A Case of Clonorchiasis Presenting as Common Hepatic Duct Mass / 대한소화기내시경학회지

The liver fluke, Clonorchis sinensis is an important human parasite and is endemic in Eastern Asia including Korea, China, and Japan. Patients acquire the infestation by eating raw or undercooked freshwater fish. Radiologic examinations usually reveal dilated peripheral intrahepatic bile ducts and normal extrahepatic bile duct. The diagnosis of clonorchiasis may sometimes be difficult and a presentation as an obstructive mass at the common hepatic duct is a rare event. Here we report a case of clonorchiasis of 54-year-old woman presented with epigastric pain. Endoscopic retrograde cholangiography revealed a mass at the common hepatic duct with dilatation of the intrahepatic ducts mimicking cholangiocarcinoma. Using an endoscopic basket, muddy, sludge-like materials were extracted through the papillary orifice. We report this case with a review of literatures.

Cationic Trypsinogen Gene Mutation in Patients with Chronic Idiopathic Pancreatitis / 대한소화기학회지

BACKGROUND/AIMS: Mutation of Cationic trypsinogen gene is clearly associated with hereditary pancreatitis and plays an important role in the pathogenesis of pancreatitis. According to literature, this mutation is occasionally occurred in patients with pancreatitis in Western countries and Japan. The aim of this study was to find out whether the mutation was observed in Korean patients with chronic idiopathic pancreatitis. METHODS: Peripheral blood samples of 11 patients with chronic idiopathic pancreatitis were collected consecutively, and DNA was extracted from the samples. Polymerase chain reaction was performed in exon 2 and 3 of cationic trypsinogen gene. Then, DNA products were purified and sequenced. RESULTS: The mutation was not found in exon 2 and 3 of cationic trypsinogen gene in these patients. CONCLUSIONS: There was no cationic trypsinogen mutation in Korean patients with chronic idiopathic pancreatitis. Further large sampled cohort study is needed.

Percutaneous Cholecystostomy and Percutaneous Abscess Drainage in Two Patients of Gallbladder Perforation with High Surgical Risk / 대한소화기내시경학회지

Gallbladder perforation is a grave complication of acute cholecystitis, which has a high incidence of morbidity and mortality in the elderly patients. The unfavorable nature of this disease is due in part to a delay in diagnosis because of the similarity in clinical presentation of patients with uncomplicated cholecystitis and those with perforation. Although prompt surgical intervention with cholecystectomy is the treatment of choice, morbidity and mortality rates rise markedly in the elderly patient with severe systemic illness. In acute cholecystitis, percutaneous cholecystostomy is a good alternative to surgical cholecystectomy or is a temporary measure until a patient is sufficiently stable for surgery. In this report, we describe our experience of successful use of percutaneous cholecystostomy and intra- abdominal percutaneous catheter drainage for the therapy of gallbladder perforation in two patients with high surgical risk.

Safe Endoscopic Removal of a Sharp Foreign Body Using Latex Glove / 대한소화기내시경학회지

Most of swallowed foreign bodies pass spontaneously. However, sharp objects are usually lodged in the proximal esophagus and cause aspiration, bleeding, obstruction, and perforation. Therefore, prompt retrieval of lodged foreign bodies are necessary. The safe extraction of sharp foreign bodies using endoscopic technique is difficult because sharp objects carry a significant risk of mucosal injury and perforation. Endoscopic techniques for retrieval of foreign body include methods using protector hood and overtube. The former is not available, the later is uncomfortable and its diameter is the limiting factor. Method using a latex glove is available, comfortable, and its diameter is not limited. The thickness of the glove is thinner than protector hood, but we think that a latex glove would seem to be a effective alternative. We report a case in which a sharp foreign body was endoscopically removed using a latex glove without complication.

A Case of Acute Hepatitis E / 대한간학회지

Hepatitis E is an infectious viral disease with clinical and morphologic features of acute hepatitis. Although HEV infection is endemic in the Indian subcontinent, Southeast and Central Asia, a large outbreak of hepatitis E was identified in China. Smaller outbreaks have been observed in the Middle East, northern and western parts of Africa, and Mexico. Sporadic hepatitis E also has been observed in several countries. In nonendemic regions, the sporadic cases of hepatitis E are almost always associated with travel to HEV-endemic regions. In Korea, there has been no report on hepatitis E. Recently, we experienced a case of acute icteric hepatitis in which serologic study showed seroconversion of IgM anti-HEV. The patient did not have any travel history to an HEV-endemic area. We report this as an initial case of acute hepatitis E in Korea.

