Unusual Treatment of Gastric Mucosa Associated Lymphoid Tissue Lymphoma Unresponsive to Helicobacter pylori Eradication

The connection between Helicobacter pylori and mucosa-associated lymphoid tissue (MALT) lymphoma is well established. H. pylori eradication is the initial treatment for MALT lymphoma. However, in H. pylori negative cases or unresponsive patients after successful eradication, radiation, systemic therapies, and surgical resection should be considered. Also local treatment modalities such as endoscopic mucosal resection (EMR) may be a therapeutic option in cases of low grade, localized MALT lymphoma. Herein, we report a case of a 53-year-old man who had a persistent endoscopic mass and tumor cells on histology for 5 months despite H. pylori eradication. Because of no early response to H. pylori eradication, the possibility of the presence of a high-grade lymphoma component, the proximal location of the tumor, and the exophytic nature of the tumor, we decided to perform EMR for complete resection. After EMR, the patient remained in complete remission throughout the 15-month follow up. In our case, endoscopic resection could lead to a more rapid complete remission. Therefore, we suggest that endoscopic resection may be a useful option for low-grade exophytic-type gastric MALT lymphoma treatment with no response to H. pylori eradication.

Takayasu's Arteritis Treated by Percutaneous Transluminal Angioplasty with Stenting in the Descending Aorta

A 17-yr-old young woman was referred to our hospital with a 2-yr history of claudication of the lower extremities and severe arterial hypertension. Physical examination revealed significantly different blood pressures between both arms (160/92 and 180/95 mmHg) and legs (92/61 and 82/57 mmHg). The hematological and biochemical values were within their normal ranges, except for the increased erythrocyte sedimentation rate (83 mm/hr) and C-reactive protein (6.19 mg/L). On 3- dimensional computed tomographic angiography, the ascending aorta, the aortic arch and its branches, and the thoracic and, descending aorta, but not the renal artery, were shown to be stenotic. The diagnosis of type IIb Takayasu's arteritis was made according to the new angiographic classification of Takayasu's arteritis, Takyasu conference 1994. Percutaneous transluminal angioplasty with stenting was performed on the thoracic and abdominal aorta. After the interventional procedures, the upper extremity blood pressure improved from 162/101 mmHg to 132/85 mmHg, respectively. She has been free of claudication and there have been no cardiac events during 2-yr of clinical follow-up.

A Case of Rectal Anisakiasis / 대한소화기내시경학회지

Anisakiasis refers to the infestation of humans by a species of marine nematode larvae belonging to the subfamily Anisakidae, and this condition is seen in people who eat inadequately prepared or raw salt-water fish and squid. Because Koreans like to eat raw fish, anisakiasis of the stomach has been reported occasionally, but involvement of the small bowel or colon is relatively rare. In the case of the colon, anisakiasis of the ascending colon or the transverse colon has been only infrequently reported, and the incidence of rectal anisakiasis is very rare. The present case is a 58-year-old man with no definite abdominal symptoms who visited our hospital for a medical checkup. A 2 cm sized whitish linear live larva was revealed in the rectum and it was removed by colonoscopy.

A Case of Acute Pancreatitis Associated with Fasciola Hepatica / 대한소화기내시경학회지

Fascioliasis is a zoonotic helminthiasis caused by the trematode Fasciola hepatica, which is a parasite that infects the hepatobiliary system of herbivorous animals such as cattle and sheep. Humans are accidentally infected after ingestion of the water, raw aquatic plants and raw liver of herbivorous animals that are all contaminated by metacercaria. Fascioliasis produces no symptoms in most patients, but adult Fasciola hepatica occasionally gives rise to intestinal obstruction or pancreatobiliary disease. The metacercaria can migrate along the vessels or lymphatic ducts, and they can induce disease of the liver, lung and heart. We report here on a rare case of a 68-year-old male who presented with acute abdominal pain. He was diagnosed as acute pancreatitis associated with Fasciola hepatica.

