Malignant Gastrointestinal Stromal Tumor of the Ampulla of Vater: A Case Report / 대한소화기학회지

GIST is a rare neoplasm, the majority of GISTs are located in the stomach and small intestine. Most GISTs are diagnosed histopathologically after resection because of submucosal location. A 37-year-old female patient presented with a 2-weeks history of generalized weakness, nausea accompanied by intermittent passage of black, tarry stools. Esophagogastroduodenoscopy and ERCP showed a large round mass measuring 5 cm in diameter in the ampulla of Vater with ulcer crack. Endoscopic multiple biopsies from the mass including ulcer base were taken. Light microscopic findings showed spindle-shaped and epitheloid tumor cells having high cellularity and frequent mitotic figures. On immunohistochemical stainings, the tumor cells were positive for CD34 and smooth muscle actin. Based on these preoperative findings, a diagnosis of malignant GIST of the ampulla of Vater was made probably. After operation, immunohistochemical studies revealed positive reaction for c-kit and vimentin, as well as focally reactive for CD34 and smooth muscle actin. We report a case of GIST in the ampulla of Vater presenting with melena that was diagnosed preoperatively and postoperatively.

Colorectal Cancer and Prostaglandin

The possibility for cyclooxygenase (COX) inhibitors in colorectal cancer prevention and theraphy is evident from epidemiologic data (reduction of colorectal cancer in nonsteroidal anti-inflammatory drugs (NSAIDs) users), animal experiments (nude mouse xenograft tumor reduced by NSAIDs or reduction of colorectal cancer in APCmin mouse and azoxymethane treated rat by using NSAIDs), and molecular genetics. Among two variant COX, inducible COX-2 enzyme is more involved in tumorigenesis than constitutive COX-1 enzyme and molecular method have given us insight into the mechanism of colorectal cancer development by COX-2 such as, apoptosis, angiogenesis, invasiveness, and immune modulation. Based on that COX-2 is involved in tumor promotion during colorectal cancer progress, a large number of prevention and treatment trials of colorectal cancer have been started. And many trials to elucidate the function of prostaglandin produced by COX-2 are now in progress.

A Case of Ischemic Colitis Associated with Colonic Carcinoma / 대한소화기내시경학회지

The rare association of obstructing colorectal carcinoma and ischemic colitis in patients without an antecedent history of inflammatory bowel disease has been documented intermittently since the early 1960s after first case was described by Kremen in 1945. The etiology is not clear, but it is thought that sluggish mucosal blood flow and consequent ischemia occurs secondary to raised intraluminal pressure distally. The radiologic features are typically 'thumbprinting' appearence by the barium study, but maybe variable according to the stage of ischemic colitis. In many cases, radiologic features may be similar inflammatory bowel disease such as ulcerative colitis and may mask the presence of the predisposing carcinoma. Sigmoidoscopy or colonoscopy may detect irregular ulceration, mucosal friability, submucosal hemorrhage and bulging folds. The mucosa is usually covered by hemorrhagic and purulent exudate. We report a case of the ischemic colitis associated with sigmoid colon adenocarcinoma in 75-year- old man.

A Case of Primary Leiomyosarcoma of the Liver / 대한간학회지

Primary hepatic leiomyosarcoma is a very rare malignant tumor of the liver and rather slowly progressing disease. When the tumor is solitary or even multiple but located in one lobe, the treatment of choice is an operation. We report a case of huge leiomyosarcoma in a 58-year old female patient treated by surgical resection.

Esophageal Tuberculosis Mimicking Malignancy / 대한소화기내시경학회지

Pulmonary tuberculosis is still endemic in Korea, but esophageal tuberculosis, especially primary esophageal tuberculosis, is very rarely seen. A 76-year-old male is presented dysphagia. The clinical presentation, barium swallow study, and chest CT were suggestive of carcinoma of the esophagus. Findings that can suggest the diagnosis are enlarged lymph nodes, ulceration, and luminal narrowing. The major differential diagnosis was primary esophageal tuberculosis. This was not excluded on biopsy obtained at endoscopy. Operation was done for severe dysphagia and exclusion of malignancy. The patient was finally diagnosed as primary esophageal tuberculosis.

