A Case of Pancreaticobiliary Duct Obstruction due to Pancreatic Tuberculosis Combined with a Colon Adenocarcinoma and Tuberculous Colitis / 대한소화기내시경학회지

Systemic manifestation of tuberculosis is common, but tuberculous biliary obstruction of the pancreas and a colon adenocarcinoma with combined colonic tuberculosis is an uncommon disorder. We encountered a case of the above condition in 63-year-old male that was admitted to our hospital because of fever, diffuse abdominal pain and rigidity. Abdominal computed tomography showed biliary and pancreatic duct dilatation with left colonic wall thickening and surrounding peritoneal infiltration. Emergency segmental resection of the descending colon with intraoperative T-tube choledochostomy was performed due to the colon mass and biliary obstruction. A colonofiberoscopy was performed for low abdominal pain and hematochezia at 12 days after surgery. It showed multiple colonic ulcerations with a partial stricture. A colonic biopsy showed granulomatous inflammation with acid-fast bacilli. The cause of the biliary obstruction was also revealed as pancreatic tuberculosis by an intraoperative pancreatic and mesenteric biopsy. The patient improved after antituberculous treatment and the patient has been in good health until the last outpatient follow-up visit.

A Study of Factors Affecting Bone Mineral Density in Korean Adolescents: Anthropometric Measurements, Life Style, and Other Environmental Factors

This study was conducted to assess the bone mineral density (BMD) and the anthropometric measurements, life style, and other environmental factors affecting BMD in Korean adolescents. Subjects were 167 high school students (83 male students, 84 female students) in Seoul. BMD was measured in the lumbar spine (LS), femoral neck (FN), femoral trochanter (FT), and Ward's triangle (WT) by dual energy x-ray absorptiometry (DEXA). The questionnaire was used to assess the anthropometric measurements, life style, and other environmental factors. Bone mineral density of LS, FN, FT and WT were 0.967, 0.960, 0.795, 0.761 g/cm2. The BMD of LS was not different by sex but the male students's BMD of FN, FT and WT were higher significantly than the female students (LS: 0.976 vs. 0.958, FN: 1.040 vs. 0.880, FT: 0.842 vs. 0.749, WT: 0.827 vs. 0.695 g/cm2) Female students's BMD of LS, FN, WT, and FT was positively correlated with weight but male students's BMD of WT was not correlated with weight. The factors such as the life style, activity and exercise have significant influence on BMD. This study confirms that the major factor affecting BMD was body weight and the factors such as the life style, activity and exercise is related to accumulation of BMD. The classification of sexual characteristics is needed for further studies on BMD of adolescents.

Clinico-pathological Study on Hepatitis B virus-Associated Nephropathy

To clarify the characteristics of HBV-associated renal lesions, renal biopsies obtained from 22 HBsAg seropositive patients(M:F=32:1) were studied. Other than two(age 4 and 12), all were adults(17-77 y.o.). Twelve of the patients had nephrotic syndrome(NS), 5 NS and hematuria(H), 10 proteinuria and H, one gross H, one microscopic H, and 4 normal urinalysis at the time of biopsy. Light microscopy showed minimal change lesion(MCL) in 9 cases, mesangial proliferative glomerulonephritis(MSPGN) in 6, MPGN type I in 7, MPGN type III in 6, and mebranous nephropathy(MGN) in 5 cases. There were variable immunofluorescent(IF) findings of 25 cases studied; IF staining were predominant with IgG in 10 cases, with IgA in 5 and with IgM in 2 cases. Complements tended to be more strong for C1 &/or C4 than C3. In electron microscopic(EM) studies of MCL group, rare mesangial deposits were noted(3/5). In MSPGN, aside from mesangial deposits, there were occasional subendothelia(2/4) or subepithelial(1/4) deposits. In MPGN type I, in addition to the usual EM features of MPGN, some subepithelial deposits were also observed in 5 cases. In MGN, 3 out of 4 showed subendothelial deposits. Among 7 cases stained for HBsAg all were negative with IF and 2 were positive with PAP method. It is concluded that clinico-pathological findings of HBV-associated nephropathy are variable and partly show lupus-like features, different from primary glomerulopathy.