A Case of Synchronous Early Gastric Cancer and Diffuse Large B Cell Lymphoma Treated with Endoscopic Submucosal Dissection and Chemotherapy / 대한소화기학회지

Among malignant tumors of the stomach, adenocarcinoma takes up about 95% and the remaining are mostly lymphomas, being less than 5%. The majority of lymphomas are B cell lymphomas, and the most common types are low-grade B cell lymphoma of mucosa-associated lymphoid tissue and diffuse large B cell lymphoma (DLBL). The synchronous occurrence of adenocarcinoma and lymphoma in the stomach is being reported rarely. Especially the concurrence of adenocarcinoma and DLBL is very scarce and less than 10 cases have been reported inside and outside this country. In the past, the general treatment for cases of concurrence of adenocarcinoma and DLBL when surgery is possible according to cancer stages was gastrectomy, followed by single or combined chemotherapy and radiation treatment. However, when considering that most cases of concurrent adenocarcinoma were early gastric cancer which is limited to the mucosa, endoscopic submucosal dissection (ESD) can become an alternative treatment method for gastrectomy. We report the experience with chemotherapy and ESD done together instead of surgery, in patients concurrently diagnosed with early gastric cancer and gastric lymphoma.

A Case of Gastro-colic Fistula with Peritonitis Due to Ingested Magnets / 대한소화기내시경학회지

The ingestion of a foreign body is common in children. But in adults, especially in those who have a mental illness, dysphagia, and consciousness disorders often occur. If a patient ingests more than two magnets, he can develop numerous complications such as bowel necrosis, perforation, and fistula formation. Here we report a case of a 32-year-old patient with gastro-colic fistula and peritonitis following ingestion of multiple magnets. In accidental ingestion of multiple magnets, early exploration should be considered.

A case of relapsing polychondritis and pyoderma gangrenosum in a patient with Down's syndrome / 대한내과학회지

Relapsing polychondritis (RP) is a rare multisystem disorder of unknown etiology that affects cartilaginous tissues, such as the auricular, nasal, and laryngotracheal cartilages. It may be accompanied by a wide spectrum of skin lesions, including erythema nodosum, erythema multiforme, and panniculitis. Pyoderma gangrenosum is a rare chronic cutaneous disease that usually presents as a painful nodule or pustule and progressively forms an enlarging ulcer. It may be associated with inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythromatosus, leukemia, and myeloproliferative disorders. Pyoderma gangrenosum is rarely associated with RP. RP and pyoderma gangrenosum have been reported in a patient with myelodysplastic syndrome (MDS), and the appearance of skin lesions in MDS may herald its progression to acute myeloid leukemia. Here, we report the first case of RP coexisting with pyoderma gangrenosum in a patient with Down's syndrome.

ACE Gene Polymorphism and the Development of Microalbuminura in Korean Type 2 Diabetes Patients / 대한신장학회지

PURPOSE: Pathophysiological causes of the development and progression of diabetic nephropathy are not well known, but the angiotensin-converting enzyme (ACE) gene polymorphism has been proposed to be involved in its development. To clarify risk factors for the development of microalbuminuria in Korean type 2 diabetes patients, a retrospective study on the last 10 years was conducted on outpatients with type 2 diabetes. METHODS: The impact of insertion/deletion (I/D) genotypes on the progression of diabetic nephropathy in 105 Korean type 2 diabetes patients with normoalbuminuria at diagnosis was investigated by retrospective review of clinical data. Polymorphisms of the ACE gene were examined. RESULTS: During the follow up over the last 10 years, 23 of 105 patients developed Microalbuminuria (21.9%). ACE genotypes were D/D 19.5%, D/I 41.5%, I/I 39% in microalbuminuria group, as compared with D/D 17.4%, I/D 26.1%, I/I 56.5% in normoalbuminuria group. Higher levels of mean HbA1c and mean triglyceride were noted in microalbuminuira group, as compared with those in normoalbuminuria group. Kaplan-Meier survival curve showed that higher HbA1c and higher triglyceride level were significant predictors to the development of Microalbuminuria, but I/D genotype of ACE gene did not affect. Cox regression model also showed that higher HbA1c and triglyceride were independent variables. CONCLUSION: The control of blood glucose or lipid, rather than the genetic factors such as ACE polymorphism, was considered to be more influential factor on the development of microalbuminuria in Korean patients with type 2 diabetes mellitus.

A Case of Diffuse Alveolar Hemorrhage Associated with Cytomegalovirus Pneumonia / 결핵및호흡기질환

Cytomegalovirus (CMV) pneumonia is a serious opportunistic infection in an immunocompromised host such as an AIDS patient or transplant recipient undergoing immunosuppressive therapy. Diffuse alveolar hemorrhage (DAH) is a relatively uncommon condition and it occurs most often in patients with systemic autoimmune disease. However, various types of infectious pneumonia with Mycoplsma hominis, Stenotrophomonas maltophilia and Pneumocystis jirovecii have been reported to be associated with the development of DAH. The association of CMV infection with the development of DAH has rarely been reported. We experienced a case of DAH associated CMV pneumonia and the patient was successfully treated with the use of antiviral agents and steroids.