A Gastric Glomus Tumor Treated by Endoscopic Resection / 대한소화기내시경학회지

Glomus tumors are benign lesions that originate from modified smooth muscle cells of the glomus body. These tumors are commonly observed in the dermis or subcutis, but they are only rarely found in the stomach. We describe here a 37-year- old male patient who presented with intermittent epigastric pain and in whom a submucosal tumor was encountered during performance of upper gastrointestinal endoscopy. A gastrofibroscopy demonstrated a 12 mm sized submucosal mass with central ulceration on the greater curvature-posterior wall of the high body. Endoscopic ultrasonography revealed a circumscribed inhomogeneneous hypo- echoic mass with a focal hyperechoic mass in the third layer of the stomach. We resected the entire mass using an endoscopic resection technique, and there were no complications. Histologically, the tumor cells had uniform small nucleuses with inconspicuous nucleoli. Immunochemical analysis of the tumor cells showed positivity for smooth muscle actin and negativity for CD34, KIT, S100 protein and desmin. This is the first case of a glomus tumor of the stomach that was resected by endoscopic resection.

A Case of Synchronous Quintuple Early Gastric Cancer / 대한소화기내시경학회지

The frequency of multiple gastric cancers has recently been on the increase due to the development of improved diagnostic methods, such as endoscopy, chromoscopy, and pathological methods. To prevent relapse by a remnant cancer, it is critical to determine the surgical area after evaluating the entire synchronous multiple gastric cancer area using closed endoscopy and a radiological evaluation prior to surgery. There have been no prior reports of a diagnosis of quintuple gastric cancer before surgery, although; a diagnosis of quadruple gastric cancer has been previously reported. Here we describe a 65-year-old male patient who received a diagnosis of early quintuple gastric cancer by endoscopy before surgery.

A comparative study on the efficacy of different dosage of alpha-interferon treatment in patients with chronic hepatitis B / 대한내과학회지

BACKGROUND: Infection with hepatitis B virus has been a major health problem. Chronic viral hepatitis B is the principal cause of chronic liver disease, cirrhosis, and hepatoma. A number of studies have showed that a course of interferon (INF) treatment induces a long-term remission in 20~40% of patients. Compared with the use of lamivudine, INF therapy is followed by delayed clearance of HBsAg and the treatment improves the natural history of chronic hepatitis B. The aim of this study is to evaluate the efficacy of the use of different dosages of alpha-interferon treatment in patients with chronic hepatitis B. METHODS: We conducted a one-and-a-half year, randomized clinical trial of interferon in 24 Korean chronic hepatitis B patients with a positive HBeAg, and excluded other liver problems with biopsies. The patients were randomly assigned to receive 5 million units (n=10) of interferon-alpha2b and 10 million units (n=14) of interferon-alpha2b three times weekly for 16/24 weeks. Patients were followed for 12 months after the cessation of the therapy, and the patients received a second biopsy. RESULTS: After treatment with interferon, 29.2% of the patients became negative for HBeAg and the presence of HBV DNA. Fifty percent of the patients showed histological improvement. The differences of the loss of HBeAg, HBV DNA and histological improvement between the two groups were not significant. HBV DNA and ALT were not valuable as predictive variables in treatment efficacy. However, the rate of histological improvement in patients with a low ALT level was higher. CONCLUSIONS: The administration of different doses of interferon-alpha2b during treatment in patients with chronic hepatitis B did not show a significant difference in efficacy.

A Case of Tubular Colonic Duplication / 대한소화기내시경학회지

Colonic duplication is a rare congenital anomaly. Generally, two-thirds of cases manifest before the age of 2 years and only a few cases are encountered in adults. The pathogenesis has not yet been confirmed. Morphologically, the condition is divided into two types, cystic and tubular. Treatment is reserved for symptomatic or complicated cases, and surgical resection is the treatment of choice. Prognosis is generally favorable. We report a case of colonic duplicaton in 59-year-old woman.

