Comparison of the clinical outcomes between intestinal Behcet's disease and simple ulcer / 대한내과학회지

BACKGROUND: This study was performed to compare the clinical outcomes of intestinal Behcet's disease with a simple ulcer. METHODS: We analyzed the medical records of 52 patients that were suspected as having intestinal Behcet's disease. Of these patients, 27 patients (Group 1) met both the criteria of the International Study Group for Behcet's Disease and the Behcet's Disease Research Committee of Japan. Thirteen patients (Group 2) met only the latter criteria and the other patients (Group 3) did not meet any criteria. The efficacy of medical treatment was assessed by the presence of gastrointestinal symptoms and follow-up colonoscopic findings. RESULTS: The mean age for patients with a diagnosis of an intestinal lesion was 38.6+/-12.2 years. The sex ratio was 1.08:1 (M:F) and the mean follow-up duration was 35.2+/-39.5 months. A single, smaller than 5 mm, round and shallow ulcer with an erythematous margin that was located at the leocecal area showed most typical colonoscopic features for intestinal Behcet's disease. No significant differences were found in the clinical manifestations and colonoscopic findings among the three groups of patients. Nineteen (44%) patients achieved complere remission from a sumptomatic point of view and 10 (39%) patients were proved to be complete remission according to follow up colonoscopy after medical treatment. Eleven patients (21.2%) underwent surgery. The overall cumulative rates of a first surgery and re-surgery were 40.5% and 71.9% at 10 years. No statistical relationship was found in the response of medical treatment and the cumulative rate of surgery among the groups. CONCLUSIONS: The clinical course and outcomes of an intestinal simple ulcer are not different from that for intestinal Behcet's disease.

An Analysis Based on Hospital Stay in Ischemic Colitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Ischemic colitis is the most prevalent form of gastrointestinal ischemia, accounting for approximately 50 to 60% of all gastrointestinal ischemic episodes. There are many conditions that predispose an individual to ischemic colitis as well as a wide variety of clinical and endoscopic presentations. This study reviewed the risk factors associated with ischemic colitis, the site of colonic involvement and the effect of antibiotics on the hospital stay. METHODS: 34 inpatients with ischemic colitis during October 2001 and November 2004 were analyzed retrospectively. All patients had intestinal bleeding. RESULTS: The mean age of the patients was 56+/-14. Among the 34 cases, 15 cases had the risk factors associated with ischemic colitis. The presenting symptoms were mainly abdominal pain and diarrhea. The endoscopic findings revealed four cases with pancolitis. One case with chronic liver disease died from septic shock. The mean hospital stay was 12+/-5 days, which was reduced by early admission and colonoscopic diagnosis, bowel rest and fluid therapy. However, patient's age, clinical presentations, location of the involved colon, the presence of risk factors and the use of antibiotics did not influence the hospital stay. CONCLUSIONS: If ischemic colitis with intestinal bleeding is suspected, an early colonoscopic diagnosis and medical treatment such as bowel rest and fluid therapy can reduce the hospital stay.

A Case of Gastric Mucormycosis Associated with Diabetes Mellitus and Alcoholic Hepatitis / 대한소화기내시경학회지

Mucormycosis is a rare, fulminating, opportunistic fungal infection that occurs almost exclusively in immunocompromised hosts such as patients with diabetes, leukemia, lymphoma. These fungi are ubiquitous in nature, and can be found on decaying vegetation and in the soil. So they are relatively frequent contaminants in the clinical microbiology laboratory. Recently the incidence of mucormycosis is rising associated with the increasing use of immunosuppressive agents, antibiotics. Though mucormycosis is frequently fatal, there has been a significant improvement in the outcome by early diagnosis and aggressive treatment. Mucormycosis can be categorized as rhinocerebral, pulmonary, gastrointestinal, cutaneous, widely disseminated and miscellaneous; gastro-intestinal involvement is extremely rare. We report a patient with gastric mucormycosis who had diabetes mellitus and alcoholic hepatitis. His chief complaint was an epigastric pain, and the gastroscopy showed huge multiple ulcers, coated with exudates. The histologic examination revealed multiple broad, nonseptate hyphae with right angle branchings, diagnosed as mucormycosis.

A case of hepatopleural fistula complicated by transcatheter arterial chemoembolization for hepatocellular carcinoma with liver abscess / 대한내과학회지

Pleural complication is extremely rare among the complications of lung following transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma. We report a case of hepatopleural fistula complicated by TACE. A 50-year-old male was admitted to the hospital because of aggravation of cough and chest pain. Fifty five days before admission, a liver abscess had developed and treated by percutaneous drainage. A hepatocellular carcinoma had been diagnosed as a cause of liver abscess. Forty five days before admission, TACE had been performed for the hepatocellular carcinoma. Thirty days after TACE, dry cough and right pleuritic chest pain developed. After admission, serial CT scans of thorax and abdomen showed the pleural effusion containing the lipiodol from the liver through hepatopleural fistula. Chest tube insertion with a urokinase instillation was performed for the treatment of empyema caused by hepatopleural fistula.

A Case of Primary MALT Lymphoma of the Breast / Journal of the Korean Cancer Association, 대한암학회지

Primary malignant lymphoma of the breast is rare. The incidence of primary malignant lymphomas of the breast is 0.04% to 0.5% of all malignant tumors of the breast and 0.07% of all non-Hodgkin's lymphomas, and comprises 1.7% of extranodal malignant lymphomas that occur in Western countries. The incidence of mucosa- associated lymphoid tissue (MALT) lymphoma of the breast is reported to be between 0% and 75% of all primary malignant breast lymphomas in United States and Japan, but the incidence in Korea is unknown. MALT is characterized by indolent behavior and good has a prognosis. The authors report on a patient who has a primary MALT lymphoma of the breast. She was treated by surgical excision, which was followed by radiation therapy. Histologically, her lymphoma type transformed into a diffuse large B-cell tumor after 10months. She received combination chemotherapy and achieved a complete state of remission. She then underwent autologous peripheral blood stem cell transplantation along with high dose chemotherapy. To our knowledge, this is the first case report in the literature in Korea.