Gastric Plexiform Fibromyxoma Incidentally Found in the Routine Checkup / 대한소화기학회지

no abstract available

Lactobacillus attenuates progression of nonalcoholic fatty liver disease by lowering cholesterol and steatosis

Background/Aims@#Nonalcoholic fatty liver disease (NAFLD) is closely related to gut-microbiome. There is a paucity of research on which strains of gut microbiota affect the progression of NAFLD. This study explored the NAFLD-associated microbiome in humans and the role of Lactobacillus in the progression of NAFLD in mice. @*Methods@#The gut microbiome was analyzed via next-generation sequencing in healthy people (n=37) and NAFLD patients with elevated liver enzymes (n=57). Six-week-old male C57BL/6J mice were separated into six groups (n=10 per group; normal, Western, and four Western diet + strains [109 colony-forming units/g for 8 weeks; L. acidophilus, L. fermentum, L. paracasei, and L. plantarum]). Liver/body weight ratio, liver pathology, serum analysis, and metagenomics in the mice were examined. @*Results@#Compared to healthy subjects (1.6±4.3), NAFLD patients showed an elevated Firmicutes/Bacteroidetes ratio (25.0±29.0) and a reduced composition of Akkermansia and L. murinus (P<0.05). In the animal experiment, L. acidophilus group was associated with a significant reduction in liver/body weight ratio (5.5±0.4) compared to the Western group (6.2±0.6) (P<0.05). L. acidophilus (41.0±8.6), L. fermentum (44.3±12.6), and L. plantarum (39.0±7.6) groups showed decreased cholesterol levels compared to the Western group (85.7±8.6) (P<0.05). In comparison of steatosis, L. acidophilus (1.9±0.6), L. plantarum (2.4±0.7), and L. paracasei (2.0±0.9) groups showed significant improvement of steatosis compared to the Western group (2.6±0.5) (P<0.05). @*Conclusions@#Ingestion of Lactobacillus, such as L. acidophilus, L. fermentum, and L. plantarum, ameliorates the progression of nonalcoholic steatosis by lowering cholesterol. The use of Lactobacillus can be considered as a useful strategy for the treatment of NAFLD.

Polydeoxyribonucleotide and Polynucleotide Improve Tendon Healing and Decrease Fatty Degeneration in a Rat Cuff Repair Model

BACKGROUND@#After surgical repair of chronic rotator cuff tears, healing of the repaired tendons often fails and is accompanied by high-level fatty degeneration. Our purpose was to explore the effects of polydeoxyribonucleotide (PDRN) and polynucleotide (PN) on tendon healing and the reversal of fatty degeneration in a chronic rotator cuff tear model using a rat infraspinatus. @*METHODS@#Sixty rats were randomly assigned to the following three groups (20 rats per group: 12 for histological evaluation and 8 for mechanical testing): saline + repair (SR), PDRN + repair (PR), and PN + repair (PNR). The right shoulder was used for experimental intervention, and the left served as a control. Four weeks after detaching the infraspinatus, the torn tendon was repaired. Saline, PDRN, and PN were applied to the repair sites. Histological evaluation was performed 3 and 6 weeks after repair and biomechanical analysis was performed at 6 weeks. @*RESULTS@#Three weeks after repair, the PR and PNR groups had more CD168-stained cells than the SR group. The PR group showed a larger cross-sectional area (CSA) of muscle fibers than the SR and PNR groups. Six weeks after repair, the PR and PNR groups showed more adipose cells, less CD68-stained cells, and more parallel tendon collagen fibers than the SR group. The PR group had more CD 68-stained cells than the PNR group. The PR group showed a larger CSA than the SR group. The mean load-to-failure values of the PR and PNR groups were higher than that of the SR group, although these differences were not significant. @*CONCLUSION@#PDRN and PN may improve tendon healing and decrease fatty degeneration after cuff repair.

