Three Cases of Gastric Anisakiasis Mimicking Submucosal Tumor / 대한소화기내시경학회지

Gastric anisakiasis is a parasitic infestation that occurs after eating raw marine fish that contain Anisakis larvae. The diagnosis is usually confirmed by endoscopy, which often reveals the presence of the larvae itself, mucosal edema, erosion, ulceration, and hemorrhage. However, gastric anisakiasis mimicking submucosal tumor is extremely rare. To date, six cases have been reported in Korea. We report three additional cases of gastrtic anisakiasis mimicking submucosal tumor. An asymptomatic 56-year-old man and a 40-year-old woman underwent endoscopis examination during a physical checkup, and a 63-year-old woman visited our hospital complaining of epigastric discomfort.The endoscopic findings indicated submucosal tumors in all cases. Endoscopic ultrasonography revealed inhomogeneous, hypoechoic lesions in submucosal layer (1 case) and muscle layer (2 cases). A laparoscopic and endoscopic resection was carried out for definite diagnosis and treatment. The pathologic findings of the resected specimens were eosinophilic granuloma caused by Anisakis.

Three Cases of Gastric Anisakiasis Mimicking Submucosal Tumor / 대한소화기내시경학회지

Gastric anisakiasis is a parasitic infestation that occurs after eating raw marine fish that contain Anisakis larvae. The diagnosis is usually confirmed by endoscopy, which often reveals the presence of the larvae itself, mucosal edema, erosion, ulceration, and hemorrhage. However, gastric anisakiasis mimicking submucosal tumor is extremely rare. To date, six cases have been reported in Korea. We report three additional cases of gastrtic anisakiasis mimicking submucosal tumor. An asymptomatic 56-year-old man and a 40-year-old woman underwent endoscopis examination during a physical checkup, and a 63-year-old woman visited our hospital complaining of epigastric discomfort.The endoscopic findings indicated submucosal tumors in all cases. Endoscopic ultrasonography revealed inhomogeneous, hypoechoic lesions in submucosal layer (1 case) and muscle layer (2 cases). A laparoscopic and endoscopic resection was carried out for definite diagnosis and treatment. The pathologic findings of the resected specimens were eosinophilic granuloma caused by Anisakis.

Expression of PTEN and Its Correlation with Angiogenesis in Gastric Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Phosphatase and tensin homolog deleted on chromosome ten (PTEN) is a recently clarified tumor suppressor gene located in 10q23.3. Alterations of this gene are associated with tumor progression and unfavorable outcome in various human cancers. Recently, PTEN has a possible role in angiogenesis by modulating angiogenic factor including vascular endothelial growth factor (VEGF). The aim of this study was to investigate the roles of PTEN and VEGF status for angiogenesis in human gastric cancer. METHODS: We conducted an immunohistochemical investigation of PTEN and VEGF expression in 90 cases of paraffin section obtained from gastric cancer patients undergone surgical treatment. RESULTS: Negative expression of PTEN and positive expression of VEGF in gastric cancer tissues, were demonstrated in 40.0% and 77.8% of cases, respectively. However, no significant correlation was found between PTEN, VEGF expression and various clinicopathological parameters. PTEN expression did not correlate significantly with VEGF expression (p=0.301). High microvessel density (MVD) was significantly associated with lymph node metastasis and poor survival (p=0.014, 0.011, respectively). The mean MVD value of PTEN negative tumors was 90.4+/-43.0 and significantly higher than that of PTEN positive tumors (p=0.028). The mean MVD value of VEGF positive tumors was 86.4+/-36.7 and significantly higher than that of VEGF negative tumors (p=0.002). The mean MVD value of PTEN negative and VEGF positive tumors was 98.0+/-42.2, and significantly higher than those of the others. CONCLUSIONS: These results suggest that loss of PTEN expression may play a critical role in tumor progression and metastasis by stimulating tumor angiogenesis in human gastric cancer.

