A Case of Esophageal Tuberculous Abscess / 대한소화기내시경학회지

Primary esophageal involvement by tuberculosis is rare. Clinical symptoms are variable and nonspecific in which dysphagia is the most common presenting symptom. Endoscopic findings are also diverse and nonspecific and ulcerative form is a common manifestation. For a definite diagnosis, Endoscopic biopsies are useful but typical granuloma is seen in approximately 50% of cases and acid-fast bacilli are demonstrated in less than 25% of patients. Fine needle aspiration cytology and polymerase chain reaction are helpful for diagnosis. A 54-year-old man was presented with throat discomport. Endoscopy demonstrated hematoma like lesion with pus discharge from ulceration in the proximal esophagus. Esophageal tuberculosis was confirmed based on the biopsy and culture results, and he was treated with antituberculous medications. At the follow-up endoscopy, 6 months later, previous lesion was completely healed to scar.

A Case of Lipohyperplasia of the Stomach / 대한소화기내시경학회지

Lipohyperplasia is a lesion characterized by diffuse infiltration of lipocyte in the submucosal layer, which was formally known as 'lipomatosis' or 'lipomatous hyperplasia'. Lipohyperplasia is distinguished from lipoma, the former is not encapsulated and has normal mucosa. Most of lipohyperplasia developed at the ileocecal valve, showed clinical manifestation of abdominal pain, rectal bleeding, intestinal intussuception and intestinal obstruction. We experienced a case of a 45-year-old woman who had polypoid lipohyperplasia of the stomach. Her chief complaint was recurrent epigastric discomfort. Endoscopic finding was a 10 9 mm sized polypoid lesion in the anterior wall of lower body of the stomach. Endoscopic polypectomy was performed and the histological examination revealed infiltration of lipocyte in the submucosal layer.

A case of lipohyperplasia of the appendix / 대한내과학회지

Large intestinal Lipohyperplasia (LPH) is a poorly recognized lesion characterized by adipose tissue infiltration in the submucosal layer of the colon. Most of all, LPH developed at Ileoceal valve, especially upper lip which was called by ileocecal valve syndrome. For endoscopists and radiologists, it has often remained difficult to make a distinction from malignant neoplasia. We report here the case of a mild obese, 51-year-old man who had polypoid lipohyperplasia of the colon associated with extreme hyperplasia of the appendix. His chief complaint was recurrent intermittent abdominal pain. The colonoscopic finding was a submucosal tumor-like polypoid mass originating from appendix with smooth surface, But ileocecal valve was intact. Abdominal CT finding was 2.5 cm sized round heterogeneous low density mass like lesion with intratumoral fatty density of cecal tip area with enhancement of peripheral portion. In barium enema study, after retrograde filling of contrast, smooth extrinsic indentation of cecal tip with partial filling of appendix was seen. Histological exemination revealed infiltration of mature adipose tissue in the submucosal layer. Because of recurrent abdominal pain, ileocecal resection was performed at operation. We discuss the case and review the literatures on this subject.

A Case of Solitary Cecal Diverticulitis Misdiagnosed as a Cecal Tumor / 대한소화기내시경학회지

Cecal diverticulitis is a rare entity and remains a difficult diagnostic problem. Most patients are presented with an acute pain in the abdomen, which is nearly indistinguishable from that of appendicitis. Preoperative diagnostic studies are not helpful. Even with an operation, the correct diagnosis may be difficult to predict with certainty. The differential diagnosis between a cecal malignant tumor and a mass caused by inflammation due to cecal diverticulitis is difficult. Suspicion of a neoplastic process continues to prompt colectomy in an emergency setting. If diagnosed preoperatively, it can be treated effectively with a broad spectruum of antibiotics without surgical intervention. The physician must be aware this condition and be prepared to choose the most apropriate treatmetn. A case was experienced involving of solitary cecal diverticulitis misdiagnosed as a cecal tumor in a 61-year-o0ld female. This unique form of diverticulitis is herein reported with literature review.