A Case of Lipoma of Parietal Peritoneum Causing Abdominal Pain / 대한소화기학회지

Lipomas are common benign tumors of mature adipose tissue, enclosed by thin fibrous capsules. They can occur on any part of the body; however, peritoneal lipoma is extremely rare. We encountered a case of a 75-year-old man presenting with intermittent abdominal pain, who had undergone right hemicolectomy due to colon cancer. Abdominal computerized tomography showed a well-defined heterogenous fatty mass measuring 4.5x3.5 cm in size, suggesting fat necrosis located in the abdominal wall. Laparotomy showed a very large soft mass of peritoneum. Pathologically, the tumor was diagnosed as lipoma containing fat necrosis located in parietal peritoneum not fixed to any organs, but with small bowel adhesion. Due to its rare etiologic origin and obscure cause of development, we report on a case of lipoma of parietal peritoneum causing abdominal pain.

Colonic Abscess Induced by India Ink Tattooing / 대한소화기학회지

Endoscopic tattooing with India ink is generally regarded as a safe procedure that enables ready identification of endoluminal cancer from the serosal surface. However, significant complications have been reported, including local inflammatory pseudotumor formation, peritonitis, rectus muscle abscess, small bowel infarction, and phlegmonous gastritis. Although the mechanism of complication is not completely understood, it may be related to the chemical compounds contained in the ink solution and enteric or extraenteric bacterial inoculation by injection needle or the ink itself. Authors encountered a case of a 60-year-old man with a resectable sigmoid colon cancer which was tattooed with India ink for subsequent localization in the intraoperative setting. During the laparoscopic operation, the proximal and distal margin of the lesion appeared edematous with bluish color. The distal resection margin was extended approximately 5 cm more than expected because of long extent of edematous mucosa. Histologic examination of the edematous tattooing area revealed an ink abscess spreading laterally above the muscularis propria. Although tattooing is widely used and relatively safe, the presented case indicates the risk of infection or inflammation by tattooing.

Xanthoma of the Esophagus

Xanthoma is an uncommon nonneoplastic lesion resulting from the accumulation of histiocytes. It predominantly shows cutaneous manifestations associated with dyslipidemia. However, xanthoma of the esophagus is extremely rare. To the best of our knowledge, only 14 cases have been reported thus far. The clinical significance of this lesion has not been established. However, this lesion should be distinguished grossly from ectopic sebaceous glands and small subepithelial tumors such as carcinoid and granular cell tumor. Moreover, signet ring cell carcinoma, which contains round cells with abundant cytoplasm and has similar histologic features to xanthoma, should be distinguished microscopically.

A Case of Polymyositis with Normal Creatine Kinase / 대한내과학회지

Proximal muscle weakness can be induced by many diseases, such as muscular dystrophies, inflammatory muscle diseases, and polymyalgia rheumatica. Differential diagnosis of these diseases is important. The patient had proximal muscle weakness with a normal creatine kinase (CK) level. Our initial diagnosis was polymyalgia rheumatica because the CK level was normal. The patient was treated with low-dose corticosteroid. However, the muscle weakness did not improve. The diagnosis of polymyositis was confirmed by a muscle biopsy. We suggest that if the patient has typical symptoms with normal CK, then evaluations for inflammatory muscle diseases are essential.

Primary Adenocarcinoma of Duodenum Located in Third Portion Cured by Wedge Resection

Primary adenocarcinoma of duodenum is an uncommon neoplasm. Besides its rarity, vague symptoms and signs with the lack of physical findings can delay diagnosis and result in poor treatment outcome. Aggressive surgical managements including pancreaticoduodenectomy was generally recommended for localized cancers despite high operational mortality. However, if early stage cancer is detected, wedge resection can be a therapeutic option. The authors encountered a 2.5x1.5 cm sized subepithelial tumor like mass with spontaneous bleeding and central dimpling located in the third portion of duodenum on esophagogastroduodenoscopy. After repeated deep biopsy, the patient underwent wedge resection and regional lymph node dissection of the duodenum. Finally, the mass was proven as adenocarcinoma and the patient remains in good condition without recurrence for over 2 years. Due to it's low incidence and high mortality, meticulous endoscopic examination of duodenum is essential for early diagnosis and limited operational methods may improve survival and quality of life of patients.

