Clinical Feature of Pseudomembranous Colitis with Ascites / 대한소화기내시경학회지

BACKGROUND/AIMS: Ascites is a fairly common condition, but the clinical features of pseudomembranous colitis with ascites are not well-known. The aim of this study was to determine how the existence of ascites is related to the clinical factors. METHODS: Between March 2002 and June 2006, 67 pseudomembranous colits patients were diagnosed by performing lower endoscopy and biopsy. The patients' ascites was identified by abdominal plain radiography, ultrasonography or computerized tomography. The extension of colitis was evaluated by ultrasonography or computerized tomography. RESULTS: 16 patients (23.9%) had ascites. The serum WBC (p=0.01), hypoalbuminemia (p<0.01), CRP (p<0.01), recurrence (p<0.01), and extension of colitis (p<0.01) were associated with the existence of ascites. The four patients who had undergone paracentesis had a low SAAG level and PMN dominant ascites. CONCLUSIONS: There were correlations of ascities with leukocytosis, hypoalbuminemia, CRP, extension of colitis and recurrence of PMC.

A Case of Pancreatic Endocrine and Exocrine Tumor with MEN Type I / 대한소화기내시경학회지

An acinar cell carcinoma of the exocrine pancreas is a rare tumor with reported a incidence of 1% to 2% of pancreatic carcinomas. Cases of acinar cell carcinomas with amphicrine features have been reported in recent decades. However, there are no reports of two simultaneous pancreatic masses: an endocrine tumor and, an exocrine tumor. We encountered a 59-year-old female patient presenting with abdominal pain and melena. The acinar cell carcinoma was a 1x1 cm-sized round solid mass in the head of the pancreas. The islet tumor was a 2.5x1.5 cm-sized round mass in the body of the pancreas. The endocrine tumor was nonfunctioning. Melena resulted from the hemosuccus pancreaticus due to a ductal invasion of the acinar cell carcinoma. The patient had a parathyroid adenoma with hyperparathyroidism. Therefore, both the islet tumor and parathyroid adenoma with hyperparathyroidism were strongly suggestive of a MEN I.

Macro-aspartate Aminotransferase in a Patient with Chronic Hepatitis C / 대한소화기학회지

Macroenzymes are normal enzymes complexed with an immunoglobulin (usually IgG, rarely IgA or IgM). A number of macroenzymes have been reported in the literature. Among them, macro-AST has been detected in diseases such as acute and chronic hepatitis, various malignancies and autoimmune diseases, but usually not associated with any specific disease. We report a case of elevated AST activity in serum due to marco-AST formation in a female with chronic hepatitis C which was confirmed by AST isoenzyme electrophoresis. To our knowledge, this is the first report of macro-AST occurred in chronic hepatitis patient in Korea.

A Case of Optic Neuritis Associated with Crohn's Disease / 대한소화기학회지

In Crohn's disease, neurologic complications such as cerebrovascular accident, headache, peripheral neuropathy have been reported sporadically. The pathogenesis of these neurologic complications is still unknown and controversial. We experienced a 22-year-old man, with Crohn's disease accompanied by optic neuritis. Loss of visual acuity was developed during the worsening course of enterocutaneous fistula. After high dose steroid treatment, his visual acuity and neurologic symptoms improved immediately.

A Case of Acute Cholecystitis Secondary to Hemobilia after Percutaneous Liver Biopsy / 대한소화기학회지

Percutaneous liver biopsy is well established for the diagnosis and follow-up of many liver diseases. Although it is rather safe, major complications, such as bleeding into the peritoneal or thoracic cavity, hemobilia, enteric perforation and intrahepatic hematoma, have been reported related to the procedure. Recently, incidence of such major complications has been decreased since the introduction of ultrasonography-guided liver biopsy. We report a case of 59-year-old female patient with acute cholecystitis secondary to hemobilia 2 days after ultrasonography-guided percutaneous liver biopsy.

Obstructive Jaundice due to Biliary Cast Syndrome Followed by Orthotopic Liver Transplantation / 대한소화기학회지

Biliary complication occurs in 6-34% of all liver transplant patients. Although bile leaks and strictures are relatively common, other biliary complications such as T-tube leak, choledocholithiasis, and biliary cast syndrome can also be observed. The biliary cast syndrome describes the presence of casts causing obstruction with its resultant sequelae of biliary infection, hepatocyte damage secondary to bile stasis and ductal damage, all contributing to cholangiopathy. Because the exact timing of cast formation after orthotopic liver transplantation is not consistent, it is difficult to define the true incidence of biliary cast syndrome without long-term follow-up data. Proposed etiological mechanisms include acute cellular rejection, prolongation of cold ischemic time, infection, biliary drainage tubes, and biliary obstruction. The diagnosis of biliary cast syndrome is usually confirmed by endoscopic retrograde cholangiopancreatography. There have been few published articles about biliary casts in Korea. Herein, we report a case of biliary cast syndrome followed by orthotopic liver transplantation.