A Case of Primary Pure Squamous Cell Carcinoma of the Stomach / 대한소화기내시경학회지

Primary pure squamous cell carcinoma of the stomach is extremely rare. To date, five cases have been reported in Korea. We report an additional case of a 71-year-old male with pure squamous cell carcinoma of the stomach. Upper gastrointestinal endoscopy showed a large ulceroinfiltrating mass with irregular margin in the body of the stomach. Histologic examination of biopsy specimen confirmed moderately differentiated squamous cell carcinoma. Abdominal computed tomography showed metastatic mass in the left hepatic lobe, pancreatic body and tail. Despite the combination chemotherapy with docetaxel, cisplatin and 5-fluorouracil, the patient died from wide spread metastasis.

A Case of Duodenal Gastrointestinal Stromal Tumor Presenting with Gastrointestinal Bleeding / 대한소화기내시경학회지

Gastrointestinal stromal tumor (GIST) is the most common non-epithelial tumor of the gastrointestinal tract. GISTs are most common in the stomach, followed by small intestine, colon and rectum, and esophagus. We report a case of duodenal GIST presenting with gastrointestinal bleeding in a 53-year-old male. Upper gastrointestinal endoscopy revealed a protruded mass with central ulceration on the second portion of the duodenum. Spontaneous spurting blood was encountered from the central ulcer of the mass. Abdominal computed tomography scan and celiac angiography revealed hypervascular tumor, located in the second portion of the duodenum. Laparotomy with wedge resection was performed. Histological and immunohistochemical studies on resected specimen revealed a duodenal GIST of a combined smooth muscle and neural type.

Clinical Effectiveness of Transcatheter Arterial Embolization for Acute Upper and Lower Non-variceal Gastrointestinal Bleeding / 대한소화기학회지

BACKGROUND/AIMS: Although the initial rate of hemostasis achieved by endoscopic treatment for acute non-variceal gastrointestinal bleeding (NVGIB) is high, recurrent or persistent bleeding occurs in 10% to 25% of the patients. The aim of this study was to assess the efficacy and safety of transcatheter arterial embolization (TAE) in patients with acute upper and lower NVGIB who could not be managed by endoscopic treatment. METHODS: A retrospective analysis of the clinical data was done in 43 patients (M/F: 26/17, mean age: 60 years) whom underwent angiography or TAE for acute upper and lower NVGIB between January 1998 and December 2003. Among 43 patients, 18 had upper NVGIB, 19 had lower NVGIB, and 6 had obscure gastrointestinal bleeding. Demographic characteristics and outcome parameters including the rates of hemostasis, in-hospital death, and complications were analyzed. RESULTS: Thirty-four patients underwent TAE while 9 patients underwent angiography. TAE was used as the first line treatment in 17 patients and as the second line treatment in others. Hemostasis was achieved in 29 of 34 patients (85.3%) by TAE. According to the site of bleeding, hemostasis was achieved in 14 of 17 patients (82.4%) with upper NVGIB and in 15 of 17 patients (88.2%) with lower NVGIB. There was no significant angiography or TAE-related complications such as bowel ischemia or infarction except a hematoma on the angiography site in one patient. CONCLUSIONS: TAE is effective and safe in patients with acute upper or lower NVGIB who cannot be managed by endoscopic treatment.

Endoscopic Findings of Children with Henoch-Schonlein Purpura

PURPOSE: This study was performed to analyze the endoscopic findings in Henoch-Schonlein purpura patients, and to compare the differences in endoscopic findings according to age and gastrointestinal symptoms. METHODS: We examined children with Henoch-Schonlein purpura aged 3 to 15 years between September 1996 and October 2002. The total number studied was 65, consisting of 41 boys and 24 girls. Endoscopy was performed and the results were analysed. RESULTS: Among 65 cases, 12 cases of duodenitis, nine cases of gastritis and duodenitis, six cases of duodenal erosion, five cases of gastritis, five cases of duodenal ulcer, two cases of gastric ulcer and one case of colonic erosion were noted. Endoscopic abnormality was found in 38 of 53 who had gastrointestinal symptoms, and in two of 12 who didn't have gastrointestinal symptoms. CONCLUSION: Most of the gastrointestinal symptoms in Henoch-Schonlein purpura patients were relieved without complication. But in some cases severe symptoms such as hematemesis, melena, and abdominal pain localized to epigastric area were developed when diagnosis was delayed. Prompt endoscopy will be helpful for diagnosis and therapy of Henoch-Schonlein purpura with gastrointestinal involvement.

