Retraction: Eosinophilic Enteritis with Eosinophilic Ascites without Eosinophilia / 이화의대지

This article has been retracted at the authors' request.

Clostridium difficile Colitis after Topical Ophthalmic Use of Levofloxacin / 이화의대지

Clostridium difficile colitis (CDC) has been associated with virtually all available antibiotics. It is well known that administration of drugs by the ocular route can result in systemic absorption with the possibility of systemic effect. We report a case of a 74-year-old woman who was treated with 0.5% levofloxacin eyedrops for ten weeks running for the post operative management of two separate bilateral cataract surgeries. Toxin assay for C. difficile was positive and the endoscopic findings were compatible with CDC. The plasma concentrations reached after intraocular administration of levofloxacin seem so trivial, but the administration of topical agents could make accumulated effect and be a potential cause of systemic toxicity.

Clostridium difficile Colitis after Topical Ophthalmic Use of Levofloxacin / 이화의대지

Clostridium difficile colitis (CDC) has been associated with virtually all available antibiotics. It is well known that administration of drugs by the ocular route can result in systemic absorption with the possibility of systemic effect. We report a case of a 74-year-old woman who was treated with 0.5% levofloxacin eyedrops for ten weeks running for the post operative management of two separate bilateral cataract surgeries. Toxin assay for C. difficile was positive and the endoscopic findings were compatible with CDC. The plasma concentrations reached after intraocular administration of levofloxacin seem so trivial, but the administration of topical agents could make accumulated effect and be a potential cause of systemic toxicity.

Eosinophilic Enteritis with Eosinophilic Ascites without Eosinophilia / 이화의대지

Eosinophilic enteritis is an uncommon disease of unknown cause characterized by eosinophilic infiltration in various areas of the gastrointestinal tract with symptoms. It is generally classified according to the layer of the gastrointestinal tract involved. Eosinophilic infiltration of the serosa is the rarest form of presentation and may manifest eosinophilic ascites. We report a case of a 47-year-old man who experienced progressing abdominal pain. A diffuse erythematous change of the gastric mucosa was observed on gastrofibroscopy. An abdominal computed tomography and colonoscopy showed diffuse wall thickening of the small bowel and colon with a small amount of ascites. Eosinophilic infiltration was confirmed by multiple biopsies of the gastrointestinal tract and peritoneal fluid analysis. The patient was treated with corticosteroid and responded dramatically.

Eosinophilic Enteritis with Eosinophilic Ascites without Eosinophilia / 이화의대지

Eosinophilic enteritis is an uncommon disease of unknown cause characterized by eosinophilic infiltration in various areas of the gastrointestinal tract with symptoms. It is generally classified according to the layer of the gastrointestinal tract involved. Eosinophilic infiltration of the serosa is the rarest form of presentation and may manifest eosinophilic ascites. We report a case of a 47-year-old man who experienced progressing abdominal pain. A diffuse erythematous change of the gastric mucosa was observed on gastrofibroscopy. An abdominal computed tomography and colonoscopy showed diffuse wall thickening of the small bowel and colon with a small amount of ascites. Eosinophilic infiltration was confirmed by multiple biopsies of the gastrointestinal tract and peritoneal fluid analysis. The patient was treated with corticosteroid and responded dramatically.

Acute Pancreatitis Caused by Dyslipidemia / 이화의대지

Hyperlipidemia can be a cause of acute pancreatitis. For example, dyslipidemia classified Fredrickson/WHO classification type I, V can induce acute pancreatitis spontaneously. Secondary hyperlipidemia (DM, alcohol, estrogen, etc.) also can induce acute pancreatitis. High serum amylase level and triglyceride level are hall markers of diagnosis. But lactescent serum interferes with accurate laboratory analysis of amylase. Serum amylase was normal or low in 50% of cases. Clinical course and treatment are similar with other causes of acute pancreatitis. Lipoprotein electrophoresis helps classify dyslipidemia by Fredrickson/WHO classification. In some cases, to prevent hyperlipidemic pancreatitis, serum triglyceride should be lower than 500 mg/dl. We report two cases of acute pancreatitis caused by dyslipidemia.