Primary Adenocarcinoma of Duodenum Located in Third Portion Cured by Wedge Resection

Primary adenocarcinoma of duodenum is an uncommon neoplasm. Besides its rarity, vague symptoms and signs with the lack of physical findings can delay diagnosis and result in poor treatment outcome. Aggressive surgical managements including pancreaticoduodenectomy was generally recommended for localized cancers despite high operational mortality. However, if early stage cancer is detected, wedge resection can be a therapeutic option. The authors encountered a 2.5x1.5 cm sized subepithelial tumor like mass with spontaneous bleeding and central dimpling located in the third portion of duodenum on esophagogastroduodenoscopy. After repeated deep biopsy, the patient underwent wedge resection and regional lymph node dissection of the duodenum. Finally, the mass was proven as adenocarcinoma and the patient remains in good condition without recurrence for over 2 years. Due to it's low incidence and high mortality, meticulous endoscopic examination of duodenum is essential for early diagnosis and limited operational methods may improve survival and quality of life of patients.

A Case of Giant Lipoma Causing Chronic Recurrent Intussusception of the Colon

Colonic lipomas, which often occur in elderly women, usually have small size and occur mainly in the cecum and ascending colon. Most colonic lipomas are asymptomatic and identified incidentally at the time of endoscopy or surgery. However, they may cause symptoms such as bleeding, obstruction or intussusception as their size increases. Intermittent episodes of intussusception are uncommon but may be caused by large pedunculated lipoma. In a 68-year-old woman suffering intermittent abdominal pain, 5.5x4.5x3.8-cm huge mass was found by colonoscopy at proximal ascending colon, which was intussuscepted to proximal transverse colon on abdominal computed tomography. Segmental right colonic resection was conducted. We report a case of symptomatic giant pedunculated colonic lipoma causing intussusception requiring surgical intervention, with a successful recovery after surgery.

A Case of a Mucinous Adenocarcinoma Arising from a Rectal Diverticulum

The occurrence of an adenocarcinoma arising from a rectal diverticulum that causes mechanical ileus is very rare. Recently, we diagnosed a case of a mucinous adenocarcinoma in a rectal diverticulum after an emergent abdominal perineal resection and permanent colostomy by laparotomy. Here, we present a case report and a review of the literature.

Tear Filim Changes and Ocular Surface Characteristics in Patients with Psoriasis Vulgaris / 대한피부과학회지

BACKGROUND: Psoriasis is associated with several extracutaneous manifestations. Signs and symptoms of eye may be subtle and overlooked. OBJECTIVE: Our purpose was to identify tear film functions and ocular surface characteristics associated psoriasis. METHODS: We examined 20 patients with psoriasis and 20 patients healthy volunteers. In addition to complete dermatological examination, tear film function, meibomian gland obstruction, Shirmer test, as well as conjunctival impression cytology grades and goblet cell density. RESULTS: Patients with psoriasis had tear film break-up time of 7.7+/-3.1 seconds. The grade of fluorescein test in patients with psoriasis was significantly higher than the grades in controls. And in impression cytology patients group showed the higher grade of epithelial metaplasia and lower density of goblet cells. But The significant differences were not found in Shirmer test and meibomian gland obstruction. CONCLUSION: Our findings showed that patients with psoriasis have high rate of dye eye disease. Dermatologists consider the possibility of ocular manifestations of patients with psoriasis and consultation with the ophthalmologists.

Tear Filim Changes and Ocular Surface Characteristics in Patients with Psoriasis Vulgaris / 대한피부과학회지

BACKGROUND: Psoriasis is associated with several extracutaneous manifestations. Signs and symptoms of eye may be subtle and overlooked. OBJECTIVE: Our purpose was to identify tear film functions and ocular surface characteristics associated psoriasis. METHODS: We examined 20 patients with psoriasis and 20 patients healthy volunteers. In addition to complete dermatological examination, tear film function, meibomian gland obstruction, Shirmer test, as well as conjunctival impression cytology grades and goblet cell density. RESULTS: Patients with psoriasis had tear film break-up time of 7.7+/-3.1 seconds. The grade of fluorescein test in patients with psoriasis was significantly higher than the grades in controls. And in impression cytology patients group showed the higher grade of epithelial metaplasia and lower density of goblet cells. But The significant differences were not found in Shirmer test and meibomian gland obstruction. CONCLUSION: Our findings showed that patients with psoriasis have high rate of dye eye disease. Dermatologists consider the possibility of ocular manifestations of patients with psoriasis and consultation with the ophthalmologists.

