An Incidental Asymptomatic Dieulafoy's Lesion in the Colon: A Case Report

A Dieulafoy's lesion is an uncommon, but important, cause of gastrointestinal bleeding. It is associated with massive, life-threatening hemorrhage and is typically difficult to diagnose. Although originally described in the stomach and rarely found below the proximal stomach, identical lesions have been reported in other gastrointestinal organs, including the duodenum, jejunum, colon, and rectum. Most cases occur with bleeding in the gastrointestinal tract. However, we present an incidental asymptomatic Dieulafoy's lesion in the colon, which was treated successfully by using an endoscopic hemoclipping technique.

Clinical Characteristics of Amebic Colitis as Diagnosed by using Colonoscopic Findings

PURPOSE: Nowadays, with improvements in hygiene and in the sewage system, the prevalence of amebic colitis in Korea is declining. However, amebic colitis still occurs every year. We investigated the clinical features of current patients with amebic colitis and compared the results with those for a past endemic period in Korea. METHODS: From June 2000 to June 2005, 10 patients were diagnosed in the Digestive endoscopy center of Song Do colorectal hospital as having amebic colitis. We evaluated their medical histories, clinical characteristics, and colonoscopic findings. RESULTS: The male-to-female ratio was 1.5 : 1. The mean age was 38.4+/-11.4 years. The mean diagnostic period from occurrence of symptoms to diagnosis was 20.4+/-17.5 days. The clinical symptoms of amebic colitis were diarrhea (80%), bloody stool (70%), mucoid stool (60%), abdominal pain (50%), fever, weight loss, nausea, and fatigue. Seven patients (70%) had a history of travel, and six of those seven patients had taken trips abroad. The foreign areas of travel included India (50%), Indonesia (28.6%), and Japan (16.7%). The diagnostic methods were colonoscopic biopsies to detect trophozoites of Entameba histolytica (90%) and serologic tests for the anti-ameba antibody (10%). The most common colonic locations of the lesions were the cecum (80%) and the rectum (80%). Another was the ascending colon (30%); pan-colonic involvement was also seen (10%). CONCLUSIONS: In the past, the cause of amebic colitis in Korea was poor hygiene. Nowadays, however, travel to amebiasis-endemic areas may be the most important cause. Therefore, the travel history of diarrheal patients is an important diagnostic factor in cases of amebic colitis and a differential diagnosis factor in cases of inflammatory bowel disease.

Analysis of Factors Influencing Secondary Bleeding after Hemorrhoidectomy

PURPOSE: Secondary bleeding is an inevitable and a troublesome complication of hemorrhoidectomy. This study analyzed the factors related to secondary bleeding after hemorrhoidectomy. METHODS: A total of 14,062 patients received a hemorrhoidectomy from Apr. 1999 to Apr. 2001. A retrospective study of 83 patients with secondary bleeding was done. At first, the doctors were divided into two groups. In one group, each doctor had performed more than 500 hemorrhoidectomies; in the other groups, each doctor had performed less than 500 hemorrhoidectomies. The incidence of secondary bleeding of the two groups was compared. Then, 155 patients without secondary bleeding were randomly selected as a control group. Clinical aspects and laboratory data were compared with those of the bleeding group. RESULTS: The total incidence of secondary bleeding was 0.6%. The incidence for the group with experienced doctors was 0.5%, that for the other group was 1.3%. When bleeding patients were compared with the control group, the proportion of patients who received a blood transfusion within 1 week before operation was 12.1% in the bleeding group and 2.6% in the control group. The postoperative WBC count was increased more in the bleeding group. The percentage treated with metronidazole was 12% compared with 25.3% in the control group. The incidences of bleeding according to operation sites were 19.6% in the right anterior, 12.2% in the left lateral, 10.9% in the right posterior, and 8.4% in the posterior portion. CONCLUSIONS: Secondary bleeding after a hemorrhoidectomy is more prevalent with less experienced doctors, recent history of blood transfusion, less use of metronidazole, and specific location of the hemorrhoid, such as the right anterior and the left lateral site of the hemorrhoid pile.

Purification and Partial Characterization of the 38 kDa Glycolipoprotein Antigen from the Culture Filtrate of Mycobacterium tuberculosis H37Rv

Mycobacterium tuberculosis infected macrophages can become ineffective at activating CD4+ T cells through presentation of peptide antigens by MHC class II, possibly contributing to the ability of M tuberculosis to persist despite the presence of an intact immune system. Presentation of lipid antigens may help to overcome this problem. CD1 represents the key component of an MHC independent pathway for presentation nonpeptide lipid antigens to T cells. The 38 kDa glycolipoprotein antigen of M. tuberculosis is actively secreted. The antigen induces strong antibody and T-cell responses and provided partial protection against M. tuberculosis infection in mice when it is administered either entrapped in biodegradable microparticles or in the form of a DNA vaccine. But an selective anergy to stimulation with peptide of the 38 kDa was observed in the majority of tuberculosis patients. An 38 kDa antigen has been isolated by affinity chromatography using a monoclonal antibody. This antigen contains some immunosuppressive cell wall associated antigens such as lipoarabinomannan. Therefore, we purified the 38 kDa glycolipoprotein from the culture filtrate of M tuberculosis H37Rv by ammonium sulfate precipitation (55~80%), hydroxylapatite and DEAE-Sephacel column. The purified antigen showed three major bands on isoelectric focusing gel, and two-dimensional electrophoresis (2-DE) analysis of this antigen revealed five distinct spots of the 38 kDa molecular mass. One of five spots had a N-terminal sequence identical to that of the 38 kDa glycolipoprotein (pstS-1). Other protein spots could not determine sequences. An antiserum against the recombinant 38 kDa antigen of M tuberculosis reacted strongly with the purified the 38 kDa antigen.