OBJECTIVES: This study was performed to investigate the incidence and the clinical significance of inlet patch of heterotopic gastric mucosa in Koreans. This lesion can be found by close observation around the upper esophageal sphincter during upper gastrointestinal endoscopy. METHODS: From March 1, 1996 to July 8, 1996, at Kwak's hospital, randomly selected 271 patients undergoing routine diagnostic upper gastrointestinal endoscopy were included in this study. Patients with the inlet patch were confirmed by histology. Clinical symptoms observed through medical history were recorded. RESULTS: Twenty-six cases(9.6%) of the 271 patients studied had heterotopic gastric mucosa which was found at or just below the upper esophageal sphincter, varing from 3 to 30mm in diameter. It was velvety red in color and distinct from the surrounding normal squamous esophageal mucosa, resembling the Z-line at the esophagogastric junction. Parietal cells were identified in all 18 cases in which biopsy specimen contained deep glands, and chief cells were found in 14 cases. Histologically, fundic gland type was most frequent. The symptoms were relatively mild, 5 out of 6 patients who complained of throat discomfort were relieved by H2 antagonists. CONCLUSION: In Koreans the incidence of heterotopic gastric mucosa in the upper esophagus was similar to the reports from western countries unlike Barrett's esophagus. The etiology of these patches appeared to be congenital rather than acquired from reflux of gastric acid. This was supported by its location in the proximal esophagus and lack of correlation with reflux esophagitis. It must be considered as one of the differential diagnosis of a patient who complains of throat discomfort during diagnostic upper gastrointestinal endoscopy. Attention needs to be paid to find possible development of complications such as stricture and adenocarcinoma in patients with the inlet patch of heterotopic gastric mucosa.
Adenocarcinoma ; Barrett Esophagus ; Bays* ; Biopsy ; Constriction, Pathologic ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Esophageal Sphincter, Upper ; Esophagitis, Peptic ; Esophagogastric Junction ; Esophagus ; Gastric Acid ; Gastric Mucosa* ; Humans ; Incidence* ; Mucous Membrane ; Pharynx ; Rabeprazole

BACKGROUND: Helicobacter pylori (H. pylori) can now be eradicated in the majority of patients with 7 days of treatment with OAC (omeprazole+amoxicillin+clarithromycin) regimen. It is unclear if additional acid-suppressing treatment should be continued beyond 7 days in patients with active gastric or duodenal ulcers. METHODS: Ninety two patients with endoscopically proven active peptic ulcers who were H. pylori positive were randomized to receive either omeprazole 20 mg plus amoxicillin 1.0g plus clarithromycin 500mg ; twice daily for 1 week alone (OAC group) or same regimen followed by 3 weeks of omeprazole (OACP group). Endoscopy and UBT (urea breath test) were performed 8 weeks after the initiation of treatment. RESULTS: Forty four of forty five (97.8%) of OAC group and forty four of forty seven (93.6%) of OACP group were noted to have healed ulcer at week 8. CONCLUSION: In patients with H. pylori infection and peptic ulcers, one week of OAC therapy without further need for PPI may heal the ulcers. Following an l week course of H. pylori eradication therapy by OAC for peptic ulcers, further 3 weeks of acid-suppressing therapy with PPI was not proven to promote ulcer healing rate.
Amoxicillin ; Clarithromycin ; Duodenal Ulcer ; Endoscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Omeprazole ; Peptic Ulcer* ; Ulcer

The first case report of granular cell tumor was by Abrikossoff in 1926, the tumor has been named with more than 20 different synonyms. It is found usually in the tongue, oral cavity, and the skin. It occurs rarely in the esophagus. Esophageal granular cell tumor is a benign lesion which can be diagnosed by endoscopic biopsy. Large symptomatic lesion can be removed by polypectomy. A 29-year-old female visited our hospital for intermittent epigastric pain and anterior chest discomfort. Endoscopy showed a 0.6 *0.4 cm whitish yellow nodule in the mid-esophagus, 25 cm from the incisor teeth. Endoscopic polypectomy was performed with "O"-type rubber band for endoscopic variceal ligation(EVL). A case of esophageal granular cell tumor conformed by S-100 protein stain is reported with the review of literature.
Adult ; Biopsy ; Endoscopy ; Esophagus* ; Female ; Granular Cell Tumor* ; Humans ; Incisor ; Mouth ; Rubber ; S100 Proteins ; Skin ; Thorax ; Tongue ; Tooth

