Primary empty sella syndrome / 대한내분비학회지

BACKGROUND: Primary empty sella syndrome (PES) is thought to arise from an incompetent diaphragma allowing progressive herniation of arachnoid membrane with secondary compression and atrophy of the pituitary gland. As a consequence of the improvement and widespread use of neuroradiological techniques, such as computerized tomography (CT) and magnetic resonance imaging (MRI), empty sella is more frequently disclosed. The aim of this study is to assess the associated clinical characteristics and endocrinologic disturbance in empty sella syndrome. METHODS: From January 1986 to June 1996, 171 patients with empty sella syndrome have undergone analysis for clinical characteristics and associated disease. RESULT: In our study, PES was diagnosed in 131 of the 171 patients (77%). Primary empty sella syndrome was frequent in middle aged women (female:male 115:16, mean age: 50.6+12.6 years). The common clinical features were headache (80.2%), obesity (72.5%), and hypertension (27.5%). Most of patients with PES have normal pituitary function (75%). The frequent pituitary dysfunction was hyperprolactinemia in PES (21%). Partial and total emptiness of sella on sella CT or MRI were in 111 (84.7%) patients, and in 20 (15.4%) patients, respectively. The most common associated disease with empty sella syndrome was pituitary adenoma. CONCLUSION: PES should be considered as a possible cause in obese middle aged women with unexplained headache. The combined pituitary function test should be considered for evaluation of pituitary dysfunction when clinically suspected.

Anti-neutrophil Cytoplasmic Antibodies (ANCA) in Patients with Chronic Inflammatory Bowel Disease / 대한내과학회지

OBJECTIVE: Anti-neutrophil cytoplasmic antibody (ANCA), known as a useful diagnostic marker in patients with ulcerative colitis (UC), are specific for granule proteins of granulocytes and monocytes and induce distinct fluorescence patterns. To evaluate the significance of ANCA in chronic inflammatory bowel disease (IHD), the presence of ANCA in chronic IBD was studied using indirect immunofluorescent test (IIF), METHODS: Between March, 1994 and September 1995, 51 patients with chronic inflammatory bowel disease were subjected in this study. We had analysed the correlation between duration, disease activity, location by colonoscopy and radiologic examinations, steroid treatment. RESULTS: 1) Among 34 patients with ulcerative colitis (UC), ANCA was demonstrated in 23 patients (67.6%). Among 19 patients with other chronic IBD (4 Crohn's disease, 6 Behcet's colitis, 7 intestinal tuberculosis and 2 radiation colitis) 2 patients (10.5%) had ANCA. The positivity of ANCA in patients with UC was significantly higher than in patients with other chronic IBD. 2) In patients with UC, c-ANCA was positive in 2 (5.9%) patients and p-ANCA was positive in 21 (61.8%) patients. In patients with other chronic IBD, ANCA was positive in one patient with Behcet's colitis or one patient with intestinal tuberculosis but negative in all patients with Crohn's disease or radiation colitis. 3) The mean duration of disease in ANCA positive patients was 42.4 +/- 39.4 months and the mean duration of disease in ANCA negative patients was 44.9 +/- 36.8 months, but there was no significant difference. 4) The number of patients in clinically mild, moderate and severe group were 23 (37.6%), 6 (83.2%) and 5 (14.7%) respectively. Among these groups the number of ANCA positive patients were 15 (65.2%), 5 (83.2%) and 3 (60%) respectively, but there was no significant difference. 5) The number of patients with proctitis, left side colitis and pancolitis were 9 (26.5%), 14 (41.2%) and 11 (32.4%) respectively, Among these groups the number of ANCA positive patients were 4 (44.4%), 10 (71.4%) and 9 (81.8%) respectively, but there was no significant difference. 6) Among 13 patients with steroid treatment 9 patients (69.2%) were ANCA positive. Among 21 patients without steroid treatment 16 patients (76.2%) were ANCA positive, but there was no significant difference. CONCLUSION: Although there was no correlation between ANCA and duration, disease activity, location or steroid treatment in UC patients, ANCA could be a diagnostic marker of UC in chronic IBD patients.

