A Case of Stump MALT Lymphoma after Partial Gastrectomy / 대한소화기학회지

Gastrectomy is known to be a risk factor for adenocarcinoma in remnant stomach. It is suggested that reflux of bile juice or duodenal secretion to remnant stomach induces atrophic gastritis, intestinal metaplasia, and gastric adenocarcinoma. Malignant lymphoma in remnant stomach after gastrectomy is very rare. Only about thirty cases are reported in the world, and there is no case report in Korea. Gastric MALT (mucosa-associated lymphoid tissue) lymphoma is associated with Helicobacter pylori infection but the mechanism of lymphoma development in remnant stomach is still unknown. We report a case of low grade gastric MALT lymphoma of gastric stump after 10 years from partial gastrectomy.

A Case of Idiopathic Colitis Developed after Barium Enema / 대한소화기학회지

It has been reported that colitis may be associated with intrarectally administered drugs or chemicals. Colonotoxicity may results from conventional medical therapy, herbal or other illicit drugs, contrast materials, and detergents. Clues that a colitis may be due to an intrarectally administered agent include perianal excoriation, segmental distal colitis due to a concentration gradient from enema administration, and recent diagnostic or therapeutic administration of high risk solutions such as hypertonic contrast agents or detergent enemas. Barium is a highly viscous contrast agent that is insoluble in water. Barium enemas are usually very safe. Also, no case report of barium-induced chemical colitis has been reported yet. We report a case of chemical colitis with colonic stricture occurring after the barium enema for diagnostic purpose.

Positive Predictability and Predictive Factors of the Third Generation Anti-Hepatitis C Virus (HCV) ELISA Test for HCV Infection / 대한소화기학회지

BACKGROUND/AIMS: Anti-HCV positivity suggests past or present infection of HCV, or false positivity. The positive predictability of this test can differ according to the subjects. This study examines the positive predictability of the third generation anti-HCV ELISA and factors predicting HCV infection with special emphasis on the significance of the anti-HCV sample/cut-off (S/CO) ratio. METHODS: One hundred and ninety patients who were anti-HCV positive were enrolled, from November 1998 to January 2002 in Kyung Hee University Hospital. RT-PCR was performed to confirm HCV infection. RESULTS: One hundred and seven patients were RT-PCR positive (56.3% positive predictability). The positive predictability changed with the S/CO ratio: 17.9% in cases below 6, 58.3% between 6 and 50, 78.6% between 51 and 75, and 60% over 75. Those with the S/CO ratio more than 6 showed significantly higher predictability, but it did not increase further when the ratio got higher. Factors predicting HCV infection were the presence of liver cirrhosis (OR 5.5, p=0.000), hepatocellular carcinoma (OR 11.67, p=0.004), liver diseases (OR 2.99 p=0.001), and increase of AST (OR 2.49, p=0.002), ALT (OR 2.32, p=0.005), alpha-FP (OR 3.49, p=0.040), and the S/CO ratio of more than 6 (OR 7.82, p=0.000). However, liver cirrhosis was the sole factor in multivariate analysis (OR 8.32, p=0.02). CONCLUSIONS: The positive predictability of the third generation anti-HCV test was 56.3% with a significant difference between those with the S/CO ratio below 6 (18%) and above 6 (63%). In liver cirrhosis, positive predictability of anti-HCV test was relatively high as 85%.

A Pure Case of Gastric Carcinoid Tumor Presented with Intestinal Pseudoobstruction / 대한소화기내시경학회지

Clinical significance and prevalence of gastric carcinoid tumor are considerably rising. This is reflective of both their increased identification, with the widespread availability of upper gastrointestinal endoscopy, as well as the development of immunohistochemical study. The improvements in survival rates of gastric carcinoid tumor indicate an ability to develop optimal therapeutic strategies and regimens. Usually, the recommended treatment is surgical or endoscopic excision of the tumor. We experienced a case of intestinal pseudoobstruction combined with gastric carcinoid tumors in a 45 year-old man. He was successfully treated with endoscopic polypectomy.

