A Case of a Primary Esophageal Bezoar after a Total Gastrectomy / 대한소화기내시경학회지

An esophageal bezoar, although uncommon, is now recognized as a distinct clinical entity. An esophageal bezoar is rare but can form due to regurgitation of a gastric bezoar, motor disorder or anatomical abnormality, or following a gastrectomy. In general, bezoars are most often found in the stomach, and are formed by the accumulation of foreign ingested materials, including vegetable material and hair. In Korea, no case of a primary esophageal bezoar has been reported after a total gastrectomy. We report a case of an endoscopically treated primary esophageal bezoar that occurred after a total gastrectomy, without complications.

Clinical Observation of Colorectal Polyps / 대한소화기내시경학회지

BACKGROUND/AIMS: The detection and removal of colorectal polyps are important for secondary prevention of colorectal cancer. We investigated the characteristics and histopathologic finding of polyps to better plan their management. METHODS: We analyzed 334 patients who underwent polypectomies for 770 colorectal polyps between October, 2005 and April, 2007 at Bong Seng Memorial Hospital. RESULTS: Colorectal polyps were frequent in the sixth decade in both sexes. The ratio of male to female patients was 1.72:1. Abdominal pain/discomfort was the most common symptom (34.4%), and the most common site of polyp localization was the rectosigmoid colon. Histopathologic examination showed tubular adenomas (54.6%), hyperplastic polyps (36.4%), and inflammatory polyps (5.6%). Adenomatous polyps were more common in patients with multiple polyps than in patients with a single polyp. Adenomatous polyps with villous histology were more common in patients with large polyps than in patients with small polyps. Non-neoplastic polyps were common before the fifth decade. Neoplastic polyps were common past the fifth decade. CONCLUSIONS: In this study, tubular adenomas were frequently found on histopathologic examination, sessile type were frequently found on gross examination, and colorectal polyps were found principally in the rectosigmoid colon. Neoplastic polyps were more frequent in patients beyond the fifth decade. There fore colonoscopy examination is recommended for secondary prevention of colon cancer.

A Case of a Gastric Metastasis of a Renal Cell Carcinoma / 대한소화기내시경학회지

A gastric metastasis is an extremely rare event accounting for 0.2 to 0.7% of gastric neoplasms seen at necropsy. Primary origins of a gastric metastasis are pancreatic cancers, colon cancers, lung cancers and malignant melanomas. A renal cell carcinoma is renowned for its metastatic potential to spread to almost any organ of the body. However, a gastric metastasis of a renal cell carcinoma is very rare. It is believed that a renal cell carcinoma metastasizes hematogenously and it spreads through a renal vein to the stomach via the inferior vena cava and hemiazygos vein. A metastasis to the stomach is frequently located in the greater curvature of body. Endoscopic findings of a gastric metastasis often resemble a submucosal tumor with or without ulcer. Presenting symptoms are bleeding, anemia, or pyloric obstruction, but often the patient is asymptomatic. We report a case and review of the literature of a metastatic renal cell carcinoma to the stomach in a 71-year-old man who complained of a palpable abdominal mass.

Relation of Serum Eosinophilic Cationic Protein, Eosinophil and Neutrophil Count to Pulmonary Function and Smoking History / 대한내과학회지

OBJECTIVES: A prospective study was performed to find out the correlation between neutrophil, eosinophil and eosinophilic cationic protein (ECP)-the granular protein in eosinophil- and smoking history and pulmonary function change, METHODS: In this study there were seventy smokers and seventy lifetime nonsmokers. None of them had the history of atopy, or the evidence of parasitic infestation. Smoking history, spirometric pulmonary function test and blood samples for CBC, serum ECP were analyzed. RESULTS: 1) Eosinophil and neutophil count was elevated in the smokers compared with the nonsmokers. 2) Serum ECP was elevated in smokers and the magnitude of this increase was greater than that of eosinophil count. 3) In the smokers, there was a direct proportional correlation between serum ECP and FEV1, but inverse proportional correlation between neutophil count and FEV. 4) In the smokers, neutrophil count was elevated regardless of FEV value. 5) The level of serum ECP well correlated with the daily tobacco consumption but not with the duration of smoking or pack-year consumption. CONCLUSION: Incresed neutrophil count, decreased eosinophil count and decreased serum ECP level could be useful in the understanding of pathophysiology of lung parenchymal destruction in smokers.

Endoscopic Findings of Colonic Tuberculosis / 대한소화기내시경학회지

The purpose of this paper is to review the colonoscopic fingings of twenty two patients with colonic tuberculosis which were diagnosed by colonoscopic finding, histopathology, and follow-up observation after antituberculosis chemotherapy at Pusan National University Hospital from January 1992 to December 1994. The results were as follows: 1) The male to female ratio was 1: 1.2, and the average age of the patients was 39.4 years with a slight predominance in women. The age of peak incidence was the 4th decade 40.9%). 2) Abdominal pain(95%), diarrhea(63%), and weight loss(50%) were the most common clinical findings. Others were constipation, melena, and palpable abdominal mass. The location of the pain was right lower abdomen, epigastrium, central abdomen, and left lower abdomen in decreasing order. 3) Hematologic findings showed decrease in hemoglobin level, increase in ESR, and positive CRP(61.5%). The white blood cell counts were mostly normal. 4) The stool examination showed positive occult blood in 7 cases among 18 cases (38.9%). Acid-fast bacteria was observed in stool of one case. 5) On colonoscopy, the lesion sites were ileoeecal valve(75%), ascending colon(72.7 %), terminal ileum(52.6%), cecum(42.9%), transverse colon(31.8%), descending colon (27.3%), sigmoid colon(9%), and rectum(9%) in decreasing order of frequency. Most of them involved ileocecal area. 6) On colonoscopy, the shape of ulcer revealed circular(41%), fusion(36%), and irregular pattern(18%). It found skipped area in 9 cases, pseudopolyp in 8 cases, patency of ileocecal valve in 5 cases, and severe deformity of ileocecal valve in 6 cases. 7) Microscopic finding of biopsy specimens revealed noncaseating granulomatous inflammation in 12 cases, and nonspecific ulcerative inflammation in 10 cases. In conclusion the diagnostic yield may be greatly enhanced by obtaining multiple target biopsies frorn tbe deep portion of the ulcer bed and margins. Judged from the colonoscopic finding and clinical improvement after antituberculosis chemotherapy, more accurate diagnosis can be acquired.

A Case of Chronic Sclerosing Mediastinitis / 결핵

Chronic sclerosing mediastinitis is a rare disease of unknown etiology, pathologically characterized by chronic inflammation and fibrosis of mediastinal soft tissue. The process is often progressive and can occur either focally or diffusely throughout the mediastinum. This can result in compression of adjacent mediastinal structures, most commonly the low-pressure superior vena cava but also the pulmonary artery and vein, trachea and bronchi, esophagus and can result in a variety of functional and roentgenographic manifestation and occasionally death. We experienced a case of chronic sclerosing mediastinitis of unknown cause, which was confirmed by biopsy with thoracotomy, so reported it with a review of literature.