Colonic Langerhans Cell Histiocytosis Presenting as an Isolated Polyp / 대한내과학회지

A 56-year-old male underwent a screening colonoscopy. An 8-mm sessile polyp was removed from the descending colon using snare polypectomy. Histology showed Langerhans cells and eosinophil infiltration of the submucosa. Immunohistochemical staining was positive for S-100 protein and CD1a antigen, which confirmed the diagnosis of Langerhans-cell histiocytosis. On further workup, there was no evidence of involvement of any other organs. Here, we report a very rare case of colonic Langerhans-cell histiocytosis presenting as an isolated polyp.

The Efficacy and Tolerability of Sugared Polyethylene Glycol for Colonoscopy / 대한소화기학회지

BACKGROUND/AIMS: Although polyethylene glycol (PEG) solution is commonly used for colonoscopic bowel preparation because of its safety and effectiveness, its salty taste decreases patient's compliance. The aim of this study was to compare the sugared PEG solution with the standard PEG solution in regard to the quality of bowel preparation and patient's compliance. METHODS: From January through June in 2012, 100 patients who underwent colonoscopy in Gangneung Asan Hospital were prospectively enrolled. They were randomly assigned to receive either standard PEG solution or sugared PEG solution. The quality of bowel preparation was assessed by a doctor's questionnaire and the patient's compliance was assessed by a patient's questionnaire. RESULTS: There was no significant difference in the quality of bowel preparation (4.2+/-2.0 vs. 4.1+/-1.5, p=0.783), and endoscopist's satisfaction score (8.2+/-1.8 vs. 8.5+/-1.3, p=0.253) between two groups. However, The degree of disgust was lower in the sugared PEG group than the standard PEG group (6.4+/-2.3 vs. 3.9+/-2.9, p=0.000). The willingness to repeat same regimen was higher in the sugared PEG group than the standard PEG group (2.0+/-0.6 vs. 2.3+/-0.7, p=0.004). There was no difference in side effects between two groups. CONCLUSIONS: The sugared PEG solution as a bowel preparation method revealed a higher patient's compliance and was effective as the standard PEG solution. When the patient dislike the taste and saltness of the standard PEG solution, the sugared PEG solution will be good alternative method.

Familial Hemiplegic Migraine with Prolonged Coma and Cerebellar Atrophy: CACNA1A T666M Mutation in a Korean Family

We report the first Korean patient with familial hemiplegic migraine type 1, with clinical and multimodal imaging findings. A 43-yr-old man was admitted for right hemianopia and aphasia, followed by coma. MRI showed only cerebellar atrophy. CT angiography showed mild vasodilation of intracranial blood vessels and increased vascularity in the left hemisphere and perfusion-weighted imaging showed elevated cerebral blood flow. Gene analysis of the patient and his mother led to the identification of a heterozygous point mutation (1997C-->T, T666M) in exon 16 of the CACNA1A gene. Familial hemiplegic migraine should be considered in patients with episodic neurological dysfunction with cerebellar atrophy.

A Case of Gastrointestinal Stromal Tumor Mistaken for Abscess Following Embolization of Superior Mesenteric Artery

Bowel ischemia following embolization is the major complication of arterial embolization in gastrointestinal bleeding. Although mild ischemia recovers with conservative treatment, perforation should be treated surgically. We report a case of gastrointestinal stromal tumor mistaken for an abscess following embolization of superior mesenteric artery. A 72-year-old female was referred to the emergency room complaining of hematochezia and hematemesis. Endoscopic examination revealed a tiny mucosal defect with spurting bleeding at distal duodenum. Hemostasis could be achieved by embolization of superior mesenteric artery. After ten days, abdominal CT scan showed an abscess-like feature around distal duodenum, but the small bowel series did not show leakage of contrast. Endoscopy revealed round intestinal wall defect. She underwent laparotomy owing to the possibility of perforation and abscess, but surgical findings showed 5 cm mass based on the jejunum just caudal to ligament of Treitz. The mass was finally diagnosed as gastrointestinal stromal tumor combined with necrosis.

A Case of Gastrointestinal Stromal Tumor Mistaken for Abscess Following Embolization of Superior Mesenteric Artery

Bowel ischemia following embolization is the major complication of arterial embolization in gastrointestinal bleeding. Although mild ischemia recovers with conservative treatment, perforation should be treated surgically. We report a case of gastrointestinal stromal tumor mistaken for an abscess following embolization of superior mesenteric artery. A 72-year-old female was referred to the emergency room complaining of hematochezia and hematemesis. Endoscopic examination revealed a tiny mucosal defect with spurting bleeding at distal duodenum. Hemostasis could be achieved by embolization of superior mesenteric artery. After ten days, abdominal CT scan showed an abscess-like feature around distal duodenum, but the small bowel series did not show leakage of contrast. Endoscopy revealed round intestinal wall defect. She underwent laparotomy owing to the possibility of perforation and abscess, but surgical findings showed 5 cm mass based on the jejunum just caudal to ligament of Treitz. The mass was finally diagnosed as gastrointestinal stromal tumor combined with necrosis.

A patient with homocystinuria complicated by superior sagittal sinus thrombosis: A case report

Homocystinuria is an inborn error of methionine metabolism and has several causes. Among the causes, cystathionine-b-synthase deficiency is the most common. The major clinical manifestations are ectopia lectis skeletal deformities, mental retardation and occlusive vascular disease A 16 year old girl was admitted with generalized seizure. She had a history of bilateral lens dislocation and thoracic scoliosis. Her brain MRI and MRA showed mass-like lesions at both frontal area and diffuses, stenosis of the right internal carotid artery She underwent a stereotaxic brain biopsy and cerebral angiography. Two days, after angiography, she was suddenly aggravated to show stuporous mentality and quadriplegia. FoIlow-up brain MRI showed newly developed acute ischemic lesions at both parietal area MR venography confirmed superior sagittal sinus thrombosis. Methionine and homocystine were markedly elevated in plasma and 24 hour urine. She recovered with anticoagulation and vitamin supplementation(folate and pyridoxine). Homocystinuria should be suspected in stroke patients of young age, especially if thy have nontraumatic lens dislocation or marfanoid features. We report a patient with homocystinuria complicated by cerebral venous sinus thrombosis which was aggrevated after cerebral angiography.

A patient with homocystinuria complicated by superior sagittal sinus thrombosis: A case report

Homocystinuria is an inborn error of methionine metabolism and has several causes. Among the causes, cystathionine-b-synthase deficiency is the most common. The major clinical manifestations are ectopia lectis skeletal deformities, mental retardation and occlusive vascular disease A 16 year old girl was admitted with generalized seizure. She had a history of bilateral lens dislocation and thoracic scoliosis. Her brain MRI and MRA showed mass-like lesions at both frontal area and diffuses, stenosis of the right internal carotid artery She underwent a stereotaxic brain biopsy and cerebral angiography. Two days, after angiography, she was suddenly aggravated to show stuporous mentality and quadriplegia. FoIlow-up brain MRI showed newly developed acute ischemic lesions at both parietal area MR venography confirmed superior sagittal sinus thrombosis. Methionine and homocystine were markedly elevated in plasma and 24 hour urine. She recovered with anticoagulation and vitamin supplementation(folate and pyridoxine). Homocystinuria should be suspected in stroke patients of young age, especially if thy have nontraumatic lens dislocation or marfanoid features. We report a patient with homocystinuria complicated by cerebral venous sinus thrombosis which was aggrevated after cerebral angiography.