BACKGROUND/AIMS: The authors compared laparoscopic changes of the diseased liver surface according to Shimadas classification with laparoscopic needle biopsy in order to clarify whether the two diagnostic criteria have consistency or discrepancy in each other. By serologicai tests the patients with chronic hepatitis B were 179 cases, chronic hepatitis C 22 cases and NBNC hepatitis 54 cases. Histologically the patients with non-specific reactive hepatitis were 35 cases, chronic lobular hepatitis 20 cases, chronic persistent hepatitis 18 cases, chronic active hepatitis 8~5 cases, subacute hepatic necrosis 32 cases, circumscribed hepatic necrosis 9 cases and liver cirrhosis 56 cases. METHODS: We performed laparoscopy on 255 patients with chronic hepatitis and laparoscopic guided liver needle biopsy was done in all cases. RESULTS: 1) Age incidence of chronic viral hepatitis was peak in chronic hepatitis C, and then that in chronic hepatitis B and NBNC heatitis in decreasing order. 2) Code numbers of liver surfaces were mainly numbers between 200 and 300 in chronic hepatitis B and NBNC hepatitis, but those of chronic hepatitis C were numbers between 300 and 400 which meant advanced patterns. 3) Comparing macroscopic fmdings of liver surfaces with histologic diagnosis by guided liver biopsy, the consistency of two criteria was 83.9% in all cases and the discrepancy was 16.1%. 4) Among the cases with diagnostic discrepancy, the patients showing macroscopically chronic hepatitis but histologically liver cirrhosis were predominant in chronic hepatitis B under the age of 40. In contrast to this, the cases showing surface changes of liver cirrhosis but histologically chronic hepatitis was mainly in chronic hepatitis C over the age of 40. CONCLUSIONS: The above results suggest that laparoscopy and guided liver biopsy may be very useful diagnostic tools to determine correct diagnosis, adequate treatment and prognosis.
Biopsy ; Biopsy, Needle ; Classification ; Diagnosis ; Hepatitis B, Chronic ; Hepatitis C, Chronic ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Incidence ; Laparoscopy ; Liver Cirrhosis ; Liver* ; Necrosis ; Prognosis

The main complications associated endoscopic mucosal resection are bleeding and perforation and the rate of complication is increasing in larger size of mucosal resection. We used a new method of endoscopic clipping technique for ligation on the large mucosal defect after endoscopic mucosal resection. A 53-year-old female patient visited our hospital because of epigastric pain. Endoscopic examination revealed a type IIa EGC(early gastric cancer) below angle. The endoscopic mucosal resection was performed and the size of resected specimen was 2.7x2.5cm. The mucosal defect was ligated with 6 hemoclips(Olympus, MD-850) after approximation of both resected margins by grasping forceps(Olympus, FG-4L). Follow up endoscopic examination revealed good quality of ulcer healing. The Endoscopic clipping technique might also be useful for treatment of minor perforation.
Female ; Follow-Up Studies ; Hand Strength ; Hemorrhage ; Humans ; Ligation* ; Middle Aged ; Stomach Neoplasms ; Ulcer

Generally, esophageal cancer metaetasizes to lymph node, lung, liver but metastasis to another digestive organ is very rare. A 51 year old man who had experienced dysphagia for 1 month was diagnosed as an esophageal cancer. After combined radiation therapy and chematherapy(5-FU, cisplatinum), he still had dysphagia. After implanta tion of self-expandable metallic esophageal stent, he could swallow solid food. Recently, he experienced pharyngeal pain for 1 month. Endoscopy showed multiple nodules in right pyriform sinus. Biopsy specimen revealed squamous cell carcinoma. Because the distance between esophageal cancer and pharyngeal nodule is more than 10 cm and computed tomography of the neck shows normal esophageal wall no cervical lymphadenopathy, we concluded that this case was an esophageal cancer with metastasis to the pharynx. Hence, we reported a case of esophageal cancer with pharyngeal metastasis with a review of literatures.
Biopsy ; Carcinoma, Squamous Cell ; Deglutition Disorders ; Endoscopy ; Esophageal Neoplasms* ; Humans ; Liver ; Lung ; Lymph Nodes ; Lymphatic Diseases ; Middle Aged ; Neck ; Neoplasm Metastasis* ; Pharynx* ; Pyriform Sinus ; Stents

