Relationship between Serum HBV DNA Levels and Liver Histology in Chronic Hepatitis B / 대한소화기학회지

BACKGROUND/AIMS: Serum HBV DNA levels are correlated with hepatic histologic activity in chronic HBV infection based on HBeAg. Liver injury may persist, even though HBV DNA are not detected by hybridization assay. This study was to investigate whether serum HBV DNA levels determined by more sensitive quantitative method are correlated with histologic activities in chronic HBV infections. METHODS: This study included 66 chronic HBV infected patients. HBV DNA level was quantified by Cobas Amplicor HBV Monitor(TM). RESULTS: Serum HBV DNA levels in HBeAg-positive patients were significantly higher than HBeAg-negative patients. In HBeAg-positive patients, serum HBV DNA levels showed a significant negative correlation with portal-periportal activity and fibrosis (r=-0.451, -0.446 respectively). AST levels were correlated with lobular, portal-periportal activity and fibrosis (r=0.432, 0.365, 0.301 respectively), whereas ALT levels were related to lobular activity (r=0.294). Elevated AST levels predicted lobular activity, portal-periportal activity, and fibrosis with moderate to severe degree (OR 1.733, 95% CI 1.083-2.775; OR 1.518, 95% 1.028-2.243, p=0.336; OR 17.897, 95% CI 1.517-211.208, p=0.022, respectively). CONCLUSIONS: In HBeAg-positive patients, serum HBV DNA level correlates inversely with histologic activity. On the other hands AST level correlates with histologic activity and the stage of moderate or severe degree.

Palliative Self-expandable Metal Stents for Malignant Gastric Outlet Obstruction / 대한소화기내시경학회지

BACKGROUND/AIM: Gastric outlet obstruction due to malignancy causes various symptoms and malnutrition and so decreases the quality of life and shortens the survival. The aim of this study was to assess the feasibility, effectiveness, safety, and outcome of a self-expandable metal stent as a palliative methods. METHODS: From January, 2000 to August, 2002, 29 consecutive patients (36 cases of stent insertion) with inoperable gastric outlet obstruction were treated palliatively with through-the scope stents (Nitis Taewoong, Korea, 29 uncovered, 7 covered). All patients had malignancy. We reviewed the success rate, complications and clinical outcome. RESULTS: There were 21 cases with advanced gastric cancer, 5 with pancreatic head cancer and 2 with cholangiocarcinoma. The other one had primary duodenal carcinoma. Technical success was achieved in thirty four cases (94.4%). After successful placement, 26 patients could eat soft or solid foods with careful education about foods impaction. During the follow-up (mean: 2.6 months, range: 1~9 months), there were no procedure related early complication. Seven stent occlusion occurred due to tumor in-growth (6 case) and over-growth (1 case). CONCLUSIONS: Endoscopic self-expandable metal stent placement in patients with inoperable gastric outlet obstruction is a highly successful, safe and effective palliative method.

A Case of Spontaneous Submucosal Dissection of the Esophagus / 대한소화기내시경학회지

Spontaneous submucosal dissection of the esophagus is a rare esophageal disorder which reveals characteristic features on radiologic and endoscopic examinations. It usually presents with acute epigastric pain, typically accompanied by dysphagia and odynophagia. We experienced a case of a 56-year-old man complaining of chest discomfort and right upper quadrant abdominal discomfort. The findings of upper gastrointestinal endoscopy and barium esophagogram were compatible with submucosal dissection of the esophagus. Chest CT scan showed multiple ulcers that formed a longitudinal tunnel canal. The patient was managed conservatively with nothing by mouth and intravenous hydration. Forty days after the first upper gastrointestinal endoscopy, the patient's symptoms disappeared completely and the massive dissection of the esophagus was much improved except for slight depression on the upper esophagus.

A case of lipohyperplasia of the appendix / 대한내과학회지

Large intestinal Lipohyperplasia (LPH) is a poorly recognized lesion characterized by adipose tissue infiltration in the submucosal layer of the colon. Most of all, LPH developed at Ileoceal valve, especially upper lip which was called by ileocecal valve syndrome. For endoscopists and radiologists, it has often remained difficult to make a distinction from malignant neoplasia. We report here the case of a mild obese, 51-year-old man who had polypoid lipohyperplasia of the colon associated with extreme hyperplasia of the appendix. His chief complaint was recurrent intermittent abdominal pain. The colonoscopic finding was a submucosal tumor-like polypoid mass originating from appendix with smooth surface, But ileocecal valve was intact. Abdominal CT finding was 2.5 cm sized round heterogeneous low density mass like lesion with intratumoral fatty density of cecal tip area with enhancement of peripheral portion. In barium enema study, after retrograde filling of contrast, smooth extrinsic indentation of cecal tip with partial filling of appendix was seen. Histological exemination revealed infiltration of mature adipose tissue in the submucosal layer. Because of recurrent abdominal pain, ileocecal resection was performed at operation. We discuss the case and review the literatures on this subject.

A case of aggressive angiomyxoma in female retroperitoneum / 대한내과학회지

Aggressive Angiomyxoma is a rare, benign but locally aggressive mesench ymal neoplasm, predominently involving the pelvis and perineum of young omen. We experienced a case of aggressive angiomyxoma in the retroperitoneum. A 47-year-old woman patient visited our hospital because of constipation and an abnormal intraabdominal mass in routine examination. Examination by abdominal ultrasonography and MR imaging indicated that it was a well capsulated large soft tissue tumor in the retroperitoneum. Thus, she underwent excision of the retroperitoneal tumor. A 15 x 10 x 2 cm yellow-whitish mass was noted. The cut surface was homogenous, tannish yellow and mucoid. Microscopic findings represent that a mass was composed of widely scattered spindle-shaped and stallate-shaped cells and variable sized vascular channels within a myxoid matrix. So we report this case with a review of literature.

A Case of Primary Angiosarcoma of The Pleura / 결핵

Angiosarcomas are rare tumors that are derived from vascular endothelial cells. They may occur in various sites, including the skin, breast, visceral organs and deep soft tissues. The pleura usually a metastatic site from angiosarcomas. However, thirty one cases of primary pleural angiosarcomas have been reported worldwide. Here, we report a 61-year-old man with a primary angiosarcoma of the pleura with a brief review of the literature.