The Endoscopic Findings and Clinical Characteristics of Gastrointestinal Amyloidosis / 대한소화기내시경학회지

BACKGROUND/AIMS: Gastrointestinal involvement is common in systemic amyloidosis. However, there have not been reports of any specific endoscopic findings which indicate amyloidosis in the gastrointestinal tracts in Korea. We aimed to find out the endoscopic findings and clinical characteristics of gastrointestinal amyloidosis. METHODS: We analyzed seventeen histologic proven amyloidosis cases that all performed the endoscopy in Hanyang Medical Cencer. RESULTS: The main findings of gastroscopy were multiple erosions (5 cases), ulcer (3 cases), nodularities and hyperemic mucosa (1 case). Colonoscopic findings were hyperemic mucosa (8 cases), nodularities (3 cases), hemorrhagic spots (3 cases) and ulcers (3 cases). CONCLUSIONS: When a patient undergoing chronic inflammatory diseases has various abdominal symptoms, endoscopic biopsy should be done in every case because grossly normal looking mucosa dose not preclude the histologic evidence of amyloidosis.

Acute Pancreatitis due to Hypertriglyceridemia: Report of 2 Cases / 대한소화기학회지

Hypertriglyceridemia (HTG) is a rare but well known cause of acute pancreatitis (AP), which can be a life- threatening complication if the degree of HTG is severe enough. It might be primary in origin or secondary to alcohol abuse, diabetes mellitus, pregnancy, or drugs. A serum triglyceride (TG) level of more than 1,000 to 2,000 mg/dL in patients with type I, IV, or V hyperlipidemia (Fredrickson's classification) is the identifiable risk factor. HTG-induced AP typically presents as an episode of AP or recurrent AP. The clinical course of HTG-induced AP is not different from other causes. Routine management of HTG-induced AP should be similar to other causes. A thorough family history of lipid abnormalities should be obtained, and an attempt to identify secondary causes should be made. The mainstay of treatment includes dietary restriction of fatty meal and lipid-lowering medications (mainly fibric acid derivatives). Although there are limited experiences with plasmapheresis, lipid apheresis, heparinization and insulin application, these can support the treatment of HTG- induced AP. We report two cases of HTG-induced AP which were successfully treated by plasmapheresis.

A Clinical Study of Pyogenic Liver Abscess at Two Different Local Hospitals / 대한간학회지

BACKGROUND/AIMS: Despite the improvement of personal and social hygiene, pyogenic liver abscess is still a common disease. We compared the incidence, infection route, underlying disease and major complications between two different local hospitals. METHODS: We reviewed the clinical data of 100 patients with pyogenic liver abscess who were treated at Seoul and Guri Hanyang University Hospital from 1999 to 2003. RESULTS: There were 64 males and 36 females in the study group; they were aged from 19 to 94 years with a mean of 56.5 years. Every year 19 to 23 pyogenic liver abscess patients were admitted to both hospitals. The most common organism isolated was Klebsiella pneumoniae in both local hospitals. In the Seoul hospital, diabetes (40.9%) was most common associated condition. In the Guri hospital, biliary tract disease or a history of hepatobiliary surgery (54.2%) was the most common associated condition. Catheter drainage and/or percutaneous needle aspiration were established as the standard treatment modality. CONCLUSIONS: In both regional hospitals, the incidence of pyogenic liver abscess did not decrease and Klebsiella pneumoniae was the most common organism. Diabetes and biliary tract disease, including, previous hepatobiliary surgery, were the most identifiable underlying disease.

A Case of Nodular Regenerative Hyperplasia of Liver that mimicked Primary Biliary Cirrhosis / 대한간학회지

Nodular regenerative hyperplasia (NRH) of the liver is a rare disease that is characterized by multiple regenerative nodules in the hepatic parenchyma without fibrosis. The exact pathogenesis of NRH has not been established, but it's been suggested that obliteration of portal veins may initiate the nodular transformation. It is also known that this disease is associated with autoimmune disease, myeloproliferative disease, lymphoproliferative disease, primary biliary cirrhosis, and some chemotherapy agents. The patients with NRH are usually asymptomatic, yet if they have symptoms, the most common clinical manifestations are those of portal hypertension, including splenomegaly and esophageal varices with or without bleeding. We report a case of nodular regenerative hyperplasia that presented with clinical manifestations similar to those of primary biliary cirrhosis.

