Autoimmune gastritis (AIG), a chronic inflammatory disease occurs as a result of a complex interaction between host-related and environmental factors. AIG may progress to severe atrophic gastritis secondary autoimmune-mediated parietal cell destruction in the stomach. AIG can be diagnosed based on anti-parietal cell antibody tests and endoscopy, which reveals widespread gastric corpus atrophy in patients with low serum pepsinogen I levels, a low pepsinogen I/II ratio, and elevated serum gastrin levels on serological testing. Tissue biopsy findings, which include mucosal atrophy and lymphocytic infiltration of the lamina propria may be useful for diagnostic confirmation. Decreased gastric acid secretion causes hypergastrinemia and enterochromaffin-like (ECL) cell proliferation, which can lead to neuroendocrine tumor development. Additionally, an autoimmune response results in parietal and chief cell injury, and proliferating ECL cells are detected in the deep mucosal layers in patients with AIG. Therefore, this condition may easily be misdiagnosed as a subepithelial tumor, and establishing a differential diagnosis for other types of subepithelial tumor accompanied by AIG is challenging. We present the case of a 54-year-old woman who was diagnosed with AIG with a concomitant subepithelial tumor based on serologic tests and biopsy findings and underwent wedge resection, which confirmed diagnosis of a schwannoma.

BACKGROUND: Since the introduction of anti-HCV assay, post-transfusion hepatitis (PTH) by Hepatitis C Virus (HCV) was remakably reduced. Recently, based on the estimation of HCV seroincidence rate in blood donors, an investigator insisted that alanine aminotransferase (ALT) test be discontinued as a surrogate marker. This study was designed to determine the HCV seroincidence in Korean blood donors. METHODS: HCV seroincidence was calculated using repeat donors who had donated repeatedly during the 26 months from Nov. 1994 through Dec. 1996. To calculate the person-years according to ALT value, the computer database of the Korean National Red Cross (KNRC) was used in which results for anti-HCV by enzyme immunoassay (EIA) were filed up. To count the true incidence cases, who were defined as donors showing seroconversion by confirmatory test in two successive donation, seroconverted donors by EIA were individually reconfirmed whether they were true seroconverters. Finally, projected impact on HCV risk of discontining of ALT screening was calculated by using two important value previously known, such as periods of seroconversion window for anti-HCV and ALT preconversion window. RESULTS: HCV seroincidence was estimated to be 13.79/100,000 person-years. Seroincidences according to the ALT groups were as follows; 13.22 in the normal ALT group (< or = 64 IU/L), 34.15 in the elevated group (65-130 IU/L), 87.13 in the highly elevated group (> or =131 IU/L). By this study, investigators also could find seroconverted donors, whose result for anti-HCV by immunoblot was positive at the first donation and changed to negative by EIA at the next donation, as many as 100 donors. Among these falsely seroconverted persons, 16% of donors showed elevated ALT value. 8 units per 1 million donations were estimated to be discarded only by abnormal results of ALT testing in Korea. CONCLUSION: HCV seroincidence in Korean donors was 2.8 times as high as in American donors. HCV seroincidence calculated by this study seems to be somewhat lower than true rate because of the problem of summing-up the person-years. Considering that higher seroincidence results in more donors in seroconversion window phase, donor selection by careful history taking should be re-emphasized to reduce the seroincidence rate in Korean blood donation program.
Alanine Transaminase ; Biomarkers ; Blood Donors* ; Donor Selection ; Hepacivirus ; Hepatitis ; Humans ; Immunoenzyme Techniques ; Incidence ; Korea* ; Mass Screening ; Red Cross ; Research Personnel ; Tissue Donors

Bortezomib is a proteasome inhibitor used for the treatment of patients with multiple myeloma. Recently, several case reports about acute pancreatitis caused by Bortezomib were published in the international literature. But Bortezomib induced pancreatitis case was not reported in Korea. Herein, we report a case of acute pancreatitis caused by Bortezomib therapy in a 76-year-old female with multiple myeloma. On three months after the first administration of Bortezomib, the patient visited the hospital with symptoms of acute pancreatitis. The common etiological factors for acute pancreatitis were all excluded. Then the patient was diagnosed as Bortezomib-induced pancreatitis. After cessation of Bortezomib, she showed clinical and laboratory improvement.
Aged ; Female ; Humans ; Korea ; Multiple Myeloma* ; Pancreatitis* ; Proteasome Inhibitors ; Bortezomib

