Associations between Nonalcoholic Fatty Liver Disease and Colorectal Adenoma in Health Screen Examinees / 대한소화기내시경학회지

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) and colorectal cancer share several risk factors. However the relationship between NAFLD and colorectal adenoma is unclear. Therefore, we investigated the possibility of an association between NAFLD and colorectal adenoma. METHODS: We reviewed the records of 3,106 subjects who had undergone colonoscopy and abdominal ultrasonography between April 2007 and August 2009. RESULTS: The sex ratio (male/female) was 4.94:1 and the mean age was 50.6+/-9.7 years in patients with colorectal adenoma; the corresponding numbers were 2.23: 1 and 45.0+/-9.2 years in patients without colorectal adenoma (p<0.001). The prevalence of NAFLD was 26.0% in the adenoma group and 21.4% in the control group (p=0.013). Additionally, there were positive associations between colorectal adenoma and BMI and lipid profile. Among the risk factors selected by univariate analysis, older age (OR 2.592; 95% CI 2.087~3.219), and being male (OR 2.470; 95% CI 1.878~3.247) were independent risk factors for colorectal adenoma. Patients with NAFLD had more colorectal adenomas (p=0.005) and their adenomas were located more in the proximal colon (p=0.009). CONCLUSIONS: NAFLD is not associated with increased risk for colorectal adenoma. However, among patients with NAFLD, colorectal adenomas were likely to be increased in number and they were likely to be located in the proximal colon.

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.

Transient Intesinal Obstruction Due to Stool Impaction in the Elderly / 대한소화기학회지

BACKGROUND/AIMS: Acute intestinal obstruction is an urgent disease to be diagnosed and treated promptly. In elderly, fecal impaction may be an important and preventable cause of colonic obstruction. We investigated the clinical features of patients presenting with denical features of intestinal obstruction transiently due to fecal impaction. METHODS: From February 2001 to March 2004, nineteen patients were diagnosed as transient intestinal obstruction due to fecal impaction. We evaluated clinical characteristics, radiologic findings, sigmoidoscopic or colonoscopic findings and managements. RESULTS: Male and female ratio was 1:1.1. Mean age was 79.3 years. All 19 patients had abdominal pain and distension. On digital rectal examination, the hard feces was palpable in only 8 patients (42%) while others showed empty rectum. The abnormal laboratory findings included leukocytosis in 5 patients (26%), anemia in 10 patients (53%) and electrolyte abnormalities in 7 patients (37%). Simple abdominal X-rays showed diffuse small and/or large bowel dilatations. In only 3 patients (16%) air-fluid levels were definite, but most patients showed abundant feces in the rectum and colon. During emergency sigmoidoscopy, abdominal pain and distension were relieved and there were Bristol type 1 hard stool in the recto-sigmoid junction in 7 patients (37%) and multiple rectal ulcers in 1 patient. On colonoscopy, there were no mass or pathologic obstruction in all patients. Patients were discharged after the adequate medication and toilet training. CONCLUSIONS: In elderly patients, fecal impaction is odd and preventable cause of intestinal obstruction. It is often significant to differentiate fecal impaction from other pathologic conditions in patients with chronic constipation.

A Case of Coffee Enema-Induced Colitis / 대한소화기내시경학회지

A coffee enema which has been suggested as a part of a cancer treatment, has been misused as a treatment for obesity and constipation among the general population. Its proponents claim that caffeine is absorbed in the colon, which leads to vasodilatation in the liver and stimulation of the hepatocellular function to detoxify the products of the tumor cell metabolism. However, the clinical efficacy of the anti-cancer effect of coffee enemas has not been demonstrated. Many side effects of coffee enemas have been reported. These include severe electrolyte imbalance, polymicrobial enteric septicemia, and even death. We experienced a patient who presented with abdominal pain and a bloody stool after receiving a coffee enema to relieve constipation. We report this case of coffee enema-induced colitis with a review of the relevant.

A case of hypersensitivity associated with oral aloe agent / 천식및알레르기

Aloe has been widely used as folk medicine for centuries, especially for skin injury and burns. The aloes consisted of various substances including highly sensitizing agent, anthraquinone and there are few reports of hypersensitivity to aloe in the medical literatures. We report herein a case of hypersensitivity associated with oral aloe agent. A 36-year-old woman was referred for recurrent pruritic hives on various parts of her body 3 days ago. She had been admitted with acute urticaria and hepatitis in another hospital 20 days previously and discharged 1 week ago. On detailed medication history, she had been consuming oral aloe agent since 1 month ago and developed pruritic hives and athralgia following ingestion of oral aloe agent. Abnormalities of liver function were also shown. The patient underwent allergic skin test and showed positive response to aloe.