No abstract available.
Autopsy*

No abstract available.

No abstract available.
Diphyllobothrium*

Mucosal-associated lymphoid tissue(MALT) lymphoma is derived from the marginal zone B-cell compartment and can be found at wide variety of extranodal sites, most frequently at the gastrointestinal sites. Recent clinicopathologic studies suggest a relationship between MALT lymphoma and chronic inflammatory disorders, such as Helicobacter pylori infection in stomach or autoimmune disorders, such as Sj gren's syndrome in salivary glands. Primary gastrointestinal MALT lymphoma most commonly arises in the stomach and less often in the small and large intestine. Recently we experienced a case who had MALT lymphoma and tuberculous enteritis at the same site (jejunum) confirmed by exploratory laparotomy.
B-Lymphocytes ; Enteritis* ; Helicobacter pylori ; Intestine, Large ; Intestine, Small ; Jejunum* ; Laparotomy ; Lymphoma* ; Lymphoma, B-Cell, Marginal Zone ; Salivary Glands ; Stomach

The pleural and lesser omental effusion were commonly seen on acute or chronic recurrent pancreatitis complication. But pericardial effusion is rare complication of recurrent pancreatitis and may result to tamponade. We report a case with literature on alcoholic acute recurrent pancreatitis complicated by development of pericardial and pleural effusion, which resolved after catheter drainage.
Alcoholics ; Catheters ; Drainage ; Humans ; Pancreatitis* ; Pericardial Effusion* ; Pleural Effusion

BACKGROUND: Antiretroviral combination therapy with one protease inhibitor and two reverse transcriptase inhibitors is profoundly suppressive of HIV replication. To determine the efficacy and safety of the triple combination therapy in persons with HIV infection in Korea, we analyzed the response of therapy in terms of immunity and viral load. METHODS: Ten persons with HIV infection, who were treated with triple combination therapy at least 12 months at Yonsei University College of Medicine from 1997 to 1999 were studied. The triple combination therapy regimen consisted of two reverse transcriptase inhibitors (zidovudine or didanosine, lamivudine) and one protease inhibitor (indinavir). We analyzed the levels of HIV RNA, CD4+ cell counts, beta2MG, and p24Ag before and after treatment. Adverse drug reactions during therapy were described. RESULTS: The mean age of patients at treatment was 38.7 years. Nine patients were male, and 1 patient was female. Six patients received triple combination therapy as initial treatment, while 4 patients received it as re-treatment. The mean level of HIV RNA was 129,222 copies/mm3 before treatment. RNA level decreased to less than 500 copies/mm3 (non-detectable range) at 1 month in 7 of 10 patients, at 12 months in 9 of 10 patients. The mean CD4+ cell counts was 206/mm3 before treatment, and 376/mm3 after 12 months treatment. The beta2MG decreased to 2.7 mg/L from 2.8 mg/L after 12 months of treatment. The p24Ag was positive in 3 of 10 patients and negative in all of the patients at 3 months treatment. Mild hyperbilirubinemia (5 cases) was the most frequent adverse reaction followed by flank pain (3 cases), skin rash (2 cases), abdominal discomfort (2 cases), and mild elevation of AST/ALT (1 case). CONCLUSION: The triple combination therapy in HIV infection appeared to be generally well tolerated, and was able to profoundly sustain suppression of HIV replication.
CD4 Lymphocyte Count ; Didanosine ; Drug-Related Side Effects and Adverse Reactions ; Exanthema ; Female ; Flank Pain ; HIV Infections ; HIV* ; Humans* ; Hyperbilirubinemia ; Korea ; Male ; Protease Inhibitors ; Reverse Transcriptase Inhibitors ; RNA ; Viral Load ; Zidovudine

