Menetrier's disease is a rare disease characterized by the presence of large rugal folds involving part or all of the stomach. Patients with hypertrophic gastropathy often have distressing abdominal symptoms, weight loss and edema due to gastric protein loss. The 48-year-old male patient was admitted to the Hangang Sacred Heart Hospital with cheif complaints of indigestion and epigastric pain. The diagnosis of Menetriers disease is established by radiologic, endoscopic, and pathologic examination. He was treated with soft diet, antacid, H2- receptor antagonist, and IV albumin. We report a case of Menetriers disease with brief review of literatures.
Diagnosis ; Diet ; Dyspepsia ; Edema ; Gastritis, Hypertrophic* ; Heart ; Humans ; Male ; Middle Aged ; Rare Diseases ; Stomach ; Weight Loss

BACKGROUND: Telomerase, an enzyme synthesizing telomere, plays an important role in cell immortalization and carcinogenesis. Telomerase activity is detected in large number of malignant tumors and also in precancerous lesions, such as intestinal metaplasia. It suggests that telomerase activation may be an early event in carcinogenesis. Helicobacter pylori (H. pylori) infection is the major carcinogen in gastric cancer. The aim of this study was to evaluate the relationship between telomerase activation and H. pylori infection in gastric cancer. METHODS: We measured telomerase activity and H. pylori infection using the tissues obtained by gastroduodenoscopy in 50 patients of gastric cancer. Telomerase activity was detected with a Telomerase PCR ELISA(R) kit and H. pylori infection was examined with a CLO(R) kit. RESULTS: Telomerase activity was detected in 32% of intestinal metaplasia and 72% of gastric cancer. The histological type, degree of differentiation, stage and ECOG performance status were found to be unrelated to telomerase activity. H. pylori infection was significantly higher in telomerase-positive patients of gastric cancer (p=0.016). Telomerase activity measured by photometric absorbance was significantly higher in intestinal metaplasia and cancers with H. pylori infection than in those without infection (p<0.05). CONCLUSION: This study suggested that H. pylori infection may induce telomerase activation in intestinal metaplasia and gastric cancer.
Carcinogenesis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Metaplasia ; Polymerase Chain Reaction ; Stomach Neoplasms* ; Telomerase* ; Telomere

Background/Aims: Various endoscopic submucosal dissection (ESD) methods for gastric tumors have been tried. However, no studies have yet compared results according to the ESD method for gastric body tumors using a dual knife. The objective of this study was to compare outcomes of two ESD methods for gastric body tumors: the pocket-creation method and conventional method. Methods: Patients who underwent ESD for a gastric body tumor were retrospectively reviewed.Patients were divided into two groups according to the ESD method: the conventional method (group I) and pocket-creation method (group II). Characteristics of patients and tumors, hospitalization period, incidence of complications, resection margin status, incidence of surgical operation, procedure time, and laboratory findings were investigated. Results: Of the total of 100 patients, 52 belonged to group I and 48 to group II. All tumors were successfully resected en bloc. Resection margin involvement was found in six (11.5%) of group I and six (12.5%) of group II. Complications were observed in seven (13.5%; major complication five, minor two) of group I and eight (16.7%; major two, minor six) of group II. There were no significant differences in ESD outcomes such as hospitalization period, incidence of complications, resection margin status, incidence of surgical operation, procedure time, or inflammatory response after ESD between the two groups. Conclusions Both methods are suitable for treating gastric body tumors with adequate treatment success rates and comparable complication rates.

BACKGROUND/AIMS: Statins act as antineoplastic agents through the inhibition of cell proliferation. This study sought to demonstrate the effects of statins on extrahepatic bile duct cancer cell apoptosis and to document the changes in protein expression involved in tumor growth and suppression. METHODS: Human extrahepatic bile duct cancer cells were cultured. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays were performed to determine the effect of statins on cell proliferation. Apoptosis was measured by a cell death detection enzyme-linked immunosorbent assay and caspase-3 activity assay, and flow cytometry was used to determine the percentage of cells in each phase of the cell cycle. The protein expression of Bax, Bcl-2, insulin-like growth factor 1 (IGF-1) receptor, extracellular signal-regulated kinase 1/2 (ERK1/2), and Akt was measured by Western blot analysis. RESULTS: Simvastatin suppressed cell proliferation by inducing G1 phase cell cycle arrest in bile duct cancer cells. Furthermore, it induced apoptosis via caspase-3 activation, downregulated the expression of the Bcl-2 protein, and enhanced the expression of the Bax protein. Moreover, simvastatin suppressed the expression of the IGF-1 receptor and IGF-1-induced ERK/Akt activation. CONCLUSIONS: Simvastatin induces apoptosis in bile duct cancer cells, which suggests that it could be an antineoplastic agent for bile duct cancer.
Antineoplastic Agents/pharmacology ; Apoptosis/*drug effects ; Bile Duct Neoplasms/*drug therapy ; Cell Cycle/drug effects ; Cell Line, Tumor ; Cell Proliferation/drug effects ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Humans ; Hypolipidemic Agents/*pharmacology ; Receptor, IGF Type 1/*drug effects ; Simvastatin/*pharmacology

