A Case of Ischemic Colitis Following Colonoscopy / 대한소화기내시경학회지

Ischemic colitis can be caused either by vascular or colonic wall factor or by both. Shunting of blood away from the mucosa may contribute to ischemia of the colon, but the mechanism of ischemia is not known. Ischemic colitis precipitated by colonoscopy has rarely been reported. Potentially air insufflation or mechanical effect during colonoscopic examination can cause ischemic colitis as a colonic wall factor. Recently, we experienced a case of ischemic colitic, which had been developed several hours after colonoscopic polypectomy. So we report this case with brief review of literature.

Henoch-Schonlein Purpura in a Disseminated Tuberculosis Patient / 대한소화기내시경학회지

Henoch-Schonlein purpura is a systemic leukoclastic vasculitis and involves small vessels resulting in vasculitis. Major pathogenetic mechanism of Henoch-Schonlein purpura has not been still elucidated. Possible causes, however, may be associated with viral infection, bacterial infection, exposure to drugs and toxins, systemic diseases and carcinomas. Henoch-Schonlein purpura rarely develops in patients with tuberculosis, though there have been some reports on the development of this syndrome during antituberculous therapy. A 24-year-old man was admitted to our hospital because of diffuse abdominal pain, lower leg purpura and disseminated tuberculosis involving lung, duodenum, colon and lumbar spine and diagnosed as Henoch-Schonlein purpura with disseminated tuberculosis. Henoch-Schonlein purpura developed before antibuberculous therapy and antituberculous treatment was effective both in disseminated tuberculosis and Henoch-Schonlein purpura. We concluded that disseminated tuberculosis might be a cause of Henoch-Schonlein purpura.

Colonoscopic Miss-rate of Colorectal Polyp and Adenoma / 대한소화기내시경학회지

BACKGROUND/AIMS: While colonoscopy is the gold standard diagnostic test for the detection of colorectal polyps (especially adenomas), it is also an imperfect method. We prospectively estimated the colonoscopic miss-rate of colorectal polyp and adenoma. METHODS: We performed polypectomies in 603 out of 2,006 patients over age of 40 who underwent their first time colonoscopy between September 1999 and June 2001. A follow-up colonoscopy was performed within 60 days in 235 (53.4%) among 440 enrolled patients. RESULTS: Seventy-three (31.0%) of 235 patients with polyps on initial colonoscopy were missed polyps and 37 (23.2%) of 159 patients with adenomas on initial colonoscopy were missed adenomas. As the number of polyps on the initial examination increased, the miss-rate increased significantly (p=0.01). The most frequent size of missed polyp was 3~4 mm (55.5%, p=0.00) and the most frequent location was sigmoid colon (27.3%, p=0.00). CONCLUSION: It may be a fallacy to declare that all colorectal polyps are removed just after one session of colonoscopy. Examiners should make every effort to reduce the miss-rate of colorectal polyps during colonoscopy.

PCNA Expression and Electron Microscopic Study of Acinus-Forming Hepatocytes in Chronic Hepatits B

BACKGROUND: One of the major morphologic characteristics of hepatitis B is a hepatocellular regeneration which is induced by massive hepatocyte necrosis and associated with proliferative activity of hepatocytes. The purpose of this study is to document the proliferative activity of hepatocytes in various types of hepatitis B by immunohistochemical staining for proliferative cell nuclear antigen-labelling index (PCNA-LI) and electron microscopy. METHODS: We studied 83 patients with hepatitis B; 11 cases of acute viral hepatitis, 24 cases of mild chronic hepatitis, 34 cases of severe chronic hepatitis with early cirrhosis and 14 cases of severe chronic hepatitis. The PCNA was tested by immunohistochemical staining using anti-PCNA antibody. Furthermore we evaluated the ultrastructure of acinus-forming hepatocytes (AFH) by electron microscopy. RESULTS: The expression rate and labelling index of PCNA were 27.3% and 5.3 +/- 0.9% in acute viral hepatitis, 62.5% and 22.9 +/- 31.7% in mild chronic hepatits, and then 47.1% and 14.1 +/- 24.2% in severe chronic hepatitis with early cirrhosis, respectively (Figure 1). By contrast, no detectable PCNA expression was noted in AFH. Electron microscopic findings showed that hepatocytes forming a rosette underwent marked degenerative changes with sinusoidal capillarization and increased fine strands of collagen fiber in portal area. CONCLUSION: The proliferative acitivity of hepatitis B was significantly decreased in severe chronic hepatitis containing AFH. This result suggested that differences in proliferative activity was associated with hepatic cell necrosis and AFH.

