Helicobacter heilmannii-associated Gastritis: Clinicopathologic Findings and Comparison with Helicobacter pylori-associated Gastritis

The aims of this study were to evaluate the clinicopathologic features of Helicobacter heilmannii-associated gastritis and to compare H. heilmannii-associated gastritis with H. pylori-associated gastritis. We reviewed 5,985 consecutive gastric biopsy specimens. All cases of chronic gastritis with Helicobacter infection were evaluated with the Updated Sydney System, and the grades of all gastritis variables were compared between H. heilmannii-associated gastritis and H. pylori-associated gastritis groups. There were 10 cases of H. heilmannii-associated gastritis (0.17%) and 3,285 cases of H. pylori-associated gastritis (54.9%). The organisms were superficially located within the mucous layer without adhesion to epithelial cells. Interestingly, in one case many intracytoplasmic H. heilmannii organisms were observed in parietal cells with cell damage. A case of low-grade mucosa-associated lymphoid tissue (MALT) lymphoma concomitant with H. heilmannii infection was detected. Compared to H. pylori-associated gastritis, H. heilmannii-associated gastritis showed less severe neutrophilic activity (p<0.0001), mononuclear cell infiltration (p=0.0029), and endoscopic findings of chronic gastritis devoid of erosion or ulcer (p=0.0309). In conclusion, we present the detailed clinicopathologic findings of H. heilmanniiassociated gastritis compared to H. pylori-associated gastritis. H. heilmannii-associated gastritis is uncommon and milder than H. pylori-associated gastritis, however it may be noteworthy with respect to the development of MALT lymphoma.

The Outcome of Endoscopic Biliary Drainage with Plastic Stents for Irretrievable Common Bile Duct Stones / 대한소화기내시경학회지

Background/Aims: Endoscopic biliary drainage (EBD) using a plastic stent has been proposed for the management of choledocholithiasis when there is difficulty with stone extraction. We investigated the long-term effects and complications of EBD with using a plastic stent in the elderly or high risk patients with common bile duct (CBD) stones. METHODS: From January 2000 to June 2004, thirty-one patients with CBD stones underwent EBD with using plastic stents (17 women and 14 men, mean age: 75.2 years). RESULTS: Biliary drainage was successful in all patients. As for the early complications, only minor hemorrhage with no requirement of transfusion occurred in 2 patients. Twelve patients (38.7%) had late complications of EBD. Six of them had cholangitis, five had biliary colics and one had nausea. Of the six patients with cholangitis, three were managed with stent exchange and one was managed by removal of the stent. The remaining two patients died from stent-related sepsis. The mean symptom-free duration was 39.9 months. CONCLUSIONS: For the elderly or high risk patients who undergo an operation, EBD proved to be a safe and effective alternative for the treatment of patients with irretrievable bile duct stones.

A Case of Clonorchiasis Presenting as Common Hepatic Duct Mass / 대한소화기내시경학회지

The liver fluke, Clonorchis sinensis is an important human parasite and is endemic in Eastern Asia including Korea, China, and Japan. Patients acquire the infestation by eating raw or undercooked freshwater fish. Radiologic examinations usually reveal dilated peripheral intrahepatic bile ducts and normal extrahepatic bile duct. The diagnosis of clonorchiasis may sometimes be difficult and a presentation as an obstructive mass at the common hepatic duct is a rare event. Here we report a case of clonorchiasis of 54-year-old woman presented with epigastric pain. Endoscopic retrograde cholangiography revealed a mass at the common hepatic duct with dilatation of the intrahepatic ducts mimicking cholangiocarcinoma. Using an endoscopic basket, muddy, sludge-like materials were extracted through the papillary orifice. We report this case with a review of literatures.

Natural History of Acute Symptomatic Hepatitis C in Korea / 대한소화기학회지

BACKGROUND/AIMS: Acute hepatitis C (AHC) has a high chronicity rate of up to 85%. Recently, several studies have demonstrated AHC has a self-limited course in about 50% especially in symptomatic cases. However, there is no investigation about the natural course of AHC in Korea. We intended to define the natural course of AHC and the influential factors on it. METHODS: We enrolled the patients with AHC from 2001 to 2004. The diagnosis of AHC was based on seroconversion to anti-HCV antibodies or the clinical and biochemical diagnostic criteria satisfactory to AHC and on the presence of HCV RNA in first serum sample. The self-limited course of AHC was defined as permanent (>6 months) loss of HCV RNA in serum and normalization of ALT. RESULTS: Eighteen patients presented with AHC. Seventeen out of eighteen was symptomatic. Twelve out of eighteen (66.7%, 95% CI 41.7-84.9%) showed spontaneous remissions. Presence of anti-HCV on first serum samples predicted chronic courses. Antibody to HCV was not detected during follow-up periods in nine patients, who all showed spontaneous viral clearance. CONCLUSIONS: AHC has a high rate of spontaneous viral resolution. Further study is needed to define the influential factors on the viral clearance in AHC.

