A Case of Eosinophilic Esophagitis With Food Hypersensitivity

Eosinophilic esophagitis (EoE) is a disorder characterized by isolated eosinophilic infiltration of the esophagus with esophageal symptoms. Although some patients with EoE are related to food hypersensitivity, it is hard to identify causative foods. This report describes a case of EoE with dysphagia. A 28-year-old man presented with dysphagia and substernal discomfort for 15 days. He had taken a protein complex for 2 months. Endoscopy showed several linear furrows and multiple mucosal nodularities on the lower and mid esophagus, and the biopsies of esophagus revealed marked eosinophil infiltration in the mucosa. The skin testing for the protein complex was positive. The patient was successfully treated with withholding treatment.

A Prospective Randomized Trial Comparing Preference of Sulfate Free Polyethylene Glycol with Standard Polyethylene Glycol / 대한소화기내시경학회지

BACKGROUND/AIMS: The standard polyethylene glycol (PEG) solution for colonic cleansing has a salty taste and a large volume of it is required, which can cause failure for the patient to ingest the required dosage. This has been a limitation for its usage. Sulfate free PEG (SF-PEG) has a less salty taste due to removal of the sodium sulfate, but the published studies in western countries about the preference and the degree of patient's satisfaction with these two solutions has shown conflicting results. The object of this study was to compare SF-PEG with PEG solution in regard to preference, the degree of patient's satisfaction and the adverse effects in Korean patients. We also attempted to determine whether these factors were associated with preference. METHODS: Ninety-four patients scheduled for colonoscopy were given one liter of both solutions (SF-PEG and PEG) and then the patients were allowed to select either of the two solutions for the further two liters intake under informed consent. Before colonoscopy, the preferred solution, the degree of patient's satisfaction, the adverse effects and other information were recorded by questionnaire. RESULTS: Fifty-nine patients among the 94 patients (63%) preferred the SF-PEG solution (p<0.05). Especially, the young patients under the age of 35 preferred the SF-PEG solution (83% vs 58%; p=0.045), and patients who had already experienced colonoscopy with PEG solution tended to prefer the SF-PEG (54% vs 78%; p=0.054). CONCLUSIONS: Korean patients preferred the SF-PEG over PEG, and especially young aged patients and the patients who had already taken the PEG solution. Similar results were obtained for both solutions concerning the adverse effects, cleansing quality and compliance, and the degree of satisfaction was not much improved, which was probably due to the same large volume of fluid that is required for colon cleaning.

The endoscopic findings in patients with noncardiac chest pain who have a normal coronary angiogram / 대한내과학회지

BACKGROUND/AIMS: Noncardiac chest pain (NCCP) mainly results from esophageal lesions in the developed world. By contrast, gastroesophageal reflux disease (GERD) is a less frequent cause of NCCP than peptic ulcer disease in China and Japan. Therefore, both esophageal lesions and stomach and duodenal lesions are likely to be important causes of NCCP in Korea. We used upper gastrointestinal endoscopy to evaluate lesions of the esophagus, stomach, and duodenum in NCCP patients after cardiac chest pain was ruled out by coronary angiography (CAG). METHODS: From the patients who underwent CAG between 2004 and 2008, we identified 89 patients who had normal CAG or minimal disease. We retrospectively analyzed the endoscopic findings of these 89 patients who were diagnosed with NCCP. RESULTS: At endoscopy for the 89 patients, the percentages of GERD, gastric ulcer, and duodenal ulcer were 20.2% (n=18), 14.6% (n=13), and 3.3% (n=3) respectively. Of the 16 cases diagnosed as peptic ulcer, 11 were evaluated by biopsy or the Campylobacter-like organism (CLO) test for suspected Helicobacter pylori infection. Six (54%) cases were positive for H. pylori and five (46%) were negative. CONCLUSIONS: In Korea, the incidence of peptic ulcer disease (17.9%) as a cause of NCCP is similar to that of GERD (20.2%). Consequently, we should perform endoscopy to determine the cause of NCCP.