A Case of Massive Upper Gastrointestinal Bleeding from a Duodenal Diverticulum / 대한소화기내시경학회지

Duodenal diverticulum is well-known pathologic entity. The incidence of duodenal diverticulum varies from 5% to 23% in the general population. Most of diverticula are asymptomatic and have been incidentally observed in upper gastrointestinal series or upper gastrointestinal endoscopy. It usually occurs in the second portion and the medial side of duodenum. The complications of duodenal diverticulum are rare but often result in significant morbidity. They include obstruction, cholelithiasis, ascending cholangitis, ulcers, hemorrhage and perforation. Major gastrointestinal hemorrhage resulting from an inflamed or ulcerated duodenal diverticulum is an uncommon event and it can be treated endoscopically. We report a case of massive upper gastrointestinal bleeding from a duodenal diverticulum which was treated endoscopically.

A Case of Bleeding Jejunal Tuberculosis Diagnosed with Intraoperative Endoscopy / 대한소화기내시경학회지

Tuberculosis is a multi-organ disease. The incidence of pulmonary tuberculosis is declining due to improvement in public health, vaccination and the development of anti-tuberculosis medication, but extrapulmonary tuberculosis has become more common, especially in immuno-compromised individuals, AIDS patients and immigrants to western worlds. Gastrointestinal tuberculosis continues to give rise to diagnostic and therapeutic challenges. The jejunal tuberculosis is uncommon and presents a difficult diagnostic problem. Bleeding jejunal tuberculosis is a very rare source of lower gastrointestinal bleeding. We have recently experienced a case of a jejunal tuberculosis which was proven to be a source of gastrointestinal bleeding by intraoperative endoscopy and was confirmed by surgical exploration. This report summarized our experience and review of literature.

A Clinical Review of Ulcerative Colitis / 대한내과학회지

OBJECTIVES: Ulcerative colitis is a chronic inflammatory disease of colon, which is common in western countries but rare in Korea. But the detection rate has been increasing in our hospital recently. The purpose of this study is to review the clinical features and trends of newly diagnosed cases in Korea each year. METHODS: We reviewed 126 cases, of which medical records were available and diagnosed by clinical finding, laboratory examinations, barium enema or colonoscopic examination, histologic and microbial tests at the hospitals in Pusan from Jan. 1986 to Dec. 1995. RESULTS: Recently, newly diagnosed cases tend to increase each year and the peak incidence of age groups was the fourth decade(27.4%) and the male to female ratio was 1:1.07. The common symptomes were hematochezia, diarrhea, abdominal pain, loss of weight, in the order of frequency. The laboratory findings were non-specific, including positive occult blood, increased erythrocyte sedimentation rate, anemia, hypoalbuminemia, and abnormal liver function test. According to the severity of disease, these was 50.8% in mild, 30.6% in moderate and 18.6% in severe disease. The difference of severity according to the extent of disease was not found. According to the extent of disease, these was 23.8% in proctitis, 25.4% in distal, 23.8% in left and 25.4% in extensive colitis. The incidence of proctitis was not more increased after 1991, compared with the previous records. 119 cases were treated medically and most cases showed exellent sort-term response(95.7%). According to the severity, the symptomatic remission rates of milder disease were significantly higher. Surgical treatment was performed in 4 cases(5 times); its indications were perforation in 2 cases, bleeding in 2 cases, and one case had failed to medical treatment. CONCLUSION: These results suggest that the trends of newly diagnosed cases each year have been increased recently. To evaluate the statistically significant clinical features, progress of disease and prognosis of ulcerative colitis in Korea, the nationwide collection of data is necessary.

A Case of Tracheobronchopathia Osteochondroplastica with Upper Airway Obstruction / 대한내과학회지

Tracheobronchopathia osteochondroplastica is a rarely reported disease, and the clinical course is usually benign. But it may cause significant tracheal stenosis. Although it is usually found by autopsy, with the development of bronchoscopic examination and computed tomography, antemortem diagnosis is increasing. We experienced a case of tracheobronchopathia osteochondroplastica which caused severe dyspnea, we did laryngoscopic examination, biosy and treated with tracheostomy.

