A Case of Bleeding Gastric Villous Adenoma Treated with Endoscopic Mucosal Resection / 대한내과학회지

Villous adenomas of the stomach are rare, although they more frequently occur in the colon and rectum. Clinical symptoms are similar to gastric polyps, but acute or chronic bleeding with anemia occurs frequently. The size of tumors varies between 4 and 6 cm, and the malignant potential is greater when the tumor is larger. Complete resection with surgery or endoscopic resection is the treatment of choice. Endoscopic findings revealed a dome-like or pedunculated appearance. Microscopically, the tumor was composed of long fronds and papillations covered by columnar epithelia with a reduced number of goblet cells. We report a case of polyps with chronic intermittent and acute bleeding for 6 months, which was alleviated by endoscopic mucosal resection and was confirmed as a villous adenoma.

A case of propofol-induced anaphylaxis / 대한내과학회지

Propofol is widely used for sedation during endoscopy. Hemodynamic compromise and respiratory depression might occur under propofol sedation, whereas anaphylaxis is rare. We recently experienced this rare side effect. A 71-year-old woman suffering from substernal chest discomfort underwent endoscopic examination under propofol sedation. She denied any history of allergic reaction to drugs or foods such as beans and eggs. After completion of the endoscopic examination, she developed a whole-body rash with pruritus and edema of her face, including the eyelids and lips. Hypotension was seen on physical examination, and her oxygen saturation was decreased on pulse oximetry. She recovered completely after treatment with epinephrine, an antihistamine, and steroids, with supportive care. Anaphylaxis to propofol is a rare side effect, and prompt treatment is mandatory when it develops.

Aortopulmonary fistula in Behcet's disease / 대한내과학회지

Arterial involvement of Behcet's disease (BD) includes arterial occlusions and aneurysms, of which aneurysms are the more common. Aortopulmonary fistula is an anomalous communication between the aorta and a segment of the tracheobronchial tree, and this may develop after thoracic vascular surgery and cause fatal hemoptysis. We experienced a case of BD in a 34-year-old man who was diagnosed as having an aortopulmonary fistula between the aortic pseudoaneurysm and the bronchus of the left upper lobe, and this developed after graft replacement surgery for aortic aneurysm.

Regulation of betaig-h3 Production in Rheumatoid Synovitis by Inflammatory Mediators / 대한류마티스학회지

OBJECTIVE: To investigate the expression pattern of transforming growth factor-beta-inducible gene-h3 (betaig-h3) within rheumatoid synovial tissue and the regulation of betaig-h3 synthesis in fibroblast-like synoviocyte (FLS). METHODS: Synovial tissues obtained from patients with rheumatoid arthritis and osteoarthritis were obtained during joint replacement surgery. betaig-h3 expression was evaluated with immunohistochemical stain. FLS was isolated from synovial tissues and stimulated with cytokines including TGF-beta, TNF-alpha, IL-1beta, IFN-gamma, IL-6, IL-4, and IL-10. betaig-h3 synthesis was measured using semiquantitative RT-PCR, ELISA, immunofluorescence stain, and flow cytometry. RESULTS: Expression of betaig-h3 was diffuse and abundant in both lining and sublining layers of rheumatoid synovium, which was more prominent than those of osteoarthritis. Production of betaig-h3 in FLS was regulated by TGF-beta1 in a dose-dependent manner and was highest at 5 ng/mL of TGF-beta1. TNF-alpha and IL-1beta upregulated the production of betaig-h3 from FLS synergistically with TGF-beta1 but other cytokines such as IL-4, IL-6, IL-10 did not affect. betaig-h3 synthesis was efficiently inhibited by dexamethasone at higher dose (100 nM) but not by cyclosporine-A. CONCLUSION: Production of betaig-h3, which is highly upregulated in rheumatoid synovitis, is differentially regulated by inflammatory cytokines.

MPO Gene Polymorphism in Behcet's Disease / 대한류마티스학회지

OBJECTIVE: Behcet's disease (BD) is a systemic vasculitis in which hyperfunction of neutrophils is one of the major pathophysiologic features. Myeloperoxidase (MPO) is an important neutrophilic lysosomal enzyme and has been implicated in tissue damage of BD. As the A allele of -463G/A polymorphism of the MPO gene is associated with diminished activity of MPO, we analyzed the association of -463G/A polymorphism of the MPO gene with BD. METHODS: We analyzed -463G/A polymorphism of the MPO gene in BD patients (n=101) and controls (n=138). Genotype of the MPO gene at position -463 was determined by PCR-RFLP assay using genomic DNA. RESULTS: The allele frequency of -463G/A polymorphism of the MPO gene did not deviate from the Hardy-Weinberg expectation in both BD patients and controls. There were no statistically significant differences in genotype distribution and allele frequency between patients and controls at position -463 (p=0.761 and p=0.549 respectively). Analysis of genotype distribution and allele frequency of the -463G/A according to sex did not show any difference between patients and controls. There were no statistically significant differences in clinical manifestations of BD among different genotypes. CONCLUSION: The present data indicate that the -463G/A polymorphism of the MPO gene was not associated with the susceptibility to and clinical manifestations of BD in Korea.

Subclavian artery stenosis in neurofibromatosis type 1 / 대한내과학회지

Vascular involvement in neurofibromatosis type 1 (NF1) is a well known but clinically underestimated phenomenon. Arterial stenosis and aneurysm have been reported and among the stenotic vasculopathy, renal artery stenosis is the most common type. On PubMed search, there have been 9 reported cases of subclavian arterial involvement in NF1, of which only one case showed subclavian arterial stenosis. We report a 41-year-old man with NF1 and a subclavian artery stenosis who was treated successfully with percutaneous transluminal angioplasty.

Prognostic Factors in Patients with Paraquat Poisoning and Effect of Hemoperfusion

PURPOSE: Paraquat is a nonselective contact herbicide that may induce damage to many organs poisoned with it. Due to the high mortality associated with paraquat poisoning, a prediction of the outcome is a prerequisite for determining the therapeutic modality. METHODS: To identify prognostic factors for paraquat poisoning, the authors analyzed retrospectively the clinical features and outcomes of 45 patients (mean age: 45.9 years; male-to-female ratio: 1.1 : 1) poisoned with paraquat herbicides; they had been admitted to the emergency room of Kyungpook National University Hospital between June 1992 and June 2001. RESULTS: Most patients (91.1%) ingested liquid paraquat concentrate; twenty-six (62%) patients had intended to commit suicide. The overall mortality rate was 64.4% (29 patients); the mortality rate with ingestion of more than two mouthfuls was 93.3%. Seventy-six percent of the fatal cases expired within 2 days after intoxication. Azotemia, hypokalemia, hypoalbuminemia, leukocytosis, and decreased level of arterial PaCO2 and bicarbonate on the first hospital day were significantly related with mortality. Increased level of serum AST on the 4th hospital day was an additional marker of mortality. The survival rates according to the Yamaguchi index were significantly different (A: 60%, B: 12.5%, C: 17%). There was no significant difference in the mortality rate between patients treated with and without hemoperfusion. CONCLUSION: Acid-base and electrolyte imbalances, an abnormal renal function, a low Yamaguchi index, and a positive urine paraquat test might be useful as early markers of poor prognosis. The effect of hemoperfusion remains to be determined by a further larger prospective study.