A Case of Duodenal Diverticulitis Mimicking Cholangitis / 대한소화기내시경학회지

The duodenum ranks second to the colon as the most common site of diverticulosis in the gastrointestinal tract with a prevalence of more than 20%. It is usually asymptomatic, and rarely requires treatments for complications, including diverticulitis, hemorrhage, and luminal obstructions. Unlike diverticulosis, duodenal diverticulitis is extremely rare. Given that the radiological appearance and clinical presentation of duodenal diverticulitis often mimic those of pancreaticobiliary neoplasms or inflammations, it is a challenge for clinicians to diagnose it correctly, which often leads to misdiagnosis and inappropriate management. Here we report a case of a 69 year-old female patient with duodenal diverticulitis, whose clinical symptoms and radiological images were similar to those of acute cholangitis. We also briefly review the literature.

Two Cases of Cytomegalovirus Pneumonia after CD34 Selected Autologous Stem Cell Transplantation

Cytomegalovirus (CMV) pneumonia is an important cause of treatment related mortality after allogeneic stem cell transplantation (SCT) and autologous SCT, particularly in a CD34 selected setting. There is little known about the immune reconstitution pertaining to the CMV after CD34 selected SCT. However, several studies have suggested there is more profound immunodeficiency early in the CD34 selected population compared with the unselected population. We encountered two fatal cases of CMV pneumonia at the CD34 selected SCT for T-cell lymphoblastic lymphoma and high-risk breast cancer that was confirmed through a lung biopsy and bronchoalveolar lavage. In conclusion, autologous CD34 selected CMV seropositive recipients need to be monitored in a similar manner to allogeneic recipients.

A Case of Protein Losing Enteropathy Caused by Primary Intestinal Lymphangiectasia / 대한소화기내시경학회지

Primary intestinal lymphangiectasia is a rare congenital cause of protein losing enteropathy that is characterized by chronic diarrhea, generalized edema, ascites, hypoproteinemia, hypoalbuminemia, and lymphopenia. We encountered an 18-year-old woman who suffered from longstanding diarrhea and progressive leg edema. The laboratory findings showed the typical features of this disorder. The presence of enteric protein loss was documented with the 24 hour fecal clearance of alpha(1)-antitrypsin and (99m)Tc human serum albumin scintigraphy. A duodenoscopy and biopsy showed scattered white spots and markedly dilated lymphatics in the tips of the villi, respectively. The patient's clinical symptoms improved after placing her on a high protein and low fat diet with medium chain triglyceride supplements.

A Case of Condyloma Acuminatum Treated by Argon Plasma Coagulation / 대한소화기내시경학회지

Condyloma acuminatum (CA) is a common sexually transmitted disease caused by the human papillomavirus. In gastrointestinal practice, we generally encounter this disease in the anal canal but rarely in the rectum during a colonoscopy. There are many therapeutic options for CA including chemical or physical destruction, immunological therapy, or a surgical excision. All these procedures have some degree of limitations such as limited clearance rate, high recurrence rate, long duration of therapy, bleeding, release of potentially infectious aerosols, scarring etc. With argon plasma coagulation (APC), which is more available than lasers in gastrointestinal practice, a high frequency current flows through the argon plasma to the tissue, allowing well-controlled superficial tissue destruction without any direct contact between the probe and the tissue. We present a case of anal CA that was treated successfully with APC during a colonoscopy with no recurrence during the follow up.

The Clinical Evaluation of Anomalous Bronchi Arising From The Trachea and Main Bronchi / 결핵및호흡기질환

OBJECTIVES: To evaluate the clinical significance of abnormal bronchi originating from the trachea or main bronchi. METHODS: 21 patients (male:female ratio, 13:8; mean age, 58.2 years, range 34-77), who were diagnosed with major tracheobronchial anomalies by bronchoscopy from January 2001 to March 2005, were enrolled in this study. The anomalous bronchi consisted of 13 tracheal bronchi and 8 cardiac accessory bronchus. The clinical features, bronchoscopic findings, and outcomes were analyzed retrospectively. RESULTS: Common symptoms, including hemoptysis, cough and dyspnea, resulted from the underlying lung disease regardless of the bronchial anomalies. In this series of 13 tracheal bronchi, 7 cases originated from the trachea within 1cm of the carina (carinal type) and 6 cases originated at a higher level(tracheal type). Most patients had favorable outcome with conservative treatment for the underlying lung disease. CONCLUSION: Most tracheobronchial anomalies are found incidentally in the process of diagnosing lung disease. The clinical outcome of patients with a bronchial anomaly depends on the underlying lung disease.