Endoscopic Band Ligation for Non-variceal, Non-ulcer Gastrointestinal Hemorrhage and Post-polypectomy Hemorrhage / 대한소화기내시경학회지

BACKGROUND/AIMS: There is no consensus as to the best treatment for non-variceal, non-ulcer gastrointestinal hemorrhage. Endoscopic band ligation is an inexpensive, readily available, and easily learned technique in contrast to conventional thermal methods of endoscopic hemostasis. The purpose of this study is to define the effectiveness of endoscopic band ligation for non-variceal, non-ulcer gastrointestinal hemorrhage and post-polypectomy hemorrhage. METHODS: Twenty eight patients were treated by band ligation between July 1996 and October 2000. The lesions treated were: Dieulafoy's lesion in 13, Mallory-Weiss tear in 7, angiodysplasia in 1, post-polypectomy bleeding in 4, post-endoscopic mucosal resection bleeding in 2, post-endoscopic biopsy bleeding in 1. RESULTS: Endoscopic band ligation was successful in 25 of 28 cases. Additional sclerotherapy was necessary in two cases of Dieulafoy's lesion. The remaining case was early band detachment. CONCLUSIONS: Endoscopic band ligation is effective for non-variceal, non-ulcer bleeding. It has the advantage of ease of use and is relatively inexpensive.

A Case of Diverticulitis of Sigmoid Colon Mimicking Carcinoma / 대한소화기내시경학회지

Diverticular disease of the colon in Korea is different from developed Western countries. Diverticulosis leads to the complications in about 20% of cases. The diverticulitis of the right colon is difficult to be differentiated from acute appendicitis. According as increase of elderly populations, incidence of the diverticulitis of the left colon increase. Therefore we should be differenciated from other diseases. In very rare case, frequent recurrence and recovery of the diverticulitis leads to a chronic state with complications such perforation, microabscess, fistula, adhesion and fibrous hypertrophy. These findings may be misdiagnosed as malignancy because of protruding mass and stricture on colonoscopy. We present a case of an pseudotumor that looks like a malignancy in the sigmoid on colonoscopy. After surgical resection, the lesion turned out to be a complicated diverticulitis.

Direct Invasion of Thyroid Papillary Carcinoma to Esophagus Presenting as an Intraluminal Polypoid Mass Which Causes Hematemesis / 대한소화기내시경학회지

We report an unusual case of metastatic thyroid papillary carcinoma directly invades the esophagus presenting as an intraluminal polypoid mass which causes hematemesis. The patient had a past medical history of thyroid nodule. Physical examination was unremarkable except the palpable thyroid mass. Esophagoscopy and esophagography revealed an intraluminal polypoid mass to the left of the cervical esophagus. Chest computed tomography showed round, homogenous, well-enhancing mass and calcifying thyroid nodule is found in front of the mass. Thyroid lobectomy and partial esophageal resection was performed. Microscopic finding showed typical features of thyroid papillary carcinoma. Metastatic thyroid papillary carcinoma should be included in the differential diagnosis of an intraluminal polypoid esophageal mass, particularly if the patient has a known thyroid tumor.

Endoscopic Band Ligation in Bleeding Dieulafoy's Lesions / 대한소화기내시경학회지

BACKGROUND AND AIMS: The Dieulafoy's lesion is an unusual cause of massive gastrointestinal bleeding resulting from the erosion of an abnormally large submucosal artery. Surgical intervention was believed to be the best treatment in the past, but recently improvement of endoscopic techniques has made effective hemostasis possible in most cases of Dieulafoy's lesions. Therapeutic endoscopic hemostasis includes sclerotherapy, electrocauterization, laser coagulotherapy, clipping band ligation. The effectiveness of the endoscopic band ligation was evaluated in bleeding Dieulafoy's lesions. METHODS: Clinical characteristics, initial endoscopic findings, and effectiveness of band ligation in Dieulafoy's lesions were all analyzed. RESULTS: 1) The patients were 8 males and 1 female, and the mean age was 56.2 years. 2) The chief complaints were melena and hematemesis, and 2 cases had histories of recurrent gastrointestinal bleeding. 3) The diagnosis of Dieulafoy's lesion was possible in 7 of 9 patients (78%) at the initial endoscopy. 4) The lesions were mostly located in the fundus and the body, characterized mainly by protruding vessels in shallow erosion areas. 5) The initial band ligation was possible with successful hemostasis, but additional sclerotherapy was necessary in two cases. There were no complications related to the procedure, except a case of early band detachment. CONCLUSIONS: The Dieulafoy's lesion requires careful endoscopic observation for diagnosis, and endoscopic band ligation was an effective therapeutic option for bleeding Dieulafoy's lesions.

A Case of an Esophageal Granular Cell Tumor Resected with an EEMR Tube / 대한소화기내시경학회지

The granular cell tumor was first described in 1926. Recently, it has been suggested that the tumor is Schwann cell in origin, and this notion has been supported by electron microscopic studies and immunohistochemistry of the S-100 protein. The most frequently involved organs include the tongue, skin, breast, and digestive tract. The esophagus is rarely involved. The treatment of choice for an esophageal granular cell tumor is still controversial. The traditional treatment has been surgical excision, but new therapeutic options, including laser surgery, diathermy loop, and multiple biopsies have recently been tried. An endoscopic esophageal mucosal resection (EEMR) tube, originally designed for resection of early esophageal cancer, is widely used nowadays. A case of a granular cell tumor of the esophagus, which was successfully removed by an EEMR tube, is herein reported.