A Clinical Study on the Upper Gastrointestinal Tract Injury Caused by Corrosive Agent / 대한소화기내시경학회지

BACKGROUND/AIMS: The incidence of corrosive injury has been decreased, compared with past years. However, the ingestion of corrosive agent for suicidal attempt is on an increasing trend. Though corrosive injury on gastrointestinal tract is very common, there are few clinical studies on this field. METHODS: Retrospective study was performed on 48 patients who ingested corrosive agent from 1992 to 1998. The kinds of corrosive agent, cause of ingestion, symptoms, gastroscopic findings, treatment and complications were analyzed. RESULTS: The most common agent of ingestion was acetic acid (47.9%), followed by hydrocholoric acid (18.8%), cresol (10.4%), lye (10.4%), sulfuric acid (4.2%). Ingestion for suicidal attempt (60.4%) was more frequent than accidental ingestion (39.6%). The frequent symptoms were sore throat (31.3%), dysphagia (27.1%), epigastric pain (22.9%), vomiting (18.8%), chest pain (18.8%), GI bleeding (12.5%), dyspnea (12.5%) and hematuria (8.3%). The esophagus was the most common site of corrosive injury and Grade IIa injury was the most frequent finding on gastroscopy. In most cases, prophylactic antibiotics with or without steroid was administered for conservative treatment. For long-term sequelae, there were 7 cases (14.6%) of esophageal stricture, and 2 cases (4.2%) of gastric outlet obstruction. CONCLUSIONS: Corrosive injury on gastrointestinal tract is frequently observed on early gastroscopy and can cause significant late sequelae, such as stricture. Therefore, it is necessary to evaluate regular follow up gastroscopy for the management of late sequelae.

A Study on The Change of HBsAg and Anti-HBs Positivities for A Recent 15 Year Period in Korea / 대한간학회지

BACKGROUND/AIMS: The HBsAg positivity in the normal Korean population has been reported as 2-10%. It has been decreasing since hepatitis B vaccine was introduced to routine vaccination regimens in 1992. Reports on the changes of anti-HBs over the years are hard to find since the discrepancies in sensitivities of test methods used by different researchers did not allow equivalent comparisons. The purpose of this study was to evaluate the changes of HBsAg and anti-HBs posivities for a recent 15 year period. METHODS: From 1998 to 2000, 4771 subjects in Chonnam province were included in this study. Serum HBsAg and anti-HBs were detected by reversed passive hemagglutination (RPHA) and passive hemagglutination (PHA) respectively. The changes in the HBsAg and anti-HBs positivity by the same test methods for the period were analyzed by comparing our results with those of 12 other previous reports. RESULTS: The positivities of HBsAg and anti-HBs were 5.3% and 47.5%. The positivity of HBsAg was significantly higher in males, while that of anti-HBs was significantly lower in males (p40) was significantly higher statistically (p<0.01). The positivity of HBsAg decreased with years (r=-0.845, p<0.01), while that of anti-HBs increased with years (r=0.616, p<0.05). CONCLUSION: The positivity of HBsAg has significantly decreased and that of anti-HBs has increased with years for the period under study.

Endoscopic Removal of Foreign Bodies from the Upper Gastrointestinal Tract in Children: Management of 78 Cases in Taegu, Korea / 대한소화기내시경학회지

