A Case of Hamartomatous Polyp without Peutz-Jeghers Syndrome Arising from Appendix / 대한소화기내시경학회지

Peutz-Jeghers syndrome is a familial syndrome consisting of mucocutaneous pigmentation and gastrointestinal polyposis and appears to be inherited as a single pleiotropic autosomal dominant gene with variable and incomplete penetrance. Cases of hamartomatous polyps of the Peutz-Jeghers type without Peutz-Jeghers syndrome have only rarely been reported. Moreover, only one case of a Peutz-Jeghers polyp at the appendix has been reported; it was resected by appendectomy. We report here on a case of a 45 year old man who had a hamartomatous polyp of the Peutz-Jeghers type arising from the appendix. The polyp was successfully removed by endoscopic polypectomy. To our knowledge, this is the first case of a hamartomatous polyp of the Peutz-Jeghers type that originated from the appendix and that was resected endoscopically.

Concurrent Malignant Carcinoid Tumor and Benign Carcinoid Tumor of the Rectum / 대한소화기내시경학회지

Neuroendocrine cells are distributed throughout the body and they are found in the gastrointestinal tract, pancreas, lung, thyroid, adrenal gland and many other organs, and especially the gastrointestinal tract. As a consequence, neuroendocrine tumors of the colon and rectum are common neoplasm. Several cases of the benign carcinoid tumor and a few cases of the malignant carcinoid tumor of the colon and rectum have been reported. Yet there have been no reports on concurrent malignant carcinoid tumor and benign carcinoid tumor at the same site of the colon. A 60-year-old man presented with an asymptomatic rectal mass. After the mass was evaluated and operated on, it was confirmed to be a concurrent malignant carcinoid tumor and benign carcinoid tumor of the rectum, and metastasis to the liver was also found.

Volatile Sulfur Compounds as a Predictor for Esophagogastroduodenal Mucosal Injury

BACKGROUND/AIMS: Halitosis is a symptom that bothers patients more socially than medically and its pathogenic mechanisms are unclear and treatment armamenterium is limited. Clinicians generally ignored active interventions. Since halitosis is closely associated with volatile sulfur compounds (VSCs), we used a Halimeter and gas chromatography to measure VSCs in patients with Helicobacter-pylori (H. pylori)-associated gastric diseases. METHODS: We categorized 72 patients with H. pylori infection into two groups based on their endoscopic findings: a non-erosive mucosal group (NE, n=24) and an erosive mucosal group (E, n=48). Halitosis was objectively assessed by applying either a Halimeter to breath air or gas chromatography to gastric juice. Simultaneously, the expression of VSC-generating enzyme was measured with reverse-transcriptase PCR using mRNA isolated from biopsy tissues. RESULTS: The levels of VSCs in exhaled breaths or aspirated gastric juices differed significantly between the NE and E groups (p<0.00001), suggesting that VSCs might reflect eroded epithelial damage induced by H. pylori infection. The expressions of cystathionine beta-synthase (CBS) and cystathionine gamma-lyase (CSE) were broadly consistent with the degree of mucosal injury. CONCLUSIONS: Erosive changes in esophagogastroduodenal mucosa were strongly correlated with increased VSC levels, suggesting that halitosis might result from H. pylori-associated erosive lesions.

A Case of Polypoid Angiolipoma of the Distal Descending Colon as Cause of Hematochezia / 대한소화기내시경학회지

Angiolipoma is a benign tumor that is mainly observed in the subcutaneous tissue and is composed of mature adipose tissue and proliferative blood vessels. However, the condition is rare in the gastrointestinal tract including the colon. There was a case report of angiolipoma of the proximal ileum but there are no reports of angiolipoma of the colon in Korea. A 47-year-old man, who presented with intermittent left lower quadrant pain and hematochezia, underwent contrast enhancement CT, which revealed a huge mass with inhomogeneous density in the distal descending colon. The colonoscopy viewed a large polypoid mass with vascular engorgement, and a laparotomy was performed urgently due to the persistent abdominal pain, intussusception and hematochezia. The histology examination disclosed a benign angiolipoma. We report this case of symptomatic angiolipoma of the distal descending colon.

