The Mucosal Changes and Influencing Factors in Upper Gastrointestinal Anisakiasis: Analysis of 141 Cases / 대한소화기학회지

BACKGROUND/AIMS: Anisakiasis is a well known parasitosis resulted from eating raw seafoods and there were many reports of cases. However, its endoscopic and clinical characteristics have not been reviewed well. The aim of this study was to clarify the gastric mucosal changes and influencing factors of upper gastrointestinal (UGI) anisakiasis. METHODS: We analyzed retrospectively the endoscopic and clinical characteristics of 141 cases with UGI anisakiasis diagnosed during UGI endoscopy, based on the review of medical records. The patients' data were collected consecutively from October 1999 through September 2006. RESULTS: In the 141 patients with UGI anisakiasis, the peak age was the 40s (44.7%). The female to male ratio was 1.82:1. The most prevailed season was winter (41.1%). The most frequent symptom was acute epigastric pain and 76.6% of the patients developed symptoms within 12 hours after the ingestion of raw seafoods. The greater curvature of body was the most preferred site of anisakid larvae. The median time from meal to symptom onset was shortest in esophageal location and longest in fundus location (3 vs. 18.7 hours). The various mucosal changes were observed and the most frequent mucosal change was edema (90.8%). Submucosal tumor was also found in 31.9% of the patients. The severity of mucosal change was related inversely with the time interval from meal to endoscopy (p=0.048). CONCLUSIONS: Anisakiasis presented various mucosal changes depending on the time interval from ingestion of raw seafood to endoscopy. Delayed endoscopy may lead chronic mucosal change and cause difficulty in the detection of anisakiasis. Therefore, the prompt endoscopic examination is required for the patients presenting acute gastrointestinal symptoms after taking raw fish.

True cyst of the spleen with high level of CA19-9 in cystic fluid / 대한내과학회지

Nonparasitic true splenic cyst is a rare disease and the epidermoid cyst accounts for the majority of the cases. And the epidermoid cyst producing CA19-9 is extremely rare. We present a case of true splenic cyst with high cystic fluid CA19-9 level. A 26-year-old woman complained left upper quadrant abdominal pain. Abdominal ultrasonography and CT depicted a 17 x 13 cm sized cystic lesion in the left upper abdomen. The aspirated cystic fluid showed high concentration of CA19-9, but serum CA19-9 level was normal. Spleen with huge unilocular cyst was removed surgically. The cyst was lined with single layered cuboidal epithelial cells and negative for immunohistochemical staining with anti-CA19-9 antibody.

A Case of Primary Squamous Cell Carcinoma of Sigmoid Colon / 대한내과학회지

Primary squamous cell carcinoma of the colon is very rare and its incidence is 0.025% to 0.05% among all colon cancers. We report a case of primary squamous cell carcinoma of the sigmoid colon in a 65year-old man. He had bowel habit change and hematochezia for 3 months. Colonoscopy with biopsy and left inguinal lymph node biopsy revealed squamous cell carcinoma. We confirmed the diagnosis of primary squamous cell carcinoma of the sigmoid colon with lymph node metastasis by diagnostic criteria. The patient was discharged against advice and expired.

Original Articles: Immunogenicity and Safety of a 20 microgram Dose of the Green Cross Recombinant Hepatitis B Vaccine ( HG -II ) in Healthy Adults / 대한간학회지

