Although multiphasic CT is an efficient technique for determination of hepatocellular carcinoma (HCC), occasionally, diagnosis of HCC using multiphasic CT can be difficult. Herein we present a case of HCC that was indicative of a typical abscess on CT imaging and compared the image findings with the gross specimen. The patient's body temperature and laboratory results indicated that inflammation were in the normal range. This case emphasizes that not only imaging findings but also clinical presentation should be considered to achieve a correct diagnosis in clinical practice.
Abscess ; Body Temperature ; Carcinoma, Hepatocellular ; Inflammation ; Reference Values

BACKGROUND: There is a clinical need for a simpler measurement of global cardiac function incorporating elements of both systole and diastole. Doppler time index is theoretically regarded as a sensitive index of global left ventricular perfomance and defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET). This study was designed to determine the clinical usefulness of the Doppler time index in patients with left ventricular diastolic dysfunction as well as systolic dysfunction. METHODS: The study population consisted of 23 patients with hypertension as a diastolic dysfunction group, 16 patients with low ejection fraction as a systolic dysfunction group and 31 subjects with normal LV function. The ejection fraction (EF) was measured using M-mode echocardiography. Doppler profiles such as IVCT, IVRT and ET were obtained from Doppler echocardiography. The Doppler time index [ (IVCT+RT)/ET] was calculated from each Doppler velocity profiles. RESULTS: IVRT, IVRT/ET and (IVCT+VRT)/ET were significantly increased in the diastolic dysfunction group (120.5+/-19.5 msec, 0.45+/-0.1, 0.64+/-0.2, respectively:p<0.001, p<0.001, p<0.001, respectively) compared with normal subjects (66.1+/-17.4 msec, 0.25+/-0.0, 0.41+/-0.1). IVCT and IVRT were significantly increased and ET was significantly shortened in systolic dysfunction group (75.4+/-25.7, 144.0+/-39.5 msec, 242.7+/-46.5 msec respectively:p<0.001, p<0.05, p<0.05, respectively) compared with diastolic dysfunction group (50.4+/-23.0 msec, 120.5+/-19.5 msec, 276.8+/-44.6 msec, respectively). IVCT/ET, IVRT/ET and (IVCT+IVRT)/ET also were increased in patients with systolic dysfunction group (0.32+/-0.1, 0.61+/-0.2, 0.93+/-0.2 respectively:p<0.01, p<0.01, p<0.001, res-pectively) compared with diastolic dysfunction group (0.19+/-0.1, 0.45+/-0.1, 0.64+/-0.2). Ejection fraction calculated by M-mode parameters was significantly correlated with (IVCT+IVRT)/ET (correlation coefficient - 0.605, p<0.001). CONCLUSION: The Doppler time index was significantly difficient from normal subjects in patients with isolated LV diastolic dysfunction as well as in those with systolic dysfunction. Thus, this index can be used as a sensitive indicator of myocardial performance.
Diastole ; Echocardiography ; Echocardiography, Doppler ; Humans ; Hypertension ; Relaxation ; Systole ; Ventricular Dysfunction, Left

Ulcerative colitis is an inflammatory bowel disease (IBD) characterized by recurrent episodes of colonic inflammation and tissue degeneration in human or animal models. The contractile force generated by the smooth muscle is significantly attenuated, resulting in altered motility leading to diarrhea or constipation in IBD. The aim of this study is to clarify the altered contractility of circular and longitudinal smooth muscle layers in proximal colon of trinitrobenzen sulfonic acid (TNBS)-induced colitis mouse. Colitis was induced by direct injection of TNBS (120 mg/kg, 50% ethanol) in proximal colon of ICR mouse using a 30 G needle anesthetized with ketamin (50 mg/kg), whereas animals in the control group were injected of 50% ethanol alone. In TNBS-induced colitis, the wall of the proximal colon is diffusely thickened with loss of haustration, and showed mucosal and mucular edema with inflammatory infiltration. The colonic inflammation is significantly induced the reduction of colonic contractile activity including spontaneous contractile activity, depolarization-induced contractility, and muscarinic acetylcholine receptor-mediated contractile response in circular muscle layer compared to the longitudinal muscle layer. The inward rectification of currents, especially, important to Ca2+ and Na+ influx-induced depolarization and contraction, was markedly reduced in the TNBS-induced colitis compared to the control. The muscarinic acetylcholine-mediated contractile responses were significantly attenuated in the circular and longitudinal smooth muscle strips induced by the reduction of membrane expression of canonical transient receptor potential (TRPC) channel isoforms from the proximal colon of the TNBS-induced colitis mouse than the control.
Acetylcholine ; Animals ; Colitis ; Colitis, Ulcerative ; Colon ; Constipation ; Contracts ; Diarrhea ; Edema ; Ethanol ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Membranes ; Mice ; Mice, Inbred ICR ; Models, Animal ; Muscle, Smooth ; Muscles ; Needles ; Protein Isoforms

Veratrum patulum is a perennial plant with toxicity, which grows wild in the high mountain areas of Korea. Various types of steroidal alkaloids contained in Veratrum patulum are known to cause symptoms such as nausea, vomiting, bradycardia and hypotension. Twenty-three patients were admitted to our center with chief complaints of nausea and vomiting after ingesting leaves of Veratrum patulum. The mean age of the group was 44 years old and was comprised of 19 males and 4 females. Some patients showed hypotension and bradycardia with symptoms such as dizziness. Ten patients with severe bradycardia coupled with other symptoms received atropine administration. Nausea and vomiting were improved after the administration of anti-emetics. Blood pressure and the pulse rate were all normalized on the day after admission, and all of the patients were discharged without any symptoms.
Alkaloids ; Antiemetics ; Atropine ; Blood Pressure ; Bradycardia ; Dizziness ; Female ; Heart Rate ; Humans ; Hypotension ; Korea ; Male ; Nausea ; Plants ; Veratrum ; Vomiting

