A Case of Esophageal Granular Cell Tumor Which Treated by 'O'-Type Band Ligation and Polypectomy / 대한소화기내시경학회지

Granular cell tumors involving the esophagus are rare tumors. Since Abrikossoff first reported five cases of granular tumor of the tongue in 1926, fewer than 200 cases of esophageal granular cell tumors have been reported in the world. The granular cell tumors usually were seen in tongue, skin & breast. it has rarely been noted in the esophagus. The treatment of this tumor was not established well. Therefore, we report a case of granular cell tumor of the low esophagus, which was resected by polypectomy following 'O'-band ligation. This 56-year-old male patient was transferred to our hospital because of abnormal endoscopic finding on the esophagus at local clinic. There was esophageal polypoid lesion on the low esophagus. After polypectomy, the lesion was revealed as granular cell tumor in histopathologic examination.

A Case of Idiopathic Myelofibrosis Causing an Esophageal Variceal Hemorrhage / 대한소화기내시경학회지

Idiopathic Myelofibrosis (IMF), a clonal disorder of a multipotent hemtopoietic progenitor cell of unknown etiology, is characterized by massive splenomegaly, leukoerythroblastic blood changes, and bone marrow fibrosis. Portal hypertension occurs in approximately 10% of patients with IMF. Alsom there mey be bleeding from esophageal varices. A 59-year-old woman was admitted with intermittent abdominal distension and melena. An esophagogastroduodenoscopy revealed extensive esophageal varices with red colored signs, and subsequently esophageal variceal ligation was performed. Marked splenomegaly and ascites was observed through abdominal US and MRI scan. Bone marrow biopsy revealed an increase in reticulin and fibrosis. Extramedullary hematopoiesis and sinusoidal change were observed in the liver biopsy specimen. This case of IMF causing an esophageal variceal hemorrhage is herein reported.

A Preliminary Study on the Expression of C-X-C Chemokine Genes in Colonic Mucosa of Patients with Ulcerative Colitis

PURPOSE: Chemokines are potent regulators of the host inflammatory or immune responses. Mucosal synthesis of chemokines may be important in the pathogenesis of mucosal inflammation in ulcerative colitis (UC). We performed this study to investigate the expression of C-X-C chemokine genes in UC. METHODS: Mucosal tissues were obtained from six normal controls and six UC patients by endoscopic biopsies. In patients with UC, mucosal tissues were separately obtained from both involved and uninvolved regions. RNA was extracted and mRNA levels of five C-X-C chemokines were determined by quantitative reverse transcription-PCR using internal RNA standards. RESULTS: Mucosal mRNA levels of all chemokines tested increased in the involved region of UC compared with the uninvolved region of UC or normal controls. CONCLUSION: Our data suggest that mucosal expression of C-X-C chemokines contributes to the pathogenesis of UC

A Preliminary Study on the Expression and Regulation of C-X-C Chemokine Genes in a Human Colon Epithelial Cell Line

Human colon epithelial cells secrete an array of proinflammatory cytokines that includes IL-8, MCP-1, GM-CSF, TNF alpha and IL-6. This response may serve to attract neutrophils and macrophags to the site of infection. In addition to IL-8 and MCP-1, the chemokine family contains other members, which, alone or in combination, can recruit and/or activate inflammatory and lymphoid cells. In this study, we asked whether colon epithelial cells express a broader array of chemokines than previously described. The colon epithelial cell line, Caco-2, was stimulated for 3h with IL-1 alpha, or was infected with Salmonella dublin. RNA was extracted and chemokine mRNA levels were determined by quantitative reverse transcription-PCR using internal RNA standards. Ex pression of GRO alpha, GRO beta, GRO gamma and IP-10 increased by bacterial infection or IL-l alpha stimulation. These data strongly support the notion that epithelal cells are an important and integral component of the host's natural immune system.