OBJECTIVE: Activities of nucleases (acid DNase and neutral RNase) and RNase inhibitor known to be involved in carcinogenesis and suppression of cancer were determined in cancer tissue, serum and ascitic fluid of patients with hepatocellular carcinoma and were compared with those of the controls. Also studied were nucleases and RNase inhibitor isolated from hepatocellular carcinoma tissue and ascitic fluid of the cancer patients to evaluate the properties and interactions between them. METHOD: Activities of nucleases and RNase inhibitor were measured in cancer tissue, serum and ascitic fluid of patients with hepatocellular carcinoma by ultraviolet spectrophotometry. Nucleases and RNase inhibitor were isolated from hepatocellular carcinoma tissue and ascitic fluid of the cancer patients by DEAE-cellulose column chromatography. As controls, normal tissue of the cancer patients, serum of healthy persons and ascitic fluid of cirrhotic patients were used. RESULT: Activities of DNase, RNase and RNase inhibitor were significantly increased in hepatocellular carcinoma tissue. DNase activity was not detected, RNase activity was increased and RNase inhibitor activity was unchanged in both serum and ascitic fluid of the hepatocellular carcinoma patients. DNase was isolated as a single enzyme and RNase as seven isozymes from the hepatocellular carcinoma tissue. The DNase isolated preferentially cleaved ds DNA over ss DNA and was endonuclease in nature (majority of hydrolytic products of DNA by the DNase were oligodeoxyribonucleotides). Of seven RNase isozymes isolated from the hepatocellular carcinoma tissue, isozyme I exhibited nonsecretory nature of RNase and other six isozymes secretory nature of the enzyme. Activity of RNase isozyme V was greatly increased and the activity of inhibitor complexed with the isozyme V was also increased. RNase in ascitic fluid of the cancer patient was separated into four isozymes, of which isozyme I exhibited mixed form of secretory and nonseretory nature and greatly increased in its activity. RNase isozyme V isolated in the hepatocellular carcinoma tissue was not detected in the ascitic fluid. CONCLUSION: The use of the nucleases and the inhibitor in the cancer tissue as biochemical markers for the hepatocellular carcinoma was suggested. RNase was released into the body fluid from the cancer tissue and could be used as a diagnostic marker for the hepatocellular carcinoma. An important role of the DNase in carcinogenesis of the liver was suggested. RNase isozyme V was limited in the cancer tissue and RNase isozyme I and V and inhibitors associated with these isozymes might be involved in carcinogenesis processes, suppression of cancer and maintenance of hepatocellular carcinoma through their interactions.
Ascitic Fluid ; Biomarkers ; Body Fluids ; Carcinogenesis ; Carcinoma, Hepatocellular* ; Chromatography ; DEAE-Cellulose ; Deoxyribonucleases* ; DNA ; Humans ; Isoenzymes ; Liver ; Ribonuclease, Pancreatic ; Ribonucleases* ; Spectrophotometry, Ultraviolet

Inflammatory pseudotumor is a benign disease entity, which is histologically composed of inflammatory cells and fibrotic stroma. It is mainly found in the respiratory tract, but it has also been reported in the liver, central nervous system, soft tissues, urological system, and gastrointestinal tract. It is extremely rare in the spleen and there have been no cases of splenic inflammatory pseudotumor associated with autoimmune thyroiditis in Korea. The pathogenesis or etiology is unknown, but hypotheses include infection, autoimmunity, and parenchymal necrosis with hemorrhage. Because inflammatory pseudotumor may mimic malignant tumors on radiologic findings, pathologic confirmation is necessary to distinguish it from lymphoproliferative disorders of the spleen and other malignant tumors. We report a case of inflammatory pseudotumor of the spleen associated with autoimmune thyroiditis in a patient who complained of periumbilical pain.
Autoimmunity ; Central Nervous System ; Gastrointestinal Tract ; Granuloma, Plasma Cell* ; Hemorrhage ; Humans ; Korea ; Liver ; Lymphoproliferative Disorders ; Necrosis ; Respiratory System ; Spleen* ; Thyroiditis, Autoimmune*

BACKGROUND/AIMS: Upper gastrointestinal (UGI) bleeding is one of the most common and serious complications in major burns. However, the clinical features of UGI bleeding have rarely been studied, and no report of UGI bleeding after burn injury has been presented in Korea. The aim of this study was to evaluate the clinical features of the UGI bleeding after acute burn injury. METHODS: Among 2,340 patieats with acute burn injury who have admitted from January 2000 to June 2004, 33 patients had UGI bleeding. We retrospectively reviewed the medical records of these 33 patients. RESULTS: The causes of bleeding were gastric ulcer (45.5%), duodenal ulcer (36.4%), esophageal ulcer (6%), Mallory-Weiss tear (6%), hemorrhagic gastritis (3%), and gastric varix (3%). Endoscopic intervention and medical treatment were taken in 13 patients (39.4%), and 20 patients (60.6%) were managed with medical treatment only. Mortality rate of post-burn UGI bleeding patients was 30.3%. In logistic regression analysis, burn size (p=0.047) and Rockall score (p=0.019) were independent risk factors of mortality in patients with UGI bleeding. CONCLUSIONS: The most common cause of UGI bleeding in burn patients is peptic ulcer. Treatment of systemic complications of burn as well as UGI bleeding itself may be important in clinical course of UGI bleeding after burn. Large, randomized, and prospective study of prophylactic proton pump inhibitor for the prevention of post-burn UGI bleeding is needed.
Burns* ; Duodenal Ulcer ; Esophageal and Gastric Varices ; Gastritis ; Hemorrhage* ; Humans ; Korea ; Logistic Models ; Mallory-Weiss Syndrome ; Medical Records ; Mortality ; Peptic Ulcer ; Proton Pumps ; Retrospective Studies ; Risk Factors ; Stomach Ulcer ; Ulcer

