The double pylorus-is a fistulous communication between the gastric antrum and duodenal bulb, usually extending from the lesser curvature of the stomach to the superior aspect of the duodenal bulb, and seperated by septum or bridge of normal mucosa. Although its incidence is rare, reports concerning double pylorus are increasing with the recent development of upper gastrointestinal endoscopy and more awareness of this abnormality. We recently experienced two cases of double pylorus; an aquired one in 72-year old male who had an another opening with healing ulcer at the superior aspect of the original pyloric channel, central erosion with clubbing and fusion of mucosal folds at the greater curvature of the lower body and a 3 x 4 cm sized ulcer at the lesser curvature of the lower body, and the other congenital one in 53-year old male who had an another opening at the superior aspect of the original pyloric channel with histologically intact muscularis mucosa in the pyloric septum with no evidence of chronic peptic ulcer scarring. We report here two cases of double pylorus, one-acquired, and the other-congenital, with a review of the literature.
Aged ; Cicatrix ; Endoscopy, Gastrointestinal ; Humans ; Incidence ; Male ; Middle Aged ; Mucous Membrane ; Peptic Ulcer ; Pyloric Antrum ; Pylorus ; Stomach ; Stomach Ulcer ; Ulcer

Rectal syphilis, known as a great masquerader, can be difficult to diagnose because of its variable symptoms. Gastroenterologists should be aware of the possibility of rectal syphilis when confronted with anorectal ulcers, and should gather a detailed history about sexual preferences and practices, including homosexuality. We report a case of primary rectal syphilis mimicking rectal cancer on radiologic imaging. In this report, we described the clinical, endoscopic, and radiologic features of this rare case.
Humans ; Male ; Middle Aged ; Rectal Diseases/*diagnosis/pathology/radiography ; Rectal Neoplasms/*pathology/radiography ; Syphilis/*diagnosis/pathology/radiography

BACKGROUND: Green Cross HG-II vaccine is recombinant hepatitis B vaccine derived from yeast Hansenula polymorpha. Its immunogenicity and safety using 0-1-6 months vaccination schedule were proven. This prospective study is conducted to evaluate immunogenicity and safety of HG-II according to 0-1-2 months schedule. METHODS: 20 g of HG-II vaccine was given intramuscularly at 0, 1, and 2 months to 118 healthy adults seronegative for hepatitis B markers. Sera were assessed for anti-HBs by radioimmunoassay at 1 months and 7-10 months after completion of vaccination. RESULTS: 113 of 118 (95.8%) completed vaccination schedules. The seroconversion rate at 1 month after completion of vaccination was 93.8% (106/113) and protective titers of anti-HBs developed in 82.3% (93/113). The geometric mean titer (GMT) of anti-HBs was 64.91 mIU/ml in all seroconverted vaccinee. There was no incapacitating serious side effect associated with vaccinations. The seropositive rate at 7-10 months after vaccination was 95.3% (81/85) with protective rate of 84.7% (72/85). The anti-HBs titers were decreased in 51.8% (44/85) of vaccinee. The GMT was 80.04 mIU/ml. The protective rate and GMT were 98.0%, 129.43 mIU/ml in the group with anti-HBs titer > or = 50 mIU/ml at 1 month after vaccination, and 64.71%, 19.62 mIU/ml in the group with anti-HBs <50 mIU/ml. CONCLUSION: Green Cross HG-II vaccine is safe and effective in protecting hepatitis B at 0-1-2 months vaccination schedule. However, the booster injection should be recommended for maintenance of immunogenicity, especially in the vaccinee with anti-HBs titer less than 50 mIU/ml at 1 month after vaccination.
Adult* ; Appointments and Schedules* ; Hepatitis B Vaccines* ; Hepatitis B* ; Hepatitis* ; Humans ; Pichia ; Prospective Studies ; Radioimmunoassay ; Vaccination* ; Yeasts

An extraordinary eye movement was seen in a vegetative patient. His eyeballs were exotropic in the primary position and showed dissociated nystagmus which appeared alternately in each eye every few seconds. He also had palatal myoclonus quite asynchronous with the nystagmus. To our knowledge, there has been no such nystagmus documented in the literature. We report the new nystagmus with his EOG and brain MRI.
Electrooculography ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myoclonus/*complications/diagnosis ; Nystagmus, Pathologic/*complications/diagnosis ; Palatal Muscles