The Incidence and Clinical Significance of Paraneoplastic Syndromes in Patients with Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Patients with hepatocellular carcinoma (HCC) may manifest paraneoplastic syndromes such as hypercholesterolemia, hypoglycemia, hypercalcemia and erythrocytosis. This study was aimed at evaluating the incidence and clinical significance of paraneoplastic syndromes in Korean HCC patients. METHODS: The medical records of 165 HCC patients who were diagnosed and died in the Kyung Hee University Hospital, were reviewed retrospectively. The following variables were analyzed: age, gender, hepatitis markers, platelet, liver function test, alpha-fetoprotein (AFP), Child-Pugh score, tumor features, and the duration of their survival. RESULTS: In total, paraneoplastic syndromes were presented in 43.6% of the HCC patients during the course of their disease. Hypercholesterolemia was solely presented in 14.5%, hypoglycemia in 12.7% and hypercalcemia in 7.8%. The patients who presented with more than 2 syndromes were 8.5%. While 80% of erythrocytosis (4/5) and 51.6% of hypercholesterolemia (16/31) was presented at the time of HCC diagnosis, hypoglycemia and hypercalcemia mainly occurred as terminal events. The patients with paraneoplastic syndromes were younger and had higher rates of portal vein thrombosis, bi-lobar tumor involvement and tumor more of more than 10 cm in diameter, compared to those patients without them. The proportion of patients with a serum AFP more than 400 ng/mL tended to be higher in the patients with paraneoplastic syndromes. The HCC patients with paraneoplastic syndromes, except for erythrocytosis, had a shorter survival than those patients without them. CONCLUSIONS: Paraneoplastic syndromes are not infrequently presented in HCC patients, especially at an advanced stage, and the survival of these patients is relatively shorter.

Frequent Epigenetic Inactivation of XAF1 by Promotor Hypermethylation in Human Colon Cancers / 대한소화기학회지

BACKGROUND/AIMS: X-linked inhibitor of apoptosis (XIAP) is the most potent member of the IAP family that exerts antiapoptotic effects. Recently, XIAP-associated factor 1 (XAF1) and two mitochondrial proteins, Smac/DIABLO and HtrA2, have been identified to negatively regulate the caspase-inhibiting activity of XIAP. We explored the candidacy of XAF1, Smac/DIABLO and HtrA2 as a tumor suppressor in colonic carcinogenesis. METHODS: Expression and mutation status of the genes in 10 colorectal carcinoma cell lines and 40 primary tumors were examined by quantitative PCR analysis. RESULTS: XAF1 transcript was not expressed or present at extremely low levels in 60% (6/10) of cancer cell lines whereas Smac/DIABLO and HtrA2 are normally expressed in all cell lines examined. Tumor-specific loss or reduction of XAF1 was also found in 35% (14/40) of matched tissue sets obtained from the same patients. XAF1 transcript was reactivated in all the low expressor cell lines by treatment with the demethylating agent 5-aza-2'-deoxycytidine. Moreover, bisulfite DNA sequencing analysis for 34 CpG sites in the promoter region revealed a strong association between hypermethylation and gene silencing. Restoration of XAF1 expression resulted in enhanced apoptotic response to etoposide and 5-flurouracil, whereas knockdown of XAF1 expression by siRNA transfection significantly inhibited chemotherapeutic drug-induced apoptosis. CONCLUSIONS: XAF1 undergoes epigenetic gene silencing in a considerable proportion of human colon cancers by aberrant promoter hypermethylation, suggesting that XAF1 inactivation might be implicated in colonic tumorigenesis.

A Case of Chinese Herbs Nephropathy / 대한신장학회잡지

No abstract available.

A Case of Behcet's Disease with Pleural Effusion / 결핵

Behcet's disease is a complex multisystem disease that features recurrent aphthous stomatitis, recurrent genital ulcerations, and eye lesions(uveitis or chorioretinitis). Among the systemic manifestat ions, pulmonary involvement is known to be rare and only a few cases have been documented. The most important features of pulmonary lesions in Behcet's disease are recurrent hemoptysis, which is often massive, and fatal pleuritic chest pain and recurrent high fever and fleeting nature of the pulmonary infiltrates. We report a case of Behcet's disease manifestated as high fever and pleural effusions which was complicated by pulmonary infarction ans a result of pulmonary arteritis.