A case of hyperinfection with Strongyloides stercoralis in terminal stomach cancer / 대한내과학회지

Strongyloides stercoralis is an intestinal nematode which infects a large portion of the world's population especially in tropical areas and other hot, humid regions. Because of an opportunistic nature of the parasite, the infection is confined to the intestinal tract in immunocompetent hosts. But, in individuals having immunocompromised state, the parasite is augmented by autoinfection, resulting in hyperinfection and/or systemic dissemination. In Korea, several cases of strongyloides hyperinfection were reported since 1959, especially who had corticosteroid therapy and other immunosuppressive medications. We experienced a case of strongyloides hyperinfection, accompanied with terminal stage of stomach cancer. The patient responded to treatment with albendazole. After one month later, repeated follow-up stool exam revealed clearance of the larvae from the patient' feces. So, we report this case with the literature.

Effect of a traditional korean very-low-calorie diet on obese patients / 대한내과학회지

BACKGROUND: There is increasing interest in the use of a very low calorie diet (VLCD) as a treatment regimen for weight loss in obese subjects. This study was designed to investigate the effects and safety of a traditional Korean very-low-calory diet. METHODS: Twelve hospitalized obese patients at Dong Eui hospital in Busan city from May 1998 to December 1998 were selected. Height, body weight, blood lipids, blood insulin level, body fat, lean body mass, subcutaneous fat and visceral fat were measured. A traditional Korean VLCD was supplied for 14 days. RESULTS: Patient's body weight was significantly decreased from 83.8 kg to 78.6 kg, body fat from 32.2 kg to 28.6 kg, lean body mass from 32.2 kg to 28.6 kg, and BMI from 31.4 to 29.5, respectively (p<0.05). Total fat was significantly decreased from 807 cc to 659 cc, subcutaneous fat from 567 cc to 473 cc, visceral fat from 273 cc to 185 cc, respectively. However there were no significant changes in minerals. After VLCD intervention, total cholesterol was significantly decreased from 199 mg/dL to 166 mg/dL, HDL-cholesterol from 42 mg/dL, to 35 mg/dL, triglyceride from 158 mg/dL, to 75 mg/dL (p<0.05). The insulin area under the curve was also significantly decreased from 205 micro International-Unit/mL x 2hr to 168 micro International-Unit/mL x 2hr (p<0.05). CONCLUSION: Above findings suggested that a traditional Korean VLCD is effective and safe for short term use in terms of reducing body fat and improving insulin resistance in obese patients.

A Case of Acute Multifocal Bacterial Nephritis / 대한신장학회잡지

Acute multifocal bacterial nephritis is a severe form of acute renal infection in which a heavy leukocytic infiltrate occurs throughout the kidney with intrarenal abscess formation. It is also early phase of renal corticomedullary abscess. It is imperative that a prompt acute diagnosis be made in most of these conditions, for these patients may be or may rapidly become septic and suddenly deteriorate if not treated appropriately and in a timely manner. Clinically, acute multifocal bacterial nephritis present as acute pyelonephritis and could be diagnosed by radiologic grounds including abdominal computerized tomography(CT) which demonstrates poorly defined wedge-shaped area of decreased contrast enhancement identical to those found in acute focal bacterial nephritis. This case was a women with high fever, pyuria and severe leukocytosis. It was diagnosed by abdominal computerized tomography which show multiple wedge-shaped area of decreased attenuation and by computerized tomography guide aspiration biopsy which demonstrates E. coli. We report one case of acute multifocal bacterial nephritis with the reviews of literatures which showed involvement of both kidneys

A Case of Huge Retroperitoneal Rhabdomyosarcoma of Embryonal Type in an Adult / 대한내과학회지

Rhabdomyosarcoma is the most common sarcoma of children and adolescents. Rhabdomyosarcoma is a highly malignant soft tissue sarcoma that can arise in any site of the body containing striated muscle or its mesenchymal analogue. The common primary sites were head and neck including orbit, extremities, genitourinary tract, trunk, retroperitoneum, gastrointestinal tract, and thorax. There are basically three types of rhabdomyosarcoma: embryonal, alveolar, and pleomorphic; these categories may overlap histologically. Retroperitoneal rhabdomyosarcoma of embryonal type is rarely reported in an adult. Since we experienced a case of 25 X 20 X 12cm-sized retroperitoneal rhabdomyosarcoma of embryonal type, we report this with a review of literatures.

