Prenatal Diagnosis of A Case of Fetus in Fetu in the Fetal Retroperitoneum / 대한산부인과학회잡지

Fetus in fetu is a very rare congenital abnormality in which one vertebrate fetus is enclosed within the abdomen of another fetus. With advancing ultrasound imaging technique, a few case of prenatal diagnosis is reported recently. A case of fetus in fetu with 6 X 6 X 4 cm sized cystic mass in the fetal retroperitoneum was diagnosed prenatally using ultrasound and confirmed by ultrasound and computer tomogram after delivery. This mass was removed completely from delivered baby and finally confirmed fetus in fetu by pathologic examination. Solid portion in this mass was composed of vertebral organization with limb bud, well-developed organ system.

A Case of Acute Myocardial Infarction due to Coronary Microembolism in Bacterial Endocarditis

Spontaneous coronary artery embolization is a known complication of infective endocarditis. However, a microembolism from the aortic valve into the left anterior descending artery resulting in an acute anterior myocardial infarction is very rare. A 44-year-old male patient suffered from chest pain and fever of seven days duration. The echocardiogram demonstrated severe aortic stenosis, aortic root abscess and mobile vegetation on bicuspid aortic valve near the left coronary artery ostium. The electrocardiogram revealed ST segment elevation in lead V1-3 and heart enzyme analysis showed LD 936 IU/L, CK 299 IU/L, CK-MB 7.2 U/L, Troponin I 9.94 ng/mL. Diagnostic coronary angiogram revealed insignificant coronary lesion. Emergent operation was required because of aortic root abscess formation and high risk of recurrent embolization. He underwent surgery for aortic valve replacement and conservative management for acute myocardial infarction. The purpose of this article is to report the successful emergent aortic valve replacement of a patient with myocardial infarction due to coronary microembolism in a case of bacterial endocarditis.

A Comparison of Patients With Hepatocellular Carcinoma Between A Short-term (Less Than 6 months) Survival Group and A Long-term (Over 24 Months) Survival Group After Treatment with Transcatheter Arterial Chemoembolization / 대한간학회지

BACKGROUND/AIM: Although hepatocellular carcinoma(HCC) shows poor prognosis, transcatheter hepatic arterial chemoembolization(TACE) can improve survival rate in some patient groups. This study investigated the synergy effect of the different clinical indices on the survival time in patients with HCC underwent TACE. MATERIALS AND METFODS: A retrospective study of 241 patients with HCC who underwent TACE with a mixture of lipiodol, mitomycin-C and adriamycin, alone or followed by gelfoam was conducted. Three different survival groups (A, less than 6 months; B, between between 6 and 23 months; and C, over 24 months) were compared. RESULTS: Alkaline phosphatase was lowest in group C (p=0.0001). The longer the survival, the lower (p=0.027, p=0.007) the AST and AST/ALT ratio were. Albumin was higher (p=0.032), GGT and LDH were lower (p=0.003, p=0.002) in the long-term survival group. The long-term survival group revealed an absence of both ascites(p<0.002) and portal vein thrombosis(p<0.001), and lower TNM stage (P<0.0001). The single nodular type of HCC was more frequent (P<0.0001) and the size of tumor was smaller in the long-term survival group (P<0.0001). Child-Pugh class was lower in the long-term survival group (p=0.017). The higher serum albumin and elder age, the higher albumin and the lower alkaline phosphatase or alpha-fetoprotein, represented synergic effects on a long term survival. The higher albumin and the smaller size or the lower tumor stage, the higher albumin and platelet revealed similar synergy effects. Although the age or platelet is high, low albumin showed poor prognosis. CONCLUSION: Patients with small-sized single, nodular HCC in a low Child-Pugh class without evidence of ascites and portal vein thrombosis, and the higher level of serum albumin but lower levels of alpha-fetoprotein, alkaline phosphatase, GGT, and LDH, can expect a long-term survival over 24 months by the treatment of TACE. There are meaningful synergies of the different clinical variables affecting the survival times in the patients with HCC undergoing TACE.

