A Case of Rectal Squamous Cell Carcinoma Mistaken for Rectal Adenocarcinoma / 고신대학교의과대학학술지

We report a case of anal squamous cell carcinoma extended to the rectal mucosa that was clinically mistaken for rectal adenocarcinoma and literature reviwed. Sigmoidoscopic finding showed spherical shaped elevated lesion with central ulceration, interpreted as rectal adenocarcinoma in the distal portion of rectum. Anal squamous cell carcinoma is very rare among gastrointestinal cancer. Pathological study of the biopsy specimen demonstrated squamous cell carcinoma and normal rectal glands. Sigmoidoscopic finding of the presented case showed the ulcerarive lesion contineuosly extended from anal verge upward to the rectum. We postulate that the presented case is primarilly originated from the anal squamous cell carcinoma extended proximally to the rectum. Immunohistochemical stain(p-63) of the biopsy specimens showed squamous cell carcinoma. This patient has been completely recovered after treartment of chemoradiation and trans-anal excision. We present a case of anal squamous cell carcinoma invading rectal mucosa clinically mistaken for rectal adenocarcinoma and literature reviewed.

Importances of the Endoscope Cleaning and Disinfecion Techniques in the Prevention of Endoscopic Transmission of Helicobacter pylori / 대한소화기내시경학회지

BACKGROUND/AIMS: H. pylori has been implicated in the pathogenesis of chronic gastritis, gastric ulcer, duodenal ulcer, and gastric cancer. The mode of H. pylori spread among individuals still largely unknown, but three possibilities such as fecal-oral, oral-oral, and gastro-oral transmission were reported. We were not exclusive possibility of H. pylori infection via endoscopic equipmemt, because endoscope was inserted directly into the gastrointestinal tract. METHODS: Fifty eight patients with upper gastrointestinal symptoms, who had visited Pusan National University Hospital from February 1999 to May 1999 were examined endoscopically and two biopsies were taken in each antrum and fundus for rapid urease test. After endoscopy, we collected the washing fluid from the surface and channel of the endoscope before and after cleaning and disinfection. Then we examined H. pylori contamination by H. pylori DNA PCR. RESULTS: The numbers of chronic gastritis, gastric ulcer, duodenal ulcer, gastric ulcer with duodenal ulcer, and gastric cancer were 15, 20, 18, 3, and 2, respectively. The positive rates were 84.5% (49/58) with CLO test, 58.6% (34/58) with H. pylori DNA PCR of the washing fluid of the endoscope surface and channel. In patients with CLO test positive, the positive rates of H. pylori DNA PCR is 44.9% (22/49) in endoscope channel, 24.5% (12/49) in surface before disinfection, but H. pylori DNA was not detected in any cases after washing and disinfection recommended by The Korean Society of Gastrointestinal Endoscopy. CONCLUSIONS: This study demonstrates that endoscopes were frequently contaminated by H. pylori during procedures performed on H. pylori-positive patients and were a potential source of nosocomial spread of the infection. However, this study also shows that the risk of endoscopic transmission of H. pylori infection could be minimized when appropriate cleaning and disinfection techniques were used.

Endoscopic Retrograde Chalangiopancreatography (ERCP) in Obstructive Jaundice / 대한소화기내시경학회지

ERCP was performed in 34 cases of obstructive janndice at Busan National University Hospital between June 1981 and October 1982, and those findings were compared with the final surgical operative diagnoses. The results were as follows: 1) The ratio of male to female was about l. 6: 1 and most of them were in the 5th decade to 7th decade, 2) Upper abdominal pain and tenderness were the cardinal symptom and sign, 3) Successful ERCP was obtained in 32 cases among the total of 34 cases(94.1%)Selective success rates by indications were 77.8%(21/27) in suspected biliary lesions and 85.7%(6/7) in suspected panceatic lesions. 4) ERCP diagnoses were biliary stone(11 cases), eholangiocarcinoma(6 cases), pancreatic head ca. (4 cases), Ampulla of Vater ca. (2 cases), normal cholangiogram(2 cases), and normal parcreatogram(2 cases). 5) Eighteen cases out of 24 surgical operative cases were diagnosed by ERCP alone, The diagnostic rates of ERCP by surgical operation in obstructive jaundce was 75%. Complications of ERCP were not clinically significant. It suggests that ERCP is a very useful diagnostic method in the differential diagnosis of obstructive jaundice.