Huge Gastric Schwannoma Characterized by a Gastric Ulcer During Endoscopy / 대한소화기내시경학회지

Gastric schwannomas are very rare mesenchymal tumors that can occur throughout the gastrointestinal tract, but are most commonly found in the stomach. The majority of patients have no symptoms, while others may complain of epigastric pain or upper gastrointestinal ulcer bleeding. Endoscopic examination of a gastric schwannoma commonly reveals a protrusive mass, but, as in this case, many types of ulceration can be observed with central necrosis. We report on a 62-year-old woman with endoscopic findings of 1 cm sized necrotizing ulceration and an 11 cm sized submucosal mass on radiological examinations. The patient underwent a wedge-shaped resection of the stomach and segmental resection of the transverse colon. Both histological and immunohistochemical staining revealed a gastric schwannoma.

A case of capsule endoscopic finding on Churg-Strauss syndrome with gastrointestinal involvement / 대한내과학회지

Churg-Strauss syndrome is a disorder of hypereosinophilia and systemic vasculitis in subjects with asthma and allergic rhinitis. Clinically, this syndrome can be involved with various manifestations of disease of lung, heart, skin, musculoskeletal system, nerve system, gastrointestinal and hepatobiliary tract. Gastrointestinal manifestations often occur in patients. However, endoscopic finding is rare because of risk on intestinal perforation and hemorrhage in vasculitis-phase. We experienced a case of Churg-Strauss syndrome in a 27-year-old male patient with severe abdominal pain and diarrhea. He also showed leukocytosis with peripheral eosinophilia, bronchial asthma, and chronic paranasal sinusitis. Based on findings, we suggested Churg-Strauss syndrome with gastrointestinal involvement and he received a capsules endoscopy and gastroduodenal endoscopy. Capsules endoscopy showed diffuse erythema and mucosal edema on proximal jejunum to ileum, which meant the Churg-Strauss syndrome with gastrointestinal involvement. We report this case with a review of the relevant literatures.

Acute pulmonary manifestation in ulcerative colitis / 대한내과학회지

The ulcerative colitis is a chronic inflammatory bowel disease of unknown etiology. The major symptoms of ulcerative colitis are diarrhea, hematochezia, tenesmus, and abdominal pain. However, occasionally the arthritis, skin disorders, hepatobiliary inflammation, and uveitis are recognized systemic complications or extracolonic manifestations of ulcerative colitis. Though there have been rare reports of coexistent pulmonary and inflammatory bowel disease, the lung is not generally considered a target organ in ulcerative colitis. Since the first observation of pulmonary involvement in ulcerative colitis by Kraft in 1976, a few cases have been reported. We describe of a patient with ulcerative colitis and extracolonic manifestations in whom pulmonary involvement developed that was responsive to corticosteroid therapy.

A Case of Pseudolipomatosis in the Gastric Mucosa / 대한소화기내시경학회지

Mucosal pseudolipomatosis is a recently described endoscopic finding consisting of benign transient lesions. This condition, resembling fatty infiltration, is characterized by the presence of small gas voids in the gastrointestinal wall, particularly in the mucosa. The frequency of colonic pseudolipomatosis is higher than the frequency of pseudolipomatosis of the stomach. Both mechanical and chemical theories have been offered to explain the pathogenesis of colonic pseudolipomatosis. The mechanical theory pertains to an air pressure-related complication of the colonoscopy procedure. The chemical theory concerns a drug-related complication of the detergent used during colonoscopies. However, the pathogenesis of gastric pseudolipomatosis is still unclear. Recently, we had a patient who experienced gastric pseudolipomatosis after endoscopoy and biopsy procedures. In the following report we discuss this interesting case of gastric pseudolipomatosis.

Two Cases of Spongy Myocardium Detected in Adult

Isolated noncompaction of the left ventricular myocardium is a rare cardiac disorder due to an arrest in myocardial morphogenesis. It is characterized by prominent and excessive trabeculation in a ventricular wall segment, with deep intertrabecular spaces perfused from the ventricular cavity. Echocardiographic findings are important clues for the diagnosis. Clinical symptoms include signs of left ventricular systolic dysfunction even to the point of heart failure, ventricular arrhythmias, and embolic events. We describe two cases of isolated noncompaction of the myocardium, with ventricular tachycardia in one, and chest pain due to microvascular dysfunction in the other.

