A Case of Peutz-Jeghers Syndrome with Nasal Polyposis / 대한내과학회지

Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disease characterized by typical mucocutaneous pigmentation and multiple hamartomatous polyps in the gastrointestinal tract. The clinical manifestations of PJS include polyp-induced bowel obstruction, abdominal pain, and gastrointestinal bleeding. The risk of gastrointestinal and extragastrointestinal cancers is also significantly increased in patients with PJS. Nasal polyposis associated with PJS has been described, and is considered an extragastrointestinal manifestation of PJS. We present an unusual case of a patient with PJS and nasal polyposis causing complete unilateral nasal obstructio.

Successful Treatment with Methotrexate and Azathioprine of Panniculitis in a Patient with Dermatomyositis: Case Report and Review of the Literature / 대한내과학회지

Dermatomyositis is an autoimmune disease wherein autoantibodies and immune complexes cause non-suppurative inflammation in skin and muscle. Although the skin lesions of this disease are well known, the clinical and pathological features of subcutaneous fat lesions remain uncharacterized. Since Weber (1924) reported the development of panniculitis in a patient with dermatomyositis, 23 subsequent cases have been reported. Here, we present the case of a woman who had been diagnosed with dermatomyositis 7 years previously, and presented with diffuse, painful, indurated nodules on her face and upper limbs. A skin biopsy allowed us to diagnose these nodules as panniculitis. The patient was initially treated with high doses of prednisolone and methotrexate. She responded inadequately to these medications, so azathioprine was added to the regimen. The skin lesions subsequently improved and the patient has remained disease-free for 1 year. Here, we present the clinical profile of this patient and review the relevant literature.

Clinical Characteristics and Gestational Complications Associated with Acute Hepatitis A in Pregnancy / 대한소화기학회지

BACKGROUND/AIMS: Acute hepatitis A was recently significant increased among women with gestational age in Korea. However, the clinical course and gestational complications have not been fully elucidated in pregnant patients with acute hepatitis A. We evaluated the clinical impact of acute HAV infection in pregnancy. METHODS: Twelve pregnant women out of 85 female patients with acute hepatitis A during 6 years were retrospectively reviewed. RESULTS: The median age of the pregnant group was 26.5 years old. The number of patient with acute hepatitis A were 5 cases in the 1st trimester, 3 cases in the 2nd and 4 cases in the 3rd. 4 cases had significant gestational complications. One case experienced the abortion in 1st trimester and one fetal distress was noted in 3rd trimester. The latter case was delivered of a low birth weight infant (2,390 g) caused by premature rupture of membrane in 36 weeks of gestational age. Other two cases experienced premature contraction and they had been required tocolytic treatment. But, all mothers featured full recovery from HAV infection. Except one aborted fetus and one premature birth, Newborn babies were not affected by maternal hepatitis A. CONCLUSIONS: Acute HAV infection during pregnancy may be associated with the risk of gestational complications. HAV serology and vaccination for women with gestation age should be considered at high prevalence area of acute hepatitis A.

A Case of Non-occlusive Ischemic Colitis of the Right Colon after Percutaneous Coronary Intervention / 대한소화기내시경학회지

Ischemic colitis is the most common form of gastrointestinal ischemic injury. Indeed, many medical conditions and medications can cause reduced blood flow to the colon. The splenic flexure, descending colon, and sigmoid colon are most commonly affected. Involvement of only the right colon is an infrequent occurrence. Ischemic colitis of the right colon usually is associated with low flow states. Given the high morbidity and mortality of this disorder, early diagnosis and aggressive management is critical. Ischemic colitis associated with heart disease, such as congestive heart failure, myocardial infarction, arrhythmias, aortic valve disease, and atherosclerotic cardiovascular disease, is usually due to low cardiac output, or to disease states resulting in dehydration, or to the splanchnic vasoconstrictive effect of some medications. Here we present a case of nonocclusive ischemic colitis of the right colon after percutaneous coronary intervention for unstable angina. The colitis was successfully treated with conservative management.

