Three Cases of Gastrointestinal Carcinoid Tumors / 대한소화기내시경학회지

Carcinoid tumors arise from enterochromaffin cells that are located predominantly in the gastrointestinal mucosa. Gastrointestinal carcinoids appear with equal frequency among men and women, most often during the fifth and sixth decades. A primary duodenal carcinoid is rare. Most carcinoid tumors of the appendix are incidentally discovered during other surgical procedures. Its natural course is usually benign and the size of the tumor is closely related with the liability of regional or distant metastasis. The vast majority of rectal carcinoid tumors are benign and can be safely treated by a local excision. Lesions larger than 2 cm that invade the muscular wall of the rectum should be considered as malignant and treated by a more radical procedure such as an abdominoperineal resection. Three cases are here in reported of gastrointestinal carcinoid tumors that were treated at presbyterian medical center.

Angiotensin Converting Enzyme Gene Polymorphism in Patients with Minimal Change Nephrotic Syndrome and Focal Segmental Glomerulosclerosis / 대한신장학회잡지

Angiotensin converting enzyme gene insertion/ deletion polymorphism has been shown to be associated with cardiovascular disease including cardiomyopathy, myocardial infarction, essential hypertension, progression of IgA nephropathy and diabetic nephropathy. Since glomerulosclerosis has similarities to atherosclerosis, angiotensin converting enzyme gene polymorphism may be associated with glomerulsclerosis. Therefore, we tested whether genotype distribution of the insertion/deletion polymorphism in angiotensin converting enzyme gene is different in patients with minimal change nephrotic syndrome and focal segmental glomerulosclerosis. In genotype distribution of the angiotensin converting enzyme gene I/D polymorphism, control subjects were II type 44.3%, ID type 40.9%, DD type 14.8% and patients with minimal change nephrotic syndrome were II type 38.2%, ID type 45.5%, DD type 16.3% and patients with focal segmental glomerulosclerosis were II type 13.3%, ID type 46.7%, DD type 40.0%. This result suggests that DD genotype was more frequent in patients with focal segmental glomerulosclerosis than minimal change nephrotic syndrome and control subjects. We also examined the association between ACE genotype and clinical characteristics in the patients with minimal change nephrotic syndrome and focal segmental glomerulosclerosis. There were no significant association between I/D polymorphism distribution and hypertension, chronic renal failure, response to steroid in patients with minimal change nephrotic syndrome. The incidence of chronic renal failure in patients with focal segmental glomerulosclerosis DD genotype was higher than that of other genotypes. The response rate to steroid in patients with focal segmental glomerulosclerosis DD genotype was lower than that of other genotypes.

A case of acute coma & respiratory arrest in Wernicke's encephalopathy caused by malnutrition / 대한내과학회지

We shoud give attention to Wernicke's encephalopathy as a cause of sudden coma & respiratory arrest in patients, who are not usually suspected to develop the disorder and empirical treatment with thiamine in cases of coma of unknown cause is recommended. Respiratory stimulants, doxapram & aminophylline have an effect in assisting ventilatory weaning in patient with central hypoventilation as a complication of acute Wernicke's encephalopathy No previous reports where doxapram had been used to assist weaning from mechanical ventilation in adults were noted. Nor has newly developed central hypoventilation been identified as an impediment to weaning in literature to date in Korea. We reported a rare case of Wernicke's encephalopathy caused by poor oral intake & inadequate nutritional suppliment after car accident, showing acute coma & respiratory arrest and treated adequately by thiamine replacement & mechanical ventilation with respiratory stimulant.