Jejunocolic Fistula Associated with an Intestinal T Cell Lymphoma

Malignant fistula of the small bowel to the colon is rare and is most often due to adenocarcinoma. Small bowel lymphoma is unusual, representing less than 1 percent of all gastrointestinal malignancies. We report a case of intestinal lymphoma presenting with diarrhea and abdominal pain. A jejunocolic fistula was discovered during colonoscopy. Celiotomy revealed a large, ulcerated fistula tract between the jejunum and distal transverse colon, and pathology was consistent with peripheral T-cell lymphoma. This is a rare entity in a nonimmunocompromised individual and has not been previously described in Korea.

Extensive Gastric Mucosal Laceration During Endoscopic Examination / 대한소화기내시경학회지

Gastric mucosal lacerations occurring during the course of upper gastroduodenal endoscopy are apparently rare. The location and extent of the lesion are little different from the usual one found in the Mallory-Weiss tear. But the pathogenesis of the gastric mucosal tear is similar to that of Mallory-Weiss tear. Hiatal hernia, atrophic gastritis, and old age are predisposing factors for Mallory-Weiss tear. There is currently only one report about extensive gastric mucosal laceration during performance of endoscopy in an elderly patient. During a standard diagnostic endoscopic procedure, we experienced extensive gastric mucosal laceration that ranged from the gastroesophageal junction to the gastric angle in an elderly woman Furthermore, her body surface area and stomach size were very small. The patient was treated successfully with hemoclip application for the laceration. We report on the case along with a review of the relevant literature.

Relationships between serum osteoprotegerin levels and insulin resistance, cardiovascular risk factors and bone metabolism in type 2 diabetic patients / 대한내과학회지

BACKGROUND: Osteoprotegerin (OPG) is a soluble glycoprotein which inhibits osteoclastogenesis through binding to receptor activator of nuclear factor-kappaB ligand (RANKL). OPG-knockout mice develop early-onset osteoporosis and arterial calcification. Recent studies report that serum OPG levels are elevated in diabetic patients with cardiovascular disease and are associated with the presence and severity of coronary artery disease. We examined the relationships between serum OPG levels and insulin resistance, bone metabolism and cardiovascular risk factors in diabetic patients. METHODS: In 84 diabetic patients (33 men, 51 women, mean age 56.7 years old) were studied. Blood pressure, body mass index (BMI), fasting blood glucose, postprandial 2-hour blood glucose, fasting insulin and lipid profiles were measured. Serum OPG levels were measured with sandwich ELISA method. Bone mineral density (BMD)s were checked and serum osteocalcin and urine deoxypyridinoline levels were checked as bone turnover markers. 24-hour urine microalbumin were checked and left ventricular mass index (LVMI) were evaluated with echocardiography. From simple chest X-ray, the presence of aortic calcification were confirmed by a trained radiologist. Homeostatic model assessment (HOMA)-insulin resistance (IR), quantitative insulin sensitivity check index (QUICKI) were calculated as insulin resistance indices. RESULTS: Serum OPG levels were positively correlated with age, LVMI, HOMA and negatively correlated with lumbar spine BMD and QUICKI. After adjustment for age, only LVMI showed persistent correlation with serum OPG levels and when multiple regression analysis was performed with LVMI as the dependent variable, BMI and OPG were the significant predictors of LVMI (R2=0.054, p=0.012). Dividing the subjects into 3 groups according to 24-hour urine microalbumin levels, mean values for serum OPG levels increased as 24-hours urine microalbumin levels increased, but without statistical significance. Mean serum OPG levels were higher in patients with aortic calcification, without statistical significance. CONCLUSION: Serum OPG levels were positively correlated with insulin resistance indices and negatively correlated with lumbar spine BMD in diabetic patients, suggesting a compensatory mechanism to counteract bone loss progression. Serum OPG levels were independent predictor for LVMI in diabetic patients, warranting further research on OPG as the marker for future cardiovascular mortality in diabetic patients.

Comparison of insulin resistance and serum hsCRP levels according to the fasting blood glucose and blood pressure in nondiabetic and normotensive range / 대한내과학회지

BACKGROUND: Insulin resistance is a strong contributor to cardiovascular diseases. The increasing prevalence of diabetes and the subsequent complications confers a great importance to the early detection and intervention of diabetes. However, the exact roles of blood glucose and blood pressure in nondiabetic and normotensive range to vascular complications are not precisely defined. High-sensitivity C-reactive protein (hsCRP) levels have consistently been associated with various cardiovascular endpoints in a number of studies. The aim of this study was to find out whether the insulin resistance and hsCRP, a non-traditional cardiovascular risk factor, increase according to the fasting glucose and blood pressure levels in nondiabetic and normotensive individuals. METHODS: In 7,979 participants (4,847 males, 3,132 females, mean age 46 yrs) undergoing medical checkup program in Kangbuk Samsung Hospital, blood pressures, body mass index (BMI), fasting blood glucose, fasting insulin, lipid batteries and hsCRP levels were checked. All participants were subdivided into 5 groups according to fasting glucose level and into 4 groups according to the blood pressures. Homeostatic model assessment-insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI) were calculated. RESULTS: HOMA-IR and QUICKI increased according to the increment in fasting glucose and blood pressure in nondiabetic and normotensive range (p<0.01). Log (hsCRP) level significantly increased in proportion to the increment in fasting glucose and blood pressure in nondiabetic and normotensive range (p<0.01). CONCLUSION: Insulin resistance correlated with increment in the fasting glucose and blood pressure even in nondiabetic and normotensive range. Cardiovascular risk might be increased in proportion to the increment of fasting glucose and blood pressure even in the normal range. There may not be the glycemic and hypertensive threshold for the cardiovascular risk.