Bowel Cleansing Method of Sodium Phosphate: Onset and Duration of Bowel Activity / 대한소화기내시경학회지

BACKGROUND/AIMS: Divided-dose oral sodium phosphate laxative is recommended for bowel cleansing before colonoscopy. Patients need information about the onset and duration of activity of the preparation. This study was designed to develop practical prescribing information for the patients to reduce anxiety and insomnia concerning bowel movement. METHODS: one hundred ninety patients were requested to take 45 mL sodium phosphate in the previous evening and the morning of the procedure, and to complete a questionnaire. The overall quality of bowel cleansing were assessed by endoscopists. RESULTS: Bowel activity began 2.25 (90 percentile: 3.58) hours after the first dose and continued for 6.55 (90 percentile: 8.5) hours. For the second dose the time of onset was 0.85 (90 percentile: 1.67) hours, and bowel activity continued for 3.6 (90 percentile: 5.17) hours. CONCLUSIONS: The onset of bowel activity from the first dose of sodium phosphate starts within 4 hours and it is completed within 8.5 hours for most. We can recommend the patients to take the first dose of NaP solution at 4 p.m. of the previous day of the exam and second dose more than 5 hours earlier before the colonoscopy in the care that the onset of the bowel activity after the first dose take longer thna 4 hours.

Can Helicobacter pylori Infection Cause Upper Gastrointestinal and Colonic Lesions Simultaneously? / 대한소화기내시경학회지

BACKGROUND/AIMS: Some studies showed the higher prevalence of H. pylori infection in the patients with colon adenoma and carcinoma than control subjects. The association between H. pylori infection and colonic diseases is controversial. We evaluated H. pylori infection rate and the related upper gastrointestinal lesions in the patients with colon polyp and cancer. METHODS: Ninety-four subjects, 67 with colonic lesions and 27 without colonic lesions were enrolled. Colon polyp and cancer were confirmed by colonoscopic biopsy or polypectomy. The enrolled subjects were received gastroduodenoscopic examination. H. pylori infection was evaluated serologically and/or with rapid urease test. The fasting serum gastrin level was measured. RESULTS: H. pylori infection rates in the patients with and without colonic lesions were 67.2% and 44.4%, respectively (p<0.05). Upper gastrointestinal lesions were observed in 27 of 67 patients (40.3%) with colonic lesions and in 11 of 27 patients (40.7%) without colonic lesions (p=1.0). Mean levels of serum gastrin with and without colonic lesions were 91.7+/-31.1 pg/mL and 88.1+/-37.7 pg/mL, respectively (p=0.15). CONCLUSIONS: Our study supports the relationship between H. pylori infection, colorectal neoplasia. Although there was no significant difference, the possibility of the simultaneous presence of upper gastrointestinal lesions in the patients with colorectal polyp and cancer was suggested. But the relationship between serum gastrin and the development of colorectal polyp and cancer was not documented.

A seroepidemiological study on the efficiency of hepatitis B vaccination - An analysis of serologic markers in a rural area, korea - / 대한내과학회지

BACKGROUND: The objectives of this study are to determine the positive rate of HBV serologic markers and infection rate, and to evaluate the efficiency of hepatitis B vaccination. METHODS: Study subjects included 905 persons in 1988-1989 and 744 persons in 1993-1994 living in typical rural communities in Korea. Three serologic markers(HBsAg, anti-HBs, anti-HBc) were tested by radio-immunoassay(RIA). Supplemental informations were collected by self-administered questionnaire and interview on age, sex, history and frequency of vaccination. RESULTS: 1) Among non-vaccinees, HBsAg, anti-HBs, anti-HBc positive rates and infection rate in 1993-1994/1988-1989 were 5.4%/6.5%, 49.1%/45.9%, 48.3%/44.1% and 60.6%/54.5% respectively. The infection rate showed a trend of continuous increase as the age increased, while statistically significant increase was seen over age 20. 2) Overall vaccination rate was 18.1% in 1988-1989 and 37.9% in 1993-1994, showing statistically significant increase in vaccination rate. The rate in younger age groups were higher than in older groups in 1988-1989, but there was no difference by age groups in 1993-1994. Among vaccinees, anti-HBs only positive group occupied 42.7% in 1988-1989 and 41.3% in 1993-1994. HBs Ag negative and anti-HBc positive group occupied 26.2% in 1988-1989 and 36.73% in 1993-1994. CONCLUSION: 1) Among non-vaccinees, HBsAg positive rate was decreased, but the hepatitis B infection rate was not decreased. 2) The test for selection of eligible person of vaccination and education program for completion of vaccination schedule must be reevaluated to improve the efficiency of hepatitis B vaccination.