Detection of Helicobacter pylori in Gastric Biopsy Specimens by Polymerase Chain Reaction / 대한내과학회지

OBJECTIVE: Helicobacter pylori (H. pylori) has been implicated in the pathogenesis of chronic gastritis, gastric ulcer, duodenal ulcer and gastric cancer. Histological examination and culture are considered to be the most specific tests, and rapid urease test and serological test are rapid but less specific tests. 'I he aim of this study was to investigate the efficiency of the polymerase chain reaction (PCR) assay as a procedure for the diagnosis of H, pylori infection in gastric biopsy specimens. METHODS: Biopsy specimens were obtained from the gastric antrum within 2cm from the pyloric channel of 42 patients during endoscopy and submitted for the histological examination, CLO test, and PCR assay. At the same time, another biopsy specimens were obtained from the lesion for the diagnosis of the diseases. Also, blood was sampled for the measure of the value of IgM and IgG. RESULTS: As the result of the histopathological examination, chronic gastritis was diagnosed in 13 patients, gastric ulcer in 11, duodenal ulcer in H, and gastric cancer in 10. By the histological examination of the antrum, H, pylori were found in 77% of chronic gastritis, 55% of gastric ulcer, 75% of duodenal ulcer, and 40% of gastric cancer. As a whole, the bacteria was identified in 62%, 60%, 88%, 90%, 69% of patients by histological test, CLD test, IgM, IgG, and P(;R respectively. The gold standard we used for the presence of bacteria was histological examination. Sensitivity, specificity, positive predictive value, ancl negative predictive value for PCR assay were 92%, 69%, 83% and 85% respectively. The results of other test were as follows. CLO test: 89%, 88%, 92%, 82%, IgM:92%, 19%, 65%, 60%, IgG:100%, 25%, 68%, 100%. CONCLUSION: CR is a very sensitive but some- what less specific test for the detection of H. pylori. This is mainly due to the contamination of H. pylori during endoscopy and biopsy. So, minimization of the contamination would make PCR clinically useful test.

A Case of Multiple Early Gastric Cancer / 대한소화기내시경학회지

Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.

A Case of Multiple Early Gastric Cancer / 대한소화기내시경학회지

Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.

A case of granular cell tumor of esophagus / 대한내과학회지

No abstract available.

ERCP Findings In Hepatic Clonorchiasis / 대한소화기내시경학회지

An endoscopic retrograde cholangiographic study of 25 consecutive cases of hepatic clonorchiasis was performed during the period from Aug. 1986 to Sep. 1991 Hepatic clonorchiasis was confirmed by stool of examination for Clonorchis sinensis. The findings consist of characteristic filling defects and changes in the intrahepatic and extrahepatic bile ducts. The filling defects due to adult worms are significant diagnostic criteria of clonorchiasis. Its appearance is elliptical and/or round. The change in the intrahepatic bile ducts consisits of dilatation, irregularity(tortousity and elongation) and blunting of termieal branches of bile tree, irregular stenosis, fuzziness and raggedness. The characteristic changes in the extrahepatic bile ducts in clonorchiasis are duct wall irregularities and mild dilatation of bile duct. ERCP is an excellent method to evaluate biliary tree in patient with clonorchiasis because it reveals not only its characteristic findings of clonorchiasis but also its severity and associated lesions.