BACKGROUND/AIMS: Foreign body (FB) removal is a common indication of therapeutic endoscopy in children. The trend is becoming wider and more rational in application. The spectrum of upper gastrointestinal FB's in children during a recent 2 year period was reviewed in Taegu, Kyungbook Province in order to obtain a the consensus of recent trend of indications and techniques of endoscopic FB removal in children. METHODS: Esophagogastroscopy was performed on 78 children who had been referred to 3 University Hospitals in Taegu for FB ingestion from Oct. 1996 to Sep. 1998. RESULTS: Age between 1~2 year was the peak age group; 22 cases (28%). Male to female ratio was 1.9:1. Thirty four cases (44%) were in the esophagus, 44 cases (56%) in the stomach. The majority (49%) of the FB's were coins, 26 of 34 esophageal FB's and 12 of 44 gastric FB's. Others were 14 sharp/pointed objects, 12 big/long objects, 7 toxic objects, etc. In 67 children (86%) the FB was successfully removed and spontaneous passage through the pylorus was observed in 9 children. CONCLUSIONS: Endoscopic FB removal can be performed safely and effectively in children with minimal or no complications by an experienced endoscopist. Proper arrangement should be conducted with consideration to the property of FB's, expected complication, and the possibility of an emergency situation.

A Case of Acute Respiratory Distress Syndrome Occurred after Pulmonary Edema in a Fullterm Newborn

Acute respiratory distress syndrome (ARDS) is a syndrome identified as acute respiratory failure and is characterized by wide spread infiltrates on chest radiograph, impaired oxygenation, and noncardiogenic pulmonary edema. This syndrome is identified very uncommonly during neonatal period. We experienced a case of ARDS in a 3-day old fullterm neonate who had had the sign of pulmonary edema. He was improved with the treatment of mechanical ventilation, but pulmonary interstitial emphysema and periventricular leukomalacia were complicated.

A Case of Multiple Sclerosis Presenting as Acute Disseminated Encephalomyelitis

Multiple sclerosis and acute disseminated encephalomyelitis are demyelinating diseases of the central nervous system those can present initially as an acute focal demyelinating syndrome. Multiple sclerosis is characterized by a multiphasic disease with stepwise or progressive deterioration in neurologic function, whereas acute disseminated encephalomyelitis is a monophasic disease with good prognosis. So the differentiation of the two diseases in a patient with single clinical episode attributable to central nervous system demyelination is of prognostic importance, but the differentiation is not easy. We report a case of multiple sclerosis with spinal cord involvement initially misdiagnosed as acute disseminated encephalomyelitis in the brain stem.

A Case of Primary Intestinal Lymphangiectasia / 대한소화기내시경학회지

We described a 22-month-old girl, who suffered from a gereralized edema and intermittent diarrhea for 1 month. Intestinal lymphangiectasia was confirmed by endoscopic biopsy. Endoscopic examination revealed showed the characteristic appearance of tiny white flakes scattered in the duodenum, which a histological examination confirmed to be dilated lymph vessels. The other findings from laboratory examinations included lymphopenia, hypoproteinemia, hypogammaglobulinemia and increased fecal a1-antitrypsin clearance. Treatment consisting of a low-fat diet and MCT supplementation was successful. The therapy has resulted in the disappearance of duodenal lesions previously observed endoscopically.

Hematopoietic Stem Cell Colony Formation of the Fetal Liver / 대한혈액학회지

BACKGROUND: Hematopoietic stem cells of the human fetal liver prior to 15 weeks gestation have remakable advantages for successful engraftment due to embryological immune immaturity, especially in-utero transplantation. This study was undertaken to obtain objective assessment data about the possibility of fetal liver hematopoietic stem cell transplantation in the future. METHODS: Six cases of the fetal liver tissue were obtained from therapeutic abortions at 12~20 weeks gestation. The fetal liver was collected in RPMI media containing 10% fetal calf serum and the cell suspensions were obtained by centrifugation following physical disruption. The number of nucleated cells in each case was counted and the colony numbers in methyl cellulose media were scored according to incubation period with or without growth factors. Some of the cells were cryopreserved in the liquid nitrogen tank, thereafter cell viability and colony numbers were evaluated according to cryopreservation period. RESULTS: The nucleated cell numbers obtained from each fetal liver increased with gestational age. The colony numbers after incubation increased with gestational age and the erythroid lineage was predominant in 3 cases which are under 15 weeks gestation. The colonogenic activity after incubation with combination of hematopoietic growth factors increased in only one case. The cell viability and the colony numbers after cryopreservation was decreased compare to the value before cryopreservation. CONCLUSION: The number of nucleated cells and hematopoietic stem cell colony formation were increased with gestational age and viability of the cells after cryopreservation was decreased. Further systematic studies using more cases would be needed to obtain objective assessment data for fetal liver transplantation program in the future.