A Case of Esophageal Benign Schwannoma Removed by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Esophageal schwannoma is a very rare neoplasm. The differentiation of schwannoma from the other submucosal tumors such as GISTs or leiomyoma is very difficult to do on the preoperative examination with performing esophagoscopy and computed tomography. The diagnosis is generally not confirmed until the histologic and immunohistochemical tests of the tumor are performed. A 38- year-old man presented to us with neck discomfort. The endoscopy showed a middle esophageal submucosal tumor that measured 12 mm in size and there were no mucosal changes. The endoscopic ultrasonography showed a tumor in the muscluaris mucosa layer without lymphadenopathy. After band ligation of the lower part of the tumor, it was removed by performing endoscopic mucosal resection and using a snare. A definitive diagnosis of esophageal benign schwannoma was made from the pathologic findings, which included positive immunohistochemical staining for S-100 protein and negative staining for C-kit, CD34 and actin. We report here on an esophageal benign schwannoma that was removed by endoscopic mucosal resection.

The Changes in Incidence of Crohn's Disease and Intestinal Tuberculosis in Korea / 대한소화기학회지

BACKGROUND/AIMS: The incidence of Crohn's disease (CD) has been steadily increasing in Korea due to westernized life style and widely used imaging studies such as colonoscopy. There were few studies about the status of longterm trend of CD and intestinal tuberculosis (IT). Therefore, we aimed to evaluate the trend of CD and IT in Korea. METHODS: We retrospectively reviewed the medical records of newly diagnosed 65 patients with CD and 54 patients with IT at Chonnam National University Hospital between January 1998 and August 2007. RESULTS: Between 1998 and 2002, 16 and 40 patients were newly diagnosed as having CD and IT respectively, but between 2003 and 2007, 39 and 14 patients were newly diagnosed as having CD and IT respectively. CD patients (28.2+/-15.2 years) were younger than IT (46.2+/-18.5 years) (p=0.001). The male to female ratio of CD and IT were 2:1 and 1.1:1, respectively. The most common symptom of CD and IT was abdominal pain. Longitudinal ulceration, hyperemia, luminal narrowing, pseudopolyp, and cobble stone appearance were more common in CD than in IT (p<0.05). CONCLUSIONS: While the incidence of CD has increased, the incidence of IT has fallen over the last decade.

Expression of c-FLIP in Gastric Cancer and its Relation to Tumor Cell Proliferation and Apoptosis

BACKGROUND: The expression of c-FLIP (cellular Fas-associated death domain-like interleukin-1 beta-converting enzyme (FLICE)-inhibitory protein), which is a member of the family of inhibitors of apoptosis, has been associated with tumor development and progression. The aim of this study was to evaluate the expression of c-FLIP in gastric cancer and its correlation with tumor cell proliferation, apoptosis and the clinicopathologic features. METHDOS: Immunohistochemical staining with anti-c-FLIP antibody was performed in 98 tissue samples obtained from gastric cancer patients who underwent surgical treatment. The apoptotic cells were visualized by terminal deoxynucleotidyl transferase (TdT) mediated deoxyuridine triphosphate (dUTP) nick-end labeling (TUNEL), and the proliferative cells were visualized by staining with Ki-67 antibody. RESULTS: The positive expression of c-FLIP in the gastric cancer tissues was demonstrated in 57.1% of the cases. The expression of c-FLIP was increased in the gastric cancer tissues compared with the matched normal gastric mucosa. The expression of c-FLIP was significantly associated with histologic differentiation (p=0.038). However, there was no association between the c-FLIP expression and the other clinicopathological parameters, including patient survival. The Ki-67 labeling index (KI) for the 98 tumors ranged from 7.6 to 85.0 with a mean KI of 50.4+/-15.7. The mean KI value of the c-FLIP positive tumors was 54.1+/-15.3 and this was significantly higher than that of the c-FLIP negative tumors (p=0.005). The apoptotic index (AI) for the 98 tumors ranged from 0.0 to 10.0 with a mean AI of 7.4+/-2.3. There was no significant difference between the c-FLIP expression and the AI (p=0.347). CONCLUSIONS: These results suggest that the c-FLIP expression may be associated with tumor cell proliferation of gastric cancer.