Primary Malignant Mesothelioma of the Peritoneum Mistaken for Peritoneal Tuberculosis due to Elevated Cancer Antigen 125 / 대한소화기학회지

A differential diagnosis of ascites is always challenging for physicians. Peritoneal tuberculosis is particularly difficult to distinguish from peritoneal carcinomatosis because of the similarities in clinical manifestations and laboratory results. Although the definitive diagnostic method for ascites is to take a biopsy of the involved tissues through laparoscopy or laparotomy, there are many limitations in performing biopsies in clinical practice. For this reason, physicians have attempted to find surrogate markers that can substitute for a biopsy as a confirmative diagnostic method for ascites. CA 125, which is known as a tumor marker for gynecological malignancies, has been reported to be a biochemical indicator for peritoneal tuberculosis. On the other hand, the sensitivity of serum CA 125 is low, and CA 125 may be elevated due to other benign or malignant conditions. This paper reports the case of a 66-year-old male who had a moderate amount of ascites and complained of dyspepsia and a febrile sensation. His abdominal CT scans revealed a conglomerated mass, diffuse omental infiltration, and peritoneal wall thickening. Initially, peritoneal tuberculosis was suspected due to the clinical symptoms, CT findings, and high serum CA 125 levels, but non-specific malignant cells were detected on cytology of the ascitic fluid. Finally, he was diagnosed with primary malignant peritoneal mesothelioma after undergoing a laparoscopic biopsy.

Primary Malignant Mesothelioma of the Peritoneum Mistaken for Peritoneal Tuberculosis due to Elevated Cancer Antigen 125 / 대한소화기학회지

A differential diagnosis of ascites is always challenging for physicians. Peritoneal tuberculosis is particularly difficult to distinguish from peritoneal carcinomatosis because of the similarities in clinical manifestations and laboratory results. Although the definitive diagnostic method for ascites is to take a biopsy of the involved tissues through laparoscopy or laparotomy, there are many limitations in performing biopsies in clinical practice. For this reason, physicians have attempted to find surrogate markers that can substitute for a biopsy as a confirmative diagnostic method for ascites. CA 125, which is known as a tumor marker for gynecological malignancies, has been reported to be a biochemical indicator for peritoneal tuberculosis. On the other hand, the sensitivity of serum CA 125 is low, and CA 125 may be elevated due to other benign or malignant conditions. This paper reports the case of a 66-year-old male who had a moderate amount of ascites and complained of dyspepsia and a febrile sensation. His abdominal CT scans revealed a conglomerated mass, diffuse omental infiltration, and peritoneal wall thickening. Initially, peritoneal tuberculosis was suspected due to the clinical symptoms, CT findings, and high serum CA 125 levels, but non-specific malignant cells were detected on cytology of the ascitic fluid. Finally, he was diagnosed with primary malignant peritoneal mesothelioma after undergoing a laparoscopic biopsy.

A Case of Malignant Pericardial Mesothelioma with Atypical CT and MR Imaging Pattern / 대한내과학회지

Primary malignant pericardial mesothelioma is a very rare and highly aggressive tumor with a poor prognosis. Here, we present the case of a 71-year-old man with symptoms of chest discomfort and exertional dyspnea starting 1 week prior to admission. We identified a pericardial mass using transthoracic echocardiography, but could not diagnose the patient using other multimodal imaging approaches and effusion cytology. Findings on contrast cardiac computed tomography (CT) and magnetic resonance imaging (MRI) were more consistent with angiosarcoma than malignant mesothelioma. Ultimately, the patient was diagnosed with malignant pericardial mesothelioma, based on immunohistochemical staining of the tumor tissue. In recent years, several cases have reported the efficacy of chemotherapy in malignant mesothelioma. Thus, we suggest that accurate diagnosis of pericardial tumors with pathology may have a profound impact on the final prognosis.

A case of stress-induced cardiomyopathy with an "inverted Takotsubo" contractile pattern / 대한내과학회지

Stress-induced cardiomyopathy, known as Takotsubo cardiomyopathy, is a newly described clinical entity characterized by transient left ventricular apical ballooning and left ventricular apical dyskinesis, with no significant stenosis on the coronary angiogram. We describe a patient who had transient cardiomyopathy with akinesia of the basal portions of the left ventricle and hyperkinesia of the apex. This is the first case of stress-induced cardiomyopathy with an "inverted Takotsubo" contractile pattern triggered by emotional stress in Korea. The cause of stress-induced cardiomyopathy is unclear, but catecholamines probably play a role in this syndrome. This entity could provide clues to the pathophysiology underlying stress-induced cardiomyopathy.