Role of Stress in Functional Dyspepsia / 대한소화관운동학회지

BACKGROUND/AIMS: Pathogenesis of functional dyspepsia consists of motor abnormality, sensory abnormality, and psychologic abnormality. Anxiety, depression, and psychosomatic disorders are well known psychopathologies that lead to dyspepsia, and stress seems to be an additional etiology. The aim of this study is to assess whether stress can cause and/or provoke dyspepsia. METHODS: Functional dyspepsia was defined and classified by Rome criteria. SCL-90-R for the detection of psychopathology, measurement of life stress scale by self-administered questionnaire, and measurement of stress coping mechanisms using a multidimensional stress coping scale test were performed in 79 functional dyspeptic patients and 25 normal controls. RESULTS: No significant difference was found in the total amount of stress between functional dyspeptic patients and the normal control. However, the patients were more stressful about issues relating to health and marital relationship among stresses in individual daily life. As the patients become more stressful, they used more negative coping mechanisms such as restraint, fatalism, criticism, religiousness, and negativism. These seem to provoke several psychopathologies including interpersonal sensitivity, depression, anxiety, hostility. However, there was no relationship in the amount of stress, the stress coping mechanism, and psychopathology among the dyspeptic symptoms and subgroups of functional dyspepsia. CONCLUSION: There was no difference in the total amount of stress between functional dyspeptic patients and the normal control. In some individuals who utilize inadequate coping mechanisms against stress, the stress can provoke dyspepsia.

Role of Stress in Functional Dyspepsia / 대한소화관운동학회지

BACKGROUND/AIMS: Pathogenesis of functional dyspepsia consists of motor abnormality, sensory abnormality, and psychologic abnormality. Anxiety, depression, and psychosomatic disorders are well known psychopathologies that lead to dyspepsia, and stress seems to be an additional etiology. The aim of this study is to assess whether stress can cause and/or provoke dyspepsia. METHODS: Functional dyspepsia was defined and classified by Rome criteria. SCL-90-R for the detection of psychopathology, measurement of life stress scale by self-administered questionnaire, and measurement of stress coping mechanisms using a multidimensional stress coping scale test were performed in 79 functional dyspeptic patients and 25 normal controls. RESULTS: No significant difference was found in the total amount of stress between functional dyspeptic patients and the normal control. However, the patients were more stressful about issues relating to health and marital relationship among stresses in individual daily life. As the patients become more stressful, they used more negative coping mechanisms such as restraint, fatalism, criticism, religiousness, and negativism. These seem to provoke several psychopathologies including interpersonal sensitivity, depression, anxiety, hostility. However, there was no relationship in the amount of stress, the stress coping mechanism, and psychopathology among the dyspeptic symptoms and subgroups of functional dyspepsia. CONCLUSION: There was no difference in the total amount of stress between functional dyspeptic patients and the normal control. In some individuals who utilize inadequate coping mechanisms against stress, the stress can provoke dyspepsia.

A Case of Isolated Left Main Coronary Ostial Stenosis due to Acute Angle Takeoff

Isolated and severe left main coronary ostial stenosis is a rare case. In the majority of these patients ostial stenosis was associated with any of the conditions known to involve the coronary ostia. These conditions include syphilitic aortitis, Takayasu's aortitis, familial hypercholesterolemia, and aortic valve disease. A 34-year young female patient was presented with exertional and stabbing anterior chest pain. There was no history of syphilis, diabetes mellitus, hypertension, hyperlipidemia and smoking. Coronary angiogram showed isolated left main coronary ostial stenosis. Transesophageal echocardiography(TEE) showed acute angle takeoff of the left main coronary artery. She underwent surgical angioplasty of coronary ostia with a patch of autologous pericardium. After angioplasty, TEE showed dilatation of left main coronary ostium and her clinical symptom improved.

A Case of Cyclopia Associated with Trisomy 13 / 대한산부인과학회잡지

Cyclopia is rare congenital craniofacial anomaly, in which the eyes are fused together and located in a single orbit. It is consistently associated with severe holoprosencephaly, which is the failure of cleavage of the prosencephalon with a deficit in the midline facial development. chromosomal study revealed 47, X( ), +13 (Patau syndrome).