Incidence of Congenital Heart Disease in Neonate by Color Doppler Echocardiography

PURPOSE: Many reports exist about the frequency of congenital heart disease (CHD) in the world, but according to the definition of CHD and subjects of study group, many differences existed between the reports. We conducted this study to evaluate the incidence and frequency of CHD by color Doppler echocardiography in neonate, and to suggest a preliminary model of incidence of neonatal CHD in Korea. METHODS: During July 1992 to June 1995, we conducted echocardiography in 285 babies who were suspected as having a CHD. RESULTS: Among the 16,672 neonate born alive at Dong San Hospital, 121 patients with CHD were identified by color Doppler echocardiography (7.26/1,000 live birth). The incidence of CHD of neonate born at our hospital were as follows: Among 121 cases, ventricualr septal defect 37.2%, atrial septal defect 17.4%, patent ductus arteriosus 12.4%, tetraology of Fallot 4.1%, transposition of great artery 4.1%. The incidence of CHD of neonate born at another hospital were as follow: Among 169 cases, ventricular septal defect 53.8%, atrial septal defect 14.2%, tetralogy of Fallot 7.7%. pulmonary stenosis 5.3%, transposition of great artery4.1%. The incidence of isolated ventricular septal defect were as follow: Perimembranous defect 79.4%, muscular defect 14.7%, subpulmonic defect 5.9%. CONCLUSION: In this study, the incidence of CHD was 7.26 per 1000 live births. The incidence of tetralogy of Fallot in neonate was less than that of in children. and among VSD, the incidence of muscular type was relatively high.

Change of Thyroid Function during Chemotherapy in Chilolren with Acute Leukemia / 대한소아혈액종양학회지

BACKGROUND: The overall prognosis of acute leukemia has dramatically improved in the past 20 years, primarily due to the use of intensive multiagent chemotherapy in combination with CNS prophylaxis. However, increased aggressiveness of treatment protocols was entailed a great risk of various toxic effects. Endocrine function was also affected. The aim of this study is to compare the effect of chemotherapy on thyroid function in children with acute leukemia. METHOD: Parameters of thyroid function during chemotherapy were measured in 11 children with acute leukemia. Level of the serum 73,74 and TSH were determined before therapy, 7th day and 30th day of chemotherapy. Determination of serum 73, 74 and TSH were performed by conventional radioimmunoassay technique. Statistical analysis was done using SAS software. RESULT: 1) Level of level 73 was normal in 7 cases before therapy and decreased in 9 cases on 7th day of remission induction therapy. On 30th day, 73 level was increased to normal value. 2) Level of 74 was normal before therapy and decreased on 7th day of therapy. On 30th day of therapy 74 level showed various change. Three of them showed sustained low level of 74 on 7th and 30th day. 3) Level of TSH were normal before therapy and decreased on 7th day of therapy, followed achievement of normal level after completion of induction therapy. CONCLUSION: We conclude that during induction chemotherapy in childhood acute leukemia, thyroid function was impaired which was reversible.

A Case of Ectopia Cordis

Ectopia cordis is a very rare cardiac anomaly that the heart is partially or totally outside the thorax, and it was classified anatomically as 5 types-cervical, thoracocervical, thoracic (most common type), thoracoabdominal, abdominal types. We experienced a case of ectopia cordis (thoracic type) in a newborn who had the symptom of generalized cyanosis since birth, and expired during operation due to recurrent bradycardia and hypotension. The brief review of literature was made

A Study of Gastroesophageal Reflux using 24hour pH Meter in Fullterm and Preterm Infants / 대한주산의학회잡지

