A Case of Intestinal Tuberculosis Extensively Involving the Upper and Lower Intestinal Tract, Accompanied by Tuberculous Lymphadenitis / 대한소화기내시경학회지

The prevalence of intestinal tuberculosis has been markedly decreased with the development of anti-tuberculous chemotherapy, preventive medicine, vaccinations, early detection and treatment of pulmonary tuberculosis, and improved eeonomic conditions. Nowadays, intestinal tuberculosis is a disease that should be differentiated from the inflammatory bowel diseases such as Crohn's disease and ulcerative colitis, Behcet's disease, and colon cancer and amebic colitis. This disease also has a new clinical significance in that it has an increased infection rate and unfavorable outcomes in patients infected by HIV or in those who undergo organ transplantation or receive immunosuppressive agents. Tuberculosis of the duodenum was a rare disease and was not reported in the last decade. Moreover Intestinal tuberculosis extensively involving the small bowel including the duodenum and colon was very rarely reported in the various relateid literature. Recently we experienced a case of advanced intestinal tuberculosis involving the duodenum, jejunum, ileum, and colon accompanied by tuberculous cervical and abdominal lymphadenopathies, in a 49-year-old woman who manifested profound general weakness, diarrhea, and marked weight loss. She was diagnosed pathologically by upper gastrointestinal endoscopy, colonoscopy, and fine needle aspiration cytology as well as by roentgenologic examination. The patient was given antituberculous medication which resulted in dramatic clinical improvement. In this report, we present this case with review of the related literature.

Comparative Analysis of the Expression of p53, Rb, PCNA in thc Gastric Carcinoma / 대한내과학회지

OBJECTIVES: Recently, the studies for oncogene and tumor marker have been actively performed to investigate the carcinogenesis of gastric carcinoma, but it is not clearly understood. We investigated the expression of tumor suppressor gene and proliferation activity in gastric carcinoma. METHODS: Immunohistochemistry for p53 protein (wild and mutant type), retinoblastoma protein(wild type), and PCNA was performed in 131 cases of formalin fixed paraffin embedded tissue sections of gastric carcinoma. We compared that expression with tissue invasiveness, lymph node metastasis, staging and, Lauren classification, and that expression with each other. RESULTS: 1) The positive ratio of p53 protein, Rb protein, also PCNA in gastric carcinoma was 64.9%, 98.5%, 99.2%, 2) The expression of p53 protein was related to invasiveness, lymph node metastasis, staging, and Lauren classification(p<0.05). 3) The positive reaction for Rb gene was identified in tumor cells as well as proliferating cells. 4) There was a close relationship between Rb gene expression and PCNA in gastric carcinoma (p<0.05). CONCLUSION: Theses results suggested that the expression of p53 gene is related to invasiveness, lymph node metastasis, staging and Lauren classification in gastric carcinoma. Expression of retinoblastoma gene is a closely related to proliferating activity.

Esophagus, Stomach & Intestine; A Case of Malignant Carcinoid Tumor of the Ampulla of Vater / 대한소화기내시경학회지

Carcinoid tumor of the ampulla of Vater comprises about 2.0-8.9% of the gastrointestinal earcinoid tumors and 3-5.5% of the duodenal tumor. The climcal manifestations of the carcinoid tumor of the ampulla of Vater are jaundice, hemorrhage, obstruction of duodenurn, or carcinoid syndrome. But the symptoms of carcinoid tumor are nonspecific and diagnosis is delayed until far advanced state, usually. Recently we experienced one case of carcinoid tienor in a 33-year-old woman who had epigastric pain and intermittent melena, so we report it with a review of the literature

Study on the Gastric Cancer Initially Diagnosed as Benign Gastric Ulcer during Endoscopic Follow-up / 대한소화기내시경학회지