ERCP Findings In Hepatic Clonorchiasis / 대한소화기내시경학회지

An endoscopic retrograde cholangiographic study of 25 consecutive cases of hepatic clonorchiasis was performed during the period from Aug. 1986 to Sep. 1991 Hepatic clonorchiasis was confirmed by stool of examination for Clonorchis sinensis. The findings consist of characteristic filling defects and changes in the intrahepatic and extrahepatic bile ducts. The filling defects due to adult worms are significant diagnostic criteria of clonorchiasis. Its appearance is elliptical and/or round. The change in the intrahepatic bile ducts consisits of dilatation, irregularity(tortousity and elongation) and blunting of termieal branches of bile tree, irregular stenosis, fuzziness and raggedness. The characteristic changes in the extrahepatic bile ducts in clonorchiasis are duct wall irregularities and mild dilatation of bile duct. ERCP is an excellent method to evaluate biliary tree in patient with clonorchiasis because it reveals not only its characteristic findings of clonorchiasis but also its severity and associated lesions.

Report of a Case of Adenomyomatosis of Gallbladder / 대한소화기내시경학회지

Adenomyomatosis of the gallbladder is Characterized by hyperplastic changes including overgrowth of the mucosa, thickening of the muscle wall, and intramural diverticula, crypts, or sinus tracts(Rokitaasky-Aschoff sinuses). The main diagnostic test for the detection of this disease is oral cholecystography but it's use is being decreased. Recently, Ultrasound, ERCP, and CT have been used for diagnosis. We present a report of case in whom ademomyomatosis of gallbladder was disgnosed on ultrasound and ERCP and confirmed by surgery. The essential feactures of ultrasound and ERCP diagnosis are discussed.

Endoscopic Findings and Its Diagnostic Accuracy in Gastric Cancer Confirmed by Surgery / 대한소화기내시경학회지

In order to evaluate the accuracy of endoscopic findings in the diagnosis of gastric can the endoscopic findings of gastric lesion were compared with the macroscopic and pathologic findings of excised identical lesion. 105 operated gastric cancer paitients (advanced cancer 95 cases, early cancer 10 cases) who were diagnosed endoscopically at Pusan National University Hospital from January 1983 to August 1987 were studied. The results were as follows; 1) The accuracy of endoscopic findings were 94.7% in the advanced gastric cancer, and 45.5% in the early gastric cancer. 2) The accuracy of gross findings endoscopic and pathologic in advanced gastric cancer were 50.0% in Borrmann type I, 45.0% in Borrmann type II, 73.2% in Borrmann type III, and 66.7% in Borrmann tyye IV. 3) The accuracy of the endoscopy ia morphologic classification of advanced gastric cancer according to pathologic tumor location were 60.0% in C (upper 1/3), 43.9% in M(middle 1/3),76.3% in A (lower 1/3), 55.6% in the anterior wall, 50.0% in the posterior wall, 66.7% in the greater curavature, and 67.2% in the lesser curvature. 4) The accuracy of endoacopy in morphologic classification of gastric cancer to tumor size ware 54.5% in below 2 cm, 54.5% in from 2.1 cm to 4 cm, 65.4% in from 4.1 cm to 6.0 cm, 80% in from 6.1 cm to 8 cm, 75.0% in above 8.1 cm. 5) The accuracy of endoscopy in the morphologic classification according to the pathologic tumor stage in advanced gastric cancer were 55.6% in TNM stage I, 52.0% in TNM stage II, 65.4% in TNM stage III, and 73,7% in TNM stage IV.

