Usefulness of interferon-γ release assay for the diagnosis of latent tuberculosis infection in young children / 소아과

PURPOSE: Latent tuberculosis infection (LTBI) in young children may progress to severe active tuberculosis (TB) disease and serve as a reservoir for future transmission of TB disease. There are limited data on interferon-γ release assay (IGRA) performance in young children, which our research aims to address by investigating the usefulness of IGRA for the diagnosis of LTBI. METHODS: We performed a tuberculin skin test (TST) and IGRA on children who were younger than 18 years and were admitted to Chung-Ang University Hospital during May 2011-June 2015. Blood samples for IGRA were collected, processed, and interpreted according to manufacturer protocol. RESULTS: Among 149 children, 31 (20.8%) and 10 (6.7%) were diagnosed with LTBI and active pulmonary TB, respectively. In subjects lacking contact history with active TB patients, TST and IGRA results were positive in 41.4% (29 of 70) and 12.9% (9 of 70) subjects, respectively. The agreement (kappa) of TST and IGRA was 0.123. The control group, consisting of non-TB-infected subjects, showed no correlation between age and changes in interferon-γ concentration after nil antigen, TB-specific antigen, or mitogen stimulation in IGRAs (P=0.384, P=0.176, and P=0.077, respectively). In serial IGRAs, interferon-γ response to TB antigen increased in IGRA-positive LTBI subjects, but did not change considerably in initially IGRA-negative LTBI or control subjects. CONCLUSION: The lack of decrease in interferon-γ response in young children indicates that IGRA could be considered for this age group. Serial IGRA tests might accurately diagnose LTBI in children lacking contact history with active TB patients.

A Case of Pigmented Eccrine Poroma on the Scalp / 대한피부과학회지

Eccrine poroma is a benign tumor, which is thought to originate from the epidermal eccrine sweat duct unit. It occurs primarily on the hairless acral surface. However, there have been some cases occurring in atypical area like scalp and face. In general, eccrine poroma lacks melanin pigment clinically and melanocytes on microscopic examination. However, in either black or yellow skin, melanin granules and melanocytes can occasionally be found dispersed within the tumor. We report a case of pigmented eccrine poroma occurring on the scalp. The lesion was located on an unusual occurring site as well as contained melanocyte and melanin.

Immunohistochemical Study for Syndecan-1 and Beta-catenin Expression in Basal Cell Carcinoma / 대한피부과학회지

BACKGROUND: Syndecan-1 and beta-catenin are cell adhesion molecules, which are expressed primarily on the surface of adult epithelial cells. The expressions of them have been appeared to be inversely correlated with tumor aggressiveness and invasiveness. OBJECTIVE: The purpose of this study was to investigate the expression of syndecan-1 and beta-catenin in tissue sections of the nodular and high-risk (micronodular and infiltrative type) basal cell carcinomas. METHODS: Ten cases of nodular basal cell carcinoma and 10 cases of high-risk basal cell carcinoma (each 5 cases of micronodular and infiltrative type) were investigated. Specimens were assessed for syndecan-1 and beta-catenin expression, using a semi-quantitative method in which the intensity of membranous staining was evaluated. RESULTS: In a nodular basal cell carcinoma, syndecan-1 and beta-catenin were expressed as similar intensity to normal epidermis. In high-risk basal cell carcinoma, syndecan-1 always showed decreased staining intensity relative to that showed in the normal skin. But, beta-catenin showed similar to normal epidermis in the 5 cases, and decreased intensity relative to that of the normal epidermis in the rest. CONCLUSION: Our results suggest that the decreased expression of syndecan-1 and beta-catenin in basal cell carcinoma is associated with the tumor aggressiveness. Especially, of the two adhesion molecules, syndecan-1 is more associated with the high-risk basal cell carcinoma.

A Case of Eruptive Collagenoma / 대한피부과학회지

Eruptive collagenoma is an acquired connective tissue nevus composed predominantly of collagen. We present a case of eruptive collagenoma in a 13-years-old female who had asymptomatic multiple 3 to 9 mm sized flesh colored scattered papules on both limbs. In addition, the differential diagnosis and other types of cutaneous collagenomas are briefly discussed.