A Case of Granulocytic Sarcoma causing Spinal Cord Compression in Chronic Myelogenous Leukemia / 대한혈액학회지

Granulocytic sarcoma is a localized tumor mass composed of immature cells of the granulocytic series. It can develope in patients with acute myelogenous leukemia or impending blast crisis of chronic myelogenous leukemia. Granulocytic sarcoma during the course of chronic myelogenous leukemia has beeen noted to occur in lymph node, bone, skin, breast, peritoneum, testis, ovary, gastrointestinal tract, kidney, brain. We reported a case of granulocytic sarcoma causing spinal cord compression in chronic myelogenous leukemia with a brief review of literature.

A Case of Gastric Hyperplastic Polyposis Associated with Colonic Hyperplastic Polyposis / 대한소화기내시경학회지

Gastric polyps are uncommon. The incidence of gastric polyps has been reported between 0.4% and 2.0%. Two histologically distinct forms of gastric polyps are hyperplastic polyps and adenomatous polyps. Hyperplastic polyps are multiple in up to a half of cases. When the polyps number is more than 50, the term "Hyperplastic polyposis" is applied and such cases are even more rare. Polypoid lesions of the stomach have heen reported in many of the polyposis syndromes, such as Familial polyposis coli, Gardners syndrome, Peutz-Jeghers syndrame, Juvenile polyposis and Cowdens disease. Only 1 case of gastric hyperplastic polyposis associated with colonic hyperplastic polyposis has been reported. The patient under study is not included in any polyposis syndrome and has no familial tendency, We report a case of gastric hyperplastic polyposis with colonic hyperplastic polyposis with literatures reviews.

A Case of Duodenal Metastasis of Hepatocellular Carcinoma Presenting Gastrointestinal Bleeding / 대한소화기내시경학회지

Extrahepatic metastasis of Hepatocellular carcinoma(HCC) to the gastrointestinal tract is uncommon. Because most of metastases to the gastrointestinal tract have no clinical manifestations, they are usually found incidentally at the time of an autopsy or a laparotomy, We experienced a case of duodenal metastasis of HCC, which presented UGI bleeding. A 59 years old male was admitted to our hospital due to generalized jaundice, which lasted for about a week. From the third day of admission, he had episodes of hematemesis and melena. An abdoinal CT scan demonstrated multiple, variable sized low-density masses in the entire liver with portal vein thrombosis and conglomerated lymph nodes. An esophagogastroduodenoscopy showed a protruded submucosal mass-like lesion with multiple ulceration in the duodenal bulb. We confirmed the duodenal mass-like lesion to be hepatocellular carcinoma by a biopsy and a histoimmunochemical study.

A Case of Primary Jejunal Adenocarcinoma / 대한소화기내시경학회지

The occurrence of the small intestinal adenocarcinoma is infrequent and the primary adenocarcinoma of the jejunum is rare. The survival of adenocarcinoma of the small bowel does not improve over the past three decades. Although symptoms appeared to be of long duration, most patients were diagnosed with advanced disease. All reports agree that these tumors are difficult to achieve good examination of the small bowel by both clinician and radiologist, so it cause a significant delay in diagnosis. The survival of these tumors appear to correlate with stage at presentation, and therefore early and aggressive diagnostic intervention seems to improve the outlook. We report a case of primary jejunal adenocarcinoma assoeiated with iron deficiency anemia with literatures review.

A Case of Behcet's Disease with Multiple Longitudinal Ulcers over the Colon / 대한소화기내시경학회지

We presented here a rare case of intestinal Behecet's disease simulating Grohn's disease. A 20 year old female complained of recurrence of oral ulcer, genital ulcer, arthralgia, erythema nodosum, abdominal pain and diarrhea, but she had no anal ulcer or anal fistulas. The colonoscopic examanation disclosed diffuse colonie involvement with multiple longitudinal ulcers and inflammatory pseudopolyposis. In hospital, she received ileocecectomy because of distal ilea perforation. Postoperative specimen showed multiple geographic ulcer on ileocecal region, creeping mesenteric fat and thickening of cecal wall. Pathological examination showed perivasculitis, transmural inflammation, fissuring, multiple lymph follicles which are compatible with intestinal Behect's disease. There were no granuloma sugges tive of Crohn's disease. Clinically, the patient met the international criteria of Behcet's disease. Punched out ulcer in the ileocecal region and pathological findings described above confirmed the diagnosis of intestinal Behcet's disease.

