancreatic type. Among the patients with biliary type(n=13), 12 patients fulfilled the criteria for group II dysfunction of SO and 1 patient for group III. Among the patients with pancreatic type(n=3), all fulfilled the criteria for group II. The manometric abnormalities were increased basal pressure(n=4), tachyoddia(n=7), increased retrograde propagation(n=3), tachyoddia and increased retrograde propagation(n=l), and tachyoddia and increased basal pressure(n=l). As treatment, 12 patients received conventional endoscopic sphincterotomy and 3 patients received endoscopic pancreatic sphincterotomy in addition to conventional endoscopic sphincterotomy. Satisfactory results (complete absence or marked reduction of pain) were obtained in 13(87%) out of 15 patients by endoscopic treatment. In conclusion, SO dyskinesia is not so common disease and the detection of patients with SO dyskinesia may increase by frequent application of ERCP manometry.

A Case of Malignant Lymphoma with Cardiac Involvement at Initial Presentation

Lymphomatous involvement of the heart, occurring at initial diagnosis and presentation, is extremely rare. We report here a case of 58 year old man who presented with generalized edema, pericardial effusion, and a large right atrial mass detected by transesophageal echocardiography. There is no other evidence of disseminated lymphoma in this patient. Tumor removal and pulmonary embolectomy was done. Pathologically, the mass was malignant lymphoma, diffuse large cell type. Unfortunately, we have no chance to perform the intensive chemotherapy. The patient discharged in moribund state.

Three Cases of Anomalous Drainage of Common Bile Duct into the Duodenal Bulb / 대한소화기내시경학회지

Classic anatomical descriptions state that the common bile duct enters to the medial border of the second part of duodenum. Isolated case reports of the common bile duct in other sites, including the fourth part of duodenum, the pyloric canal, stomach, and the duodenal bulb, have appeared in the literature. We report three cases of anomalous drainage of the common bile duct into duodenal bulb, which caused recurrent cholangitis and peptic ulcer. All patients required choledochoenteric anastomosis to relieve their syrnptoms.

A case of giant hemangioma of the liver presenting with fever of unknown origin

A 37 year-old-woman was admitted to the hospital because of 15 days' duration of continuous fever. Routine studies for detection of fever foci were negative. Imaging studies revealed giant hemangioma of the liver with central thrombosis. The fever persisted for a period of 4 weeks, and subsided after conservative management. We report a case of hepatic hemangioma presenting with fever of unknown origin. The condition is very rare, but should be regarded as one of the causes of fever of unknown origin.

Vasospastic Angina with Clinical Presentation of Unstable Angina in Korea:Prospective Study with Ergonovine Echocardiography

BACKGROUND: Two dimensional echocardiographic monitoring of left ventricular resional wall motion abnormalities(RWMA) with incremental injection of ergonovine up to 350microg(ErgEcho) is useful for a noninvasive diagnosis of coronary vasospasm(CVS). The prevalence that CVS may evoke unstable angina(UA). However, this theory has not been the subject of any systematic analysis to date. This prospective study was carried out on patients who had been tentatively diagnosed as having UA when they were carried out on patients who has been tentatively diagnosed as having UA when they were admitted to the coronary care unit due to chest pain. The aim was to determine the significance of CVS in the clinical spectrum of UA and the value of Erg Echo when applied to this situation. METHODS: With antianginal medications a diagnostic coronary angiography was done to rule out significant fixed athrosclerotic disease(FD), with more than 70% narrowing of luminal diameter. In patients with normal coronary angiograms of insignificant FD. Erg Echo was performed to diagnose CVS after the discontinuation of all antianginal medications. All patients with postinfarction or secondary angina were excluded in this study. RESULTS: Of 191 patients(135 males, 57+/-9 yrs) enrolled from Mar 1992 to June 1993,71%(135/191) showed significant FD in the angiography. CVS was documented in 18%(34/191) using Erg Echo with mean injected ergonovine dosage of 125+/-89microg. In patients with CVS only 24%(8/34) had mild fixed lesion in the angiography with mean luminal narrowing of 60%(+/-12%). RWMA in the territory of left anterior descending artery was the most common(70%, 24/34). Other causes of chest were esophageal spasm in 3 patient(1%, 3/191) and hypertrophic cardiomyopathy in 2 patients, and 17 patients were diagnosed as having chest pain of unkwnon etiology. One of them redeveloped chest pain 2 months later. when repeated Erg Echo revealed RWMA. Others were symptom free during the follow-up(8+/-4 months) and there were no cardiac events. CONCLUSION: Our data suggest that in patients presenting UA in Korea, CVA is the main cause of myocardial ischemia in considerable number of patient, and Erg Echo after the angiography is useful and safe for noninvasive diagnosis of CVS in this situation.

Vasospastic Angina with Clinical Presentation of Unstable Angina in Korea:Prospective Study with Ergonovine Echocardiography

BACKGROUND: Two dimensional echocardiographic monitoring of left ventricular resional wall motion abnormalities(RWMA) with incremental injection of ergonovine up to 350microg(ErgEcho) is useful for a noninvasive diagnosis of coronary vasospasm(CVS). The prevalence that CVS may evoke unstable angina(UA). However, this theory has not been the subject of any systematic analysis to date. This prospective study was carried out on patients who had been tentatively diagnosed as having UA when they were carried out on patients who has been tentatively diagnosed as having UA when they were admitted to the coronary care unit due to chest pain. The aim was to determine the significance of CVS in the clinical spectrum of UA and the value of Erg Echo when applied to this situation. METHODS: With antianginal medications a diagnostic coronary angiography was done to rule out significant fixed athrosclerotic disease(FD), with more than 70% narrowing of luminal diameter. In patients with normal coronary angiograms of insignificant FD. Erg Echo was performed to diagnose CVS after the discontinuation of all antianginal medications. All patients with postinfarction or secondary angina were excluded in this study. RESULTS: Of 191 patients(135 males, 57+/-9 yrs) enrolled from Mar 1992 to June 1993,71%(135/191) showed significant FD in the angiography. CVS was documented in 18%(34/191) using Erg Echo with mean injected ergonovine dosage of 125+/-89microg. In patients with CVS only 24%(8/34) had mild fixed lesion in the angiography with mean luminal narrowing of 60%(+/-12%). RWMA in the territory of left anterior descending artery was the most common(70%, 24/34). Other causes of chest were esophageal spasm in 3 patient(1%, 3/191) and hypertrophic cardiomyopathy in 2 patients, and 17 patients were diagnosed as having chest pain of unkwnon etiology. One of them redeveloped chest pain 2 months later. when repeated Erg Echo revealed RWMA. Others were symptom free during the follow-up(8+/-4 months) and there were no cardiac events. CONCLUSION: Our data suggest that in patients presenting UA in Korea, CVA is the main cause of myocardial ischemia in considerable number of patient, and Erg Echo after the angiography is useful and safe for noninvasive diagnosis of CVS in this situation.