A Case of Ulcerative Colitis with Prolonged Remission Following Azathioprine-Induced Pancytopenia

Azathioprine (AZA) is widely used for the treatment of inflammatory bowel disease. Bone marrow suppression is a common side effect with AZA treatment. However, data from AZA trials has indicated that a leukocyte count less than 5,000/mm3 was a good predictor of induction and maintenance of remission. Moreover, there is evidence that eradication of sensitized leukocytes by leukapheresis or bone marrow transplantation improves inflammatory bowel disease. We report a case of a patient who had a chronic relapse of ulcerative colitis requiring the frequent use of systemic steroids, but presented prolonged remission following AZA-induced severe pancytopenia. Also colonoscopy showed accelerated healing of diffuse active ulcers following just recovery from pancytopenia.

Cyclooxgenase-2 Expression in Chronic Inflammatory Bowel Disease:Comparing of Immunohistochemical Stain to Real-time PCR

BACKGROUND/AIMS: This study compared the results of cyclooxygenase-2 (COX-2) expression in inflammatory bowel disease and tuberculous colitis as evident by immunochemical staining and real time polymerase chain reaction (PCR). METHODS: Patients with ulcerative colitis (n=18), Crohn's disease (n=7), tuberculous colitis (n=7) and 10 normal controls were included. Biopsied colonic mucosa was simultaneously used for immunohistochemical staining and real time PCR. RESULTS: Patients with inflammatory bowel disease and tuberculous colitis showed high COX-2 expression by both methods compared to the normal controls. In Crohn's disease patients, the real time PCR value correlated well staining grade; this correlation was not evident in ulcerative colitis patients. In real time PCR, grossly normal colonic mucosa in ulcerative colitis also showed higher expression of COX-2 than normal mucosa. CONCLUSIONS: Real time PCR value of COX-2 is more representative of inflammation state in inflammatory bowel disease than the value from immunohistochemical staining.

A Case of Ulcerative Colitis Relapsed by Influenza Vaccination / 대한소화기학회지

Although a large number of studies have reported the causes of the exacerbation of ulcerative colitis (UC), the effect of influenza vaccination on the relapse of UC has not been reported. We experienced a case of prompt exacerbation of quiescent UC due to influenza vaccination. A 39-year-old woman was diagnosed as UC 4-years ago and was well controlled with oral mesalazine. She experienced abdominal pain and frequent bowel movements with hematochezia 3 days after the vaccination. On admission, laboratory findings showed elevated erythrocyte sedimentation rate and C-reactive protein. Sigmoidoscopy showed marked edematous mucosa on rectum and sigmoid colon with fine ulceration and spontaneous bleeding. She recovered from the exacerbation of UC after steroid treatment. Vaccination should be administered to the patients with inflammatory bowel disease with the caution of its possible side effects.

A case of endobronchial aspergilloma in patient with collapse of right middle lobe / 대한내과학회지

Pulmonary aspergilloma usually results from the ingrowths of the colonized Aspergillus in the damaged bronchial tree, pulmonary cyst or cavities of patients with underlying lung diseases. We experienced a case of endobronchial aspergilloma developed in a healthy female patient with asymptomatic collapse of right middle lobe (RML). She visited our clinic with intermittent hemoptysis for one year. The chest X-ray and HRCT showed severe collapse of the RML and multiple calcifications of peribronchial nodes around the proximal part of RML bronchus. Bronchoscopy revealed an aspergilloma in theorifice of the lateral segmental bronchus of RML. Patient had undergone RML and right lower lobe resection because of recurrent hemoptysis in spite of medical therapy. After surgery patient's symptoms were relieved. We present this unusual case with a review of the literature.

