No abstract available
Cardiovascular Diseases/*microbiology/physiopathology ; Helicobacter Infections/*complications ; *Helicobacter pylori ; Humans

No abstract available.
Diagnosis, Differential ; Humans ; Intestinal Diseases/complications/*diagnosis ; Tuberculosis, Gastrointestinal/complications/*diagnosis ; Tuberculosis, Pulmonary/complications/diagnosis

Burkitt's lymphoma is a rare disease that belongs to the aggressive non-Hodgkin's lymphomas. Burkitt's lymphoma usually occurs in children or younger persons. There is a strong association between endemic Burkitt's lymphoma and Epstein-Barr virus, whereas the association is weaker in the sporadic form occurring in Western countries. Burkitt's lymphoma of the gastrointestinal tract occurring in adults has not been reported in Korea. We herein report an unusual case of Burkitt's lymphoma presenting with a palpable abdominal mass in a 52-year-old man infected with Epstein-Barr virus. A computed tomographic scan showed marked low density wall thickening of the terminal ileum. An endoscopy revealed a narrow lumen, shallow ulcerations, and irregular nodularity of the terminal ileum. Small bowel resection and hemicolectomy were performed and a histologic examination of the resected specimen confirmed the diagnosis. Six cycles of adjuvant chemotherapy were given and the patient has been doing well without evidence of recurrence.
Adult* ; Burkitt Lymphoma* ; Chemotherapy, Adjuvant ; Child ; Diagnosis ; Endoscopy ; Gastrointestinal Tract ; Herpesvirus 4, Human ; Humans ; Ileum ; Korea ; Lymphoma, Non-Hodgkin ; Middle Aged ; Rare Diseases ; Recurrence ; Ulcer

Pancreatic metastasis of gastric cancer almost takes the form of direct continous invasion to the pancreas from the primary lesions or dissemination. Isolated lymphogenous pancreatic metastasis of stomach cancer is rare. A 39-year-old woman was admitted to our institution due to high serum CA 19-9 level. Abdominal computed tomography showed a diffusely enlarged pancreas, and endoscopic retrograde cholangiopancreatography revealed a segmental stricture of pancreatic duct on mid-body. Ultrasonography guided pancreatic biopsy revealed a metastatic poorly differentiated adenocarcinoma with lymphatic tumor emboli. We perfomed esophagogastroduodenoscopy and total colonoscopy. There was a ulcerative lesion at the posterior wall of high body with clubbing change of surrounding mucosal folds. Endoscopic biopsy of the stomach lesion revealed a poorly differentiated adenocarcinoma. Positron emission tomography-computed tomography scan revealed bone metastasis in the sternum. Herein, we report a case of 39 year old female with the diagnosis of gastric adenocarcinoma, with lymphogenous pancreatic metastasis and solitary sternal metastasis detected by elevated serum CA 19-9 level.
Adenocarcinoma ; Adult ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Colonoscopy ; Constriction, Pathologic ; Diagnosis ; Electrons ; Endoscopy, Digestive System ; Female ; Humans ; Neoplasm Metastasis* ; Pancreas ; Pancreatic Ducts ; Sternum ; Stomach ; Stomach Neoplasms* ; Ulcer ; Ultrasonography

BACKGROUND/AIMS: Rhabdomyolysis is a serious and lethal condition that can be induced not only by traumatic causes but also by a variety of nontraumatic causes. However, there are few reports about rhabdomyolysis developed in patients with liver cirrhosis. We carried out this study to elucidate the clinical characteristics and courses of rhabdomyolysis in patients with liver cirrhosis. METHODS: We analyzed 19 cases of nontraumatic rhabdomyolysis in patients with liver cirrhosis who had admitted at Korea University Ansan Hospital between October 2001 and September 2004. RESULTS: Alcohol (50%) was the main etiology of rhabdomyolysis in alcoholic liver cirrhosis patients, and the precipitating factors were not apparent (69.2%) in majority of nonalcoholic liver cirrhosis patients with rhabdomyolysis. Nonalcoholic liver cirrhosis patients had complaints of pain referable to the musculoskeletal system, but alcoholic liver cirrhosis patients had no typical complaints. Mortality of rhabdomyolysis in liver cirrhosis patients was high (42.1%), especially in decompensated liver cirrhosis patients (p=0.04). In nonalcoholic liver cirrhosis patients, the development of oliguria (p=0.007) and acute renal failure (p=0.049) in the course of rhabdomyolysis increased the mortality significantly. CONCLUSIONS: In cirrhosis patients, rhabdomyolysis showed a poor prognosis, especially in nonalcoholic liver cirrhosis with oliguria, acute renal failure, or decompensated liver cirrhosis. It is believed that a high clinical suspicion for the occurrence of rhabdomyolysis in liver cirrhosis patients can lead to quicker recognition and better patient care.
Adult ; Aged ; Female ; Humans ; Kidney Failure, Acute/complications ; Liver Cirrhosis/*complications ; Liver Cirrhosis, Alcoholic/complications ; Male ; Middle Aged ; Rhabdomyolysis/*diagnosis/etiology/mortality ; Survival Rate

