The Seroprevalence Rate, Vaccination Rate and Seroconversion Rate of Hepatitis A in Central Region of Korea / 대한소화기학회지

BACKGROUND/AIMS: Acute hepatitis A (HAV) is markedly increasing recently on. Some patients with acute hepatitis A show severe clinical course. The seroprevalence rate of IgG anti-HAV has been changing with the regions and the times. Vaccination and seroconversion rate of HAV are not well known. In this study, we aimed to study the difference of seroprevalence rate of IgG anti-HAV according to various clinical factors and to know the vaccination rate and seroconversion rate below 10 years old in the central region of South Korea including Cheonan city. METHODS: Seven hundred seventy two subjects were included in the study from January to September 2009. We analyzed seroprevalence rate of IgG anti-HAV according to sex, age, region, and other viral markers. We interviewed the history of vaccination(1st, 2nd) and analyzed seroconversion rate according to vaccination time below 10 years old. RESULTS: The total seroprevalence rate of IgG anti-HAV was 65.3%. The seroprevalence rate of IgG anti-HAV rate in 2nd, 3rd, and 4th decade was very low (1.9%, 18.8%, 44.8%). The vaccination rate of children was about 50%. The seroconversion rate after 1st, and 2nd vaccination were 85%, 96%. CONCLUSIONS: Catch-up vaccination for teenagers and young adults is needed. Immunizing children with HAV vaccine as a routine schedule should be considered.

Two Granular Cell Tumors of the Colon with the Endosonographic Features / 대한소화기내시경학회지

Granular cell tumor is relatively uncommon, it is usually benign and it can be located anywhere throughout the body. It is uncommon in the digestive tract, and especially in the colon and rectum. The endosonographic features of granular cell tumor are usually a relatively hypoechoic, heterogenous lesion in the submucosa, but this tumor has rarely been reported in the colon. We report here on two cases of granular cell tumors of the colon that were observed by using endoscopic ultrasonograpy for making the differential diagnosis of a submucosal tumor and these tumors were confirmed by microscopic examinations after endoscopic mucosal resection.

Phlebosclerotic Colitis in a Cirrhotic Patient with Portal Hypertension: The First Case in Korea

Phlebosclerotic colitis is a rare form of ischemic colitis characterized by the thickening of the wall of the affected colon due to fibrous degeneration of submucosal layer of colon and fibrotic obstruction of the colono-mesenteric vein, resulting in the disturbance of venous return from the colon. The pathogenic mechanism of this entity remains unknown but chronic liver disease with portal hypertension is maybe thought to be one of the speculated mechanisms. Here we first report the case of surgically confirmed phlebosclerotic colitis, that was in the early stage but showed the aggressive nature, in a 61-yr-old cirrhotic patients with portal hypertension in Korea.

A Case of Delayed Massive Hemorrhage after Endoscopic Resecting a Rectal Carcinoid Tumor / 대한소화기내시경학회지

Endoscopic resection is currently accepted as a standard therapy for colon polyp because of its safety and efficiency. The indications for endoscopic resection have been expanded to treat mucosal colon cancer and submucosal tumor. The major complications of endoscopic resection are hemorrhage, perforation and post- polypectomy coagulation syndrome. Hemorrhage is the most common complication, and this can occur immediately following colonoscopic polypectomy or it can be delayed after completion of the procedure. Delayed hemorrhage usually occurs within 7 days and this can stop by itself or the hemorrhage can be controlled endoscopically in the majority of patients, with only the unusual and serious cases requiring transfusion, angiography and surgery. We experienced a case of delayed massive hemorrhage with hypotension that required transfusion 12 days after performing endoscopic resection for rectal carcinoid tumor. We report here on this case to provide a good example and to place emphasis on delayed massive hemorrhage after endoscopic resection.

Common Bile Duct Obstruction Caused by Tumor Thrombus after Trans-arterial Chemoembolization in a Hepatocellular Carcinoma Patient / 대한소화기내시경학회지

The jaundice in hepatocellular carcinoma patient can be found when the tumor progresses or hepatic function deteriorates. Rarely, it can be occurred when the bile duct is obstructed. The main reason of obstructive jaundice in hepatocellular carcinoma is bile duct invasion of tumor, tumor thrombus, blood clot of hemobilia and direct bile compression by tumor or metastatic lymph node. Although the tumor thrombi among them is difficult to think, prompt diagnosis and treatment should be done because the symptom and prognosis can be improved by removal of the tumor thrombus. We experienced a case of hepatocellular carcinoma patient associated with obstructive jaundice caused by tumor thrombus after transarterial chemoembolization (TACE). The tumor thrombus was removed by endoscopic retrograde cholangiopancreatography (ERCP) and confirmed as degenerated hepatocellular carcinoma cell.