A case of bleeding from the Dieulafoy lesion of the jejunum

Dieulafoy lesion is an uncommon cause of gastrointestinal bleeding, reported to be only 2% of acute or chronic upper gastrointestinal bleeding episodes. Bleeding occurs from a small mucosal erosion involving an unusually large submucosal artery in an otherwise normal mucosa. It is associated with massive, life threatening hemorrhage and is difficult to diagnosis. In most cases the lesion is encountered in the proximal stomach, antrum, duodenum, colon and rectum. In particular, extragastric Dieulafoy lesion is an extremely rare source of intestinal bleeding. In Korea, no case of bleeding from a Dieulafoy lesion of the small intestine has been previously reported. We experienced one case of bleeding from a jejunal Dieulafoy lesion, which was confirmed by the pathologic examination of the resected specimen, and report here.

Clinical Characteristics of Mumps in Postpubertal Age / 감염

BACKGROUND: Mumps is a generalized viral infection that usually occurs in school-aged children and young adults, characterized by nonsuppurative swelling and tenderness of salivary glands. Mumps in postpubertal person is usually a more severe and commonly associated with extrasalivary gland involvement. This study was undertaken to analyze clinical characteristics of mumps in postpubertal person in Korea. METHODS: Forty-four cases of mumps, diagnosed during March 1983 to February 1995 in Severance hospital, were analyzed retrospectively. RESULTS: Since the end of 1980's, mumps seemed to resurge among postpubertal persons, mainly during the winter and spring. The majority of patients were under 25 years old. Parotitis was developed in all 44 cases. Sixty-five percent of male patient suffered orchitis accompanied by high fever(>38.5degreeCC). Meningitis occurred in 18% of cases. Average hospital stay was 6.3 days. All cases were cured without any sequelae. CONCLUSION: Mumps was more severe and extrasalivary gland involvement was common in postpubertal person than in children. Occurrence of high fever during the course of illness may indicate development of orchitis. Therefore, MMR vaccination should be performed in nonimmunized postpubertal persons. Additionally, booster immunization should be considered in immunized postpubertal persons.

Evaluation of Gastric Emptying in Patients with Chronic Slow Transit

OBJECTIVES: Slow transit type of chronic constipation can be divided into two types, colonic constipation, and generalized gastrointestinal dysmotility. However, it is debatable whether generalized GI dysmotility should be considered as upper gastrointestinal dysmotility secondary to colonic constipation or independent type of chronic constipation. In this study, we compared gastric emptying time(T1/2) of patients of chronic constipation with that of normal controls, and tried to find out any relationship between segmental colonic transit time and gastric emptying time. METHODS: Twenty three patients with chronic slow transit constipation who either visited or admitted to Youngdong Severance Hospital between september 1995 to lune 1997, and 27 normal controls were recruited. Both the patients and normal controls were fed with radioopaque material and colonic transit time and gastric emptying time were measured. RESULTS: 1) Seventy four percent of patients with chronic slow transit constipation showed a delayed gastric emptying time. Patients group showed a significantly delayed gastric emptying time compared with that of normal controls(110.9+/-32.3 min vs. 72.1+/-11.4 min, p<0.05). Gastric emptying time in respect to gender showed significant differences in normal controls(M=65.5+/-9.6 min, F=78.7+/-10.4 min). However, no significant difference was found in patient group(M=97.8+/-11.8 min, F=114.5+/-35.4 min). 2) In chronic slow transit constipation, colonic transit time was 48.8+/-11.7 hr. Each segments of colon showed a different transit time: Right colon 19.3+/-7.3 hr, left colon 21.2+/-12.3 hr, and rectosigmoid 8.3+/-9.2 hr. All of which were significantly delayed, compared with those of normal controls. 3) In patients group, colonic transit time of the whole colon had no significant correlation with gastric emptying time. 4) Seventy five percent of patients with chronic slow transit constipation whose right colonic transit time was delayed showed a delayed gastric emptying time. On the other hands, 63% of patients with delayed left colonic transit time had a delayed gastic emptying time. Patients with delayed gastric emptying time and those with normal gastric emptying time had no significantly different colonic transit time(49.1+/-13.2 hr vs 48.0+/-6.5 hr). CONCLUSIONS: Large number of patients with chronic slow transit constipation had a delayed gastric emptying time. When surgical treatment is considered in patients with chronic slow transit constipation, it seems to be beneficial to estimate such parameters as manometry or gastric emptying time in order to evaluate functional derangement of UGI tract. These parameters may provide a guideline in treatment of chronic idiopathic constipation.