Peritonitis due to spontaneous rupture of the urinary bladder in an end stage renal disease patient with anuria / 대한내과학회지

Patients with nonfunctioning bladders, such as found in anuric renal failure, are prone to a severe form of urinary tract infection called pyocystis. Pyocystis is the accumulation of pus in the bladder. Anuric patients are often believed to be incapable of acquiring a urinary pathogen; thus, the urinary tract may be mistakenly discounted as a possible source of sepsis and bladder rupture. Although bladder rupture is normally associated with trauma, spontaneous bladder rupture may occur, especially in patients with mental disabilities, alcohol abuse and urinary tract infection. We report a rare case of a spontaneous intraperitoneal bladder rupture, probably precipitated by pyocystis. Symptoms and signs were atypical and included pain and vomiting with fever, abdominal distension and ascites. An abdominal CT and retrograde cystography showed a large quantity of intraperitoneal fluid and tearing in the dome of the bladder. Repair of the rupture site of the bladder after laparotomy was performed. However,, the patient expired due to peritonitis and pulmonary infection.

A Case of Pseudohypoparathyroidism Type I / 대한내분비학회지

Pseudohypoparathyroidism (PHP) is a rare clinical type of hypoparathyroidism. The patients with PHP show classic clinical and biochemical features of hypoparathyroidism, but elevated serum level of parathyroid hormone (PTH) and characteristic physical appearances termed 'Albright's hereditary osteodystrophy' (AHO). PHP is classified into types Ia, Ib, Ic and II according to the presence of AHO phenotype and the mechanism of PTH resistance. We experienced a case of PHP in a 12 year-old girl with carpopedal spasm, syncope and partial AHO. She showed very low serum calcium level (1.4 mmol/L), high phosphorus level (3.62 mmol/L) and high immunoreactive PTH level (186.6 ng/L). In the Ellsworth-Howard test, urinary cyclic adenosine monophosphate and phosphorus levels after an exogenous PTH injection remained unchanged. Therefore, we were able to classify the patient as either PHP type Ia or Ic. After the patient had been treated with daily calcium carbonate (1 g), cholecalciferol (250 IU) and calcitriol (0.5 microgram), her neurological signs and symptoms as well as her biochemical abnormalities of hypocalcemia and hyperphosphatemia were improved.

A Case of Pseudohypoparathyroidism Type I / 대한내분비학회지

Pseudohypoparathyroidism (PHP) is a rare clinical type of hypoparathyroidism. The patients with PHP show classic clinical and biochemical features of hypoparathyroidism, but elevated serum level of parathyroid hormone (PTH) and characteristic physical appearances termed 'Albright's hereditary osteodystrophy' (AHO). PHP is classified into types Ia, Ib, Ic and II according to the presence of AHO phenotype and the mechanism of PTH resistance. We experienced a case of PHP in a 12 year-old girl with carpopedal spasm, syncope and partial AHO. She showed very low serum calcium level (1.4 mmol/L), high phosphorus level (3.62 mmol/L) and high immunoreactive PTH level (186.6 ng/L). In the Ellsworth-Howard test, urinary cyclic adenosine monophosphate and phosphorus levels after an exogenous PTH injection remained unchanged. Therefore, we were able to classify the patient as either PHP type Ia or Ic. After the patient had been treated with daily calcium carbonate (1 g), cholecalciferol (250 IU) and calcitriol (0.5 microgram), her neurological signs and symptoms as well as her biochemical abnormalities of hypocalcemia and hyperphosphatemia were improved.

Antibiotic Resistance and Genotypic Characterization of Escherichia coli Isolated from Pig Farm Environment

The use of antibiotics, including therapeutically in human and veterinary medicine, or as prophylaxis of growth promotion in animal husbandry, ultimately exerts selective pressure favorable for the propagation of antibiotic resistant bacteria. In this study we have determined the resistance for antibiotics of E. coli from pig farm environment, and investigate genetic relatedness by random amplification of polymorphic DNA (RAPD). Six farms were randomly selected in Gyeongsanman-do and Busan provinces for collecting samples from feces, manure and underground water. A total of 88 isolates from feces, 74 isolates from manure and 1 isolate from underground water were analyzed by antibiotic resistance and RAPD. Antibiotic resistance testing was performed by disk diffusion method using 16 antibiotics. The highest percentage of antibiotic resistance of isolates from feces and manure was found to the following antibiotics; tetracycline (100% and 100%), sulfamethoxazole/trimethoprim (60.2% and 62.2%), streptomycin (50.0% and 68.9%), chloramphenicol (56.8% and 56.8%), ampicillin (50.0% and 81.1%) and cephalothin (50.0% and 51.4%). Of isolates from feces and manure, 22.7% and 20.3% showed multiple resistance to 4 and 5 antibiotics, respectively. The isolates from GE pig farm showed six RAPD patterns. A single pattern, RAPD-C, was predominat in feces isolates (50.0%) and manual isolates (46.7%), and the rest of feces isolates showed RADP-A, B and E pattern and manure isolates showed D and E pattern. One isolate from underground water showed F pattern. The appearance of multiresistant in E. coli isolates from pig farms environment is a problem of major concern of public health and RAPD may offer an useful tool of discrimination for the epidemiological investigation.

