Serial Endoscopic Observation in a Case of Spontaneous Submucosal Dissection of the Esophagus / 대한소화기내시경학회지

Spontaneous submucosal esophageal dissection is a rare disorder, characterized by a longitudinal dissection along the axis of the esophagus between submucosa and muscle layer without an obvious cause. The diagnosis is made by typical esophagographic or endoscopic findings which are double-barreled esophagus in esophagography or mucosal defect in upper esophagus and false lumen running along the distal side of the esophagus on esophagoscopy. The condition usually follows a benign course with good prognosis requiring a supportive treatment, but rarely treated by endoscopy or surgery. A 74-year-old man was admitted to our hospital complaining of chest pain and odynophagia after upper respiratory infection. We diagnosed a case of spontaneous submucosal dissection of the esophagus and observed its healing process by series of endoscopy with a conservative treatment.

Anaphylactoid reaction to ofloxacin with cross-reactivity to other fluoroquinolones / 천식및알레르기

Fluoroquinolones are antimicrobial agents that have a broad range of activity against both gram-negative and gram-positive organisms. Anaphylactoid reactions have been sporadically reported with fluoroquinolones. There have been a few reports that describes cross-reactivity between fluoroquinolones. We experienced a case of ofloxacin-induced anaphylactoid reaction, and confirmed cross-reactivity between ofloxacin and ciprofloxacin with the oral challenge test. Cross-reactivity between fluoroquinolones may be important, and avoidance of any fluoroquinolones should be mandatory for patients with hypersensitivity reaction to one of these drugs.

A Case of Sarcomatoid Combined Hepatocellular-Cholangiocarcinoma / 대한소화기학회지

Combined hepatocellular-cholangiocarcinoma (HCC-CC) with sarcomatoid features is an extremely rare primary liver cancer, of which only four cases have been reported. We report a case of sarcomatoid combined HCC-CC in a 60-year-old woman who complained of right upper quadrant pain and presented with a 7 cm mass in the S4 region of the liver in abdominal CT. Ultrasonography-guided needle biopsy diagnosed it as HCC, and left lobectomy of the liver followed. Microscopically, the tumor consisted of two portions: HCC portion showing trabecular pattern, which had partially sarcomatous area with spindle-shaped tumor cells, and CC portion with glandular pattern. Immunohistochemically, HCC portion reacted positively with alpha-fetoprotein while CC portion demonstrated positive reactivity with carcinoembryonic antigen and mucicarmine. Sarcomatoid cells reacted positively for cytokeratin. She died of tumor recurrence and hepatic failure 12 months after the operation. Combined HCC-CC has poor prognosis, and sarcomatoid HCC has high metastatic potential and poor prognosis compared with ordinary HCC.

A case of eosinophilic cholecystitis with hepatitis associated with clonorchiasis / 대한내과학회지

Eosinophilic cholecystitis is a rare condition of cholecystitis which was first described by the Albot in 1949. We describe a case of eosinophilic cholecystitis associated with Clonorchis sinensis. A 42-year-old woman presented with a classic history of acute cholecystitis and a peripheral eosinophilia of 56% without an allergic history. An abdominal CT scan showed thickened, edematous gallbladder wall but no cholelithiasis, and an cholecystectomy was performed. Pathological examination revealed diffuse infiltration of eosinophils throughout all gallbladder wall layers and marked eosinophilic infiltration of the liver. Skin test for clonorchis sinensis was strong positive and serologic test for Clonorchis sinensis antibody was high titer. The serum alkaline phosphatase, SGOT, SGPT and eosinophil count normalized within a week after praziquantel medication.

Usefulness of Endoscopic Mucosal Resection for Curative Treatment of Early Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been widely accepted as a curative treatment of early gastric cancer (EGC). The aim of this study was to determine the usefulness and limitations of EMR for treatment of EGC by analyzing our own experience. METHODS: We retrospectively evaluated 51 EGC lesions (45 mucosal and 6 submucosal cancers) from 49 patients who had undergone EMR between Oct. 1997 and Aug. 2002 at Inha Universtiy Hospital. RESULTS: Among 45 lesions of mucosal cancer, enbloc resection was performed in 13 lesions and piecemeal resection in 32 lesions. Complete resection rates of enbloc and piecemeal resection were 84.6% and 43.8%, respectively (p=0.012). Complete resection rate of the lesions smaller than 1 cm in size was 71.4%, 1 to 2 cm in size 52%, and greazter than 2 cm in size 37.5%. Complete resection rates of well, moderately, and poorly differentiated EGC were 59.4%, 71.4%, and 16.7%, respectively (p=0.048). Thirty-three patients underwent a follow-up endoscopy at I month after EMR and two were found to have residual cancers. One patient who had a piecemeal EMR showed cerical and abdominal lymph node metastasis 10 months after EMR. CONCLUSIONS: In selected patients with EGC, EMR can be a curative treatment modality. However, complete resection rate is low in large sized and poorly differentiated EGCs and when piecemeal resection is performed.

A case of adrenal lymphangioma misdiagnosed as biliary cystadenoma / 대한내과학회지

Lymphangioma is resulted from faulty development or ectasia of lymphatic vessels. Adrenal lymphangioma was reported first in 1965 and very rare with approximately 20 cases having been reported so far in worldwide. Adrenal lymphangioma is usually asymptomatic and most often identified incidentally at imaging study or autopsy. If symptoms do occur, they are related to size and position of the lesion and contain fever, abdominal pain, or palpable mass. Laboratory findings are nonspecific and usually not helpful as a diagnostic tool. Although ultrasonography and computerized tomography play a major role in the exploration of adrenal cysts, the nature of unexpected adrenal cysts is confirmed by histology. Recently, we experienced a case of 50-year-old female patient, who complained right upper abdominal pain and suspected with biliary cystadenoma in radiologic studies. The surgical enucleation was performed and final diagnosis was adrenal lymphangioma. Considering of rare incidence, we report a case of lymphangioma arising from right adrenal gland with a review of the relevant literature.

The Usefulness of Endoscopic Retrograde Biliary Drainage Using Plastic Stents for Patients with Common Bile Duct Stone / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic sphincterotomy is considered the primary option for treatment of common bile duct (CBD) stones. In some cases, however, complete stone removal is difficult or even impossible. Endoscopic retrograde biliary drainage (ERBD) has been suggested to be an alternative treatment in such cases or in patients with high surgical risks. In this study, we evaluated the effectiveness of ERBD using a plastic stent for treatment of CBD stones. METHODS: From Mar. 1996 to Aug. 1999, ERBD was performed in 12 patients with CBD stones. Indications for ERBD were old age in 4, a large perivater diverticulum in 4, refusal of surgery in 2, bleeding risk and biliary stricture in 1 each. Nine had one of the significant associated medical conditions. RESULTS: Six of the 12 patients were symptom-free at the time of evaluation (mean 32.9 months). Of the remaining 6 patients, 3 had operation, 1 had a successful endoscopic stone removal, 1 had a stent exchange, and 1 was lost to follow-up at 26 months. Thus, overall success rate of ERBD for treatment of CBD stones was 75% (9/12). Median symptom-free duration was 41 months (range 18~59 months). CONCLUSIONS: In view of its relatively high success rate and long-term effect, ERBD is an alternative modality for treatment of CBD stones, especially in patients with high surgical risks.