Hypertriglyceridemia-induced Pancreatitis / 대한소화기학회지

Hypertriglyceridemia (HTG) is a rare cause of pancreatitis. However, the relationship between acute pancreatitis and severe HTG is well recognized. We report a case of necrotizing pancreatitis due to severe HTG (type IV) in a patient with poorly controlled diabetes. It was of particular interest that serum pancreatic enzymes were normal even though the imaging studies indicated the presence of necrotizing pancreatitis. Our case clearly demonstrates the various indices of HTG-induced necrotizing pancreatitis with a normal pancreatic enzyme level despite there being a serum triglyceride level < or=1,000 mg/dL. We present this case with a review of literature for hyperlipidemic pancreatitis in Korea.

The Correlation of Child-Pugh Score, PGA Index and MELD Score in the Patient with Liver Cirrhosis and Hepatocellular Carcinoma According to the Cause of Alcohol and Hepatitis B Virus / 대한간학회지

BACKGROUND/AIMS: To determine the treatment modalities and the prognosis of a patient with liver cirrhosis, quantitative estimation of liver function is important. We assessed the Child-Pugh score (CPS), the common method as a severity index for the cirrhosis, the Promthombin, gamma GT, and Apolipoprotein A1 (PGA) index and model for end-stage liver disease (MELD) score. The purpose of this study was to evaluate the correlation between these indices in the patients with cirrhosis only and hepatocellular carcinoma (PHC), according to underlying causes (HBV and alcohol). METHODS: We reviewed medical records of 339 cirrhotic patients with/without hepatocellular carcinoma and divided patient groups by disease and underlying cause: cirrhosis caused by alcohol; LC-Al, cirrhosis caused by HBV; LC-B, hepatocellular carcinoma with cirrhosis caused by alcohol; HCC-Al, hepatocellular carcinoma with cirrhosis caused by HBV; HCC-B. We assessed the CPS, PGA index and MELD score and calculated the correlation coefficient between these scores. RESULTS: Among the total of 339 patients, 201 patients were diagnosed on the liver cirrhosis only, and 138 patients on the hepatocellular carcinoma with cirrhosis. In each groups, mean score values were not significantly different in CPS, PGA index and MELD score. The correlation of CPS, PGA index and MELD score in all groups, except for the correlation of PGA index and MELD score in HCC-Al group, was significantly positive (p<0.05). Compared to correlation coefficients between three indices, the patients with cirrhosis only had higher tendencies than the patients with hepatocellular carcinoma. The patients by HBV had higher tendencies than by alcohol. CONCLUSIONS: The correlations between CPS, PGA index and MELD score showed significantly positive correlations in the patients with liver cirrhosis only and hepatocellular carcinoma with cirrhosis (except in HCC-Al group). The patients with cirrhosis only had higher correlation coefficients than the patients with PHC and the patients by HBV had higher than by alcohol.

Ingestion of a Mouthpiece Fragment during Intravenous Sedated Upper Gastrointestinal Endoscopy: Three Cases / 대한소화기내시경학회지

The demand for intravenous sedated upper gastrointestianl endoscopy is currently increasing steeply. Despite this trend, patient status complication due to this procedure is largerly neglected by most physicians. Recently, in three patients, mouthpiece fragment were left within the patients' body after intravenous sedated upper gastrointestinal endoscopy. They were transferred to our institution for the removal of the fragment. The patients complained of an uneasy sensation from within their body, around their necks and chests. After conducting therapeutic endoscopy, the fragment could be located around the distal part of their esophagus and within their stomach. The fragment were removed successfully by using snare in two patients, and by using forceps in another patient.

Relation of Apolipoprotein E Polymorphism to Clinically Diagnosed Fatty Liver Disease / 대한간학회지

BACKGROUND/AIMS: Apolipoprotein E (Apo E) is important in plasma lipid metabolism and is a component of several plasma lipoprotein-lipid particles. Three major Apo E isoforms are encoded by three common allelic forms, epsilon2, epsilon3, and epsilon4 at the APO E locus. The goal of this study was to examine the association between polymorphisms in the apolipoprotein E gene (APOE) and fatty liver disease. METHODS: We examined the distribution of APOE alleles from 116 fatty liver patients and 50 controls in Korea. RESULTS: The frequencies of APOE alleles in fatty liver patients were 6.5% in epsilon2, 85.7% in epsilon3 and 7.8% in epsilon4. The corresponding frequencies in control subjects were 4.0% in epsilon2, 91.0% in epsilon3 and 5.0% in epsilon4. There were no significant differences in the distribution of APOE genotypes between fatty liver patients and controls. APOE epsilon2 and epsilon4 allele frequencies in fatty liver patients were more than those in controls. However, there was no significant differences in APOE epsilon2 and epsilon4 allele frequencies. CONCLUSIONS: These results suggest that APOE alleles seem not to be directly associated with the pathogenesis of fatty liver disease.

