A Case of Acute Lower Gastrointestinal Bleeding from Appendiceal Ulcer / 대한소화기내시경학회지

The common causes of acute lower gastrointestinal bleeding include diverticulosis, colonic vascular ectasia, neoplasm and colitis. Acute lower gastrointestinal bleeding from the appendix is a very rare malady and the causes are reported as angiodysplasia, diverticulum, appendicitis and endometriosis. We report here on the case of a 47-year-old man, who was taking enteric coated aspirin, with severe lower gastrointestinal bleeding that was due to appendiceal ulcer. An active bleeding was identified as coming from the appendiceal orifice during colonoscopy. He was treated by simple appendectomy. Histologic evaluation showed ulceration with both acute and chronic inflammation, along with thickened vessel walls in the submucosa of the appendix.

Clinical features of gastritis cystica profunda in patients without history of gastric surgery (Gastric Cancer Patients vs. Non-cancerous Patients) / 대한내과학회지

BACKGROUND: The relationship between gastric cancer and gastritis cystica profunda (GCP) has been frequently reported on, but there have been no systemic studies on whether or not GCP is a precancerous lesion. The aim of this study is to retrospectively analyze the groups in which some of the patients were accompanied by carcinoma and the other patients were non-cancerous (35 GCP cases were without previous surgery). METHODS: From February 2000 through July 2005, 35 cases of GCP without antecedent gastric surgery were diagnosed histologically. We reviewed the medical records, the endoscopic findings and the histologic findings of the patients. RESULTS: In these cases, the age ranged from 33 and 82 years (mean: 63+/-10.1 years). The endoscopic findings of GCP were various: there were 6 erosions and 9 ulcers in the cancer group and 12 polyps in the non-cancer group (p=0.000). The mean size of the lesions was 21.4+/-17.8 mm in the cancer group and 14.6+/-9.3 mm in the non-cancer group (p=0.337). Hypertension was associated with 15 cases (42.9%) in the cancer group and with 2 cases (5.7%) in the non-cancer group (p=0.000). There were 13 smokers (37.1%) in the cancer group and 6 smokers (17.1%) in the non-cancer group (p=0.028). For the histologic findings, 6 GCP patients were associated with dysplasia of adenomas, 4 GCP patients with intestinal metaplasias and 28 GCP patients (80%) with precancerous lesions and carcinomas. CONCLUSIONS: In this study, 18 GCP patients (51.4%) were associated with carcinoma and 10 GCP patients (29%) were associated with precancerous lesions. These results suggest that GCP is a precancerous or paracancerous lesion and it may be one step in the development of carcinoma. The underlying mechanisms of gastric carcinogenesis might be confirmed if we investigate the gene mutations and environmental differences of documented GCP cases that are without previous surgery.

A Case of Gastric Ectopic Pancreas Complicated by Chronic Pancreatitis / 대한소화기내시경학회지

An ectopic pancreas is defined as the presence of pancreatic tissue lacking the anatomical and vascular continuity of the main body of the pancreas. Most cases of ectopic pancreas are found incidentally in the stomach and duodenum. The most commonly reported symptoms are abdominal pain, epigastric discomfort, nausea, vomiting and bleeding. An ectopic pancreas is subject to various pathological changes occurring in the pancreas itself: namely, cyst, pancreatitis, hemorrhage, necrosis and neoplastic changes. We report a case of a 28-year old man with epigastric pain in whom the surgical pathological diagnosis was an ectopic pancreas of the stomach with chronic inflammation.

A Case of Gastric Ectopic Pancreas Complicated by Chronic Pancreatitis / 대한소화기내시경학회지

An ectopic pancreas is defined as the presence of pancreatic tissue lacking the anatomical and vascular continuity of the main body of the pancreas. Most cases of ectopic pancreas are found incidentally in the stomach and duodenum. The most commonly reported symptoms are abdominal pain, epigastric discomfort, nausea, vomiting and bleeding. An ectopic pancreas is subject to various pathological changes occurring in the pancreas itself: namely, cyst, pancreatitis, hemorrhage, necrosis and neoplastic changes. We report a case of a 28-year old man with epigastric pain in whom the surgical pathological diagnosis was an ectopic pancreas of the stomach with chronic inflammation.

Purulent Pericarditis Caused by Group G Streptococcus as an Initial Presentation of Colon Cancer

Bacterial pericarditis has been recognized as a rare disease since the development of antibiotics. Usually, the disease is associated with underlying conditions or a seeding of infection elsewhere to the pericardium. Here we describe a case of group G streptococcal pericarditis as an initial presentation of colon cancer. A 52-yr-old man was admitted because of dyspnea. An electrocardiogram showed a diffuse ST-segment elevation and a two-dimensional echocardiogram showed a large amount of pericardial effusion. A pericardiocentesis was done and purulent fluid was drained. Group G streptococci was cultured in pericardial fluid. The patient was treated with antibiotics and pericardiostomy with saline irrigation. A colonoscopy revealed a small mass with moderately differentiated adenocarcinoma in rectosigmoid colon. He underwent a mucosectomy and was recovered without any complication.

Expression of MAGE-1, -2, and -3 genes in gastric carcinomas and cancer cell lines derived from Korean patients

We investigated the expression of MAGE-1, -2, and -3 genes in tissues of 51 gastric carcinomas from Korean patients and in 11 gastric cancer cell lines established in Korea using reverse transcriptase-polymerase chain reaction along with immunohistochemical analyses and DNA sequencing. Among the 51 gastric carcinomas, MAGE-1, -2, and -3 genes were expressed in 16 (31%), 22 (43%), and 17 (33%), respectively, and 31 (60%) expressed at least one of the three genes. In contrast, none of the three MAGE genes were expressed in normal sites of gastric tissue from each cancer patient. Out of 11 gastric cancer cell lines, MAGE-1, -2, and -3 genes were expressed in two (18%), five (46%), and four (36%), respectively. According to the clinicopathological analysis, the expression of any of the three MAGE genes was not significantly correlated with several clinicopathological factors except histologic types (p= 0.067). Immunohistochemical analyses identified positive staining with monoclonal antibodies 77B and 57B specifically against MAGE-1 and -3 proteins, respectively, in nuclei and cytoplasms of cells in mRNA-positive tumor tissue. These findings suggest the possibility as a target for tumor-specific immunotherapy for Korean patients.

Successful Immunosuppression with Cyclosporine after Renal Transplantation in a Patient with Chronic Renal Failure Due to Postpartum Hemolytic Uremic Syndrome / 대한이식학회지

Hemolytic uremic syndrome is characterized by the symptoms of microangiopathic hemolytic anemia, thrombocytopenia and renal failure. The incidence of hemolytic uremic syndrome associated with pregnancy is 10 to 25 percent. Hemolytic uremic syndrome is treated with adjunctive therapies, such as anti-platelet agents, glucocorticoid and plasma exchange. However, many patients experience a residual impairment in renal function and some of them progress to end-stage renal disease requiring dialysis or renal transplantation. Immunosuppression with cyclosporine has been implicated as a significant risk factor for post- transplant hemolytic uremic syndrome. A number of reports on transplant recipients have recognized cyclosporine-induced hemolytic uremic syndrome as a distinct entity and a potentially serious complication of cyclosporine administration.We report a case of a patient with successful renal transplantation using cyclosporine who had a severe case of post-partum hemolytic uremic syndrome that progressed to end-stage renal disease. After cadaver-donor renal transplantation using cyclosporine, mycophenolate mofetil and prednisolone her graft function at two years is normal with serum creatinine 1.0 mg/dl.