Trichuris trichiura infection is a common helminth infection, which is transmitted via soil, with worldwide distribution, especially in rural areas of developing countries. Occasionally, sporadic cases occur in non-endemic, developed areas due to the widespread of immigration. We experienced a case of Trichuris dysentery syndrome in a young North Korean defector, who had been suffering from chronic abdominal pain for 10 years. He is relatively short and thin compared with his older brother. Unexpectedly, the diagnosis, made by a colonoscopy, revealed numerous, small, white, and gently moving worms at the cecum and ascending colon. After 3 days of albendazole (400 mg once daily) administration, clinical symptoms subsided dramatically. On the follow-up colonoscopy, which was performed two months after the completion of his treatment, complete eradication was identified. Soil-transmitted helminths, including Trichuris trichiura, are disappearing becoming less prevalent in South Korea as a result of both national driving force and environmental improvement. However, these diseases should be considered when we meet foreign patients from developing countries, like North Korea, presenting chronic abdominal pain. Moreover, proper treatment of North Korean defectors and performing cohort studies of them would help to prepare for the possible unification era in the field of gastroenterology.
Abdominal Pain* ; Albendazole ; Cecum ; Cohort Studies ; Colon, Ascending ; Colonoscopy ; Democratic People's Republic of Korea ; Developing Countries ; Diagnosis ; Dysentery ; Emigration and Immigration ; Follow-Up Studies ; Gastroenterology ; Helminths ; Humans ; Korea ; Siblings ; Soil ; Trichuris*

The lung nodule is one of the pleuropulmonary menifestations in rheumatoid arthritis. We report here a case exhibiting hydropneumothorax due to a bronchoplerual fistula resulting from a ruptured rheumatoid lung nodule complicated with a aspergilloma in it. A 39 year-old man with rheumatoid arthritis was admitted because of cough for one month. Multiple subcutaneous nodules were noted and multiple lung nodules were seen on chest X-ray, Peripheral white cells were 9,600/mm3 with 1896 of eosinophils. The percutaneous needle aspiration biopsy of the largest lung nodule of right upper lobe showed massive necrosis without acid fast bacillus, fungus, or malignant cell. Three months after discharge, air-meniscus sign was seen on the biopsied lung nodule on X-ray. Five months later, the patient was readmitted due to dyspnea and chest pain and simple chest X-ray showed hydropneumothorax on the right side. The pneumothorax was not healed after closed thoracotomy and tube drainage, and high fever developed. The pleural fluid culture revealed Pseudomonas aeroginosa and Aspergillus fumigatus. Seventy days after admission, exploratory thoracotomy was done. Aspergilloma was found in the cavitated lung nodule which was ruptured into the pleural cavity through bronchopleural fistula.
Adult ; Arthritis, Rheumatoid* ; Aspergillus fumigatus ; Bacillus ; Biopsy, Needle ; Chest Pain ; Cough ; Drainage ; Dyspnea ; Eosinophilia* ; Eosinophils ; Fever ; Fistula* ; Fungi ; Humans ; Hydropneumothorax ; Lung* ; Necrosis ; Needles ; Pleural Cavity ; Pneumothorax ; Pseudomonas ; Thoracotomy ; Thorax

Sternocostoclavicular hyperostosis is a chronic arthro-osteitis affecting mostly jux-tasternal structures. It is characterized clinically by painfull swelling of the upper anterior chest wall and occasionally is associated with pustulosis palmaris and plantaris. A 34-year-old female presented with upper anterior chest pain and low back pain. She was well until three months ago, then left shoulder pain and multiple pustule on both palms developed. She felt gradually exhausted in spite of symptomatic medication at drug store. Eight months before this admission she underwent an operation on the right sided breast due to a benign mass. On examination there was no evidence of conjunctivitis or aphthous oral ulcer, tenderness on left sternoclavicular joint was noted and flextion of the left hip joint was limited because of pain in the joint area. Multiple pustules were noted in the palms of both hands, but it wasn't associated with nail change. The mammographs was normal. Plain radiographs of the spine showed disc space narrowing of seventh thoracic spine and spondylolysis on fifth' lumbar vertebra. Radionuclide imaging with 99mTc-methylene diphosphonate of the bone showed multiple increased uptake on both sacroiliac joints, both first costochondra] joints, left sternoclavicular joint, and eighth thoracic vertebra. Magnetic Resonance Imaging reavealed low signal intensity in medial end of the left clavicle with joint effusion and Schmorl's node in seventh thoracic disc space. Laboratory tests were normal, except ESR 23mm/h. In this case we think that careful clinical differential diagnosis of sternocostoclavicular hyperostosis should include sclerotic metastasis.
Adult ; Breast ; Chest Pain ; Clavicle ; Conjunctivitis ; Diagnosis, Differential* ; Female ; Hand ; Hip Joint ; Humans ; Hyperostosis, Sternocostoclavicular* ; Joints ; Low Back Pain ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Oral Ulcer ; Radionuclide Imaging ; Sacroiliac Joint ; Shoulder Pain ; Spine ; Spondylolysis ; Sternoclavicular Joint ; Technetium Tc 99m Medronate ; Thoracic Wall

