The Effect of ER:YAG Laser & ER,CR:YSGG Laser on the Tissue of the Inflammation-Induced Mouse

A Case of Duodenal Diverticulitis / 대한소화기내시경학회지

Duodenal diverticulitis is difficult to diagnose because it can mimic other common diseases such as cholecystitis and perforated ulcer. Recently, we experienced a rare case of duodenal diverticulitis that was initially suspected on abdominal computed tomography as focal pancreatitis. Although duodenal diverticulitis has been increasingly recognizable before surgery, with the advent of multi-detector computed tomography, misdiagnosis remains problematic since duodenal diverticulitis is commonly not considered in the differential diagnosis of acute abdominal pain. We have to consider this rare disease entity because delayed diagnosis might be a cause of substantial morbidity and mortality.

A Case of Early Bile Duct Cancer Arising from Villous Adenoma in Choledochal Cyst / 대한소화기학회지

Choledochal cyst is an uncommon premalignant anomaly. The morphology and pathogenesis of the premalignant lesion of cholangiocarcinoma arising from the choledochal cyst has not been well described. Herein, we report a rare case of bile duct adenoma arising from choledochal cyst with anomalous union of pancreaticobiliary duct (AUPBD). 50-year-old woman was admitted to our hospital with the complaint of epigastric pain. She had received common bile duct (CBD) exploration and choledocholithotomy and cholecystectomy 3 months earlier under the diagnosis of multiple CBD stones. Intraoperalive cholangiogram was not remarkable except CBD dilatation at that time. Endoscopic retrograde cholangiopancreatography revealed choledochal cyst with AUPBD and round filling defect which disappeared easily on the balloon cholaniogram. On magnetic resonance cholangiopancreatography, the filling defect was confirmed as 2 cm polypoid mass attached to the distal bile duct wall. At laparotomy, a soft whitish mass was palpable on the lower CBD. On histological examination, adenoma with focal carcinoma change arising from choledochal cyst was diagnosed.

The analysis of synovial fluid by proteomics from TMD

Temporomandibular joint disorder (TMD) can induce severe pain but, its pathogenic mechanisms remain poorly understood. In this study, we analyzed proteomes of human synovial fluid in the superior joint space in the patients with TMD, which is obtained during the treatment arthrocentesis. We've got this result that one of the spots was consistently down-regulated in synovial fluid of patients with TMD from analysis of protein pattern. Its molecular weight was estimated to be 33 kDa. Synoviolin was identified in our proteomics analysis of LC/MS/MS. This protein was recently reported as one of the proteins that might affect rheumatoid arthritis (RA). Synoviolin that might be associated with RA was detected in synovial fluid of patients with TMD. We can conclude that synoviolin might be involved not only in the pathogenesis of RA but also in TMD. In result, synoviolin might be involved in the pathogenesis of TMD and can be candidates as new therapeutic targets of TMD or early detection biomarkers.

The analysis of synovial fluid by proteomics from TMD

Temporomandibular joint disorder (TMD) can induce severe pain but, its pathogenic mechanisms remain poorly understood. In this study, we analyzed proteomes of human synovial fluid in the superior joint space in the patients with TMD, which is obtained during the treatment arthrocentesis. We've got this result that one of the spots was consistently down-regulated in synovial fluid of patients with TMD from analysis of protein pattern. Its molecular weight was estimated to be 33 kDa. Synoviolin was identified in our proteomics analysis of LC/MS/MS. This protein was recently reported as one of the proteins that might affect rheumatoid arthritis (RA). Synoviolin that might be associated with RA was detected in synovial fluid of patients with TMD. We can conclude that synoviolin might be involved not only in the pathogenesis of RA but also in TMD. In result, synoviolin might be involved in the pathogenesis of TMD and can be candidates as new therapeutic targets of TMD or early detection biomarkers.

A Case of Anti-LKM 1 Positive Autoimmune Hepatitis Accompanied by Systemic Lupus Erythematosus / 대한소화기학회지

Overlap of autoimmune hepatitis and systemic lupus erythematosus (SLE) is a comparatively rare condition. Although both autoimmune hepatitis and SLE can share common autoimmune features such as polyarthralgia, hypergammaglobulinemia and positive ANA, it has been considered as two different entities. We report a case of anti-LKM1 positive autoimmune hepatitis who developed SLE two years later. The presence of interface hepatitis with lymphoplasma cell infiltrates and rosette formation points to the autoimmune hepatitis rather than SLE hepatitis. Autoimmune hepatitis is infrequently accompanied by SLE, therefore, it could be recommended to investigate for SLE in patients with autoimmune hepatitis.

