A Case of Malignant Lymphoma in Patient with Ulcerative Colitis / 대한소화기내시경학회지

Ulcerative colitis has been recognized as a premalignant condition because a considerable proportion of patients with colitis eventually develop colorectal carcinoma at the site of the inflammatory disease. Malignant lymphoma occurring in cases of long-standing ulcerative colitis is rare. Cancer risk is positively correlated with duration and anatomic extent of colitis, but do not appear to be increased by early age at onset of disease. Patients with chronic ulcerative colitis should have periodic rectal and colonoscopic biopsies, and those with moderate to marked dysplasia require colectomy because of the increased risk of colon carcinoma. We report a case of malignant lymphoma in patient with ulcerative colitis.

A comparative study on initial pleural fluid findings of tuberculous pleurisy between patients with and those without pleural thickening / 대한내과학회지

BACKGROUND: Indicator that can predict pleural thickening in pleural tuberculosis has not been known clearly. By the previous study, patients with pleural thickening > or =10 mm had significantly lower glucose and pH values and higher lysozyme and TNF-alpha values than those with pleural thickening or =10 mm and 12 patient (54.5%) had pleural thickening > or =3 mm. Initial pleural fluid protein, LDH, pH, glucose and IFN-gamma, Interleukin-1alpha (IL-1alpha) were studied. RESULTS: Pleural fluid levels of protein, LDH, glucose, and IFN-gamma were not statistically significant different not only between the group of pleural thickening > or =3 mm and the group of pleural thickening or =10 mm and the group of pleural thickening or =3 mm (85.9+/- 37.1 U/mL) was significantly higher than without thickening (44.8+/-32.0 U/mL) (p or =10 mm (106.9+/-8.6 U/mL) was significantly higher than without thickening (58.5+/-8.6 U/mL)(p< 0.001). CONCLUSION: Although patient number of our study was smaller than the previous study, IFN-gamma level in initial pleural fluid of pleural tuberculosis may be considered as the predictive factor of pleural thickening.

A Case of a Gastric Bezoar Regurgitated from the Stomach to the Esophagus / 대한소화기내시경학회지

Bezoars are persistent concretions of indigestible material, usually seen in the stomach. Esophageal bezoars are very rare and generally occur in elderly patients with anatomic defects such as diverticulum or stricture, or with esophageal motility disorders. However, it is quite unusual that a gastric bezoar would be regurgitated into a normal esophagus during forceful vomiting. Endoscopic removal of a bezoar is safe and successful in most cases. A case of a gastric bezoar regurgitated into the esophagus was recently experienced and removed by an endoscopic polypectomy snare and bezoar (lithotripsy) basket.

Clinical Evaluation of Surgical Treatment for Hemoptysis Patients / 대한흉부외과학회지

The expectoration of blood is always a fearful experience for the patient and a matter of grave concern to the attending physician, because it may be the warning sign of serious diseases. When such bleeding occurs, the possibility of its being due to pulmonary tuberculosis, bronchiectasis or carcinoma of the lung is promptly suggested. Nowadays, with the advance of modern diagnostic studies, differential diagnosis has become possible for the hemoptysis patients to have appropriate treatment. This evaluation is based on the review of 75 cases of patients whom we performed emergency open thoracotomies for 6 years from March 1992 to February 1997 in the Department of Thoracic and Cardiovascular Surgery, Seoul Adventist Hospital. The mean age of the patients was 36.6 years old with a range from 19 to 68, and most prevalent age group was thirties. The most common underlying lung disease causing hemoptysis was tuberculosis(44%). Most accurate diagnostic study was bronchoscopy during hemoptysis(95%) and right middle and lower lobe(17.3%) was the most common site of lesion. Lobectomy(50%) was the most frequent operative method and recurrent hemoptysis(31.6%) was the most common postoperative complication. But most of the patients(82.6%) were completely recovered by surgical treatment. Now we concluded that the proper management of hemoptysis was completed by surgical approach with definite diagnosis and supportive medication.

Clinical Evaluation of Traumatic Diaphragmatic Injuries / 대한흉부외과학회지

Diaphragm injuries are very important because, if both thoracic and abdominal viscera are damaged, a combination of shock and acute respiratory distress may develop. It can be highly lethal. This evaluation was based on the reviews of 17 cases of traumatic diaphragm injuries treated at the Department of Cardiovascular Surgery, Seoul Adventist Hospital during 5 years from March 1993 to February 1997. The mean age of the patients was 37.2 years and sex ratio was 3.2:1 with male dominance. Blunt trauma(N=5, Rt.=4, Lt.=1) was 29.5%, penetrating trauma(N=12, Rt.=5, Lt.=7) was 70.5%. Dyspnea(76%) was the most common symptom. Blunt trauma(9.8 3.7 Cm) was larger than the penetrating trauma(3.2 1.3 Cm)(P<0.05) in the size(mean SD) of the injury. All of the patients had associated injuries and repaired immediatley with thoracic approach 11 cases(64%), abdominal approach 3 cases(18%) and thoracoabdominal approach 3 cases(18%). 5 cases of penetrating diaphragmatic trauma was diagnosed on the operation of other organ injury. Now we suggest that diaphragmatic injury should be suspected in all patients with penetrating as well as blunt injury of the chest and abdomen to protect the patient from its late complications.