A clinical study on liver abscess over a recent 10-year period / 대한내과학회지

BACKGROUND: The mortality of liver abscess has remained relatively constant during this century despite earlier diagnosis, treatment of underlying causes and more aggressive antibiotics therapy. The aims of this study were to evaluate the risk factors that associated with mortality of liver abscess. METHODS: This study was carried out retrospectively including 70 patients with liver abscess from January 1992 to August 2001. The clinical features, laboratory, imaging, and microbiologic findings, management strategy, and final outcome were studied, and prognostic factors were analyzed. RESULTS: There were 37 males and 33 females whose ages ranged from 17 to 89 years. The mean age of the patients was 57 years, and the male to female ratio was 1.1:1. In the major part of patients, the abscess was located in the right lobe (61.4%) and single in number (78.5%). Upper abdominal pain, fever and chills were the most common symptoms, and right upper abdominal tenderness was the most common physical findings. Twenty-six percent of patients were diabetic and 40%, 10% had biliary tract disease, malignancy on presentation, respectively. A hypoalbuminemia (

A Tubulovillous Adenoma of Duodenal Bulb Treated by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Solitary tubulovillous adenoma of the duodenal bulb is a rare tumor, which has not been reported in the Korean literature. Most of duodenal adenoma is located in the second portion of the duodenum. We report an unusual case of tubulovillous adenoma of the duodenal bulb. The lesion was treated by the endoscopic mucosal resection and was histologically diagnosed as tubulovillous adenoma.

Efficacy of Triple Therapy with Rabeprazole for Helicobacter pylori Infection in relation to CYP2C19 Genotype / 대한소화기학회지

BACKGROUND/AIMS: Genetic polymorphism of cytochrome P450 CYP2C19 influences the efficacy of proton pump inhibitor (PPI) in Helicobacter pylori (H. pylori) eradication therapy. We investigated the difference in the cure rates of H. pylori infection by triple (rabeprazole plus amoxacillin and clarithromycin) therapy in relation to CYP2C19 genotype status. METHODS: One hundred and sixteen H. pylori infected patients with gastric ulcer and duodenal ulcer completed the triple therapy with 10 mg of rabeprazole b.i.d., 1,000 mg amoxacillin b.i.d. and 500 mg of clarithromycin b.i.d. for one week. The genotype of CYP2C19 was determined by a PCR-restriction fragment length polymorphism method. RESULTS: According to the univariate analysis, heterozygous extensive metabolizers (hetero EMs) and poor metabolizers (PMs) showed the highest (87.0%) and the lowest (80.0%) eradication rates, respectively. The difference in the therapeutic efficacy of rabeprazole among the different CYP2C19 genotypes was insignificant. With regard to gender, age and smoking history in relation to eradication rate, a statistical significance was noted only with age with odds ratio of 1.063 and p-value of 0.0202. CONCLUSIONS: In the eradication therapy of H. pylori, no statistically significant difference in therapeutic efficacy of rabeprazole was found among different CYP2C19 genotypes.

A Case of Multiple Hyperplastic Polyps in the Stomach and Colorectum / 대한소화기내시경학회지

Hyperplastic polyps are a benign epithelial proliferation and a common type of colorectal and gastric polyps. Malignant change of hyperplatic polyps is rare. Patients with multiple lesions however, tend to have a high frequency of malignancy. Colorectal polyposis syndromes with gastric polyps include familial adenomatous polyposis, Gardners syndrome, Peutz-Jeghers syndrome, juvenile polyposis and others. But the case of colorectal hyperplastic polyposis with multiple gastric hyperplastic polyps has not been reported until now. A case was recently experienced involving a 32 year old women with both colorectal and gastric hyperplastic polyposis. Multiple hyperplastic polyps were found in the lower part of the body and the antrum of the stomach, rectosigmoid, transverse and ascending colon.

A Case of Necrotizing Liver Abscess and Bile Duct Necrosis Following Hepatic Arterial Chemoembolization in Hepatocelluar Carcinoma / 대한간학회지

Transcatheter arterial chemoembolization (TACE) is widely used in the treatment of hepatocellular carcinomas. We report a case of mult iple liver abscess with bile duct necrosis following gallbladder infarction after TACE in a patient with hepatocellular carcinoma. A 62-year old man, wit h four cm sized hepatocellular carcinoma in right lobe, was treat ed by TACE for six times during 18 months. Two days after the last TACE, acute cholecystitis occurred and antibiotics were used until the recovery of cholecystitis. After two months, abdominal CT scan revealed a gas containing liver abscess and percutaneous transhepatic drainage was performed. Cholangiography via drainage cathet er showed findings of bile duct necrosis. Ant ibiotics sensit ive to the causative organism were administered intravenously. However, the abscess persisted despite of treatment for three mont hs.