Epidermal Cyst-like Skin Metastasis in Ovarian Cancer Patient / 대한피부과학회지

Cutaneous metastasis from the ovarian cancer has been found to be exceedingly rare. We report a case of a metastatic ovarian mucinous cystadenocarcinoma, which clinically manifested as the epidermal cyst-like skin nodule on the right upper quadrant of abdomen.

A Statistical Study of Cutaneous Basal Cell Carcinoma and Squamous Cell Carcinoma in Gwangju City and Chonnam Province (2006~2010) / 대한피부과학회지

BACKGROUND: The incidence of cutaneous malignant tumors has been continuously increasing worldwide. OBJECTIVE: The purpose of this study was to analyze recent trends in the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in patients from Gwangju City and Chonnam Province. METHODS: We reviewed clinical data and histopathological reports of 82 cases of BCC and 60 cases of SCC in outpatients who had visited the department of dermatology at Chosun University Hospital between 2006 and 2010. RESULTS: The male-female ratio was 0.61:1 in patients with BCC and 0.87:1 in patients with SCC. The most frequent age group was the eighth decade (42% BCC and 67% SCC). Mean patient ages were 65.1 years and 67.8 years, respectively. The most common involved site was the face (90.2% BCC and 78.3% SCC), particularly the cheek. More skin cancers were found on the left than the right side of head and neck area in male automobile drivers only. The most frequent histological BCC subtype was the nodulocystic type (59.7%), followed by the pigmented (12.1%), and adenoid type (9.7%). The most frequent histological pattern of SCC was the well-differentiated type (66.6%). Development of BCC (61.3%) was more frequent than that of SCC in sun-exposed areas. CONCLUSION: Our data were similar to those previously reported. In our study, no difference in demographic variables such as age, gender or residence were found between patients with BCC and SCC. Additionally, no differences were observed in the incidence of BCC or SCC among the other variables. Further cohort studies that include cumulative lifetime sun exposure and a large sample size are needed.

Immunohistochemical Study for the Syndecan-1, E-cadher in and Beta-catenin Expressions in Epidermal Tumors / 대한피부과학회지

BACKGROUND: Syndecan-1, E-cadherin and beta-catenin are cell adhesion molecules that are primarily expressed on the surface of adult epithelial cells. The expressions of them appear to be inversely correlated with tumor aggressiveness and invasiveness. OBJECTIVE: The purpose of this study was to investigate the expressions of syndecan-1, E-cadherin and beta-catenin in tissue sections of normal sun-damaged skin, cutaneous premalignant lesions and squamous cell carcinoma in all stages of the evolution of lesions associated with sun exposure. METHODS: Ten normal skins from patients with actinic keratosis, 10 cases of seborrheic keratosis, 5 cases of actinic keratosis, 5 cases of Bowen's disease, 5 cases of keratoacanthoma without dysplatic cells, 5 cases of keratoacanthoma with dysplastic cells in an invasive margin, 5 cases of poor-differentiated squqmous cell carcinoma and 5 cases of acantholytic squamous cell carcinoma were investigated. The specimens were assessed for the syndecan-1, E-cadherin and beta-catenin expressions using a semi-quantitative method in which the intensity of membranous staining was evaluated. RESULTS: In almost all the cases the expression of the E-cadherin and beta-catenin was very similar. These adhesion molecules were progressively reduced in the epidermis of normal sun-damaged skin through premalignant lesions to squamous cell carcinoma. Also, the expression of syndecan-1 was similar to the E-cadherin and beta-catenin expressions except for a normal expression in premalignant lesions. But all three adhesion molecules were diminished with decreasing cell differentiation. CONCLUSION: Our results suggest that syndecan-1, E-cadherin and beta-catenin are expressed similarly in the epithelium, and that the decreased expression of these adhesion molecules is associated with malignant transformation.