The graft height changes after sinus augmentation procedures using deproteinized bovine bone mineral and beta-tricalcium phosphate: A retrospective comparative study using panoramic radiography

PURPOSE: Previous clinical investigations of sinus floor augmentation have demonstrated repneumatization of grafted sinus. The aim of this study is to evaluate and compare the height changes of sinus floor after grafting with deprotenized bovine bone mineral (DBBM) and beta tricalcium phosphate (TCP). MATERIALS AND METHODS: 34 sinuses in 28 patients were augmented with 100% DBBM or 100% TCP through lateral approaches. Sinusgraft height was measured before, immediately after, and 6 months after bone graft with panoramic radiography. RESULT: After 6 months, the decreases of graft heights were 14.53% for DBBM group and 15.15% for TCP group. There was no statistically significant difference. DISCUSSION AND CONCLUSION: Long-term stability of sinus-graft height represents an important factor for implant success. After the uses of DBBM and TCP for maxillary sinus floor augmentations, acceptable graft height maintenances were observed.

A Case of Diphyllobothrium latum Infection in a Patient with Abdominal Pain / 대한소화기학회지

The growing popularity of eating raw fish has resulted in increase of certain human parasitic infection, such as diphyllobothriasis. Even though, upper and lower gastrointestinal endoscopy reveal no specific abnormality, if a patient complains of persistent abdominal pain, we should consider the possibility of parasitic infection. Careful history taking and stool examination can avoid further invasive study. We report a case of Diphyllobothrium latum infection in a patient with vague abdominal pain who showed normal finding on endoscopy.

A Case of Sarcomatoid Hepatocellular Carcinoma in a Young Female without Risk Factor / 대한소화기학회지

A previously healthy 22-year-old woman was admitted with a complaint of right upper quadrant abdominal pain for 2 weeks. Her past history was not remarkable. On admission, HBsAg and anti-HCV were negative and alpha-FP was within normal range. Abdominal sonography and CT showed a mass in liver measuring 10 11 cm with features of central necrosis and hemorrhage. On 6th hospital day, hemoperitoneum developed suddenly. She underwent emergency laparotomy and trisegmentectomy. Intraoperative finding revealed a hemoperitoneum with a tumor filled with liquefied necrotic tissues. Microscopically, the tumor was mostly composed of pleomorphic spindle cells with abundant anastomosing vascular channels and partly composed of tumor cells with trabecular arrangement. On immunohistochemical staining, tumor cells reacted with cytokeratin and vimentin, while CD34 and hepatocyte staining revealed negative. She died 2 months after the operation. We report a case of rapidly deteriorated primary sarcomatoid hepatocellular carcinoma in a young female without any risk factor.

A Case of Lymphoepithelial Cyst of the Pancreas Showing Characteristic Findings on Endoscopic Ultrasonography / 대한소화기내시경학회지

Lymphoepithelial cyst of the pancreas is a rare benign cystic tumor which is histologically characterized by cyst containing keratin, lined by mature squamous epithelium surrounded by lymphoid tissue, often with prominent follicles. Cystic lesions of the pancreas are more often detected because sensitive abdominal imaging tests are used for multiple indications, but preoperative differential diagnosis is difficult despite the advancements of imaging technologies. We herein report a case of lymphoepithelial cyst incidentally found on routine abdominal ultrasonography which showed characteristic findings on endoscopic ultrasonography preoperatively and discuss the radiologic features of lymphoepithelial cyst.