Prevalence of Specific Clone of Salmonella enterica Serovar Typhimurium Clones in the Swine Population of Kyungpook Province During 1998 to 2000

A total of 40 Salmolella enterica serovar Typhimurium (S. typhimurium) strains were isolated from clinical specimens of swine at 10 farms in Kyungpook province from 1998 to 2000. We investigated the clonal relationship of S. typhimurium isolates by antimicrobial susceptibility, plasmid profile, and Southern hybridization analysis with tetA, and pulsed-field gel electrophoresis (PFGE). All S. typhimurium isolates showed identical biochemical characteristics and were resistant to tetracycline, streptomycin, and sulfamehtoxazole. They were classified into 5 groups by antimicrobial resistance patterns. S. typhimurium isolates carried 3 to 5 plasmids and were classified into 5 groups by plasmid profiles. Southern hybridization showed that tetA gene was located in 21 kb of plasmid. S. typhimurium isolates from 9 different farms showed identical or similar PFGE patterns, which indicates clonal origin of the strains. All S. typhimurium isolates, except one isolate from 1998, seemed to belong to be one clone by the combination of three epidemiological typing methods. These data demonstrated that a specific clone of Salmolella enterica serovar Typhimurium was widely spread in swine farms in Kyungpook province.

Age-Specific Reference Ranges for Serum Prostate-Specific Antigen: Community-based Survey in Namhae Region / 대한비뇨기과학회지

PURPOSE: To establish the relationship between serum prostate specific antigen (PSA) concentration and age in a community-based population without clinically evident prostate cancer, a population based screening study was performed in a rural area in Southern Korea. MATERIALS AND METHODS: From January 1999 to December 1999, 1,278 volunteer men aged from 40 to 89 years in Namhae, Korea participated in a clinical examination that included a serum PSA determination (TANDEM-R assay), digital rectal examination and transrectal ultrasonography. The subjects who had clinical evidence of prostate cancer and high PSA concentration (>10ng/ml) were excluded. The PSA levels were compared with age using Pearson correlation and linear regression analysis. RESULTS: The serum PSA concentration correlated with patient age (r=0.129, p=0.001). The observed 95th percentile increased from 1.37ng/ml for subjects in the 40's to 6.18ng/ml for subjects in the 80'2. The reference range for serum PSA (95 percentile) for men in the 40's was 0.24 to 1.37ng/ml; for 50 to 59 years, 0.27 to 2.68ng/ml; for 60 to 69 years, 0.25 to 4.00ng/ml; for 70 to 79 years, 0.29 to 4.55ng/ml; and for 80 to 89 years, 0.31 to 6.18ng/ml. CONCLUSIONS: Our data showed that the serum PSA concentration directly correlated with patient age (Pearson correlation coefficient=0.129, P=0.001). Thus, rather than relying on a single reference range regardless of different age groups, it may be more appropriate to have age-specific reference ranges. Our data were lower than that of the Western data, and could provide an adjunctive information in interpreting PSA data in Korean men, especially in the elderly population.