To examine the relationship between gastric ulcer and gastric cancer, we investigated petients with gastric ulcer diagnosed from 1986 to l993. We reviewed the endoscopic reports and films of patients with gastric ulcer retrospectively. We excluded the patients who was diagnosed as gastric cancer in two years follow-up. The results were as follaws; 1) During follow-up of the original cohort, there were 5 patients(0.5~%) in whom gastric cancer developed at the same site initially diagnosed as gastric ulcer. The gross type of the lesion was early gastric cancer in two and advanced gastric cancer in three patients 2) The time interval between the initial diagnosis of gastric ulcer and cancer development was from 31 months to 70 months (average 51 months). 3) At the initial examination of 5 gastric cancer patients, the diagnosis was active gastric ulcer in four, multiple gastric ulcer in one, and linear gastrie ulcer in one patient. Characteristic endoscopic findjngs were gastric ulcer with clubbing mucosal folds in three and gastric ulcer with bleeding in one patient. 4) During the follow-up period, endoscopicailly and histologically healing of gastric uleer was observed in one patient and histologic finding showed chronic superficial gastritits with intestinal metaplasia. These results suggest that gastric ulcers rarely progress to gastric cancer. However if the endoscopic findings are suspicious for malignancy, then follow-up endoscopy until complete healing should be done.

Differentiation of malignant from benign pancreatic mass by Tl-201 abdominal SPECT

The aim of the present study was to evaluate the ability of Tl-201 abdominal SPECT to differentiate between chronic focal pancreatitis and pancreatic malignancy. Seventeen patients (12 men, 5 women; mean age, 56 years; 9 pancreatic cancer, 8 chronic pancreatitis) with pancreatic mass were prospectively investigated with Tl-201 abdominal SPECT. In all patients, CT and/or US could not clarify the nature of the pancreatic mass. Focal hot uptake was present in 8 of 9 patients with pancreatic cancer, while it was present in 2 of 8 patients with chronic pancreatitis. Therefore, the sensitivity and specificity of the present study were 89% and 75%, respectively. A significant difference of Tl-201 uptakes was noted between benign and malignant masses (p& 0.05). Therefore, we concluded that Tl-201 abdominal SPECT was a useful test in differentiation of malignant from benign pancreatic mass, especially when the differentiation could not be made by other imaging modalities

A Case Report of Leiomyosarcoma of the Duodenum / 대한소화기내시경학회지

Leiomyosarcoma of the duodenum is an uncommon tumor and have not specific symptoms and signs, almost all cases of tumor were diagnosed in operating room. This tumor is generally firm, relatively well encapsulated, lobulated and often soft if they undergo hemorrhagic necrosis. Most authors emphasized the relative number of mitosis as the most reliable findings of leiomyosarcoma. Recently, we experienced a case of leiomyosarcoma of duodenum which was confirmed by operative and pathological diagnosis.

Gastric red spots and serum pepsinogen I levels in cirrhotic patients / 대한내과학회지

No abstract available.

A Case of Angiodysplasia in the Jejunum / 대한소화기내시경학회지

Angiodysplasia of the small bowel is an uncommon disorder in Korea, and is often found to be the cause of unexplained gastrointestinal bleeding. A 53-year-old male patient visited an emergeney room because of repeated melena and dizziness, He underwent selective superior mesenteric arterial angiography which revealed abnormal clusters of small arteries and early opacification of veins draining a segment of lower jejunum. An exploratory laparotomy was performed under the impression of angiodysplasia. An ulceration on the lower jejunum was found, and was resected. Subsequent jejunojejunostomy was performed. Histology of the resected specimen showed an irregularly dilated vessels in mucosa and submucosa.

A Case of Angiodysplasia in the Jejunum / 대한소화기내시경학회지

Angiodysplasia of the small bowel is an uncommon disorder in Korea, and is often found to be the cause of unexplained gastrointestinal bleeding. A 53-year-old male patient visited an emergeney room because of repeated melena and dizziness, He underwent selective superior mesenteric arterial angiography which revealed abnormal clusters of small arteries and early opacification of veins draining a segment of lower jejunum. An exploratory laparotomy was performed under the impression of angiodysplasia. An ulceration on the lower jejunum was found, and was resected. Subsequent jejunojejunostomy was performed. Histology of the resected specimen showed an irregularly dilated vessels in mucosa and submucosa.