Cardiovascular Regulation of GABAB Receptor in the Spinal Cord of the Rats / 대한내과학회지

OBJECTIVES: The purpose of present study is to investigate the influence of a spinal gamma-aminobutyric acid B (GABAB) receptor on a central regulation of blood pressure(BP) and heart rate(HR), and to define its mechanism in the spinal cord. METHODS: In urethane-anesthetized, d-tubocurarine- paralyzed and artificially ventilated male Sprague-Dawley rats, intrathecal administration of drugs were carried out using injecton cannula(33-gauge stainless steel) through the guide cannula(PE 10) which was inserted intrathecally at lower thoracic level through the puncture of a atlantooccipital membrane. RESULTS: Intrathecal injection of an GABAB receptor agonist baclofen(30, 60, 100 nmol) decreased both blood pressure and heart rate dose-dependently. Pretreatment with 8-bromo-cAMP(50 nmol), a cAMP analog or glipizide(50 nmol), a ATP-sensitive K+ channel blocker attenuated the depressor and bradycardic effects of baclofen (100 nmol) but not with 8-bromo-cGMP(50 nmol) a cGMP analog. CONCLUSIONS: The GABAB receptor in the spinal cord plays an inhibitory role in central cardiovascular regulation and that this depressor and bradycardic actions are mediated by the decrease of cAMP via the inhibition of adenylate cyclase and the opening of K+ channel.

A Case of Gastric Strongyloidiasis Diagnosed by Endoscopic Biopsy / 대한소화기내시경학회지

Korea Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis which exists in two forms : the free living and parasitic forms. It exists in warm, moist climate in areas where there is frequent fecal contamination of the soil. After cutaneous invasion by the filariform larvae, petechial hemorrage, pruritus, papular rashes, edema, and urticaria occur. Infection commonly occurs in the proximal intestine of the gastrointestinal (G-I) tract but may extend from the stomach to the anus. Once the worm is established in the small intestine, the physical findings may include epigastric tenderness to palpation. The mucosal biopsy is an inefficient way of making the diagnosis because the worm is found in the biopsy specimen in only 2% of patients. Gastric strongyloidiasis is rare. We experienced a case of gastric strongyloidiasis diagnosed by the endoscopic biopsy and serologic test for parasite specific IgG antibody by micro-ELISA.

Clinical Features of Hepatitis A in Korean Adults / 대한내과학회지

OBJECTIVE: This study was aimed to characterize the clinical features and course of acute hepatitis A in Korean adults. METHODS: One-hundred and thirteen cases of acute hepatitis A, diagnosed between Jan. 1995 to July 1998 at 6 medical centers in Korea, were reviewed retrospectively. The clinical course of 94 cases with follow-up duration longer than 3 months were analyzed. RESULTS: The median age was 26 (16-65) years and 97.3% of the patients were under 40 years. The presumed sources of infection were identifed in 62 cases (54.9%). Among those, the leading source was ingestion of raw food. All patients showed normalization of bilirubin level within 8 weeks. The ALT levels normalized within 8 weeks in all patients except three patients (3.2%). Three patients with prolonged elevation of ALT showed second rise of ALT, suggesting a possibility of relapsing hepatitis. Prolonged fever (>38 degree C) more than 10 days was observed in 3 patients (3.2%). One case showed prolonged elevation of alkaline phosphatase (> x3 upper normal limit). No case of fulminant hepatic failure or death was observed. CONCLUSION: The majority of cases with acute hepatitis A in Korean adults showed self-limited course with full recovery.

A Case of Primary Gastric Amyloidosis Diagnosed by Endoscopy / 대한소화기내시경학회지

Amyloidosis is characterized by deposition of amyloid, which is resistant to proteolysis & phagocytosis, in intercellular spaces & vascular walls. The amyloid deposition provokes dysfunction of an accumulated organ & displays variable clinical symptoms depending upon the involved organ. A diagnosis is rendered through a biopsy of the affected organ, followed by staining using congo red which reveals an apple greenish refractile birefringence via polarizing microscopy. Using an electro-microscopy specific filaments can be found. Amyloidosis is classified into primary amyloidosis, composed of light chain filaments (AL) and secondary amyloidosis, comprised of A protain (AA). The AL type of amyloidosis shows deposition of amyloid in muscularis mucosa & muscularis externa. Priunary amyloidosis on the other hand, is relatively rare. We experienced primary stornach amyloidosis (AL), which was mistaken for stomch cancer.

A Review of an Endoscopic Extraction in 19 Cases of Gaastrointestinal Foreign Bodies / 대한소화기내시경학회지

BACKGROUND/AIMS: Foreign bodies in the upper gastrointestinal (G-I) tract are produced chiefly by accidental swallowing and rarely produce symptoms. But it is recommended to remove the foreign bodies if they produce symptoms or remain in the G-I tract for a long duration. The purpose of this study was to anlyze the results of therapeutic endoscopic foreign bodies extraction and appropriate removal methods for each foreign bodies. METHODS: A clinical review was performed in 19 cases involving a foreign body in the upper & lower G-I tract which underwent the endoscopic extraction of the foreign body at Samsung Medical Center from November 1995 to November 1997.

