The Application of Clips during ERCP: A New Anchoring Method for Redundant Kerckrings Folds Covering the Duodenal Papilla / 대한소화기내시경학회지

During an endoscopic retrograde cholangiopancreatography (ERCP). cannulation is more difficult in patients with anatomical variations, papillary stenosis, an impacted stone in the papilla, papillary cancer, peripapillary diverticulum, postoperative states such as those after Billroth II or Braun operations, or redundant Kerckring's folds of the duodenum covering the duodenal papilla. For a patient suffering from a redundant Kerckrings folds of the duodenum and a common bile duct stone, a new technique applying clips to expose the duodenal papilla properly during ERCP was performed. After the application of the clips, the duodenal papilla was well exposed in a favorable position for proper cannulation. In this setting, an ERCP was easily performed with the standard cannula. After an endoscopic sphincterotomy (EST) with the pull-type papillotome was conducted, the common bile duct stone was successfully removed with a Dormia basket.

A case of intravenous immunoglobulin therapy in severe aspirin - sensitive asthma patient combined with IgG1 and IgG3 subclass deficiency / 천식및알레르기

Common complications in a patient with IgG subclass deficiency include recurrent respiratory infections and concomitant inflammatory lung disease. The most effective therapy in these patients is the administration of intravenous immunoglobulin. The authors report a case of severe aspirin-sensitive asthma and recurrent pneumonia with combined IgG1, and IgG3 subclass deficiency in a 19-year-old man. The patient was treated with 0.4g/kg at monthly intervals for 6 months, and is still receiving 0.2g/kg every 2 weeks at our clinic. After the replacement of intravenous immunoglobulin, the patient has clinically improved.

Serum IgG and IgG subclass in bronchial asthma / 천식및알레르기

BACKGROUND AND OBJECTIVE: IgG subclass deficiency has been reported in patients with bronchial asthma and is associated with recurrent respiratory tract infections. This study was done to identify prevalence of IgG subclass deficiency and to evaluate the possible difference between atopic and non-atopic asthmatics. Subjects and METHODS: We measured serum levels of IgG and IgG subclass in 35 asthmatic patients and 50 healthy controls using nephelometry. Reference values of each IgG subclass was defined as cumulative percentile between 2.5% to 97.5% of controls. RESULTS: Total IgG, IgG1 and IgG2 of asthmatics were significantly lower than for those of controls(p<0.05, respectively). In atopic asthmatics, compared with non-atopic asthmatics, IgG4 level was significantly higher (p<0.05). The frequency of IgG subclass levels below the reference value was eight (22.9%) of 35 asthmatics. CONCLUSION: IgG, IgG1 and IgG2 were significantly lower in asthmatic patients. Some patients had IgG subclass levels below reference value. Further studies will be needed to evaluate their clinical significance.

A case of acquired angioedema with C1 esterase inhibitor deficiency / 천식및알레르기

Angioedema is a well-demarcated localized edema involving the deeper layers of the skin, including the subcutaneous tissue. Angioedema occurs with Cl esterase inhibitor (Cl INH) deficiency that may be inborn as an autosomal dominant characteristic or may be acquired. Acquired angioedema (AAE) is a rare disorder characterized by adult onset and lack of evidence of inheritance of the disease. Two types of AAE are known today: type I in which there are lowering of functional Cl INH, an underlying disease such as a B-cell disease, and no detectable autoantibodies to Cl INH, type II with anti Cl INH autoantibodies in the circulation without detectable underlying disease and with depressed functional Cl INH levels. We experienced a case of angioedema in a 29-year old man. He had no family history of angioedema and laboratory data showed depressed Cl-INH levels. We diagnosed the case as acquired type of angioedema. Even though we could not measure anti-Cl INH auto-antibodies, we identified the case as type II because there was no evidence of underlying disease.

Application of Grasp Forceps on Selective Cannulation of Pancreatobiliary Duct in a Patient with Peripapillary Diverticulum / 대한소화기내시경학회지

During endoscopic retrograde cholangiopancreatography (ERCP), cannulation is more difficult in patients with anatomical variations, ampullary stenosis, impacted stone in the papilla, papillary cancer, peripapillary diverticulum, postoperative states such as those after Billroth II or Braun operations. In patients with peripapillary diverticulum, the position of the papilla can be modified by the presence of the diverticulum, rendering the cannu-lation more difficult. In this situation, the success rate of ERCP is lower than that in nor-mal situation. We have, therefore, used a new technique with the application of grasp forceps to expose the duodenal papilla properly during ERCP in a patient whose papilla was located on the edge of a large duodenal diverticulum and the papillary orifice was hidden behind the edge of the diverticulum.

A Case of Acute Pancreatitis as a Complication of Systemic Lupus Erythematosus / 대한신장학회잡지

Systemic lupus erythematosus(SLE) is a multisystem disease. Gastrointestinal manifestations are common in SLE, occurring in 35% to 40% of patients at some stage of their illness. Acute pancreatitis is a rare complication of SLE. To date, seventy cases of acute pancreatitis related to SLE have been reported and fourteen cases were unrelated to drugs such as steroids, diuretics or other immunosuppressive agents. Furthermore, only seven out of fourteen cases manifested acute pancreatitis in their initial course of SLE as was seen in our case. Additionally, there have been no such cases reported in Korea. Corticosteroids have been considered as both a cause and as a therapy for acute pancreatitis. We report a case of acute pancreatitis in a 40 year old Korean man presenting with multi-organ manifestations and diagnosed to have SLE. Renal biopsy showed membranous glomerulonephritis(WHO Class V). His serum amylase and lipase returned to normal on high dose prednisolone treatment.

Primitive Neuroectodermal Tumor Arising from the Cerebellum: A Case Report

We report a 16-month-old male with a primitive neuroectodermal tumor of the cerebellar hemisphere. This tumor consisted of undifferentiated cells resembling germinal or matrix cells of the embryonic neural tube and prominent mesenchymal component.

Multiple Cerebral Aneurysms Associated with Extracranial Carotid Aneurysm: Case Report

We report a rare case of multiple cerebral aneurysms associated with an extracranial internal carotid aneurysm. This 59-year-old woman had a history of hypertension and a stroke. Brain CT scan and angiographic findings are presented.