Immunohistochemical Study for the Syndecan-1, E-cadher in and Beta-catenin Expressions in Epidermal Tumors / 대한피부과학회지

BACKGROUND: Syndecan-1, E-cadherin and beta-catenin are cell adhesion molecules that are primarily expressed on the surface of adult epithelial cells. The expressions of them appear to be inversely correlated with tumor aggressiveness and invasiveness. OBJECTIVE: The purpose of this study was to investigate the expressions of syndecan-1, E-cadherin and beta-catenin in tissue sections of normal sun-damaged skin, cutaneous premalignant lesions and squamous cell carcinoma in all stages of the evolution of lesions associated with sun exposure. METHODS: Ten normal skins from patients with actinic keratosis, 10 cases of seborrheic keratosis, 5 cases of actinic keratosis, 5 cases of Bowen's disease, 5 cases of keratoacanthoma without dysplatic cells, 5 cases of keratoacanthoma with dysplastic cells in an invasive margin, 5 cases of poor-differentiated squqmous cell carcinoma and 5 cases of acantholytic squamous cell carcinoma were investigated. The specimens were assessed for the syndecan-1, E-cadherin and beta-catenin expressions using a semi-quantitative method in which the intensity of membranous staining was evaluated. RESULTS: In almost all the cases the expression of the E-cadherin and beta-catenin was very similar. These adhesion molecules were progressively reduced in the epidermis of normal sun-damaged skin through premalignant lesions to squamous cell carcinoma. Also, the expression of syndecan-1 was similar to the E-cadherin and beta-catenin expressions except for a normal expression in premalignant lesions. But all three adhesion molecules were diminished with decreasing cell differentiation. CONCLUSION: Our results suggest that syndecan-1, E-cadherin and beta-catenin are expressed similarly in the epithelium, and that the decreased expression of these adhesion molecules is associated with malignant transformation.

Genetic Study in a Case of Birt-Hogg-Dube Syndrome

Birt-Hogg-Dube syndrome (BHDS) is an autosomal dominantly inherited disorder characterized by multiple trichodiscomas, fibrofolliculomas, and acrocordons. There is also an increased risk of developing renal neoplasms and lung cysts/spontaneous pneumothorax. We present a 43-year-old man with multiple, 2~4 mm sized, dome-shaped, and skin-colored papules on his cheek and neck. On the basis of clinical finding and histopathologic examination on the cheek lesion, it was diagnosed as multiple trichodiscomas. Subsequently, molecular analysis revealed a mutation in the folliculin gene. We report a rare case of BHDS with a proved gene mutation.

A case of clonorchiasis with peripheral eosinophilia and marked infiltration of eosinophils in the liver / 대한내과학회지

A marked accumulation of eosinophils occurs in several disorders, such as allergic diseases, parasitic infections, and cancers. Recently we experienced a case of clonorchiasis with a presentation of peripheral eosinophilia and eosinophilic infiltration in the liver. A 46-year-old man was admitted to the hospital because of epigastric pain. The white boold cell count was 33,900/mm3 with 70% eosinophils. Two stool examinations were negative for parasite eggs. Skin test gave a positive test for Clonorchis sinensis. CT showed inhomogeneous enhancement with multiple subcapsular low attenuation in the liver. The pathological features of the liver, which were characterized by marked infiltration of eosinophils in the periportal and intralobular areas and no evidence of parasitic ova, granuloma, or tumor, suggested that the lesions were caused by the hypereosinophilic syndrome. He was treated with corticosteroids. During management, however, antibody against C. sinensis in serum using micro-ELISA was positive and a stool specimen gave a positive test for C. sinensis ova. We diagnosed clornorchiasis and administered praziquantel to him. Peripheral eosinophilia has improved.

A Case of Intraabdominal Sparganosis Presenting as Submucosal Tumor on Gastroscopy / 대한소화기내시경학회지

Sparganosis in humans is caused by migrating larvae of the cestode Spirometra. Humans are considered the second intermediate host that are incidentally infected. Sparganosis usually infestates the subcutaneous tissues and visceral organs have rarely been reported to be involved. A case is herein reported however, a 67-year old female patient with sparganosis in the gastric wall and perigastric region, presented as a submucosal tumor upon gastrofiberscopy. The diagnosis was made after surgery by the pathologic findings determining a characteristic degenerated Sparganum and multiple tunnel-shape cavities surrounded by many inflammatory cells and necrotic materials.