Prevalence of Varicoceles in Children and Adolescents in Namhae-gun / 대한비뇨기과학회지

PURPOSE: The aim of this study was to elucidate the current incidence of varicoceles in unselected Korean children and adolescents. MATERIALS AND METHODS: 4271 Korean school boys aged 7-18, resided in Namhaegun, Gyungnam province were investigated. The study population comprised more than 95% (4271/4403) of all boys in the respective age in a rural country with a total population of 61,820 (29,840 males and 31,980 females). All examinations were carried out by a single urologist from March to June 2000. The patients with varicocele were divided according to the classification of Dubin-Amelar. RESULTS: No case of varicocele was encountered in 1,233 boys between 7 to 10 years, while the incidence in the 3,038 boys aged 11 to 18 years was 9.61% (292 boys). There was a peak varicocele incidence from aged 14 to 16 (11.78-13.52%). The proportion of varicocele grades were grade I 21.58% (63/292), grade II 44.68% (131/292), grade III 33.56% (98/292). There were 2 cases of bilateral varicoceles. Other abnormalities found were 7 cryptorchidism (0.16%) and 27 hydroceles (0.63%). In 33 older boys (aged between 16-18) with varicocele, semen analyses were performed and two boys had subnormal sperm concentration. CONCLUSIONS: Our finding of peaking at ages 14 to 16 was parallel with the old Danish report,11 but our incidence was substantially lower than the report of 16.2%.

Prostate Volume Variation with Age: Community-based Survey in Namhae Region / 대한남성과학회지

PURPOSE: The size of prostate increases with age, but there has been few Korean data on the prostate size in the general population. We thereby report the size of prostate with respect to age in Korean men residing in Namhae, Korea. MATERIALS AND METHODS: To determine the prostate size, 1421 men from Namhae, Korea underwent transrectal ultrasonography. Size of the prostate was estimated as a weight by the elliptical method. RESULTS: The mean prostate weight was 33.5 10.6 ml. The relationship between prostate volume and age was statistically significant in 1421 men (Pearson correlation coefficient=0.156, p=0.0001). Also, between the normal group and the groups of men with lower urinary tract symptoms (LUTS), there was significant correlation with age (Pearson correlation coefficient=0.162, p=0.0001), while results were insignificant with size (Pearson correlation coefficient= 0.170, p=0.0001). CONCLUSIONS: Size and rate of growth of the prostate were smaller compared to the Western society, nevertheless, prostate size increased with age. For accurate and reasonable age-specific size of the prostate of Korean male, more community based multicenter study will be needed with more refined measurement techniques such as step-section planimetry for the prostatic volume estimation.

Comparative Study on the Healing Process of the Calvarial Defect filled with Hydroxyapatite and Bioglass in Rats

Bone or bone substitute has been widely used for the reconstruction of bony defect developed by trauma, infecton, cyst, tumor, congenital abnormality, etc. Owing to its variety in quality and quantity, the use of alloplasts is increased rapidly. Among the various graft materials, HA has been studied and applied in clinic most exensively. When HA applied to bony defect, it is considered to help the bone healing by osteoconduction but tends to be encapsulated with fibrous tissue and floated in the applied area by the lack of consolidation. Bioglass is considered as a subsitute which can cover such weak point of HA. Bone defect were artificially prepared in the calvaria of the rats followed by grafts of HA and bioglass into defects. Sequential sacrifice was peformed at the 3rd, 7th, 14th and 28th day of experiment. The staining of the obtained specimen was performed with H&E, MT, immunohistochemical stain and then histological examinaions were carried out under the light and scanning electron microscope. 1. In the features of H&E stain, infiltration of chronic inflammatory cell were present in all group at the 3rd and 7th day of experiment with decrease at the 14th day in bioglass group. The infiltration of inflammatory cells was more active in control and HA group whereas the formation of granulation tissue was more active in bioglass group was larger and more irregular than in HA group. 2. The features of MT stain showed new bone formation from the 7th day in all groups and the evidence of advanced calcification was observed at the 28th day. 3. In the features of immunohistochemical stain, bioglass group showed more PCNA positive response in the osteoblasts at the site of new bone formation and the lower activity of undifferentiated mesenchymal cells than HA group. 4. In scanning electron microscopic features, fibrous tissue formation and osteoid attached to HA was observed in the HA group after the 7th day. In bioglass group, osteoid formation was observed between the absorbed bioglass. Generally in HA group, bone formation progressed with characteristic of the fibrous and osteoid tissue mainly attached to the surface and the high activity of undifferented mesenchymal cells was seen at the graft site. In bioglass group, osteoid tissue formation was seen between the irregulary absorbed bioglass and the increased PCNA positive response was observed in the osteoblast at the new bone formation site.

