Short-term efficacy of 1-month and 3-month gonadotropin-releasing hormone agonist depots in girls with central precocious puberty

Purpose@#Gonadotropin-releasing hormone agonist (GnRHa) has been the mainstay of central precocious puberty (CPP) treatment for decades, but few reports have compared the efficacy of 1-month and 3-month depot GnRHa formulations. This study investigates the short-term efficacy of 1-month and 3-month GnRHa depots in girls with CPP. @*Methods@#Overall, 150 girls with CPP were included in a retrospective review of medical records. Subjects in group 1 (n=105) were treated with 1-month GnRHa depots for ≥12 months, and those in group 2 (n=45) were treated with 1-month GnRHa depots for 6 months followed by 3-month GnRHa depots for ≥6 months. Anthropometric and biochemical data were compared between the groups at 3-time points (after 0, 6, and 12 months of GnRHa treatment). @*Results@#Demographic and clinical characteristics did not differ between the groups at baseline or after 6 months of GnRHa treatment. After 12 months of GnRHa treatment, patients in the both groups showed no difference in bone age (BA), chronological age (CA), BA–CA difference, height standard deviation score (SDS) for CA and BA, or body mass index SDS for CA and BA. The sexual maturity rate of the breast was prepubertal at 12 months in most of subjects. GnRH-stimulated luteinizing hormone (LH) level was suppressed during GnRHa treatment in both groups at 6 and 12 months, although the LH level in group 2 was higher than that in group 1. @*Conclusion@#Treating CPP with a 3-month GnRHa depot showed short-term efficacy comparable to that with a 1-month depot in anthropometric parameters and pubertal suppression.

Short-term efficacy of 1-month and 3-month gonadotropin-releasing hormone agonist depots in girls with central precocious puberty

Purpose@#Gonadotropin-releasing hormone agonist (GnRHa) has been the mainstay of central precocious puberty (CPP) treatment for decades, but few reports have compared the efficacy of 1-month and 3-month depot GnRHa formulations. This study investigates the short-term efficacy of 1-month and 3-month GnRHa depots in girls with CPP. @*Methods@#Overall, 150 girls with CPP were included in a retrospective review of medical records. Subjects in group 1 (n=105) were treated with 1-month GnRHa depots for ≥12 months, and those in group 2 (n=45) were treated with 1-month GnRHa depots for 6 months followed by 3-month GnRHa depots for ≥6 months. Anthropometric and biochemical data were compared between the groups at 3-time points (after 0, 6, and 12 months of GnRHa treatment). @*Results@#Demographic and clinical characteristics did not differ between the groups at baseline or after 6 months of GnRHa treatment. After 12 months of GnRHa treatment, patients in the both groups showed no difference in bone age (BA), chronological age (CA), BA–CA difference, height standard deviation score (SDS) for CA and BA, or body mass index SDS for CA and BA. The sexual maturity rate of the breast was prepubertal at 12 months in most of subjects. GnRH-stimulated luteinizing hormone (LH) level was suppressed during GnRHa treatment in both groups at 6 and 12 months, although the LH level in group 2 was higher than that in group 1. @*Conclusion@#Treating CPP with a 3-month GnRHa depot showed short-term efficacy comparable to that with a 1-month depot in anthropometric parameters and pubertal suppression.

Cytomegalovirus Enteritis Causing Ileal Perforation in an Elderly Immunocompetent Individual

Cytomegalovirus (CMV) infection is usually subclinical in immunocompetent individuals, however it can be life threatening in an elderly immunocompetent individual. We report a case of CMV enteritis causing ileal perforation in a physically active elderly man. An 88-year-old healthy man presented with abdominal pain and diarrhea. After initial conservative treatment, emergency laparotomy was performed for ileal perforation. The diagnosis of CMV enteritis was based on histological findings revealing many large cells with CMV inclusion bodies in the surgical specimen. In elderly individuals, even though they are immunocompetent, CMV enteritis may result in major complications such as bowel perforation, and it should be included in the differential diagnosis of diarrhea if it is resistant to conventional treatment.

A Case Report with Lymphangiomatosis of the Colon

The incidence of lymphangiomas in the gastrointestinal tract is low, particularly in the colon and rectum, and most cases are solitary. Lymphangiomatosis of the colon are encountered infrequently with only one report in the English literature, and polypectomy was performed for the diagnosis in that case report. However, trends in the diagnosis of lymphangiomatosis of colon have been changing since the development of endoscopic ultrasonography (EUS), and this case is the first in that lymphangiomatosis of the colon was diagnosed without invasive procedures. Here we describe the case of 31-yr-old woman with lymphangiomatosis of the colon with numerous polyposis-like appearing lesions diagnosed by endoscopic ultrasonography and a colonoscopy.

