Prevalence of subclinical hypothyroidism in hypercholesterolemic adults and influence of serum TSH on the serum total cholesterol level / 대한내과학회지

BACKGROUND: Subclinical hypothyroidism is frequently discovered from hypercholesterolemic adults. It is defined as an asymptomatic state which characterized by normal free thyroxine (FT4) and elevated thyroid stimulating hormone (TSH) level. Hypercholesterolemia is a major risk factor for coronary heart disease, however hypercholesterolemia caused by hypothyroidism can be easily managed by thyroid hormone replacement. The screening of thyroid disease in hypercholesterolemia patient must be emphasized in order to find out correctable hypothyroidism. So we screened the prevalence of overt and subclinical hypothyroidism at different hypercholesterol levels in middle-aged men and women and also analyzed the correlation between TSH and total cholesterol level. METHODS: We measured serum TSH levels and FT4 by radioimmunoassay from 491 patients with hypercholesterolemia. The subjects were divided into two groups according to serum cholesterol level. Group I was serum cholesterol > or = 240 - or = 300 mg/dL. Subclinical hypothyroidism was defined as TSH levels higher than 4 mU/L, in the presence of normal FT4 concentration. RESULTS: The overall prevalence of subclinical and overt hypothyroidism was 3.4% and 2.5% in men and 4.7% and 3.5% in women of middle age. In men the prevalence of overt and subclinical hypothyroidism increased from 2.3% of group I to 16.1% in the group II (p<0.05). In women that increased from 5.2 % to 12.9 % (p<0.05). After age correction, an increase of 1 mU/L TSH in men was associated with an increase of 3.2 mg/dL total cholesterol (p<0.01). A similar trend was also found in women (2.1 mg/dL p=0.052). CONCLUSION: In this population, the prevalence of hypothyroidism is up to 16.1% in middle-aged men, 12.9% in middle-aged women with high total cholesterol and it may justify screening of thyroid disease in hypercholesterolemic patients especially in clinical practice.

Immune Thrombocytopenic Purpura in a Patient with Preexisting Ulcerative Colitis: A Case Report / 대한소화기내시경학회지

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with evidence of immune activation and is associated with extraintestinal diseases in numerous target tissues. Extraintestinal manifestations of UC are well described in numerous tissues, most notably mucotaneous, synovial, biliary, and opthalmic. Among hematological complications of UC, autoimmune hemolytic anemia is often reported, but immune-mediated thrombocytopenia (ITP) is rare. We present one case in which exacerbation of UC sequentially induced development of ITP. Platelet-associated antibodies were positive. Bone marrow examinations revealed increased megakaryocyte number. ITP was treated with corticosteroids, intravenous immune gamma- globulin and plasmapheresis. However, because previous treatments were not successful, splenectomy was done. This may provide further evidence that ITP is causally associated with UC, and is the result of immunostimulation from luminal antigens and altered immunoregulation.

Desmoid Tumor and Duodenal Adenoma in a Patient with Familial Adenomatous Polyposis: A Case Report / 대한소화기내시경학회지

Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited disorder due to germline mutation of the tumor suppressor adenomatous polyposis coli (APC) gene. Multiple large bowel polyps usually develop in adolescence or early adulthood with inevitable progression to colorectal carcinoma. It is well known that patients with FAP are at considerable risk of developing extracolonic manisfestations of the disease. Particularly, desmoid tumors of the abdominal cavity, and duodenal adenomas and carcinomas are the most serious ones. Desmoid tumors and duodenal carcinomas are major causes of death in those patients in whom a prophylactic (procto) colectomy has been performed. We report the case of a 38-year-old man with desmoid tumor and duodenal adenoma developing after total colectomy with ileostomy due to FAP, and literatures were reviewed.

Usefulness of Endoscopic Brush Cytology from Malignant Biliary Obstruction / 대한소화기내시경학회지

BACKGROUNDS/AIMS: In patients with obstructive jaundice due to malignant biliary tract stricture, a tissue diagnosis is essential because the various treatment options are available. The tissue biopsy from the biliary tree is difficult because of the focal, sclerotic, small annular nature and lower celluarity. Brush cytology is an effective method for obtaining a tissue from bile duct stricture, and the diagnostic sensitivity of endoscopic brush cytology is reported as between 40% and 70% from malignant bile duct strictures. In this study, we analyzed the diagnostic value of endoscopic brush cytology in patient with extrahepatic bile duct strictures. METHODS: The eight patients with extrahepatic bile duct strictures diagnosed with endoscopic retrograde cholangiopancreatography underwent endoscopic brush cytology and aspiration bile cytology. Brushing were taken using a Greenen cytology brush passed with a guide wire through the stricture. RESULTS: The final diagnoses were made by surgical pathology and clinical follow-up. The sensitivity of brush cytology (62.5%, 5/8) was significantly higher than the sensitivity of bile cytology (0%; 0/8). No procedure related complication occured. CONCLUSIONS: Endoscopic brush cytology would be an effective and a relatively safe method for tissue diagnosis in patients with malignant biliary obstruction.

Colonic Intussusception in a Patient with Familial Adenomatous Polyposis: A Case Report / 대한소화기내시경학회지

A 26-year-old man with intermittent lower, abdominal, cramping pain, nausea, vomiting, and diarrhea was found to have intussusception by computed tomography. Whole emergency laparotomy was performed, intus-susception reduced spontaneously. Postoperately, familial adenomatous polyposis (FAP) was diagnosed by colonoscopy and barium enema. Innumerous polyps were found in the entire colon and one of these was presumed to have caused sigmoid invagination. If is believed that FAP is quite a rare cause of colonic intus-susception. This case of a 26-year-old man with an intussusception of the colon due to FAP is herein reported. It is important that surgeons and internists are aware of this rare cause of intussusception due to FAP because of the therapeutic implications.