Expression of Eotaxin in Gastric Epithelial Cells Stimulated with Helicobacter pylori Vacuolating Cytotoxin

Helicobacter pylori-infected gastric mucosa is characterized by infiltration of various inflammatory cells such as neutrophils and eosinophils. Although several mechanisms for neutrophil infiltration are well known, there has been little known the role of eotaxin, which is a potent chemoattractant for eosinophils, on the inflammatory process of H. pylori infection. The present study was to investigate the mechanisms of eotaxin expression in gastric epithelial cells stimulated with H. pylori vacuolating cytotoxin (VacA). Stimulation with VacA purified from VacA+ H. pylori slightly increased eotaxin expression in MKN-45 gastric epithelial cells. In contrast, the combined stimulation with VacA and IL-4 synergistically increased the eotaxin expression as determined by quantitative RT-PCR and ELISA. In MKN-45 cells transfected with an eotaxin promoter-luciferase reporter plasmid, costimulation with VacA and IL-4 induced more luciferase activity than either VacA or IL-4 alone did. However, such up-regulation was significantly decreased in the cells transfected with luciferase reporter plasmid bearing an eotaxin promoter which has a mutation at STAT6 binding site. These results suggest that the up-regulation of eotaxin in VacA-stimulated gastric epithelial cells may be synergistically facilitated by IL-4 via a STAT6-dependent mechanism.

Expression of Eotaxin in Gastric Epithelial Cells Stimulated with Helicobacter pylori Vacuolating Cytotoxin

Helicobacter pylori-infected gastric mucosa is characterized by infiltration of various inflammatory cells such as neutrophils and eosinophils. Although several mechanisms for neutrophil infiltration are well known, there has been little known the role of eotaxin, which is a potent chemoattractant for eosinophils, on the inflammatory process of H. pylori infection. The present study was to investigate the mechanisms of eotaxin expression in gastric epithelial cells stimulated with H. pylori vacuolating cytotoxin (VacA). Stimulation with VacA purified from VacA+ H. pylori slightly increased eotaxin expression in MKN-45 gastric epithelial cells. In contrast, the combined stimulation with VacA and IL-4 synergistically increased the eotaxin expression as determined by quantitative RT-PCR and ELISA. In MKN-45 cells transfected with an eotaxin promoter-luciferase reporter plasmid, costimulation with VacA and IL-4 induced more luciferase activity than either VacA or IL-4 alone did. However, such up-regulation was significantly decreased in the cells transfected with luciferase reporter plasmid bearing an eotaxin promoter which has a mutation at STAT6 binding site. These results suggest that the up-regulation of eotaxin in VacA-stimulated gastric epithelial cells may be synergistically facilitated by IL-4 via a STAT6-dependent mechanism.

A Case of Endobronchial Tuberculosis with Repeated Expectoration of Nodular Tissues / 결핵및호흡기질환

Herein, we report a case of tumorous endobronchial tuberculosis with successful recovery of atelectasis without any significant bronchial stricture, after repeated expectorations of nodular tissues. A 24-year-old male patient was presented with persistent cough. The patient was diagnosed to be suffering from tuberculous lymphadenitis on right axillar and mediastinum of lung, and was subsequently treated with antituberculosis agents. After two months, clinical deteriorations and atelectasis were observed on right upper lobe of lung. Multiple endobronchial tumorous lesions, which obstructed the right main bronchus, were revealed on bronchoscopy, and based on the endobronchial biopsy findings we confirmed that the patient was suffering from endobronchial tuberculosis. We decided to administer antituberculosis agents without any additional procedure. After few weeks, the patient spontaneously expectorated nodular tissues with vigorous coughing. Later on, the symptoms and atelectasis disappeared and the patient was completely recovered. This case shows that in patients suffering from tumorous endobronchial tuberculosis, endobronchial mass can be expectorated spontaneously without sequelae of significant bronchial stenosis.

A Case of Papillary Thyroid Microcarcinoma Presenting as a Contralateral Cervical Lymph Node Metastasis / 대한내분비학회지

Papillary carcinomas account for 85~90% of all thyroid cancers, with the tumor size considered an important prognostic factor. As the use of high-resolution ultrasonography and fine needle aspiration biopsy have increased, the diagnosis of papillary microcarcinomas of the thyroid gland; defined by the World Health Organization as being less than 1 cm in diameter, has increased. They are generally associated with an excellent prognosis, with distant metastasis being extremely rare. They usually remain clinically silent until their incidental histological diagnosis by autopsy or surgical material. The incidence discovered at autopsy varies between 3 and 36%. Cervical lymph node metastases from papillary microcarcinomas have often been discovered, which may be the first and sole manifestation of the disease, without clinical suspicion of a thyroid tumor. Herein, the case of a papillary thyroid microcarcinoma, diagnosed after a total thyroidectomy due to its first presentation as a contralateral cervical lymph node metastasis, without evidence of a clinical thyroid tumor, is described.