Bone metastasis of gastric cancer: Clinical evaluation on bone scintigram / 대한내과학회지

BACKGROUND: It has been known that bone metastasis rarely occurs in gastric cancer, compared with lung and breast cancers. But its incidence is variable according to authors and has not been reported in Korea. We investigated the incidence and related clinical parameters of bone metastasis. METHODS: We studied a total of 226 gastric cancer patients who were diagnosed by endoscopic biopsy at Our Lady of Mercy Hospital and UiJongBu St. Mary's Hospital from 1993 to 2000. We performed abdominal CT and bone scan at the time of cancer diagnosis in all patients. The data of parameters including gross findings on gastrofibroscopy, histology, laboratory findings were obtained for analysis. RESULTS: 226 patients (male : 158 patients, female : 68 patients) were included and their mean age was 58.9+/-13.0 years. The rate of early gastric cancer was 24.8% and 75.2% for advanced cancer. The incidence of bone metastasis based on bone scintigram was 11.9% (27/226 subjects) and the main involvement sites were spine (81.5%), rib (74.1%), skull (29.6%), pelvis (14.8%). The incidence was higher in advanced stage or corpus location or elevated CEA level. Other parameters including age, sex, pathology, endoscopic gross morphology, levels of Ca, alkaline phosphatase were not significant in relation to bone metastasis. Bone metastasis was more related to lung metastasis than liver metastasis. CONCLUSION: In our study, bone metastasis is not rare in gastric cancer. Therefore, the evaluation of it should be performed selectively according to the staging, tumor location and tumor marker level.

Utility of Magnetic Resonance Cholangiopancreatography for the Diagnosis of Cholangiocarcinoma in a Patient with Situs Inversus / 대한소화기내시경학회지

Situs inversus is a rare condition with genetic predisposition and is characterized by transposition of both heart and intra-abdominal viscera to the opposite side of the body. Cholangiocarcinoma in this condition has rarely been reported. We present a case of adenocarcinoma of the common hepatic duct proximal to the cystic duct in a 68-year-old male with total situs inversus. The patient presented with complaints of abdominal pain, intermittent fever and chilling sensation without jaundice. Magnetic resonance cholangiopancreatography prior to surgery demonstrated segmental narrowing of the common hepatic duct proximal to the cystic duct and two stones in the proximal portion of the narrowed segment. Open laparotomy was performed to remove the lesion. Cholangiocarcinoma was confirmed pathologically. Magnetic resonance cholangiopancreatography was the only pre-operative diagnostic method which had suggested malignancy in this case.

Expression Patterns of E-cadherin and beta-catenin According to Clinicopathological Characteristics of Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: E-cadherin is involved in intercellular binding and cellular polarity formation. beta-catenin plays a fundamental role in regulation of the E-cadherin cell adhesion complex. The abnormalities of the components of the complex may disrupt this adhesive function. We investigated the expression patterns of E-cadherin and beta-catenin to determine the clinical significance of these proteins in hepatocellular carcinoma. MATERIALS/METHODS: Thirty-six hepaticellular carcinoma tissues and adjacent non-tumor specimens were analyzed. Subcellular distribution of E-cadherin and beta-catenin was examined by immunohistochemistry staining. We evaluated the patterns of the expression, and investigated the relationship with the cause of HCC; level of AFP; TNM stage; tumor size; growth types; metastasis; differentiation grade of HCC; and presence of portal vein thrombosis. RESULTS: Immunohistochemistry showed that all non-tumor tissues had membranous type staining of E-cadherin. All non-tumor tissues showed cytoplasmic type staining of beta-catenin, but no beta-catenin accumulation in nuclei was found. 58% (21/36) of HCC showed positive expression of E-cadherin in cytoplasmic membrane. The cytoplasmic expression of beta-catenin in HCC was 83% (30/36); nuclear expression in 14% (5/36); and no staining in 3% (1/36). Nuclear beta-catenin expression was observed in none (0/4) of the well-differentiated HCC; 17%(3/9) of moderate-differentiated HCC; and 17%(2/6) of poorly-differentiated HCC. There were no relationships between E-cadherin and beta-catenin expression with other clinicopathologic factors. CONCLUSIONS: Loss of cytoplasmic staining of E-cadherin and nuclear accumulation of beta-catenin were observed in HCC. Nuclear accumulation of beta-catenin was not found in well differentiated HCC but was found in poorly differentiated HCC.

