Expression of Peroxisome Proliferator-activated Receptor (PPAR)gamma in Helicobacter pylori-infected Gastric Epithelium / 대한소화기학회지

BACKGROUND/AIMS: Peroxisome proliferator-activated receptorgamma (PPARgamma), a nuclear transcription factor, plays a critical role in the regulation of gene expression associated with inflammation and cancer. PPARgamma is expressed in human gastric cancer as well as in colon cancer. Activation of PPARgamma by ligand produces pro-apoptotic effect and ameliorate growing of cancer cells. Helicobacter pylori (H. pylori) is a main etiologic agent for gastric inflammation, and raises cell turnover in gastric epithelium. Longstanding infection with this organism is related with the development of non-cardiac gastric cancer. The aim of this study was to investigate the effect of H. pylori on the expression of PPARgamma protein and mRNA in chronic gastritis. METHODS: Gastric biopsy samples were taken from H. pylori infected (n=18) and non-infected (n=21) patients during endoscopic examination. PPARgamma expressions were assessed by real time polymerase chain reaction and immunohistochemistry. RESULTS: PPARgamma was localized to the nuclei of the foveolar epithelial cells in both infected and non-infected mucosa. PPARgamma protein expression was higher in H. pylori infected patients than in non-infected patients (3.8+/-0.4 vs. 2.6+/-1.0, H. pylori infected and non-infected, respectively; p<0.05). However, PPARgamma mRNA levels were not significantly different between the two groups (24+/-18 vs. 29+/-25, H. pylori infected and noninfected, respectively). CONCLUSIONS: PPARgamma expression is increased in the gastric mucosa of H. pylori infected chronic gastritis, which suggests a certain role of PPARgamma in the mucosal inflammatory reaction to H. pylori infection.

Interobserver Agreement among Experts in Determining the Depth of Invasion of Early Colorectal Carcinoma / 대한소화기내시경학회지

BACKGROUND/AIMS: Discrimination between mucosal and submucosal colorectal cancer is important because of different therapeutic plan. Although many characteristic endoscopic findings suggesting submucosal cancer were demonstrated, there are few reports about diagnostic accuracy and interobserver agreement among experienced endoscopists. So we studied about diagnostic accuracy and interobserver agreement about the diagnosis of submucosal invasive colorectal carcinoma by endoscopic findings. METHODS: Fifty patients (58% male, mean age 64 years) diagnosed pathologically as early colorectal carcinoma after polypectomy and operation were randomly selected. Fifteen cases were submucosal invasive colorectal carcinoma. Three experienced endoscopists (A, B and C) blinded to the patient's data reviewed photographs. RESULTS: Diagnostic accuracy of submucosal cancer by A, B and C were 82%, 74% and 78%, respectively. A to B and A to C showed moderate agreement in the diagnosis of submucosal invasion (kappa=0.504 and kappa=0.649). However, agreement power between B and C was somewhat weak (kappa=0.298). Among endoscopic findings, three experts strongly agreed on the features of white spots, hemorrhage and exudate (kappa=0;73, kappa=0.649 and kappa=0.641, respectively). CONCLUSIONS: Interobserver agreement in the diagnosis of submucosal colorectal carcinoma was moderate among three experts. More meticulous effort to improve interobserver agreement and accuracy in the diag- nosis of submucosal invasive colorectal carcinoma is mandatory.

A Case of Pulmonary Thromboembolism in Active Ulcerative Colitis / 대한소화기학회지

Thromboembolic disease is a significant cause of morbidity and mortality in patients with inflammatory bowel disease. The reported incidence is 1-6%. The most common thromboembolic complications are deep venous thrombosis of legs and pulmonary thromboembolism. Cerebral thrombosis, portal vein thrombosis, retinal venous thrombosis and arterial thrombosis were also reported. We experienced a case of ulcerative colitis complicated with pulmonary thromboembolism. The patient was a 70-year-old woman who was diagnosed as ulcerative colitis on colonoscopy. We used prednisolone and sulfasalazine for the treatment of ulcerative colitis. Twenty five days later, she complained of abrupt dyspnea and chest pain. Chest CT and ventilation-perfusion scan revealed a thromboembolism in both lung. After the treatment of heparin & warfarin therapy, follow-up chest CT showed much regressed pulmonary thromboembolism. We report a 70-year-old woman with ulcerative colitis complicated with pulmonary thromboembolism and treated with heparin & warfarin therapy successfully.

