A Case of Porphyria with Acute Pancreatitis / 대한내분비학회지

The porphyrias are a group of disorders caused by deficiency in the enzymes of the heme biosynthetic pathway. Patients with porphyria may develop neurovisceral attacks which include severe abdominal pain, neuropsychiatric manifestations and potentially fatal respiratory paralysis. However, these patients may also have abdominal pain not due to porphyria itself, and in such case, careful evaluation is important. We report a case of acute pancreatitis with masquerading acute attack of porphyria, which made us difficult to make a correct diagnosis. A 29-year-old female, previously diagnosed to have hepatic porphyria, presented with acute abdominal pain, back pain and leg pain for 3 days. Serum amylase was normal and 24-hour urine -ALA and PBG showed increased levels. After intravenous infusion of glucose, symptoms were improved. From the 10th day of admission, she complained severe abdominal pain, and was found to have severe metabolic acidosis, shock, and signs of peritonitis on the 12th day of admission. Emergency exploration revealed edematous pancreas. Amylase and lipase levels in serum and ascites were found to be markedly elevated. After conservative management, her general condition gradually improved and serum amylase and lipase levels were normalized.

Clinicopathological Features of Gastric Carcinoma in the Korean Elderly

BACKGROUND: Gastric carcinoma is the leading cause of cancer death in Korea. Although the incidence of gastric carcinoma has the tendency to increase in recent years with the increase in the elderly in Korea, clinicopathological characteristics of gastric carcinoma in the elderly has not been studied in detail yet. This study was undertaken to investigate the clinicopathological features of gastric carcinoma in the Korean elderly. METHODS: The clinicopathological data, such as age, gender, cancer location, macroscopic appearance, histopathology, depth of invasion, lymph node metastasis, distant metastasis, stage, and type of operation, were retropectively reviewed from the hospital records of 682 patients with gastric adenocarcinoma admitted to the Asan Medical Center from Jan. 1996 to Dec. 1996. In 581 patients treated with gastrectomy, the postoperative findings were used in analysis, while in 101 patients receiving no operation due to mestastasis, clinical and laboratory findings were used. All patients were divided into three groups: the young; 39 years of age or younger, the middle-aged; between 40 and 64 years old, and the elderly; 65 years old or over. RESULTS: A total of 183(26.8%) of 682 patients were in the elderly, while 91(13.3%) and 408(59.8%) were in the young and middle-aged, respectively. The gender ratio for male to female was 2.3: 1 in the elderly, which was not different from that the young or middle-aged. In the elderly patients, as compared with the young or middle-aged, the antral involvement, well and moderately differentiated adenocarcinoma, Borrmann type I and II, and stage IV were more frequent, and the rate of early gastric cancer was less common. There was no significant difference in the depth of invasion, lymph node metastasis, distant metastasis and type of operation between three groups. CONCLUSION: Some of the clinicopathological features of gastric adenocarcinoma in the elderly are different from those of the young or middle-aged, and in consequence these differences should be considered in the management and study of the elderly patients with gastric carcinoma.