PURPOSE: It is known that lactoferrin serves as a source of iron for H. pylori in gastric mucosa. This study was undertaken to investigate the relationship between lactoferrin and H. pylori infection coexistent with iron-deficiency anemia by determining the lactoferrin levels in gastric biopsy specimens, and by locating the major sites of lactoferrin expression, according to the presence or absence of iron-deficiency anemia. METHODS: Fifty-five adolescents that underwent gastroduodenoscopy were divided into three groups: NL (n=19) for normal controls, HP (n=15) for patients with H. pylori, and IDA (n=21) for patients with H. pylori gastritis and coexisting iron-deficiency anemia. Histopathologic features were graded from null to marked on the basis of the Updated Sydney System. The gastric mucosal levels of lactoferrin were measured by immunoassay. Immunohistochemical technique was used to allow identification of the location and quantification of the lactoferrin expression. RESULTS: Lactoferrin levels in the antrum increased significantly, in proportion to, H. pylori density, polymorphonuclear cell infiltration, and chronic inflammation in the histologic specimens. Patients in the HP and IDA groups showed significantly increased mucosal levels of lactoferrin compared with that observed in the normal group (p=0.0001). The lactoferrin level in IDA group tended to be higher than that in the HP group (p=0.2614). The major sites of lactoferrin expression by immunohistochemistry were in glands and neutrophils within epithelium. Lactoferrin was stained weakly in NL, and strongly in HP and IDA. CONCLUSION: The lactoferrin sequestration in the gastric mucosa of IDA was remarkable, and this finding seems to give a clue that leads to the clarification of the mechanism by which H. pylori infection contributes to iron-deficiency anemia.
Adolescent ; Anemia, Iron-Deficiency* ; Biopsy ; Epithelium ; Gastric Mucosa* ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoassay ; Immunohistochemistry ; Inflammation ; Iron* ; Lactoferrin* ; Neutrophils

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a skeletal disease characterized by ligamentous ossification of the anterolateral side of the spine. Paravertebral and ligamentous ossification appears to be an usual complication of hypoparathyroidism. Diabetes Mellitus has often been mentioned in associated with DISH. The patient was presented with back pain, stiffness and intermittent numbness of hands and feet. Spine X-ray showed extensive ligamentous ossification of the anterolateral side of the spine with normal disc space height. Sacroiliac joints are normal. Increased bone mineral density of the L-spine and femur neck was observed, as well. Hypocalcemia, hyperphophatemia and low intact parathyroid hormone level were detected. Postprandial sugar were elevated. HLA B27 was negative.
Back Pain ; Bone Density ; Diabetes Mellitus* ; Femur Neck ; Foot ; Hand ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal* ; Hypesthesia ; Hypocalcemia ; Hypoparathyroidism* ; Ligaments ; Parathyroid Hormone ; Sacroiliac Joint ; Spine

PURPOSE: Prader-Willi syndrome(PWS) is a complex disorder affecting multisystems with characteristic clinical features. Its genetic basis is an expression defect in the paternally derived chromosome 15q11-q13. We analyzed the clinical features and genetic basis of PWS patients for early detection and treatment. METHODS: We retrospectively studied 24 patients with PWS in Department of Pediatrics, Samsung Medical Center, from September 1997 to September 2001. We performed cytogenetic and molecular genetic techniques using high resolution GTG banding techniques, fluorescent in situ hybridization and methylation-specific PCR for CpG island of SNRPN gene region. RESULTS: The average birth weight of PWS patients was 2.67+/-0.47 kg and median age at diagnosis was 1.3 years. The average height and weight of PWS patients under one year at diagnostic time were located in a 3-10 percentile relatively, and a rapid weight gain was seen between two and six years. Feeding problems in infancy and neonatal hypotonia were the two most consistently positive major criteria in over 95% of the patients. In 18 of the 24 cases(75%), deletion of chromosome 15q11-q13 was demonstrated and one case among 18 had an unbalanced 14;15 translocation. In four cases without any cytogenetic abnormality, it may be considered as maternal uniparental disomy and the rest showed another findings. CONCLUSION: We suggest diagnostic testing for PWS in all infants/neonates with unexplained feeding problems and hypotonia. It is necessary for clinically suspicious patients to undergo an early genetic test. As the genetic basis of PWS was heterogenous and complex, further study is required.
Birth Weight ; Chromosome Aberrations ; CpG Islands ; Cytogenetics ; Diagnosis ; Diagnostic Tests, Routine ; Humans ; In Situ Hybridization, Fluorescence ; Molecular Biology ; Muscle Hypotonia ; Pediatrics ; Polymerase Chain Reaction ; Prader-Willi Syndrome* ; Retrospective Studies ; snRNP Core Proteins ; Uniparental Disomy ; Weight Gain