A Case of a Granular Cell Tumor of the Stomach / 대한소화기내시경학회지

Granular cell tumors of the gastrointestinal tract are uncommon, and the esophagus is the gastrointestinal site most frequently affected. Such tumors are rarely seen in the stomach, colon, or rectum. Azzopardi first described a granular cell tumor of the stomach in 1956. Since then a few gastric granular cell tumors have been reported in corresponding literature. It is believed that there have been no reported case of a granular cell tumor of the stomach in Korea. Subsequently one case of a granular cell tumor of the stomach in 38 year-old female who complained epigastric soreness is herein reported, and was successfully managed by endoscopic resection.

A Prospective Endoscopic Blind Trial Comparing Precolonoscopy Bowel Cleansing Methods / 대한소화기내시경학회지

BACKGROUND AND AIMS: Although some authors have suggested that sodium phosphate (NaP) is more effective than polyethylene glycol (PEG) in bowel cleansing, there has been no crossover study proving the superiority of NaP over PEG in bowel cleansing and patients' compliance. The aim of this study was to compare the two solutions for colonoscopy, PEG and NaP, through crossover design with regard to patients' compliance, cleansing ability and side effects. METHODS: Thirty patients underwent two separate colonoscopies for colonic polyp(s) with PEG and NaP, respectively. Before and after bowel preparation, blood pressure, body weight, and serum biochemical parameters were measured in all patients. In addition, a detailed questionnaire was used to assess side effects and the patients' preference. The presence of bubbles, types of residual stool, and overall quality of colon cleansing were assessed by one endoscopist blinded to the type of preparation used. In each colonoscopy, two biopsy specimens were taken at rectum. RESULTS: In the NaP group, but not in the PEG group, there were significant changes in several biochemical parameters including sodium ( +3.0 +/- 3.0 mEq/L), potassium ( -0.3 +/- 0.3mEq/L), calcium ( -0.5 +/- 0.5 mg/dL), phosphorus ( +3.9 +/- 2.2 mg/dL) and osmolarity ( +10.1 +/- 9.3 mOsm/kg) after bowel preparation. In addition, the degree of body weight change was greater with NaP ( -2.2 +/- 2.3 kg) than with PEG ( -1.2 +/- 2.0 kg) (p=0.06) and the formation of bubbles that disturb luminal observation was more frequently found in the NaP group (p<0.01). There was no difference, however, in the type of residual stool and the overall quality of bowel preparation between the two groups and no significant mucosal change was noted after bowel preparation in both groups. Moreover, PEG was found to be more difficult to take than NaP (p<0.05) and among the 30 patients, 26 (87%) preferred NaP, while only two favored PEG (p<0.01). CONCLUSIONS: We conclude that NaP can replace PEG at least in patients with good general condition. Further studies to decrease the incidence of bubbles and to establish subgroups suitable for NaP are needed.

Long-Term Recurrent Bleeding Rate of Bleeding Peptic Ulcer / 대한소화기내시경학회지

BACKGROUND AND AIMS: Bleeding from a peptic ulcer is one of the common and serious complications associated with the rate of reported mortality, which ranges from 5% to 10%. Endoscopic therapy is effective in controlling active bleeding and reducing the emer-gency surgery, the immediate mortality rate and the incidence of early rebleeding. But few recent studies have documented the long-term recurrent bleeding rate after discharge in patients with bleeding peptic ulcers. The aim of this study was to determine the long-term recurrent bleeding rate and factors predisposing to recurrent bleeding. METHODS: Eighty-eight patients with bleeding peptic ulcers discharged after medical treatment between Dec. 1990 and Jul. 1992 were included in this study and retrospectively followed up with medical records and telephone interviews. The end point of follow-up was recur-rent hemorrhage, surgery for treatment of ulcer complication, or death. RESULTS: By July 1997, retrospective follow-up was available in 76 patients. Recurrent bleeding occurred in 23 patients (30.3%) with bleeding peptic ulcers and the median follow-up period was 69 months (range, 1 ~79 months). The estimated cumulative recurrent bleeding rate after 1, 2, 3, 4, 5 and 6 years was 11.8%, 14.5%, 19.9%, 24.2%, 27.2% and 34.2%, respectively. There was no difference between the recurrent bleeding group and the non-recurrent bleed-ing group according to age, sex, prior NSAIDs use, previous history of bleeding or pepticulcer, site of ulcer, stigmata of recent hemorrhage at initial examination, method of treatment and amount of transfusion. CONCLUSION: Recurrent bleeding occurred in one-third of patients with bleeding peptic ulcers after 6 years of follow-up and one-third of recurrent bleeders rebled within 1 year. The factors predisposing to recurrent bleeding in the long-term follow-up could not be found. Therefore, further studies designed to identify factors predisposing to recurrent bleeding are needed and the evaluation of Helicobacter pylori status in bleeding peptic ulcer is needed because Helicobacter pylori is an important factor of peptic ulcer recurrence.