A Case of Idiopathic Retroperitoneal Fibrosis with Acute Renal Failure / 대한신장학회잡지

Retroperitoneal fibrosis is proliferation of fibrous tissue with inflammatory process in retroperitoneal cavity. It is relatively rare disease that has been reported less than 20 cases in Korea until now. Idiopathic type is more frequent but secondary type is increasing nowadays. Secondary causes include drugs, infections, and leakage of blood or urine, malignancies, connective tissue diseases, etc. Recent studies suggest the relationship between retroperitoneal fibrosis and autoimmunity to own vascular or lipoid tissue. It can cause compression and obstruction of ureter, abdominal aorta, hypertension and finally collapse of renal function. Surgical procedure and immunosuppressive therapy consist of mainstay of management. Corticosteroid therapy may reduce inflammation and reverse fibrosis. Retroperitoneal fibrosis is thought to have some reVersible components in early stage. Corticosteroid may be used as initial therapy but more studies should be performed. We report a case of idiopathic retroperitoneal fibrosis with acute renal failure improved with ureter stent insertion and steroid therapy.

HBV DNA Levels, Aminotransferase and Histological Activity in Young Male Patients with HBeAg Positive Chronic Hepatitis B / 대한간학회지

BACKGROUND/AIM: A significant correlation between HBV DNA and liver damage was found in precore mutant strains but there was no significant association between viral replication and liver damage in HBeAg positive patients. Laboratory tests are often requested to predict hepatitis activity (grade) and fibrosis (stage) in HBeAg positive chronic hepatitis B. We assessed ALT, AST, and HBV-branched DNA to find which is the best for predicting hepatitis activity and fibrosis. METHODS: Routine biochemical liver function tests and HBV DNA in sera were assessed in 119 young patients positive with HBsAg and HBeAg. The mean age of patients was 21+/-2 years. All patients were male. By logistic regression analysis the relationships between laboratory data, hepatitis activity, fibrosis, or risk of chronic active hepatitis were analyzed. RESULTS: There was a significant correlation between aminotransferase (AST, ALT) and hepatitis activity/ fibrosis. A significant inverse relationship between the HBV bDNA and hepatitis activity was demonstrated (Pearson's correlation coefficient: lobular activity,-0.305; porto-periportal activity, -0.410). But HBV bDNA was not correlated with severity of fibrosis. AST and HBV bDNA was the important test for predicting the more severe hepatitis activity (lobular activity and porto-periportal activity: score> or =3, respectively) CONCLUSION: The higher AST, but the lower HBV bDNA, in sera shows the more severe hepatitis activity. AST and HBV bDNA could be helpful for assessing the hepatitis activity in young male patients with HBeAg positive chronic hepatitis B if proper reference values are used.

A Case of Fulminant Hepatic Failure in Wilson's Disease Combined with Systemic Lupus Erythematosus / 대한간학회지

Patients with systemic lupus erythematosus (SLE) have a chance of developing liver involvement in their lifetime. The main cause of liver involvement in SLE patients is previous treatment with hepatotoxic drugs or hepatotropic viral hepatitis. Wilson's disease is a hereditary disorder and is usually diagnosed in patients presenting either neuropsychiatric disorders or manifestations related to chronic liver disease. Fulminant hepatic failure as the initial manifestation of Wilson's disease is rare. The relationship between systemic lupus erythematosus and Wilson's disease has not been established. We report a case of a 12-year-old girl with SLE who presented fulminant hepatic failure as an initial manifestation of Wilson's disease. The diagnosis was established with decreased serum ceruloplasmin level and the presence of Kayser-Fleischer ring. We treated with repeated plasma exchange. Despite repeated plasma exchange she died of multi-organ failure on the 16th hospital day. Considering this case, Wilson's disease should be considered as a cause of fulminant hepatic failure, especially in juvenile age cases.