Small-for-gestational-age (SGA) is associated with poor perinatal outcomes. The term SGA is descriptive and means that the fetal size and weight at birth are less than expected (in general, 10th percentile using standard curves for gestational age) regardless of the cause. It was estimated that about 50~70% of fetuses born weighing less than the 10th percentile for gestational age are constitutionally small, with fetal growth appropriate for parental size and ethnicity; these are usually associated with normal placental function and have a normal outcome. Fetal growth restriction (FGR) describes a decrease in the fetal growth rate that prevents an infant from obtaining the complete genetic growth potential. It is common with placental dysfunction occurring in about 3% of pregnancies despite advances in obstetric care. In human pregnancies, placental insufficiency is the leading cause of FGR and is usually due to poor utero-placental blood flow and placental infarcts. The reduction of placental supply of nutrients to the fetus has been associated with several adaptive changes taking place in both the placenta and fetus. Adaptive changes can be followed by pathology leading to fetal death, and therefore staging of the disease is fundamental to timing delivery. Thus, it is responsible for the obstetricians to distinguish SGA from intrauterine growth restriction, correct the causes if possible, and if not, accurately stage the disease progress so as to deliver at the most suitable time. In this review, the management of fetal growth restrictions is summarized based on the diagnosis, etiologic factors, antenatal surveillance, and their possible therapeutic approaches.
Constitution and Bylaws ; Fetal Death ; Fetal Development ; Fetus ; Gestational Age ; Humans ; Hypogonadism ; Infant ; Mitochondrial Diseases ; Ophthalmoplegia ; Parents ; Parturition ; Placenta ; Placental Insufficiency ; Pregnancy

The Peutz-Jeghers syndrome is an autosomal dominant disease characterized by hamartomatous polyps in the gastrointestinal tract and mucocutaneous melanin pigmentation. Although these polyps are believed to have little potential for malignancy, and the disease was believed to have a relatively benign course, it recently has been recognized that patients with this syndrome are at increased risk for the development of cancer at gastrointestinal and nongastrointestinal sites. A 33-year-old male patient was admitted because of vomiting and abdominal pain for 3 months duration. A diagnosis of Peutz-Jeghers syndrome was made 3 years ago by multiple hamartomatous polyps confined to the colon and mucocutaneous pigmentation. A barium study showed abrupt string like luminal narrowing at the 4th portion of the duodenum. On laparotomy, there was an annular constricting mass involving the serosa of duodenum with multiple metastasis to liver, so a segmental resection of small bowel followed by chemotherapy was performed. The histologic finding was adenocarcinoma.
Abdominal Pain ; Adenocarcinoma* ; Adult ; Barium ; Colon ; Diagnosis ; Drug Therapy ; Duodenum ; Gastrointestinal Tract ; Humans ; Laparotomy ; Liver ; Male ; Melanins ; Neoplasm Metastasis ; Peutz-Jeghers Syndrome* ; Phenobarbital ; Pigmentation ; Polyps ; Serous Membrane ; Vomiting

Isolated rectal tuberculosis commonly involves sigmoid, ascending, or transverse colon. Rectal involvement in tuberculosis is uncommon and poorly characterized. Isolated rectal tuberculosis was defined as focal lesions of rectum in the abscence of demonstrable lesions in the small and large bowel. Diagnosis of rectal tuberculosis was based on characteristic endoscopic appearance of lesions, histopathologic feature of tuberculosis in biopsy material and response to antitubercular therapy. Three patients with isolated rectal tuberculosis were seen at Kwak's hospital. The lesions observed was classified according to macroscopic morphology as follows: ulcerative, hypertrophic and ulcero-hypertrophic. Clinical manifestations were non-specific and consists of rectal bleeding, fever, weight loss, constipation and abdominal pain. One of the three patients had coexisting tuberculous pleurisy. Response to antitubercular chemotherapy was good.
Abdominal Pain ; Biopsy ; Colon, Sigmoid ; Colon, Transverse ; Constipation ; Diagnosis ; Drug Therapy ; Fever ; Hemorrhage ; Humans ; Rectum ; Tuberculosis* ; Tuberculosis, Pleural ; Ulcer ; Weight Loss

Various fetal and maternal conditions are known to be associated with oligohydramnios. In general, oligohydramnios developed early in pregnancy is less common but frequently has a poor prognosis. The use of angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists during pregnancy has been associated with oligohydramnios as well as growth restriction, pulmonary hypoplasia with respiratory distress, acute renal failure, cranial malformation and fetal death. Although many researchers report a use of oral hypoglycemic agents such as glyburide or metformin in gestational diabetes mellitus, but potential adverse effects of glimepiride, which is relatively recently developed, is not well known owing to the lack of clinical data, especially early in pregnancy. A 41-year-old woman with chronic hypertension and type 2 diabetes mellitus was treated with drugs including metformin, glimepiride and angiotensin receptor antagonist until approximately 20 weeks' gestations, when severe oligohydramnios was noted. After the hospitalization for bed rest, fetal surveillance, and discontinuation of the agents, amniotic fluid reaccumulated, and the infant was delivered at term. We report this case with a brief review of literatures.
Acute Kidney Injury ; Amniotic Fluid ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; Antihypertensive Agents ; Bed Rest ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Diabetes, Gestational ; Female ; Fetal Death ; Glyburide ; Hospitalization ; Humans ; Hypertension ; Hypoglycemic Agents ; Infant ; Metformin ; Oligohydramnios ; Pregnancy ; Prognosis ; Sulfonylurea Compounds

