Rectal Polypoid Endometriosis Mimicking Malignant Rectal Tumor / 대한소화기내시경학회지

Endometriosis is a disorder that presents as endometrial glands and stroma outside the uterine cavity and its musculature. It is a common gynecologic disease affecting approximately 15% of fertile women. However, polypoid endometriosis is rare. Our patient visited the hospital due to bowel habit changes and bloody stools. The colonoscopy revealed a large ulcerating polypoid mass in the rectum. Image studies including CT scan, MRI, and PET-CT suggested rectal cancer but the biopsy was negative for a malignancy. Finally, she was diagnosed with rectal polypoid endometriosis by a surgical rectal mass resection. We report a case of rectal polypoid endometriosis mimicking a rectal polypoid cancer.

A Case of Hypernatremia by Folk Remedies in a CRF Patient / 대한신장학회잡지

We report a case of chronic hypernatremia caused by excessive salt intake as folk remedies for three months. The patient had chronic tubulointerstitial nephritis (CTIN), but without documented cognitive or psychiatric disorders. She presented with severe hypernatremia 189 mmol/L and general weakness. Fluid therapy was done initially with isotonic and then with 0.45% hypotonic saline until serum sodium level reached to 157 mmol/L. Finally hemodialysis was supplemented to achieve normal serum sodium level, and she recovered without any sequelae. This report might be the first case of chronic hypernatremia due to voluntary ingestion of excessive salt in an adult patient with CTIN but without cognitive or psychiatric disorders.

A Case of Primary Follicular Lymphoma Arising in the Rectum / 대한소화기내시경학회지

Follicular lymphoma (FL) is one of the most common non-Hodgkin's lymphomas in the United States, but it is relatively rare in Asia. FL typically arises in lymph nodes together with spleen, liver, and bone marrow involvement. So, primary extra-nodal FL without peripheral nodal involvement is rare. Histologically, it shows nodular aggregates of lymphoma cells and positivity for CD 10, CD 20 and bcl-2. Not only the stage, but also the grade is associated with the survival rate. Grade 3 FL presents a worse prognosis than does grade 1 and 2 FL and this should be treated with an anthracycline based CHOP regimen. We report here on a case of primary follicular lymphoma arising in the rectum; this was observed in a 58-year-old woman who complained of anorexia, dyspepsia and diarrhea.

A Case of Zenker's Diverticulum Treated by Argon Plasma Coagulation / 대한소화기내시경학회지

Zenker's diverticulum occurs mainly in elderly patients with typical symptoms including dysphagia, regurgitation, chronic cough, aspiration, and weight loss. A diagnosis is easily established on upper endoscopy or barium studies. The treatment is surgery or endoscopic cricopharyngeal myotomy. Endoscopic procedures include staple assisted diverticulostomy, CO2 laser, transparent oblique-endhood attached endoscopic diverticulostomy, and argon plasma coagulation. Minimally invasive endoscopic treatments are associated with a shorter operating time, shorter postoperative hospital stay, quicker resumption of oral intake, and fewer overall complications. Argon plasma coagulation can be performed in any regular endoscopy unit and is less invasive, economical, faster, and well-tolerated. In particular, older patients in a poor general condition, at high surgical risk or with contraindications to general anesthesia can be treated with argon plasma coagulation.

A Case of Peritonitis due to Listeria Monocytogenes Pomplicating on Continuous Ambulatory Peritonial Dialysis Patient / 대한신장학회잡지

Peritonitis in continuous ambulatory peritoneal dialysis is a major cause of technical failure in peritoneal dialysis. The major pathogen is gram positive bacteria, and other main pathogens include gram negative bacteria, mixed infection and fungal infection actively involved in the order named. Coagulate-negative Staphylococcus, Streptococcus, Staphylococcus aureus and Enterococcus cause most of the gram positive bacterial infections, and cases with other pathogens are very rare. We hereby report a case of peritonitis by Listeria Monocytogenes that was not responsive to the usual antibiotics for CAPD-associated peritonitis. A 58-year-old male who has been treated with CAPD for 17 years visited our hospital for abdominal pain, fever and turbid peritoneal fluid. He was diagnosed as diabetes mellitus 20 years ago. White blood cell and neutrophil count increased at the initial peritoneal fluid analysis, so we diagnosed him as CAPD-associated peritonitis. Antibiotic therapy was initiated with intraperitoneal injections of cefazolin/tobramycin, which were soon changed to vancomycin/ceftazidime. However, vancomycin/ceftazidime regimen was also proven ineffective. On the sixth hospital day, L. Monocytogenes was cultured in the peritoneal fluid sampled on the first visiting day. So we accordingly changed the antibiotics for ampicillin/sulbactam, which led to clinical and laboratory improvement. In the cases of CAPD associated peritonitis in immunosuppressive patients such as the elderly, caused either by diabetes or by taking immunosuppressive agent, if they do not respond to the usual antibiotics, we should consider the possible infection by unusual pathogens. Gram positive rod in peritoneal fluid is a supporting evidence of peritonitis by L. monocytogenes.

Survival Analysis according to Treatment Modality in Pancreatic Cancer Patients / 대한소화기학회지

BACKGROUND/AIMS: Pancreatic cancer is the 5th leading cause of cancer death in Korea and its incidence is increasing. At present, surgical resection offers the best chance of cure. However, most of pancreatic cancers are already unresectable at initial diagnosis. Thus, the majority of patients depend on chemotherapy, radiotherapy, or supportive care. We investigated the effect of treatment modalities on the survival in pancreatic cancer. METHODS: Between September 1994 and May 2003, one hundred and fifty four patients with pancreatic cancer were treated by surgery, radiotherapy, chemotherapy or conservative management. The clinical datas were analyzed retrospectively for survival according to stage and treatment modality. RESULTS: Overall median survival time was 5.7 months and 1 year survival rate was 18.3%. In patients with stage I to III disease, the median survival time was 13.9 months in surgery group, 10.2 months in radiation group, and 6.1 months in supportive care group (p<0.01). Survival rate according to treatment modality was significantly different among groups. In patients with stage IV disease, the median survival time was 6.1 months in radiation therapy group, 7.1 months in chemotherapy group, and 2.7 months in supportive care group. Overall survival was significantly higher in treatment groups than in supportive care group (p<0.01), but there was no difference in survival between chemotherapy group and radiotherapy group. CONCLUSIONS: In patients with stage I to III pancreatic cancer, surgery can improve median survival. In patients with stage IV, either chemotherapy or radiotherapy can prolong survival compared to supportive care. These results suggest that more active treatment of pancreatic cancer even in advanced stage will be needed to prolong the survival.