A Case of Hemorrhagic Colitis Complicated by Thrombotic Thrombocytopenic Purpura / 대한소화기내시경학회지

Hemorrhagic colitis may be seen as a complication of inflammatory bowel disease, as well as infectious colitis related to several pathogens, including enterohemorrhagic E. coli, Shigella, Yersinia and Campylobacter. Also, it is seen in the form of antibiotic-associated hemorrhagic colitis. However, Escherichia coli serotype O157:H7 is now recognized as an important identifiable cause of hemorrhagic colitis. Occasionally, patients with E. coli serotype O157:H7 infection are diagnosed as having thrombotic thrombocytopenic purpura (TTP), a condition similar to hemolytic uremic syndrome (HUS) but with more prominent neurological findings and less renal involvement. We report a case in a 47-year-old woman who developed hemorrhagic colitis complicated by TTP, responded to steroid and antibiotic treatment.

Fatal Cytomegalovirus Pneumonia in a Immunocompetent Patient / 감염

Serious cytomegalovirus (CMV) infection occurs frequently in immunocompromised patients and is a common cause of death. Although primary infection in immunocompetent hosts is normally subclinical, mononucleosis-like syndrome that is characterized by malaise, protracted fever, mild liver function abnormalities, and lymphocytosis with atypical lymphocytes occurs in -10% of patients. Rarely fulminant infection may develop. In both the United States and the United Kingdom, ganciclovir and foscarnet are recommended for the treatment of serious CMV infections in immunocompromised patients. In contrast, there are no recommendations for treatment of severe CMV disease in immunocompetent patients. We describe a case of 45-year-old woman with CMV pneumonia with a fatal outcome for whom there was no evidence of prior immunodeficiency.

Three Cases of Double Pylorus Due to Gastroduodenal Fistula Complicating Peptic Ulceration: Disappearance of gastroduodenal fistula in 1 case after eradication of a Helicobacter pylori infection / 대한소화기내시경학회지

Double pylorus is either a congenital abnormality or an acquired complication of peptic ulcer disease. An accessory channel normally connects the lesser or greater curvatore of the prepyloric antrum with the duodenal bulb. Three cases of double pylorus, an unusual complication of peptic ulcer disease is herein reported. A peptic ulcer lay in the accessory channel in all cases. In one of the cases, the fistula closed spontaneously after Helicobacter pylori eradication. The remaining 2 patients became asympto-matic despite the persistence of the accessory channel.

Delayed Hemolytic Transfusion Reaction Caused by Anti-Jkb Antibody in a Renal Transplant Recipient / 대한신장학회잡지

We report a case of 46-year-old women who suffered from delayed transfusion hemolytic anemia due to anti-Jkb antibody after renal transplantation. The patient had been treated with hemodialysis and had a past history of multiple transfusion. On the second postoperative day, she received 2 units of packed red cell. During transfusion, she complained of mild chest tightness only, but 10 days later, anemia of unknown origin developed. Irregular antibody was found in her serum and identified as anti- Jkb antibody. Together with other serologic findings, she was diagnosed as delayed hemolytic transfusion reaction due to anti -Jkb antibody. We thought that this reaction might be the amnestic response to previous exposure during delivery or remote multiple transfusion. Our patient responded to steroid and plasmapheresis and recovered without severe hemolytic transfusion reaction. In conclusion, antibody screening tests and identification test might be considered as a routine pretransfusion test for all renal recipients for safe transfusion practices.

A Case of Liver and Spleen Abscesses Secondary to Yersinia Enterocolitica Septicemia in a Chronic Renal Failure Patient on Hemodialysis / 대한신장학회잡지

Yersinia enterocolitica, a gram-negative rod-like organism, has been recognized as an uncommon human pathogen producing a wide spectrum of clinical manifestations. It has been associated with gastroenteritis, acute ileitis, mesenteric lymphadenitis, and erythema nodosum. More recently polyarthritis, chronic arthritis, and Reiter syndrome have been related to previous infection with these organism. Liver and splenic abscesses have been found rarely in Yersinia enterocolitica bactermia, and these have not been reported yet in Korea. We report a case of multiple liver and splenic abscesses secondary to Yersinia enterocolitica septisemia in a chronic renal failure patient on hemodialysis.

A Case of Mucormycosis Obstructing the Trachea / 결핵

Mucormycosis is the common name given to several different diseases caused by fungi of the order Mucorales. The mucoraceae are ubiquitous fungi and are common inhabitants of decaying matter. In contrast to the widespread distribution of these fungi disease in humans is limited, in most case, to people with severe immunocompromised, diabetes mellitus, or trauma. The fungus gains entry to the body through the respiratory tract. The spores are presumably deposited in the nasal turbinates and may be inhaled into the pulmonary alveoli The manifestations of mucormycosis are rhinocerebral, pulmonary, cutaneous, gastrointestinal, central nervous system, and miscellaneous. Sporadic reports can be found of mucormycosis involving other areas : heart, bones, kidney, bladder, mediastinum, and trachea. However, isolated tracheal mucormycosis is very rare. Therefore, we report a 57-year old, noninsulin dependent diabetic woman who presented with acute, severe degree of upper airway obstruction due to isolated mucormycosis of the trachea.