BACKGROUND: Gastroesophageal reflux is common in infants. The incidence of reflux in preterm infant has been reported to be higher than in fullterm infant. We perform this study to evaiuate the gastroesophageal reflux in preterm infant and fullterm infant. METHOD: A continuous 24 hour esophageal pH monitoring was performed in 28 asymptomatic infant(16 preterm infants and 12 fullterm infants). Four parameters(reflux index, number of reflux episodes in 24 hours, number of reflux episodesp 5 minutes in 24 hours, and duration of the longest reflux episode) were analyzed by gestation and birth weight. RESULT: All four parameters were not different in the low birth weight infant group(birth weight or =2,500gm. In preterm infant group, mean reflux index was 3.08+/-6.84%; number of reflux episodes in 24 hours was 85.94+/-145.99; number of reflux episodes longer than 5 minutes was 0.38+/-0.72; and duration of the longest reflux episode was 3.69+/-4.88 minutes. In fullterm infant group, mean reflux index was 9.42+/-8.98%; number of reflux episodes in 24 hours was 190.58+/-158.27; number of reflux episodes longer than 5 minutes was 5.17+/-5.97; and duration of the longest reflux episode 16.58+/-15.41 minutes. Significant differences in reflux index, number of reflux episode longer than 5 minutes, and duration of the longest reflux episode were found between the preterm infant and fullterm infant. The number of reflux episodes in 24 hours was not different between preterm and fullterm infants. CONCLUSION: In continuous 24 hour esophageal pH monitoring, gastroesophageal reflux was more common in fullterm infant than preterm infant.

Normal Values of Left Ventricular Mass by Echocardiography in Korean Children

PURPOSE: Determination of left ventricular myocardial mass with echocardiography is feasible and validated. American Society of Echocardiography(ASE) issued recommendations for the quantitation of the left ventricle by M-mode echocardiography. The purpose of this study is to determine the mean value of left ventricular mass in Korean children. METHODS: We measured left ventricular mass in 498 subjects(male 289, female 209) using ASE cube method with correction in M-mode method. RESULTS: 1) The mean value of left ventricular mass corrected by body surface area are respectively: 54.87+/-27.45 gm/m2 in Korean male children, and 49.57+/-23.16 gm/m2 in Korean female children, by echocardiography in accordance with the ASE convention. 2) The left ventricular mass correlated well with the left ventricular end-diastolic dimension, interventricular septal thickness, left ventricular posterior wall thickness, and left ventricular end-diastolic volume. CONCLUSIONS: These normal values shoud provide a valuable database for further studies of the development of left ventricular mass in patients with various cardiac abnormalities.

Comparisons of the Left Ventricular Ejection Fraction Between M-Mode, Two-Dimension Echocardiographic Studies and Digital Cardiac Imaging(DCI) System in Ventricular Septal Defects*

BACKGROUND: Left ventricular performance is one of the most important factors for the prognosis of congenital and acquired heart diseases. Measure of left ventricular performance such as chamber volume and ejection fraction are usually deemed most reiable when derived from cardiac catheterization data. Measurement of ventricular volume and ejection fraction by M-mode echocardiography may be compromised by segmental dysfunction or paradoxical septal motion. We compared ejection fraction derived from M-mode and two-dimensional echocardiographic methods to those derived from newly developed DCI (Digital Cardiac Imaging) system to determine the most accurate noninvasive technique for prediction these variables in children. METHODS: The ejection fraction measured by M-mode, Two-dimensional echocardiography was compared with the ejection fraction by DCI system in 22 patients who were admitted to the department of Pediatrics, Dong San Hospital during the period of 8 months from November 1992 to June 1993 for the evaluation of ventricular septal defect. RESULTS: M-mode measured ejection fraction correlated with Two-dimensional echocardiography measured ejection fraction(gamma=0.54). M-mode measuredd ejection fraction correlated with the DCI system measured ejection fraction(gamma=0.52). Two-dimensional echocardiography measured ejection fraction correlated well with the DCI system measured ejection fraction(gamma=0.88). CONCLUSION: 1) For ejection fraction, the best correlation with DCI was achieved by two-dimensional Simpson's method. 2) Two-dimensional Simpson's method appeared a safe and useful noninvasive method of evaluation left ventricular ejection fraction.