Primary angiitis of the central nervous system (PACNS) is a poorly understood form of vascular inflammatory disease that is restricted to the brain and spinal cord. A 38-year-old woman presented with severe headache and transient aphasia. Her cerebrospinal fluid exhibited aseptic meningitis, and high-resolution vessel-wall MRI (HRVW-MRI) revealed narrowing of multiple intracranial vessels with concentric wall thickening and diffuse enhancement, suggestive of PACNS. High-dose steroid and azathioprine therapy resulted in a significant improvement in vessel wall thickening, and enhancement was observed on the follow-up HRVW-MRI.
Adult ; Aphasia ; Azathioprine ; Brain ; Central Nervous System* ; Cerebrospinal Fluid ; Female ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging* ; Meningitis, Aseptic ; Spinal Cord ; Vasculitis* ; Vasculitis, Central Nervous System

PURPOSE: This study was designed to exclude radiation in advanced(stage 3, 4) Wilms tumor (WT) by increasing the chance of complete surgical removal with preceding neoadjuvant chemotherapy, thereby reducing the incidence of late effects. METHODS: Between December 1998 and July 2002, we conducted neoadjuvant chemotherapy after needle aspiration biopsy on patients who had advanced WT. If needle biopsy was accessible, we conducted neoadjuvant chemotherapy(vincristine, adriamycin, dactinomycin) for 12 weeks and then performed surgical removal, excluded radiation therapy and conducted postoperative chemotherapy (vincristine, dactinomycin+/-adriamycin). In other cases, we firstly conducted the operation and then performed radiation and postoperative chemotherapy. RESULTS: Of the 17 patients diagnosed as WT, 12 patients had an advanced stage of disease. In two of the 12 patients, initial surgical removal was conducted. The median age of patients was 21 months(5-103 months). Of the 10 the patients who received neoadjuvant chemotherapy, eight patients were stage 1, one patient was stage 2, and the other was stage 3 at operation. In nine patients except one with stage 3 disease, we could perform complete surgical resection and there fore could omit radiation. In four cases we could also exclude adriamycin after operation. All but one patient was alive, disease-free, for a median follow-up of 21 months(9-43 months). CONCLUSIONS: After neoadjuvant chemotherapy, we could increase the chance of complete tumor resection, exclude radiation and decrease the intensity of postoperative chemotherapy in selected cases. Long term follow-up is needed to determine whether our method would significantly decrease late effects.
Biopsy, Needle ; Doxorubicin ; Drug Therapy* ; Follow-Up Studies ; Humans ; Incidence ; Needles ; Wilms Tumor*

The Urachus lies between the peritoneum and transversalis fascia and extends from the anterior dome of the bladder toward the umbilicus. During the 4th and 5th months of gestation, the urachus narrows to a small-calibered epitherial tube. During fetal development, as the bladder descends into the pelvis, its apical portion narrows progressively into a fibromuscular strand of urachus. Recently, we reviewed three cases of urachal anomalies with literatures.
Fascia ; Fetal Development ; Pelvis ; Peritoneum ; Pregnancy ; Umbilicus ; Urachus ; Urinary Bladder

PURPOSE: To evaluate the extent of pain response and objective response to palliative radiotherapy (RT) for bone metastases from hepatocellular carcinoma according to RT dose. MATERIALS AND METHODS: From January 2007 to June 2010, palliative RT was conducted for 103 patients (223 sites) with bone metastases from hepatocellular carcinoma. Treatment sites were divided into the high RT dose and low RT dose groups by biologically effective dose (BED) of 39 Gy10. Pain responses were evaluated using the numeric rating scale. Pain scores before and after RT were compared and categorized into 'Decreased', 'No change' and 'Increased'. Radiological objective responses were categorized into complete response, partial response, stable disease and progression using modified RECIST (Response Evaluation Criteria In Solid Tumors) criteria; the factors predicting patients' survival were analyzed. RESULTS: The median follow-up period was 6 months (range, 0 to 46 months), and the radiologic responses existed in 67 RT sites (66.3%) and 44 sites (89.8%) in the high and low RT dose group, respectively. A dose-response relationship was found in relation to RT dose (p=0.02). Pain responses were 75% and 65% in the high and low RT dose groups, respectively. However, no statistical difference in pain response was found between the two groups (p=0.24). There were no differences in the toxicity profiles between the high and low RT dose groups. Median survival from the time of bone metastases diagnosis was 11 months (range, 0 to 46 months). The Child-Pugh classification at the time of palliative RT was the only significant predictive factor for patient survival after RT. Median survival time was 14 months under Child-Pugh A and 2 months under Child-Pugh B and C. CONCLUSION: The rate of radiologic objective response was higher in the high RT dose group. Palliative RT with a high dose would provide an improvement in patient quality of life through enhanced tumor response, especially in patients with proper liver function.
Carcinoma, Hepatocellular ; Follow-Up Studies ; Humans ; Liver ; Neoplasm Metastasis ; Quality of Life