Hematochezia with Colonic Polypoid Angiodysplasia in a Young Female Patient

A 18-year-old girl visited the hospital due to hematochezia. Colonoscopy revealed a 6-mm Yamada type II polyp with stigmata of bleeding, and a shallow ulcer on top was found at the cecum base. The polyp was removed by snare polypectomy, and hematochezia stopped thereafter. Angiodysplasia was diagnosed histopathologically. Generally, angiodysplasia appears as a flat or elevated, bright-red lesion on endoscopy, with a polypoid shape being extremely rare. This case is significant because the lesion occurred at the youngest reported age and was the smallest that has been reported, and is the only polypoid arteriovenous malformation to be discovered in the cecum.

Correlation between Clinical Symptoms and Radiologic Findings before and after Pneumatic Balloon Dilatation for Achalasia / 대한소화기학회지

BACKGROUND/AIMS: We investigated the risk factors for short-term recurrence and analyzed the correlation between subjective clinical symtoms and objective radiological findings in patients with achalasia undergoing pneumatic balloon dilatation. METHODS: Twenty patients who were treated by pneumatic balloon dilatation were enrolled. We compared prospectively various indices before and after the treatment as follows: 1) Eckardt symptom score and dysphagia grade, 2) The ratio of the maximal width in mid-esophageal lumen to the minimal width in distal esophagus around lower esophageal sphincter, and 3) the percentage of maximum activity retained in the esophagus at 30 seconds and T in esophageal scan two days after the treatment. RESULTS: 1) Clinical indices and radiologic indices significantly improved after pneumatic dilatation. 2) There was no significant correlation between the clinical indices and the radiologic indices before and after the treatment. 3) The difference percentage of clinical indices did not show significant correlation with the difference percentage of the radiologic indices. 4) Compared to the group above 20% in the difference percentage of 30 second residual fraction, the one below 20% had a four-fold risk in short-term recurrence. CONCLUSIONS: Clinical symptoms and radiologic indices significantly improve after pneumatic dilatation but have no significant correlation to each other. The group below 20% in the difference percentage of 30 second residual fraction has a high risk of recurrence and may need careful examination and early repeated pneumatic dilation.

A Case of Primary Breast Lymphoma with Brain Metastasis Detected during Pregnancy / 대한혈액학회지

Primary breast lymphoma (PBL) is a rare clinical presentation of localized non-Hodgkin's lymphoma (NHL), and it makes up 0.04~1.1% of all breast tumors and it is 0.38~0.7% of all NHLs. The prognosis and patterns of relapse of PBL are still not clearly defined. The clinical features of PBL are different from those of breast carcinoma and the usual form of lymphoma. These features are a rapidly enlarging breast mass, multiple lesions, the absence of nipple discharge and retraction, and softer axillary lymph nodes as compared to the metastatic lymph nodes from breast carcinoma. B symptoms are unusual in PBL. A 30-year-old pregnant woman was admitted due to dysarthria and right side weakness that she had experienced for 7 days. She had several medical problems: intrauterine pregnancy at 34 weeks, some neurologic deficits and enlargement of both breasts. A biopsy from the breast and a brain magnetic resonance image (MRI) revealed diffuse large B cell lymphoma and multiple brain metastases, respectively. After delivery of a healthy, premature infant by Cesarean section, whole brain radiation therapy and combination chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone) were started. She showed good response to therapy. We report here on this unusual case and we review the related literature.

The Effects of Probiotics on Symptoms of Irritable Bowel Syndrome / 대한소화기학회지

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) tract disorder that has heterogeneous clinical presentations such as abdominal pain, diarrhea, constipation, and abdominal distension. It is known that several mechanisms are involved in the pathogenesis of IBS. Probiotics may target one or more pathophysiologic pathways in IBS and may improve the symptoms of IBS. However, the results of studies about probiotics on IBS are controversial. Therefore, the aim of this study was to evaluate the effect of probiotics on GI symptoms and intestinal gas volume changes in patients with IBS. METHODS: Forty patients were randomly allocated to be treated with medilac DS(R) (Bacillus subtilis, Streptococcus faecium) (n=20) or placebo (n=20) in a double-blind, prospective manner. The change in intestinal gas volume and symptom scores after 4-week treatment were evaluated for the efficacy. RESULTS: There was no significant difference in bloating, frequency of gas expulsion, frequency of defecation, and hardness of stool before and after the treatment. However, the severity of abdominal pain and the frequency of abdominal pain decreased significantly in medilac DS(R)group (2.4+/-1.3 cm/day -> 1.6+/-1.6 cm/day, 1.7+/-1.3/day -> 1.0+/-1.0/day) (p=0.044, p=0.038), but not in placebo group (2.1+/-2.0 cm/day -> 1.8+/-2.1 cm/day, 1.3+/-1.2/day -> 1.4+/-1.9/day). In both groups, intestinal gas volume at baseline, after 2-week treatment, and after 4-week treatment did not show significant change. Medilac DS(R)was well tolerated without adverse events. CONCLUSIONS: Medilac DS(R)is a safe and useful probiotic agent for the treatment of abdominal pain in patients with IBS.

The Effects of Probiotics on Symptoms of Irritable Bowel Syndrome / 대한소화기학회지

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) tract disorder that has heterogeneous clinical presentations such as abdominal pain, diarrhea, constipation, and abdominal distension. It is known that several mechanisms are involved in the pathogenesis of IBS. Probiotics may target one or more pathophysiologic pathways in IBS and may improve the symptoms of IBS. However, the results of studies about probiotics on IBS are controversial. Therefore, the aim of this study was to evaluate the effect of probiotics on GI symptoms and intestinal gas volume changes in patients with IBS. METHODS: Forty patients were randomly allocated to be treated with medilac DS(R) (Bacillus subtilis, Streptococcus faecium) (n=20) or placebo (n=20) in a double-blind, prospective manner. The change in intestinal gas volume and symptom scores after 4-week treatment were evaluated for the efficacy. RESULTS: There was no significant difference in bloating, frequency of gas expulsion, frequency of defecation, and hardness of stool before and after the treatment. However, the severity of abdominal pain and the frequency of abdominal pain decreased significantly in medilac DS(R)group (2.4+/-1.3 cm/day -> 1.6+/-1.6 cm/day, 1.7+/-1.3/day -> 1.0+/-1.0/day) (p=0.044, p=0.038), but not in placebo group (2.1+/-2.0 cm/day -> 1.8+/-2.1 cm/day, 1.3+/-1.2/day -> 1.4+/-1.9/day). In both groups, intestinal gas volume at baseline, after 2-week treatment, and after 4-week treatment did not show significant change. Medilac DS(R)was well tolerated without adverse events. CONCLUSIONS: Medilac DS(R)is a safe and useful probiotic agent for the treatment of abdominal pain in patients with IBS.