About 5% of patients with SCLC have the ectopic production of ACTH. Ectopic ACTH production of SCLC is suspected when patients of SCLC have unexplained metabolic alkalosis and hypokalemia. Most patients lack the classic feature of Cushing's syndrome. According to the recent report, they have poor prognosis, which median survival is less than 4 months and associated with a high rate of complication during chemotherapy. Also a case of paraneoplastic CRH production with SCLC can mimic the ectopic ACTH syndrome hut it can be distinguished by immunohistochemistry or direct measurement of serum CRH level. We report here a case of small cell lung cancer associated with Cushing's syndrome of ectopic ACTH production. That is immunohistochemically provened by staining with ACTH.
ACTH Syndrome, Ectopic ; Adrenocorticotropic Hormone* ; Alkalosis ; Cushing Syndrome* ; Drug Therapy ; Humans ; Hypokalemia ; Immunohistochemistry ; Lung Neoplasms* ; Lung* ; Prognosis ; Small Cell Lung Carcinoma

A 63 Year-old-lady has had substernal chest pain on exertion for 8 years. The chest pain has been increased over the last 3 years. A continuous murmur was heard at the left second to third inercostal spaces along the left sternal border. The electrocardiogram showed the inverted T-waves in the precordial leads. The right heart catheterization revealed 5% oxygen step up between RV and PA. The right sided pressures were normal. The coronary arteriography revealed markedly tortuous vessels starting shortly after the left main stem coronary artery was normally originated. One of the large vessel was shown to be drained into the pulmonary artery. In the operation room, without using heart-lung machine this abnormally drained vessel was simply ligated at it's draining site into pulmonary artery. After the operation the patient is feeling well with little symptoms and the continuous murmur is no longer heard.
Angiography ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Vessels* ; Electrocardiography ; Heart-Lung Machine ; Humans ; Middle Aged* ; Oxygen ; Pulmonary Artery*

We have attempted to measure parafoveal retinal acuity directly on the exact retinal locus, while observing the retinal image in real time using the scanning laser ophthalmoscope(SLO 101, Rodenstock, Munish, Germany). By the SLO Visumetry software(Rodenstock v. 3.0), thirty eyes of healthy volunteers were examined in 20degrees image field. Using Snellen E as stimulus, the examination was performed from the fovea by the radial pattern. The maximal retinal distance point, which responded to stimulus, was recorded by the pixel, and the distance(mm) from the fovea was calculated by the Bennett formula. The maximum distance from the fovea at the given stimulus size was achieved as follows: 0.32+/-0.01mmat the 15 x15 arc of minute(0.333), 0.63+/-0.01mm at the 17 x17 arc of minute(0.294), 1.05+/-0.03 mmat 20 x 20 arc of minute(0.25), and 1.44+/-0.0 5 mmat the 23 x23 arc of minute(0.217). It was also revealed that the horizontal maximal distance from fovea at given stimulus size was statistically superior to the vertical maximal distance(p<0.05). In conclusion we were able to establish the normal range of parafoveal retinal acuity in healthy volunteers. It may serve as the baseline for subsequent study of retinal pathology and functional evaluation as well as its treatment.
Healthy Volunteers* ; Pathology ; Reference Values ; Retinaldehyde* ; Visual Acuity*

Acute appendicitis is the most common operative disease in general surgery, but it is not also rate disease to see in other clinical department such as Internal Medicine and Obstetric and Gynecology, because it reqnires to differenciate from many other diseases which have similar symptoms. Expecially, because the clipical aymptoms of acute appendicitis are not typieal in children, elderly, and women, it is hard to be diagnosed as acute appendicitis and it is often misdiagnosed as other disease. We performed colonoscopy due to be interpretated aa one of the colon diseases rather than acute appendicitis. But in colonoscopic findings, there were hyperemie and edematous change on the appendiceal orifice of cecum(cherry or acorn shape). So we report 5 cases of acute appendicitis diagnosed br colonoscopy.
Aged ; Appendicitis* ; Child ; Colon ; Colonoscopy* ; Female ; Gynecology ; Humans ; Internal Medicine