A Case of Invasive Aspergillosis Manifestated by Pneumothorax and Pneumomediastinum in Acute Myelogenous Leukemia / 대한혈액학회지

Invasive aspergillosis (IA) is frequent in patients with acute leukemia and results in significant morbidity and mortality among neutropenic patients. Although the lung is a common site of this disease, pneumothorax and pneumomediastinum is rare as initial manifestations of IA. A 22-year-old male was admitted to the hospital due to aggrevated dyspnea, productive cough, fever and nasal bleeding. Acute myelogenous leukemia (AML, M2) was diagnosed. His clinical course was aggrevated despite patient was treated with empirical antibiotics. Chest X-ray and high-resolution computed tomography showed pneumothorax and pneumomediastinum on the left thorax. The clinical course was improved after closed thoracostomy and empirical amphotericin B therapy for the fungal infections was started. IA was pathologically diagnosed by his sputum contained a mucus plug. His symptoms and radiological lesions were completely resolved after amphotericin B therapy alone with a total doses of 2.58g. We report a case of IA complicated by pneumothorax and pneumomediastinum in acute myelogenous leukemia with the review of literatures.

Quantitative Rapid Urease Test in Helicobacter Pylori Infection / 대한소화기내시경학회지

BACKGROUND/AIMS: The principle of the rapid urease test is the assessment of the color change of the pH indicator, phenol red, by ammonium and bicarbonate ions which were produced by the urease. We modified a conventional rapid urease test, and quantified H. pylori infection by measuring the change of spectrophotometric absorbance. METHODS: 202 patients with upper gastrointestinal symptoms were endoscopically examined and three biopsies were performed in each antrum and fundus. Two biopsy specimens were stained with Giemsa and scored from 0 to 4 according to the distribution of bacteria by the Wyatt method. Another specimen was used for the quantitative rapid urease test. The tissue was incubated in a cuvette containing 10% of urea solution and phenol red at 37C. We measured optical densities in 550 nm at 5 min, 10 min, 15 min, 30 min, 1 hrs, 2 hrs, 4 hrs and 24 hrs time points.

A Case of Hypercalcemia in the Blastic Phase of Chronic Myeloid Leukemia Associated with Elevated Parathyoid Hormone-related Protein / 대한내과학회지

Hypercalcemia is a rare complication of chronic myelogenous leukemia, especially in the blastic phase. The incidence is below 5%. PTH-rP (parathyroid hormone- related protein) plays various roles in human physiology by binding PTH receptors. The patient was 32-year-old male, admitted with blatic crisis of chronic myelogenous leukemia associated with hypercalcemia, elevated PTH-rP, depressed PTH level. Chemotherapy was instituted with hydroxyurea and two courses of idarubicin and Ara-C. After chemotherapy serum calcium and PTH-rP level, number of blast were depressed to near normal and PTH was elevated to normal range. But when the patient was re-admitted with recurrence of blastic crisis and hypercalcemia, PTH-rP level was elevated and PTH level was depressed below normal range. There was no other evidence of hypercalcemia as like hyperthyroidism or hyperparathyroidism, bone destruction. These suggest that the hypercalcemic event in this patient was induced by PTH-rP produced by blast cells.

A case of accessory tracheal bronchus in patient with bronchial asthma / 알레르기

Tracheal bronchus is an aberrant bronchus that arises most often from the right tracheal bronchial wall above the carina and is the result of an additional tracheal outgrowth early in embryonic life. Its incidence ranges from 0.1 to 5%. This anomaly is usually diagnosed incidentally during bronchoscopy or bronchography in patients with various respiratory problems. Tracheal bronchus may be associated with other bronchopulmonary anomalies such as tracheal stenosis, pulmonary agenesis, pulmonary sequestration, abnormal lobulation, and Down's syndrome. In patients without specific clinical symptoms, a incidentally diagnosed tracheal bronchus does not require any treatment. We report a case of 59-year-old man incidentally detected accessory tracheal bronchus associated with bronchial asthma with review of literatures.