The Diagnostic Value of Segmental Nerve Conduction Study in Diabetics

Nerve conduction study has been an important part of electrodiagnosis and has been utilized as a clinical diagnostic technique in diabetic neuropathy. But conduction study of the more proximal segment has been a few reports. This study demonstrated segmental method for obtaining orthodromic motor nerve conduction and mixed nerve conduction, and antidromic distal sensory nerve conduction in diabetic group and normal group. The purpose of the study was to determine diagnostic value of segmental nerve conduction in diabetic neuropathy. The results were as follows: 1. Significant difference at P0.05 between diabetic group and normal group; in ulnar motor terminal letency, ulnar sensory nerve conduction velocity at axilla-Erb's point segment and finger-wrist segment, peroneal motor terminal latency and peroneal motor nerve conduction velocity at popliteal fossa-fibula head segment, posterior tibial motor terminal latency, sural sensory nerve conduction velocity. 3. The nerve conduction of proximal segment is more statistically significant than that of distal segment.

The Study of Serum Free Fatty Acid, Triglycerides and Glycerol in Congestive Heart Failure, Essential Hypertension and Liver Cirrhosis

Just as hyperbetalipoproteinemia is the most common kind of familiar hyperlipoproteinemia, hyperprebetalipoproteinemia or increased very low density lipoprotein (VLDL) and its associated hypertriglyceridemia is an abnormality frequently found in association with several metabolic and nutritional disorders. This VLDL abnormality is demonstrable in high percentage of insulin dependent diabetic children before they receive treatment. It is also observed in many older, overweight, insulin resistant diabetic, with poor control of diabetes. An elevation of VLDL was also observed after ethanol intake. A mild to moderate degree of VLDL elevation is the most frequently observed from of clinical hyperlipidemia. Many investigators reported that hyperprebetalipoproteinemia (hypertriglyceridemia) is associated with an increasing incidence of coronary artery disease. As opposed to hyperbetalipoproteinemia, hyperprebetalipoproteinemia is prone to influence on the development of atherosclerosis in the middle and older aged persons which indicates the importance of triglyceride determination in these aged groups. There has been relatively rare study reported on the triglyceride metabolism in patients with congestive heart failure, essential hypertension and liver disease in Korea. This study was designed to determine serum triglyceride, free fatty acid and glycerol in the disease mentioned in Busan University Hospital between jan. 1975 and December 1976 and analized the change of lipid profile in each different condition. The results were as follows; 1. The mean of serum FFA, triglyceride and glycerol in the 37 normal were as follows 502.32+/-146.54microEq/L, 111.84+/-40.53mg% and 432.00+/-212.13microM/ml. 2. 23 patients with congestive heart failure showed a significant reduction in serum triglycerides (91.96+/-27.80mg%) and a significant increase in serum free fatty acid (576.77+/-129.67microEqL) and glycerol (432.50+/-212.13microM/ml). 3. In 15 patients with essential hypertension a significant elevation of serum triglycerides (149.38+/-42.28mg%) was noted. 4. In 13 patients with liver cirrhosis, a reduction in serum triglycerides (80.50+/-34.27mg%) was noted.

The Study of the Serum Electrolytes in the Normal Person

We studied the serum electrolytes in the 727 normal persons who visited Busan University hosptial, Benedict Hospital and Maryknoll Hospital from 1970 to 1976. The results were as follows: 1. Mean value of the serum Na+ being measured in 729 normal persons was 138.7+/-6.2mEq/L and 140+/-6.5mEq/L in 450 male, while 136.8+/-6.6mEq/L in 279 female. 2. Mean value of serum Cl- being measured in 701 persons was 99.6+/-5.9mEq/L, and 99.7+/-6.0mEq/L in 437 male while 100+/-5.7mEq/L in 264 female. 3. Mean value of serum K+ being measured in 707 normal persons was 4.4+/-0.9mEq/L in 434 male, while 4.2+/-0.8mEq/L in 273 female. 4. Mean value of serum Ca+ being measured in 557 normal persons was 4.5+/-0.6mEq/L and 4.7+/-0.7mEq/l in 355 male, while 4.3+/-0.5mEq/L in 202 female. 5. Mean value of serum phosphorus being measured in 94 normol persons was 4.2+/-0.6mg%, and 4.1+/-1.0mg% in 65 male, while 4.5+/-1.5mg% in 29 female.