Little has been known about clinical outcome in computed tomography(CT) documented intraventricular hemorrhage (IVH), especially in the third and fourth ventricles. A series of 114 patients with IVH in spontaneous intracranial hemorrhage diagnosed by CT, from January 1994 to December 1996, were studied retrospectively. The clinical findings, especially Glasgow Outcome Score(GOS), of these patient were compared with computed tomographic parameters on the Graeb's score, evidence of third ventricular hemorrhage, patency of fourth ventricle and hemorrhagic dilatation of fourth ventricle. The results were as following: 1) The underlying etiologies, in descending order, were hypertensive intracerebral hemorrhage(61.4%), subarachnoid hemorrhage(16.7%), moyamoya disease(13.2%), vascular malformation(5.3%), and unknown cause(3.5%). Moyamoya disease was the most common cause of pure IVH. 2) The bifrontal index (BFI), as an indicator of acute hydrocephalus after IVH, was closely correlated with consciousness level on admission, but not with GOS. 3) Graeb's score was correlated with GOS, but not with the volume of the intracerebral hematoma. 4) The third ventricular hemorrhage was associated with a worse outcome and hemorrhagic dilatation(>10.0mm) was associated with high mortality. 5) The absence of patency and the lateral dilatation(>20.0mm) in the fourth IVH was correlated with outcome. 6) In patients having the hemorrhagic dilatation of the fourth ventricle, Graeb's score and volume of intracerebral hematoma did not affect the outcome. In conclusion, Graeb's score, hemorrhagic dilatation of third ventricle, absence of fourth ventricle patency and lateral dilatation of the fourth ventricular hemorrhage in CT findings are correlated with the outcome in spontaneous IVH.
Consciousness ; Dilatation ; Fourth Ventricle ; Hematoma ; Hemorrhage* ; Humans ; Hydrocephalus ; Intracranial Hemorrhages ; Mortality ; Moyamoya Disease ; Retrospective Studies ; Third Ventricle

BACKGROUND/AIMS: Nonalcoholic steatohepatitis (NASH) is chronic liver disease that can potentially progress to end stage liver disease. Oxidative stress to the vulnerable fatty liver has been reported as a key mechanism in development of NASH. Several antioxidant pathways have been identified, but reports that involved quantitative analysis of each antioxidant systems are rare, and these reports have shown various results. So, we investigated antioxidant status and the degree of oxidative stress by measuring several antioxidant enzymes, the total antioxidant status (TAS), and the metabolites of superoxide in NASH patients. METHODS: Nineteen NASH patients who were confirmed by liver biopsy and fifteen controls were involved in this study. The levels of body mass index (BMI), AST, ALT, superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase, TAS, hydrogen peroxide (H2O2), and malondialdehyde (MDA) were compared between both groups. The relationship between the histologic severity and the levels of each antioxidants were analyzed in the NASH group. RESULTS: The activities of SOD and catalase were lower in the NASH group. The concentrations of TAS and H2O2 were higher in NASH group. The level of GPx and MDA showed no significant differences between both groups. There were no significant relationships between the above variables and the pathological severity. CONCLUSIONS: The disturbed metabolism of superoxide due to the decreased activities of SOD and catalase seem to be important in the pathogenesis of NASH. Further investigations about the nonenzymatic secondary antioxidant mechanism are necessary because the TAS was higher for the NASH group. The lack of difference between both groups for the concentration of MDA indicates that mechanisms other than lipid peroxidation also may be important in the pathogenesis of NASH.
Adult ; Antioxidants/*metabolism ; English Abstract ; Fatty Liver/*metabolism/pathology ; Female ; Humans ; Liver/pathology ; Male ; Oxidative Stress

PURPOSE: The purpose of this study was to compare the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with those of conventional open plating (COP) for treating comminuted mid-clavicular fractures and to evaluate the usefulness of MIPO. MATERIALS AND METHODS: Thirty-nine patients who underwent surgical treatment for mid-clavicular comminuted fractures were analyzed retrospectively. Nineteen patients were treated with MIPO and twenty patients with COP. Radiological evaluation included time to union, fracture healing, and clavicular length difference measured as the proportional length difference with the unaffected side. Clinical assessment was performed using the simple shoulder test score, American Shoulder and Elbow Surgeons score, and quick disability of the arm, shoulder and hand score. Moreover, the mean operation and radiation times, as well as exposure were compared. RESULTS: All clavicles achieved bone union. The mean time to union was 12.1 weeks in the MIPO group, and 14.6 weeks in the COP group (p=0.587). There was no significant difference between the two groups regarding the functional and radiological outcomes at 2-year follow-up. A significantly shorter operation time was observed in the MIPO group than in the COP group (75.8 min vs. 106.9 min, p=0.002). More radiation time and exposure were identified in the MIPO group (52.8 s vs. 37.1 s, p=0.002; 209.4 mGy vs. 43.1 mGy, p=0.005). CONCLUSION: Both COP and MIPO were shown to be effective treatment options for mid-clavicular comminuted fractures. MIPO may be a better alternative to COP due to shorter operation time and no need for a bone graft, although the functional and radiological outcomes were not significantly different. However, all surgeons should pay close attention to minimize radiation hazard.
Arm ; Clavicle ; Elbow ; Follow-Up Studies ; Fracture Healing ; Fractures, Comminuted ; Hand ; Humans ; Retrospective Studies ; Shoulder ; Surgeons ; Transplants