Simultaneous Measurement of Choledochal and Pancreatic Sphincter Motility ; Comparative Study of Manometric Parameters / 대한소화기내시경학회지

If manometric profiles of sphincter of Oddi(SO) measured from the pancreatic duct and the bild duct are essentially equal, then measurement of manometric profiles from only one duct would be adequate in evaluating SO dysfunction. We report a series of 9 patients whom we evaluate with SO manometry. Cannulation of both the biliary sphincter segment and pancreatic sphincter segment was archived consecutively in one session and we compared the manometric parameters of choledochal sphincter from those of pancreatic sphincter. 1) In 7 out of 9 patients(78%), normal manometric finding of SO were seen in both choledochal and pancreatic sphincters. However, in 2 out of 9 cases(22%) abnormal manometric findings were noted in only one sphincter segment. Elevation of basal pressure(n = l) and increased retrograde propagation(n = 1) were found in the pancreatic sphincter segment alone. 2) Tbe mean intraductal pressure in the pancreatic duct was significantly greater(12.6+/- 5.8mmHg) than that of common bile duct(3.8+/- 3.3mmHg)(p<0.01). However, basal pressure, amplitude, frequency and propagation sequence in the phasic contraction of SO were not different significantly between choledochal and pancreatic sphincter segment. In conclusion, SO manometry of both the pancreatic and bile duct is needed if complete manometric information is desired. Selective cannulation of common bile duct and pancreatic duct during SO manometry is necessary in order to diagnose segmental 50 dysfunction.

Application of Peroral Cholangioscopy in Biliary Diseases / 대한소화기내시경학회지

Retrograde transpapillary cholangioscopy can be safely performed by use of a mother-baby-scope system after endoscopic sphincterotomy. Improved endoscopes are now available and may lead to a better acceptance of this technique. Cholangioscopy is complementary to cholangiography for differential diagnosis of various types of bile duct lesions. From march 1992 to September 1994, we performed 15 cases of peroral cholangioscopy for evaluation of bile duct lesions. Indications of peroral cholangioscopy were 6 cases of benign biliary diseases and 9 cases of malignant biliary diseases. In benign diseases, two cases of extrahepatic bile duct stones, 1 case of intrahepatic duct stone with stricture, 2 cases of benign elevated lesions of bile duct and 1 case of occluded expandable metallic stent were involved. In malignant diseases, 7 cases of primary bile duct cancer, 2 cases of hepatocellular carcinoma with bile duct invasion were involved. By use of peroral cholangioscopy with biopsy, differential diagnosis of bile duct lesion was possible. As a complication, severe abdominal pain and hypotension was developed in one case during the procedure and in another case, cholangitis was developed after the procedure. In conclusion, peroral cholangioscopy is a safe and useful procedure in various types of biliary diseases especially in the differential diagnosis of malignancy.

The Clinical Characteristics of 16 Patients with Sphincter of Oddi Dyskinesia / 대한소화기내시경학회지

We evaluated the clinical characteristics of patients with SO dyskinesia(n=16) who were confirmed by ERCP manometry during past 5 years. They were 14 male and 2 female and mean age was 52-year-old(range, 32-75). According to the criteria suggested by Hogan and Geenen, 13 patients were classified into biliary type and 3 patients into pancreatic type. Among the patients with biliary type(n=13), 12 patients fulfilled the criteria for group II dysfunction of SO and 1 patient for group III. Among the patients with pancreatic type(n=3), all fulfilled the criteria for group II. The manometric abnormalities were increased basal pressure(n=4), tachyoddia(n=7), increased retrograde propagation(n=3), tachyoddia and increased retrograde propagation(n=l), and tachyoddia and increased basal pressure(n=l). As treatment, 12 patients received conventional endoscopic sphincterotomy and 3 patients received endoscopic pancreatic sphincterotomy in addition to conventional endoscopic sphincterotomy. Satisfactory results (complete absence or marked reduction of pain) were obtained in 13(87%) out of 15 patients by endoscopic treatment. In conclusion, SO dyskinesia is not so common disease and the detection of patients with SO dyskinesia may increase by frequent application of ERCP manometry.