A Case of Pneumatosis Cystoides Intestinalis: Diagnosed by CT Colonoscopy / 대한소화기학회지

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas filled cysts in the intestinal wall. The diagnosis of PCI is usually made by colonoscopy, histology, or radiologic findings. We report a case of PCI in a 35-year-old man. The patient initially complained of watery diarrhea and abdominal bloating for 2 weeks. Simple abdominal X-ray demonstrated numerous, small, round, air densities on the right upper abdomen along the ascending and proximal transverse colon. Colonoscopy revealed numerous, 5-20 mm sized, sessile polypoid, balloon-like distended, protruding subepithelial masses covered with normal colonic mucosa from cecum to proximal transverse colon. We performed a CT colonoscopy and confirmed PCI with multiple air-filled cystic masses along the colonic wall from cecum to proximal transverse colon. The patient was treated with antibiotics and oxygen inhalation for 2 weeks. Follow-up CT colonoscopy revealed marked regression in the number and size of the air-filled cystic masses. Herein, we report the first case of the PCI in Korea diagnosed by CT colonoscopy. Follow-up evaluation with CT colonoscopy was performed after the treatment of the PCI. CT colonoscopy is a useful non-invasive diagnostic tool for the diagnosis of pneumatosis cystoides intestinalis.

A Case of Enteropathy-Associated T-cell Lymphoma (EATL) Presenting Perforation after Chemotherapy for Primary Intestinal Lymphoma / 대한소화기내시경학회지

Intestinal T-cell lymphomas are fairly uncommon, and can sometimes be associated with enteropathy. Enteropathy-associated T-cell lymphoma (EATL) is commonly accompanied by a nonspecific mucosal ulceration, similar to that observed as a complication of celiac disease. The clinical course of EATL is quite unfavorable, and tends to have a generally poor prognosis. When a tumor invades the bowel wall and is treated with corticosteroids and chemotherapy, cell lysis with perforation often occurs, particularly in case of lymphoma. Recent data indicate that extensive resection may improve local control, and eliminate the risk of early mortality due to visceral perforation or hemorrhaging in unresected lesions during chemotherapy. Here, we report the case of a 51-year-old male who was diagnosed with primary gastrointestinal lymphoma after colonoscopy, and presented with EATL after emergent exploratory laparatomy. We also include a review of the literature regarding this uncommon entity.

A Case of Pituitary Macroadenoma Accompanied with CRH Deficiency / 대한내분비학회지

Pituitary tumor can be accompanied with various pituitary hormone abnormalities. Pituitary tumors can be divided into functioning or nonfunctioning tumors. A functioning pituitary tumor, via the oversecretion of pituitary hormones, causes diverse clinical features. A nonfunctioning pituitary tumor can be accompanied with pituitary dysfunction and this may be due to compression or destruction of normal pituitary tissue, suppression of the pituitary portal system or direct damage to the hypothalamus. Corticotropin-releasing hormone (CRH) deficiency, which is caused by defects in the synthesis or release of CRH, is a cause of secondary adrenocortical insufficiency. The clinical presentations are hypoglycemia, weight loss, anemia, weakness, nausea, vomiting and hyponatremia. Acquired CRH deficiency has also been suggested to occur based on a lack of adrenocorticotropic hormone (ACTH) response to insulin-induced hypoglycemia, but there is a normal ACTH response to exogenous CRH. We experienced a case of a woman with pituitary macroadenoma accompanied with CRH deficiency. We report here on this case with the review of the literature.

A Case of Doudenal Diaphragm in an Adult Treated with Endoscopic Membranotomy using Insulated Tip Electrosurgical Knife / 대한소화기내시경학회지

A duodenal diaphragm is rare congenital anomaly among the duodenal obstructions. Its symptoms and signs usually appear from birth if the obstruction is complete. However, a diagnosis may be delayed until the patient reaches adulthood in cases of an incomplete obstruction. Treatment of an adult duodenal diaphragm is usually surgical. To our knowledge, there are few reports of the endoscopic treatment of an adult duodenal diaphragm but none in Korea. We report a duodenal diaphragm in a 26- year-old female with epigastric pain, who was treated with an endoscopic membranotomy using an insulated tip knife.