A Case of Salmonella paratyphi Infection Manifested as Duodenal and Terminal Ileal Ulcers / 대한소화기내시경학회지

Infection due to Salmonella typhi and Salmonella paratyphi is called enteric fever which is manifested by fever, abdominal pain, and intermittently other gastrointestinal symptoms like vomiting and diarrhea. Although Salmonella species may invade any site of the gastrointestinal tract, it usually invades terminal ileum. The pathologic manifestation of salmonellosis may vary from nonspecific mucosal change (erythema, edema, ulceration etc.) of invaded site to intestinal perforation or hemorrhage. However, the report of upper gastrointestinal invasion by Salmonella species is rare, and confirmation by tissue culture is difficult because gastric acid and the normal propulsive peristaltic flow of the small bowel help to limit the bacterial populations of the upper gastrointestinal tract. We report here a case of Salmonella paratyphi infection proven by tissue culture in a 26-year-old man who presented with fever and watery diarrhea and was found to have multiple duodenal and terminal ileal ulcers.

A Case of Asymptomatic, Anicteric Early-stage Intrahepatic Ductal Cholangiocarcinoma / 대한소화기내시경학회지

Asymptomatic intrahepatic early-stage bile duct carcinoma without jaundice is difficult to diagnose because it does not have any characteristic clinical signs and symptoms. The clinical implication of early-stage intrahepatic ductal cholangiocarcinoma is great, because it allows curative resection and excellent long-term survival. Recently we experienced early-stage intrahepatic cholangiocarcinoma which was incidentally detected by a clue of elevated serum alkaline phosphatase and gamma-GT without jaundice and any symptoms. Abdominal US showed focal intrahepatic bile duct dilatation. ERCP could not demonstrate the lesion, while MRCP revealed the obstructed duct (S6) with proximal dilatation. For evaluation of a focal intrahepatic stricture, PTCS examination and biopsy were done. With the help of MRCP and PTCS, the lesion was diagnosed as papillary adenocarcinoma preoperatively. The patient was underwent right liver lobectomy and confirmed early-stage intrahepatic ductal adenocarcinoma and she is well-being without cancer recurrence for a follow-up period of 1 year.

Clinical Analysis of the Delayed Post-Traumatic Epidural Hematoma after Hematoma Evacuation

OBJECTIVE: The authors analyze the incidence, etiological and prognostic factors between contralateral and ipsilateral delayed epidural hematoma after evacuation of initial hematoma and to formulate recommendations for early detection of evolving hematoma and improvement of outcome. METHODS: Between July 1997 and December 1999, 417 patients underwent craniotomy at department of neurosurgery to evacuate an acute posttraumatic intracranial hematoma. Analysis of these clinical and neuroradiologic data showed that we underwent a second operation on 24 patient(5.8%) for removal of delayed epidural hematoma. In 10(2.4%) of these patients the second operation was undertaken to evacuate a new hematoma that had developed at a contralateral side from the initial hematoma. In 14 patients(3.4%), the second operation was to remove a epidural hematoma at the same site as the first craniotomy. RESULTS: 24 patients were divided into two groups. In Group A, 10 patients who developed contralateral delayed epidural hematoma were 31.5 years(11-61) of age and had skull fracture at the site of delayed epidual hematoma formation. Two of these patients revealed severe brain swelling during the evacuation of acute subdural hematoma. Eight of them were diagnosed within 24 hours after craniotomy through immediately postoperative computed tomography scan. In Group B, 14 patients who developed ipsilateral epidural hematoma were 56.1 years(27-75) of age. Six of them had hemorrhagic tendency related to past medical history. Eleven of these patients were associated with thrombocytopenia and consumptive coagulopathy when required second operation. Twelve patients were diagnosed within 48-72 hours after craniotomy due to clinical deterioration or failure to improve. There was no significant difference in outcome between two groups. CONCLUSION: The authors sought differential factors between contralateral and ipsilateral delayed epidural hematoma. Delayed epidural hematoma after craniotomy may need an urgent operation or lead to serious complication or disability. Postoperative computed tomography scan, intracranial pressure monitoring and repeat computed tomography scan within 72 hours of injury are strongly recommended in these cases, especially after decompression of cranial cavity.