Antigenic diversity and serotypes of Helicobacter pylori associated with peptic ulcer diseases

OBJECTIVES: Clinical presentation of Helicobacter pylori (H. pylori) infection has marked variation mainly due to the strain diversity and host susceptibility. Although H. pylori is identified as a major risk factor for gastric and duodenal ulcers, the ulcerogenic or pathogenic strain has not been documented yet. The objective of this study was to investigate antigenic types of the ulcerogenic strain of H. pylori. METHODS: The sera of 64 patients were tested by Western blot using Helicoblot 2.0 for six major anti-H. pylori antibodies, together with CLO test and histological examination of gastric biopsy tissues. Thirty-five, nine and 20 patients had duodenal ulcer, gastric ulcer and chronic active gastritis, respectively. The antigenic types of H. pylori were analyzed in 54 patients with positive H. pylori infection. In this study, H. pylori was divided into four serotypes according to the presence and absence of CagA and VagA: type I; CagA (+) and VacA(+), type Ia: CagA (+) and VacA(-), type Ib: CagA(-) and VacA(+), and type II: CagA(-) and VacA(-). RESULTS: There was no difference in the number of bands for six antigens: 3.2 +/- 1.4, 3.0 +/- 1.2 and 3.1 +/- 1.4 in 35 duodenal ulcer, 7 gastric ulcer and 12 chronic gastritis, respectively. The band with 119 kDa was 90.7%, which was the most common band with the order of 35, 30, 26.5, 89 and 19.5 kDa. Type I, la and Ib were positive in 22.2, 42.6 and 27.8%, respectively, which were significantly higher than type II (p < 0.05). There was no difference in the positive rates of four urease subtypes between the four serotypes.

A Case of Pneumatosis Cystoides Intestinalis / 대한소화기내시경학회지

Pneumatosis cystoides intestinalis (PCI) is defined as the presence of multiple gas filled cysts in the wall of gastrointestinal tract, and was first reported by Duvernoi in 1730 from the pathologic findings at autopsy. The etiology and pathogenesis of this relatively rare but distinctive disorder remain unresolved. We recently experienced a case of PCI, in a 28-year old woman with chronic constipation for about 10 years. The case is presented with review of the literature.

A Case Report on Acute to Subacute Panautonomic Polyneuropathy: Presenting as a Gastrointestinal Motility Disorder / 대한소화관운동학회지

The acute to subacute panautonomic polyneuropathy is an uncommon peripheral nerve disease, including (1) acute to subacute onset, (2) widespread and severe sympathetic and parasympathetic failure, and (3) relative or complete sparing of somatic nerve fibers. Widespread sympathetic failure is manifested as severe orthostatic hypotension, anhidrosis, and parasympathetic failure, as indicated dry eyes, dry mouth, and disturbances of bowel and bladder function. Abdominal pain, often colicky, is very common, and gastrointestinal symptoms, such as early satiety, bloating, nausea, vomiting, pain, diarrhea, or alterating constipation and diarrhea, may persist for years. Patients usually have a fixed heart rate (HR) and pupils. There may be an antecedent viral infection but the frequency of infection is unknown. Little information is available on the course and prognosis of panautonomic neuropathy. The mainstay of treatment is supportive for the management of orthostatic hypotension, and bowel and bladder symptoms. We have examined a 66-year-old woman complaining epigastric pain, orthostatic hypotension and voiding difficulty, and we report a case of acute to subacute panautonomic neuropathy presenting as gastrointestinal symptoms.