Electron Microscopic Mesenchymal Response in Chronic Viral Hepatitis / 대한간학회지

BACKGROUND/AIMS: This study was designed to clarify the fine structures of the hepatocytes and mesencymal tissues in chronic hepatitis according to severity. METHOD: For the purpose of elucidating the ultrastructural characteristics of mesenchymal tissues, liver biopsy specimens were studied by light and electron microscopy in 20 patients with chronic hepatitis. RESULTS: 1) Hepatocytes in mesenchymal tissues were thought to be in the stage of regenerated or degenerated process. 2) Regenerating nodules were surrounded by a basement membrane-like materials in the space of Disse. 3) In the widened Disse space the deposition of collagen fiber bundles and increased numbers of hepatic stellate cells in necrotic area were observed. 4) In necrotic areas, hepatic mesenchymal cell response including an increase of collagen fibers and fibroblast, angiogenesis, and a proliferation of bile ductules were also observed. CONCLUSIONS: These observations suggest that the fibrosis in severe chronic hepatitis was accompanied by the mesenchymal response including the proliferation of hepatic stellate cells, fibroblasts, capillarization of Disse space, and mesenchymal proliferation. Finally, this fibrosis observed electron microscopically may be a cause of functional hepatic failure.

Lamivudine-Resistance in Patients with Chronic Hepatitis B and/or Cirrhosis and Detection of Mutations in YMDD Motif of Hepatitis B Virus Genome / 대한간학회지

BACKGROUND/AIMS: Lamivudine is an antiviral nucleoside analogue effective for the treatment of hepatitis B virus (HBV) infection via the inhibition of DNA polymerase activity. The mutations, however, in YMDD motif, such as YVDD and YIDD, have been found to interfere with the therapeutic efficacy of lamivudine. This study was performed to identify the role of such mutant-type HBV among Korean hepatitis B patients with chronic hepatitis or cirrhosis receiving lamivudine treatment. METHODS: Serum samples were collected from four groups of patients; patients with breakthrough (group I, n = 8); patients who showed no response after the treatment (group II, n = 6); patients who showed good response (group III, n = 6); patients with chronic hepatitis B without any treatment (group IV, n = 4). Mutations were detected by PCR-cloning and automated sequencing. RESULTS: Mutations in YMDD were found in only 4 (50%) in group I and were negative in group II. No mutations could be identified in the serum samples collected before treatment and from groups III and IV. YVDD mutation was found to be associated with two additional mutations, 'L-to-M' in 528th amino acid and 'L-to-V' in 577th amino acid. CONCLUSIONS: Lamivudine resistance appeared in three different patterns: (1) breakthrough related to the mutations in YMDD motif; (2) breakthrough not related to the YMDD mutations; and (3) primary non-responder not related to the YMDD mutations.

Mutations of hepatitis C virus 1b NS5A 2209-2248 amino acid sequence is not a edictive factor for response to interferon-alpha therapy and development of patocellular carcinoma

Genetic changes between codons 2209 and 2248 of NS5A of genotype 1b hepatitis C virus (HCV-1b) have been reported to be associated with the sensitivity to interferon-alpha (IFN-alpha). The present study was performed to analyze such relationship in Korean patients with chronic hepatitis C and HCV-1b (n=19), including 12 chronic hepatitis C patients treated with IFN-alpha, 3 chronic hepatitis C patients without treatment as controls, and 4 patients with hepatocellular carcinoma (HCC). Two serum samples, before and after the treatment, were analyzed for the mutations by reverse transcription-polymerase chain reaction, cloning and sequencing. The mutations were identified in 32% (6/19), including five intermediate type (1-3 mutations) and one mutant type (4 or more). In 12 patients treated with IFN-alpha, the number of amino acid substitutions in NS5A2209-2248 was not associated with outcome of the treatment.