BACKGROUND: As a tumor marker, lactate dehydrogenase is widely used as a prognostic factor in malignant lymphomas and a therapeutic monitor in ovarian dysgerminoma. But in other tumors, the clinical role of lactate dehydrogenase is not clear yet. To investigate the role of LD as a tumor marker, we analyzed patients with various cancers and high LD level. METHODS: The serum LD level was assayed in the cancer patients who visited our hospital. For the patients with high LD level, isoenzyme was also assayed. The response of chemotherapy was classified according to the WHO criteria into remission, which covers complete and partial remission, stable disease and progressive disease. The relationship between the tumor response and the LD response was examined in terms of sensitivity, specificity and positive predictive value. RESULTS: A total of 100 cancer patients were found to have high LD level; among them, 76 patients underwent chemotherapy. There were 38 patients with LD increased and 38 patients with LD decreased after chemotherapy. No patient was in remission, 6 patients in stable disease, and 32 patients in progressive disease among 38 patients with increased LD level; 18 patients in remission, 10 patients in stable disease, and 10 patients in progressive disease among 38 patients with decreased LD level. The sensitivity of LD increase in the patients with tumor progression is 76.2%, the specificity 73.7%, and the positive predictive value 84.2%(71.4%, 25.0% and 76.9% respectively in stomach cancer patients). The sensitivity of LD decrease in the responsive patients is 100%, the specificity 65.5% and the positive predictive value 47.4%.(100%, 64.7% and 14.3% in stomach cancer patients respectively). The LD isoenzyme pattern was not specific in this study. CONCLUSION: Serum LD measurement may be helpful in monitoring tumor response, especially for stomach cancer, after chemotherapy.
Drug Therapy ; Dysgerminoma ; Humans ; L-Lactate Dehydrogenase ; Lactic Acid* ; Lymphoma ; Sensitivity and Specificity ; Stomach Neoplasms

BACKGROUND: Although it is generally accepted that high serum glucocorticoid levels causes osteoporosis by suppressing the bone formation, conflicting results have reported on bone resorption. But, previous studies have been carried out in patients with glucocorticoid excess secondary to exogenous glucocorticoid treatment of disorders, which also affect bone turnover and mass by themselves. The purpose of this study were to assess the effect of glucocorticoid excess on bone mass and turnover not influenced by other diseases known to affect skeleton and by different gonadal status and sex and to study the reversibility of osteopenia after cure of Cushing's syndrome. METHODS: We measured bone mineral density using dual energy X-ray absorptiometry(DEXA) in 28 patients with Cushing's syndrome before and after surgical cure. In addition, in the patients with Cushing's syndrome and 21 healthy premenopausal women matched for age, we measured biochemical bone markers. RESULTS: 1) Marked osteopenia was present in most patients with active Cushing's syndrome. Lumbar spine BMD and Ward's triangle BMD were significantly lower than femoral neck BMD and femoral great trochanter BMD.(Z-score: lumbar spine -2.22+/-1.17, femoral neck -0.71+/-1.08, Ward's triangle -1.77+/-0.97, femoral great trochanter -0.64+/-0.71; mean+/-SD, p< 0.05). In patients with active Cushing's syndrome, serum osteocalcin, a marker of osteoblastic function, was reduced(p< 0.05), and bone resorption was increased, as indicated by increased urinary N-telopeptide(p< 0.05). 2) Osteopenia was still in patients after surgical cure.(Z-score: lumbar spine -1.59+/-1.01, femoral neck -0.47+/-0.58, Ward's triangle -1.44+/-0.77, femoral great trochanter -0.42+/-0.61). In Cushing's syndrome patients after surgical cure, serum osteocalcin and urinary N-telopeptide were higher compared to controls but not stastistically significant(p> 0.05). 3) When compared with pretreatment values, BMD after surgical cure of Cushing's syndrome was increased significantly(p< 0.05). Serum osteocalcin was increased and urinary N-telopeptide was decreased significantly(p< 0.05). CONCLUSION: These results show that compared to age matched control, premenopausal Cushing's syndrome patients have reduced bone formation, increased bone resorption, and reduced BMD, especially trabecular bone and that these abnormalities are improved after surgical cure.
Bone Density* ; Bone Diseases, Metabolic ; Bone Resorption ; Cushing Syndrome* ; Female ; Femur ; Femur Neck ; Gonads ; Humans ; Osteoblasts ; Osteocalcin ; Osteogenesis ; Osteoporosis ; Skeleton ; Spine

