Multiple complications associated with hepatitis A in a pregnant woman / 대한내과학회지

The incidence of hepatitis A has increased sharply in Korea, and cases have been associated with many complications. We report a pregnant woman who developed acute renal failure, acute pancreatitis, and stillbirth associated with hepatitis A. She had no relevant medical history. She was admitted to hospital with vaginal bleeding, fever, and myalgia. The initial laboratory data and clinical findings were compatible with acute hepatitis, renal failure, and pancreatitis. To the best of our knowledge, this is the first case report of non-fulminant hepatitis with multiple complications in Korea.

Clinical Features of Iatrogenic Mallory-Weiss Syndrome / 대한소화기내시경학회지

BACKGROUND/AIMS: The detection of iatrogenic Mallory-Weiss syndrome during the course of upper GI endoscopy is apparently rare. The aim of this study was identify the clinical features of the disease and associated medical conditions. METHODS: We retrospectively analyzed 46 cases (0.08%) of iatrogenic Mallory- Weiss syndrome identified from 54,188 consecutive upper GI endoscopies performed at our institution during a period of 85 months. RESULTS: A total of 36 patients (78.2%) had retching or belching during the procedure. Hiatal hernias were noted in 20 patients (43.5%). We identified a difference of the attack rate by sex and age for iatrogenic Mallory-Weiss syndrome; the disorder developed predominantly in men. All of the patients had a mucosal tear and oozing and 16 patients underwent endoscopic hemostasis. After being diagnosed with iatrogenic Mallory-Weiss syndrome, 17 patients underwent follow- up endoscopy and all of the patients showed good results without rebleeding. No patient showed a complicated clinical course. CONCLUSIONS: A small number of patients had iatrogenic Mallory-Weiss syndrome and most of the patients showed a good prognosis. If there is a predictable risk factor identified during an upper GI endoscopy or an associated medical condition, special care needs to be taken to minimize belching or retching.

Severe Acute Liver and Pancreas Damage in Anorexia Nervosa / 대한소화기학회지

Anorexia nervosa, a syndrome most commonly affecting young women, is characterized by weight less than 85% of weight that is considered normal for that person's age and height, distorted body image, and fear of becoming obese, and its mortality is up to 9%. We present a case of a 33-year-old woman with a 9-year history of anorexia nervosa. She admitted to our institution with decreased mentality, and her body mass index was 11.5 kg/m2 of the time admission. Initial aminotransferase level was severely elevated, but it was normalized solely with improved nutrition and weight gain. Five and sixteen days after the admission urinary tract infection and elevation of pancreatic enzymes occurred. They were successfully treated with antibiotics and nutritional support. Fifty seven days after the admission, she discharged. We report a case of acute hepatitis and pancreatitis treated with nutritional rehabilitation in a patient with severe anorexia nervosa for the first time in Korea.

Clinical Analysis of Upper Gastrointestinal Diseases in Elderly Patients Underwent Esophagogastroduodenoscopy

Background: Recently the elderly people have increased in Korea. So, the interest of upper gastrointestinal diseases have increased. Our aim was to determine clinical characteristics of upper gastrointestinal diseases in the elderly patients underwent esophagogastroduodenoscopy. Methods: We investigated clinical characteristics of 1190 elderly patients aged 65 years or older and 952 controls aged 64 years or younger who underwent esophagogastrodu odenoscopy in Seonam University Hospital from Jan. 2000 to Dec. 2004. retrospecti vely. Only two main symptoms were included among symptoms of two or over. The endoscopic findings were in the same manner. Results: The average age were 73.9 (+/-7.25)-year-old in the elderly, and 47.2 (+/-11.32)-year-old in controls. The most common symptom was dyspepsia in the elderly and in controls. The most common endoscopic findings showed chronic atrophic gastritis in the elderly, and chronic erythematous & erosive gastritis in controls. 64% was positive in 424 cases performed rapid urease test in the elderly and 63% was positive in controls. The most common associated diseases was hypertension in both group. The history of Non-steroidal anti-inflammatory drugs and aspirins were 21% in the elderly, and 15% in controls. Conclusion: We found that dyspepsia was the most common symptom in the elderly and controls underwent esophagogastroduodenoscopy. The most common upper intestinal disease was chronic atrophic gastritis in the elderly. We recommend esophagogastroduodenoscopy for the elderly patients in regular interval because they may have vague and atypical symptoms or asymptom.

Idiopathic Granulomatous Appendicitis: A case report

Crohn's disease is a chronic condition characterized by a non-specific granulomatous necrosis involving potentially any location in the alimentary tract, but a primary lesion confined to the appendix alone is very rare. It is difficult to discriminate Crohn's appendicitis from acute appendicitis preoperatively because of their clinical similarities. Because Crohn's disease confined to the appendix has a more favorable prognosis than typical Crohn's disease, it is considered a separate disease from Crohn's disease. Recently, the term idiopathic granulomatous appendicitis has gained wide acceptance as a distinct disease entity. We experienced a case of Crohn's disease giving rise to appendicitis or idiopathic granulomatous appendicitis and report a case with a review of the literature.

Clinicopathologic Features and Clinical Significance of Small and Diminutive Colorectal Polyps

PURPOSE: Small (6 to 10 mm) and diminutive colon polyps (below 5 mm) are routinely removed at the time of colonoscopy for the prevention of colon cancer. Our aims in this study were to determine clinicopathologic features and frequency of significant synchronous neoplastic lesions of small colon polyps and diminutive colon polyps and to investigate development of colorectal carcinoma via surveillance colonoscopy. METHODS: We evaluated medical reports of all patients undergoing total colonoscopic examination over a 12-month period. Three hundred thirty nine small colorectal polyps, removed during colonoscopy, have been analyzed. We investigated the result of surveillance colonoscopy, also. Using this database, all adenomas were categorized into two groups: Group I, < or =5 mm diameter (diminutive polyp), Group 2, 6 to 10 mm diameter (small polyp). Significant synchronous adenomas were defined as adenoma over 6 mm diameter, dysplasia or cancer. RESULTS: The most common age group was the sixth decade. The male-to-female ratio was 2.1 : 1. Of the small colorectal polyps, 180 (53.1%) were adenomatous, 32 (10.0%) were hyperplastic, 119 (34.9%) were chronic nonspecific inflammation, 3 (0.9 %) were lymphoid hyperplasia, and 4 (1.1%) were cancerous. The most frequent sites of these lesions were rectum and sigmoid (60.2%). Recognizable endoscopic features of polyps were redness (35.8%) and nodule (26.3%). The prevalence of advanced proximal synchronous polyps was 20.7% among patients with distal small lesions. And we detected 2 cases (25%) had new small polyps in follow up colonoscopic examination. CONCLUSIONS: All polyps should be removed when encountered during colonoscopy due to the higher prevalence of adenoma among these lesions. Effort to find new polyps via surveillance colonoscopy is needed.