Fracture of Self-Expandable Metal Stent during Endoscopic Removal in Benign Biliary Stricture

The endoscopic insertion of the self-expandable metal stent (SEMS) in benign biliary stricture has become an alternative to surgery. Fracture or migration of SEMS can occur rarely as complications. We report a case of fracture of SEMS during endoscopic retrieval in patients with chronic pancreatitis. In this case, broken stent was successfully removed with endoscopic ballooning of bile duct and with a snare device.

An Inverse Relationship between the Expression of the Gastric Tumor Suppressor RUNX3 and Infection with Helicobacter pylori in Gastric Epithelial Dysplasia

BACKGROUND/AIMS: This study was performed to determine the association between RUNX3 expression and Helicobacter pylori infection in premalignant gastric lesions. METHODS: We examined 107 patients with gastric epithelial dysplasia who had undergone endoscopic mucosal resection or submucosal dissection. All tissue samples were evaluated by RUNX3 staining and subclassified by immunophenotype. H. pylori infection in dysplastic lesions and the normal surrounding tissue was examined by silver staining, and cagA status was assessed by polymerase chain reaction. RESULTS: The loss of RUNX3 expression was observed in 62 cases (57.9%), and an association with H. pylori infection was found in 54 cases (50.5%). The infection rate with the cagA-positive H. pylori strain was 63.0%. In RUNX3-negative lesions, the rate of H. pylori infection (p=0.03) and the frequency of category 4 lesions (according to the revised Vienna classification) were high (p=0.02). In addition, the gastric mucin phenotype was predominant. In RUNX3-negative category 4 lesions, the rate of cagA-positive H. pylori infection rate was high but not significantly increased (p=0.08). CONCLUSIONS: Infection with H. pylori is associated with inactivation of RUNX3 in early gastric carcinogenesis. This mechanism was prominent in gastric cancer with a gastric mucin phenotype.

Gastrointestinal Stromal Tumor with Accelerated Growth Pattern in the Stomach

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and can be benign or malignant. To date, there have been no clear standards for the preoperative assessment of GIST malignancy. Currently it is believed that tumors with diameter smaller than 2.0 cm is benign. Herein, we experienced two cases of GISTs that showed an accelerated growth pattern during the follow-up period. In both cases, the tumors were <2.0 cm in size initially and became larger unexpectedly. The resected tumors revealed GIST with intermediate risk and high risk of malignancy according to National Institutes of Health (NIH) consensus symposium.

A Synonymous Genetic Alteration of LMX1B in a Family with Nail-Patella Syndrome

The gene responsible for nail-patella syndrome, LMX1B, has recently been identified on chromosome 9q. Here we present a patient with nail-patella syndrome and an autosomal dominant pattern of inheritance. A 17-year-old girl visited our clinic for the evaluation and treatment of proteinuria. She had dystrophic nails, palpable iliac horns, and hypoplastic patellae. Electron microscopy of a renal biopsy showed irregular thickening of the glomerular basement membrane. A family history over three generations revealed five affected family members. Genetic analysis found a change of TCG to TCC, resulting in a synonymous alteration at codon 219 in exon 4 of the LMX1B gene in two affected family members. The same alteration was not detected in an unaffected family member. This is the first report of familial nail-patella syndrome associated with an LMX1B in Korea mutation, However, we can not completely rule out the possibility that the G-to-C change may be a single nucleotide polymorphism as this genetic mutation cause no alteration in amino acid sequence of LMX1B.

Clinical Usefulness of Bioimpedence Analysis in Determining Volume Status in CAPD Patients / 대한신장학회지

PURPOSE: Determination of accurate body fluid is essential for treating hypertension in end stage renal disease patients undergoing dialysis. However, the determination of dry body weight based on clinical assessment has low sensitivity and specificity. This study was done in order to examine the usefulness of bioimpedance analysis in determining the volume of CAPD patients. METHODS: Twenty-four hours ambulatory blood pressure and plasma concentrations of atrial natriuretic peptide (ANP) were measured and peritoneal equilibration test (PET) were obtained from 32 stable CAPD patients. Patients were divided into three groups; patients with normal blood pressure (group A, 11 people), and patients who have hypertension but controlled (under 130/80mmHg) with anti-hypertension medication (group B, 9 people), patients who have high blood pressure (over 130/80 mmHg) with 2 more anti-hypertension medication (group C, 12 people). We measured normalized extracellular fluid (nECF), extracelluar fluid/intracellular fluid ratio (ECF/ICF) and extracellular fluid/total body water (ECF/ TBW) of each group by using bioimpedance analysis (BIA) and compared the results of each group. We also compared the values of nECF, ECF/ICF, ECF/TBW indices from patients with those from normal renal function people. RESULT: Thirteen men and nineteen women participated in this test. Their mean age was 53+/-12 years and mean duration of CAPD was 49+/-38 months. Among three groups, plasma ANP level in group C (53.1+/-13.6 pg/mL) was significantly higher than the level in group A (10.3+/-7.2 pg/mL) and B (13.7+/-8.1 pg/mL) (p<0.05). The values of nECF, ECF/ICF, ECF/TBW that measured by BIA in group C was significant higher than the values in group A and B, but the values in group A and B were not significant different. The values of nECF, ECF/ICF, ECF/TBW from patients with normal kidney function were not different from those of group A and B, but the values were significantly lower than the values in group C (p<0.05). Plasma ANP level was correlated with nECF, ECF/ICF, ECF/TBW (p<0.05) value. Plasma ANP and nECF, ECF/ICF, ECF/TBW was not influenced different PET result. CONCLUSION: BIA is considered as a useful standard to predict the volume status in CAPD patients. In the future, prospective studies are demanded for clinical application.

