The Effect of Hematopoietic Stem Cell Transplantation in the Origin and the Osteoblastic Differentiation of the Human Bone Marrow Stromal Cell / 대한내분비학회지

BACKGROUND: Bone marrow transplantation is the treatment of choice for patients with certain- hematological malignancies, many of whom will survive many years thereafter. Bone disease is a potential longterm complication. But, little is known about the effects of bone marrow transplantation on bone. METHODS: In this study, bone marrow was obtained from healthy donor and transplant recipients. Then mononuclear cells including marrow stromal cells were isolated and cultured. At near confluence, bone marrow stromal cells were subcultured. Thereafter alkaline phosphatase activities of each group were measured by time course of secondary culture. We also analysed the origin of marrow stromal cells by the polymerase chain reaction using YNZ 22 minisatellite probe. RESULTS: l. Cells cultured in our system showed the characteristics of marrow stromal cells differentiated to osteoblasts. They were in fibroblast-like spindle shape and positive to alkaline pbosphatase histochemistry and Von Kossa histochemistry in secondary cultures. 2. The time required for the near confluence in the primary culture was 15 days and 22.9 days on the average in healthy donors and transplant recipients, respectively (p=0.003). 3. In secondary cultures, healthy donors and transplant recipients showed peak alkaline phosphatase activity at 10 days and 17 days, respectively (p=0.031). Alkaline phosphatase activity was lower in BMT recipients than in healthy donors during the whole period of secondary cultures. 4. In polymerase chain reaction analysis using YNZ 22 minisatellite probe, bone marrow stromal cells were of recipient origin. CONCLUSION: Recipient-derived bone marrow stromal cells may be damaged secondary to the effect of chemotherapy, glucocorticoid & total body irradiation which have given before bone marrow transplantation. So it may affect the differentiation of bone marrow stromal cells into the osteoblasts.

A Case of Watermelon Stomach ( Gastric Antral Vascular Ectasia ) / 대한소화기내시경학회지

Watermelon stomach or gastric antral vascular ectasia is a rare disorder causing gastric blood loss and iron deficicncy anemia. Endoscopically, it has characteristic thickened red vascular folds radiating from the pylorus to the antrum. This condition is often mis- diagnosed as antral hemorrhagic gastritis. Diagnosis is made primarily by endoscopy. Histologic examination of the endoscopic mucosal biopsies may confirm the endoscopic diagnosis. Treatment for watermelon stomach includes steroids, estrogen-progesterone combinations, somatostatin antagonists, tranexamic acid, heater probe, and laser therapy. Herein we report a case of watermelon stomach presenting with general weakness and persistent iron deficiency anemia for about 2 years in a 70-year-old woman.

A Case af Chronic Cholecystitis Diagnosed with Double Contrast Study of the Gallbladder / 대한소화기내시경학회지

The combined diagnostic modalities using abdominal ultrasound, endoscopic ultrasound and endascopic retrograde cholangiopancreatogram are useful for the diagnosis of gall bladder disease. But, these diagnostic methods have limitations for the detection of early flat-type gallbladder cancer. To cope with these problems, double contrast study of gallbladder disease is being recently used to diagnose the flat-type cancer of gallbladder in Japan. Herein we report a case of chronic cholecystitis confirmed histologically and assisted by double contrast method of gallbladder, which was diagnosed as a gallbladder polyp by abdominal sonogram at first. The method requires the cystic duct cannulation and placement of the catheter to the gallbladder. And then Barium sulfate and CO2 are injected through the catheter. The patient didnt experience any complication during and after this procedure except for hyperamylasemia. After the simple cholecystectomy, he improved completely. In conclusion, double contrast study of gallbladder can be useful in the diagnosis of the gallbladder disease and compensate for the other dignostic tools.

Two Cases of Anomalous Termination of the Common Bile Duct and the Pancreatic Duct into the Duodenal Bulb / 대한소화기내시경학회지

Many examples of congenital anomalies of the pancreatobiliary ductal system are now being found due to the development of new diagnostic techniques. Recently, despite the improvement in diagnosis and management of pancreatobiliary lesions, a lack of knowledge and understanding of these variations is undoubtedly responsible for many problems in medical and surgical management. In particular, drainage of the common bile duct and pancreatic duct at sites other than the second portion of the duodenum is an anatomieal curiosity. We report two cases in this study, of anomalous termination of the common bile duct and the pancreatic duct into the duodenal bulb, diagnosed by an ERCP and a gastroscopy.

The causes of Unsatisfactory Unaided visual Acuity after Exximer Laser PRK for Myopia

we analyzed data from 102 patients(152 eyes) who underwent photorefractive keratectomy to investigate the postoperative causes of unsatisfactory unaided visual acuity. A VISX 20/20 exicimer laser(VISX, Inc, Santa Clara, DA USA, version 4. 01) was used in all cases by one surgeon(J.W.H). The patients who showed unsatisfactory unaided vision, less than 20/40 uncorrected visual acuity, with minimal follow-up periods of 6 months were included. A decreased unaided visual acuity was detected in 20 eyes(13%). Range of preoperative myopia was -2.50 to -14.00 diopters. Mean postoperative uncorrected visual acuity(geometric mean)was 0.33+/-0.12 and mean corrected visual acuity was 0.83 +/-0.25. Multiple factors contributed to unsatisfactory unaided vision; myopic regression in 8 eyes, irregular astigmatism in 4 eyes, overcorrection in 1 eye, severe corneal opacity in 1 eyes(2.6%) and the causes were as follows; irregular astigmatism, decentration combined with central island and severe corneal opacity. In conclusion, refractive results after photorefractive keratectomy were reasonably predictable and stable, but some sight threatening complications occured in a minority eyes. Improved techniques such as centering procedures and improved excimer laser program will be essential to prevent unsatisfactory unaided vision.