Background: Obesity is a chronic disease associated with metabolic diseases such as diabetes and cardiovascular disease. Since the U.S. Food and Drug Administration approved liraglutide as an anti-obesity drug for nondiabetic patients in 2014, it has been widely used for weight control in overweight and obese people. This study aimed to systematically analyze the effects of liraglutide on body weight and other cardiometabolic parameters. Methods: We investigated articles from PubMed, EMBASE, and the Cochrane Library to search randomized clinical trials that examined body weight changes with liraglutide treatment. Results: We included 31 studies with 8,060 participants for this meta-analysis. The mean difference (MD) between the liraglutide group and the placebo group was −4.19 kg (95% confidence interval [CI], −4.84 to −3.55), with a −4.16% change from the baseline (95% CI, −4.90 to −3.43). Liraglutide treatment correlated with a significantly reduced body mass index (MD: −1.55; 95% CI, −1.76 to −1.34) and waist circumference (MD: −3.11 cm; 95% CI, −3.59 to −2.62) and significantly decreased blood pressure (systolic blood pressure, MD: −2.85 mm Hg; 95% CI, −3.36 to −2.35; diastolic blood pressure, MD: −0.66 mm Hg; 95% CI, −1.02 to −0.30), glycated hemoglobin (MD: −0.40%; 95% CI, −0.49 to −0.31), and low-density lipoprotein cholesterol (MD: –2.91 mg/dL; 95% CI, −5.28 to −0.53; MD: −0.87% change from baseline; 95% CI, −1.17 to −0.56). Conclusion Liraglutide is effective for weight control and can be a promising drug for cardiovascular protection in overweight and obese people.

Background: Obesity is a chronic disease associated with metabolic diseases such as diabetes and cardiovascular disease. Since the U.S. Food and Drug Administration approved liraglutide as an anti-obesity drug for nondiabetic patients in 2014, it has been widely used for weight control in overweight and obese people. This study aimed to systematically analyze the effects of liraglutide on body weight and other cardiometabolic parameters. Methods: We investigated articles from PubMed, EMBASE, and the Cochrane Library to search randomized clinical trials that examined body weight changes with liraglutide treatment. Results: We included 31 studies with 8,060 participants for this meta-analysis. The mean difference (MD) between the liraglutide group and the placebo group was −4.19 kg (95% confidence interval [CI], −4.84 to −3.55), with a −4.16% change from the baseline (95% CI, −4.90 to −3.43). Liraglutide treatment correlated with a significantly reduced body mass index (MD: −1.55; 95% CI, −1.76 to −1.34) and waist circumference (MD: −3.11 cm; 95% CI, −3.59 to −2.62) and significantly decreased blood pressure (systolic blood pressure, MD: −2.85 mm Hg; 95% CI, −3.36 to −2.35; diastolic blood pressure, MD: −0.66 mm Hg; 95% CI, −1.02 to −0.30), glycated hemoglobin (MD: −0.40%; 95% CI, −0.49 to −0.31), and low-density lipoprotein cholesterol (MD: –2.91 mg/dL; 95% CI, −5.28 to −0.53; MD: −0.87% change from baseline; 95% CI, −1.17 to −0.56). Conclusion Liraglutide is effective for weight control and can be a promising drug for cardiovascular protection in overweight and obese people.

Collagenous gastroduodenitis is a rare gastrointestinal disease diagnosed histologically by subepithelial collagen deposition in the lamina propria. Its clinical presentation is diverse. The authors encountered a 17-year-old female patient who complained of epigastric pain. Endoscopy revealed several deep ulcers in the gastric body. The gastric mucosa around the ulcer showed diffuse fine nodularity in the shape of cobblestones with open-type atrophy. The duodenal mucosa showed nodular lesions similar to those of the gastric mucosa. The gastric ulcer healed completely with proton pump inhibitor treatment. The patient was followed up, showing no remarkable mucosal change of stomach or duodenum for several years. Collagenous gastroduodenitis was diagnosed by repeated histologic examinations. This paper reports a rare case of chronic collagen gastritis with deep gastric ulcer and its long-term clinical progress.