A Case of Synchronous Quintuple Early Gastric Cancer / 대한소화기내시경학회지

The frequency of multiple gastric cancers has recently been on the increase due to the development of improved diagnostic methods, such as endoscopy, chromoscopy, and pathological methods. To prevent relapse by a remnant cancer, it is critical to determine the surgical area after evaluating the entire synchronous multiple gastric cancer area using closed endoscopy and a radiological evaluation prior to surgery. There have been no prior reports of a diagnosis of quintuple gastric cancer before surgery, although; a diagnosis of quadruple gastric cancer has been previously reported. Here we describe a 65-year-old male patient who received a diagnosis of early quintuple gastric cancer by endoscopy before surgery.

A Case of Tracheobronchomegaly with Pneumonia / 결핵및호흡기질환

A 66-years-old man was refered to our hospital because of cough, sputum, chill and fever. Enlargement of the trachea and main bronchi on radiography and bronchoscopy is compatible with Mounier-Kuhn syndrome. Mounier-Kuhn syndrome or tracheobronchomegaly is a rare disorder of uncertain etiology, characterized by marked dilatation of the trachea and major bronchi. This syndrome is associated with tracheal diverticulosis, bronchiectasis and recurrent respiratory tract infection. We report a rare case of Mounier-Kuhn syndrome with pneumonia and literature reviews.

A Case of Hyponatremia Due to Angiotensin Converting Enzyme Inhibitor

We describe a patient with hyponatremia induced by the use of angiotensin-converting enzyme (ACE) inhibitor; imidapril HCl. Although the mechanism of severe hyponatremia due to ACE inhibitor is not clear, it is conceivable that ACE inhibitor therapy may complicate the syndrome of inappropriate secretion of antidiuretic hormone and induce hyponatremia. In addition, the possibility should be considered that hyponatremia in our patient is a presumptive interaction between oxcarbazepine and imidapril HCl.

Treatment of Pulmonary Hypertension with Percutaneous Stenting of Pulmonary Artery in Fibrosing Mediastinitis

Fibrosing mediastinitis is a rare benign disorder caused by excessive proliferation of fibrous tissue within the mediastinum. Pulmonary artery stenosis is uncommon complication of fibrosing mediastinitis. We present a case of percutaneous stent deployment in a patient with severe pulmonary artery stenosis causing pulmonary hypertension secondary to fibrosing mediastinitis.

Two Cases of Successful Use of Urokinase in Continuous Ambulatory Peritoneal Dialysis Patients with Relapsing Peritonitis / 대한신장학회잡지

Peritonitis is a frequent and serious complication in continuous ambulatory peritoneal dialysis (CAPD) patients. Recently, due to educational promotion in general hygiene and development of laboratory technique for bacterial cultures and sensitivity test, proper use of antibiotics, the incidence of CAPD peritonitis has gradually decreased. However, CAPD peritonitis is still one of the most common causes of peritoneal dialysis failure and of removal peritoneal catheter. It has been suggested that the formation of biofilm on the inner surface of peritoneal catheter leads to relapsing peritonitis and removal of the peritoneal catheter in CAPD patients. The biofilm is a kind of protecting coat which consists of fibrin inhibiting the penetration of antibiotics. It surrounds and covers the bacteria, making them to survive from the attack of antibiotics. Therefore thrombolytic therapy, urokinase modifies the structure of biofilm, and helps the antibiotics penetrating the fibrin coat, eventually amplify the bacteriocidal effect. We experienced two cases of successful treatment with urokinase and antibiotics in CAPD peritonitis patients. The combination of thrombolytic agents and antibiotics might be one of the strategies for the treatment of CAPD patients who experienced it frequently.