A case of simple type Caroli's disease confined to one segment of the liver / 대한내과학회지

Caroli's disease is a rare congenital anomaly of the intrahepatic biliary tree characterized by multiple, saccular and cystic dilatation of the bile ducts that are connected with the biliary drainage system. It is frequently associated with congenital hepatic fibrosis, resulting in portal hypertension. The complications are stone formation, recurrent cholangitis and occasionally cancer. Less than 20% of all cases reported describe monolobar or segmental invovement. In the pure form or simple type, the patient presents without hepatic fibrosis or portal hypertension. We report a case of simple type Caroli's disease confined to the one hepatic segment in a 22 year-old woman. She was admitted because of cystic mass, associated with right upper abdominal pain. Radiologic findings including abdominal ultrasonography, computerized tomography, magnetic resonance imaging demonstrated that the cystic lesions involving segment VIII of the liver. The lesion was treated with hepatic segmentectomy.

Endoscopic Removal of a Spoon from the Stomach Using Guidewire / 대한소화기내시경학회지

Foreign body ingestion is a relatively uncommon, but potentially serious condition. Most of gastrointestinal foreign bodies pass spontaneously. But, large objectives are usually lodged in the stomach and cause perforation, bleeding, and obstruction. Therefore, prompt retrieval of lodged foreign bodies are necessary before complications develop. Particularly, in the case of long metallic spoon, there have been no cases of spontaneous passage reported. Therefore, prompt retrieval of a metallic spoon are necessary. A 28-year-old woman with schizophrenia who ingested a long spoon for suicidal attempt was referred to our hospital. Simple abdomen showed a 18 cm sized long, metallic spoon with saw-toothed end placed in the stomach. We removed a spoon by an endoscopic technique and an extraction maneuver using a guidewire and a Magill forceps.

Secondary Esophageal Cancer Originated from Rectal Cancer / 대한소화기내시경학회지

Secondary esophageal carcinoma usually originates from a primary site in either the lung or breast. Only one case of metastatic esophageal cancer with a radiologic evidence that it was originated from the rectal cancer had been reported. We report an unusual case of a 80-year-old man with secondary esophageal carcinoma originated from the rectal cancer. It was diagnosed by histopathologic confirmation using immunohistochemical staining including CK20 and CK7 by comparing the histopathologic findings of surgical specimen of rectal cancer and endoscopic biopsy tissue from the esophagus. To the best of our knowledge, this is the first case of secondary esophageal cancer arising from rectum in Korea.

A Case of Hemosuccus Pancreaticus Showing Active Bleeding from the Ampulla of Vater / 대한소화기내시경학회지

Hemorrhage through the pancreatic duct into the duodenum, so called 'hemosuccus pancreaticus', is a rare cause of gastrointestinal bleeding with diagnostic difficulties. We report a 44-year-old man with recurrent upper gastrointestinal bleeding due to rupture of pseudoaneurysm into the pancreatic duct. Initial upper gastrointestinal endoscopy failed to identity the site of the hemorrhage. Active bleeding from the ampulla of Vater in duodenum was found on repeat endoscopy. Abdominal computed tomography disclosed pseudoaneurysm arising from the splenic artery caused by chronic pancreatitis. Splenic angiogram showed large psudoaneurysmal sac with wide neck, arising from distal splenic artery. Angiographic embolization was successful in controlling the arterial hemorrhage. The patient remained symptom-free 5 months after the embolization. Hemosuccus pancreaticus, although rare, remains important in the differential diagnosis of upper gastrointestinal bleeding of obscure orgin.

A case of spontaneous rupture of hepatic angiomyolipoma / 대한내과학회지

Hepatic angiomyolipoma (AML) is a very rare neoplasm compared to that of the kidney. Few of these occurred in symptomatic patients and showed intratumoral hemorrhagic foci. The spontaneous rupture of AML is a rare complication that occurs most commonly in the kidney. Only two cases of spontaneous rupture of hepatic AML treated surgically have been published. We now report a case of a 39-year-old woman with chronic hepatitis B and spontaneous rupture of hepatic AML mimicking hepatocellular carcinoma, which was successfully treated by transcather arterial chemoembolization. To our knowledge, this is the first reported case of ruptured hepatic AML treated successfully by transarterial embolization.

Primary Malignant Fibrous Histiocytoma (MFH) of the Small Bowel Presenting as an Intussusception Causing Small Bowel Obstruction / 대한소화기학회지

Adult intussusception secondary to primary sarcoma is a rare cause of small bowel obstruction. Only a few cases of malignant fibrous histiocytoma (MFH) of small bowel presenting as an intussusception have been reported in the literatures. We report a case of small bowel obstruction associated with jejuno-ileal intussusception caused by MFH. A 75-year-old man was admitted with an one-month history of vomiting and epigastric pain aggravated with meals. He was diagnosed as an jejuno-ileal intussusception based on CT scanning and underwent small bowel resection and anastomosis. Resected specimens revealed a polypoid tumor in the ileum and the histology of the tumor was consistent with MFH.