Predictors of Outcome in Patients with Primary Achalasia Treated by Pneumatic Dilation / 대한소화기내시경학회지

BACKGROUND/AIMS: Pneumatic dilation is the most effective non-surgical treatment option for the patients with achalasia. The aim of this study was to determine the predictors of outcome after pnematic dilation in patients with primary achalasia. METHODS: Thrity-five patients with primary achalasia between May 1996 and April 2001 were included. They were divided into two groups; responder and nonresponder. Esophageal manometry, scintigraphy and barium esophagogram was performed before dilation and 4 weeks after dilation. RESULTS: Seven patients having symptomatic relapse were treated with repeated pneumatic dilation. Remaining 28 patients (83%) had no recurrence during follow-up period (mean duration 16 month, range 6~43 month). Among the factors evaluated in the initial examination, only young age affected outcome (p=0.039). The post treatment retention fraction at 5, 20 minutes were the most valuable factors for predicting the clinical response (p<0.05). CONCLUSIONS: Older patients are more likely to have sustained response. Radionuclide esophageal emptying test remains a useful objective study evaluating esophageal transit before and after pneumatic dilation in the patients with achalasia and may have an important role in the follow-up evaluation of treatment for achalasia.

A Case of Anomalous Drainage of the Common Bile Duct into the Duodenal Bulb Presenting with Obstructive Jaundice / 대한소화기내시경학회지

The common bile duct classically enters the posteromedial aspect of the second part of the duodenum through an oblique, 1 to 2 cm long intramural tunnel. Some case reports of the common bile duct emptying into other sites including the fourth part of the duodenum, the pyloric canal, stomach and duodenal bulb have appeared in the literature. We report a case of a 40-year-old man who showed anomalous drainage of the common bile duct into the duodenal bulb presenting with obstructive jaundice and duodenal ulcer. This patient required choledochoenteric anastomosis to relieve obstructive jaundice and abdominal pain. We report the case with a review of other cases in Korean literature.

Dural Arteriovenous Malformation on the Anterior Cranial Fossa

Dural arteriovenous malformations(AVM) are not uncommon. Reports of intracranial dural AVM have been increasing but most of them deal with dural AVM in the region of the cavernous sinus, posterior fossa and tentorium, but those of the anterior cranial fossa are very rare. Recently, we experienced two cases of right frontal dural arteriovenous malformation fed mainly by both ethmoidal arteries. The angiographic appearance in these two cases is quite uniform. The nidus was located in the frontal dura, although their main feeders were dural arteries. They were drained through an intracerebral cortical vein associated with aneurysmal dilatation of proximal portion into superior sagittal sinus. Spontaneous intracerebral hematoma was the cause of the clinical symptoms. We report two cases of intracerebral hematoma, caused by dural AVM, which was successfully managed by surgical treatment.

A Case of Papillary Adenocarcinoma of Intrahepatic Duct: Malignant Transformation from Papillary Adenoma / 대한소화기내시경학회지

Biliary papilloma usually consists of single or multiple papillary adenomas in the biliary tract and has a potential for recurrence and malignant transformation. We described herein a case of papillary adenoma of intrahepatic duct that transformed into papillary adenocarcinoma. A 49-year-old male patient was admitted to our hospital because of right upper quadrant pain. A CT scan revealed marked dilatation of S7 segmental duct and cholangioscopy and biopsy revealed mucin-secreting papillary adenoma in the right intrahepatic duct. Three years later, a follow up of CT scan showed aggravated S7 ductal dilatation and inner ill-defined mass. Cholangioscopy revealed multiple papillary mucosal projections with large amount of mucin in the right intrahepatic duct and biopsy revealed well differentiated papillary adenocarcinoma. The patient underwent right lobectomy, the papillary adenocarcinoma was extended in the dilated right intrahepatic duct and also showed hepatic parenchymal invasion.

Early Onset Cerebellar Ataxia with Retained Tendon Reflexes Developed in Brothers: Report of two cases

Early onset cerebellar ataxia with retained tendon reflexes is distinctive clinical syndrome characterized by progressive cerebellar ataxia of unknown etiology with an onset within the first two decades. This disorder was distinguished from Friedreich's ataxia by the preservation of the deep tendon reflexes. There is 22-year-old male with 13 year history of slowly progressive cerebellar ataxia and dysarthria. His elder brother, also, has milder clinical manifestations, electrophysiological and radiological abnormalities. We experienced two cases of early onset cerebellar ataxia with retained tendon reflexes developed in brothers which was diagnosed by clinical manifestations, electrophysiologic, radiologic studies and report with brief review of related literatures.