BACKGROUND/AIMS: The introduction of Hansenula polymorpha for recombinant hepatitis B vaccine production allowed high product yield with plasmid stability and less glycosylation than conventional Saccharomyces cerevisiae system. A Green Cross HG-II vaccine formulated from HBsAg produced by a recombinant strain of the yeast H. polymorpha was evaluated for immunogenicity and safety in an open label triaL METHOFD: A 20 ug dose of Green Cross HG-II vaccine was administered intramuscularly at 0, 1 and 6 months at the deltoid region in 118 healthy adults seronegative for HBV markers. The anti-HBs titers were determined at one month after administration of the third dose of vaccine by radioimmunoassay. RESULTS: The seroconversion rate was 96.8% (90 out of 93), with seroprotective rate of 95.7% (89 out of 93). The geometric mean titers(GMT) of the anti-HBs response was 153.1mIU/ml in seroconverters. An age-dependent effect was observed in the anti-HBs response. But sex-dependent effect was not prominent. Reactogenecity was in incidence and general reactions were short-lasting and a mainly mild in severity. CONCLUSIONS: The results of this study have shown that the Green Cross HG-II vaccine is safe and clinically well tolerated, a nd that it may provide protection against HBV infection.

A Case of Solitary Gastric Neurofibroma Presenting as Hematemesis and Melena / 대한소화기내시경학회지

Gastric neurofibroma is rare and its exact incidence is unknown. We experienced a case of solitary gastric neurofibroma. A 49-year-old woman was admitted because of hematemesis and melena. Neither cafe-au-lait spots in skin nor superficial tumor were found. Gastrofibroscopic examination and UGI series showed a 3 * 4 cm sized luminal protruding mass with adjacent bridging mucosal fold and cental ulceration on the anterior wall of lower body. Mass excision was performed. Grossly, the mass was 4.5 * 3.0 * 2.0 cm sized, well circumscribed submucosal tumor with homogenous cut surface, Microscopically, each of the tumor cells had oval shaped nucleus and spindle shaped cytoplasm. Nuclear atypism and frequent mitosis were not observed. We report a rare case of solitary gastric neurofibroma with review of the literatures.

Longterm Follow-up after Endoscopic Variceal Ligation for Esophageal Varices / 대한소화기내시경학회지

Endoscopic variceal ligation is an accepted new form of safe treatment for esophageal varices. But, there are a few reports of long-term effect of EVL. We analysed 60 patients to evaluate long-term effect of EVL for esophageal varices. The eradication rate was 96.5%, the mean session for eradication of varices 3.0, the number of bands per person 21.5 and the number of bands per session 7.2, Child-Pugh classes(A: B: C) of patients were improved in 25, not changed in 30, deteriorated in 2 cases by EVL(34:19:4 at postEVL vs 20:19:21 at baseline, p<0.01). No serious treatment-related complication resulted from 167 EVL sessions. The patients were followed for a mean of 10.5 months, during which recurrence rate of varices was 14.5%, rebleeding rate 16.4%, and mortality rate 12,7%. The period from last session to recurrence was 4-19 months(mean 9.6). No late complication of EVL was documented. In conclusion, EVL is a safe and effective for hemostasis and eradication of esophageal varices. Thus it can improve liver function and reduce bleeding-related mortality in patients with liver cirrhosis. But the regular periodic examination for recurrence after an eradication of varices should be required.

Longterm Follow-up after Endoscopic Variceal Ligation for Esophageal Varices / 대한소화기내시경학회지

Endoscopic variceal ligation is an accepted new form of safe treatment for esophageal varices. But, there are a few reports of long-term effect of EVL. We analysed 60 patients to evaluate long-term effect of EVL for esophageal varices. The eradication rate was 96.5%, the mean session for eradication of varices 3.0, the number of bands per person 21.5 and the number of bands per session 7.2, Child-Pugh classes(A: B: C) of patients were improved in 25, not changed in 30, deteriorated in 2 cases by EVL(34:19:4 at postEVL vs 20:19:21 at baseline, p<0.01). No serious treatment-related complication resulted from 167 EVL sessions. The patients were followed for a mean of 10.5 months, during which recurrence rate of varices was 14.5%, rebleeding rate 16.4%, and mortality rate 12,7%. The period from last session to recurrence was 4-19 months(mean 9.6). No late complication of EVL was documented. In conclusion, EVL is a safe and effective for hemostasis and eradication of esophageal varices. Thus it can improve liver function and reduce bleeding-related mortality in patients with liver cirrhosis. But the regular periodic examination for recurrence after an eradication of varices should be required.