A Case of Primary Leiomyosarcoma of the Inferior Vena Cava Treated by Surgical Resection and Reconstruction with Synthetic Graft Replacement / 대한소화기학회지

Leimyosarcoma of the inferior vena cava (IVC) is a rare tumor, with about 200 cases reported in the world literature. There were 5 cases reported in Korea. We report a case of primary leiomyosarcoma of the inferior vena cava in a 50 year-old woman who presented with a heterogenous enhancing mass within IVC on CT scan and MRI scan. The tumor expanded the IVC with displacement of the adjacent structures. The patient underwent ultrasound guided percutaneous biopsy which was consistent with leiomyosarcoma. The patient was treated by surgical resection and synthetic graft replacement of the inferior vena cava and postoperative external beam radiation therapy. We report the case of leiomyosarcoma of the inferior vena cava with a review of relevant literatures.

The prevalence and risk factors of diabetes mellitus in people of Hope Village / 대한내과학회지

BACKGROUND: Recently, the prevalence of diabetes mellitus in Korea is rapidly increasing. It is known that this increase is related with the change of environmental factors. We performed study to determine the prevalence of diabetes and to investigate their risk factors in Hope Village taking in low socio-economic people. METHODS: Total 1,425 subjects (905 men and 520 women) aged over 20 years in Daegu city Hope Village were venipunctured after overnight fasting to measure plasma glucose level and interviewed about their past medical and social history. We also collected standard anthropometric data. All the data were analyzed by SPSS 9.0 program. RESULTS: The prevalence of diabetes by using the revised new American Diabetes Association criteria was 13.5% (male=10.1%, female=19.4%) and the prevalence of impaired fasting glucose was 11.3% (male=8.7%, female=15.8%). It was observed that the significant factors associated with diabetes were age, sex, serum triglyceride level, systolic blood pressure. CONCLUSION: The prevalence of diabetes in Hope Village was relative higher than that of the previous suggested population based studies in Yonchon County and Jungup District. But the risk factors of newly diagnosed diabetes were similar with those of the previous studies.

Adrenal Myelolipoma Confirmed by Fine Aspiration Biopsy / 대한내분비학회지

Adrenal myelolipomas are rare, benign tumors cornposed of mature fat and bone marrow elements. Most are small, asymptomatic tumors found incidentally at postmortem examination, Fine needle aspiration biopsy can be used to confirm the diagnosis and avoid an unnecessary operation. We report a case of adrenal myelolipoma confirmed by fine needle aspiration biopsy. A 77-year-old woman with complaining of upper abdominal pain for 2 days was found to have an adrenal mass. She took dexamethasone frequently for 3 years due to multiple arthralgia. Ultrasono-graphy showed a 6cm-sized, suprarenal mass and a stone in the gall bladder with thickened wall. Computed tomography and magnetic resonance imaging scan also presented a suprarenal mass. Endocrinologic results were within normal limits. Adrenal myelolipoma was confirmed by computed tomography-guided fine needle aspiration biopsy without surgery.

A Clinical Study on Patients with Chronic Lymphocytic Leukemia / 대한암학회지

PURPOSE: Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in western countries but it has been reported rarely in Korea. The purpose of this study was to evaluate the clinical characteristics, treatment responses and prognosis of the patients with CLL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 17 patients with CLL diagnosed at the Catholic University of Taegu-Hyosung & Kyungpook National University Hospital from Jan. 1986 to Mar. 1996. RESULTS: There were 9 males and 8 females and the mean age was 55 years. The majority of patients had systemic symptoms (77%) and advanced clinical stage (Binet stage C, 70%) at the time of diagnosis. The bone marrow histology was reviewed in 13 cases and patients were subdivided into those with a diffuse (9cases) and nondiffuse (4cases) pattern of bone marrow histology. In patients with advanced clinical stage, diffuse pattern was predominated and showed poor survival. 14 patients were treated with chlorambucil/steroid or combination chemotherapy. Among the 13 evaluable patients, 1 (8%) achieved a complete response and 7 (54%) achieved partial responses, and median survival duration was 18months. 11 patients died after 2~18 months of follow-up and infection was the main cause of death. CONCLUSION: Poor prognostic factors, such as high blood lymphocyte counts, diffuse bone marrow involvement pattern & advanced clinical stage, are common in our patients at presentation & showed poor survival.

Roentgenogram of the Issue: A Case of Primary Malignant Fibrous Histiocytoma of Lung in a Coal Miner / 결핵

A 62-year-old male was admitted for evaluation of a mass shadow on chest film. Chest PA showed 7×5cm lobulated homogenous mass in right upper medial area of lung. On chest computed tomography, there was a Barge irregularly lobulated mass with central necrotic low density area in apical segment of right upper lobe. Right upper lobectomy of the lung was performed. Partial adhesion to parietal pleura of posterior mediastinum and severe adhesion to right upper apicoposterior segment was found during the operation Microscopic and ultrastructural studies(including immunocytochemical stains) of the mass revealed malignant fibrous histiocytoma.