BACKGROUND/AIMS: Gastrointestinal stromal tumors (GIST) in the small intestine are rare and can cause bleeding. The study investigated the clinical characteristics of GIST in the small intestine and to determine the factors related to gastrointestinal bleeding. METHODS: We retrospectively evaluated the clinical outcomes of 22 patients with small bowel GIST who were pathologically diagnosed at Gangneung Asan Hospital between March 1997 and August 2012. RESULTS: The median age was 63.5 (38-82) years. Nine patients (40.9%) had gastrointestinal bleeding, five patients (22.7%) had abdominal pain, two patients (9%) had palpable mass. The site of tumor was the duodenum in nine cases (40.9%), jejunum in 7 cases (31.8%), and ileum in six cases (27.3%). Most patients underwent small bowel resection or wedge resection but three patients underwent pancreaticoduodenectomy. Tumor size ranged from 1.6 to 19 cm (median 6.5 cm). The median mitotic rate was 2 (0-50)/50 high power fields (HPF). The median mitotic rate was 2 (0-50)/50 HPF. Five patients (25%) showed recurrence. Gender, aspirin or warfarin use, size and mitotic index of tumor, hospital stay, recurrence and survival were not significantly different between bleeding and non-bleeding group. Bleeding group showed older age, proximal location in small intestine and mucosal ulceration significantly. CONCLUSIONS: Small bowel GISTs with bleeding were marked by older age, mucosal ulceration and location of proximal small bowel (duodenum and jejunum) rather than distal small bowel (ileum).
Abdominal Pain ; Aspirin ; Duodenum ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors ; Hemorrhage ; Humans ; Ileum ; Intestine, Small ; Jejunum ; Length of Stay ; Mitotic Index ; Pancreaticoduodenectomy ; Recurrence ; Retrospective Studies ; Ulcer ; Warfarin

A 43-year-old man, who received total gastrectomy five years ago for advanced gastric cancer, underwent a screening colonoscopy and abdominal CT scan. Abdominal CT scan revealed no abnormal findings. Colonoscopy revealed polyps at the rectum, which were removed by polypectomy. The patient did not complain of abdominal pain or discomfort throughout the procedure. But, he developed right upper quadrant abdominal pain on the next day after colonoscopy. Abdominal CT scan revealed the distended gallbladder with mild wall thickening and suspicious sandy stones or sludge in the gallbladder. The patient underwent an open cholecystectomy. Pathology was compatible with acute cholecystitis. We should be aware of and consider cholecystitis in the differential diagnosis for patients with abdominal pain after colonoscopy.
Adult ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy ; Cholecystitis, Acute/*diagnosis/etiology/pathology ; Colonoscopy/*adverse effects ; Diagnosis, Differential ; Gallbladder/pathology ; Gallstones/diagnosis ; Humans ; Male ; Polyps/pathology ; Tomography, X-Ray Computed

Anaphylaxis is a potentially life-threatening allergic reaction, presenting with various clinical symptoms. The most common etiologies of anaphylactic reactions include allergic responses to food, medications, latex, and Hymenoptera stings. In its classic form, anaphylaxis typically involves the cutaneous, respiratory and cardiovascular systems. Gastrointestinal symptoms, including nausea, vomiting, diarrhea and cramping abdominal pain, can occur transiently but mucosal lesions are rarely detected. We recently experienced a case of ischemic colitis presenting with hematochezia after bee venom-induced anaphylactic shock. To the best of our knowledge, this is the first case in Korea. We report the case with a review of the literature.
Abdominal Pain ; Anaphylaxis ; Bee Venoms ; Bees ; Bites and Stings ; Cardiovascular System ; Colitis, Ischemic ; Diarrhea ; Gastrointestinal Hemorrhage ; Hymenoptera ; Hypersensitivity ; Korea ; Latex ; Muscle Cramp ; Nausea ; Vomiting

Scrub typhus is an acute febrile illness that results from the destruction of endothelial cells by Orientia tsutsugamushi and subsequent systemic vasculitis. It manifests as fever, headache, myalgia, eschar formation, and lymphadenopathy. Some authors have reported that such vasculitis involves the gastrointestinal tract and that hyperemia, erosion, ulceration, and active bleeding of the gastric mucosa subsequently develop. However, no case of ulcer perforation in a patient with scrub typhus has been reported to date. Here, we report the case of a perforated duodenal ulcer in a 70-year-old female patient with scrub typhus.
Aged ; Duodenal Ulcer ; Endothelial Cells ; Female ; Fever ; Gastric Mucosa ; Gastrointestinal Tract ; Headache ; Hemorrhage ; Humans ; Hyperemia ; Lymphatic Diseases ; Orientia tsutsugamushi ; Scrub Typhus ; Systemic Vasculitis ; Ulcer ; Vasculitis

Fundic gland hyperplasia is a hyperplasia of glandular portion on epithelium of gastric fundus or body. The incidence of fundic gland hyperplasia is 1.4% in the general population. Fundic gland hyperplasia is the most common cause of multiple polyposis. Probably the most cause of fundic gland hyperplasia is a hamartomatous origin but some hyperplastic origin because of spontaneous remission. We have experienced and reported a case of atypical fundic gland hyperplasia confirmed by endoscopic mucosal resection.
Epithelium ; Gastric Fundus ; Hyperplasia* ; Incidence ; Remission, Spontaneous