Gastric Outlet Obstruction by Impacted Phytobezoar at the Normal Duodenal Bulb

Phytobezoars are the most common bezoars composed of non-digestible food materials, such as fiber, seeds, skin of fruits. The predisposing factors of bezoars are altered gastrointestinal motility and anatomy. It is uncommon for bezoars occurring in patient with normal gastric anatomy to cause impaction on the duodenal bulb. We experienced a phytobezoar at the duodenal bulb causing gastric outlet obstruction in a patient who had no predisposing factors. The patient was treated by endoscopic removal.

A Case of Bleeding on the Ampulla of Vater Due to Angiodysplasia in a Patient with End Stage Renal Disease / 대한소화기내시경학회지

Gastrointestinal angiodysplasia is one of the causes of acute and chronic gastrointestinal bleeding, and gastrointestinal angiodysplasia makes up 2~6% of all the cases of upper gastrointestinal bleeding. Bleeding from the ampulla of Vater is very rare. We report here on an unusual case of bleeding from angiodysplasia at the ampulla of Vater in a 58-aged woman with end stage renal failure. This lesion was successfully treated with endoscopic argon plasma coagulation.

Genetic Polymorphisms of UGT1A and their Association with Clinical Factors in Healthy Koreans

Glucuronidation by the uridine diphosphateglucuronosyltransferase 1A enzymes (UGT1As) is a major pathway for elimination of particular drugs and endogenous substances, such as bilirubin. We examined the relation of eight single nucleotide polymorphisms (SNPs) and haplotypes of the UGT1A gene with their clinical factors. For association analysis, we genotyped the variants by direct sequencing analysis and polymerase chain reaction (PCR) in 218 healthy Koreans. The frequency of UGT1A1 polymorphisms, -3279T>G, -3156G>A, -53 (TA)(6>7), 211G>A, and 686C>A, was 0.26, 0.12, 0.08, 0.15, and 0.01, respectively. The frequency of -118 (T)9>10 of UGT1A9 was 0.62, which was significantly higher than that in Caucasians (0.39). Neither the -2152C>T nor the -275T>A polymorphism was observed in Koreans or other Asians in comparison with Caucasians. The -3156G>A and -53 (TA)6>7 polymorphisms of UGT1A were significantly associated with platelet count and total bilirubin level (p=0.01, p=0.01, respectively). Additionally, total bilirubin level was positively correlated with occurrence of the UGT1A9-118 (T)(9>10) rare variant. Common haplotypes encompassing six UGT1A polymorphisms were significantly associated with total bilirubin level (p=0.01). Taken together, we suggest that determination of the UGT1A1 and UGT1A9 genotypes is clinically useful for predicting the efficacy and serious toxicities of particular drugs requiring glucuronidation.

A Case of Infective Endocarditis associtaed with Microcytic Hypochromic Anemia / 대한혈액학회지

We experienced a case of infective endocarditis, which unusual has symptoms and microcytic hypochromic anemia. Anemia associated with infective endocarditis is a common manifestation, but is generally normocytic nor-mochromic. However, microcytic hypochromic anemia is an uncommon manifestation of infective endo-carditis, and has only been noted in a few previous reports. We systematically evaluated anemia, and diagnosed fatal underlying diseases, such as infective endocarditis.

Venous thrombosis associated with psoas abscess: successful treatment with percutaneous drainage of abscess and antibiotics / 대한내과학회지

We report an unusual case of venous thrombosis complicated by pyogenic psoas muscle abscess in a patient with chronic biliary tract disease. A 64-year-old woman presented with high fever and progressive back and left flank pain. She had been admitted because of recurrent cholangitis and liver abscess 7 months ago. Both abscess and blood cultures had revealed Klebsiella pneumoniae and she had improved with treatment of antibiotics and percutaneous drainage of abscess. Computed tomography demonstrated psoas abscess and thrombosis of inferior vena cava and left iliac vein adjacent to abscess. Several days later, abscess culture showed Klebsiella pneumoniae. Because there was no evidence of deep vein thrombosis and the thrombosis was confined only to the vein adjacent to the abscess, we considered that the thrombosis would be associated with the abscess. She was immediately treated with percutaneous drainage of abscess and antibiotics. Follow-up computed tomography demonstrated complete disappearance of both psoas abscess and venous thrombosis.

Three Cases of the Gastric Carcinoid Tumor Combined with the Gastric Adenoma / 대한소화기내시경학회지

Carcinoid tumor in the stomach is neuroendocrine tumor originated from enterochromaffin cells in submucosa in the stomach. It is very rare, account for 0.3% of gastric tumor. It is likely to be demonstrated with other tumor in the stomach simultaneously, such as adenocarcinoma. According to paper published in Korea, it is only 4 cases that gastric carcinoid combined with other gastric tumors have been reported. But there has been no reports of gastric carcinoid combined with gastric adenoma, such as our cases. We report 3 cases of gastric carcinoid tumor combined with atypical adenoma, with review of paper presented.