Giant Mesenteric Lipoma As an Unusual Cause of Abdominal Pain: A Case Report and a Review of the Literature

We report a rare case of giant mesenteric lipoma presenting with colicky abdominal pain. A 29-yr-old woman underwent laparoscopic resection for a giant mesenteric lipoma causing compression of the ileal loop. The resected ileal segment was encased by a giant fatty tissue, and normal mucosal fold patterns of the resected ileum were effaced by the mass. Microscopically, the mass was characterized by homogenous mature adipose tissue without cellular atypia, which was compatible with the diagnosis of a mesenteric lipoma. Despite the benign nature of this tumor, total excision with or without the affected intestinal loop should be considered if intestinal symptoms such as abdominal pain are present.

Granular Cell Tumor of the Descending Colon Treated by Endoscopic Mucosal Resection: A Case Report and Review of the Literature

Although colorectal granular cell tumors (GCTs) are rare, their incidental finding has increased as the use of diagnostic colonoscopy has become more common. Here we describe the case of a 41-yr-old man with a GCT in the descending colon that was detected after a screening colonoscopy. Endoscopic examination revealed a yellowish submucosal tumor, 13x12 mm in diameter, in the descending colon. Endoscopic mucosal resection (EMR) followed by histological examination revealed that the tumor was composed of plump histiocyte-like cells with an abundant granular eosinophilic cytoplasm and small round nuclei. The tumor cells expressed S-100 protein and stained with periodic acid-Schiff, but were negative for desmin and cytokeratin. The resected tumor was diagnosed as a GCT. Colonoscopists should consider the possibility of GCT in the differential diagnosis of yellowish submucosal tumors of the colon. In such patients, EMR seems to be a feasible and safe approach for diagnosis and treatment.

The Safety and Efficacy of Azathioprine and 6-Mercaptopurine in the Treatment of Korean Patients with Crohn's Disease

BACKGROUND/AIMS: This study aimed to evaluate the adverse events and efficacy of azathioprine (AZA) and 6-mercaptopurine (6-MP) in Korean patients with Crohn's disease (CD). METHODS: We retrospectively analyzed 700 patients with CD (male : female=469 : 231; median age at diagnosis, 22 years; agerange, 9-74 years) who were treated at the Asan Medical Center between January 1997 and January 2006. RESULTS: Of 700 patients, 372 (53.1%) were treated with AZA/6-MP. The cumulative rates of AZA/6-MP treatment at 1, 5, 10, and 20 years were 17.4%, 51.6%, 73.1%, and 94.5%, respectively. Of 372 patients treated with AZA/6-MP, 217 patients (58.3%) experienced 291 adverse events, requiring discontinuation of therapy in 41 patients (11%). Nausea occurred in 120 patients (32.3%) and led to discontinuation of therapy in 11 patients (3.0%). Leukopenia developed in 116 patients (31.2%), requiring dose adjustments in 100 patients (26.9%) and discontinuation of medications in 16 patients (4.3%). Other adverse events included infections (2.7%), abnormal liver function tests (2.7%), fever (0.8%), hair loss (0.8%), arthralgias (0.5%), pancreatitis (0.5%), headaches (0.5%), and skin rashes (0.3%). Complete corticosteroids withdrawal was achieved in 70.9% of the patients based on an intention-to-treat analysis. The remission rate of perianal fistulas was 32.6%. CONCLUSIONS: The risk of leukopenia by AZA/6-MP is higher in Korean patients with CD than in Western patients. Although the adverse events of AZA/6-MP are not uncommon in Korean patients with CD, the actual discontinuation rate of the treatment is low. Therefore, AZA/6-MP can be administered to most Korean patients with CD without serious adverse events.

A Case of Small Rectal Carcinoid Tumor with Local Lymph Node Metastases / 대한소화기내시경학회지

Carcinoid tumors are rare and they arise from the enterochromaffin cells of the gastrointestinal tract. The rectum is the most common site for gastrointestinal carcinoids, and the majority of rectal carcinoids are found incidentally during colonoscopy. As the use of diagnostic colonoscopy has recently become more common, the number of cases with small rectal carcinoids resected by endoscopic resection has increased. However, distinguishing benign from malignant carcinoids is usually imposible based solely on the histology; therefore, evaluation for the local and distant metastases of rectal carcinoids is necessary even after complete endoscopic resection. We have experienced a case of small rectal carcinoid tumor that was endoscopically completely resected and surgical resection was done for the associated lymph node metastases.