Clinical Features of Eosinophilic Gastroenteritis / 대한소화기학회지

BACKGROUND/AIMS: Eosinophilic gastroenteritis (EG) is an uncommon disease with various gastrointestinal symptoms characterized by eosinophilic infiltration. Its incidence increases recently. We investigated the clinicopathologic features of the patients with EG. METHODS: Between January 1970 and July 2003, a total of 28 cases of EG have been reported. By adding 3 cases diagnosed in the Eulji Hospital, we evaluated the 31 cases of EG for the symptoms, laboratory findings, histologic findings, method of treatment, and allergic history. RESULTS: The incidence increased during 1990s. The predominant site of the eosinophilic infiltration was mucosa in 10 cases, muscularis in 5 cases, and subserosa in 5 cases. The remaining 11 patients had the EG in two sites. The most frequently affected organ was small intestine (12 patients), but there were 12 cases which more than two organs involved. Melena and hematochezia were dominant findings in the patients whose infiltration occurred in mucosa. On the other hand, ascites was a dominant finding in the cases that infiltration occurred in subserosa or involving over 2 layers. There was no difference in eosinophilia, clinical symptoms, and duration between two groups according to the symptom duration for less or more than 30 days. Additionally, seven patients had allergc histories. Peripheral eosinophilia was found in 24 cases. There was no recurrence of EG after the treatment. CONCLUSIONS: Our retrospective studies about EG reported in Korea could not clarify whether EG is related to allergy. Recently, the occurrence of EG is increasing and it is frequently involved in young men. The most apparent finding include peripheral eosinophilia. There is no significant clinical feature which is consistent with Klein's classification, though blood loss was more common in mucosal type and ascites was more common in serosal type and in case above two layers.

Intraoperative use of Real-time Ultrasonography in Neurosurgery

Recent technological advances in ultrasound instrumentation have resulted in equipment that will image in "real-time" slices of the human brain similar in quality to computerized tomography(CT). Multiple authors have attested to its usefulness in locatin, characterizing, and facilitating in the biopsy or removal, or both, of intracerebral masses. In this study, the author has examined the efficacy of intraoperative neurosurgical ultrasound in 18 patients who were admitted to the Department of Neurosurgery, Kyung Hee University Hospital. The results were as follows : 1) It can provide critical assistance in precise localization of subcortical masses, since in many instances the overlying surface of brain provides no clue for localization. 2) This technique is very useful for the identificantion of deep lesions, provding infromation about their solid and cystic components and about the shortest route of access to tumor. 3) It provides precise information to help guide biopsy needles into deep lesions, and to confirm their presence within the lesion itself. 4) The system is highly accurate in visualizing ventricular catheters during and after their placement. 5) The system is inherently safe for the patient and the operating room personnel since there is no radiation exposure.

A Case of Intramedullary Cysticercosis in Thoracic Cord

Cerebral cysticercosis is relatively common disease in Korea. But spinal intramedullary cysticercosis is very rare. We have recently experienced a case of thoracic intramedullary cysticercosis which was misdiagnosed as intramedullary tumor. We performed CT myelography and MRI, and they showed a cystic mass, suggesting intramedullary tumor. Laminectomy was performed and cystic mass was removed. Pathological diagnosis of specimen was cysticercosis.

A Case of Intramedullary Cysticercosis in Thoracic Cord

Cerebral cysticercosis is relatively common disease in Korea. But spinal intramedullary cysticercosis is very rare. We have recently experienced a case of thoracic intramedullary cysticercosis which was misdiagnosed as intramedullary tumor. We performed CT myelography and MRI, and they showed a cystic mass, suggesting intramedullary tumor. Laminectomy was performed and cystic mass was removed. Pathological diagnosis of specimen was cysticercosis.