A Case of Primary Gastric Marginal Zone B-Cell Lymphoma Presenting as Multiple Polyps / 대한내과학회지

Marginal zone B-cell lymphoma of the gastrointestinal tract most commonly affects the stomach. Endoscopic findings of primary gastrointestinal lymphoma are various and heterogeneous. Lesions may appear as ulcers, erosions, or erythemas. Gastrointestinal lymphomas presenting as multiple polyps on endoscopy are rare. No case of marginal zone B-cell lymphoma manifesting as multiple polyps has been reported on the stomach, although a few cases have been reported in the colon. We present a rare case of a 77-year-old female patient diagnosed as primary gastric marginal zone B-cell lymphoma presenting as multiple polyps. She was fully treated by combination chemotherapy.

A Case of Hemophagocytic Syndrome in an Ulcerative Colitis Patient / 대한소화기학회지

A case of hemophagocytic syndrome associated with ulcerative colitis is very rare. A 32-year-old man visited the hospital complaining of fever and severe abdominal pain for 7 days. He was diagnosed to have ulcerative colitis 2 years ago and had been treated with sulfasalazine. Three months ago, he had abdominal pain, weight loss, and hematochezia, so prednisolone and mercaptopurine were added to the treatment. On admission, the physical examination showed splenomegaly. Peripheral blood counts revealed pancytopenia, and bone marrow aspirate smears showed many histiocytes with active hemophagocytosis. There was no evidence of viral and bacterial infections and other neoplasms, which were commonly associated with hemophagocytic syndrome. He was successfully treated with high dose steroid. We report this case along with a review of the related literatures.

A Case of Spontaneous Regression of Advanced Gastric Cancer

An 84 yr-old male with a history of nausea and vomiting for 3 weeks was admitted to our hospital. Esopahgogastroduodenoscopy showed the diffuse infiltrative type of gastric cancer encircling from the cardia to the lower body. On abdominal computerized tomography, the gastric wall was diffusely thickened with overlying mucosal enhancement without lymph node involvement. Histologic examination revealed poorly differentiated adenocarcinoma. So surgical resection was planned. However, patient refused all medical care, and then he was discharged. He lived without any medical support and then he revisited our hospital and showed relieved symptoms on the follow-up exam. On esophagogastroduodenoscopy, the gastric mucosa of the body looked normal without any dysplastic change. Abdominal CT revealed a decreased thickening of the gastric wall of the body. The histology from the endoscopic forceps biopsy showed no evidence of malignancy. The patient is alive without any sign of tumor recurrence after 14 months.

A Case of Cystic Brunner's Gland Hyperplasia with Intracystic Inverted Growth / 대한소화기내시경학회지

Cystic Brunner's gland hyperplasia is a benign lesion of the duodenum that may not be familiar to gastroenterologists because of its rarity. Moreover, cystic Brunner's gland hyperplasia with intacystic inverted growth is more uncommon lesion. Here, we report a case of cystic Brunner's gland hyperplasia in a 34-year-old man. An endoscopy of the upper digestive tract revealed the presence of a 1.2 cm sized polypoid mass of the duodenal second portion. Endoscopic submucosal dissection was performed to remove the mass. Microscopically, a cystic lesion was seen in the submucosa underneath the normal surface duodenal mucosa. Hyperplastic Brunner's glands were seen close by the cyst. The cyst was lined by a layer of columnar epithelium similar to that of Brunner's gland ducts with no cytologic atypia. Also, a part of the cyst lining was inverted into the cyst lumen with fibrovascular core. Therefore, The final diagnosis was a cystic Brunner's gland hyperplasia with intracystic inverted growth.

A Comparison of the Clinical Features between Panic Disorder with and without Agoraphobia

OBJECTIVES: This study was performed to investigate the differences of the clinical feature between panic disorder with agoraphobic patients and panic disorder without agoraphobic patients. METHODS: Two hundred nine patients meeting the criteria of DSM-IV panic disorder were recruited. One group was panic disorder with agoraphobia(n=78, 42 male(53.8%), mean age 37.6+/-9.9 years), another was panic disorder without agoraphobia(n=131, 81 male(61.8%), mean age 40.5+/-10.3 years). The numbers and frequency of panic symptoms were compared between two groups with t-test, and the logistic regression analysis were used for predicting panic disorder with agoraphobia. RESULTS: The number of panic symptoms during panic attack was significantly higher in the group of panic disorder with agoraphobia than the group of panic disorder without agoraphobia(p<0.05). 'Sweating', 'nausea or abdominal distress', 'fear of losing control of going crazy', 'chills or hot flushes' were more frequent in the group of panic disorder with agoraphobia(p<0.05). Among panic symptoms on logistic regression analysis, 'sweating', 'nausea or abdominal distress', 'fear of losing control or going crazy' turned out to correlate significantly with risk of development of agoraphobia in panic disorder. CONCLUSION: These results suggest that the frequency of some symptoms during panic attack may be a predictor of agoraphobia in patients with panic disorder.

