A Case of Massive Hematochezia from a Meckel's Diverticulum without Ectopic Mucosa / 대한소화기내시경학회지

Meckel's diverticulum, which is a persistence of a remnant of the omphalomesenteric duct, is the most common developmental anomaly of the gastrointestinal tract, with an incidence of about 2% in the general population. Typically, Meckel's diverticulum is a true diverticulum because it arises from the antimesenteric border of the small bowel and all layers of the intestinal wall are present. Complications of Meckel's diverticulum include bleeding, perforation, diverticulitis, intestinal obstruction, stones, intussusception, hernia, and neoplasm. Bleeding in particular is a common complication and has always been caused by an ulceration of the ileal mucosa adjacent to the acid-producing ectopic gastric mucosa in a Meckel's diverticulum. A case was recently experienced involving massive hematochezia from Meckel's diverticulum without ectopic gastric mucosa in a 27 year-old woman, and in herein reported.

A case of subacute infective endocarditis with colon cancer caused by streptococcus bovis / 대한내과학회지

Streptococcus bovis, a group D non-enterococcal organism has recently received increased attention, especially for its role as a cause of infective endocarditis and associated colorectal neoplasm. Infectious endocarditis due to group D streptococci include two non-enterococcal species, S. bovis and S. equinas, which may be mistaken for enterococci in clinical laboratory. However, S. bovis is readily distinguished from the enterococci by screen with bile-esculin hydrolysis and growth in 6.5% NaCl broth. Although endocarditis caused by S. bovis or enterococci share common clinical findings, therapeutically and prognostically, S. bovis endocarditis more resembles infection with viridans group organism. Also the infection of S. bovis significantly increased the prevalence of colorectal cancer in previous report. As discussed above, the patients with S. bovis endocarditis are carried out study of colorectal cancer. We report a case of endocarditis with colon cancer caused by S. bovis in 54 year old female.

Anomalous Origin of Left Coronary Artery from Pulmonary Artery:Report of an Adult Case

Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is a rare congenital cardiovascular anomaly. The mortality rate among infants and children without operation has been eighty to ninety-five percents and few patients survive till teen-age or adulthood. This anomaly was detected during elective coronary angiogram in a 32 year-old female patient with atypical chest pain. Reversible ischemia was demonstrated on myocardial 201Tl-SPECT. Coronary angiogram revealed anomalous origin of left coronary artery from pulmonary artery.

A Case of Tracheal Hemangioma Manifested Massive Hemoptysis / 결핵

Hemangioma is benign tumor that represent an fail in development of the vascular system, network or retiform stage. As with hemangioma elsewhere, spontaneous regression may occur. Histologically capillary hemangioma has a diagnostic lobular arrangement of capillaries and almost all of them are located in nasal or oral mucous membranes. But, as we know, there is no report of hemangioma located in the trachea in Korea, so we report a case of tracheal hemangioma which was manifested massive hemoptysis.

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.

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 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.