A Case of Isolated Rectal Tuberculosis / 대한소화기내시경학회지

Isolated rectal tuberculosis is defined as focal lesions of the rectum in the absence of demonstrable lesions in the small and large bowel, and it is a very rare form of intestinal tuberculosis. Common presenting features are rectal bleeding, diarrhea, constipation, tenesmus, and constitutional symptoms. Of them, rectal bleeding is the most common symptom. There are ulcerative, hypertrophic and combined types in the colonoscopic classification. Ulcerative type is the most common findings. The size of the ulcers are variable. The margins of the ulcer are irregular, swollen, erythematous and nodular. The base is covered with whitish to yellowish exudates and shows a granular appearance. For diagnosis of rectal tuberculosis it is important to obtain specimens at more than 6 regions in the base and margins of the ulcer. Important histologc findings are granuloma and demonstration of acid fast bacilli. I report a case of isolated rectal tuberculosis confirmed by colonoscopic study and histology.

A Case of Primary Hepatocellular Carcinoma with Metastasis to The Spinal Cord / 대한간학회지

Hepatocellular carcinoma is one of the most common malignancies reported in Korean adult males. Hepatocellular carcinoma usually spreads to regional lymph nodes around porta hepatis via lymphatics and to distant metastasis via hematogenous spread. The lung is most common distant metastatic site, followed by the adrenal glands, local lymph nodes and bones. But metastasis to the spinal cord of hepatocellular carcinoma is very rare. Recently we experienced a patient with hepatocellular carcinoma who had suffered from lower leg weakness for 10 days. The patient was proved to have hepatocellular carcinoma with metastasis to the spinal cord. MRI showed an ovoid intracordal mass between the twelfth thoracic and first lumbar vertebra level. After emergency irradiation, the patient could recover.

Two Cases of Primary Esophageal Small Cell Carcinoma / 대한소화기내시경학회지

Primary extrapulmonary small cell carcinoma have been described in the esophagus, stomach, pancreas, salivary gland, paranasal sinus, small bowel, uterus, urinary bladder and skin. Primary small cell carcinoma of the esophagus has rarely been reported since McKeown had reported the first 2 cases of small cell carcinoma of the esophagus in 1952. Primary small cell cancer of esophagus is extremely aggressive tumor with grave prognosis. Because of the highly malignant potency, multimodality treatment including chemotherapy for the primary therapy is accepted generally. We experienced 2 cases of small cell carcinoma of the esophagus. One patient was a 57 year-old male without metastasis and we treated him with a multi-drug regimen (cisplatin and VP-16) being used in small cell carcinoma of the lung at our hospotal. But the other patient was a 67 year-old male with bone metastasis, and he refused all management.

A Case of Duodenal Tuberculosis Conceived as Submucosal Tumor Accompanied by Tuberculous Lymphadenitis / 대한소화기내시경학회지

In spite of decrease in prevalence, yet tuberculosis is not rare disease in Korea and the morbidity is over one percent. Because extrapulmonary tuberculosis is less common than that of lung, quick and accurate diagnosis is not easy and there may be some problems in selecting the methods and the times to treat it. Especially, each or combination of abdominal lymphadenitis and duodenal tuberculosis are so rare that differential diagnosis from other common or rare diseases is difficult, and much attention is required to diagnose and treat those. Recently we experienced a case of tuberculous lymphadenitis accompanied by duodenal bulbar tuberculosis which had been conceived as submucosal tumor at endoscopy and diagnosed by explorative operation. So we report this case with review of related literatures.

A Case of Liver Abscess Associated with Fascioliasis Diagnosed by MRI / 대한간학회지

Fascioliasis is a zoonotic helminthiasis caused by Fasciola hepatica, the sheep liver fluke. Humans are accidental hosts in the life cycle of the parasite. They are infected by the ingestion of water or raw aquatic vegetables contaminated with the metacercaria. The diagnosis of fascioliasis is based on clinical symptoms, absolute eosinophilia, serologic test (ELISA), radiologic finding, and presence of eggs in the feces or duodenal fluid. Recently, some radiologists have been reporting specific findings of fascioliasis by MRI. We report a case of liver abscess associated with fascioliasis diagnosed by MRI.