Recently it has been discovered that anomalous union of pancreaticobiliary duct (AUPBD) may play an important role in the pathogenesis of bile duct cancer. Similar to this fact, there were a few reports on the clinical significance of the low junction of the cystic duct (LJCD). LJCD refers to the situation whereby the cystic duct enters the common duct at a low position between the upper margin of the pancreas and the duodenal opening of the bile duct. The pathogenetic mechanism in LJCD is similar to AUPBD in that the pancreatic juice refluxes to the bile duct, mixes with biles, and then generates the mutagens, which act as inflammatory substances and carcinogens on the epithelium of the bile duct. A 51-year-old male who experienced dyspepsia was hospitalized due to his abnormally functioning liver and dilated common bile duct. We confirmed primary cholangiocarcinoma on the common hepatic duct and gallbladder carcinoma associated with LJCD by ERCP and pathologic review of surgical specimen. We report a case of synchronous type double primary cancer associated with LJCD with a brief review of the literatures.
Bile ; Bile Duct Neoplasms ; Bile Ducts ; Carcinogens ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Cystic Duct* ; Dyspepsia ; Epithelium ; Gallbladder ; Hepatic Duct, Common ; Humans ; Liver ; Male ; Middle Aged ; Mutagens ; Pancreas ; Pancreatic Juice

Pseudomembranous colitis (PMC) is mostly related with the antibiotics and it presents with diarrhea, abdominal pain, fever, hypoalbuminemia and hypovolemia. In the clinical course of pseudomembranous colitis (PMC), ascites is a rare presentation, and high elevation of carcinoembryonic antigen (CEA) associated with PMC is also a very rare presentation. We experienced a case taken cephalosporin group antibiotics for six weeks and presented with fever, abdominal pain, severe diarrhea, and massive ascites. During evaluation, we found low serum-ascites albumin gradient and high level of CEA in both ascites and plasma. With the impression of hidden malignancy, the special studies were done, but PMC was only found without malignancy. After vancomycin therapy, all symptoms were relieved and CEA level declined.
Abdominal Pain ; Anti-Bacterial Agents ; Ascites* ; Carcinoembryonic Antigen ; Diarrhea ; Enterocolitis, Pseudomembranous* ; Fever ; Hypoalbuminemia ; Hypovolemia ; Plasma ; Vancomycin

We studied and analyzed 66 cases of choledochal cyst in a 9 year period from March, 1985 to December, l993 at Hangang, Kangnam and Chuncheon Sacred Heart Hospital. The results were as follows; 1) Age ranged from 1 year to 82 years and ll of 66 cases were below 10 years. The ratio of men to women was 1: 1.9. 2) The frequency of the triad of symptoms and signs were in order of abdominal pain 53 cases(80.3%), jaundice 12 cases(18.2%) and abdominal mass 9 cases(13.6%). The classical triad of pain, mass and jaundice was present in only 2 cases(3.0%). 3) Alkaline phosphatase was elevated in 42 cases(63.6%), hyperbilirubinemia in 29 cases(43.9%) and hyperamylasemia in 9 cases(13.6%). 4) Performed diagnostic procedures were ultrasonogram in 57 cases(86.4%), endo- scopic retrograde cholangiopancreatogram in 32 cases(48.5%), DISIDA scan in 18 cases(27.3%), computed tomogram in 14 cases(21.2%) and percutaneous transhepatic cholangiagram in 6 cases(9.1%). 5) Among 38 cases which ERCP or PTC were performed, according to the Todani's classification, Type I was seen in 28 cases(73.7%), Type IVA in 7 cases(18. 4%), Type II in 2 cases(5.3%) and Type V in I case(2.6%). 6) The associated diseases were cholangitis in 15 cases(22.7%), choledocholithiasis in 12 cases(18.2%) and cholangiocarcinoma in 2 cases(3.0%). 7) Operative procedures were performed in 22 of 66 cases, excision of cyst with Roux-en-Y c~holedochojejunostomy in 17 cases, choledochocystojejunostomy in 2 cases and external drainage in 3 cases.
Abdominal Pain ; Alkaline Phosphatase ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledochal Cyst* ; Choledocholithiasis ; Classification ; Drainage ; Female ; Gangwon-do ; Heart ; Humans ; Hyperamylasemia ; Hyperbilirubinemia ; Jaundice ; Male ; Surgical Procedures, Operative ; Ultrasonography