Down-regulation of survivin in growth inhibition of hepatoma cells induced by a selective cyclooxygenase-2 inhibitor / 대한간학회지

BACKGROUND/AIMS: Cyclooxygenase-2 (COX-2) inhibitors reportedly inhibit the growth of hepatocellular carcinoma (HCC) via caspase-dependent or caspase-independent apoptosis, which is due to COX-2 being associated with hepatocarcinogenesis. Survivin is highly expressed in most human cancers, but the mechanism regulating survivin expression remains unclear. We investigated the regulatory expression of survivin in selective-COX-2-inhibitor-induced growth inhibition of hepatoma cells. METHODS: After treatment with NS-398 (a selective COX-2 inhibitor) at various concentrations (10, 50, 100, 150, and 200 micrometer), the growth inhibition of Hep3B hepatoma cells was assessed by an MTT cell-viability assay, DNA fragmentation gel analysis, and flow cytometry. The expression of survivin transcript was analyzed by reverse-transcription polymerase chain reactions. RESULTS: NS-398 inhibited the growth of hepatoma cells by an amount dependent on the concentration and the time since treatment. Apoptotic DNA ladder and flow-cytometry shifting to the sub-G1 phase were revealed in NS-398-induced growth inhibition of hepatoma cells. NS-398 suppressed the expression of the survivin gene in a concentration- and time-dependent manner. CONCLUSIONS: Survivin was down-regulated in the growth inhibition of hepatoma cells induced by a selective COX-2 inhibitor, NS-398, in a concentration- and time-dependent manner. These results suggest the therapeutic inhibition of COX-2 via suppression of survivin in HCC.

A Case of Hepatocellular Carcinoma Presented as a Huge Intrahepatic Hematoma / 대한소화기학회지

Spontaneous intrahepatic bleeding is a rare condition. In the absence of trauma, intrahepatic hematoma may be due to underlying liver disease. We report a case of hepatocellular carcinoma in the patient who had huge intrahepatic hematoma without definite intrahepatic tumor at the time of initial presentation. A 54-year-old man was admitted to our hospital with a sudden onset of upper abdominal pain. Initial abdominal CT scan showed huge hematoma measuring more than 13 cm in diameter in the right lobe of the liver. However, there was no enhancing lesion in the liver. Laboratory data showed high alanine aminotransferase, alpha-fetoprotein and positive HBsAg. The MRI and angiography could not also depict any mass in the liver. The patient was treated with percutaneous drainage on the intrahepatic hematoma. The cytology from drainaged blood revealed no malignant cell. After hematoma decreased, follow-up CT scan depicted an enhancing tumor in the liver. He underwent right hepatic lobectomy and histopathological examination showed hepatocellular carcinoma.

Clinical, Radiological and Pathological Exploration of Focal Nodular Hyperplasia of Liver Reported in Korea / 대한소화기학회지

BACKGROUND/AIMS: Focal nodular hyperplasia (FNH) is mandatory to be differentiated from other hepatic tumorous conditions such as hepatocellular carcinoma and adenoma. The purpose of this study was to explore the clinical, radiological and pathological features of FNH cases reported in Korea. METHODS: We have searched the journals from the web site "http://koreamed.org" using keywords "focal nodular hyperplasia" and "liver" - total of 38 cases of FNH, 37 cases from 17 published articles and one case from our experience confirmed histologically, were reviewed and analyzed. RESULTS: Thirty eight cases were diagnosed between gestational age of 36 weeks and 67 years. Seventeen female patients (45%) had no history of taking oral contraceptives. Twenty cases (52.6%) experienced clinical symptoms such as abdominal pain and palpable mass. Computed tomography revealed contrast-enhancement in 34 nodules (85%) and typical central stellate scar in 9 (22.5%) of 40 nodules. Magnetic resonance imaging showed T1 weighted low signal in 18 (60%) and T2 weighted high signal in 22 (73.3%) of 30 nodules. Six (60%) of 10 cases showed hypervascular staining on hepatic angiography. Among 38 cases, 32 (84.2%) cases had single nodule and their mean size was 3.9 cm (0.5-16 cm). Pathologically, fibrous septa, proliferation of bile ductules and arterial wall thickening were seen in most cases. CONCLUSIONS: Of all the FNH cases reported in Korea, there were some differences in clinical aspects of sex ratio, accompanying clinical symptoms, and relationship with oral contraceptives, compared with previous reports. Further prospective studies are needed by means of nation-wide clinical survey and analysis.

