Clinical Features of Drug-induced Liver Injury According to Etiology

Drug-induced liver injury (DILI) is an increasingly common cause of acute hepatitis. We examined clinical features and types of liver injury of 65 affected patients who underwent liver biopsy according DILI etiology. The major causes of DILI were the use of herbal medications (43.2%), prescribed medications (21.6%), and traditional therapeutic preparations and dietary supplements (35%). DILI from herbal medications, traditional therapeutic preparations, and dietary supplements was associated with higher elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels than was DILI from prescription medications. The types of liver injury based on the R ratio were hepatocellular (67.7%), mixed (10.8%), and cholestatic (21.5%). Herbal medications and traditional therapeutic preparations were more commonly associated with hepatocellular liver injury than were prescription medications (P = 0.002). Herbal medications and traditional therapeutic preparations induce more hepatocellular DILI and increased elevations in AST and ALT than prescribed medications.

Jackhammer Esophagus Treated by a Peroral Endoscopic Myotomy / 대한소화기학회지

A 49-year-old woman visited our hospital with dysphagia and chest pain. In another hospital, she was diagnosed as reflux esophagitis. Although she had taken proton pump inhibitor and prokinetics drugs for a long time, she was not relieved of any symptoms. On the basis of high resolution manometry and endoscopic ultrasonography findings, Jackhammer esophagus was diagnosed. In this patient, peroral endoscopic myotomy (POEM) was performed for long myotomy of thickened circular muscle. During the procedure, there were no significant complications and she was discharged uneventfully. Symptoms were completely improved during three months after POEM. Here, we report on a case of Jackhammer esophagus treated by POEM.

Two Cases of Supraclavicular Lymph Node Metastasis in Pancreatic Adenocarcinoma / 대한내과학회지

The supraclavicular lymph node (SCN) is frequently involved in lymphoma and metastatic malignancies of the breast and lung, but is extremely rarely involved in pancreatic cancer. Only 10 such cases have been reported in the medical literature worldwide. We herein report an additional two cases. An 83-year-old male patient had a 7.6 x 5 cm pancreatic tumor from the pancreatic head to tail, and a 71-year-old male patient had a 2.8 x 1.9 cm pancreatic body tumor. PET-CT revealed SCN metastasis, and subsequent excisional biopsy confirmed metastatic adenocarcinoma. With the more popular use of PET-CT in patients with pancreatic cancer, the number of cases of metastasis to the SCN is expected to increase. This suggests that lymphatic spread is the main metastatic route in pancreatic cancer. Further large-scale studies along with increased numbers of case reports are needed to determine whether lymphatic spread is the main metastatic route in pancreatic cancer.

A Case of Gastric Duplication Cyst at Fundus Presenting as a Large Subepithelial Tumor

Gastric duplication cyst is a congenital disease and an uncommon finding in adult patients. Presenting symptoms are often asymptomatic during adulthood. Most cases are discovered incidentally by radiological examination or gastric endoscopy. Preoperative diagnosis of gastric duplication is difficult because definitive diagnosis requires a well-developed coat of smooth muscle with an epithelial lining that represents some portion of the alimentary tract in the lesion. In majority of reported cases, the diagnosis is established by surgical exploration and the treatment is primarily managed by complete excision. We report a case of a gastric duplication cyst in a 40-year-old man.

A Case of Gastric Duplication Cyst at Fundus Presenting as a Large Subepithelial Tumor

Gastric duplication cyst is a congenital disease and an uncommon finding in adult patients. Presenting symptoms are often asymptomatic during adulthood. Most cases are discovered incidentally by radiological examination or gastric endoscopy. Preoperative diagnosis of gastric duplication is difficult because definitive diagnosis requires a well-developed coat of smooth muscle with an epithelial lining that represents some portion of the alimentary tract in the lesion. In majority of reported cases, the diagnosis is established by surgical exploration and the treatment is primarily managed by complete excision. We report a case of a gastric duplication cyst in a 40-year-old man.

The Natural Course of the Intraductal Papillary Mucinous Neoplasm of Pancreas

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by cystic dilatation of the pancreatic duct, excessive mucin production, and papillary growth of the tumor. Occasionally, it forms a fistula into other organs. Because of the higher malignant potential of the main duct type IPMN compared to the branch duct type, patients with main duct type IPMN usually undergo surgical treatment and the natural history of the main duct type IPMN is not commonly observed in clinical practice. An 84-year-old woman was diagnosed with main duct type IPMN of pancreas, but she refused operative treatment. Seven years later she was admitted by chance for another disease, and then referred to our gastrointestinal department. We think this case can give us an insight of the natural course of the main duct type IPMN.