The Correlation Between The Histologic Activity and Fibrosis and The Distribution of Intrahepatic HBsAg and HBcAg in Patients With Chronic Hepatitis B / 대한간학회지

BACKGROUND/AIMS: The purpose of this study was to assess the correlation between histologic activity and fibrosis and the distribution of intrahepatic hepatitis B core antigen (HBcAg) and surface antigen (HBsAg) in patients with chronic hepatitis B. METHODS: 141 patients (M:F=141:27) with biopsy-proven chronic hepatitis B, abnormal liver function, and a positive HBV viral marker (serum HBeAg, serum HBV DNA) were enrolled. RESULTS: HBcAg was expressed in 96 of 141 patients (68.1%), nHBcAg in 23 (16.3%), cHBcAg in 58 (41.2%), and n-cHBcAg in 15 (10.6%). In the cases of HBsAg, 114 of 141 patients (80.9%) were expressed as cHBsAg, 2 (1.4%) as mHBsAg, and 16 (11.3%) as m-cHBsAg. The presence of intrahepatic HBcAg and HBsAg according to Gudat's classification was not correlated with activity and fibrosis. But the groups with nuclear expression of HBcAg revealed less inflammatory activity (grade, p=0.003), and less fibrotic stage (p = 0.002) than with cytoplasmic or no expression of HBcAg. HBsAg was not. CONCLUSIONS: These observations suggest that inflammatory activity and fibrosis of chronic hepatitis B are related to the presence of HBcAg in hepatocytes and the expression of HBcAg. This is a very important finding in hepatocytolysis.

Amatoxins Poisonings in Korea / 대한간학회지

BACKGROUND/AIMS: From the review of Korean literature most fatal mushroom poisonings have been due to amatoxins with high mortality. So far there have never been investigations on the amatoxins poisonings such as annual incidence, mortality, common causal species, and endemic areas. This study was carried out to develop some basic statistics as part of studies for an effective management of amatoxins intoxications. METHOD: For the year 1999 authors collected cases of mushroom poisonings which had been mainly gathered from hospitals nation-wide. All of the cases with suggestive amatoxins poisonings were screened by symptomatology and laboratory findings. The causal species of mushrooms were identified grossly and microscopically. RESULTS: A total of 54 victims with mushroom poisonings were evaluated. The causal mushroom toxins were diagnosed or strongly suggested as amatoxins in 43 of 54 victims. Eleven of 54 victims did not conform to the category of amatoxins intoxication due to absent or minimal elevation of aminotransferase. Mean age of the victims was 44.3 23.3 (range: 7-78) with male predominance (1.2 : 1). The causal species were confirmed, or strongly suggested, as Amanita virosa in 25 victims, Amanita subjunquillea in 14, and unknown species in 4. Thirty-five out of a total of 43 were regarded as moderate to severe intoxication (AST or ALT >1,000 IU/L) with 20% mortality. Most fatal victims showed marked thrombocytopenia (40,000 19,000/mm3) compared to non-fatal victims (109,066 42,245/mm3). A total of 88.4% of victims was developed in the Kangwon and Kyungpuk provinces. Both are west of the Taebaek Mountains (38/43). CONCLUSIONS: Although the common causal species for amatoxins poisonings in Korea are different from European countries and North America, the mortality is similar to that of those areas. In order to further reduce the mortality, bedside diagnostic methods using biological fluids and more effective therapy for liver failure should be established.

Subtypes of Intestinal Metaplasia in Chronic Gastritis / 대한소화기내시경학회지

BACKGROUND/AIMS: Gastric carcinoma is the most common malignant neoplasm in Korea and is known to be associated with intestinal metaplasia (IM) of gastric epithelium, of which type III IM is suggested to play a special role in the carcinogenesis. This study is to evaluate the subtypes of IM and to measure each subtype in chronic gastritis. Methods: From October 1997 to September 1999, 321 patients with endoscopic chronic gastritis were evaluated the grade of chronic gastritis and IM by histologic and histochemical stain. RESULTS: Chronic inflammation and IM were remarkably severe in men and Helicobacter pylori (H. pylori) positivity was 69.4% in men and 65.2% in women. The frequency of IM was 50.1%, of which 65.4% was in men and 34.6% in women. The frequency of IM subtypes was 43.2%, 11.7% and 45.1% for type I, II and III respectively. Sixty percent of IM was noted in more than 50 years of age and ninety percent in more than 40 years of age. The frequency of type III IM was 61.6% in men and 38.4% in women. Sixty one percent of type III IM was noted in more than 50 years of age and ninety percent in more than 40 years of age. Interestingly, fifty three percent of type III IM was noted in men more than 40 years of age. The prevalence of H. pylori infection in type III IM was similar to in type I and II. The glandular atrophy in type III IM was remarkably severe than that in type I and II. Conclusions: The results of this study show that the proportion of type III IM in chronic gastiritis is remarkably high in Korean and age and sex distribution is similar to that of gastric carcinoma.

