A Case Report of Tuberculous Brain Abscess and Tuberculous Peritonitis Developing Due to Paradoxical Reactions / 결핵및호흡기질환

While receiving appropriate treatment, patients with tuberculosis occasionally have unusual, paradoxical reactions, with transient worsening of lesions or the development of new lesions. This report is a case of tuberculosis brain abscess and tuberculosis peritonitis with intra-abdominal abscess that developed during appropriate anti-tuberculosis chemotherapy. A 45-year-old male patient had been diagnosed as with all-drug susceptible pulmonary tuberculosis with pleurisy. Subsequently, the patient underwent standard treatment with anti-tuberculosis therapy; the pulmonary lesions improved. Three months after initial treatment, the patient developed brain abscesses and peritonitis. With the addition of corticosteroid treatment, the patient's neurologic symptoms were relieved. Exploratory laparotomy with surgical drainage was performed and a diagnosis of tuberculosis peritonitis was confirmed on biopsy. Anti-tuberculosis therapy was continued for 19 months, the patient improved eventually without further complications, although the therapeutic regimen had not been altered. In this case, the paradoxical response to treatment may have been involved in the pathogenesis of disease.

Endoscopic Resection of a Giant Duodenal Brunner's Gland Adenoma / 대한소화기학회지

Brunner's gland adenoma is a rare tumor of duodenum. Patients are usually aymptomatic and most are discovered incidentally during the upper gastrointestinal (GI) series or esophagogastroduodenoscopy. These lesions are most commonly located in the duodenal bulb and clinical manifestations are variable. In symptomatic patients, the most common manifestations are GI hemorrhage and duodenal obstruction. On histologic examination, Brunner's gland adenoma that causes clinical symptoms is composed of hyperplastic Brunner's glands and contains mostly an admixture of glandular, adipose, and muscular tissues. We report a case of large Brunner's gland adenoma causing upper gastrointestinal hemorrhage in a 47-year-old woman which was successfully removed by endoscopic resection without complications such as bleeding or perforation. Microscopically, it was entirely composed of variable Brunner's glands.

A case of Diphyllobothrium latum infection with a brief review of diphyllobothriasis in the Republic of Korea

A case of Diphyllobothrium latum infection in a 49-year old man is described, and diphyllobothriasis latum in the Republic of Korea is briefly reviewed. An incomplete strobila of a tapeworm, 95 cm in length, without scolex and neck, was spontaneously discharged in the feces of a patient. On the basis of morphologic characteristics of the worm and eggs, the worm was identified as D. latum. The patient was successfully treated with a single dose (15 mg/kg) of praziquantel. The most probable source of infection was salmon flesh according to the past history of the patient. The first case of D. latum infection was documented in 1971, and this is the 43rd recorded case in the Republic of Korea. The 43 cases were briefly reviewed. The patients' main complaints were gastrointestinal troubles, such as mild abdominal pain, indigestion, and diarrhea, and discharge of tapeworm segments in the feces. The suspected infection sources included raw or improperly cooked flesh of fresh or brackish water fish, including the perch, mullet, salmon, and trout.

A Case of Endoscopic Hemoclip Management of Dieulafoy-like Lesion on the Hyperplastic Polyp in the Duodenum / 대한소화기내시경학회지

Dieulafoy's lesion (DL) is an uncommon but important cause of massive upper gastrointestinal bleeding that has been reported to be involved in 0.3~6.7% of cases of major gastrointestinal bleeding. The lesion usually occurs in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been observed in the esophagus, duodenum, small intestine, colon, and rectum. Most DLs encountered in the duodenum occur in the bulb. Recently, with the advances in endoscopic techniques, the successful management of DL has been achieved through the application of a hemoclip or elastic band ligation. In particular, the application of a hemoclip is considered to be a safe and effective treatment for DL located on a relatively narrow and thin walled canal such as the duodenum. We report the successful application of endoscopic hemoclipping for the treatment of a rare Dieulafoy-like lesion on a hyperplastic polyp in the 2nd portion of the duodenum.