Unusual Case of Tuberculosis in Hemodialysis Patient-Tuberculoma Involving Right Atrium / 대한신장학회잡지

There is a high incidence of tuberculosis in patients with chronic renal failure undergoing hemodialysis. Clinical features and laboratory findings are intermittent high fever of unknown origin, weight loss, high ESR and CRP. The diagnosis of tuberculosis in patients with hemodialysis can be difficult due to non specific symptoms, insidious onset, and unusually high frequency of extrapulmonary involvement. Sites of extrapulmonary involvement include mediastinum, meninges, pleura, kidney, peritoneum, and rarely pericardium. We experienced a unusual case of tuberculoma involving the right atrium in a hemodialysis patient. Our initial impression of this case was pericardial effusion. However, chest CT and echocardiography revealed a mass on the right atrium. Exploratory thoracotomy revealed tuberculous granuloma scattered throughout pericardium and tuberculoma involving right atrium. Following the administration of anti Tbc medication, clinical symptoms and signs resolved and follow up chest CT showed significant decrease in the size of the tuberculoma.

A Case of Eosinophilic Enteritis / 대한소화기내시경학회지

Eosinophilic gastroenteritis is a rare disorder of the stomach, small intestine and colon, characterized by variable eosinophilic infiltration of the bowel wall and peripheral blood eosinophilia, abnormal gastrointestinal symptoms and signs. The pathogenesis of this disease still remains unknown, but several studies support allergic or immunologic etiology. Considerable variability in clinical presentation depends on the site of the gastrointestinal tract and the depth of bowel wall involvement. Herein we experienced a case of eosinophilic gastroenteritis confined to small intestine presenting progressive weight loss, abdominal pain and diarrhea. Enteroscopic findings showed diffuse multiple nodularity of mucosal folds in small bowel, especially duodenum and proximal jejunum. Jejunal and duodenal biopsy specimen demonstrated marked eosinophilic infiltration. These symptoms and signs were improved within 3 weeks after short course of prednisone therapy.

Concurrent Malignant Lymphoma of the Colon and Small Bowel as the Primary Origin / 대한소화기내시경학회지

Primary gastrointestinal lymphoma primarily confined to gastrointestinal tract is relatively rare diaease. Although the lymphoma primarily involved colorectum or small bowel was commonly reported than primary gastric lymphoma in Korea, the concurrent primary lymphoma of colon and small bowel is very rare in reported cases. We report a case of combined primary malignant lymphoma of the jejunum and cecum, who was admitted due to melena and anemia. She had right hemicolectomy and end-to-side ileotransverse colostomy at 2 months ago, due to primary colon lymphoma. The laparotomy was performed and identified hard, 2 x 3 cm sized masses on distal 25 cm, 80 cm and 150 cm from the Treitz ligament. The histology of these small ma showed histiocytic lymphoma as same as cecal specimen. In general, the small bowel lymphoma shaws poor prognosis than gastric or colorectal lymphoma due to diffieulty in diagnosis and late symptoms, but this problem could be resolved through the knowledge about primary gastrointestinal lymphoma and the development of diagnostic methods.

Appendiceal Mucocele with Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

The appendiceal mucocele is very rare disease of 0.2% incidence. About 24% of patients are asymptomatic and symptomatic patients present with pain in the right lower quadrant of abdomen in 64%, plapable maas in the right lower quadrant of abdomen in 50%, and rarely, melena, hematochezia, anemia, diarrhea, malaise, and abdominal distension. The gastrointestinal bleeding may be presented in the patient with intussusception, but the massive bleeding is generally absent. We report a case of appendiceal mucocele accompanying with gastrointestinal bleeding and review of literature.

Clinical Experiences about Effect of IV Disopyramide Phosphate Injection on PVC

The present study was undertaken to evaluate the effect on PVC with IV disopyramide injection in 23 patients with PVC. There were 6 male and 17 female patients with age from 16 to 71 years. Three patients of hypertension, two patients of atherosclerotic heart disease, one patient of myocardial infarction, one patient of mitral stenosis, one patient of cardiomyopathy, one patient of uremic heart, fourteen patients of fuctional PVC were studied. The dose of 100mg of disopyramide was given with IV injection repeatedly until PVC disappeared.(Total: 40 Times) EKG monitering was performed in all cases to reveal the following results while the patients were on the regimen. 1. PVC disappearance rate in 23 patients was 78.2%. Average disappearance time and average dose is 7 minutes, 70.5mg respectively. 2. EKG revealed no change in P-R interval and pulse rate but slight prolongation of QRS and QTc interval. 3. When repeated injection was performed, the effect against PVC was decreased. 4. Acute heart failure as complication of disopyramide was not developed in all patients. As a result of present study, we recommended IV disopyramide injection, when disappearance of PVC was required immediately and safely.