A Case of High Grade Dysplasia in Sporadic Fundic Gland Polyp / 대한소화기내시경학회지

Fundic gland polyps (FGP) are the most common type of gastric polyps, with an incidence on endoscopy of 0.8~1.9%. They have been considered as benign lesions, without the potential for malignant transformation. High grade dysplasia and gastric adenocarcinomas associated with FGP have been described in patients with familial, as well as attenuated adenomatous polyposis (FAP). In contrast, dysplasia associated with FGP in non-FAP patients is extremely rare, and there have been no reports of sporadic FGP with high grade dysplasia in the Korean literature. Herein, we report one case of high grade dysplasia associated with sporadic FGP in a non-FAP patient treated with an endoscopic polypectomy.

Accuracy of Endoscopic Ultrasonographic Impression Compared with Pathologic Diagnosis in Gastrointestinal Submucosal Tumors / 대한소화기학회지

BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) is a valuable imaging modality for the evaluation of gastrointestinal submucosal tumor (SMT). EUS is helpful in assessing the layer of origin, tumor diameter, shape, border characteristics, and internal echo patterns of SMTs and thus makes it possible to predict histologic diagnosis with educated guess. However, some studies have found no significant differences in EUS features between benign and malignant mesenchymal tumors. By comparing EUS impressions with histologic diagnosis, we evaluated the accuracy of EUS in differential diagnosis of gastrointestinal SMTs. METHODS: 58 cases of gastrointestinal SMTs with both EUS findings and pathologic reports were compared retrospectively from August 2001 to September 2003. RESULTS: 34 patients had lesions in the stomach and 13, 8, 3 in the esophagus, duodenum, and colon respectively. Benign lesions were predominant (46 of 58). The EUS and pathologic diagnosis coincided in 46/58 (79.3%) of the cases. Use of EUS led to the correct diagnosis in 7/9 (77.8%) of malignant GISTs (gastrointestinal stromal tumor) and leiomyosarcomas. Two small malignant gastric GISTs were diagnosed as benign with EUS. CONCLUSIONS: EUS is a useful tool in the differential diagnosis of gastrointestinal SMTs and predicting malignant lesions. However, some malignant GISTs were diagnosed as benign tumor with EUS examination.

Grading of Histology, Expression of Apoptosis and Cell Proliferation in Gastric Mucosa Adjacent to Gastric Adenoma or Adenocarcinoma / 대한소화기학회지

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) infection can lead to gastric adenoma and carcinoma through atrophic gastritis and intestinal metaplasia. Imbalance between apoptosis and proliferation may play a role in gastric carcinogenesis. We tried to investigate H. pylori infection rate, grade of gastritis, environmental risk factors, expression rate of apoptosis and cell proliferation in mucosa adjacent to tumor, and we also tried to find significant factors associated with gastric carcinogenesis. METHODS: Endoscopically diagnosed twenty cases of intestinal type gastric carcinoma, 20 cases of gastric adenoma, and 40 cases of control (normal or gastritis) were enrolled. H. pylori infection rate, histologic grading, apoptosis and immunohistochemical stain (Ki-67 and p53) to check mucosal proliferation were done in endoscopically biopsied tissues at antrum and body at least 2 cm apart from adenoma or carcinoma. RESULTS: In three groups, H. pylori infection rates were not significantly different. In the multivariate analysis, only atrophy of gland was a significant risk factor for adenoma compared to control group (OR 3.7). Intestinal metaplasia in antrum and alcohol drinking were significant risk factors for carcinoma compared to control group (OR 4.4 and 4.9 respectively). Expressions of apoptosis, Ki-67 and p53 were not significantly different in three groups. CONCLUSIONS: Intestinal metaplasia in antrum and alcohol drinking are significant risk factors for gastric carcinoma. Degree of mucosal proliferation and apoptosis in gastric mucosa adjacent to tumor are not significantly different in three groups.