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.

IgG4-Related Sclerosing Sialadenitis: Report of Three Cases

Chronic sclerosing sialadenitis, Mikulicz disease or Kuttner tumor has been recently recognized as a spectrum of IgG4-related sclerosing disease. IgG4-related disease is characterized by a high serum IgG4 level and tissue infiltration of IgG4-positive plasmacytes. We report three cases of chronic sclerosing sialadenitis with variably associated systemic involvement. All patients presented with a submandibular mass or swelling, and all the resected submandibular glands showed diffuse lymphocytic infiltration, lymphoid follicles, and septal fibrosis. Two of the specimens revealed numerous IgG-positive plasma cells, most of which were IgG4-positive on immunohistochemical staining. One of them was associated with dacryoadenitis and hypophysitis. The other patient had ureterorenal lesions. Immunohistochemical study was unavailable in remaining one case, but the histologic features along with elevated IgG level and associated pancreatitis supported the diagnosis. All patients received steroid therapy postoperatively and are doing well. Salivary gland involvement in IgG4-related fibrosclerosis should be recognized in systemic medical pathology.

Histological and Immunohistochemical Findings of the Intermediate Trophoblasts in Normal Full Term and Pre-eclamptic Placentas

BACKGROUND: Recent studies have suggested that implantation site intermediate trophoblasts (ISITs) and chorionic type intermediate trophoblasts (CTITs) show different immunohistochemical findings, and that each type has specific location in placentas. However, we observed that both subtypes are intimately admixed in many areas of the placentas and both types are proliferated around the infarcts. METHODS: In order to examine the site specificity in their distribution and the changes of intermediate trophoblasts (ITs), if any, in the pre-eclamptic placentas, quantitative analyses of ISITs and CTITs using p63, CD146, placental alkaline phosphatase, human placental lactogen, and alpha-inhibin were performed in normal and pre-eclamptic placentas containing infarcts. RESULTS: In the fetal membranes of both normal and pre-eclamptic placentas, CTITs and ISITs were equally identified, forming distinct layers. ISITs were predominant in the intervillous septum and basal plate, while CTITs were predominant in the subchorionic area. At the margin of infarcts in pre-eclamptic placentas, both subtypes were increased in number, forming distinct layers. CONCLUSIONS: The subtypes of ITs do not have site specificity in placentas. Increased number of ITs and zonal distribution around infarcts suggest that CTITs and ISITs have differentiation associated relationship, and the differentiation might be related to the microenvironment of placenta, such as intraplacental oxygen concentration.

Omental Histiocytic Sarcoma: A Case Report

We report a case of perigastric histiocytic sarcoma (HS) involving the lesser omental sac in a 30-year-old man. HS is an exceedingly rare malignancy of mature tissue histiocyte. The tumor was a multi-lobulated, bulging enhancing mass in the lesser omentum with metastasis to lymph nodes and liver. The tumor consisted of diffuse non-cohesive proliferation of pleomorphic large oval to round neoplastic cells with giant cells showing vesicular chromatin and ample eosinophilic cytoplasm. In some areas, the tumor cells showed spindling with elongation of the nuclei and cellular shapes. Many of the tumor cells, especially giant forms contained phagocytosed lymphocytes. Immunohistochemical analysis of the tumor cells showed expression of leukocyte common antigen, CD68, lysozyme, vimentin, CD4, and CD163. Ki-67 index was 50-60%. After the operation, he was treated with chemotherapy, but the response was poor.

A Case of Falciform Retinal Fold

The authors experienced a case of falciform retinal fold which occurred congenitally in the right eye of a 13 years old Korean female. This was situated in the inferior nasal quadrant in the extreme periphery of the retina and was associated with abnormal shape and position of disc and macula without foveal reflex. Visual acuity of right eye was 20/50 and refractive error was not present. We described the characteristic fundus findings of this case with brief review of relating literature.