Primary biliary cirrhosis (PBC) is rare in Korea. Although its pathogenesis is not fully understood, immunologic dysregulation is suspected because it is frequently associated with other immunologic disorders. A few cases of primary biliary cirrhosis associated with idiopathic thrombocytopenic purpura (ITP) has previously been reported. However, PBC associated with ITP and Sjogren's syndrome simultaenously has not been reported yet. We experienced a 72-year-old woman had been finally diagnosed as PBC, ITP and Sjogren's syndrome. To the best of our knowledge, this is the first case in the world. We report this case with review of related literature.
Aged ; Female ; Humans ; Korea ; Liver Cirrhosis, Biliary* ; Purpura, Thrombocytopenic, Idiopathic* ; Sjogren's Syndrome*

A malignant fibrous histiocytoma (MFH) is a major subset of soft tissue sarcomas, which occurs principally on the extremities or in the retroperitoneum, as well as on the head and neck of elderly patient. However, it is an extremely rare event when a MFH occurs primarily in the diaphragm of a young people. A 25-year-old woman visited our hospital complaining of right chest pain. The chest X-ray showed a diaphragmatic mass. An exploratory thoracotomic biopsy revealed a primary MFH of the diaphragm. The patient was treated with combined chemotherapy consisting of ifosfamide and doxorubicin. A partial response was seen after 6 cycles of chemotherapy. However, she died of brain metastasis 12 months after the diagnosis.
Adult ; Aged ; Biopsy ; Brain ; Chest Pain ; Diagnosis ; Diaphragm* ; Doxorubicin ; Drug Therapy ; Extremities ; Female ; Head ; Histiocytoma, Benign Fibrous ; Histiocytoma, Malignant Fibrous* ; Humans ; Ifosfamide ; Neck ; Neoplasm Metastasis ; Sarcoma ; Thorax

A 67 year-old man was admitted due to findings that were suspicious for malignancy on gastroscopy at a primary clinic. We also performed gastroscopy and this showed the presence of a 3 cm sized nodular elevated lesion at the angle of the stomach. A biopsy demonstrated the presence of adenocarcinoma of the stomach. A distal gastrectomy with D2 lymph node dissection was performed and the microscopic features of the resected specimen confirmed the diagnosis of adenocarcinoma of the stomach and also metastatic large cell neuroendocrine carcinoma of lymph nodes of an unknown primary origin. Although double primary gastric adenocarcinoma and gastric neuroendocrine tumor with regional lymph node metastasis has been seldom reported, a double primary carcinoma of gastric adenocarcinoma and metastatic large cell neuroendocrine carcinoma of lymph nodes has seldom been reported. We report on this unusual case along with a review of the relevant medical literature.
Adenocarcinoma ; Biopsy ; Carcinoma, Neuroendocrine ; Gastrectomy ; Gastroscopy ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Stomach

Spontaneous hemoperitoneum is rare. The most common etiologies are gynecologic, splenic, and hepatic. Gastric arteriovenous malformations are commonly associated with intraluminal bleeding, but gastric arteriovenous malformations are an unusual cause of spontaneous intraperitoneal hemorrhage. A 54-year-old man presented with acute onset of epigastric pain. The patient was given an operation and pathology confirmed that it was a gastric arteriovenous malformation.
Arteriovenous Malformations ; Hemoperitoneum ; Hemorrhage ; Humans ; Middle Aged

The major causes of terminal ileitis are inflammatory bowel disease and NSAIDs but parasites such as Anisakis rarely induce ileitis. Ascaris lumbricoides, the most common intestinal helminth in Korea, may enter the pancreaticobiliary ducts and cause pancreatitis or cholangitis. However, no case of A. lumbricoides-associated terminal ileitis has been previously reported in Korea. We report a case of a 58-year-old woman who presented with epigastric discomfort and bloating, and was diagnosed with terminal ileitis due to A. lumbricoides detected during colonoscopy.
Anisakis ; Anti-Inflammatory Agents, Non-Steroidal ; Ascaris ; Ascaris lumbricoides ; Cholangitis ; Colonoscopy ; Crohn Disease ; Female ; Helminths ; Humans ; Ileitis ; Inflammatory Bowel Diseases ; Korea ; Middle Aged ; Pancreatitis ; Parasites

Endoscopic polypectomy is a widely used therapeutic modality for the treatment of polypoid lesions in the gastrointestinal tract. Postpolypectomy bleeding is the most common procedure-related complication. Bleeding can occur immediately after the polypectomy or be delayed from hours to up to days. The severity of bleeding ranges from slight oozing to spurting arterial bleeding that requires immediate endoscopic hemostasis. Because severe hemorrhage can be a cause of repeat endoscopy, blood transfusion, hospitalization or surgery, endoscopists must carefully observe the patient's symptoms and hemodynamic status after an endoscopic polypectomy. Here, we report a large intramucosal hematoma and subsequent huge ulcer in the stomach as a rare complication of endoscopic snare polypectomy.
Blood Transfusion ; Endoscopy ; Gastrointestinal Tract ; Hematoma ; Hemodynamics ; Hemorrhage ; Hemostasis, Endoscopic ; Hospitalization ; SNARE Proteins ; Stomach ; Ulcer