The Natural Course of the Intraductal Papillary Mucinous Neoplasm of Pancreas

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by cystic dilatation of the pancreatic duct, excessive mucin production, and papillary growth of the tumor. Occasionally, it forms a fistula into other organs. Because of the higher malignant potential of the main duct type IPMN compared to the branch duct type, patients with main duct type IPMN usually undergo surgical treatment and the natural history of the main duct type IPMN is not commonly observed in clinical practice. An 84-year-old woman was diagnosed with main duct type IPMN of pancreas, but she refused operative treatment. Seven years later she was admitted by chance for another disease, and then referred to our gastrointestinal department. We think this case can give us an insight of the natural course of the main duct type IPMN.

DNA Profiles of Trichoderma spp. in Korea

Molecular approaches, internal transcribed spacer(ITS) sequences of ribosomal DNA, and Universal Rice Primer Polymerase Chain Reaction(URP-PCR) were used to investigate the genetic diversity, taxonomic complexity, and relationships of Trichoderma species in mushroom farms. Forty-one isolates of 13 Trichoderma spp. were used in this study and clustered into eight groups. The DNA fingerprint patterns and ITS1 region sequence alignment data showed similar results, but not in some species, such as T. virens, T. atroviride, T. harzianum, and T. aureoviride. Results of this study have proven that the morphology-based taxonomic system has some limitations in terms of classification. The data obtained in this study would be a good index for classifying indistinguishable Trichoderma strains.

DNA Fingerprinting Analysis of the Genus Phytophthora in Korea

In order to investigate biodiversity and establish identification system for Phytophthora spp. in Korea, a variety of band pattern was produced by using the URP (universal rice primer). The fingerprint patterns of Phytophthora spp. showed many common and variable fragments according to their isolates in distinct genotypes. In particular, P. drechsleri was classified into four distinct types (I to IV). P. drechsleri (KACC 40498 and KACC 40499) and P. cryptogea (KACC 40413) appeared to have almost equal bands despite their being different species. Ninety isolates of Phytophthora spp. were clustered into 13 groups based on UPGMA (unweighted pair group method with arithmetic means) analysis. These DNA fingerprinting data would be helpful for inter- and intra-species identification of Phytophthora species.

PCR Based Detection of Phellinus linteus using Specific Primers Generated from Universal Rice Primer (URP) Derived PCR Polymorphic Band

This study was carried out to develop specific primers for PCR detection of Phellinus linteus. Diverse genomes of 15 Phellinus spp. including five Phellinus linteus isolates were fingerprinted by Primer Universal rice primer (URP)1F. The URP-PCR pattern differentiated P. linteus isolates from other phellinus spp. A polymorphic band (2.8 kb), which is unique for P. linteus isolates, was isolated and sequenced. Twenty four-oligonucleotide primer pairs were designed based on information of DNA sequence. The primer set (PLSPF2/PLSPR1) amplified single band (2.2 kb) of expected size with genomic DNA from seven Phellinus linteus, but not with that of other Phellinus species tested. The primers could be used identically in both DNA samples from mycelium and fruit bodies. This specific primers could offer a useful tool for detecting and identifying P. linteus rapidly.

Genomic Differentiation Among Oyster Mushroom Cultivars Released in Korea by URP-PCR Fingerprinting

URP primers of 20 mer derived from repetitive sequence of rice were used to assess genetic variation of oyster mushroom consisting of 10 cultivars of Pleurotus ostreatus, two cultivars of P. florida and two cultivars of P. sajor-caju which were registered in Korea. URP2F and URP38F primers produced cultivar-specific PCR polymorphic bands in the Pleurotus species. UPGMA cluster analysis using the URP-PCR data showed that 14 Pleurotus cultivars are genetically clustered into large three groups. The URP-PCR data provided important information for more efficient breeding strategies of Pleurotus cultivars.

PCR-Based Sensitive Detection of Wood-Decaying Fungus Phellinus linteus by Specific Primer from rDNA ITS Regions

Based on the rDNA ITS sequences data, specific primer set for PCR detection of wood-decaying fungus Phellinus linteus was designed. The length of PCR products using designed primer set(SHF and SHR) was about 540 bp. Among 11 species, 17 isolates of Phellinus spp. including Phellinus linteus, P. pomaceus, P. spiculosus, P. baumi, P. pini, P. igniarius, P. gilvus, P. biscuspidatus, P. weirii, P. johnsonianus, P. robutus, and P. igniarius, seven isolates of Phellinus linteus showed about 540 bp-sized single band. This molecular technique could offer a useful tool for detecting and identifying Phellinus linteus.