A Case of Synchronous Four Gastric Cancer / 대한소화기내시경학회지

The incidence of synchronous gastric cancer is variously reported to be 2.07%, 5.22%, 6.5%, 8.6%, or 9% and has been increasing recently, probably with advance in the diagnosis of gastric cancer. Our case in presentation is a 70-year-old male patient who had total gastrectomy and esopbagiojunostomy done for synchronous four gastric cancer. Each has different histologic types, Some of these lesions are not suspected before operation and are found almost by chance during histologic examinations after surgery performed only to remove main lesion. So we report this case with a review of literatures.

Scintigraphic demonstration of Chilaiditi syndrome / 대한핵의학회잡지

No abstract available.

Herpetic Esophagitis in a Renal Transplant Patient / 대한소화기내시경학회지

Herpetic esophagitis is a rare diaease and is usually deecribed in autopsied reports. Most of the cases are reported in an immunocompromised host. We report a patient with herpetic esophagitis, following renal transplantation and longstanding steroid therapy due to rejectioh phenomenon. The patient complained of dysphagia and odynophagia. Endoscopic finding revealed multiple scattered or confluent erosions and hemorrhagie tendency, diffusely scattered linear or confluent shallow ulcer covered by a whitish exudate on a elevated margin. Microscopic finding revealed uicerated squamous epithelium of ballooning degeneration, ground glass nuclei, multinuclear giant cell and intranuclear inclusion body. The patient responded dramatically to intravenous acyclovir and leading to syniptomatic and endoscopic improvement.

Clinical Observations of 66 Endoscopic Gastric Polypectomies / 대한소화기내시경학회지

Advance in fiberoptic endoscopy have improved diagnostic capabilities and management in patients with gastric polyps and increased experience with endoscopic polypectomy offers the most simple and safe method in removal of gastric polyps. Sixty six endoscopic gastric polypectomies was performed in 59 patients who visited Chonnam National University Hospital from 1980 to 1989 The results obtained were as follows. 1) The most patients were in the seventh decade followed by fifth, fourth decade. The ratio of male to female was 1: 1.95. 2) The common clinical symptoms with which patients presented were epigastric discomfort (54. 2%), epigastric pain (44.1%), indigestion (16.9%), nausea and vomiting (13.6%) and hematemesis (3.4%). The associated diseases of gastric polyp were chronic superficial gastritis (28.8%), chronic atrophic gastritis (13.6%), benign gastric ulcer, gastric caecer, cancer of ampulla of Vater. 3) The number of patients with single gastric polyp wa 47 (79.7%), and that of multiple gastric polyps was 12 (20.3%). The most common location of gastric polyps was gastric antrum (66.6%) follawed by gastric body (27.3%) and gastric fundus (6.1%). 4) The removed polyps were mostly 1.0 cm to 2.0 cm in size and in the gross findings by Yamadas classification, type IV (48.5%) was most common. 5) Histogical examinations revealed that 49.6% of remoyed polyps were hyperplastic polys and 18. 7% of those were adenomatous polyps. Only one case of adenomatous polyp had contaied focally malignant change of mucosa. 6) Almost all cases were in the absenee of significant complications, but three patients showed bleeding at the site of polypectomy, which controlled by conservative means.

A Case of Granulocytic Sacoma in Esophagus / 대한소화기내시경학회지

Granulocytic sarcoma.(chloroma) is a localized tumor mass composed of immature cells of the granulocytic series infiltrating an extramedullary site. The tumor may involve anywhere in the body, especially orbit, bone, epidural space and lymph node, but there is no case involved the esophagus. In a 34-year-old male presented with sudden anset of dysphagia, esophagoscopic examination revealed concentric narrowing of the esophageal lumen wirith alight granular mucosa in the midesophagus, which hiatologically proved to b a granulocytic sarcoma. Peripheral blood and bone marrow aspiration smears showed blastic crisis of chronic myelocytic leukemia. After the systemic chemotherapy, dysphagia and mid-esophageal luminal narrowing disappeared completely.