The main complications associated endoscopic mucosal resection are bleeding and perforation and the rate of complication is increasing in larger size of mucosal resection. We used a new method of endoscopic clipping technique for ligation on the large mucosal defect after endoscopic mucosal resection. A 53-year-old female patient visited our hospital because of epigastric pain. Endoscopic examination revealed a type IIa EGC(early gastric cancer) below angle. The endoscopic mucosal resection was performed and the size of resected specimen was 2.7x2.5cm. The mucosal defect was ligated with 6 hemoclips(Olympus, MD-850) after approximation of both resected margins by grasping forceps(Olympus, FG-4L). Follow up endoscopic examination revealed good quality of ulcer healing. The Endoscopic clipping technique might also be useful for treatment of minor perforation.
Female ; Follow-Up Studies ; Hand Strength ; Hemorrhage ; Humans ; Ligation* ; Middle Aged ; Stomach Neoplasms ; Ulcer

Generally, esophageal cancer metaetasizes to lymph node, lung, liver but metastasis to another digestive organ is very rare. A 51 year old man who had experienced dysphagia for 1 month was diagnosed as an esophageal cancer. After combined radiation therapy and chematherapy(5-FU, cisplatinum), he still had dysphagia. After implanta tion of self-expandable metallic esophageal stent, he could swallow solid food. Recently, he experienced pharyngeal pain for 1 month. Endoscopy showed multiple nodules in right pyriform sinus. Biopsy specimen revealed squamous cell carcinoma. Because the distance between esophageal cancer and pharyngeal nodule is more than 10 cm and computed tomography of the neck shows normal esophageal wall no cervical lymphadenopathy, we concluded that this case was an esophageal cancer with metastasis to the pharynx. Hence, we reported a case of esophageal cancer with pharyngeal metastasis with a review of literatures.
Biopsy ; Carcinoma, Squamous Cell ; Deglutition Disorders ; Endoscopy ; Esophageal Neoplasms* ; Humans ; Liver ; Lung ; Lymph Nodes ; Lymphatic Diseases ; Middle Aged ; Neck ; Neoplasm Metastasis* ; Pharynx* ; Pyriform Sinus ; Stents

BACKGROUND: It has been known that the sero- logic markers of infectivity and viral replication in patients with hepatitis B virus(HBV) infection are hepatitis B e antigen(HBeAg), HRV DNA and HBV DNA polymerase. METHODS: In order to clarify the relationship between chronic liver diseases and HBV infection, and the mechanism of chronicity in HBV related liver diseases, the expression patterns of hepatic HBeAg by imrnunohistochemical stain and histologic activity index(HAI) were studied from 10% formalin fixed paraffin embedded tissues in 114 patients performed liver biopsy. RESULTS: The results were as follows: 1) Incidence of serum HReAg positivity in HBsAg positive patients was 74.6% and that of hepatic HBeAg expression was 77.6% among serum HBeAg positive cases. Hepatic HBeAg expression was 72.4% in serum HBeAg negative cases. 2) In serum HBeAg positive cases, almost all infected hepatocytes exhibited cytoplasmic HBeAg expression and half of patients showed nuclear HBeAg expression, but cytoplasmic HBeAg expression was solely predominant in serum HBeAg negative cases. Hepatic HBeAg expression showed a decreasing trend from AVH and CPH, through CAH, to cirrhosis with or without HCC, which was a consistent finding with serum HBeAg in decreasing manner. Hepatic HBeAg expreassion was highly sustained in about 60-90% of cases, regardless of duration of their illnesses. 3) HAI showed slighf3y higher tendency in patients with hepatic HBeAg negative expression than in positive cases. CONCLUSION: The above results suggest that HBeAg may play a role as a viral target antigen for immune-mediated liver injury and may be also related to the pathogenetic mechanism of chronicity in chronic hepatitis B.
Biopsy ; Cytoplasm ; DNA ; Fibrosis ; Formaldehyde ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Hepatocytes ; Humans ; Incidence ; Liver ; Liver Diseases ; Logic ; Paraffin