Benign mediastinal cysts are challenging to diagnose. Although Endoscopic Ultrasound (EUS) and EUS-guided fine needle aspiration (FNA) can accurately diagnose mediastinal foregut cysts, little is known about their complications. This paper reports a rare case in which EUS-FNA performed on mediastinal hemangioma resulted in an aortic hematoma. A 29-year-old female patient was commissioned for EUS of an asymptomatic accidental mediastinal lesion. Chest CT revealed a 4.9×2.9×10.1 cm thin-walled cystic mass in the posterior mediastinum. EUS revealed a large, anechoic cystic lesion with a regular thin wall with negative Doppler. EUS-guided FNA was performed using a single-use 19-gauge aspiration needle (EZ Shot 3; Olympus, Tokyo, Japan), and approximately 70 cc of serous pinkish fluid was aspirated. The patient was in a stable condition with no signs of acute complication. One day after EUS-FNA, thoracoscopic resection for mediastinal mass was conducted. The purple and multi-loculated large cyst was removed. Upon removal, however, an aortic hematoma caused by a focal descending aortic wall injury was observed. After a few days of close observation, the patient was discharged upon stable 3D aorta angio CT findings. This paper reports a rare and severe complication of EUS-FNA, in which an aspiration needle caused a direct injury to the aorta. The injection must be performed carefully to avoid damaging the adjacent organs or digestive tract walls.

Objectives: Adenosine triphosphate-binding cassette subfamily G member 2 (ABCG2) and CD133 are recognized stem cell markers of gastric cancer. Extensive research has examined the significance of these markers in different types of cancers and their impact on prognoses, linking them to unfavorable clinical outcomes in various tumors. However, the prognostic value of these markers for gastric cancer remains unclear. We investigated the expression of ABCG2 and CD133 and their relationship with clinical outcomes in gastric cancer. Methods: ABCG2 and CD133 expression levels were analyzed, using immunohistochemistry and tissue microarrays, in tumor samples from 459 patients who underwent surgical resections due to gastric cancer. ABCG2 and CD133 expression levels were defined by intensity and dichotomized as medians. The associations among the expression levels of these markers, disease severity, and patient survival were also determined. Results: In the 411 patients for whom we analyzed the expression levels of these markers, 74.9% and 80.5% were found to have high levels of ABCG2 and CD133, respectively. High expression levels of ABCG2 and CD133 were more commonly observed in well-differentiated (p<0.001 and p=0.004, respectively) and intestinal lesions (p<0.001 and p=0.002, respectively). High ABCG2 expression correlated with improved survival outcomes, whereas high CD133 expression was associated with poorer outcomes. Cox regression analysis confirmed that stage, high ABCG2 (overall survival [OS]: hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.41–0.91; p=0.015; recurrencefree survival [RFS]: HR, 0.55; 95% CI, 0.34–0.88; p=0.012), and CD133 expression (OS: HR, 1.59; 95% CI, 1.00–2.51; p=0.049; RFS: HR, 2.29; 95% CI, 1.21–4.34; p=0.011) were predictors of survival. A subgroup analysis indicated that ABCG2 expression was also associated with an improved RFS rate in patients who received systemic chemotherapy. Conclusions High ABCG2 expression and low CD133 expression in tumors correlated with improved survival outcomes in post-resection patients with gastric cancer, suggesting their potential utility as prognostic biomarkers.

Intestinal lymphangiectasia is characterized by protein- losing enteropathy, and is diagnosed by a small bowel biopsy demonstrating dilated lymphatics in the mucosa, submucosa and serosa in the absence of coexistent inflammation. We report a case of primary intestinal lymphangiectasia that occurred in a 2-year-6-month-old girl who was treated successfully with antiplasmin and octreotide. Initially, the patient was treated with a lipid restriction diet with medium chain triglyceride oil, but her symptoms were not relieved. This case shows that antiplasmin and octreotide therapy might be useful for treating refractory primary intestinal lymphangiectasia.
Biopsy ; Diet ; Female ; Humans ; Inflammation ; Mucous Membrane ; Octreotide* ; Serous Membrane ; Triglycerides