The Survey for Correlation of ECG Findings to Prognosis in Hyperkalemia / 대한신장학회잡지

BACKGROUND: Hyperkalemia, one of life threatening medical emergencies, has had its prognosis and treatment determined clinically based on the findings of EKG. To date, there hasn't been enough data on the effect of very early EKG features of hyperkalemia on the long-term outcome of treatment. Therefore, we have conducted this study to suggest possible treatment guideline for hyperkalemia by analyzing the correlations between initial parameters, treatment methods and treatment outcomes. METHODS: We reviewed retrospectively the medical records of 58 patients with hyperkalemia who visited the Hanyang University Kuri Hospital from May 1995 to April 2000. We examed underlying diseases, electrolytes, regular hemodialysis, hemodialysis trials, clinical and ECG findings(at initial and recovery state). RESULTS: High systolic pressure seems to be significantly correlated with high recovery rate. Subjects with unique EKG finding of hyperkalemia were more likely to have higher serum potassium level and death rate than those without unique EKG finding. However, this group has shown improved recovery rate after undergoing hemodialysis. Serum potassium level of hyperkalemia phase does not correlate with final outcomes and EKG findings. Over 80 percent of the hyperkalemic subjects are accompanied with renal failure, and there was significant improvement in the survival rate in renal failure subjects whom had undergone hemodialysis. CONCLUSION: In hyperkalemia, the EKG has the importance in diagnosis, severity classification and treatment choice. However, prognosis of the hyperkalemia does not rely solely on the EKG itself but rather on the appropriate individualized treatment including hemodynamic stabilization and hemodialysis. Therefore, prompt and adequate treatment based on early speculation upon possible etiologic candidates, EKG, and general condition may lead to recovery from the hyperkalemia, including critical conditions such as conduction disorder and severe arrhythmia.

The Survey for Correlation of ECG Findings to Prognosis in Hyperkalemia / 대한신장학회잡지

BACKGROUND: Hyperkalemia, one of life threatening medical emergencies, has had its prognosis and treatment determined clinically based on the findings of EKG. To date, there hasn't been enough data on the effect of very early EKG features of hyperkalemia on the long-term outcome of treatment. Therefore, we have conducted this study to suggest possible treatment guideline for hyperkalemia by analyzing the correlations between initial parameters, treatment methods and treatment outcomes. METHODS: We reviewed retrospectively the medical records of 58 patients with hyperkalemia who visited the Hanyang University Kuri Hospital from May 1995 to April 2000. We examed underlying diseases, electrolytes, regular hemodialysis, hemodialysis trials, clinical and ECG findings(at initial and recovery state). RESULTS: High systolic pressure seems to be significantly correlated with high recovery rate. Subjects with unique EKG finding of hyperkalemia were more likely to have higher serum potassium level and death rate than those without unique EKG finding. However, this group has shown improved recovery rate after undergoing hemodialysis. Serum potassium level of hyperkalemia phase does not correlate with final outcomes and EKG findings. Over 80 percent of the hyperkalemic subjects are accompanied with renal failure, and there was significant improvement in the survival rate in renal failure subjects whom had undergone hemodialysis. CONCLUSION: In hyperkalemia, the EKG has the importance in diagnosis, severity classification and treatment choice. However, prognosis of the hyperkalemia does not rely solely on the EKG itself but rather on the appropriate individualized treatment including hemodynamic stabilization and hemodialysis. Therefore, prompt and adequate treatment based on early speculation upon possible etiologic candidates, EKG, and general condition may lead to recovery from the hyperkalemia, including critical conditions such as conduction disorder and severe arrhythmia.

Distribution of HBV Genotypes in Patients With Chronic HBV Infection in Korea / 대한간학회지

BACKGROUND/AIMS: Chronic HBV infection is associated with a wide spectrum of clinical manifestations, including asymptomatic carrier state, chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Genotypically, HBV genomes have been classified into seven groups, designated A to G. Several studies have suggested recently that HBV genotypic differences influence the severity of liver disease and clinical outcomes. The distribution of HBV genotypes in Korea and its clinical relevance are poorly understood. We investigated the prevalence of HBV genotypes in Korea and the association between the distinct genotypes and the severity of liver disease. METHODS: A total of 214 HBV-DNA positive serum samples, were used for the genotyping. All patients were HBV-bDNA positive chronic HBsAg carriers. 199 patients were histologically verified with liver cirrhosis (6), chronic hepatitis (192) and fatty liver (1). The other patients were clinically diagnosed with liver cirrhosis (13) or hepatocellular carcinoma (2). HBV genotype was determined by PCR using type-specific primers. RESULTS: Genotyping was possible in all patients. Out of 214 patients, 213 (99.5%) were HBV genotype C. Only one (0.5%) was genotype A. The patient with genotype A had minimal hepatitis as diagnosed by liver biopsy. CONCLUSIONS: These results indicate that almost all chronic HBV infections are genotype C in Korea. HBV genotypic difference therefore does not influence the clinical outcome of HBV infection in Korea. Because genotype C may be associated with more severe liver disease, the predominance of genotype C in Korea may result in more severe outcomes than in other countries where other genotypes are predominant.