A Case of Emphysematous Pyelonephritis in a Diabetic Patients: Radiographic Demonstration of Gas Shadow in Renal Pelvis Experiance of Successful Management by Medical Treatment / 대한신장학회잡지

Emphysematous pyelonephritis is an uncommon and, but life-threatening necrotizing inflammation of renal parenchyme and perinephric tissue by gas-forming organisms. This disease is encountered mainly in patients with uncontrolled diabetes mellitus and/or urinary tract obstruction etc. Clinically, it appears as an acute severe clinical pyelonephritis that needs emergency care with poor prognosis. Though the pathogenesis of this disease is still pooly understood, radiographic demonstration of gas shadow in renal parenchyme and peri- nephritic tissue establishes the diagnosis of emphysematous pyelonephritis. The identification of this finding has been believed to consider incision and drainage or nephrectomy in addition to medical treatment, because of high mortality rate of this disease in spite of vigorous medical management. We herein present 1 diabetic patient with emphysematous pyelonephritis who responded to medical treatment alone. The patient was treated with antibiotics alone, the clinical signs and laboratory findings were improved, CT scan 1 month after medical treatment revealed absence of gas in the renal pelvis.

A Case of Glomus Tumor of the Stomach: Role of Endoscopic Ultrasonography / 대한소화기내시경학회지

A glomus tumor of the stomach is a rare submucosal lesion that was first described by De Busscher in 1948. Submucosal tumors of the stomach are mostly leiomyoma, leiomyosarcoma, and malignant lymphoma. It is difficult to diagnose this kind of tumor preoperatively. We present a patient with a gastric glomus tumor which showed the characteristic endoscopic ultrasonographic (EUS) finding. Our case was also diagnosed by pathology after surgery. The major EUS findings in the present case are circumscribed low echoic mass in the forth submucosal layer and an internal heterogenous echo mixed with high echoic spots. The EUS seems to be useful in distinguishing between glomus tumor and other submucosal tumors.

A Case of Massive Hematochezia from a Meckel's Diverticulum without Ectopic Mucosa / 대한소화기내시경학회지

Meckel's diverticulum, which is a persistence of a remnant of the omphalomesenteric duct, is the most common developmental anomaly of the gastrointestinal tract, with an incidence of about 2% in the general population. Typically, Meckel's diverticulum is a true diverticulum because it arises from the antimesenteric border of the small bowel and all layers of the intestinal wall are present. Complications of Meckel's diverticulum include bleeding, perforation, diverticulitis, intestinal obstruction, stones, intussusception, hernia, and neoplasm. Bleeding in particular is a common complication and has always been caused by an ulceration of the ileal mucosa adjacent to the acid-producing ectopic gastric mucosa in a Meckel's diverticulum. A case was recently experienced involving massive hematochezia from Meckel's diverticulum without ectopic gastric mucosa in a 27 year-old woman, and in herein reported.

A Case of Pseudopolycytemia in Dilated Cardiomyopathy

We experience a case of pseudopolycytemia in dilated cardiomyopathy in a 62 years old man with chronic alcoholism. The patient was successfully managed by stress reduction, stopping of smoking, abstaining from alcohol drinking, use of digoxin, small dose lasix, and phlebotomy. To our knowledge, this is the first case of pseudopolycytemia in dilated cardiomyopathy in Korea. We reported this case with a review of literatures.

A Case of Hypereosinophilic Syndrome with Hepatic and Gastrointestinal Involvement / 대한간학회지

Hypereosinophilic syndrome is characterized by prolonged eosinophilia of blood and tissue without an identifiable underlying cause and multiorgan system dysfunction by eosinophil-related tissue damage to variable organs: liver, heart, lung, kidney, gastrointestinal tract, skin, nerve. Some case of hypereosinophilic syndrome with hepatic and gastrointestinal involvement have been reported, but not much. We are reporting a case of hypereosinophilic syndrome with hepatic and gastrointestinal involvement in 56-year-old man who presented general weakness and epigastric discomfort. In abdominal US, CT and MRI, intrahepatic multifocal ill-defined lesions were detected. The patient was treated with prednisolone for 16 weeks and recovered from eosinophilia and gastric involvement. A gastric biopsy was taken to confirm recovery. Also, the ill-defined lesions in US and CT disappeared after treatment.