OBJECTIVE: The objective of this study was to evaluate the ultrasonographic appearance of suspected fetal cardiac tumor and their evolution until delivery and in the postnatal period, and to document the associated problems including tuberous sclerosis. METHODS: We retrospectively reviewed the medical records of all cases born in Yonsei University Health System, Seoul, Korea, between September 1996 and August 2006, and diagnosed as fetal cardiac tumor prenatally. RESULTS: 10 cases were found in all medical records. The mean age of the mothers on delivery was 30.2+/-2.4 and the mean gestational age on diagnosis was 30.6+/-5.4 weeks. The cardiac tumors were single in five cases and multiple in the other five cases. The size ranged from 7 to 34mm. Most of the tumors were located in right ventricle (RV, n=9), left ventricle (LV, n=6), but they also located in interventricular septum (IVS, n=4), right atrium (RA, n=1). In one case, fetal arrhythmia was found, which was normalized in two days after birth, and in another case, mild intracardiac flow obstruction was noted. The duration of postnatal follow-up ranged from 2 months to 36 months (mean, 18.9+/-13.1 months). In most cases the tumor masses decreased after birth (n=6), but had no change in utero (n=5). Three of them were diagnosed as tuberous sclerosis after birth, and none of them needed surgical intervention. CONCLUSION: Fetal cardiac tumors and their effect on the fetal cardiac function could be well evaluated by two-dimensional and Doppler echocardiography. The fetal cardiac tumors may have little effect on the fetal well being both prenatally and postnatally from the cardiovascular standpoint in most affected fetuses, but are important in the early diagnosis of tuberous sclerosis and in suggesting careful follow-up and management.
Arrhythmias, Cardiac ; Early Diagnosis ; Echocardiography, Doppler ; Fetus ; Follow-Up Studies ; Gestational Age ; Heart Atria ; Heart Neoplasms ; Heart Ventricles ; Humans ; Korea ; Medical Records ; Mothers ; Parturition ; Prenatal Diagnosis ; Retrospective Studies ; Tuberous Sclerosis

PURPOSE: We report a case of intraocular Thelazia callipaeda infestation in a patient with panuveitis who had a successful recovery after pars plana vitrectomy. METHODS: A 73-year-old female patients complained of a floating sensation and gradually decreasing visual acuity in her right eye. On slit lamp examination, severe intraocular inflammatory reaction was observed. Fundus examination revealed severe vitreous haze with mobile linear structure. Three-port pars plana vitrectomy was performed and then the worm was removed. RESULTS: The worm was confirmed to be Thelazia callipaeda. At postoperative 2 months, the patient's visual acuity was 0.6 and intraocular pressure 14 mmHg. There was no evidence of intraocular inflammatory reaction. CONCLUSIONS: Thelazia callipaeda usually lie in the conjunctival sac or lacrimal apparatus, causing ocular surface disease, but intraocular infestation rarely occurs. If intraocular infestation does occur, early surgical removal should be performed.
Aged ; Female ; Humans ; Intraocular Pressure ; Lacrimal Apparatus ; Panuveitis ; Sensation ; Thelazioidea ; Visual Acuity ; Vitrectomy

A Cesarean section scar pregnancy is a rare but possibly life-threatening condition. The diagnosis is made mainly based on transvaginal ultrasonography. We used the Doppler and serial beta HCG in determining the severity and prognosis. Because of the rarity, universal treatment has not been established. In our cases, the severity of bleeding was independent of the level of beta HCG and the duration of amenorrhea. The shorter the interval from the previous cesarean section, the more severe the symptom, in such case, we were able to preserve fertility by uterine artery embolization. Cesarean section scar pregnancy can be managed conservatively with methotrexate injection. Based on our case review, we can conclude that it is very important that we choose the each therapeutic management based on her history and condition. In our review, we present four cases diagnosed with Cesarean section scar pregnancy all managed conservatively to preserve future fertility.
Amenorrhea ; Cesarean Section* ; Cicatrix* ; Diagnosis ; Female ; Fertility ; Hemorrhage ; Methotrexate ; Pregnancy ; Pregnancy* ; Pregnancy, Ectopic ; Prognosis ; Ultrasonography ; Uterine Artery Embolization