A Case of Esophageal Tuberculosis as the Cause of a Fever of an Unknown Origin / 대한소화기내시경학회지

Fever of an unknown origin (FUO) means a fever that does not resolve spontaneously, and the cause remains elusive after an extensive diagnostic workup. The most common cause of FUO is infectious disease, and the most common infectious cause documented in Korea is tuberculosis, and particularly extrapulmonary or miliary tuberculosis. Among the extrapulmonary tuberculosis, esophageal tuberculosis is a very rare form of adult tuberculosis, and even in Korea with its high prevalence of tuberculosis. Esophageal tuberculosis can present as systemic symptoms such as weight loss, fever, chills and general weakness, or as local symptoms such as chest pain, dysphagia, cough and hematemesis. However, it can present as a prolonged fever of an unknown origin without any other symptoms. In this report, we describe a patient with esophageal tuberculosis, and the patient presented with a fever of unknown origin for 1 month. The patient was diagnosed by esophagogastroduodenoscopy with biopsy and he responded well to antituberculosis therapy.

Clinicopathologic Characteristics of Barrett's Cancer in Korea

BACKGROUND/AIMS: The incidence of Barrett's cancer is increasing in Western countries, but there have been only a few case reports of this condition in Korea. The aim of this study was to elucidate the endoscopic and pathologic characteristics of Barrett's cancer in a single center in Korea. METHODS: We retrospectively reviewed the demographic, endoscopic, and pathologic characteristics of six patients with Barrett's cancer, defined as a tumor centered above the esophagogastric junction and surrounded by Barrett's esophagus. RESULTS: All six patients were male, and three (50%) were symptomatic. Barrett's cancer had developed from short-segment Barrett's esophagus in all patients. All tumors were located on the right side of the lower esophagus and showed hyperemic mucosal changes. Three patients were treated surgically and three by endoscopic resection. All cases had pathologic evidence of Barrett's cancer. CONCLUSIONS: Early detection of Barrett's cancer requires meticulous endoscopic observations of subtle mucosal color and morphological changes around the esophagogastric junction.

A Case of a Sharp Denture-Induced Esophageal Perforation Managed by Medical Treatment / 대한소화기내시경학회지

Foreign bodies in the esophagus are regarded as clinically important as they cause symptoms such as pain and dysphagia and can cause complications such as perforation. Recent progress in therapeutic endoscopy has made it possible to extract most foreign bodies in the esophagus. However, endoscopic extraction of sharp foreign bodies impacted in the esophagus may be a difficult and complicated procedure. Although rapid surgical intervention is the main treatment for esophageal perforation, medical treatment can be successful for a minor perforation after early diagnosis if the perforation size is small and symptoms or signs associated with the perforation are mild. We report a case of a sharp denture- induced esophageal perforation managed by medical treatment that consisted of parenteral nutrition and antibiotics. This case highlights the necessity for an early diagnosis and treatment for an esophageal perforation, which can occur even after removal of a foreign body.

A Case of a Myxoid Variant of a Pedunculated Extraluminal Gastrointestinal Stromal Tumor (GIST) in the Stomach / 대한소화기내시경학회지

Gastointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. They are frequently identified as incidental lesions found by routine endoscopy or in resection specimens that are removed for other reasons. The macroscopic morphology of GISTs may be classified as the intraluminal type, extraluminal type, mixed type and intramural type. The extraluminal type is the second most frequent tumor encountered, but a GIST pedunculated externally from the stomach is very rare. In addition, the myxoid epithelioid variant, which is characterized by an unusually myxoid stroma and epithelioid histology, is also a rare distinct subtype of a GIST that is closely correlated with negative immunoreactivity for c-kit. We report a case of a myxoid epithelioid variant of a pedunculated extraluminal GIST in a 62-year-old man that presented with an abdominal mass.

