A Case of Malakoplakia Treated by Antibiotics in the Rectum / 대한소화기내시경학회지

Malakoplakia is a rare chronic inflammatory process, most commonly affecting the urinary tract. This entity was first described by Michaelis and Gutman in 1902. As of 1995, only 85 cases of malakoplakia of the gastrointestinal tract has been reported. The common sites of colonic involvement are the rectum, sigmoid, and right colon, in descending order of frequency. The most common disease associated with malakoplakia is colorectal carcinoma. Surgical resection is the treatement of choice for cases associated with carcinoma or complications. But in other cases, medical treatment could be attempted. Antimicrobial drugs, such as trimethoprime-sufamethoxazole, rifampin, or as recently suggested, ciprofloxacin can be used. We report a case of rectal malakoplakia treated by ciprofloxacin with a review of literatures.

A Pancreaticobiliary Maljunction (New Komi Classification, Type IIIc3) with a Choledochal Cyst, Common Bile Duct Stones and Pancreatic Duct Stones / 대한소화기내시경학회지

A pancreaticobiliary maljunction (PBM) is synonymous with abnormal union of the pancreaticobiliary ducts (AUPBD), anomalous arrangement of the pancreaticobiliary ductal system, etc. PBM is a congenital anomaly defined as a union of the pancreatic and biliary ducts located outside the duodenal wall. Free reflux of pancreatic juice up to the biliary tree and/or bile up to the pancreatic duct occurs. Accordingly, various pathologic conditions occur in the biliary tract and pancreas. Although the common channel is long in most cases, some patients have more complicated junctions of the pancreatic and bile ducts. We report a case of PBM with choledochal cyst and stones of the pancreaticobiliary duct in a 39 year-old woman.

Emphysematous Gastritis Developed in a Patient with Klatskin's Tumor / 대한소화기내시경학회지

Emphysematous gastritis is a rare disease characterized by air in the wall of the stomach due to gas-forming microorganisms. This lethal entity was first described by Fraenkel in 1889. Forty-six cases have been reported so far in the literature. The predisposing factors include corrosive ingestion, immunocompromized state, alcohol abuse, cancer, diabetes and so on. Computed tomography is the procedure of choice for early diagnosis. Only prompt diagnosis and treatment can avoid mortality. Initial antibiotic therapy should cover gram-negative organisms and anaerobes. We report a case of emphysematous gastritis in a 41-year-old man with Klatskin's tumor.

A Case of Ileocecal Burkitt`s Lymphoma with Intussusception in an Adult / 대한소화기내시경학회지

Burkitt`s lymphoma is a distinct pathologic entity characterized by a diffuse proliferation of small, noncleaved cells of B-lymphocytes origin. It was first reported as "jaw sarcoma" in East African children and described as endemic in tropical Africa. Burkitt`s lymphoma usually occurs in youth and children, but it is very rare in an adult gastrointestinal tract of an adult. We recently experienced an unusual case of Burkitt`s lymphoma in a 69-year-old male with lower abdominal pain and a mass. A colonoscopy and abdominal CT scan detected an ileocecal fungating mass with intussusception, and the histologic examination of the resected and biopsy specimens showed infiltration of medium-sized lymphoblasts with characteristic "starry sky" machrophages. So we report it with a brief review of literatures.

A Case of Gastric Wall Abscess Associated with Gastritis Cystica Profunda / 대한소화기내시경학회지

Gastric wall abscess is a form of phlegmonous gastritis and has been very rarely reported. The pathogenesis of gastric wall abscess is thought to involve a focal injury to the gastric mucosa such as a penetrating trauma from an ingested foreign body or an endoscopic biopsy, where by bacterial infection occurs. Gastritis cystica profunda is a rare disease in which hyperplasia of mature glandular epithelium extends into the tissues beneath the submucosa. It shows multiple small cysts in the mucosa and submucosa of the stomach. To our knowledge, the association of gastric wall abscess with gastritis cystica profunda has never been reported yet. We, recently, experienced a case of gastric wall abcess associated with gastritis cystica profunda. Herein, we report it with a brief review with literatures.

A Case of Gastric Kaposi's Sarcoma Successfully Treated with VP-16 / 대한소화기내시경학회지

Kaposi's sarcoma, a rare tumor, usually presents itself with skin lesions. However, extracutaneous lesions are common and the gastrointestinal tract is often involved. Gastric Kaposi's sarcoma is usually asymptomatic, but may cause massive gastrointestinal hemorrhage, perforation, intestinal obstruction, intussusception, protein-losing enteropathy, or sepsis. The gastroscopic appearances of Kaposi's sarcoma range from reddish purple maculopapules to polypoid, umbilicated nodules. In Korea, only one case of gastric Kaposi's sarcoma had been reported until now. A case of gastric Kaposi's sarcoma treated with VP-16 (etoposide) is here in reported with the endoscopic findings before and after chemotherapy.