Malignant melanoma occurs most frequently on the skin. However, it can also arise in other organs and tissues of the body. Primary pulmonary malignant melanoma is a very rare non-epithelial neoplasm accounting for 0.01% of all primary pulmonary tumors. The treatment of choice is surgical resection of the tumor with an oncologically adequate margin as in lobectomy or pneumonectomy. The prognosis of this condition is rather poor. Based on previous data, its 5-year survival is at least 10%. Here, we report a case of an 82-year-old woman whose primary pulmonary melanoma was detected incidentally.
Aged, 80 and over ; Female ; Humans ; Lung ; Melanoma* ; Pneumonectomy ; Prognosis ; Skin

BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality. This observational, non-randomized study evaluated the effect of rosuvastatin loading before percutaneous coronary intervention (PCI) on the incidence of CIN in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: A total of 824 patients who underwent PCI for ACS were studied (408 patients in the statin group=40 mg rosuvastatin loading before PCI; 416 patients of control group=no statin pretreatment). Serum creatinine concentrations were measured before and 24 and 48 hours after PCI. The primary endpoint was development of CIN defined as an increase in serum creatinine concentration of > or =0.5 mg/dL or > or =25% above baseline within 72 hours after PCI. RESULTS: The incidence of CIN was significantly lower in the statin group than that in the control group (18.8% vs. 13.5%, p=0.040). The maximum percent changes in serum creatinine and estimated glomerular filtration rate in the statin group within 48 hours were significantly lower than those in the control group (5.84+/-22.59% vs. 2.43+/-24.49%, p=0.038; -11.44+/-14.00 vs. -9.51+/-13.89, p=0.048, respectively). The effect of rosuvastatin on preventing CIN was greater in the subgroups of patients with diabetes, high-dose contrast medium, multivessel stents, high baseline C-reactive protein, and myocardial infarction. A multivariate analysis revealed that rosuvastatin loading was independently associated with a decreased risk for CIN (odds ratio, 0.64; 95% confidence interval, 0.43-0.95, p=0.026). CONCLUSION: High-dose rosuvastatin loading before PCI was associated with a significantly lower incidence of CIN in patients with ACS.
Acute Coronary Syndrome ; C-Reactive Protein ; Contrast Media ; Creatinine ; Glomerular Filtration Rate ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Kidney ; Mortality ; Multivariate Analysis ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Stents ; Rosuvastatin Calcium

BACKGROUND/AIMS: Presence of enhanced mural nodules, which can be visualized using computed tomography (CT), is one of high-risk stigmata in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs). Conversely, the absence of enhanced mural nodules on preoperative imaging does not exclude malignant risk. The present study aimed to investigate other morphological features as predictors of malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT. METHODS: This retrospective study included 180 patients with surgically confirmed “pure” BD-IPMNs of the pancreas and no enhanced mural nodules on preoperative CT. The study was conducted at 15 tertiary referral centers throughout South Korea. Univariate and multivariate analyses were used to identify significant predictors of malignancy. RESULTS: BD-IPMNs with low-grade (n=84) or moderate-grade (n=76) dysplasia were classified as benign; those with high-grade dysplasia (n=8) or invasive carcinoma (n=12) were classified as malignant. The multivariate analysis revealed that cyst size ≥30 mm (odds ratio, 8.6; p=0.001) and main pancreatic duct diameter ≥5 mm (odds ratio, 4.1; p=0.01) were independent risk factors for malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT. Endoscopic ultrasound detected enhanced mural nodules (6/82) that had been missed on CT, and two IPMNs with enhanced mural nodules were malignant. CONCLUSIONS: In patients with “pure” BD-IPMNs who have no enhanced mural nodules on CT, cyst size ≥30 mm and main pancreatic duct diameter ≥5 mm may be associated with malignancy.
Christianity ; Humans ; Korea ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatic Ducts ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Ultrasonography