Two Cases of Blind Ending Duplication of Ureter / 대한비뇨기과학회지

The blind ending duplication of ureter represents a rare anomaly in development of ureteric bud, and may almost be asymptomatic. We report two cases of blind ending duplication of ureter, that were detected incidentally.

The 16 Cases of Impotence Due to Pituitary Tumor / 대한비뇨기과학회지

Elevated levels of serum prolactin in patients with pituitary tumors have been associated with hypogonadism, frequently manifested in men as impotence and/or loss of libido. Among 2,896 consecutive impotent patients investigated at Severance Hospital 208( 7.2%) patients had serum levels of prolactin greater than 30 ng/ml. Of the 208 patients 16(7.7%) were diagnosed as pituitary tumor. The average age of 16 patients was 37.8 years and mean duration of erectile dysfunction was 4.2 years. The mean serum prolactin level was 238.14 ng/ ml. 13 of these patients were treated with operation, two with bromocriptine, and one was lost. The mean duration of follow up was 2.4 years(1 month-4.2 years). Of the eleven of thirteen who were able to follow up, six were combined with bromocriptine therapy and three were combined with bromocriptine and radiation therapy. Of the two who were managed with only bromocriptine, one was improved after bromocriptine for four months and the other was received penile prosthesis due to no improvement of symptoms. It is emphasized that pituitary tumor should be considered in the investigation of impotence of endocrine causes when markedhyperprolactinemia (specially greater than 100 ng/ml) is noted.

A Case of Ureteral Nephrogenic Adenoma / 대한비뇨기과학회지

Nephrogenic adenoma is a rare proliferative response of urothelium to chronic irritation or infection. It has been reported in the bladder, ureter, renal pelvis and urethra, but to date there have been only 15 reports, of its occurrence in the ureter. We present a further case of this lesion in this unusual location.

A Case of Unilateral Ectopic Scrotum / 대한비뇨기과학회지

Congenital anomalies of the scrotum are uncommon and among them the ectopic scrotum is extremely rare. Only one case of ectopic scrotum has been recorded in Korea. In 1993 we experienced a case of unilateral ectopic scrotum with no other congenital abnormalities in a 22-year-old man. His left scrotum was normal in position and size, and contained a normal palpable testis. There was definite median raphe but no scrotal development to the right of this line. The penis showed externally normal appearance. A large sac of skin, having the typical hyperpigmented wrinkled appearance of normal scrotum, was overlying right inguinal ring. The sac contained a normally developed testis.

Relationship between Pressure Response to Repeated Elevation of Intracranial Pressure and Central alpha-Adrenoceptor in Rabbit

It is well documented that elevation of intracranial pressure is accompanied by arterial blood pressure(cushing response) in laboratory animals as well as in human. When the elevation of intracranial pressure(ICP) was repeated in a rabbit at an interval of 30-60 min, the blood pressure increased more promtly than in the first elevation of ICP, suggesting that mechanism involved in the pressure might be different. Therefore, this study was undertaken to clarify the pharmacological characteristics of the response to the first and repeated(second) elevation of ICP in urethane anesthetized rabbits. Increasing ICP, induced by infusion of saline into a ballooned in the epidural space, produced arise of the arterial blood pressure. When the blood pressure reached a peak, the balloon was suddenly deflated to reduced the ICP and blood pressure declined (the first ICP elevation experiment). After 30-60 min the same procedure was repeated (the second ICP-elevation experiment) Results are summarized as follows; 1) In the first ICP elevation experiment, the arise of ICP was relatively slow at the beginning of the infusion but became sharp as the infusion proceeded. When ICP increased sharply BP also increased abruptly and heart rate decreased. 2) In the second ICP elevation experiment, the slight decrease in BP which appeard at the beginning of the first ICP elevation experiment rat observed, so that only an abrupt arise of BP was seen. 3) Intravenous chlorisondamine inhibited the pressure responses in the second ICP elevation experiment. 4) Intraventricular corynanthine had little effect on the pressure response to the first ICP elevation but inhibited the pressure response to the second ICP elevation. 5) Intraventricular clonidine, yohimbine and prazosin little effect on the pressure response to the second ICP elevation. From this results that functional integrity of central alpha 2-adrenoceptor which took part in the pressure response to the first ICP elevation might have deranged in the second ICP elevation and that central alpha 1-adrenoceptors play a dominant role in the pressure response to the second ICP elevation.