BACKGROUND/AIMS: Capsule endoscopy (CE) is a new method enabling noninvasive diagnosis of small bowel diseases. There have been few studies examining the possibility of interobserver variation according to proficiency. We evaluated the interobserver variability between expert and novice for reviewing CE images. METHODS: Among patients who were taken CE from June 2003 to July 2003, twenty patients were randomly selected. Captured images were assessed by an expert and a novice separately. The expert has experience of more than 150 CE interpretation and the novice only had experience in performing EGD and colonoscopy. The novice had trained on interpretation of the CE with 5 cases before this study. Interobserver agreement was evaluated using kappa coefficient. RESULT: CE findings were divided into normal/ abnormal groups. Abnormal groups were classified into small focal, large focal, multiple diffuse, structural deformity groups. Compared with the expert, the novice missed 2 cases (Meckel's diverticulum and angiodysplasia). There was no disagreement in other cases. CONCLUSION: There is 90% (18/20) interobserver agreement between the expert and the novice for the interpetation of findings CE (k=0.737). Normal findings and diffuse large lesions tended to have higher concordance, whereas small focal lesion and structural deformities were more likely to be a source of disagreement.
Capsule Endoscopy* ; Colonoscopy ; Congenital Abnormalities ; Diagnosis ; Diverticulum ; Humans ; Observer Variation

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is known to be one of the contributing factors to cause epigastric soreness, which we often experience after intake of flour-based meals. The aim of this study was to evaluate gastroesophgeal reflux (GER) and its mechanism according to intake of different ingredients of meals. METHODS: We investigated the effect of meals of different ingredients on the lower esophageal sphincter (LES) pressure, the frequency of transient LES relaxation (tLESR) and GER in seven healthy volunteers. The meals used in this study were either rice cakes or flour cakes, which were isocaloric and isovolumetric. A mylohyoid electromyogram, LES pressure and esophageal pH were simultaneously recorded for 3 hours after ingestion of each meal on two different occasions. RESULTS: There was no significant difference in incidence of GER between two meals. CONCLUSION: The intake of isocaloric and isovolumetric meals of either flour or rice cake did not result in significant discrepancies in frequency of GER. The increase in the frequency of swallow- and strain-associated GER observed in the case of a flour cake may be caused by reduced LES pressure after ingestion.
Eating ; Esophageal Sphincter, Lower ; Flour* ; Gastroesophageal Reflux ; Healthy Volunteers ; Hydrogen-Ion Concentration ; Incidence ; Meals* ; Relaxation

BACKGROUND/AIMS: The nonspecific esophageal motility disorder (NEMD) has been reported to be related to gastroesophageal reflux disease (GERD) in some cases. However, the pathophysiologic mechanism of NEMD has not been estabilished. The aim of this study was to assess the prevalence of esophagitis and gastric acid reflux following abnormal contractions in patients with NEMD. METHODS: 122 NEMD patients were enrolled (76 male and 46 female) and their endoscopic findings and 24 hour esophageal pH data were compared with 24 healthy subjects. The abnormal contractions were classified as 1) non-transmitted contraction, 2) low amplitude contraction, 3) non-transmitted and low amplitude contraction, and 4) others. RESULTS: Among the 122 patients with NEMD, 62 patients (50.8%) had GERD, 53 patients (43.4%) had endoscopic reflux esophagitis, and 41 patients (33.6%) had both. Acid exposed time studied by 24 hour pH monitoring was more increased in NEMD patients than in healthy controls (7.48 +/- 10.68 vs 1.42 +/- 1.17), but there were no differences among abnormal contraction patterns. Moderate to severe reflux esophagitis were frequently seen in patients with combined abnormal contractions as the results of endoscopic findings. Pre-existing factors for the gastric acid reflux in NEMD patients were male and esophageal hiatal hernia. CONCLUSIONS: Large numbers of NEMD patients were found to have concurrent GERD in our study. However, the esophageal peristaltic dysfunction was more closely related to the severity of esophagitis rather than to the amount of refluexed gastric acid itself.
Esophageal Motility Disorders* ; Esophagitis ; Esophagitis, Peptic ; Gastric Acid ; Gastroesophageal Reflux* ; Hernia, Hiatal ; Humans ; Hydrogen-Ion Concentration ; Male ; Prevalence*

A 35-year old male developed epigastric pain and hematemesis one week before admission. Esophagogastroduodenoscopy was performed and a communication between the esophagus and another opening was discovered. On a follow-up CT and barium esophagogram, a tubular duplication was suspected and the patient was referred to the department of cardio-thoracic surgery. A pathological diagnosis of esophageal duplication (tubular type) was established. The patient was discharged and is currently being followed up. Esophageal duplication is a rare congenital malformation. Moreover, it has not heen reported in Korea that esophageal duplication presents with hematemesis.
Adult ; Barium ; Diagnosis ; Endoscopy, Digestive System ; Esophagus ; Follow-Up Studies ; Hematemesis* ; Humans ; Korea ; Male

Small cell neuroendocrine carcinoma is a type of undifferentiated, malignant neuroendocrine tumor. Most of neuroendocrine tumors exhibit well-differentiated features and are classified as carcinoid tumors. However, carcinomas of the liver with anaplastic characters, which are classified as small-cell carcinomas are extremely rare and only few cases have been reported in the literature. We report an unusual case of primary small cell neuroendocrine carcinoma of the liver in a 67-year-old man. The patient was found to have a palpable mass on right upper quadrant of abdomen on physical examination. The diagnosis was made by immunohistochemical stains of biopsied specimen from the liver. Other possible primary site was excluded by radiologic and endoscopic evaluations. The tumor was composed of small monotonous and hyperchromatic poorly differentiated cells with higher nuclear to cytoplasmic ratio, and were positive for neuroendocrine tissue markers such as synaptophysin, c-kit, and CD56.
Aged ; Carcinoma, Neuroendocrine/*diagnosis/pathology ; Carcinoma, Small Cell/*diagnosis/pathology ; Humans ; Liver Neoplasms/*diagnosis/pathology ; Male