Effects of bovine colostrum in diclofenac induced gut injured rat model / 대한내과학회지

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed medicine but induce damage throughout the entire gastrointestinal tract including small intestine with protein and blood loss. Impaired epithelial barrier function, overgrowth of luminal bacteria and others have been implicated in the pathogenesis of NSAID induced enteropathy. Colostrum is a first milk produced after birth and is particularly rich in growth factors, immunoglobulins and antimicrobial peptides. The present study aimed to exam whether defatted bovine colostrum reduce small intestinal injury caused by diclofenac in the animals. METHODS: 64 rats were utilized in four groups; control group, diclofenac group, diclofenac with 5% colostrum group and diclofenac with 10% colostrum group. The animals with colostrum were fed with 5% or 10% colostral solution for 5 days before diclofenac administration. Small intestinal injury was induced by administering a single dose of diclofenac (50 mg/kg subcutaneously). Epithelial permeability, enteric aerobic bacterial counts, serum albumin and protein levels, and pathologic findings of distal ileum were measured. RESULTS: Diclofenac caused marked increase in intestinal permeability, enteric bacterial numbers and intestinal villous damage, and declines in serum levels of total protein and albumin. Co-administration of bovine colostrum reduced intestinal permeability and enteric bacterial numbers, declines in serum albumin and protein levels, and mucosal damage of small intestine induced by diclofenac. CONCLUSION: Bovine colostrums may have beneficial effects on preventing NSAID induced small intestinal injury and bacterial translocation.

Fibrinolytic Activities and Their Relations to Esophageal Variceal Bleeding in Patients with Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: Esophageal variceal bleeding in liver cirrhosis is a major complication and has high mortality rate. We tried to find fibrinolytic parameters, which correlated with variceal bleeding in cirrhotic patients. METHODS: We divided the cirrhotic patients into two groups: bleeding group (group A, n=15) and non-bleeding group (Group B, n=17). Fibrinolytic parameters (fibrinogen, D-dimer, plasminogen, tissue plasminogen activator [t-PA], fibrin degradation product [FDP], and plasminogen activator inhibitor type-1 [PAI-1]) were compared between two groups. In the group A, serial samplings were taken at the initial period, 3 days, 8 days, 15 days and 6 weeks after the bleeding onset. RESULTS: Plasma levels of FDP and D-dimer in the group A were significantly higher than the group B (1.7 +/- 1.16 vs. 0.95 +/- 1.27 mg/L and 10.96 +/- 6.58 vs. 4.99 +/- 3.50 micro gram/mL, respectively, p value<0.05). The clinical, biochemical, and coagulation parameters didn't show significant differences in both groups. The fibrinolytic parameters were improved along with the hemodynamic stabilization in group A. CONCLUSIONS: Cirrhotic patients with increased fibrinolytic activity were at higher risk of bleeding. Thus, the measurement of these parameters would be useful to identify patients at higher risk of esophageal variceal bleeding.

Relationship between Peripheral Leukocyte Count and the Severity of Stable Angina Determined by Coronary Angiography

BACKGROUND: Inflammation has been demonstrated to be an important risk factor for the development of cardiovascular disease (CVD). The relationship of the peripheral leukocyte count to the severity of stable angina remains to be clarified. The present study analyzed the relationship of the peripheral leukocyte count to the severity of stable angina determined by coronary angiography. METHODS: The data from 108 patients with stable angina, and 92 subjects with normal coronary angiograms were reviewed, and the role of the peripheral leukocyte count as a risk factor for stable angina evaluated. In addition, the correlation of the peripheral leukocyte count and the severity of stable angina, as assessed by the Gensini's score in the stable angina group, were analyzed. RESULTS: Age, the prevalence of hypertension and diabetes, and the fasting blood sugar were significantly higher, and the HDL was lower in the stable angina than the control group. A multivariate analysis showed that a peripheral leukocyte count over 6, 800/mm3 was an independent variable, but with no statistical significance (p=0.067), and diabetes (OR=3.02, 95% CI: 1.29~7.02) and old age (OR=3.62, 95% CI: 1.33~9.87) were independent risk factors for stable angina. A positive correlation between peripheral leukocyte count and Gensini's score was noted in the stable angina group even after adjusting for age, fasting blood sugar, blood pressure and lipid profiles (R2=0.198, p=0.015). CONCLUSION: An increased peripheral leukocyte count is considered not so much an indicator of the pathogenesis of stable angina, but as a predictor for disease progression. Furthermore, it is considered that the above correlation will be helpful in screening high-risk groups that require relatively active interventional therapy.

A Kimura's disease developing during follow up period after remission of lymphoma / 대한내과학회지

The presented case is a 43-year-old male with a painless mass in the right neck for two weeks. Excisional biopsy was performed under the clinical impression of malignant lymphoma, because he experienced lymphoma 32 months ago. Histopathologically, it shows hyperplasia of small blood vessels and lymphoid cells with eosinophilic infiltration, so it was diagnosed as Kimura's disease. This seems to be the first reported case of Kimura's disease developed during follow up period after remission of lymphoma.