A case of complete atrioventricular block persisting for 5 days in a patient with variant angina / 대한내과학회지

Variant angina is more common in Asian people, including Koreans. Variant angina has a broad spectrum of clinical manifestations, from intermittent non-exertional pain to syncope and sudden cardiac death. Complete atrioventricular block is a major cause of syncope in patients with variant angina. The complete atrioventricular block related to variant angina is usually transient and easily terminated immediately after the restoration of coronary blood flow. We experienced a case of variant angina combined with prolonged complete atrioventricular block. The complete atrioventricular block persisted after the restoration of coronary blood flow, but normal sinus rhythm was restored spontaneously 5 days later. Here, we report this rare case

Coronary vasospasm during esophagogastroduodenoscopy / 대한내과학회지

The incidence of serious cardiac complications associated with esophagogastro-duodenoscopic examination is very rare. An episode of cardiac arrest developed in 49-year-old during endoscopic examination. The patient had no history of pulmonary or ischemic heart disease. After cardiopulmonary resuscitation, he recovered completely. In this patient, we were able to demonstrate a focal spasm by coronary angiography.

Coronary vasospasm during esophagogastroduodenoscopy / 대한내과학회지

The incidence of serious cardiac complications associated with esophagogastro-duodenoscopic examination is very rare. An episode of cardiac arrest developed in 49-year-old during endoscopic examination. The patient had no history of pulmonary or ischemic heart disease. After cardiopulmonary resuscitation, he recovered completely. In this patient, we were able to demonstrate a focal spasm by coronary angiography.

The Detection Rate of H. pylori and Intestinal Metaplasia in the Antrum and in the Body / 대한소화기내시경학회지

AIMS: In this paper we have investigated the detection rate of each H. pylori test in the antrum and in the body for patients with nonulcer dyspepsia (NUD), duodenal ulcer (DU), benign gastric ulcer (BGU), and stomach cancer. In addition, we examined whether or not there is any relationship between the decrease of H. pylori detection rate and intestinal metaplasia in the antrum. METHODS: Three different test methods for identifying H. pylori infection-CLOtest, Gram stain, H&E stain-were taken in the antrum and in the body. RESULTS: 1) The detection rates of CLOtest, Gram stain, and H&E stain for NUD group were 88%, 75%, and 64% (mean: 76%) in the antrum, and 89%, 78%, and 67% (mean: 78%) in the body, respectively, and those of DU group were 95%, 95% and 81% (mean: 90%) in the antrum, and 97%, 87% and 64% (mean: 83%) in the body, respectively. Those of BGU group were 86%, 74%, 53% (mean: 71%) and 98%, 82%, 58% (mean: 79%), respectively, and those of stomach cancer group were 80%, 88%, 58% (mean: 75%) in the antrum, and 100%, 96%, 83% (mean: 93%) in the body, respectively. The B/A detection ratio which means the ratio of mean H. pylori detection rate of body to that of antrum was 1.03 in NUD, 0.93 in DU, 1.11 in BGU, and 1.24 in stomach cancer group. 2) The rate of intestinal metaplasia in the antrum was 12% for NUD, and 15% for DU group. Those of BGU and stomach cancer group were 47% and 72%, respectively. 3) The correlation etween B/A detection ratio and intestinal metaplasia in the antrum was good (correlation coefficient(r)=0.93). CONCLUSIONS: The result that body is more adequate for H. pylori detection in BGU and stomach cancer patients rather than antrum can be explained by the high rate of intestinal metaplasia in the antrum which is hostile surrounding for H. pylori.

Effect of eradication of Helicobacter pylori on the benign gastric ulcer recurrence - a 24 month follow-up study

OBJECTIVES: To evaluate the effect of eradication of Helicobacter pylori (H. pylori) on the recurrence of benign gastric ulcer (BGU) in the patients with BGU. METHODS: This study was performed for 40 H. pylori-positive BGU patients cured of BGU and H. pylori eradicated, and for 25 H. pylori-positive patients (non-eradicated group) who were not treated with H. pylori eradication regimen or H. pylori was not eradicated. Four different methods--CLOtest, microscopy of Gram stained mucosal smear, culture and histology of modified Giemsa staining--were taken for identifying colonization of H. pylori before treatment, and 4 weeks after completion of triple therapy. For the control group in which triple therapy was not tried, follow-up gastroscopy was done to confirm the healing of the ulcer. To detect BGU recurrence, the gastroscopy was performed at 6, 12, 18, and 24 months after therapy. RESULTS: In the non-eradicated group, the BGU recurrence rate was 16% within 6 months, 40% within 1 year, 56% within 18 months and 60% within 2 years. The respective recurrence rates in the 40 patients in whom the bacteria had been eradicated were 0%, 7.5%, 10% and 10% (4 patients), respectively. Among the four BGU-recurred patients in whom H. pylori had been eradicated, one patient was found to have BGU recurring with H. pylori positive again in one year, and another two patients had NSAIDs ingestion history. CONCLUSION: The eradication of H. pylori in patients with BGU reduces the recurrence of BGU. In addition, the major causes of BGU recurrence look like NSAIDs ingestion and reinfection of H. pylori.