A Case of the Massive Upper GI Bleeding from the Arteriovenous Malformation of Stomach / 대한소화기내시경학회지

The arteriovenous malformation(AVM) of the gastrointestinal tract is a rare cause of gastrointestinal bleeding. With the increasing use of angiography over the past 30 years in the assessment of gastrointestinal bleeding, AVM has been more frequently recognized. There are few reports, however, about the arteriovenous malformation of stomach. From 1884, about 40 cases were reported all over the world. The clinical manifestation of gastric AVM are asymptomatic massive upper gastrointestinal bleeding or chronic iron deficiency anemia, The diagnosis of gastric AVM is difficult because of nonspecific findings using an endoscopy. This lesion is easily detected using a selective angiography. Furthermore, the therapeutic embolization of the feeding artery have a better chance for stopping the bleeding. In this paper we are reporting one case of gastric AV malformation, wherein rnassive UGI bleeding and dingnosis was made usmg a selective angiography. A review of literatmes was conducted to make this report possible.

Expression of Mucin Carbohydrate Antigen, sTn and Tn in Patients with Ulcerative Colitis(UC) / 대한내과학회지

OBJECTIVES:Long standing observation, which may relate either to the causes or the effects of UC, reveals that there is a pronounced alteration of mucin such as quantitative and qualitative abnormalities of mucin glycoprotein. But recently in situ hybridization technique showed no specific difference in the expression of apomucin mRNA in UC. Therefore we investigated whether abnormality of mucin was originated from defect in glycosylation. And we also tried to find differences in the expression of Tn and sTn antigens between Korean and Jewish patients with UC. METHODS: We performed the immunohistochemical staining using the monoclonal antibody of mucin carbohydrate antigens Tn and sTn in 19 patients with UC. RESULTS: Tn and sTn antigens were not expressed throughout the crypt and surface epithelium in normal colon but both of mucin carbohydrates antigens were well expressed in mild UC, Tn antigen was seen in the surface epithelium with perinuclear pattern and sTn antigen was shown not only in surface but also in crypt epithelium. In severe UC, Tn antigen was well expressed, but sTn antigen was not expressed. Tn antigen seemed to be ex-pressed more frequently than sTn antigen with severity of inflammation. These results were similar in Korean and Jewish patients with UC. CONCLUSION: These results suggest that inflammatory bowel disease has some deterioration in the step of glycosylation in the cytoplasm and there was no racial difference in the expression of Tn and sTn antigen in Korean and Jewish patients with UC.

Esophagus, Stomach & Intestine; One Case of Early Gastric Stump Cancer Following Partial Gastrectomy for Gastroptosis / 대한소화기내시경학회지

Gastric stump cancer is defined as cancers that develop in the gastric remnant after the gastric resection of nonmalignant lesions or malignant lesions. The interval between gastrectomy and the detection of gastric stump cancer must be over 5 years in nonmaligant lesions and 10 years in malignant lesions. Symptoms of gastric stump cancer are not specific, so, diagnosis is often delayed. Early detection and curative operation is very important in gasric stump cancer and follow-up endoscopic examination is the most importaint diagnostic tool to detect gastric stump cancer. Recently we experienced a case of early gastric stump cancer. We report review of the literature to remind the important of gastric stump cancer and the important of follow-up endoscopic examination.

A Case of Heterotopic Pancreas of Gastric Corpus / 대한소화기내시경학회지

Heterotopic pancreas is an aberrant pancreatic tissue that lacks anatomic and vascular continuity with the main pancreas. Although heterotopic pancreas is a relatively rare entity and usually noted as an incidentel findings at autopsy and during surgery for other causes, it is capable of producing symptoms depending on the site and size of lesions as well as various pathological changes occuring in the pancreas itself. We have recently experienced a case of heterotopic pancreas on the mid-body of posterior wall along the lesser curvatrue of stomach in a 30-year-old man, who visited our hospital for the evaluation of postprandial epigastric discomfort and indigestion for two months. Gastrofiberoscopy revealed a 3x4 cm sized submucosal mass, and subtotal gastrectomy gastrojejunostomy was performed and he was discharged without any postoative complication.

A Case of Esophageal Granular Cell Tumor

Esophageal granular cell tumor of is rare neoplesin, and 3 cases were reported in Korea so far. We report a case of esophageal granular cell tumor in a 28 year old man. The patient was a 28 year old man who visited this hospital because of upper abdominal pain, acid belching and weight loss. A small nodule, 5 mm in diameter, was found in mid esophagus on esophagoscopy. This nodule was proved to be a granular cell tumor.