[A case of inferior vena cava thrombosis and acute pancreatitis in a patient with ulcerative colitis].

A 21-year-old man admitted complaining of sudden severe epigastric pain for 1 day. He had been diagnosed as ulcerative colitis (UC) and taking mesalazine for two months. UC was in nearly complete remission at admission. He never drank an alcohol, and serum amylase was 377 IU/L. CT scan showed inferior vena cava (IVC) thrombosis in addition to mild acute pancreatitis. To evaluate the cause of acute pancreatitis and IVC thrombosis, magnetic resonance cholangiopancreatogram (MRCP), endoscopic ultrasonogram (EUS), lower extremity Doppler ultrasonogram (US) and blood test of hypercoagulability including factor V, cardiolipin Ab, protein C, protein S1, antithrombin III, and anti phospholipids antibody were performed. There was no abnormality except mild acute pancreatitis and IVC thrombosis in all the tests. He was recommended to stop taking mesalazine and start having anticoagulation therapy. After all symptoms disappeared and amylase returned normal, rechallenge test with mesalazine was done. Flare-up of abdominal pain occurred and the elevation of serum amylase was observed. Ulcerative colitis came to complete remission with short-term steroid monotherapy. Acute pancreatitis and IVC thrombosis were completely resolved after 3-month anticoagulation therapy with no more mesalazine. We postulated that IVC thrombosis occurred due to hypercoagulable status of UC and intra-abdominal inflammation caused by mesalazine-induced pancreatitis.

Aberrant maspin expression is involved in early carcinogenesis of gallbladder cancer.

Mammary serine protease inhibitor (maspin, SERPIN-B5) is expressed in normal human mammary epithelial cells and is known to be down-regulated during cancer progression. Aberrant maspin expression has been reported in a number of cancers, including pancreatic and ovarian cancer. Recently, we identified several genes that may be tumor markers for gallbladder (GB) cancer using a DNA microarray method. There are no published data regarding maspin expression in GB cancer. The aims of this study were to determine maspin expression in normal mucosa, adenoma, dysplasia and carcinoma of GB, and to compare the pattern of maspin expression in early and advanced GB cancers. One hundred one patients with primary GB cancer who underwent resection between March 1999 and May 2008 were included. Twenty-five adenomas and 10 normal GB specimens were also included. We performed tissue microarray construction and immunohistochemical staining to evaluate maspin expression. The immunostaining results were estimated semiquantitatively by one pathologist. The positive rate of maspin expression was 59.4% (60/101) in GB cancer, whereas no maspin was expressed in adenomas and normal mucosa of GB. In case of positive maspin expression, it was gradually increased from dysplasia to carcinoma. No significant difference in the positive rate of maspin expression between early and advanced cancer was detected (49% versus 60%; P = 0.731). This result suggests that maspin expression may be involved in dysplasia-carcinoma sequence and the early steps of GB carcinogenesis.

Differential diagnosis for intrahepatic biliary cystadenoma and hepatic simple cyst: significance of cystic fluid analysis and radiologic findings.

GOALS: This study evaluated the significance of cystic fluid analysis and radiologic findings in the differential diagnosis of biliary cystadenomas (BCA) and hepatic simple cysts (HSCs). BACKGROUND: BCA are premalignant lesions. The treatment of choice is surgical excision. It is important to differentiate BCA from HSCs because they have different clinical significances and treatment plans. However, it is difficult to preoperatively differentiate a BCA from a HSC. STUDY: This retrospective study was done with 31 patients suffering from pathologically diagnosed BCA or HSC. All patients underwent surgery between May 1995 and June 2008 at a single institution and had cystic fluid analysis preoperatively or intraoperatively. RESULTS: We discovered no statistically significant differences in cystic fluid carbohydrate antigen 19-9 (CA 19-9) levels or carcinoembryonic antigen levels when comparing BCA (n=17) and HSCs (n=14). BCA were significantly more frequently associated with female sex (17/17 vs. 10/14, P=0.032), presence of a septum (16/17 vs.5/14, P=0.001), and septal thickening (8/17 vs. 1/14, P=0.021). All 3 cases with calcifications belonged to the BCA group, but sample size was too small to demonstrate statistical significance. There were no statistically significant differences in other clinical and radiologic findings including age, presence of symptoms, serum tumor markers, serum chemistry, size, location, lobulation, septal enhancement, wall enhancement, wall thickening, mural nodule, or biliary dilatation. CONCLUSIONS: Cystic fluid carbohydrate antigen 19-9 levels and carcinoembryonic antigen levels were not useful for differential diagnosis of BCA vs. HSC. BCA were more common than HSCs in females, patients with a septum, and patients with septal thickening.

[An evaluation of web-based information about Barrett's esophagus in Korea].

BACKGROUND/AIMS: Internet has become an important source of medical information not only for doctors but also patients. However, information available in the Internet may provide wrong or even harmful knowledge to the public. The aim of this study was to evaluate the quality of Internet-based medical information about Barrett's esophagus in Korea. METHODS: The first 50 Internet links were retrieved from the Google using the key word Barrett's esophagus. The quality of information from a total of 49 websites was evaluated using a checklist. RESULTS: Among total 49 sites related to Barrett's esophagus, only 4 sites (8.2%) were made by hospitals or clinics, and 11 sites (22.4%) were for patients. Of the 49 sites, only one web site (2.0%) had all HON CODE principles (authority, complementarity, confidentiality, attribution, justifiability, transparency of authorship, transparency of sponsorship, honesty in advertising and editorial policy). Sixteen Internet links (32.0%) had fair contents for the definition, and 24 links (48.0%) for the diagnosis, and 15 links (30.0%) for the treatment. CONCLUSIONS: Information about Barrett's esophagus was incomplete in the majority of medical web sites. It will bring about confusion in patients who want to get information about Barrett's esophagus from the Internet. There is a need for better evidence-based information about Barrett's esophagus on the web.