Effects of Electrical Field Stimulation of the Isolated Corpus Cavernosum from Hypertensive Rats / 대한비뇨기과학회지

The present study was aimed to investigate whether and to what extent hypertension affects the relaxation of the corpus cavernosum. The corpus cavernosum was isolated from 12-week 2- kidney, 1-clip hypertensive rats. The corporal strips were isolated and suspended longitudinally in an organ bath. They were precontracted with phenylephrine, and their responses to electrical field stimulation (EFS) were examined. EFS caused a frequency-dependent contraction (60%) or relaxation (40%) of the corpus cavernosum precontracted with phenylephrine. The contraction response was inhibited or abolished and only frequency-dependent relaxation appeared in the presence of atropine (0.00001mol/L) and guanethidine (0.00001mol/L). The relaxation response to EFS of the corporal preparation precontracted with phenylephrine was attenuated or abolished in the presence of L-NAME (0.0001mol/L). The corporal preparation from the hypertensive rats also showed a frequency-dependent relaxation, however, the degree of which was lower at a low frequency of stimulation than that from the normotensive control. These results suggest that endothelium-derived nitric oxide released upon neural stimulation partly mediate the relaxation of the corpus cavernosum. It is also suggested that hypertension is associated with a partly attenuated relaxation response to EFS.

The Study for Isoforms of Nitric Oxide Synthase in the Rat Penis and Major Pelvic Ganglion / 대한비뇨기과학회지

Immunohistochemical staining was used to evaluate the presence of nitricoxide synthase (NOS) family enzymes in the rat penis and major pelvic ganglion.We used three kinds of antisera which are brain(neuronal), endothelial cell andmacrophge(inducible) enzymes of NOS. Many brain NOS positive neurons wereobserved in the major pelvic ganglion, especially in the initial portion of thecavenous nerve. In the penile erectile tissue, many delicate, beaded or linearbrain NOS-positive fibers were observed on the bundle of smooth muscles,adventitia of helicine artery and wall of cavernous space. Brain NOS-positiveimmunoreactivity were also seen on the encapsulated nerve ending and adventitiaof dorsal vessels of penis. Endothelial cell NOS immunoreactivity was exclusivelyin the urethral epithelium of corpus spongiosum. There was no inducible NOSimmunoreactivity in rat penis and major pelvic ganglion. These results suggestthat NO related to penile erection in rat was made from brain NOS rather thanendothelia1 cell or inducible NOS.

Neoadjuvant M-VAC (Methotrexate, Vinblastine, Adriamycin and Cisplatin) Effect on the Invasive Bladder Tumor / 대한비뇨기과학회지

We evaluated the effect of M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy in 63 patients with invasive transitional cell carcinoma of the bladder between January 1987 and December 1993. The patients consisted of 59 male and 4 female. Patient age ranged from 35 to 80 years with a mean of 61.5 years. All patients were given 1-7 cycles(mean 2.7 cycles) of M-VAC chemotherapy and followed for 1 to 8 years. Ten patients(16%) achieved a clinical complete remission(CR), 22(35%) partial remission(PR), 11(17.5%) minor response(MR), 11(17.5%) stabilization(STAB), and 9(14%) progression(PROG). The overall clinical response rate was 51%. Of 22 patients who underwent surgery(radical cystectomy in 15, partial cystectomy in 7), 3 patients(14%) achieved objective pathologic response. The estimated 5-year survival rate according to response of primary tumor to chemotherapy was 86%, 55% in patients with response and non-response, respectively. This difference between the groups was statistically significant(P<0.05). Overall 3-years and 5-years survival rates were 73% and 71%, respectively, and mean survival was 3.1 years. The toxicity of the regimen was generally acceptable, but 79% of the patients experienced myelosuppression, 8% hepatic toxicity and 6% stomatitis. In conclusion, the patients who achieved a clinical response seem to have a better prognosis and neoadjuvant M-VAC chemotherapy may result in bladder preservation for selected patients with muscle invasive bladder cancer.

Cystic Lymphangioma of the Adrenal Gland: Report of a Case / 대한비뇨기과학회지

Cystic lymphangiomas are uncommon benign tumor due to the lack of adequate drainage from the sequestrated lymphatic vessels to the venous system because of insufficiency or atresia of the efferent channels. They occur mostly in children and predilection sites are the neck and axilla. Treatment is complete surgical excision. Unless completely removed, recurrences are common. We report a case of cystic lymphangioma of adrenal gland in a 45-year-old woman with right flank pain. Adrenalectomy was performed and the mass consisted of three well demarcated cysts.