A Case of Abdominal Actinomycosis Mimicking Colon Carcinoma / 대한소화기내시경학회지

Actinomycosis is a chronic suppurative and granulomatous-disease caused by Actinomycosis israelli. Clinical presentation of the abdominal form of actinomycosis is nonspecific-pain, fever, leukocytosis, increased erythrocyte sedimentation rate, a sensation of abdominal mass and a formation of fistula. In addition, abdominal actinomycosis may mimic a carcinoma, diverticular abscess, inflammatory bowel disease, and tuberculosis. Most of abdominal actinomycosis develops after trauma, appendicitis, diverticulitis or gastrointestinal perforation. We report a case of abdominal actinomycosis preoperatively mimicking as colon carcinoma, which had no predisposing factors.

Relationship between Bowel Symptom Changes and Dysmenorrhea in Irritable Bowel Syndrome in Women / 대한소화관운동학회지

BACKGROUND/AIMS: This study was performed to evaluate the relationship between bowel symptom changes and dysmenorrhea in irritable bowel syndrome (IBS) according to the menstrual cycle. METHODS: Two hundred thirty-seven female medical students filled up questionnaires including change of bowel symptom, dysmenorrhea and perimenstrual symptom. Seventeen volunteered to keep diaries concerning their bowel habits and menstruation for two menstrual cycles. RESULTS: One hundred and sixty-three (68.8%) reported that their bowel habit was changed according to menstrual cycle. Ninety-three (39.2%) fit the Rome II criteria of IBS. The number of subjects who reported changed bowel habit during the menstruation period was more in the IBS group than in the non-IBS group (84/93 vs. 83/144, p<0.005). The severity of dysmenorrhea was not different between IBS and non-IBS groups. The menstrual distress score during the menstruation period was significantly higher in the IBS group than in the non-IBS group. In 17 volunteers (12 IBS, 5 non-IBS), stool consistency and frequency were not significantly different between the menstruation and non-menstruation periods, regardless of their IBS status. The mean score of abdominal pain was higher in the menstruation than in the non-menstruation period only in the IBS group. CONCLUSIONS: IBS women have more bowel symptoms during their menstruation period than non-IBS women. Its mechanism should be further clarified.

A Case of Cowden's Syndrome / 대한소화기내시경학회지

A 17-year-old man was referred to our hospital because of dizziness and mild dyspnea. He had a history of partial thyroidectomy due to benign mass when he was 10 year-old. His conjunctiva was anemic and acral keratosis was noted. He had a goiter and a previous surgical scar on the anterior neck just below the thyroid cartilage. Blood counts were as follows; Hb was 4.3 g/dL, WBC 5,500/mm3, PLT 366,000/ mm3. Esophagogastroduodenoscopy and colonoscopy showed esophageal acanthosis and numerous variable sized polyps in the stomach, duodenum and colon. The small bowel series showed numerous polypoid lesions in the entire small bowel. Gastric polyps revealed hamartoma and colon polyps revealed inflammatory polyp with lymphoid hyperplasia by pathologic examination. Thyroid ultrasonograph showed multiple nodules and cysts and I131 scintigraphy showed multiple cold and hot nodules in his remnant thyroid gland. We diagnosed the patient as Cowden's syndrome.

Analysis of causative agents using biopsy specimens and intraluminal fluid obtained during colonoscopy in patients with acute diarrhea / 대한내과학회지

BACKGROUND: The aim of this study was to investigate the value of colonoscopy for assessment of colonic mucosal lesions and for microbial identification in patients with acute diarrhea. METHODS: From March 2000 to August 2000, forty-one patients with watery or bloody diarrhea lasting less than 15 days were participated after the exclusion of patients who had previous history or presumption of inflammatory bowel disease, radiation colitis, ischemic colitis, or pseudomembranous colitis. Both biopsy specimens and colonic luminal fluid were taken during the colonoscopy and used for bacterial cultures. RESULTS: Male and female ratio was 22:19 and mean age was 45+/-20 years. The extent of acute colitis was as followed: the normal colonoscopic finding in five cases (12.2%), involvement of one segment in 3 cases (7.3%), involvement of two or more segments in 14 cases (34.1%), pancolitis in 10 cases (24.4%) and pancolitis with terminal ileitis in 9 cases (22.0%). In culture study, identification of more than one pathogen was in 19/41 (46.3%) and the common pathogens were Enterobacter (11 cases), Salmonella species (6 cases), Citrobacter freundii complex (2 cases), Klebsiella oxytoca (2 cases) and Morganella morganii (1 case). Pathogen could be identified in 11.8% with stool specimen, 46.2% with biopsy specimen and 62.5% with intraluminal fluid, but without statistical significance. CONCLUSION: Colonoscopy was useful in the evaluation of extent and severity of acute infectious colitis. Obtaining the biopsy specimens and intraluminal fluid during colonoscopy seemed to assist in identifying the pathogen in patients with acute diarrhea.

A Case of Vacuolar Myelopathy in Patient with Acquired Immunodeficiency Syndrome / 감염

The spinal cord is a commonly affected site in human immunodeficiency virus (HIV) infection. Even though the most common disease of the spinal cord is vacuolar myelopathy, there is no case report yet in Korea. We experienced a case of suspicious vacuolar myelopathy in a 33 year-old male patient with acquired immunodeficiency syndrome. The patient presented with progressive paraparesis, gait disturbance, urinary difficulty, and the loss of sensation below thoracic spine 6~7 dermatome. Cerebrospinal fluid showed mild pleocytosis, increased protein level, and normal glucose content. The spine MRI showed extensive ill defined areas of increased signal intensity through the visualized lower cervical and thoracic spinal cord. Steroid therapy with antiretroviral drugs appeared to be ineffective to improve the symptoms of the patient.