A Case of MALToma Involving Stomach and Small Intestine / 대한소화기내시경학회지

A 74-year old male was admitted to St. Mary's Hospital due to symptoms of diarrhea and fever. He was diagnosed with MALToma in the jejunum 6 months previously, but had refused any treatment. This time, an endoscopy revealed multiple erosions and nodular mucosa in the body, fundus of the stomach and 3rd portion of duodenum. Abdominal computed tomography showed wall thickening in 3rd portion of the duodenum and upper jejunum with multiple lymph nodes enlargement. Additionally, an endoscopic biopsy revealed MALToma in the stomach and duodenum. Salmonella group B grew in a blood culture and a chest PA determined pneumonic infiltration in the left lower lobe. He received sulperazone for 7 days, but again refused any further treatment and was thereby discharged after had improved condition.

A Case of Boerhaave Syndrome with Empyema in both Lungs in Alcoholic Liver Cirrhosis / 대한소화기내시경학회지

Spontaneous esophageal perforation (Boerhaave Syndrome) is an unusual condition that frequently leads to fatal complications. It typically occurs with rigorous emesis after an unduly large meal or heavy drinking. Its diagnosis is often delayed in almost all cases due to nonspecific symptoms and signs, resulting in increased morbidity and mortality. Therefore early diagnosis and appropriate treatment are very important. Recently we experienced a case of esophagogastric junctional perforation accompanied by bilateral empyema and mediastinitis after heavy alcohol drinking in a 56-year-old male patient. He was presented with hematemesis and abdominal pain. We diagnosed him using esophagography and chest CT. Thus, we report a case with a brief review of related literatures.

A Case of Lupus Cystitis / 대한내과학회지

Systemic lupus erythematosus is a disease of unknown cause which involves various organs and primary involvement of urinary bladder is very rare. We experienced a case of a female patient with SLE and urologic manifestations (interstitial cystitis, hydroureters and hydronephrosis), which were resolved spontaneously without any immunosuppressive therapy. There was no significant correlation between clinical course and disease activity index.

Relationship between Intrahepatic Expression of Hepatitis Be Antigen and Histology in Patients with Hepatitis B Virus Infection / 대한내과학회지

BACKGROUND: It has been known that the sero- logic markers of infectivity and viral replication in patients with hepatitis B virus(HBV) infection are hepatitis B e antigen(HBeAg), HRV DNA and HBV DNA polymerase. METHODS: In order to clarify the relationship between chronic liver diseases and HBV infection, and the mechanism of chronicity in HBV related liver diseases, the expression patterns of hepatic HBeAg by imrnunohistochemical stain and histologic activity index(HAI) were studied from 10% formalin fixed paraffin embedded tissues in 114 patients performed liver biopsy. RESULTS: The results were as follows: 1) Incidence of serum HReAg positivity in HBsAg positive patients was 74.6% and that of hepatic HBeAg expression was 77.6% among serum HBeAg positive cases. Hepatic HBeAg expression was 72.4% in serum HBeAg negative cases. 2) In serum HBeAg positive cases, almost all infected hepatocytes exhibited cytoplasmic HBeAg expression and half of patients showed nuclear HBeAg expression, but cytoplasmic HBeAg expression was solely predominant in serum HBeAg negative cases. Hepatic HBeAg expression showed a decreasing trend from AVH and CPH, through CAH, to cirrhosis with or without HCC, which was a consistent finding with serum HBeAg in decreasing manner. Hepatic HBeAg expreassion was highly sustained in about 60-90% of cases, regardless of duration of their illnesses. 3) HAI showed slighf3y higher tendency in patients with hepatic HBeAg negative expression than in positive cases. CONCLUSION: The above results suggest that HBeAg may play a role as a viral target antigen for immune-mediated liver injury and may be also related to the pathogenetic mechanism of chronicity in chronic hepatitis B.