To investigate the potential implication of the subtype of intestinal metaplasia in the progression to the gastric carcinoma, we analyzed the mutations of the p53 gene and microsatellite instability (MSI) both in the complete type (type I) and in the sulphomucin-secreting incomplete type (type III) intestinal metaplasia located adjacent to the gastric carcinoma. p53 mutations were observed in 13.3% of type I, in 6.6% of type III intestinal metaplasia, and in 40% of gastric carcinoma. The difference between p53 mutations observed in type I and type III intestinal metaplasia was not statistically significant. No identical mutation of the p53 gene was found in the intestinal metaplasia and carcinoma specimens from the patients. There was no case of intestinal metaplasia showing MSI. In gastric carcinomas, MSI was observed in six cases (40%). The cases harboring BAT-26 instability did not have the mutation of the p53 gene. These data suggest that intestinal metaplasia adjacent to gastric carcinoma, irrespective of its subtype, do not have the genetic alterations as showing in their carcinoma tissues.
Carcinoma/genetics/pathology ; Exons ; *Genes, p53 ; Humans ; Metaplasia/genetics/pathology ; *Microsatellite Repeats ; *Mutation ; Precancerous Conditions ; Stomach/*pathology ; Stomach Neoplasms/genetics/pathology ; Tumor Suppressor Protein p53/genetics/metabolism

Colonic pseudo-obstruction (CPO) is a syndrome characterized by obstructive symptoms and signs without mechanical obstruction. Parkinson's disease is one of the various clinical situations developing CPO. Recently, one study group reported that neostigmine was significantly more effective than placebo in rapidly decreasing colonic dilatation in the majority of patients with acute CPO. We experienced a 69-year-old male patient with Parkinson's disease who complained abdominal distension. There was a marked colonic dilatation on plain abdominal radiographs without mechanical obstruction. Colonic dilatation failed to improve with conservative management. Immediate clinical response was achieved after patient received 2.0 mg of neostigmine intravenously under monitoring by electrocardiography. One month later, he had recurrent colonic dilatation, but no clinical response to second administration of neostigmine, leading to colonic decompression. After a third recurrence of colonic dilatation, the patient was refractory to conservative management, and he underwent surgical treatment.
Aged ; Colon* ; Colonic Pseudo-Obstruction* ; Decompression ; Dilatation ; Electrocardiography ; Humans ; Male ; Neostigmine ; Parkinson Disease* ; Recurrence

Tuberculous involvement of the esophagus is very rare even in the presence of extensive pulmonary tuberculosis or in the endemic area. This is resulted from local extension to the esophagus from contiguous tuberculosis organs or miliary spread. Such secondary involvement is more common than primary tuberculosis, in which there is no evidence of tuberculosis elsewhere. The diagnosis of esophageal tuberculosis may be difficult. So the radiologic, endoscopic, histologic findings and clinical feature including the response to chemotherapy may be needed to avoid misdiagnosis. Most cases can be treated successfully with antituberculosis medication. A 67-year-old man was admitted to our hospital complaining of swallowing difficulty for 2 months. On the gastrofibroscopic examination, 22 cm sized protruding mass with central deep ulceration was discovered at the mid-esophagus. The biopsy showed the ulcer with chronic granulomatous inflammation and multinucleated giant cells consistent with tuberculosis. After antituberculosis medication, the lesion of esophageal tuberculosis was healed completely remaining minimal ulcer scar.
Aged ; Biopsy ; Cicatrix ; Deglutition ; Diagnosis ; Diagnostic Errors ; Drug Therapy ; Esophageal Neoplasms* ; Esophagus ; Giant Cells ; Humans ; Inflammation ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

The endoscopic mucosal resection is a useful method of both accurate diagnosis and treatment of gastric mucosal lesion and has been accepted as a standard procedure of early gastric cancer. Over the 3 year period from 1992 to 1994, 57 adenomas and 10 early gastric carcinomas were resected endoscopically at the St. Mary's hospital of Catholic University Medical College. The purpose of this study was to clarify the technical limitations of endoscopic mucosal resection with respect to size, location, methods. (continue...)
Adenoma* ; Diagnosis ; Stomach Neoplasms