Melanosis can affect various parts of the gastrointestinal tract. Melanosis of the colon is not uncommon, while melanosis of the ileum is extremely rare. We report a case of melanosis ilei associated with chronic ingestion of oral iron (256 mg of ferrous sulfate once or twice daily for approximately 5 years) in a 32-year-old woman with end-stage renal disease. The findings of a colonoscopy, which was performed as a part of her medical checkup, were normal up to the cecum; however, numerous brownish-black punctuate pigmentations of the ileal mucosa were observed. Microscopic examination revealed hemosiderosis in the lamina propria of the ileal mucosa, particularly at the tips of villi. The diagnosis of melanosis (hemosiderosis) ilei was made based on the endoscopic and histological findings.
Adult ; Colon ; Colonoscopy ; Eating ; Female ; Ferrous Compounds ; Gastrointestinal Tract ; Hemosiderin ; Hemosiderosis ; Humans ; Ileum ; Iron ; Kidney Failure, Chronic ; Melanosis ; Mucous Membrane ; Pigmentation

Eosinophilic gastroenteritis (EG) is characterized by eosinophilic infiltration of the bowel wall and variable gastrointestinal manifestations. Clinicians should have a high index of suspicion for EG when faced with gastrointestinal symptoms and peripheral eosinophilia to avoid incorrect diagnosis and inappropriate treatments. A 24-year-old woman was admitted to our hospital complaining of acute right lower quadrant abdominal pain and a laparoscopic appendectomy performed for a presumed diagnosis of an acute appendicitis. However, the procedure revealed bowel edema and a moderate amount of ascites without evidence of a suppurative appendicitis. Postoperatively, she showed persistent and progressive eosinophilia, exudative eosinophilic ascites, eosinophilic infiltration of the resected appendix wall, and eosinophilic infiltration of gastroduodenal mucosa. A punch biopsy of the abdominal skin also revealed inflammation with marked eosinophilic infiltration of the skin. She recovered after the treatment with a low dose of steroid for the EG with eosinophilic dermatitis. EG with eosinophilic dermatitis has not been reported yet and is considered fortuitous in this case.
Adult ; Dermatitis/*diagnosis/drug therapy/pathology ; Eosinophilia/*diagnosis/drug therapy/pathology ; Female ; Gastroenteritis/*diagnosis/drug therapy/pathology ; Humans ; Steroids/therapeutic use ; Young Adult

PURPOSE: The purpose of this study was to find a method of proving cold discomfort in patients who complain during the winter seasons, after receiving an internal fixation with a metal plate, and to determine the different in the developments of cold discomfort according to the type of metal plate used. MATERIALS AND METHODS: Among 26 cases of lateral malleolar fracture, 16 stainless-steel plates and 10 titanium plates were compared. Discomfort was induced by placing ice over both lateral malleoli (ice provocation test), and the side on which discomfort was induced first was recorded. RESULTS: Ten patients who felt discomfort in the winter, among which 8 cases stainless-steel plate and 2 cases titanium plate. The degree of pain was rated as 3.6 on average (ranging 2-4) on the VAS (visual analogue scale). CONCLUSION: Cold discomfort during the winter season can be confirmed by using the ice provocation test (p=0.0004). The frequency of discomfort during the winter season was higher (p=0.126) in cases filted with stainless-steel plate (50%) than in those with a titanium plate (20%).
Ankle ; Humans ; Ice ; Seasons* ; Stainless Steel* ; Titanium*

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.
Aged, 80 and over ; Cytomegalovirus Infections/*complications/diagnosis ; Enteritis/*complications/diagnosis ; Humans ; Immunocompetence ; Intestinal Perforation/*etiology ; Male ; Tomography, X-Ray Computed

Moyamoya disease is a progressive cerebrovascular disorder with stenosis or occlusion of the bilateral internal carotid arteries with abnormal vascular networks at the base of the brain. Previous reports have shown that there are extracranial vascular involvements in Moyamoya disease, especially in the renal artery. We report a 7-year-old patient with Moyamoya disease associated with renovascular hypertension, who presented in infancy with seizures and hemiparesis. Renal angiography showed multiple stenoses of the right renal artery. Although renal artery stenosis in Moyamoya disease has been effectively treated with balloon angioplasty, stent implantation, or surgery, balloon angioplasty could not be done in this patient due to multiple stenoses. His blood pressure was successfully controlled with medical treatment, and remained normotensive during the follow up period of 6 months.
Angiography ; Angioplasty, Balloon ; Blood Pressure ; Brain ; Carotid Artery, Internal ; Cerebrovascular Disorders ; Child ; Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Hypertension, Renovascular* ; Moyamoya Disease* ; Paresis ; Renal Artery ; Renal Artery Obstruction ; Seizures ; Stents