Thre Cases of Mucinous Ductal Ectasia of the Pancreas Which Were Diagnosed by Duodenoscopic Findings / 대한소화기내시경학회지

We have experienced three cases of mucinous ductal ectasia of the pancreas. They showed the characteristic duodenoscopic findings and underlying pathology was hyperplasia in two cases and adenocarcinoma in one case. When endoscopic retrograde pancreatography was performed, bulging ampulla of Vater, patulous ampullary orifice and mucus leakage from papillary orifice were noted. Also cyst-like dilatation of main duct or side branch of the uncinate process were observed.

Diagnostic Usefulness of Serum Level of Cyfra 21-1, SCC Antigen and CEA in Lung Cancer / 결핵

BACKGROUND: Cytokeratin 19 is a subunit of cytokeratin intermediate filament expressed in simple epithelia such as respiratory epithelial cells and their malignant counterparts. An immu- noradiometric assay is available to detect a fragment of the cytokeratin, referred to as Cyfra 21-1 in the serum. This study was conducted to evaluate the clinical utility of this new marker in the diagnosis of lung cancer compared with established markers of squamous cell carcinoma antigen (SCC Ag) and carcino-embryonic antigen(CEA). In addition, we compared the diagnostic sensitivity and specificity of Cyfra 21-1 with those of SCC Ag in squamous cell carcinoma of the lung. We also measured the level of Cyfra 21-1 in the different stages of squamous cell carcinoma of the lung. METHOD: We measured Cyfra 21-1(ELSA-CYFRA 21-1), SCC Ag(ABBOTT SCC RIABEAD) and CEA(ELSA2-CEA) in 79 patients with primary lung cancer and in 78 persons as a comparison group including 32 patients with pulmonary tuberculosis, 23 patients with benign lung disease and 23 cases with healthy individual. Cyfra 21-1 is measured by a solid-phase immunoradiometric assay(CIS Bio International, France) based on the two-site sandwich method. SCC Ag is measured by a radioimmunoassay (Abbott Laboratories, USA). CEA is measured by a immunoradiometric assay(CIS Bio International, France). All data were expressed as the mean+/-standard deviation. RESULTS: 1) The mean value of Cyfra 21-1 was 18.38+/-3.65 ng/mL in the lung cancer and 1.16+/-0.53 ng/mL in the comparison group(p<0.0001). SCC Ag was 3.53+/-6.06 ng/mL in the lung cancer and 1.19+/-0.5 ng/mL in the comparison group(p<0.01). CEA was 35.03+/-13.9 ng/mL in the lung cancer and 2.89+/-1.01 ng/mL in the comparison group(p<0.0001). 2) Cyfra 21-1 level in squamous cell carcinoma(31.52+/-40.13 ng/mL) was higher than that in adenocarcinoma(2.41+/-1.34 ng/mL)(p<0.0001) and small cell carcinoma(2.15+/-2.05 ng/mL)(p= 0.007). SCC Ag level in squamous cell carcinoma(5.1 +/-7.68 ng/mL) was higher than that in adenocarcinoma(1.36+/-0.69 ng/mL)(p=0.009) and small cell carcinoma/1.1 +/-0.24 ng/mL) (p=0.024). 3) The level of Cyfra 21-1 was not correlated with the progression of stage in squamous cell carcinoma of the lung. 4) Using the cut-off value of 3.3ng/mL, the diagnostic sensitivity of Cyfra 21-1 was 83% in squamous cell carcinoma, 22% in adenocarcinoma and 17% in small cell carcinoma. The sensitivity of SCC Ag and CEA were 39% and 20%, respectively in squamous cell carcinoma, 11% and 39% in adenocarcinoma, and 0% and 33% in small cell carcinoma. 5) Comparison of the receiver operating characteristics curves(ROC curve) for Cyfra 21-1, SCC Ag and CEA revealed that Cyfra 21-1 showed highest diagnostic sensitivity among them in the diagnosis of lung cancer. CONCLUSION: Cyfra 21-1 is thought to be a better tumor marker for the diagnosis of lung cancer than SCC Ag and CEA, especially in squamous cell carcinoma of the lung.

A case report of anti-neutrophil cytoplasmin autoantibody positive polyarteritis nodosa / 대한내과학회지

No abstract available.