A Case of Liddle's Syndrome Associated with Muscle Weakness / 대한신장학회잡지

Liddle's syndrome was described in 1963 by Liddle, et al., as the disease featuring a hypertension and hypokalemia but with negligible secretion of aldosterone. This syndrome, which morphologically belongs to an abnormal intrinsic tubular disorder with normal renal function, is characterized by hypokalemia, metabolic alkalosis, and hypertension due to the abnormal increase in excretion of potassium in distal tubules or collecting duct and the increase in reabsorption of sodium in distal tubules. This syndrome, which is rare disease, is observed with the low level of plasma and urinary aldosterone and suppressed plasma renin level and is known as dominant mode of inheritance with a family background. The authors paid attention to a 79-year-old man who showed a high blood pressure of 210/130mmHg as well as musle weakness, especially lower extremities due to metabolic alkalosis featuring a hypokalemia level of 2.0mEq/L when he was admitted to our hospital, Because his serum potassium were not improved with the medication of intravenous potassium supply, and his blood pressure continued to be high without the improvement of muscle weakness, we prescribed 300mg of spironolactone for two weeks. His symptom, however, was not cured. Then, instead of spironolactone, we prescribed 150mg of triamterene and a low salt diet which finally improved his symptoms. Because there has been no reported case in the Korean medical literature, we report a case of successfully treated Liddle's syndrome due to triamterene administration.

A Case of Endoscopically Removed Duodenal Carcinoid Tumor / 대한소화기내시경학회지

Primary carcinoid tumor of duodenum are rare, Usually, small duodenal carcinoid tumors are often discovered endoscopically. Most of these tumors are asymptomatic, but in rare cases, jaundice, hemorrhage, duodenal obstruction, or carcinoid syndrome were apparent. Uaually, the recommended treatment is surgical or endoscopic excision of the tumor. We experienced a case of carcinoid tumor of duodenu in 53 year-old women. A 53-year-old female patient was admitted to our hospital because of epigastric discomfort and indigestion. On the gastrofiberscopic examination, 0.9 cm sized polypoid mass with central umblication was noted on the duodenall bulb. The biopsy specimen showed carcinoid cells. She was treated with endoscopic polypectomy.

The Endoscopic Polypectomy in Two Cases of Colonic Lipoma / 대한소화기내시경학회지

Lipomas are one of the most common benign nonepithelial tumors of the colon and which are often detected incidentally at radiologic investigation or on operation without specific symptoms, Most of them look like submucosal tumor with yellowish-white color, smooth surface and solitary lesion. Sometimes they produce symptoms with large size, bleeding, constipation, diarrhea, abdominal pain, indigestion, intestinal obstruction and intussusception. Diagnosis can be made by colonoscopy, abdominal CT, MRI, barium enema and histologic confirmation achieves by the endoscopic polypectomy. Endoscopic polypectomy or mucosectomy can make it easy to remove them, as therapeutic method. We report 2 cases of lipomas successfully removed by endoseopic polypectomy-the one with two lipomas each at right descending colon and ileocecal valve and the other with one lipoma at the ileocecal valve-with the relevant literatures.

A Case of Clinical Ulcerative Colitis with Concurrent Hepatocellular Carcinoma / 대한소화기내시경학회지

Ulcerative colitis is a diffuse inflammatory disease which is characterized by the vascular congestion and superficial ulcerations in the mucosal and the submucosal layers of the rectum and colon. Extraintestinal manifestations such as arthritis, skin lesion, hepatobiliary and ocular diseases occur in a large number of patients with ulcerative colitis, though gastrointestinal symptoms of mucous and bloody stool, diarrhea and abdominal pain are frequently presented. The association of ulcerative colitis and hepatobiliary disease has been frequently reported in the western countries since the first description by Thomas C.H. in 1874. Fatty degeneration, chronic active hepatitis, cirrhosis, primary sclerosing cholangitis and hepatobiliary carcinoma are included in this list of complications. In the case of hepatobiliary carcinoma, however, the histological diagnosis has almost invariably been cholangiocarcinoma. We report a case of clinical ulcerative colitis with coneurrent hepatocellular carcinoma confirmed by the histologic examination of biopsy specimen in a 49 year old man with the relevant literatures.

A Case of Duodenal Tuberculosis Which is Hardly Differentiated from Duodenal Lymphoma / 대한소화기내시경학회지

Primary duodenal tuberculosis, duodenal Crohn's disease, duodenal lymphoma, duodenal cancer is extremely rare event. Vague upper abdominal pain, weight loss(10 Kg) had been present for several months in a 52-yeer-old woman. Endoscopy revealed an irregular ulcer in the second part of the duodenum. CT of the abdomen revealed pooly defined hypodense and centrally low density masses along the hepatoduodenal ligament, with poor separation from the head of pancreas. Hypotonic duodenogram showed spiculation and smooth indentation of mucosal fold at medical aspect of sup. portion m descending duodenum. ERCP showed medially displaced distal CBD and main pancreaticduct. At first, lymphoma, cancer, Crohn's disease, duodenal tuberculosis were considered in the differential diagnosis. Endoscopic biopsy sepecimen of duodenal lesion showed atypical lymphocytes. We excluded the diagnosis of the duodenal cancer. We started anti-tubercular drugs because in our country tuberculosis is endemic. After 4 weeks anti-tuberculosis therapy, follow up endoscopy and biopsy specimens showed healing stage of duodenal ulcer and chronic granulomatous inflammation with multinucleated giant cell. Thus we concluded that when duodenal lesion which could not confirmed histopathologically it was wise to start antitubercular therapy than to perform exploraparotomic dianostic procedures.

A Case Report of Cystic Lymphangioma of Colon / 대한소화기내시경학회지

Lymphangioma is a benign tumor of lymphatic origin. Lymphangioma can occur anywhere in the body and only rarely affects the intestinal tract. Most intestinal lymphangiomas are asymptomatic and detected incidentally at autopsy or surgery. Occasionally, they may be large enough to present as a mass to cause obstruction or intussusception. Recently, we examined a case of a 27-year-old woman who complained right upper quadrant abdominal pain, increased bowel sound and weight loss. By surgical resection after the double contrast barium enema and colonoscopy, we could confirm cystic lymphangioma of the transverse colon. So we report this case with brief review of relevant literature.