Peripheral nitric oxide activity in patients with liver cirrhosis / 대한내과학회지

BACKGROUND: Nitric Oxide (NO) induced by NO synthase is known to be associated with hyperdynamic circulation and collateralization by vascular remodeling in patients with cirrhosis. METHODS: To assess the significance of peripheral NO activity in patients with cirrhosis, we measured the production of NO metabolites, nitrate and nitrite, using the nitrate/nitrite colorimetric assay with Griess reagents in the peripheral venous blood of 95 cirrhotic patients with or without clinical portal hypertension (PHT), and in the peripheral venous blood of 32 control patients without liver disease. RESULTS: The peripheral NO activities in cirrhotic patients with clinical PHT, cirrhotic patients without clinical PHT, and non-liver disease control patients were 86.1+/-40.6 micro mol/L, 83.5+/-47.2 micro mol/L and 52.3+/-38.4 micro mol/L, respectively. NO activity was significantly higher in cirrhotic patients than in non-liver disease control patients (p<0.05), while there was no significant difference of NO activity between the cirrhotic patients with or without clinical PHT. Peripheral NO activities in cirrhotic patients with Child-Pugh classification A, B, and C were 84.9+/-45.5 micro mol/L, 81.9+/-53.2 micro mol/L and 86.4+/-39.8 micro mol/L, respectively; these results were not significantly different. A significant correlation of NO activity with the biochemical profiles of the serum albumin level, bilirubin level and prothrombin time were not defined. CONCLUSIONS: Peripheral NO activity was increased in cirrhotic patients, but it did not reflect the degree of clinical portal hypertension and the function of the hepatic reserve in this study. For a precise analysis of the association of NO and hyperdynamic circulation with collateralization in cirrhosis, intrahepatic or portal NO activity might be considered rather than peripheral NO activity.

A Case of Early Gastric Adenocarcinoma Mimiking a Submucosal Tumor / 대한소화기내시경학회지

Early gastric adenocarcinoma with the endoscopic features resembling a submucosal tumor is extremely rare and is characterized by erythema, central depression and erosion on the surface of the lesion, which can be distinguished from submucosal tumor. When a tumor is completely covered with normal mucosa, it is extremely difficult to obtain endoscopic biopsy specimens from the underlying lesion. EUS alone is not necessarily diagnostic. Various techniques have been advocated to overcome this problem, including US-guided biopsy, partial removal by an endoscopic snare excision, endoscopic mucosal resection as well as EUS with FNA. We encountered a case of an early gastric adenocarcinoma with well differentiation, presenting as a submucosal tumor. The early gastric adenocarcinoma was evaluated by endoscopy and EUS, and was confirmed by a surgical resection. We report this case with a review of the relevant literature.

A Case of Severe Skin Eruption Caused by Lamivudine in a Patient with Chronic Hepatitis B / 대한소화기학회지

Lamivudine is widely used for the treatment of chronic hepatitis B infection because of it's remarkable antiviral efficacy and safety. We report a case of severe skin eruption caused by lamivudine. A 47-year-old female was admitted because of jaundice and itching sensation. She was diagnosed as chronic hepatitis B infection a few years ago but did not receive any specific treatment. Laboratory data showed acute deterioration of chronic hepatitis B infection. We prescribed lamivudine as a rescue therapy. Her general condition improved and lab data showed improvement in liver function test thereafter. However, she complained of severe skin eruption and itching sensation a few days after the discharge. We stopped lamivudine because the symptoms did not improve despite the use of anti-histamine. Skin biopsy showed interface dermatitis. After stopping lamivudine, her symptoms improved. However, the skin eruption developed again after lamivudine was restarted. Adefovir was used instead, and the patient did not experience any further skin problems since then.

A Case of Spontaneous Pneumomediastinum and Pneumopericardium in a Patient with Acute Exacerbation of Idiopathic Pulmonary Fibrosis / 결핵

Background: Spontaneous pneumopericardium is a very rare condition. Spontaneous pneumothorax and pneumomediastinum have been reported to be associated with an idiopathic pulmonary fibrosis (IPF). However, spontaneous pneumopericardium has not yet been reported in association with IPF. Here we report a case of spontaneous pneumomediastinum and pneumopericardium in a patient with acute exacerbation of IPF with a review of the relevant literature.