Clinical Studies on the 34 Cases of pm - Gastric Cancer / 대한소화기내시경학회지

The records of 34 patients with histologically proven pm-gastric cancer were reviewed from Chonnam University Hospital during the recent 6 year period, 1981, to 1986. The male outnumbered female in a ratio of 2.4:1.0. The peak incidence was 6th decade and mean age were 53.8 years in male, 48.7 years in female respectively. pm-gastric cancer was most often seen on the lesser curvature side, eapecially in the lower 1/3 of the stomach. Macroscopically, it can be divided into early-cancer-like type and Borrmann type. Early-cancer-like type was more frequent than Borrmann type. Early-cancer-like type IIc+III was most often seen with a rate of 20.6%, followed in the order of frequency by Borrman type II, early-cancer-like type IIc, IIa+IIc, and Ile+ IIa. The incidence of lymph node involvement was 26.4% and were related to the macroscopic types and/or histologic differentiation degrees. 5 cases out of 34 pm-gastric cancer expired during the follow up period, and their mean survival time was 32.8 months. The type of operation and the extent of resection were closely related to survival. Five year survival rate was 54.0%. These results shows the significance of the pm-gastrie cancer as a early simulating advanced cancer.

Anisakis / 대한소화기내시경학회지

Acute gastric anisakiasis is occurred when men intake a raw or inadequate cooked anisakis infected fish. The clinical symptoms are severe cramping abdominal pain, nausea, vomiting, and epigastric fulling sensation. It is well known that the whale is final host and man is opportunistic host. Recently, we experienced three cases of acute gastric anisakiasis. We think that acute gastric anisakiasis is probably rather undetected than rare disease. So through immediate gastrofiberscopy of patients with severe cramping epigstric pain occuring after ingestion of raw fish,we can find more cases of the anisakis larvae. In is adequate to abstract of larvae by biopsy forceps through gastrofiberscopy.

A Case of Anomalous Termination of the Common Bile Duct into the Duodenal Bulb / 대한소화기내시경학회지

Anatomy of the pancreaticobiliary ductal system is so variable that one should think of its normal anatomy as nonexistent. But exact location of the termination of the common bile duct in important to the biliary surgeon when performing transduodenal exploration of the common bile duct, to the physician and radiologist when diagnosing pancreaticobilijary disease by ERCP. We report a case of Lnomalous termination of the common bile duct into thii. duadenal bulb diagnosed by ERCP and operative cholangiogram.

Colonoscopically Diagnosed Case of Behcet's Syndrome Involving Cecum / 대한소화기내시경학회지

Authors came acoss a case of Behcet's syndrome involving cecum. The patient was a 33-year-old female. Her chief complaint was right lower quadrant pain, Colonoscopy revealed several ulcerations the base of which was covered by thick whitish coat, They were surrounded by mulitiple nodular masses. Endoscopic biopsy showed noaspecific ulceration. The patient had a history of aphthous ulceration of mouth and external genitalia. So she was diagnosed to have Behcets syndrome. She underwent right hemicolectomy with tetminal ilectomy. We report this case with literiature review.

A Case of Ascarid Chronic Pancreatitis Due to Impaction of Ascaris Lumbricoides into the pancreatic Duct / 대한소화기내시경학회지

Authors report a case with recurrent epigastric pain who revesled to have chronic pancreatitis due to impaction of Ascaris lumbricoides into the pancreatic duct. She was a 41-year-old female who favored raw meat. ERCP revealed a living round worm in the pancreatic duct which was also showed by ultrasonegraphy and computed tomography. She underwent distal pancreatectomy and developed glucose intolerance but was well controlled.

A Case Report of Choledochal Cyst / 대한소화기내시경학회지

Congential bile duct cysts, the so called "choledochal cysts" occur at all levels of the biliary tree and may be of saccular, diverticular, or fusiform configuration. There are 6 types of choledochal cysts proposed by todani et al based on roentgenologic and operative findings. This disease is usually diagnosed at the childhood or early adult life and predilection for orientals. Clinical manifestations are usually jaundice, right upper quadrant abdominal pain and abdominal mass. Here we are reporting a case of choledochal cyst, type IV-A diagnosed by abdominal ultrasonogram. 99mTc-DISIDA hepatobiliary scan and endoscopic retrograde cholangiopancreatogram.