A Case of Carcinoid Tumor of the Rectum / 대한소화기내시경학회지

Carcinoid tumor primarily affects the intestinal tract, which arise from the Kulchitsky cells found at the base of the crypts of Lieberk hn. Rectal carcinoids are relatively uncommon lesions, representing only 1.3 percent of all rectal tumors. Rectal carcinoids have benign course and are usually asymptomatic. While their prognosis is generally favorable, it is known that about 15% of these tumors metastasize. Rectal carcinoid tumors should be treated appropriately and aggressively when indicated. Present-day treatment programs call for radical cancer resection only for lesions larger than 2 cm in diameter and local resection for all others. We have experienced a case of carcinoid tumor of the rectum treated by endoscopic polypectomy.

A Case of Lower Esophageal Ring with Dysphagia / 대한소화기내시경학회지

Lower esophageal ring are uncommon. We experienced a case of lower esophageal ring in a 51-year-old man who had intermittent swallowing difficulty for 2 years. Endoscopy revealed a circumferential narrowing at 34 cm from the incisors and congested and eroded mucosa was noted proximal to the ring. Esophagography revealed an elevation of G-E junction above the diaphragm and a reflux of dye from the stomach into the esophagus with thickened and irregular esophageal wall.

Dieulafoy - like Lesions of Nontraditional Locations in Gastric Antrum and Jejunum / 대한소화기내시경학회지

Dieulafoy's lesion is a rare distinetive arterial malformation that can cause massive gastrointestinal henorrhage. Although in most cases the lesion is encountered in the proximal stomach within 6 cm of the gastroesophageal junction, similar lesions have been described in the antrum, duodenum, jejunum, colon, and rectum. We report 3 unusually located Dieulafoy-like lesion, two gastric antrum and one jejunum in patient who had gastrojejunostomy for pancreatic caneer. After a year follow up there was no bleeding episode in patient after endoscopic treatment.

Sphincter-saving procedures for distal carcinoma of the rectum

No abstract available.

A Case of Pulmonary Artery Aneurysm Associated with Patent Ductus Arteriosus

Pulmonary artery aneurysms are very rare. They are usually associated with congenital cardiac defect. We present one case of pulmonary artery aneurysm associated with patent ductus arterious with the review of the literatures.

Diffuse Lymphoid Hyperplsia of Gastric Antrum / 대한소화기내시경학회지

We experienced three young patients with diffuse lymphoid hyperplasia of the gastric antrum. The peculiar nodularity of the stomach in tliese patients is another cause of etat mammelanne in addition to hypertrophic gastritis and prominence of the areae gastricae. The etiology of the diffuse lymphoid hyperplasia of the gastric antrum is not known. The symptqm is not specific and not related to hitologic and gastroscopic finding but rather to psychological disturbance. We propose longstanding observation for the change of the nodularity.

One Family with Asymmetric Septal Hypertrophy

One family with asymmetric septal hypertrophy was reported. The propositus of this family was 31 years old man who was admitted because of transient syncope. His father and one brother were affected but asymptomatic. His sister was suddenly died at age 21 years. The interventricular septal thickness to left ventricular posterior wall thickness ratios were measured using M-mode echocard ogram. In the affected family, echocardiogram revealed asymmetric septal hypertrophy (1.5:1, 2:1, 1.9:1 respectively). In the propositus, cardiac catheterization and simultaneous biventricular cineangiography were performed. Pressure study revealed mild peak systolic pressure gradient within left ventricular apex and left ventricular outflow tract (4mm Hg respectively). Biventricular cineangiogram showed the septal width increased inferiorly, and left ventricular endocardial surface of the septum was straight, while the right ventricular border convex toward the right ventricle.