A Case of a Meckel's Diverticular Bleeding Diagnosed by the Use of Double Balloon Enteroscopy / 대한소화기내시경학회지

Meckel's diverticulum is one of the most common congenital anomalies, and its incidence is about 2% in the population. Most of the cases are asymptomatic and only 5% of cases are symptomatic with complications, including bleeding, intestinal obstruction, inflammation and perforation. Bleeding from a Meckel's diverticulum is usually painless and is sometimes massive. Recently, the use of double balloon enteroscopy has allowed improved access in patients with obscure gastrointestinal bleeding; however, a case of bleeding from a Meckel's diverticulum treated with double balloon enteroscopy hs rarely been reported. Double balloon enteroscopy can diagnose a Meckel's diverticulum without difficulty as the lesion is usually located at the distal ileum, and the method provides endoscopic hemostasis for the bleeding. Therefore, double balloon enteroscopy might be a useful diagnostic and therapeutic modality for bleeding from a Meckel's diverticulum. We experienced a case of bleeding from a Meckel's diverticulum that was detected and was treated by the use of double-balloon enteroscopy in a 47-year-old man with recurrent episodes of melena.

A Case of Colon Cancer Coexisting with Colonic Tuberculosis / 대한소화기내시경학회지

Patients with chronic inflammatory bowel disease have a potential risk for developing colorectal cancer. Simultaneous occurrence of tuberculosis and colon cancer at the same segment of the colon has been reported; however, there is little causal relationship between the two disorders. The occurrence of tuberculosis and an adenocarcinoma at the same segment of the colon may lead to a histological misdiagnosis of either lesion. Furthermore, it may be difficult to determine the correct radiological cancer staging before surgery, as tuberculous lymphadenitis may be misinterpreted as a lymph node metastasis of colon cancer. We report here a rare case of colon cancer coexisting with colonic tuberculosis at the same segment of the colon. In addition, we review the clinical characteristics of reported patients with similar conditions following a computerized search of KoreaMed and PubMed.

A Case of Multiple Carcinoid Tumors of the Rectum / 대한소화기내시경학회지

Carcinoid tumors are rare and arise from enterochromaffin cells of the gastrointestinal tract. The rectum is the most common site for gastrointestinal carcinoids. The tumor usually present as small solitary submucosal nodules and multicentricity is rare, occurring in only a few percent of cases. The treatment for a rectal carcinoid tumor is based on the size of the lesion and depth of invasion. Although the present treatment guidelines for multiple rectal carcinoids are controversial, each small lesion of less than 1 cm without evidence of a metastasis can be adequately treated by local resection such as an endoscopic mucosal resection. We experienced a case of multiple rectal carcinoids that were completely resected after a hot biopsy and endoscopic mucosal resection.

A Case of Recurrent Intestinal Obstruction Caused by Meckel's Diverticulum / 대한소화기학회지

Meckel's diverticulum is the most common anomaly of the intestine. It is usually asymptomatic but approximately 4% are symptomatic with complications such as bleeding, intestinal obstruction, and inflammation. Gastrointestinal bleeding is the most common presenting symptoms of Meckel's diverticulum in children, however, intestinal obstruction is the most common complications in adult patients. Reported mechanism of intestinal obstruction in Meckel's diverticulum include intussusception, adhesion, and volvulus. Recently, we experienced a case with Meckel's diverticulum associated with ileal stricture causing recurrent partial intestinal obstruction in a 48-year-old man. In contrast to other published cases of small bowel obstruction in Meckel's diverticulum, this case was caused by ileal stricture associated with Meckel's diverticulum.

Dietary Habit and Helicobacter pylori Infection in Early Gastric Cancer Patient / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Helicobacter pylori (H. pylori) is now generally accepted to be strongly associated with the development of gastric cancer, as well as intakes of some salted foods, charred foods, etc. To evaluate the association among dietary habits, H. pylori infection, and early gastric cancer in Koreans, a hospital based case-control study was conducted. Material and Method: A total of 268 persons participated in this case-control study. Sixty nine patients were newly diagnosed as an early gastric cancer (EGC) at the Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea. One hundred ninety-nine subjects with no symptoms who visited the Health Promotion Center for their general checkups were selected as the controls. All subjects were examined for H. pylori infection, biochemical blood test the life style, and dietary habit were interviewed by a trained dietition with semi-quantitative food frequency question naire (FFQ) and adaptive salt concentration were taste evaluated. RESULTS: H. pylori seropositivity was observed in 88.4% in cases, as compared with 74.9% in controls (OR=2.5, 95% CI: 1.1-5.7). The adaptive salt concentration was associated with early gastric cancer risk (chi-squir=50.8, p<0.001). The analysis of food intake frequency demonstrated that early gastric cancer risk was reduced by the intake of clear soups, raw vegetables, fruits and juices, beef with vegetables and soybean curds. On the other hand, high intake of salt-fermented fish and kimchi elevated the risk of early gastric cancer. CONCLUSION: These results suggest that some dietary factors and H. pylori infection have a significant association with the development of early gastric cancer.