The Usefulness of Endoscopic Ultrasonography in the Diagnosis of Common Bile Duct Stones / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosis and treatment of common bile duct stones (CBDS). However it is associated with some complications. Endoscopic ultrasonography (EUS) is an efficient diagnostic tool for CBDS with better accuracy than ultrasonography (USG) or computed tomography (CT) and lower complication rate than ERCP. We evaluated the diagnostic usefulness of EUS in suspicious CBDS. METHODS: From Oct. 2001 to Mar. 2004, 84 patients with the suspicion of CBDS, without definite evidence on CT and/or USG were evaluated with EUS. The reports were reviewed retrospectively. RESULTS: Patients were 38 males, 46 females with mean age of 56 years old. CBDS were found in 25 (29.8%) patients. In the diagnosis of CBDS undetected in CT and/or USG, EUS gave 96% sensitivity, 96.6% specificity, 92.3% positive predictive value and 98.3% negative predictive value. When CBDS were found in EUS, the average sizes of CBD and CBDS were 8.8 mm (4~16.7) and 6.4 mm (3.3~9.1) respectively. Diagnostic ERCP was avoided in 54 (64.3%). EUS provided additional diagnosis such as gallbladder stones, gallbladder cancer, ampullary cancer and adenoma. No complication was associated with EUS. CONCLUSIONS: EUS is reasonably safe and accurate procedure in detecting CBDS. EUS may possibly replace diagnostic ERCP in CBDS.

Frequency of Vertebral Compression Fractures in Spinal Osteoarthritis Patients in Relation to Bone Mineral Density / 대한류마티스학회지

OBJECTIVE: To investigate the association between bone mineral density (BMD) and osteoporotic compression fractures in radiographic spinal osteoarthritis (OA) patients. METHODS: Subjects were 382 female patients (ages 45 to 85) from outpatient clinic for osteoporosis and rheumatic diseases. BMD was measured at lumbar spine and hip by dual X-ray absorptiometry (Hologic QDR 2000). The standard anteroposterior and lateral plain radiographs of thoracic and lumbar spine were taken to define spinal OA and vertebral compression fractures. Radiographic spinal OA was defined by grade of disc degeneration and facet joint degeneration. Frequency of vertebral fractures was compared between spinal OA and control patients in relation to their BMD, age, weight, body mass index (BMI) and years post menopause. RESULTS: Higher proportion of fracture cases were observed in spinal OA patients than non-spinal OA patients (34.1%, 44/129 vs. 18.2%, 46/253, p<0.001) despite comparable mean BMD (0.836+/-0.152 vs. 0.834+/-0.185, p=0.89) and older mean age (65.8+/-8.5 vs. 57.8+/-10.3, p<0.001). In subjects of ages from 65 to 74, spinal OA patients showed significantly higher BMD than non-spinal OA patients (0.784+/-0.125 vs. 0.719+/-0.119, p=0.007), but the frequency of fractures seems to be higher than that of non-spinal OA patients (44.9%, 22/50 patients vs. 34%,19/55 patients, p=0.58). When all study subjects were stratified according to their spine BMD (normal, osteopenia, and osteoporosis), significantly higher proportion of vertebral compression fractures was noted in spinal OA than non-spinal OA patients in osteopenia group (38.5% vs. 13.5%, p<0.001). CONCLUSION: Higher BMD does not seem to be translated directly into decreased risk of osteoporotic compression fractures in spinal OA patients. Careful assessment of risk factors for osteoporotic fractures and newer methods for assessing bone strength in this group of patients are needed.

A Case of Emphysematous Pyelonephritis in a Autosomal Dominant Polycystic Kidney Disease Patient Successfully Treated by Medical Treatment / 대한신장학회잡지

Emphysematous pyelonephritis is an uncommon and potentially life-threatening infectious disease. Although there is still controversy about optimal treatment of emphysematous pyelonephritis, published results indicate that the mortality rate in the patients treated with radical nephrectomy is equivalent to that in patients given more conservative treatment. Emphysematous pyelonephritis with autosomal dominant polycystic kidney disease is extremely rare and its clinical course is not revealed clearly. Hearin, we report an emphysematous pyelonephritis in a 64- year-old female patient with autosomal dominant polycystic kidney disease, successfully treated by antibiotics and percutaneous cyst drainage.

A Case of Emphysematous Pyelonephritis in a Autosomal Dominant Polycystic Kidney Disease Patient Successfully Treated by Medical Treatment / 대한신장학회잡지

Emphysematous pyelonephritis is an uncommon and potentially life-threatening infectious disease. Although there is still controversy about optimal treatment of emphysematous pyelonephritis, published results indicate that the mortality rate in the patients treated with radical nephrectomy is equivalent to that in patients given more conservative treatment. Emphysematous pyelonephritis with autosomal dominant polycystic kidney disease is extremely rare and its clinical course is not revealed clearly. Hearin, we report an emphysematous pyelonephritis in a 64- year-old female patient with autosomal dominant polycystic kidney disease, successfully treated by antibiotics and percutaneous cyst drainage.