Three Cases of Gastric Carcinoma Spread to the Duodenum / 대한소화기내시경학회지

It has been thought for many years that gastric adenocarcinoma almost never crosses the pylorus. Although this theory was generally accepted, several studies have refuted it. We report three cases of gastric adenocarcinoma direct spreading into the duodenum that was diagnosed by endoscopic duodenal biopsy and review the literature.

Anomalous Drainage of the Common Bile Duct and Pancreatic Duct into the Duodenal Bulb / 대한소화기내시경학회지

While anomalies of the pancreaticobiliary system are not uncommon, drainage of the common bile duct into the bulb of the duodenum has rarely been reported. The awareness of ectopic drainage of the CBD is stressed to prevent surgical damage and improve medical management in this area. We reported one case of anomalous drainage of the CBD and pancreatic duct associated with nonvisible gallbladder or agenesis of gallbladder and cystic duct diagnosed by ERCP, ultrasonography and upper abdominal CT.

Anomalous Drainage of the Common Bile Duct and Pancreatic Duct into the Duodenal Bulb / 대한소화기내시경학회지

While anomalies of the pancreaticobiliary system are not uncommon, drainage of the common bile duct into the bulb of the duodenum has rarely been reported. The awareness of ectopic drainage of the CBD is stressed to prevent surgical damage and improve medical management in this area. We reported one case of anomalous drainage of the CBD and pancreatic duct associated with nonvisible gallbladder or agenesis of gallbladder and cystic duct diagnosed by ERCP, ultrasonography and upper abdominal CT.

Prevalence of anti-HCV in hemodialysis patients / 대한신장학회잡지

No abstract available.

Comparison between Planar View and SPECT View on the Dipyridamole Thallium 201 Myocardial Perfusion Scintigraphy

Exercise testing with Thallium imaging is widely used for the noninvasive evaluation of patients suspected of having coronary artery disease. However, many patients referred for stress testing connot exercise adequately for either physical or psychological reasons, and as a result may have nondiagnostic or suboptimal test results. Intravenous dipyridamole in conjunction with Thallium imaging is as effective alternative method without exercise. But, myocardial imaging using the standard scintillation camera technique(planner view) is hampered by superposition of proximal & distal cardial walls and by the segmental nature of myocardial ischemia. For this reason, Single Photon Emission Computed Tomography(SPECT) reslut in high specificity & sensitivity rates for the detection of coronar artery disease compared with conventional technique. So we performed dipyridamole Th-201 myocardial scintigraphy on 25 subjects who have suspicious angina or myocardial infarction instead of exercise Th-201 myocardial scintigraphy, and compared SPECT view with conventional plannar view. The results obtained are as follows : 1) T1-201 scintigraphic findings in 17 patients with suspicious angina were as follows ; redistribution defect was seen in 4 cases in plannar view and 13 cases in SPECT view. 2) T1-201 scintigraphic findings in 8 patients with myocardial infarction were as follows ; in planner view, perfusion defect was seen in all cases and 1 cases of them, redistribution defect was accompained, and in SPECT view, perfusion defect was seen in all cases and 6 cases of them, redistribution defect was accompained. 3) During dipyridamole infusion, the mean systolic & diatolic pressure decreased from 133+/-22.7/86+/-13.5 to 121+/-23.9/78+/-13.1mmHg and the heart rate increased from 68+/-12.4 to 84+/-12.4beats/min. 4) Adverse effects of dipyridamole were noted in 14(56%) of the subjects, but in 12 of these, the symptoms were mild in severity and subsided spontanously. To summarize, Dipyridamole-201 myocardial imaging is a useful and test for coronary artery disease, and the new tomographic technique, SPECT view, is more useful than the conventional plannar view.

A Case of Congenital Isolated Unilateral Absence of It. Pulmonary Artery

Unilateral adsence of a pulmonary artery is frequently undiagnosed. Unless this entity is recognized, a patient with a potentially curable lesion may become inoperable. The importance of considering unilateral absence of a pulmonary artery in the diffirential diagnosis of cyanotic congenital heart disease and pulmonary hypertension has become clear. We exeperienced a case of congenital isolated unilateral absence of it. pulmonary artery confirmed by clinical features, lung scan, echocardiogram and angiogram.