A Case of a Primary Gastric Choriocarcinoma Diagnosed by Endoscopic Biopsy / 대한소화기내시경학회지

A case of primary choriocarcinoma in the stomach of a 60-year-old male is herein presented. The tumor was diagnosed as a choriocarcinoma by histologic examination and the immunohistochemical method of endoscopic biopsy of a specimen. Serum alpha- fetoprotein and beta-human chorionic gonadotropin were found to be significantly elevated. Multiple distant metastasis of the liver, intraabdominal lymph nodes and malignant ascites were also discovered. The high alpha-fetoprotein level in the serum might have been due to the coexistence of embryonal cell carcinoma or hepatoid adenocarcinoma or both in the stomach.

Salt Consumption as a risk factor of Gastric Cancer and Helicobacter pylori Infection / 대한내과학회지

OBJECTIVES: Gastric cancer is one of the most important malignancy of the gastrointestinal tract. High salt intake has been suggested as a risk factor of gastric cancer and promoting Helicobacter pylori infection. Few studies have been addressed about the relation between excessive salt intake and gastric cancer. This study was performed to investigate the relation of high salt intake to H. pylori infection and gastric cancer. METHODS: Between May 1996 and July 1997, hospitalized patients with epigastric pain or dyspepsia were prospectively recruited. Patients with underlying diseases which could reduce kidney function were excluded. Salt consumption was estimated by the urine sodium to creatinine ratio(U-Na/Cr) on fresh single urine sample. Gastric cancer was diagnosed by endoscopic biopsies. H. pylori infection was evaluated by CLOtest. Gastric cancer was classified histologically by Lauren classification. RESULTS: Ninety seven patients, 52 patients with gastric cancer and 45 patients with chronic gastritis were enrolled. There was no statistically significant difference in the sodium to creatinine ratio between gastric cancer group (173.60+/-123, range; 21-665.2) and chronic gastritis group (164.02+/-138, range; 20.4-482.7) (p=0.361). In gastric cancer, the sodium to creatinine ratio was not different between CLOtest positive and negative group (p=0.201), and among intestinal, diffuse and mixed type (p=0.419), either. CONCLUSION: This study does not support the causal relation of high salt diet on gastric carcinogenesis. There is no significant difference in H. pylori infection rate between CLOtest positive group and negative group.

Immunogenicity and Safety of Recombinant Hepatitis B Vaccine(Engerix B) / 감염

BACKGROUND: Several studies on the efficacy and safety of the hepatitis B vaccine have shown variable immunogenicity. In this study we reexamined the immunogenicity and safety of recombinant hepatitis B vaccine, Engerix B which have currently been administered to the children in Korea. METHODS: Serum samples were collected from 126 children and 111 adults who were immunized according to the 0, 1, 2-month and 0, 1, 6-month vaccination schedule. Anti-HBs antibody titers were measured by ELISA in sera obtained after each immunization, and compared by immunization schedules. RESULTS: In 62 children with 0, 1, 2-month immunization schedule seroconversion rate was 83.9% after 1st vaccination, 96.8% after 2nd, and 98.4% after 3rd. In 64 children with 0, 1, 6-month immunization schedule seroconversion rates was 78.1% after 1st vaccination, 87.5% after 2nd and 100% after 3rd. In 50 adults immunized with 0, 1, 2-month schedule seroconversionrates was 48.0% after 1st vaccination, 74.0% after 2nd and 90.0% after 3rd. In 61 adults immunized with 0, 1, 6-month schedule seroconversion rate was 44.3% after 1st vaccination, 65.6% after 2nd and 93.4% after 3rd. Seroconversion rate after 0, 1, 2- month vaccination schedule were 98.4% in children and 90.0% in adults. Seroconversion rate after 0, 1, 6-month schedule were 100% in children and 93.4% in adults. There were no significant local and systemic untoward reactions among vaccinees. CONCLUSION: The recombinant Engerix B is excellent in immunogenicity with 93.4% and 100% seroconversion rates in adults and children, respectively. There is no significant difference in seroconversion rate between two vaccination schedule. The vaccine is safe.