A case of multiple gastric carcinoid tumors associated with Sjogren's syndrome / 대한내과학회지

Carcinoid tumors are rare endocrine neoplasms arising from the enterochromaffin or enterochromaffin-like cells. Gastric carcinoids associated with autoimmune atrophic gastritis and hypergastrinemia, are usually multiple and the prognosis are better compared to solotary lesions with out hypergastrinemia. Gastric carcinoids are commonly associated with other endocrine disorders or tumors, but any associations with autoimmune disorders other than autoimmune atrophic gastritis have rarely been reported. Sjogren's syndrome is an autoimmune exocrinopathy that primarily affects the salivary glands, but it can also involve almost any other part of the gut. The most common form of gastrointestinal involvement in Sjogren's syndrome is chronic atrophic gastritis, which can lead to hypergastrinemia and the subsequent development of carcinoid. However, gastric carcinoid tumor associated with Sjogren's syndrome has not yet been reported on. To the best of our knowledge, this is the first such case in the world. We report on this case along with review of the related literature.

An Endobronchial Fibroepithelial Polyp Treated by Bronchoscopic Excision / 결핵및호흡기질환

An 81-year-old man underwent bronchoscopy to investigate the cause of his dyspnea symptoms. A benign natured mass was observed in the bronchus and was excised. The pathology examination revealed a fibroepithelial polyp. He has been asymptomatic since the simple bronchoscopic excision. A fibroepithelial polyp is a benign tumor with a mesodermal origin. It is commonly found in the skin, urogenital area and chest, but is extremely rare in the respiratory system. We report a case of a fibroepithelial polyp in the bronchus, which was treated with a bronchoscopic excision, with a brief review of the relevant literature.

The Effect of Weight Training and Aerobic Exercise on Men's Sex Hormone / 대한비뇨기과학회지

PURPOSE: The detrimental effect of strenuous exercise is well documented. The effect of moderate exercise (weight training and aerobic exercise) in healthy men was evaluated by analyzing the trend of hormones responsible for male reproduction. MATERIALS AND METHODS: The subjects were divided into 3 groups: systemically trained by a combination of bench press, sit-up and leg squat by 70% of 1RM for 10 weeks in the weight training group (n=5), systemically trained by a combination of treadmill running or walking by 70% of HRmax for 10 weeks in the aerobic exercise group (n=5), and non-training control group (n=5). RESULTS: In the weight training group, there were significant reductions of serum testosterone, FSH and LH during exercise (p>0.01). There was no difference in hormone values between weight training and aerobic groups for any of the hormones measured. CONCLUSIONS: Weight training and aerobic exercise lowered the serum FSH and LH levels, suggesting that moderate exercise may positively affect the reproductive hormonal status of males.

A Case of Superior Vena Cava Syndrome Due to Catheterization of the Internal Jugular Vein for Hemodialysis / 대한신장학회잡지

Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. However, the exponential increase in use of indwelling central venous catheters and cardiac pacemakers over the last two decades has resulted in more patients with SVC syndrome. Internal jugular vein cannulation has become the preferred approach for temporary hemodialysis catheter placement following the reports of an increased incidence of subclavian vein stenosis due to subclavian vein catheterization. We describe a patient who developed SVC syndrome after internal jugular vein catheterization. The patient had been swollen the left arm intermittently due to left central vein stenosis for 1 year and experienced balloon angioplasty and stent insertion for three times. We diagnosed the SVC syndrome through the both subclavian venography, which revealed complete obstruction of the left brachiocephalic vein with extensive collateral circulation and mild stenosis of the distal right internal jugular vein. Resolution of the clinical SVC sydrome occurred after catheter removal.

A Case of Superior Vena Cava Syndrome Due to Catheterization of the Internal Jugular Vein for Hemodialysis / 대한신장학회잡지

Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. However, the exponential increase in use of indwelling central venous catheters and cardiac pacemakers over the last two decades has resulted in more patients with SVC syndrome. Internal jugular vein cannulation has become the preferred approach for temporary hemodialysis catheter placement following the reports of an increased incidence of subclavian vein stenosis due to subclavian vein catheterization. We describe a patient who developed SVC syndrome after internal jugular vein catheterization. The patient had been swollen the left arm intermittently due to left central vein stenosis for 1 year and experienced balloon angioplasty and stent insertion for three times. We diagnosed the SVC syndrome through the both subclavian venography, which revealed complete obstruction of the left brachiocephalic vein with extensive collateral circulation and mild stenosis of the distal right internal jugular vein. Resolution of the clinical SVC sydrome occurred after catheter removal.