A Case of Right Diaphragmatic Hernia of Sigmoid Colon Showed by Colonoscopy / 대한소화기내시경학회지

A 53-year-old man complained of constipation and abdominal pain including the right flank area for three days. He had suffered multiple rib and clavicular fractures on the right side 10 years earlier. Colonoscopy was performed to assess the constipation, which showed a twisted constricted lumen in the sigmoid colon or descending colon. Passing through it, the saccular dilated bowel wall demonstrated edematous, erythematous changes in the mucosa with a purplish color and necrosis. The proximal part of the saccular lumen also showed a twisted stricture with necrotic materials. The abdominal CT showed subsegmental atelectasis in the right lung, right pleural effusion and a diaphragmatic hernia of the colon. In addition, multiple dilated bowel loops were observed in the abdomen. The patient underwent emergency surgery with a segmental resection of the sigmoid colon. We report this case of delayed traumatic right diaphragmatic hernia of the sigmoid colon with strangulation, which is extremely rare and was revealed by colonoscopy.

Endoscopic Ultrasonograpic Findings of Benign Mediastinal and Abdominal Lymphadenopathy Confirmed by EUS-guided Fine Needle Aspiration

BACKGROUND/AIMS: Distinguishing benign and malignant lymph nodes by the findings of endoscopic ultrasonography (EUS) is still controversial. We tried to evaluate EUS findings of benign mediastinal and abdominal lymphadenopathy (BLAP) confirmed by EUS-guided fine needle aspiration (FNA). METHODS: A total of 37 patients with enlarged mediastinal or abdominal lymph nodes (diameter > or =1 cm) were enrolled and EUS-FNA was performed. Final diagnosis was based on FNA cytology and follow up imaging studies (CT scans or EUS). RESULTS: Thirteen patients were confirmed to have BLAP by EUS-FNA. Causes of BLAP were as follows; (i) extrapulmonary tuberculosis in six cases including patients with postoperative states due to cervical cancer and advanced gastric cancer, (ii) Kikuchi disease in one case, (iii) hypereosinophilic syndrome in one case, (iv) reactive hyperplasia in five cases including patients with postoperative states due to thyroid cancer, lung cancer, and EGC with ESD. EUS findings of BLAP revealed that median lymph node size was 24.7 mm. Lymph nodes were oval or round shaped in 9 cases, sharp borders in 9 cases, hypoechoic echo pattern in 7 cases, heterogenous internal echo pattern in 7 cases. Other findings included internal septation, calcification, multiplicity, attachment to the gastrointestinal tract wall, and conglomeration. CONCLUSIONS: EUS findings of BLAP were not different from those of malignant lymphadenopathy previously reported in other studies.

Endoscopic Features of Ectopic Gastric Mucosa in the Duodenum / 대한소화기내시경학회지

BACKGROUND/AIMS: The origin of gastric mucosa outside of the stomach may be developmental (heterotopic gastric mucosa) or acquired (gastric metaplasia). The aim of this study was to evaluate the endoscopic features, according to the subtypes, of the gastric mucosa outside the stomach in the duodenum. METHODS: A total of 30 consecutive patients who underwent esophagogastroduodenoscopy from January 2002 to August 2004 and who were confirmed histopathologically as having gastric mucosa outside the stomach were retrospectively analyzed. Twenty three patients were males and seven were females. RESULTS: Nine patients had heterotopic gastric mucosa and 21 patients had gastric metaplasia. Seven patients with heterotopic gastric mucosa were asymptomatic and 2 patients had dyspepsia, whereas 21 patients with gastric metaplasia had dyspepsia. The dyspepsia rate showed a significant difference between the two groups (p<0.001). Endoscopically, the appearance of the heterotopic gastric mucosa tended to resemble area gastricae (p=0.08). However, there were no statistically differences between the two groups for the endoscopic features of the duodenum. Other abnormal lesions in stomach and duodenum appeared more frequently in the gastric metaplasia than in the heterotopic gastric mucosa (p=0.004, p<0.001). There was no difference in the prevalence of Helicobacter pylori infection between the two groups. CONCLUSIONS: There are no specific endoscopic findings to differentiate heterotopic gastric mucosa from gastric metaplasia. The presence of symptoms and the associated gastroduodenal inflammatory lesions were more prominent in the gastric metaplasia compared with the heterotopic gastric mucosa.

A Case of Complete Regression of Hepatocellular Carcinoma during Administration of COX-2 Inhibitor / 대한간학회지

Overexpression of cyclooxygenase-2 (COX-2) has been associated with hepatocarcinogenesis. Inhibitors of COX-2 have proapoptotic and antiproliferative effects on malignant tumors and inhibit tumor invasion to the surrounding tissues. We report here a case of complete regression of advanced hepatocellular carcinoma (HCC) during COX-2 inhibitor administration. An eighty-year-old female was diagnosed as an advanced HCC, which was associated with HCV infection. She received COX-2 inhibitor for 3 months due to degenerative arthritis of both knees. Tumor enhancement on arterial phase CT completely disappeared without specific treatment for the HCC, and the tumor size decreased on the follow-up CT scan.

A Case of Adenocarcinoma Arising in Hyperplastic Polyp in the Stomach / 대한소화기내시경학회지

Epithelial gastric polyps can be categorized as hyperplastic or adenomatous polyps. Hyperplastic polyps are predominant, comprising 75 to 90% of gastric polyps. It has been generally accepted that adenomatous gastric polyps exhibit malignant change. However, potential of malignant transformation of hyperplastic gastric polyps was originally denied and have been rarely reported, the incidence varying from 1.5 to 2.1%. The size and the associated dysplasia of polyps seem to be important in transformation to gastric carcinoma. Most of the reported cases of hyperplastic gastric polyps with transformation to adenocarcinoma were histopathologically well differentiated. We report a rare case of moderately differentiated adenocarcinoma arising in a hyperplastic polyp on the greater curvature of the midbody in the stomach with a brief review of the literatures.

Cytochrome P450 2E1 activity in a Korean population

Cytochrome P450 2E1 (CYP2E1) is involved in the toxicity and carcinogenicity of a number of solvents and xenobiotics. Like the various types of oxidation pharmacogenetics, the activity of the enzyme shows a discernible interindividual and interethnic variation. However, no pharmacogenetic information on CYP2E1 polymorphism has been available from a Korean population. The aim of this study was to explore the pharmacogenetics of CYP2E1 polymorphism in a native Koreans after an oral 400 mg dose of chlorzoxazone administered to 128 subjects. Urine samples were collected during the subsequent 8-hour period and urinary concentrations of chlorzoxazone and 6-hydroxychlorzoxazone were determined by a high performance liquid chromatography with an ultraviolet detector. The limit of detection in the samples was found to be 0.5 mug/ml. The mean value of the 6-hydroxychlorzoxazone excreted in 8 hr urine expressed as the percentage was 48.2 13.8%. The frequency distribution of percentage of the administered dose excreted as the 6-hydroxy metabolite was unimodally distributed in the subjects studied. However, the values showed wide (7-fold) interindividual difference, ranged from 11.6% to 79.8% of the dose of chlorzoxazone. Thus, it was considered that the pharmacogenetic characteristics of CYP2E1 in a Korean population did not-represent multimodal distribution in the 6-hydroxychlorzoxazone excreted in 8-hr urine expressed as the percentage. And the activity of the CYP2E1 in a Korean population seemed to be less compared with that of the Caucasian subjects.