Esophagus, Stomach & Intestine; A Case of Ectopic Pancreas of the Duodenum with Massive upper Gastrointestinal Bleeding / 대한소화기내시경학회지

Ectopic pancreas is commonly located at stomach, duodenum and jejunum. It is a relatively rare entity and is usually of no clinical importance which especially is a very rare source of massive upper gastrointestinal bleeding. We have recently experienced a case of an ectopic pancreas in the second portion of the duodenum which was proven to be a source of massive gastrointestinal bleeding by duodenoscopy and was confirmed by surgical exploration.

Analysis of 15 Cases of Ischemic Colitis Induced by Increased Abdominal Pressure / 대한소화기내시경학회지

It was suggested that temporary vascular insufficiency within the wall of the colon causes iachemic colitis. So, motivated by this fact, we studied and analyzed 15 cases of iachemic colitis, which were confirmed by the diagnostic criteria of Nagasako(1982), through 32 months from January, 1993 to August, 1995 at Our Lady of Mercy Hospital, Incheon.(continue...)

Analysis of 15 Cases of Ischemic Colitis Induced by Increased Abdominal Pressure / 대한소화기내시경학회지

It was suggested that temporary vascular insufficiency within the wall of the colon causes iachemic colitis. So, motivated by this fact, we studied and analyzed 15 cases of iachemic colitis, which were confirmed by the diagnostic criteria of Nagasako(1982), through 32 months from January, 1993 to August, 1995 at Our Lady of Mercy Hospital, Incheon.(continue...)

A Case of Bleeding from Jejunal Leiomyosarcoma Diagnosed with Small Bowel Enteroscopy / 대한소화기내시경학회지

In the evaluation of the source of occult bleeding, it is mandatory that the small bowel be investigated. But, the small bowel is the area where endoscopic approach is most difficult. The endoscopic evaluation of the small intestine has rapidly evolved over the last 10 years and now includes many of the diagnostic and therapeutic capabilities of standard endoscopic procedures. Various techniques have been developed, including fiberoptic sonde enteroscopy, retrograde ileoscopy, intraoperative enteroscopy, "push" enteroscopy using a pediatric colonoscope, and video enterocopy. Therefore, the small bowel enteroscope has shown great promise in the evaluation of obscure or persistent gastrointestinal bleeding. We have experienced a case of bleeding from jejunal leiomyosarcoma, which diagnosed with small bowel enteroscopy. So we report the case with a brief review of literature.

Three Cases of Primary Adenocarcinoma of the Buodenal Dulb / 대한소화기내시경학회지

Duodenal tumor is relatively rare disease, accounting for about 0.3% of all carcinomas of the gastrointestinal tract. Although radiological and endoscopic examinations have become popular, we are not so familiar with the duodenal tumors as those of the other gastrointestinal tumors. The absence of precise symptoms and the rarity of primary malignant neoplasms in this localization are frequently the reason for the late diagnosis. And so, often the true nature and localization of the tumor are only determined during surgery or autopsy. But, recently, duodenal bulb is examined with ease and pathologic diagnosis is possible following the diffusion of panendoscopy. We have experienced three cases of primary duodenal bulb carcinoma, which diagnosed by biopsies with gastrofibroscopic endoscopy. So we report the cases with a brief review of literature.

Diminutive Colonic Polyps (Less than 5 mm in diameter) : Endoscopic and Histologic Study / 대한소화기내시경학회지

A series of 241 polyps from 127 patients endoscopically removed during the period from march 1991 through July 1992 at our department were analysed. The following items were studied. 1) Incidence, age, and sex distrlbution of the patients 2) Number of the calonic polyps 3) Histologic classification and polyp size 4) Anatomic distribution and polyp size 5) Gross types and polyp size 6) Hietopathologic types and polyp size In conclusion, colonic diminutive polyps should not be ignored or overlooked clinically. The majority were neoplastic polyps. It is suggested that diminutive polyps should be removed endoscopically if possible