Hemangiomas are uncommon benign vascular tumors that account for up to 10% of all small bowel tumors. The jejunum is the most common location, and gastrointestinal bleeding is a frequent clinical presentation. Histologically, hemangiomas are classified as cavernous, capillary, or mixed types. Capillary hemangiomas are dense collections of capillaries usually with a hyperplastic endothelium. There have been a few cases of small bowel capillary hemangioma revealed by capsule endoscopy and confirmed after surgical resection. But preoperative detection of hemangiomas in the small intestine has not been reported, as far as we know, associated with the use of balloon-assisted enteroscopy. This report describes a 44-year-old male with a small bowel mass considered to be a cause of severe iron deficiency anemia. In this case, we performed capsule endoscopy and single balloon enteroscopy to examine the lesion. The patient then underwent a segmental resection of the jejunum, which confirmed the presence of a capillary hemangioma with surface ulceration.
Adult ; Anemia ; Anemia, Iron-Deficiency ; Capillaries ; Capsule Endoscopy ; Caves ; Endothelium ; Hemangioma ; Hemangioma, Capillary ; Hemorrhage ; Humans ; Intestine, Small ; Jejunum ; Male ; Ulcer

The diagnostic considerations are broad for patients who clinically present with obscure abdominal pain. Acute appendicitis can be diagnosed according to the clinical signs and symptoms, yet this can often be extremely challenging. Difficulties particularly arise when the presentation is atypical. Investigations that may help include laboratory tests, non-invasive imaging and laparoscopy. We experienced 3 cases of acute appendicitis that were diagnosed by colonoscopy. The colonoscopy revealed a bulging of the appendix into the cecal lumen. The mucosa was erythematous and edematous with pus draining from the appendiceal orifice. These findings were suggestive of appendicitis, which was confirmed after surgical appendectomy. In our experience, making the colonoscopic diagnosis of appendicitis might be helpful for patients with atypical symptoms, but colonoscopy should not be used for the diagnosis in the beginning if appendicitis is initially suspected.
Abdominal Pain ; Appendectomy ; Appendicitis ; Appendix ; Colonoscopy ; Humans ; Laparoscopy ; Mucous Membrane ; Suppuration

BACKGROUND/AIMS: There are no proper guidelines for the management of gastric low-grade dysplasia (LGD). We evaluated clinical parameters, histological results and follow-up endoscopies to find a management strategy of LGD. MATERIALS AND METHODS: A total of 590 patients with LGD, high-grade dysplasia (HGD), functional dyspepsia (FD), early or advanced gastric cancer (early gastric cancer [EGC] or advanced gastric cancer [AGC]) were consecutively enrolled. We examined the association of clinical parameters including low serum pepsinogen (PG) I/II ratio < or =3.0 with the disease phenotypes. Histological results between initial forceps-biopsy and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) specimens were compared. RESULTS: The PG I/II ratio in FD was 4.2+/-1.7, but was significantly low in LGD (2.8+/-1.6, P<0.0001). The ratio was not further decreased in the HGD, EGC, and AGC groups. In FD patients with the ratio of < or =3.0, smoking habits and high salt intake were independent risk factors for gastric dysplasia or gastric cancer. In about 11% (n=8/70) of LGD lesions, the pathologic diagnoses were upgraded to HGD or EGC after endoscopic resection. Neither serious complications nor recurrence at the primary site were found. CONCLUSIONS: It is proposed that endoscopic resection followed by endoscopic surveillance might be a beneficial strategy for patients with LGD having a PG I/II ratio of < or =3.0.
Dyspepsia ; Follow-Up Studies ; Humans ; Pepsinogen A ; Phenotype ; Recurrence ; Risk Factors ; Smoke ; Smoking ; Stomach Neoplasms

BACKGROUND/AIMS: The aim of this study was to evaluate the change in circulating levels of adipokines, including leptin, adiponectin, resistin, and visfatin, after induction therapy of patients with active inflammatory bowel disease (IBD). METHODS: We prospectively evaluated 20 patients with Crohn's disease (CD) and 14 patients with ulcerative colitis (UC) who received induction therapy. The disease activity, body mass index (BMI), and C-reactive protein (CRP) and serum adipolines levels were checked before treatment and 10 weeks after treatment. RESULTS: After induction therapy, significant reduction of disease activity was noted in patients with CD (CD activity index, 267.9+/-73.7 vs. 50.8+/-36.5, P<0.001) and patients with UC (Mayo score, 9.8+/-2.2 vs. 1.4+/-1.6, P<0.001). The mean serum leptin, adiponectin, resistin, and visfatin levels were 4.0+/-2.7 ng/mL and 4.4+/-2.3 ng/mL (P=0.323), 27.0+/-20.5 microg/mL and 33.8+/-26.5microg/mL (P=0.084), 9.0+/-4.0 ng/mL and 10.2+/-3.2 ng/mL (P=0.108), and 4.6+/-3.7 ng/mL and 2.5+/-4.1 ng/mL (P=0.046) before and after infliximab treatment, respectively. No significant correlation between the changes in BMI, CRP level, or the clinical indices of activity and alterations of the measured adipokines was demonstrated. CONCLUSIONS: The serum levels of leptin, adiponectin, and resistin showed no significant alterations, whereas the serum visfatin level decreased significantly after induction therapy, suggesting a possible pro-inflammatory property of visfatin and a role as a marker of successful therapy of IBD.
Adipokines ; Adiponectin ; Antibodies, Monoclonal ; Body Mass Index ; C-Reactive Protein ; Colitis, Ulcerative ; Crohn Disease ; Humans ; Infliximab ; Inflammatory Bowel Diseases ; Leptin ; Nicotinamide Phosphoribosyltransferase ; Prospective Studies ; Resistin