[A patient diagnosed as autoimmune pancreatitis 6 years after onset of jaundice].

The clinical manifestations of autoimmune pancreatitis (AIP) are diffuse pancreatic swelling, diffuse irregular narrowing of the main pancreatic duct, and increased serum IgG or positive serum autoantibody. Clinically, AIP can be improved dramatically with oral steroid therapy. In this report, we describe a 62-year-old woman diagnosed as autoimmune pancreatitis six years after onset of jaundice, who presented with uncontrolled blood glucose levels. The laboratory tests revealed obstructive jaundice, and the computed tomography of the pancreas showed pancreatic swelling. After six years of onset, she was diagnosed with AIP and successfully treated with steroid treatment.

[Virologic response to adefovir dipivoxil monotherapy is not durable in HBeAg-positive, lamivudine-resistant chronic hepatitis B patients].

BACKGROUNDS/AIMS: It has been shown that adefovir dipivoxil is an effective antiviral agent in the treatment of chronic hepatitis B (CHB), not only in wild-type hepatitis B virus (HBV) infection, but also in lamivudine-resistant (LAMV-R) cases. However, little is known about the durability of the virologic response to adefovir in LAMV-R CHB patients. METHODS: Fifteen HBV e-antigen (HBeAg)-positive, LAMV-R CHB patients showed a virologic response to adefovir monotherapy. These patients received additional adefovir for at least a further 12 months. The virologic relapse rate after discontinuation of adefovir was evaluated. In addition, predictive factors associated with virologic relapse were investigated. RESULTS: The median level of serum HBV DNA before adefovir administration was 7,457,840 IU/mL (range 107,920-99,524,960 IU/mL). The median duration of adefovir treatment was 30 months (range 14-46 months). During a median follow-up period of 14 months after discontinuation of adefovir, the 1-, 2-, 3-, 6-, and 12-month cumulative relapse rates were 26.7%, 53.3%, 73.3%, 80%, and 80%, respectively. High pretreatment HBV DNA levels were found to be the only factor that was predictive of off-therapy relapse. CONCLUSIONS: Our data suggest that the adefovir-monotherapy-induced virologic response is not durable in most patients with LAMV-R HBeAg-positive CHB, especially in those with a high pretreatment HBV DNA level.

[Clinical usefulness of Rockall scoring system in patients with bleeding peptic ulcer--comparison with Forrest classification].

BACKGROUND/AIMS: The Rockall risk assessment score was developed to predict the risk of rebleeding and death in patients with upper GI hemorrhage. The validity of this score, however, was not established in Korea. We tried to assess the reliability of the Rockall score to predict outcomes in patients with bleeding peptic ulcer. METHODS: Medical records of 175 patients with benign peptic ulcer bleeding treated in Samsung Medical Center from January 2000 to May 2003 were retrospectively analyzed. They were classified into three groups: no rebleeding rebleeding, and death and mean Rockall score was compared. Forrest classification was also compared with the Rockall score regarding the clinical usefulness of predicting poor outcomes in patients with bleeding peptic ulcer. RESULTS: One hundred forty five patients did not show rebleeding, with mean Rockall score of 3.5 (SD=1.5). On the other hand, rebleeding occurred in 25 patients and the mean score was 6.4 (SD=1.44). There were 13 deaths with mean score of 7.0 (SD=1.08). The differences between the three groups were significant (p<0.001). In multivariate analysis, Rockall score was a independent risk factor of rebleeding and mortality (odds ratio, OR=2.73 and OR=8.74). CONCLUSIONS: The Rockall scoring system is useful to predict poor outcome such as rebleeding and death in patients with bleeding peptic ulcer.

Dose ascites mean more severe Crohn's disease?

BACKGROUND/AIMS: Ascites that can be induced by various causes is not a rare finding in Crohn's disease. The clinical implication of ascites in Crohn's disease remains unknown in the cases without any specific cause of ascites except Crohn's disease itself. The purpose of this study was to investigate the clinical implication and characteristics of ascites in Crohn's disease. METHODS: We reviewed the medical records of the patients with Crohn's disease who underwent abdominal CT scan. Patients were categorized into two groups: patients with ascites (22 cases) and without ascites (23 cases). We compared clinical features, disease activities and clinical courses of the two groups. RESULTS: Serum albumin level was significantly lower and the C-reactive protein level was significantly higher in the ascites group than in the control group. Harvey and Bradshaw index was significantly higher in the ascites group (8.32 +/- 2.51) than in the control group (6.09 +/- 2.07) (p=0.002). The average dose of prednisolone was higher in the ascites group. On the other hand, there was no significant difference in the number of cases requiring surgery due to complication between two groups. CONCLUSIONS: Our results suggest that the presence of ascites in Crohn's disease is associated with increased disease activity and inflammations requiring more aggressive treatment.