A case of endobronchial aspergilloma in patient with collapse of right middle lobe / 대한내과학회지

Pulmonary aspergilloma usually results from the ingrowths of the colonized Aspergillus in the damaged bronchial tree, pulmonary cyst or cavities of patients with underlying lung diseases. We experienced a case of endobronchial aspergilloma developed in a healthy female patient with asymptomatic collapse of right middle lobe (RML). She visited our clinic with intermittent hemoptysis for one year. The chest X-ray and HRCT showed severe collapse of the RML and multiple calcifications of peribronchial nodes around the proximal part of RML bronchus. Bronchoscopy revealed an aspergilloma in theorifice of the lateral segmental bronchus of RML. Patient had undergone RML and right lower lobe resection because of recurrent hemoptysis in spite of medical therapy. After surgery patient's symptoms were relieved. We present this unusual case with a review of the literature.

Transient Intesinal Obstruction Due to Stool Impaction in the Elderly / 대한소화기학회지

BACKGROUND/AIMS: Acute intestinal obstruction is an urgent disease to be diagnosed and treated promptly. In elderly, fecal impaction may be an important and preventable cause of colonic obstruction. We investigated the clinical features of patients presenting with denical features of intestinal obstruction transiently due to fecal impaction. METHODS: From February 2001 to March 2004, nineteen patients were diagnosed as transient intestinal obstruction due to fecal impaction. We evaluated clinical characteristics, radiologic findings, sigmoidoscopic or colonoscopic findings and managements. RESULTS: Male and female ratio was 1:1.1. Mean age was 79.3 years. All 19 patients had abdominal pain and distension. On digital rectal examination, the hard feces was palpable in only 8 patients (42%) while others showed empty rectum. The abnormal laboratory findings included leukocytosis in 5 patients (26%), anemia in 10 patients (53%) and electrolyte abnormalities in 7 patients (37%). Simple abdominal X-rays showed diffuse small and/or large bowel dilatations. In only 3 patients (16%) air-fluid levels were definite, but most patients showed abundant feces in the rectum and colon. During emergency sigmoidoscopy, abdominal pain and distension were relieved and there were Bristol type 1 hard stool in the recto-sigmoid junction in 7 patients (37%) and multiple rectal ulcers in 1 patient. On colonoscopy, there were no mass or pathologic obstruction in all patients. Patients were discharged after the adequate medication and toilet training. CONCLUSIONS: In elderly patients, fecal impaction is odd and preventable cause of intestinal obstruction. It is often significant to differentiate fecal impaction from other pathologic conditions in patients with chronic constipation.

A Case of Endobronchial Tuberculosis with Repeated Expectoration of Nodular Tissues / 결핵및호흡기질환

Herein, we report a case of tumorous endobronchial tuberculosis with successful recovery of atelectasis without any significant bronchial stricture, after repeated expectorations of nodular tissues. A 24-year-old male patient was presented with persistent cough. The patient was diagnosed to be suffering from tuberculous lymphadenitis on right axillar and mediastinum of lung, and was subsequently treated with antituberculosis agents. After two months, clinical deteriorations and atelectasis were observed on right upper lobe of lung. Multiple endobronchial tumorous lesions, which obstructed the right main bronchus, were revealed on bronchoscopy, and based on the endobronchial biopsy findings we confirmed that the patient was suffering from endobronchial tuberculosis. We decided to administer antituberculosis agents without any additional procedure. After few weeks, the patient spontaneously expectorated nodular tissues with vigorous coughing. Later on, the symptoms and atelectasis disappeared and the patient was completely recovered. This case shows that in patients suffering from tumorous endobronchial tuberculosis, endobronchial mass can be expectorated spontaneously without sequelae of significant bronchial stenosis.

Clinical Features of Eosinophilic Gastroenteritis / 대한소화기학회지

BACKGROUND/AIMS: Eosinophilic gastroenteritis (EG) is an uncommon disease with various gastrointestinal symptoms characterized by eosinophilic infiltration. Its incidence increases recently. We investigated the clinicopathologic features of the patients with EG. METHODS: Between January 1970 and July 2003, a total of 28 cases of EG have been reported. By adding 3 cases diagnosed in the Eulji Hospital, we evaluated the 31 cases of EG for the symptoms, laboratory findings, histologic findings, method of treatment, and allergic history. RESULTS: The incidence increased during 1990s. The predominant site of the eosinophilic infiltration was mucosa in 10 cases, muscularis in 5 cases, and subserosa in 5 cases. The remaining 11 patients had the EG in two sites. The most frequently affected organ was small intestine (12 patients), but there were 12 cases which more than two organs involved. Melena and hematochezia were dominant findings in the patients whose infiltration occurred in mucosa. On the other hand, ascites was a dominant finding in the cases that infiltration occurred in subserosa or involving over 2 layers. There was no difference in eosinophilia, clinical symptoms, and duration between two groups according to the symptom duration for less or more than 30 days. Additionally, seven patients had allergc histories. Peripheral eosinophilia was found in 24 cases. There was no recurrence of EG after the treatment. CONCLUSIONS: Our retrospective studies about EG reported in Korea could not clarify whether EG is related to allergy. Recently, the occurrence of EG is increasing and it is frequently involved in young men. The most apparent finding include peripheral eosinophilia. There is no significant clinical feature which is consistent with Klein's classification, though blood loss was more common in mucosal type and ascites was more common in serosal type and in case above two layers.