Diagnostic value of ultrasonography to distinguish between benign and malignant lesions in the management of thyroid nodules / 대한내과학회지

BACKGROUND: Thyroid ultrasonography can accurately detect nonpalpable nodules, estimate the size of the nodule during follow-up, and discriminate between solid nodules and simple cysts. Many studies have recently been done to detect malignant thyroid nodules by high-resolution ultrasonography. However, the exact role of high-resolution ultrasonography in distinguishing benign from malignant nodules is still unresolved. We analyzed the sonographic characteristics of thyroid nodules and assessed the diagnostic value of ultrasonography. METHODS: We retrospectively analyzed the sonographic feature of thyroid nodules in patients who had been examined with fine-needle aspiration cytology or had surgery for a thyroid nodule at St. Mary's Hospital, Korea from January 2003 to January 2005. Sonographic features that suggested malignancy include microcalcifications, an irregular or microlobulated margin, marked hypoechogenicity, and a shape that was more tall than it was wide. If even one of these sonographic features was present, the nodule was classified as category 3 (malignant). If a nodule had none of the features described, it was classified as category 2 (benign). Anechogenic cystic nodule was classified as category 1 (benign). RESULTS: Of 124 lesions classified as category 3, 60 were malignant. Of 418 lesions classified as category 1 or 2, 409 was benign. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy based on sonographic classification method were 90%, 86.5%, 48.4%, 97.8%, 86.5%, respectively. CONCLUSIONS: Our results identified sonographic classification with calcification, margin, echogenicity and shape as useful tool in the differentiation of malignant from benign nodule. In view of the high value of negative predictive value of sonographic classification, a more aggressive approach is recommended only for nodules with category 3.

4 Cases of Intracardiac Metastasis of Hepatocellular Carcinoma

Antemortem diagnosis of inferior vena cava (IVC) and cardiac metastasis of hepatocellular carcinoma (HCC) is difficult but important to decide on treatment strategy. There are only a few cases of cardiac metastasis of HCC which have been diagnosed antemortem by echocardiography. We experienced 3 cases of IVC and Right atrial metastasis and 1 case of Left atrial metastasis of HCC. The tumor was discovered during computed tomography scanning. The patients had exhibited no signs of cardiac involvement. In this case, transesophageal echocardiography was valuable in providing information regarding the exact location of the tumor and its relation to surrounding anatomical structures. Left atrial metastasis of HCC is unusual patterns and probably related to tumor growth from the pulmonary veins following massive metastasis to the lung.

A Case of Intraaortic Mass

Primary aortic malignant tumors are extremely rare. When symptomatic, aortic intimal sarcomas give clinical findings secondary to embolic phenomena;they can produce mesenteric ischemia, hypertension, skin necrosis, absence of peripheral pulses. The diagnosis can be suspected radiologically Fibrosarcoma is the most common primary aortic malignancy, but angiosarcoma and leiomyosarcoma may also occur. We experienced a case of intraaortic mass, that was suspected as angiosarcoma, that diagnosed by chest CT, transesophageal echocardiography, aortography, and biopsy.

A Case of Gastrointestinal Stromal Tumor of the Stomach with a Gastric Fistula / 대한소화기내시경학회지

Gastrointestinal stromal tumors (GIST) are mesenchymal gut tumors that lack markers of myogenic differentiation, but express CD34 and CD117, which are products of the c-kit oncogene. They present commonly gastrointestinal bleeding and abdominal pain and/or palpable mass. The other symptoms may include anorexia, weight loss, obstruction, perforation or fever. Fever due to abscess formation is rare complaint of GIST. We report a case of GIST of stomach with abscess and gastric fistula in a 54-year-old male who presented a three-week history of abdominal pain and fever. Fistula opening site was observed by endoscope, and abdominal CT showed multiple air pockets within the mass representing communication with bowel lumen by fistula.

In vitro study of the tensile bond strength of cement-eetained single implant prosthesis by the various provisional luting cements and the surface treatment of abutments / 대한치과보철학회지

The main disadvantage of cement-retained implant restorations is their difficulty in retriev-ability. Advocates of cemented implant restorations frequently state that retrievability of the restoration can be maintained if a provisional cement is used. The purpose of this study was to find the optimal properties of provisional luting cements and the surface treatment of abutments in single implant abutment system. 30 prefabricated implant abutments, height 8mm, diameter 6mm, 3-degree taper per side, with light chamfer margins were obtained. Three commercially available provisional luting agents which were all zinc oxide eugenol type ; Cavitec, TempBond and TempBond NE were eval-uated. No cement served as the control. TempBond along with vaseline, a kind of petrolatum(2:1 ratio) was also evaluated. Ten out of thirty abutments were randomly selected and abutment surfaces were sandblasted with 50 mu m aluminum oxide. Another ten abutments were sandblasted with 250 mu m aluminum oxide. A vertical groove, 1 mm deep and 5mm long was cut in each twenty abutments. Ten of them were sandblasted with 50 mu m aluminum oxide. The full coverage casting crowns were cemented to the abutments with the designat-ed provisional luting agent. Specimens were stored in distilled water at 37 degrees C for 24 hours. Each specimen was attached to a universal testing machine. A crosshead speed of 0.5mm/min was used to apply a tensile force to each specimen. Within the limitations of this in vitro study, the following conclusions were drawn: 1. Tensile bond strength of provisional luting cements in no surface treatment decreased with the sequence of TempBond NE, TempBond, Cavitec, TempBond with vaseline, no cement. 2. Tensile bond strength more increased by surface treatment. Sandblasting with 250 mumaluminum oxide exhibited the highest tensile bond strength in the abutment cemented with TempBond NE and sandblasting with 50 mu m aluminum oxide exhibited the highest tensile bond strength in cemented with TempBond. 3. In the aspect of a groove formation, tensile bond strength significantly increased in TempBond with vaseline only and the others had no significant effect on tensile bond strength.