A Case of Atypical McCune-Albright Syndrome Associated with Hyperthyroidism / 대한내분비학회지

McCune-Albright syndrome (MAS) is a sporadic disease that's characterized by polyostotic fibrous dysplasia, cafe-au-lait pigmentation of the skin, and multiple endocrinopathies, including sexual precocity, hyperthyroidism, acromegaly, and hypercortisolism. Recent evidence has shown that the clinical manifestations are caused by a postzygotic activating missense mutation in the gene coding for the alpha-subunit of Gs protein that stimulates c-AMP formation in the affected tissues. Substitution of the Arg(201) residue in Gsalpha with cysteine or histidine have been identified in many MAS patients and Arg(201) to Gly or Leu mutations have also been recently identified. We identified the Arg(201) to His mutation in the gene encoding Gsalpha in the thyroid tissue from a 36-year-old man who was suffering with polyostotic fibrous dysplasia and hyperthyroidism.

A Case of Bladder Cancer in a Patient with Systemic Lupus Erythematosus Treated with Oral Cyclophosphamide / 대한류마티스학회지

Cyclophosphamide, a cytotoxic alkylating agent, is widely used in various benign diseases like systemic lupus erythematosus (SLE), Wegener's granulomatosis, rheumatoid arthritis, nephrotic syndrome as well as in malignancies and organ transplantation. Cyclophosphamide is metabolized in the liver to various chlormethine metabolites and acrolein, which mediates the toxic effect to the urothelium and can cause hemorrhagic cystitis, bladder fibrosis, and has also been associated with urothelial malignancies including bladder cancer. It is known that SLE is not associated with an increased risk for the development of most of the solid tumors. But it has been suggested that the risk of the bladder cancer increases in patients with benign diseases such as SLE treated by cyclophosphamide. There are only very few reports of cyclophosphamide-induced bladder cancer in SLE so far. We report a case of a patient who developed bladder cancer 13 years after cyclophosphamide was given as therapy for SLE. This case shows that careful observation and urologic evaluation is undoubtedly important for patients treated with cyclophosphamide.

Clinical Evaluation of Children with Psychiatric Problems Among Pediatric Patients

No abstract available.

Clinical Study of Hypertention

A retrospecive clinical observation was done on 325 cases of hypertension admitted to Department of internal Medicine of Seoul Red Cross Hospital from January, 1979 to December, 1982. The following results have been obtained. 1) The observed patients were 157 males and 168 females, and the prevalence rate of malignant hypertension among 325 hypertensions was 16 cases (4.9 percent). Among 16 cases of malignant hypertension 9 cases were male and 7 cases were female. Most frequently in 50, 60 and 40 years of age in this order each sex. 2) The average admitted dates are 7 days. 27 cases (8.3percent) were readmitted above 2 times after one discharged. 3) The most freqeuntly observed duration of Known hypertension 37.9 percent was 6-10 years and the next frequently observed duration 37.4 percent was 3-5 years. 4) The highest percentage of malignant hypertension had systolic blood pressure between 190-209mmHg and diastolic blood pressure between 150-169mmHg. 5) The highest percentage of seasonal number was spring (31.1 percent) and the next autumn, summer, winter in this order and the prevalence rates of hypertention are increased average 1.9% of each year. 6) The 78.5 percent of the patients were found that their blood pressure were abnormaly high when they were examined with related symptoms on admission, and they major symptorms were headache and dizziness. 7) The physical examination on admission, tachycardia (56percent), tachypnea (15.1percent), semicoma to coma (12.9 percent) in this order. 8) The status of treatment in hypertension on admission was as follows; imtermittent treatment 54.5 percent, no treatment 31 percent and continuous treatment 14.5 percent in this order. 9) In the chest X-ray on admission, the most frequent finding was cardiomegaly, and normal finding was the next frequency. The pulmonary Tbc was noted in 12.6 percent. 10) According to the degree of fundoscopic abnormality by K-W classification stage III was 68.8 percent and stage IV was 31.2 percent. 11) Electrocardiogram abnormalities were 44.9 percent, and 87.5 percent of malignant hypertension revealed electrocardiographic abnormalities and left ventricle hypertrophy was observed in 70.5 percent. 12) Hypercholesterolemia 78 percent, Hypernatremia 69.8 percent, Hypokalemia 22.8 percent, serum chloride 34.5 percent (20mg/dl) and creatinine 45.8 percent (>3mg/dl) on admission. 13) Proteinuria was observed in 87.5 percent of malignant hypertension. 14) Marked improved for clinically was 24 percent and mortality rate was 5.2 percent, most common cause of death are cardiovascular accident (64.7percent) and renal failure (23.5percent).