Endoscopic Therapy for Early Rectal Cancer: Piecemeal polypectomy and strip biopsy resection technique / 대한소화기내시경학회지

The incidence of colorectal cancer has been increased gradually and it was about 6.9% of all malignancies in Korea. Early diagnosis was recognized as the most important factor influencing the prognosis of colorectal cancer and the incidence of early colorectal cancer was increasing. Thus great change was observed in the treatment of early colorectal cancer, endoscopic therapy as well as curative surgical resection is being accepted. We report a case of effective and safe endoscopic therapy for early rectal cancer in 5S-year-old male patient. He presented with rectal prolapse and bleeding of a year's duration. A large polypoid mass with fine nodular surface and thick, short stalk was seen in the rectum at 4cm above the anal verge during flexible sigmoidoscopy. After the histologic examination of specimen obtained by bite biopsy, CT scan of pelvic cavity and ultrasonogram of abdomen, the tumor was removed safe and completely by 2 sessions of piecemeal polypectomies and strip biopsy. He has been well without symptoms and signs of recurrence of rectal cancer for 20 months.

Serum Pepsinogen Levels as a Screening Test of Gastric Cancer and Adenoma in Korea / 예방의학회지

To evaluate the validity of serum pepsinogen levels as a screening tool for gastric cancer and adenoma, immunoradiometric assays of serum pepsinogen I level (PG I), II level (PG II) and esphagogastroduodenal endoscopies were done in 757 health examlnees. Serum PG I level was higher in subjects with active duodenal ulcer (n=45, 75.2+/-34.3 microgram/l(mean+/-standard deviation), p<0.01) and gastroduodenal ulcers (n=8,756+/-19.8 microgram/l, p<0.05), and was lower in those with gastric adenoma (n=4,37.7+/-37.2 microgram/l, p<0.2) than those with normal, mild gastritis findings or ulcer scars (n=378, 56.6+/-24.9 microgram/l). Serum PG II level las higher in subjects with active duodenal ulcer (17.2+/-13.8 microgram/l, p<0.2), active gastro-duodenal ulcers (l8.3+/-7.4 microgram/l, p<0.2) and gastric carcinoma (n=3, 23.8+/-10.9 microgram/l, p<0.05) than those with normal, mild gastritis findings or ulcer scars (14.5+/-7.9 microgram/l). Serum PG I/PG 11 ratio was higher in subjects with active duodenal ulcer (5.1+/-1.6, p<0.05) and was lower in those with chronic gastritis (n=107, 4.1+/-1.7, p<0.05), gastric polyp (n=19, 3.9+/-1.4, p<0.2), gastric adenoma (n=4, 2.1+/-1.9, p<0.01) and gastric carcinoma (n=3, 2.7+/-1.2, p<0.1) than those with normal, mild gastritis findings or ulcer scars (4.5+/-1.7). Serum PG 11 level increased with age until 6th decade, whereas serum PG I/PG II ratio decreased with age in 378 subjects with normal, mild gastritis findings or ulcer scars. The screening criteria of serum PG I<70 microgram/l and PG I/PG II ratio<3.0 for detecting gastric cancer and adenorna gave a positive rate of 15.7%, sensitivity of 57.1% and specificity of 84.7%.

A clinical review of continuous ambulatory peritoneal dialysis

No abstract available.

Immunocytochemical study on the changes of the T lymphocytes and subsets in the peripheral blood of stomach cancer patients

No abstract available.

A Case of Traumatic Tricuspid Insufficiency

Traumatic tricuspid insufficiency(TI) is a relatively uncommon disorder. We experienced a case in which traumatic TI was suspected by history and the diagnosis was confirmed nonivasively by 2-D echocardiography with Doppler technique. Tricuspid valve in this case showed flail anterior leaflet during systole and Doppler echocardiography demonstrated the presence of tricuspid insufficiency.