An associatioin of cagA+ helicobacter pylori infection with cell proliferation in gastric mucosae of gastritis and gastric cancer patients / 대한내과학회지

BACKGROUND: It has been suggested that cytotoxin associated gene A (cagA) is a marker of more virulent strains of H. pylori and cagA bearing H. pylori is more pathogenic in the gastrointestinal diseases. On the other hand, according to several reports H. pylori causes the cell proliferation, which may be an important mechanism of gastric carcinogenesis. So, we studied to elucidate whether there is the association of the cagA positive H. pylori infection with cell proliferation on the gastric mucosae of the patients with gastritis and gastric cancer or not. METHODS: In this study, 27 gastritis and 35 gastric cancer patients were included. PCR assay for the detection of H. pylori(ureA PCR) and cagA bearing H. pylori(eagA PCR) were performed on the gastric mucosal biopsy specimen. Immunohistochemical study using the MIB 1 Ab against Ki 67 antigen was carried out to evaluate the cell proliferation. RESULTS: The prevalence of H. pylori infection was 85.2%(23/27) in the patients with gastritis and 54.3%(19/ 35) in the patients with gastric cancer. The prevalence of cagA+ strain of H. pylori was 52.2%(12/23) and 47.4%(9/ 19) in the patients with gastritis and gastric cancer. In the patients with gastritis, the degree of cell proliferation was not different in the ureA positive(24.8%) and ureA negative(21.7%) gastric mucosae. Moreover, the difference of cell proliferation was not observed according to the presence or absence of cagA gene(29.4% vs 19.9%) among the ureA positive gastric mucosae. In the patients with gastric cancer, cell proliferation indices were 25.5% and 27.5% in the ureA postive and cagA negative gastric mucosae, 28.1% and 22.2% in the cagA positive and cagA negative group among the ureA positive gastric mucosae. There was no significant difference statistically. CONCLUSIONS: There was no association of cagA+ strain of H. pylori with cell proliferation in the gastric mucosae of the patients with gastritis and gastric cancer. It was presumed that more studies are needed to elucidate the role of H. pylori infection in the gastric carcinogenesis.

The Clinical Significance of Serum Hyaluronic Acid and Type IV Collagen Levels in Chronic Viral Hepatitis and Liver Cirrhosis / 대한내과학회지

OBJECTIVE: Histopathologic evaluation has been used to evaluate the degree of hepatic fibrosis. This method may have limitations because percutaneous liver biopsy is invasive and histopathologic change shows heterogenicity in the liver. It has been reported that the biochemical markers may have an important role in evaluating the degree of hepatic fibrosis. This study was performed to evaluate the clinical significances of serum hyaluronic acid (HA) and type IV collagen (IV-C) levels on hepatic fibrosis in the patients with chronic viral hepatitis B and liver cirrhosis. METHODS: This study included fifty eight patients with chronic viral liver diseases caused by HBV. Scheuer's classification was used to determine the degree of hepatic fibrosis. The levels of hyaluronic acid and type IV collagen was evaluated by one-step sandwich binding protein assay and one-step sandwich enzyme immunoassay respectively. RESULTS: The level of hyaluronic acid and type IV collagen in stage III (HA:589.4+/-193.7ng/ml, IV-C:444.5+/- 221.3ng/ml) and IV (727.5+/-306.1ng/ml, IV-C:519.2+/-210.5 ng/ml) were higher than stage I (HA:207.2+/-206.8ng/ml, IV-C:210.0+/-92.0ng/ml) and II (HA:223.7+/-172.9ng/ml, IV- C:209.6+/-70.7ng/ml) in the patients with chronic viral hepatitis and cirrhosis. At cutoff value of 500ng/ml for HA and 250ng/ml for IV-C in chronic hepatitis B patients, the sensitivities were 85% and 85%, and specificities were 89.5% and 78.9%, and diagnostic efficiencies were 87.9% and 81% respectively for discriminating patients with advanced hepatic fibrosis (stageIII-IV) from those with mild hepatic fibrosis (stageI-II). CONCLUSION: The serum levels of hyaluronic acid and type IV collagen correlated significantly with the degree of hepatic fibrosis in the patients with chronic viral hepatitis B and cirrhosis. The serum hyaluronic acid and type IV collagen is useful biochemical markers for evaluating hepatic fibrosis and follow up of the patients with chronic viral hepatitis B and cirrhosis.