A Case of Duodenal Ischemic Enteritis Due to Mesenteric Venous Thrombosis / 대한소화기내시경학회지

Mesenteric vein thrombosis (MVT) is an infrequent but old form of acute mesenteric ischemia, various forms of which have been recognized through imaging techniques. Pre- viously, diagnosis was made only by a laparotomy or autopsy. MVT is an abdominal emergency that is rarely diagnosed early. Review of the literature has shown that most cases have been treated by intestinal resection, and a few by thrombectomy with or with- out resection. Most are primary thromboses, but some are related to thromboembolic dise- ases, sepsis, cirrhosis, coagulopathy, abdominal neoplasms, traurna, or use of oral contra- ceptives. We report a case of superior mesenteric vein thrombosis with acute ischemic bowel disease, diagnosed early through a duodenoscopy and definitively assessed by superior mesenteric angiography and computed tomography. The predisposing factor for this case was a pelvic abscess post placenta previa operation. The first symptoms were hematemesis and abdominal pain. An intestinal mucosal lesion and clinical symptoms were improved by only heparinization and symptomatic treatment without resection.

Usefulness of Combined CTAP and CTHA as a Preoperative Study of Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Combined computed tomography during arterial portography(CfAP) and computed tomography during hepatic arteriography(CBiA) are more sensitive methods compared to conventional spiral CT in detecting small hepatocellular carcinoma. However, there are few data available on the influence of combined CTAP and CTHA on decision making for treatment of hepatocellular carcinoma. We aimed to evaluate the usefulness of CTAP and CfHA as a preoperative study of hepatocellular carcinoma for surgical treatment. METHODS: Eighty-two patients with histologically proven hepatocellular carcinoma who were considered to be surgical candidates on spiral CT and angiography were included. CfAP and CTHA were performed as the routine protocol. The findings of CTAP and CTHA were analyzed and compared to conventianal spiral Cl and angiography. ReESULTS: 1) 105 nodules were found on spiral Cf plus angiography, whereas, 138 nodules found on combined CIAP and CTHA: 33 additional nodules were found in 23 cases(28%). 2) The treatment plan changed from surgery to nonsurgical treatment in 10(12%) cases: 9 cases(10%) with bilobar involvement, and 1 case (1%) with more than three nodules. 3) The larger the tumor nodules on the spiral CT, the more additional tumor nodules were found on CTAP and CTHA: combined CTAP and CTHA were able to find more nodules in 21% of tumor 10cm on spiral CI' (p=0.03). CONCLUSION: Compared to spiral CT plus angiography, CI'AP and CfHA may be useful in avoiding unnecessary operation of hepatocellular carcinoma, especially in large tumors.

Effect of terazosin on blood pressure and serum lipids in nild to moderate hypertension

BACKGROUND: We evaluated the antihypertensive effect, safety and effect on serum lipids of terazosin, second generation alpha1-blocker. METHODS: Terazosin 1-4mg was adminstered once daily in 20 patients for 12 weeks with dose titration every 2 weeks. RESULTS: 1) The systolic and diastolic blood pressure were decreased from 170.0+/-13.0/104.0+/-6.0mmHg to 144.0+/-13.3/88.0+/-5.6mmHg(p<0.01), but the heart rate and body weight were independant of terazosin administration. 2) Total cholesterol was decreased significantly from 209.9+/-33.5mg/dL to 194.6+/-30.1mg/dL after 12 weeks treatment(p<0.05), triglyceride was decreased significantly from 185.4+/-37.0mg/dL to 168.9+/-35.0mg/dL(p<0.05). and LDL-cholesterol was decreased significantly from 134.5+/-31.9mg/dL to 122.7+/-29.9mg/dL(p<0.05), but HDL-cholesterol was increased significantly from 37.8+/-5.6mg/dL to 40.6+/-5.5mg/dL(p<0.05). 3) The adverse effects of terazosin were dizziness in 2, headache in 2, asthenia in 1, peripheral edema in 1 and skin rash in 1 patient, but were not troublesome enough to stop medication. CONCLUSIONS: Terazosin 1-4mg once daily regimen was effective and safe as an antihypertensive agent, and moreover terazosin has favorable effects on serum lipids.