BACKGROUND: It is known that hyperglycemia increase oxidative stress. Korean type 2 diabetic patients usually appear to be insulin deficient and insulin resistant. The blood glucose control can be normalized by the intensive insulin therapy. It has been reported that hyperinsulinemia have harmful effects on oxidative stress. The purpose of this study was to determine whether continuous subcutaneous insulin infusion (CSII) therapy by insulin pump affects the defense mechanism of oxidative stress in Korean type 2 diabetic patients. METHODS: Fasting blood from eighty three subjects was collected prior to starting CSII therapy using portable insulin pump and after hospitalization for 2 weeks. Serum and red blood cell lipid peroxide concentrations were analyzed by Yagi's methods. Serum tocopherol and vitamin C concentrations were measured by HPLC. Red blood cell glutathione peroxidase, superoxide dismutase and catalase activities were also measured. RESULTS: The mean age of subjects were 50.0+/-10.9 years, and they had diabetes for 8.4+/-5.8 years. Their average body mass index was 23.4+2.7 kg/m2. Their blood glucose levels were not controlled by oral hypoglycemic agents, diet and exercise treatment. Patients were divided into two categories according to blood glucose levels prior to CSII treatment. One category consists of patients with less than 11.1 mmol/L of average daily blood glucose levels prior to CSII treatment (the controlled group). The other category consists of patients with more than 11.1 mmol/L of average daily blood glucose levels (the uncontrolled group). Patients in the uncontrolled group had higher serum lipid peroxide levels than those in the controlled group before CSII therapy. After 2 weeks of CSII therapy, oxidative stress was not changed in controlled and uncontrolled groups. Serum insulin levels of all patients were increased after CSII treatment, but the levels before and after treatments were in the normal range, not hyperinsulinemic. Also, serum insulin levels did not correlate with serum lipid peroxide levels regardless of CSII treatment. Average serum vitamin C levels were remarkably increased after the therapy in all patients, but average serum total tocopherol levels was not altered. Also, activities of antioxidant enzymes such as glutathione peroxidase, superoxide dismutase, and catalase were not significantly changed. CONCLUSION: The blood glucose levels were normalized with the normal ranges of serum insulin levels after two weeks of CSII treatment. However, serum lipid peroxide levels were not changed even though serum vitamin C levels were increased. It is concluded that the oxidative stress of Korean type 2 diabetic patients are not changed after two weeks of CSII treatment, but there may be possibility the longer duation of CSII therapy may gradually improve oxidative stress.
Antioxidants ; Ascorbic Acid ; Blood Glucose ; Body Mass Index ; Catalase ; Chromatography, High Pressure Liquid ; Diet ; Erythrocytes ; Fasting ; Glutathione Peroxidase ; Hospitalization ; Humans ; Hyperglycemia ; Hyperinsulinism ; Hypoglycemic Agents ; Insulin* ; Oxidative Stress* ; Reference Values ; Superoxide Dismutase ; Tocopherols

BACKGROUND: Mallory-Weiss syndrome is a laceration of gastroesophageal junction due to abruptly increased intraabdominal pressure. Bleeding from Mallory-Weiss tears stops spontaneously within 2-3 days without specific therapy in 80-90% of cases, but in some cases, aggressive treatment is required due to massive bleeding. METHODS: Among two hundreds and fifteen cases of upper gastrointestinal bleeding from January 1997 to January 1999, twenty three cases (10.7%) were diagnosed as Mallory-Weiss syndrome by endoscopy. We assessed the site, number, coexisting diseases, precipitating factors and bleeding lesion according to the time interval after the tears. After supportive care or specific therapy, we performed follow-up endoscopy to evaluate the healing of the lesions. RESULT: The mean age was 49.1 years and male:female ratio was 4.8:1. The most common precipitating factors were nausea, vomiting and alcohol drinking. In twenty cases, coexisting diseases such as gastritis and esophageal varix were detected. As for the number of tears, one tear was the most common (69.6%), while two tears were identified in five cases and three were in two cases. Thirteen cases of the Mallory-Weiss tears were located on the gastroesophageal junction, seven cases on the lower esophagus, one case on the cardia and two cases from lower esophagus to cardia. Eighteen cases were diagnosed by endoscopy within 24 hours after bleeding, of whom fourteen cases had active bleeding. Among four cases diagnosed after 24 hours, endoscopic finding revealed active bleeding in two cases and blood clots in the other two cases. We treated thirteen cases with supportive care, one case with hypertonic saline injection and nine cases who had active bleeding or deep and long tears with endoscopic band ligation. One or two weeks later, we performed follow-up endoscopy, and no bleeding was detected in all cases. CONCLUSION: We diagnosed twenty three cases of Mallory-Weiss syndrome by endoscopy and treated all cases with supportive care or endoscopic band ligation successfully.
Alcohol Drinking ; Cardia ; Diagnosis* ; Endoscopy ; Esophageal and Gastric Varices ; Esophagogastric Junction ; Esophagus ; Follow-Up Studies ; Gastritis ; Hemorrhage ; Lacerations ; Ligation ; Mallory-Weiss Syndrome* ; Nausea ; Precipitating Factors ; Vomiting