The Prognostic Significance of the p53 Overexpession on Complete Response and Survival in Preoperative Chemoradiotherapy Treated Squamous Cell Esophageal Carcinoma / 대한암학회지

PURPOSE: To determine the frequency of p53 overexpression and to analyse the relationship between p53 overexpression and complete response rate, survival in locoregionl squamous cell esophageal cancers treated with preoperative chemoradiation multimodality approaches. MATERIALS AND METHODS: Using a microwave oven heating method, we have detected p53 overexpression by immunohistochemically with a monoclonal antibody(DO-7) in formalin- fixed paraffin-embedded samples of 42 patients with locoregional squamous cell esophageal cancer, who treated with concurrent chemotherapy and radiatian followed by surgery. RESULTS: In 27 of 42 tumors(64.2%), nuclear immunoreactivity for the p53 protein was detected. Complete response rate, evaluated in surgical specimen 3-4 weeks after chemoradiation seemed to be high in p53 positive group compared to p53 negative group, however, there was no statistically significant difference in acquiring better complete response rate, overall survival and progression free survival between p53 positive and p53 negative group(p=0.0546, p=0.0599, p= 0.6832). Complete response group(n=17) survived longer than non-complete response group(n=25)(p=0.0010). CONCLUSION: The results indicate that p53 is not a statistically significant prognostic factor in obtaining better complete response rate, overall survival and progression free survival of the patients with esophageal carcinoma treated with preoperative chemoradiotherapy. Additional studies are warranted for further evaluation.

Clinicopathological Features of Gastric Carcinoma in the Korean Elderly

BACKGROUND: Gastric carcinoma is the leading cause of cancer death in Korea. Although the incidence of gastric carcinoma has the tendency to increase in recent years with the increase in the elderly in Korea, clinicopathological characteristics of gastric carcinoma in the elderly has not been studied in detail yet. This study was undertaken to investigate the clinicopathological features of gastric carcinoma in the Korean elderly. METHODS: The clinicopathological data, such as age, gender, cancer location, macroscopic appearance, histopathology, depth of invasion, lymph node metastasis, distant metastasis, stage, and type of operation, were retropectively reviewed from the hospital records of 682 patients with gastric adenocarcinoma admitted to the Asan Medical Center from Jan. 1996 to Dec. 1996. In 581 patients treated with gastrectomy, the postoperative findings were used in analysis, while in 101 patients receiving no operation due to mestastasis, clinical and laboratory findings were used. All patients were divided into three groups: the young; 39 years of age or younger, the middle-aged; between 40 and 64 years old, and the elderly; 65 years old or over. RESULTS: A total of 183(26.8%) of 682 patients were in the elderly, while 91(13.3%) and 408(59.8%) were in the young and middle-aged, respectively. The gender ratio for male to female was 2.3: 1 in the elderly, which was not different from that the young or middle-aged. In the elderly patients, as compared with the young or middle-aged, the antral involvement, well and moderately differentiated adenocarcinoma, Borrmann type I and II, and stage IV were more frequent, and the rate of early gastric cancer was less common. There was no significant difference in the depth of invasion, lymph node metastasis, distant metastasis and type of operation between three groups. CONCLUSION: Some of the clinicopathological features of gastric adenocarcinoma in the elderly are different from those of the young or middle-aged, and in consequence these differences should be considered in the management and study of the elderly patients with gastric carcinoma.

Two Cases of Pyoderma Gangrenosum Associated with Inflammatory Bowel Diseases / 대한소화기내시경학회지

Pyoderma gangrenosum is a painful, chronic, ulcerating skin disease of unknown cause. It commences as an erythematous papulopustule and rapidly evolves to form an area of frank ulceration with undermined, violaceous edges and a bright outer halo of erythema. Diagnosis is clinical, there being no accepted histological diagnostic criteria. An underlying systemic illness is present in more than 50 percent of patients. Pyoderma gangrenosum develops in 0.8~5.0 percent of patients with inflammatory bowel disease, which is the most frequent underlying disease of pyoderma gangrenosum. There is no report of pyoderma gangrenosum associated with Crohn's disease in Korea. We recently experienced two cases of pyoderma gangrenosum, a 52-year old man with Crohn's disease and a 30-year old man with ulcerative colitis. The cases are presented with the review of literature.