A Case of Complete Remission in Ruptured Hepatocellular Carcinoma after One -time Transcatheter Arterial Chemoembolization / 대한간학회지

There are many kinds of treatments for hepatocellular carcinoma (HCC) such as surgical resection, liver transplantation, chemotherapy, interventional therapy [TACE, ethanol embolization, Immuno -chemoembolization, I131 -lipiodol embolization], thermal therapy, cryotherapy, and radiation therapy. Generally spontaneous remission is not common in HCC, however underlying mechanism of spontaneous remission is uncertain. We report a case of complete remission after one time TACE in ruptured HCC with review of literature about the effect of TACE and spontaneous remission. We conclude that arterial embolization is an effective alternative to surgery for hepatic hemostasis in patients with spontaneous rupture of hepatocellular carcinoma.

A Case of Endoscopically Removed Duodenal Carcinoid Tumor / 대한소화기내시경학회지

Primary carcinoid tumor of duodenum are rare, Usually, small duodenal carcinoid tumors are often discovered endoscopically. Most of these tumors are asymptomatic, but in rare cases, jaundice, hemorrhage, duodenal obstruction, or carcinoid syndrome were apparent. Uaually, the recommended treatment is surgical or endoscopic excision of the tumor. We experienced a case of carcinoid tumor of duodenu in 53 year-old women. A 53-year-old female patient was admitted to our hospital because of epigastric discomfort and indigestion. On the gastrofiberscopic examination, 0.9 cm sized polypoid mass with central umblication was noted on the duodenall bulb. The biopsy specimen showed carcinoid cells. She was treated with endoscopic polypectomy.

A Case of Duodenal Tuberculosis Which is Hardly Differentiated from Duodenal Lymphoma / 대한소화기내시경학회지

Primary duodenal tuberculosis, duodenal Crohn's disease, duodenal lymphoma, duodenal cancer is extremely rare event. Vague upper abdominal pain, weight loss(10 Kg) had been present for several months in a 52-yeer-old woman. Endoscopy revealed an irregular ulcer in the second part of the duodenum. CT of the abdomen revealed pooly defined hypodense and centrally low density masses along the hepatoduodenal ligament, with poor separation from the head of pancreas. Hypotonic duodenogram showed spiculation and smooth indentation of mucosal fold at medical aspect of sup. portion m descending duodenum. ERCP showed medially displaced distal CBD and main pancreaticduct. At first, lymphoma, cancer, Crohn's disease, duodenal tuberculosis were considered in the differential diagnosis. Endoscopic biopsy sepecimen of duodenal lesion showed atypical lymphocytes. We excluded the diagnosis of the duodenal cancer. We started anti-tubercular drugs because in our country tuberculosis is endemic. After 4 weeks anti-tuberculosis therapy, follow up endoscopy and biopsy specimens showed healing stage of duodenal ulcer and chronic granulomatous inflammation with multinucleated giant cell. Thus we concluded that when duodenal lesion which could not confirmed histopathologically it was wise to start antitubercular therapy than to perform exploraparotomic dianostic procedures.

A Case of Clinical Ulcerative Colitis with Concurrent Hepatocellular Carcinoma / 대한소화기내시경학회지

Ulcerative colitis is a diffuse inflammatory disease which is characterized by the vascular congestion and superficial ulcerations in the mucosal and the submucosal layers of the rectum and colon. Extraintestinal manifestations such as arthritis, skin lesion, hepatobiliary and ocular diseases occur in a large number of patients with ulcerative colitis, though gastrointestinal symptoms of mucous and bloody stool, diarrhea and abdominal pain are frequently presented. The association of ulcerative colitis and hepatobiliary disease has been frequently reported in the western countries since the first description by Thomas C.H. in 1874. Fatty degeneration, chronic active hepatitis, cirrhosis, primary sclerosing cholangitis and hepatobiliary carcinoma are included in this list of complications. In the case of hepatobiliary carcinoma, however, the histological diagnosis has almost invariably been cholangiocarcinoma. We report a case of clinical ulcerative colitis with coneurrent hepatocellular carcinoma confirmed by the histologic examination of biopsy specimen in a 49 year old man with the relevant literatures.