Triptolide-induced Transrepression of IL-8 NF-kappaB in Lung Epithelial Cells / 결핵

BACKGROUND: NF-κB is the most important transcriptional factor in Il-8 gene expression. Triptolide is a new compound that recently has been shown to inhibit NF-κB activation. The purpose of this study is to investigate how triptolide inhibits NF-κB-dependent IL-8 gene transcription in lung epithelial cells and to pilot the potential for the clinical application of triptolide in inflammatory lung diseases. METHODS: A549 cells were used and triptolide was provided from Pharmagenesis Company (Palo Alto, CA). In order to examine NF-κB-dependent IL-8 transcriptional activity, we established stable A549 IL-8-NF-κB-luc. cells and performed luciferase assays. IL-8 gene expression was measured by RT-PCR and ELISA. A Western blot was done for the study of IκBα degradation and as electromobility shift assay was done to analyze NF-κB DNA binding. p65 specific transactivation was analyzed by a cotransfection study using a Gal4-p65 fusion protein expression system. To investigate the involvement of transcriptional coactivators, we perfomed a transfection study with CBP and SRC-1 expression vectors. RESULTS: We observed that triptolide significantly suppresses NF-κB-dependent IL-8 transcriptional activity induced by IL-1β and PMA. RT-PCR showed that triptolide represses both IL-1β- and pMA-induced IL-8 mRNA expression and ELISA confirmed this triptolide-mediated IL-8 suppression at the protein level. However, triptolide did not affect IκBα degradation and NF-κB DNA binding. In a p65-specific transactivation study, triptolide significantly suppressed Gal4-p65TA1 and Gal4-p65TA2 activity suggesting that triptolide inhibits NF-κB activation by inhibiting p65 transactivation. However, this triptolide-mediated inhibition of p65 transactivation was not rescued by the overexpression of CBP or SRC-1, thereby excluding the role of transcriptional coactivators. CONCLUSIONS: Triptolide is a new compound that inhibits NF-κB-dependent IL-8 transcriptional activation by inhibiting p65 transactivation, but not by an IκBα-dependent mechanism. This suggests that triptolide may have a therapeutic potential for inflammatory lung diseases.

A Case of Complete Agenesis of Dorsal Pancreas / 대한소화기내시경학회지

Agenesis of dorsal pancreas is a rare congenital anomaly that arises from the failure of the dorsal pancreatic bud of endodermal cells to form the body and tail of the pancreas. It may be associated with diabetes mellitus, pancreatic exocrine dysfunction, or abdominal pain. Complete or partial agenesis of dorsal pancreas has been reported in a small number of pediatric and adult patients. A case is herein described involving a complete agenesis of dorsal pancreas and diabetes mellitus. A 38-year-old man with a 7-months history of non-insulin dependent diabetes mellitus was admitted due to weight loss and abdominal pain. Abdominal ultrasonography and computed tomography showed a normal biliary tree and enlarged head of the pancreas without visualization of the pancreatic body and tail. Endoscopic retrograde cholangiopancreatography (ERCP) revealved the short duct of Wirsung in the uncinate process and a head without opacification of any ducts in the pancreatic body or tail. The patient underwent explo-laparotomy for evaluation of the suspected pancreatic cancer. The patient was diagnosed as having complete agenesis of the dorsal pancreas by ERCP, CT, and surgery.

Cervical tuberculous lymphadenitis : Clinicopathological reatures and AFB positivity / 결핵

BACKGROUND: Histological analysis of tuberculosis shows a spectrum of findings, from well formed granulmatous inflammation with few bacilli in patient with normal immune response to M. tuberculosis to poorly formed granulomatous inflammation with many bacilli in patient with defective immune response. To evaluate the degree of immune response to M. tuberculosis, we studied the histologic features, including the presence of acid fast bacilli(AFB) in lymph node of patients with cervical tuberculous lymphadenitis, and compared them with clinical characteristics. METHODS: We reviewed the histologic features of 33 cases of cervical tuberculous lymphadenitis and processed the excised nodes for auramine-rhodamine staining to detect AFB. The AFB positivity in tissue was compared with the histologic features(degree of granuloma formation, presence of caseation necrosis, presence of neutrophilic infiltration) and clinical characteristics (lymph node size, duration of symptom, presence of local symptom or radiologic evidence of pulmonary tuberculosis). RESULTS: 1) The mean age at diagnosis was 42.4 years, and male to female ratio was 1 : 45. 2) Histologically, all cases showed well formed granuloma and variable degrees of caseation necrosis, and 39% of the cases showed neutrophilic infiltration in the granulomatous inflammation. 3) AFB were confirmed in 52% of the cases, and they were found extracellularly and at the periphery of caseation necrosis. 4) There was no association between AFB Positivity and histological features or clinical characteristics. CONCLUSION: Cervical tuberculous lymphadenitis showed well formed granulomatous inflammation with caseation necrosis, and there was no association between AFB positivity in the tissue and histological or clinical characteristics.