A case of chronic diarrhea caused by duodenocolic fistula / 대한내과학회지

The four basic mechanisms that cause chronic diarrhea are osmotic, secretory and exudative factors, and abnormal intestinal transit. A gastrointestinal fistula cause chronic diarrhea by abnormal intestinal transit, and it must be included differential diagnosis for unknown cause of chronic diarrhea. Duodenocolic fistula is an uncommon cause of chronic diarrhea. The most common cause of duodenocolic fistula is a colon cancer. Benign duodenocolic fistula is a rare disease, which the most common cause is a duodenal ulcer. Patients usually complain of diarrhea, weight loss. Physical examinations are nonspecific. Barium enema is the most useful diagnostic procedure. Prognosis is good if surgery is undertaken at an early stage. We present a case of a 66-years old man in whom a duodenocolic fistula maybe caused by recurrent microperforation of duodenal ulcer. He complained of chronic diarrhea and weight loss. He had an operation on his fistula, and remained well.

A Case of Gastric Schwannoma

Schwannoma of the stomach is a rare controversial neoplasm which requires extensive studies to clarify its nature as a stromal tumor or leiomyoma. We describe the pathologic, immunohistochemical, and ultrastructural characteristics of schwannoma of the stomach in a 33-year-old woman. The tumor was a well-circumscribed submucosal mass located in the posterior wall of the midbody of the stomach. Microscopically, the cells were made up of fasciculating bundles of spindle cells featured with peripheral lymphoid cell cuffing. The tumor cells revealed a diffuse, strong immunoreactivity to S-100 protein and vimentin, but were negative to desmin and smooth muscle actin. They also had a focal positive reaction to glial fibrillary acidic protein. Ultrastructurally, many tumor cells showed a number of thin, elongated and interdigitating dendritic-cell-like processes, distinctly uniformed basal laminae, frequent cellular attachments, and microfilaments. These findings support the schwannian nature of the tumor.

Adenomatous Hyperplasia of the Liver: Triple-phase Helical CT Findings

PURPOSE: To evaluate the triple-phase helical CT findings of adenomatous hyperplasia of the liver. MATERIALS AND METHODS: Forty-seven cases of adenomatous hyperplasias (size range: 8 -45 mm, mean: 14mm) in nineteen patients were confirmed by histologic examination following surgery (n=32) or gun biopsy (n=15) and formed the basis of this study. All patients underwent helical CT scanning involving the injection of 100mL nonionic contrast material at a rate of 3mL/sec. Hepatic arterial, portal venous, and equilibrium phase CT images were obtained 30, 60, and 180 seconds, respectively, after the start of contrast injection. The attenuation of each nodule (hyper-, iso-, hypo-, or mixed) was retrospectively determined and the detection rate according to lesion size (> or =14mm or or =14mm) and 76 % (16/21) in the large size group(< 14mm). This rate was thus significantly higher in the large size group than in that in which lesions were small. CONCLUSION: Triple -phase helical CT revealed that in cases of adenomatous hyperplasia, attenuation was variable,with iso-attenuation the most frequent type. Seventy-six percent of nodules larger than 14 mm were detected. Adenomatous hyperplasia may be seen during the hepatic arterial phase as a hyper-attenuated nodule.

A Case of Osteogenesis Imperfecta: Diagnosed in Uterus by Ultrasonogram / 대한산부인과학회잡지

Osteogenesis imperfecta is a relatively rare genetic condition of breakable bones with an incidence of 1 per 20,000~60,000. The clinical, genetic, and biochemical heterogeneity in osteogenesis imperfecta allows to least four subtypes to be distinguished. Prenatal diagnosis of osteogenesis imperfecta type II have been reported several times with ultrasonography. We recently experienced a case of osteogenesis imperfecta diagnosed in uterus by ultrasonogram and confirmed after termination and autopsy. We report here with a brief review of the literature.