Esophagus, Stomach & Intestine; A Case of Carcinosarcoma of Esophagus / 대한소화기내시경학회지

More than 17 different terms, including carcinosatcoma and pseudosarcoma, have been applied to the rare polypoid tumors of the esophagus that demonstrate both carcinomatous and sarcomatous components. The multiplicity in terminology seems related to the uncertain histogenesis of these tumors. A demonstration of the ultrastructure of the spindle cells (containing desmosomes and tonofilaments) is consistent with an epithelial origin. The patient was a 53 year-old man who had suffered from dysphagia and foreign body sensation in larynx. Endoscopic finding was a large polypiod mass with ulceroinfiltrative lesion at the level of 27cm from the incisor. Pathologic findings were that the covering epithelium showed well differentiated squamous carcinoma with invasive pattern and the stroma contained islands of sarcoma and squamousl cell carcinoma. Immunoreactivity to cytokeratin was not observed. Partial esophagectomy and esophagogastrostomy was done. We report a case of rare malignant esophageal carcinosarcoma.

Clinical Analysis of Choledochal Cyst / 대한소화기내시경학회지

We studied and analyzed 66 cases of choledochal cyst in a 9 year period from March, 1985 to December, l993 at Hangang, Kangnam and Chuncheon Sacred Heart Hospital. The results were as follows; 1) Age ranged from 1 year to 82 years and ll of 66 cases were below 10 years. The ratio of men to women was 1: 1.9. 2) The frequency of the triad of symptoms and signs were in order of abdominal pain 53 cases(80.3%), jaundice 12 cases(18.2%) and abdominal mass 9 cases(13.6%). The classical triad of pain, mass and jaundice was present in only 2 cases(3.0%). 3) Alkaline phosphatase was elevated in 42 cases(63.6%), hyperbilirubinemia in 29 cases(43.9%) and hyperamylasemia in 9 cases(13.6%). 4) Performed diagnostic procedures were ultrasonogram in 57 cases(86.4%), endo- scopic retrograde cholangiopancreatogram in 32 cases(48.5%), DISIDA scan in 18 cases(27.3%), computed tomogram in 14 cases(21.2%) and percutaneous transhepatic cholangiagram in 6 cases(9.1%). 5) Among 38 cases which ERCP or PTC were performed, according to the Todani's classification, Type I was seen in 28 cases(73.7%), Type IVA in 7 cases(18. 4%), Type II in 2 cases(5.3%) and Type V in I case(2.6%). 6) The associated diseases were cholangitis in 15 cases(22.7%), choledocholithiasis in 12 cases(18.2%) and cholangiocarcinoma in 2 cases(3.0%). 7) Operative procedures were performed in 22 of 66 cases, excision of cyst with Roux-en-Y c~holedochojejunostomy in 17 cases, choledochocystojejunostomy in 2 cases and external drainage in 3 cases.

A Case of Gastric Tuberculosis / 대한소화기내시경학회지

Gastric tuberculosis is a rare disease and the diagnoeis of gastric tuberculosis is based on either positive histological or bacteriological study. We experienced a case of gastric tuberculosis with pleural effuaion in 59 year-old woman, diagnosed by the histological study of the endoscopic biopsy specimen. Follow up endoscopic finding revealed marked improvement of gastric lesion after anti-tubercadoua medication. We reported the case with review of literature.

Gastric Xanthoma / 대한소화기내시경학회지

Authors analysed 42 cases of gastric xanthoma, confirmed by gatroscopic biopsy, at Kangnam Sacred Heart Hospital, College of Medicine, Hallym University from March 1986 to December 1988 The results were as follows; 1) The prevalence of gastric xanthome was 0.9% in 7699 consecutive gastroacopies. 2) The prevalence of gastric xanthoma increased with age. 3) The frequent locations of gastric xanthoma were the antrum (56%) and the lower bady (29%). 4) The most frequent gastroduodenal lesion associated with gastric xanthoma was chronic superficial gastritis (77%). 5) The average level of cholosterol was 169.9 mg/dl, triglyceride was 102.6 mg/dl, and no conelation existed between the serum cholesterol or triglyceride level and the presence of gastric xanthoma.