Clinicopathological Features of Malignant Lymphoma Detected by Colonoscopy: An Analysis According to the Endoscopic Classification / 대한소화기내시경학회지

BACKGROUND/AIMS: There have been only a few endoscopic studies of lower intestinal lesions of malignant lymphoma. The aims of this study were to classify the ileocolonic lymphomas according to the colonoscopic findings and to reveal the clinicopathological relationship according to the classes. METHODS: Subjects were 24 cases of ileocolonic lymphomas. We evaluated the clinicopathological features according to their endoscopic findings. RESULTS: The chief complaints were abdominal pain, bleeding, and abdominal mass. Twenty-six lesions from 22 patients, excluding 2 multiple lymphomatous polyposis, were endoscopically classified as follows: fungating (10 lesions), ulcerofungating (7 lesions), infiltrative (5 lesions), ulceroinfiltrative (3 lesions), and ulcerative (1 lesion). The location of the lesions was the terminal ileum in 11 lesions, the colon in 10 lesions, and both regions in 5 lesions. Within the large bowel, the cecum was involved most frequently, followed by the ascending colon and the remainder. Most of pathological types were the diffuse large cell and the large cell immunoblastic. There was no relationship between the endoscopic findings and the histologic types. Eight cases were manifested as intussusception. CONCLUSIONS: Ileocolonic lymphomas can be classified endoscopically into five types. Among the types, fungating and ulcerofungating types are the most frequent.

Frequency and clinical characteristics of suspected hereditary non-polyposis colorectal cancer / 대한내과학회지

BACKGROUND: The current diagnosis of hereditary non-polyposis colorectal cancer (HNPCC) is dependent on a detailed family history based on the Amsterdam criteria proposed by the International Collaborative Group on HNPCC (ICG-HNPCC) in 1990. On recognizing the shortcomings of the ICG-HNPCC criteria, the Korean Hereditary Colorectal Cancer Registry (a subdivision of the Korean Hereditary Tumor Registry) designated the term 'suspected HNPCC' for families who do not fullfill the criteria of the ICG-HNPCC but in whom a genetic basis for colon cancer is strongly suggested. The present study was designed to determine the frequency and define the clinical characteristics of suspected HNPCC. METHODS: We analysed the clinical characteristics of 42 suspected HNPCC patients and their family members and compared these characteristics with that of 1,692 non-hereditary colorectal cancer patients. RESULTS: The frequency of suspected HNPCC was 2.4% in our study. The mean age of suspected HNPCC patients at the time of diagnosis was 45.1+/-9.6 years and that of non-hereditary colorectal cancer patients was 57.4+/-11.9 years. The incidence of synchronous colorectal cancers in HNPCC was 7.1% and that of non-hereditary colorectal cancers was 0.9%. In suspected HNPCC families, 18 patients had extracolonic malignancies and the stomach cancer was the most common (55.5%).CONCLUSION: The frequency of suspected HNPCC among total colorectal cancer cases was 2.4% in our study. Tumors in suspected HNPCC differed from non-hereditary colorectal cancers in an early age of onset.

Two Cases of Mucinous Ductal Ectasia of Pancreas with Normal Duodenoscopic Findings / 대한소화기내시경학회지

Fairly specific and important duodenoscopic findings for diagnosing mucinous ductal ectasia (MDE) of pancreas include a prominant ampulla, patulous ampullary orifice and extrusion of mucin through the ampulla. However, we have experienced two cases of mucinous ductal ectasia without these pathognomonic appearance of ampulla. Initially, two cases were admitted for evaluation of pancreatic multicystic lesions, and MDE was incidentally found. Their pancreatographic findings showed normal main duct and cystic dilatation confined to the branch ducts. On gross findings of surgical specimens, a duct dilatation with gelatinous mucin was localized at the uncinate process of the pancreas. Microscopically, the ductal epithelia containing mucin were lined with well-differentiated tall columnar cells showing focal hyperplastic change. We report these unusual cases of MDE with review of the literatures.