Autoimmune Pancreatitis, Not Otherwise Specified, Accompanied by Pericardial Effusion / 대한내과학회지

Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis characterized by an autoimmune inflammatory process. This is the first case report of AIP, not otherwise specified, accompanied by pericardial effusion. A 52-year-old female visited our hospital due to dyspnea. Echocardiography showed a large amount of pericardial thickening. Abdominal computed tomography revealed diffuse enlargement of the pancreas body and tail with a sausage-shaped appearance, surrounded by a thick hypodense rim. Endoscopic retrograde cholangiopancreatography could not identify the tail portion of the pancreas, despite forceful contrast injection. Serology was positive for antinuclear antibody and IgG4 was normal. Endoscopic ultrasound-guided core biopsy of the pancreas was performed. Histologic examination revealed a fibrous connective tissue with inflammatory infiltration. The patient was treated with steroids. In the follow-up images, abnormal findings of pericardial effusion were improved, although an irregular long stricture of the pancreas tail portion remained.

Duodenal Mucosa-Associated Lymphoid Tissue Lymphomas: Two Cases and the Evaluation of Endoscopic Ultrasonography

Mucosa-associated lymphoid tissue lymphoma mainly arises in the stomach, with fewer than 30% arising in the small intestine. We describe here two cases of primary duodenal mucosa-associated lymphoid tissue lymphoma which were evaluated by endoscopic ultrasonography. A 52-year-old man underwent endoscopy due to abdominal pain, which demonstrated a depressed lesion on duodenal bulb. Endoscopic ultrasonographic finding was hypoechoic lesion invading the submucosa. The other case was a previously healthy 51-year-old man. Endoscopy showed a whitish granular lesion on duodenum third portion. Endoscopic ultrasonography image was similar to the first case, whereas abdominal computed tomography revealed enlargement of multiple lymph nodes. The first case was treated with eradication of Helicobacter pylori, after which the mucosal change and endoscopic ultrasound finding were normalized in 7 months. The second case was treated with cyclophosphamide, vincristine, prednisolone, and rituximab every 3 weeks. After 6 courses of chemotherapy, the patient achieved complete remission.

A Case of Sarcomatoid Carcinoma Arising from Mucinous Cystadenocarcinoma of Appendix

Sarcomatoid carcinoma or carcinosarcoma is a very rare biphasic tumor characterized by a combination of malignant epithelial and mesenchymal cells. The pathogenesis of sarcomatoid carcinoma is not fully elucidated and the guideline of treatment has not been established yet. Although the upper aerodigestive tract, lung and female urogenital system are known to be the most frequently affected, this tumor also can occur in various sites, including the digestive tract. Since sarcomatoid carcinoma in colon was firstly reported in 1986, 24 cases have been reported to date. We report a rare case with sarcomatoid carcinoma of appendix. Interesting histologic feature of our case was the presence of mucinous cystadenocarcinoma with morphological "transition" between carcinomatous and sarcomatous tissue. To our knowledge, this is the first case of sarcomatoid carcinoma arising from mucinous cystadenocarcinoma of the appendix.

A Case of Endoscopic Treatment for Gastrocolocutaneous Fistula as a Complication of Percutaneous Endoscopic Gastrostomy

As a rare complication of percutaneous endoscopic gastroscopy (PEG), a gastrocolocutaneous fistula may occur after PEG placement. This paper reports an interesting case which PEG tube unintentionally penetrated transverse colon during PEG. A 72-year-old female patient who suffered from medullary infarction underwent PEG procedure for enteral nutrition, and fecal materials were observed 6 days after the procedure. Transverse colon located in antero-superior site of stomach was observed through abdominal computed tomography, and also the wrong inserted tube was found through gastroscopy and colonoscopy. Endoscopic treatment for the fistula was performed by the use of hemo-clip and detachable snare, closure of the fistula was finally confirmed 6 days after the endoscopic procedure. Therefore, the gastrocolocutaneous fistula should be considered as one of the complications of PEG when fecal material is observed through PEG tube in a few days after PEG procedure and endoscopic treatment can be feasible in this case.

The Safety of Endoscopic Sphincterotomy in Patients Taking Aspirin / 대한내과학회지

BACKGROUND/AIMS: Endoscopic sphincterotomy (EST) is a common therapeutic technique for biliary and pancreatic disease, but it can cause several complications. Although the literature suggests that there is no need for patients to stop taking aspirin before undergoing EST, there are no definite guidelines on this in Korea. Consequently, we compared the frequency of bleeding and safety between aspirin users and nonusers undergoing EST. METHODS: This retrospective study recruited 1003 patients who underwent EST at our hospital between 1 February 2005 and 30 September 2008. Thirteen patients continued to take aspirin until the day of the sphincterotomy (group 1), and 990 patients had not taken aspirin before the sphincterotomy (group 2). The incidence of post-sphincterotomy bleeding was compared between the two groups retrospectively. RESULTS: There was no significant difference in age or gender between the two groups. The indications for EST included common bile duct stones in 12 patients (92.3%, 12/13) in group 1 and 706 patients (71.3%, 706/990) in group 2 (p = 0.124). Regarding combined disease, cholangitis was observed in 11 patients (84.6%, 11/13) in group 1 and 815 patients (82.3%, 815/990) in group 2 (p = 0.974). Clinically significant post-sphincterotomy bleeding was observed in three patients in group 2 (0.3%, 3/990) versus none in group 1. CONCLUSIONS: Taking aspirin does not appear to clinically increase bleeding after EST. Therefore, there is no definite need to stop aspirin before undergoing EST.

Changes in Heart Rate Variability after Weight Reduction in the Obese

BACKGROUND: Obesity increases morbidities and mortalities due to cardiovascular diseases. In previous studies, decrease in heart rate variability was associated with cardiovascular death and reduced heart rate variability in the obese had been reported. The authors investigated immediate changes in the heart rate variability after weight reduction in obese individuals. METHODS: The subjects for this study were 39 Korean adults (35 female, 4 male), who visited obesity clinic in a university hospital from January 2002 to July 2003. At first visit, weight, height, body mass index (BMI) and waist circumference of the subjects were measured. We also measured parameters of heart rate variability: Mean Heart Rate (MHR), Standard Deviation of N-N interval (SDNN), The Square Root of the Mean Squared Difference of successive NN intervals (RMSSD), Total Power (TP), Low Frequency (LF), High Frequency (HF), and LF/HF ratio. Weight reduction protocol included nutritional counseling, exercise, behavioral modification and anti-obesity medications, if needed. RESULTS: At 12 weeks of intervention, weight, BMI, waist circumference, fat mass, and lean body mass significantly decreased (3.90+/-3.11 kg, -1.50+/-1.21 kg/m2, -4.45+/-5.61 cm, -3.03+/-2.45 kg, -1.32+/-1.16 kg, P <0.01, respectively). MHR (-6.17+/-9.65 bpm, P <0.01) and LF/ HF (-0.61+/-1.56, P <0.05) showed significant reduction. Changes of weight and LF were positively correlated (r=0.338, P <0.01). Changes of waist circumference was correlated with changes of SDNN (r= 0.331, P <0.05). Changes of BMI showed positive correlation with changes in TP (r=0.327, P <0.05) and LF (r=0.345, P <0.05). CONCLUSION: Short term intervention for obese people decreased sympathetic nervous activity.