An Outbreak of Hepatitis A in South Korean Military Personnel: A Clinical and Epidemiologic Study / 대한간학회지

BACKGROUND/AIMS: Increasing the susceptibility of young populations to HAV infection could result in an outbreak in a high-risk group. The author investigated the characteristics of hepatitis A outbreaks among Korean military personnel to obtain the fundamental data for determining the necessity for selective HAV vaccination. METHODS: A case was defined as a person who had an onset of an illness compatible with acute viral hepatitis A between 4 February and 6 April 1998. RESULTS: A widespread outbreak of hepatitis A affected 102 military personnel. The epidemic curve indicated a common-source exposure in the initial stage. At the end of the first month of the initial onset, the occurrence was specific to the location of the military post. Investigation suggested that contamination most likely occurred prior to the local distribution of food. The mean age was 23 years. The overall attack rate was 91 cases per 10000 persons at risk. All cases were jaundiced. The most frequently reported symptoms included icteric sclerae, dark urine, anorexia, malaise and fatigue, nausea, fever, abdominal pain, headache, upper respiratory symptoms, vomiting, itching, diarrhea, light-colored stools, myalgia, arthralgia, and skin rash. The laboratory test showed the serum total bilirubin of 5.5 mg/dL, AST of 344 IU/L, and ALT of 868 IU/L (mean value). CONCLUSION: All patients were clinically apparently diseased with jaundice and were completely recovered. The outbreak was food borne common-source exposure. The changing epidemiology hepatitis A in Korea calls for the economic evaluation of costs and benefits for selective HAV vaccination in high risk adult groups including military personnel.

Effect of thyroid hormone on the alcohol dehydrogenase activities in rat tissues

The effects of thyroid hormone on hepatic and gastric alcohol dehydrogenase (ADH) activities (nM of NADH/min/mg of cytosolic protein) have been investigated in male Sprague Dawley rats treated with thyroxine (1 mg/kg, po) for 14 days. Whereas hepatic ADH activity in thyroxine-treated rats decreased by 61.3% of control rats (26.4 vs 43.2, p<0.001), gastric ADH activity increased by 262.9% of control rats (4.9 vs 1.9, p<0.001). As for the activities of the lung and kidney, thyroxine treatment did not produce any statistically significant changes. These data suggest that thyrotoxicosis causes a decrease of hepatic alcohol metabolism, and that the increase of gastric ADH activity in thyrotoxic rats can partly restore the first-pass metabolism of ethanol.

A Case of Gastric Hamartoma Presenting as a Submucosal Tumor / 대한소화기내시경학회지

Hamartomatous polyps in the stomach have been described as gastric lesions of familial polyposis coli or not associated with polyposis coli. However, submucosal tumor-like lesion of the gastric hamartoma is very rare. We have experienced an unusual hamartoma in the stomach in a 69-year-old man. He was hospitalized with epigastric discomfort. Endoscopy revealed a submucosal mass at the greater curvature of the high body of the stomach. The resected mass measured 3 X 2 X 1.5 cm and was characterized by cystic dilation of glandular structures. The glandular structures consisted of various types of lining cells, including surface foveolar cell types, pyloric cell types and parietal-like cells, and irregularly arranged smooth muscle bundles and collagen fibers were noted. We report this unusual gastric hamartoma presenting as a submucosal tumor with a review of literatures.

Post EST Papillary Restenosis: A Case Report / 대한소화기내시경학회지

The occurrence of papillary restenosis following endoscopic sphincterotomy is uncommon and usually reported as a late complication. Its frequency varies from 0.8% to 3% and at present, only a few reports describe the late complication rate for a mean follow-up exceeding 10 years. The diameter of the sphincterotomy opening diminishes by about 30% in the first year without further narrowing, suggesting that restenosis occurs mainly during the first post-sphincterotomy year. Papillary restenosis may be promoted by insufficient cutting and may depend on the indication for EST such as common bile duct stones, papillary stenosis, duodenal diverticular, sphincter of Oddi dysfunction. A bleeding sphincterotomy requiring a sclerosing injection is considered a potential risk factor for papillary stenosis. However, stenosis may develop in the absence of specific predisposing factors. A case of papillary restenosis following endoscopic sphincterotomy for gollstone pancreatitis in a 33-year-old female patient is herein reported.