The role of hypoalbuminemia as a marker of the severity of disease in patients with tsutsugamushi disease / 대한내과학회지

BACKGROUND: Although hypoalbuminemia is common in patients with tsutsugamushi disease, acute rickettsial infectious disease, its impact on the severity of disease is not reported. Therefore, we studied the role of hypoalbumiemia as a marker of the severity of disease in patients with tsutsugamushi disease. METHODS: We retrospectively reviewed clinical data of 95 patients with tsutsugamushi disease who were admitted between January 1994 and December 1999 at Uijongbu St. Mary's hospital. We compared clinical and laboratory findings, complications, and mortality between hypoalbuminemic group (serum albumin or = 3.0 g/dL). RESULTS: Of the total 95 patients, 50 patients (52.6%) had hypoalbuminemia. In hypoalbuminemic group, the incidence of hypotension was higher (20.0% vs 2.2%, p=0.006) and the duration of admission was longer (12.0+/-4.5 vs 8.8+/-2.7 days, p<0.001), compared to control. The degree of thrombocytopenia in hypoalbuminemic group was severer than that in control (84,000+/-46,000 vs 138,000+/-75,000/mm3, p<0.001). Hypoalbuminemic group showed higher incidence of interstitial pneumonia (64.0 vs 13.3%, p<0.001), hypoxia (40.0 vs 6.6%, p<0.001), metabolic acidosis (12.0 vs 0%, p=0.018), and acute renal failure (18.0 vs 4,4%, p=0.038), compared to control. Four patients who had hypoalbuminemia died due to septic shock and multiorgan failure. CONCLUSION: This study shows that hypoalbuminemia could be used as a marker of the severity of disease in patients with tsutsugamushi disease.

A Case of Primary Adenocarcinoma of the Duodenal Bulb Associated with Early Gastric Cancer / 대한소화기내시경학회지

Multiple primary tumors are defined as cases involving primary malignant tumors of different histologic origins in one person. Recently, the number of reports dealing with multiple primary tumors has been increasing due to more developed diagnostic procedures and patients with longer survival rates. Both the occurrence of multiple primary tumors and the primary adenocarcinoma of the duodenum are infrequent, accounting for less than 1% of all carcinoma of the gastrointestinal tract. Also, It has been reported that duodenal bulb cancer combined with early gastric cancer is extremely rare. One case was experienced involving duodenal bulb cancer combined with early gastric carcinoma, and is herein reported with a review of related literatures.

Expression of p53 and NDP-K/nm23 in gastric carcinomas: association with metastasis and clinicopathologic parameters

To evaluate the role of p53 and NDP-K/nm23(nm23) protein as a prognostic factor and their relation to metastasis of cancer, we studied metastatic and nonmetastatic gastric carcinoma specimens by immunohistochemical staining. Among the 101 specimens examined, 37(36.6%) showed positivity in staining for p53 protein and 64(63.4%) showed no detectable p53 protein in tumor cells. p53 overexpression was correlated with depth of invasion, lymphatic invasion, lymph node metastasis and distant metastasis. Out of 101 specimens, 35 cases had no staining for nm23. 62 cases(61.4%) exhibited a cytoplasmic staining on most cells and 42 cases (41.6%) had nuclear staining. In 16 of 101 cases(15.8%), a mild to moderate membranous staining was observed in some cells. Cytoplasmic nm23 expression was negatively correlated with lymph node metastasis(P < 0.01) and distant metastasis(P < 0.01). The nuclear nm23 expression showed negative correlation with depth of invasion(P < 0.01), lymphatic invasion(P < 0.01), lymph node metastasis(P < 0.01), and distant metastasis(P < 0.04). The membranous nm23 expression revealed negative correlation with lymphatic invasion(P < 0.02), lymph node metastasis(P < 0.01) and distant metastasis(P < 0.02).

Gastric Lymphoid Follicles in Helicobacter Pylori Infection: Frequency, Distribution and Relationship to Inflammation in 331 Gastric Biopsy Material

Helicobacter pylori(H. pylori) infection is considered the most important cause of chronic active gastritis and peptic ulcer. To determine the prevalence, distribution and it's relationship to degree of inflammation, gastric biopsy specimens were obtained from 331 nonulcer dyspepsia(NUD) patients consisting of 52 H. pylori negative normal volunteers and 279 H. pylori infected patients. Lymphoid follicles, degree of acute and chronic inflammation(Grade 0 to 3), and degree of H. pylori(Grade 0 to 4) were observed. The prevalence of H. pylori in NUD was 84.29%. The lymphoid follicles were found in 138 patients(41.7%) and only 5 patients(l.5%) without H. pylori showed lymphoid follicles. There was strong a relationship between lymphoid follicles and degree of acute and chronic inflammation and intensity of H. pylori infection(P<0.001). Acute and chronic inflammation were more serious in the antrum than body in H. pylori infected patients. There was no relationship between lymphoid follicles and the site in the stomach of H. pylori infection(P<0.078), but the body portion had an increased frequency of lymphoid follicles compared to the in antrum. Our results indicate that the prevalence of H. pylori infection in Korea is higher than in Western people and the degree of acute and chronic inflammation are strongly correlated with the presence of lymphoid follicles. The lymphoid follicles are believed to be absent from the normal stomach and their presence is strongly associated with H. pylori infection. The fact there is an that increased frequency of lymphoid follicles in H. pylori infected patients, and that they are more prevalent in the body of the antrum, support the concept that H. pylori may be a precursor in the development of primary gastric lymphoma.