A Case of Aggravated Esophageal Candidiasis and Gastric Yeast Bezoar Formation following Gastric Outlet Obstruction due to Duodenal Stenosis / 대한소화기내시경학회지

Esophageal candidiasis is the most common disease among all candida infections of the gastrointestinal tract, and generally develops in immunocompromised patients. The prevalence of esophageal candidiasis has increased in patients undergoing antibiotic therapy, diabetes, adrenal dysfunction, alcohol intoxication, old age, esophageal injury, esophageal stasis, gastric surgery, and acid suppressive therapy. However, the overall prevalence is not higher than that of immunocompromised patients. Gastric candidiasis is uncommon because of the strong acidity of the gastric juices. The most common clinical setting for gastric candidiasis is in patients with neoplastic disease. However, there are some case reports suggesting an increase in the prevalence of gastric candidiasis after gastric ulcer therapy with surgery or acid suppressive agents. Delayed gastric emptying, increased intragastric pH, and reflux of the duodenal contents into the stomach are factors indicative of the pathophysiology of gastric candidiasis after gastric surgery. We encountered a case of aggravated esophageal candidiasis and the formation of a gastric yeast bezoar following a gastric outlet obstruction due to a duodenal stenosis. We herein report this case along with an overview of the relevant literature.

A Case of Renal Cell Carcinoma Presented with Chest Wall Metastasis / 결핵

The appearance of a tumor in the chest wall is rare compared to that in any other part of the body. It can be classified into benign and malignant types and can be located in the rib, clavicle, sternum, cartilage and soft tissues. Tumors that are metastatic are commonly located in the lung, breast, bone and pleura. But, the soft tissue mass of anterior chest wall is rarely metastasized from a distant organ that is not confined to the thoracic cavity. This and thus has rarely been described. A 68-year-old man was admitted to our hospital with a chief complaint of resting dyspnea. A huge non-tender mass of about 10*15 cm in size was visible on his left lower anterior chest wall. We pathologically confirmed that the mass was a metastatic renal cell carcinoma of clear cell type by incision biopsy. Through an incision biopsy, the mass was pathologically confirmed as a metastatic renal cell carcinoma of the clear cell type.

Difference in the distribution pattern of Helicobacter pylori and grade of gastritis in the antrum and in the body between duodenal ulcer and benign gastric ulcer patients

OBJECTIVES: To investigate the relationship between the Helicobacter pylori (H. pylori) colonization and the grade of gastritis in the antrum and in the body of patients with duodenal ulcer (DU) or benign gastric ulcer (BGU). METHODS: This study was performed in H. pylori-positive 220 DU patients and 180 BGU patients. H. pylori density was evaluated by modified Giemsa staining and CLO test, and gastritis grade was graded by H+ACY-E staining in the antrum and in the body. RESULTS: H. pylori grade by Giemsa staining was 1.24 in the antrum and 0.82 in the body for DU group (p +ADw- 0.01), and those of BGU group were slightly reversed, 0.83 and 0.87, respectively, but without statistical significance. Similarly H. pylori grade by CLO test was 3.1 in the antrum and 2.8 in the body for DU group (p +ADw- 0.01), and those of BGU group 2.3 and 2.6 (p +ADw- 0.05), respectively. In contrast, gastritis grade was 1.7 in the antrum and 1.2 in the body for DU group (p +ADw- 0.01), and those of BGU group 1.6 and 1.3 (p +ADw- 0.01), respectively, similar to those of DU. However, there was a correlation between H. pylori grade and gastritis grade in the antrum and in the body, not only in DU but also in BGU group (p +ADw- 0.01). CONCLUSION: In spite of different distribution patterns of H. pylori between DU group and BGU group, gastritis grade of the antrum was significantly higher than that of the body in both DU and BGU. However, gastritis is correlated with H. pylori density not only in DU but also in BGU patients. It looks like the inflammatory reaction to H. pylori is stronger in the antrum than in the body.

A Case of Appendiceal Mucocele with Concominant Colon Cancer

The appendiceal mucocele is a rare disorder, usually found incidentally during ultrasonography or radiologic studies. Mucoceles of the appendix include benign or malignant disease. Both of benign cystadenoma and malignant cystadenocarcinoma are characterized by an obstructed, mucin-filled appendix displacing the cecum. We experienced a case of partial obstruction of large bowel who had a cystadenoma at appendix and a colon cancer at other site on operation field. Here in, we report a case of appendiceal mucocele and concominant colon cancer with the review of literatures.

Secondary Amyloidosis Involving Liver in Rheumatoid Arthritis Treated with Methotrexate and Low dose Prednisolone / 대한류마티스학회지

Amyloidosis is a heterogenous group of often fatal disorders characterized by extracellular deposition of a proteinaceous material with a unique fibrillar form in various tissues and organs. Presenting with severe hepatomegaly, a 46 year-old man who has suffered with rheumatoid arthritis lasting more than 12 years was confirmed to have secondary amyloidosis by liver biopsy. After treatment with methotrexate and low dose prednisolone, we have observed clinical improvement in which hepatomegaly was resolved remarkably. This is the first published case report of a patient with rhuematoid arthritis complicated by liver amyloidosis which partially regressed after treatment with methotrexate and prednisolone.