A Case of Plummer - Vinson Syndrome Treated with Endoscopic Balloon Dilatation / 대한소화기내시경학회지

Plummer-Vinson syndrome is characterized by dysphagia associated with anemia, glossitis and esophageal web. The cause of this syndrome is still not clear, but the most important one is thought to be the iron deficiency. The patient with small sized ageal web is treated by administration of iron but large sized web with dyspha gia requires breakage of web. In the following case report, we describe a patient with Plummer-Vinson syndrome who showed clinical improvement after treatmeat with endoscopic balloon dilatation of upper esophageal web with a review of literatures.

A Case of Endoscopic Polypectomy with a Detachable Snare in a Huge Duodenal Brunner's Gland Adenoma / 대한소화기내시경학회지

Duodenal Brunner's gland adenoma is characterized by hyperplasia of the Brunner's gland, which is usually found in a duodenal bulb as a pedunculated polypoid mass. Conservative management is advocated for asymptomatic small lesions, but in larger lesions causing obstructive symptoms or bleeding, either endoscopic or surgical removal of the mass should be performed. But an endoscopic polypectomy for a huge mass lesion, especially one having a broad base, runs the risk of bleeding, so to minimize this complication, detachable snare is used before the polypectomy. We have experienced a case of huge duodenal Brunner's gland adenoma was successfully removed by an endoscopic polypectomy with a detachable snare, in a patient with recurrent upper gastrointestinal bleeding.

Hypotensive Efficacy and Safety of Manidipine on the Patient with Essential Hypertension

Thirty patient with essential hypertension were administered Manidipine, a new calcium antagonist, 10~20mg once daily to evaluate the hypotensive efficacy and safety for 8 weeks. And the followings were the result. 1) Patients were consists of 14 male, 16 female, aged 53 in average and classified as mild in 21 and moderate in 9 patients. 2) Optimum intial dose was 10mg and 10 to 20mg were the doses recommended. 3) Blood pressure dropped after 8 weeks 24/13mmHg in average, rewarding 80% effectiveness and normalized in 87%. 4) Most frequent side reaction was facial flushing in 5 patiens followed by palpitation and dizziness, all of which did not disturb the continuation of medication. 5) Most of routine laboratory parameter were normal and unchanged between before and after the trial. 6) Overall rating of usefulness was 77%. In conclusion, Manidipine 10 to 20mg once daily regimen is well tolerated and effective in the treatment of mild to moderate essential hypertension.

Reproducibility of Ambulatory Electrocardiography

To evaluate the reproducibility of the Ambulatory Electrocardiography (AECG), we examined the consistency rates of premature beats between the baseline AECG's and the repeat AECG's in 23 patients who underwent AECG's times within 1 year. 12 patients were male and 11 patients were female. Their mean age was 48 years. (Range ; 20 years-75 years) The time interval between both AECG's was 1 month 20 days. (Range ; 1 day-9months) They did not take any antiarrhythmic druge during the observation period except 4 patients who were taking calcium channel blockers or beta receptor blockers for hypertensive heart disease or ischemic heart disease. The consistency rate of both frequency and complexity of ventricular premature beats was 52%. The consisency rate of both frequency and complexity of supraventicular premature beats was 35%. These consistency rates seemed to vary as the time interval between both AECG's differed. In the case of ventricular premature beats, the consistency rates of 1 day, 8 days and 5 months as the time interval were 100%, 38% and 14% respectively. In the case of supraventricular premature beats, the consistency rates were 50%, 25% and 29%. We concluded that the reproducility of the AECG was low and this reproducibility became lower as the time interval between both AECG's became longer and that hese facts had to be considered when the effect of the antiarrhythmic drugs was evaluated.

Effects of Tripamide(Tripamol(R)) on Serum Lipids and Hypertension

The antihypertensive effects and serial changes of serum lipids were observed in 17 patients with essential hypertension, administered daily 30-60mg dose of Tripamide(Tripamol(R)) for 8 weeks. The results were as follows ; 1) After 8 weeks treatment, there is no change of serum total cholesterol, serum triglyceride and HDL-cholesterol were decreased by 3.2mg/dl(-1.9%) and 0.9mg/dl(-2.8%) respectively. The changes were not significant statistically. 2) After 8 weeks treatment, mean systolic and diastolic blood pressure were decreased by 11.2mmHg(-6.8%) and 7.7mmHg(-7.3%). 3) No significant side effect was observed during treatment except of 2 patients of mild headache and insomnia.