Crohn's disease is a chronic, nonspecific inflammatory process which most commonly involves the terminal ileum, but which can affect any region of the gastrointestinal tract from the mouth to the anus. When Crohn's disease does involve the upper gastrointestinal tract, there is nearly always concomitant disease in the small bowel or colon. However isolated gastric Crohn's disease is a rare entity, and gastroduodenal involvement in Crohn's disease has been considered unusual, having an incidence of 1.5 to 7.0%. Gastric Crohn's disease usually localizes to antrum of the stomach and or the pyloroduodenal junction. No single feature is pathognomonic of Crohn' disease, and the diagnosis is based on supportive clinical, radiographic, endoscopic, and pathologic findings. Crohn's disease is invariably a diagnosis of exclusion, so infectious, neoplastic, ischemic, infiltrative, and other inflammatory processes must be ruled out. Usually a patient with isolated Crohn's disease of the stomach will have the clinical symptoms of nausea, vomiting, and epigastric pain, and there will be radiographic evidence of a small contracted stomach (or occasionally, a huge dilated stomach). The treatment of stomach Crohn's disease is palliative and symptomatic. In this paper, we describe a patient with Crohn's disease who had diffuse involvement of the entire stomach without any evidence of involvement elsewhere in the gastrointestinal tract.
Anal Canal ; Colon ; Crohn Disease* ; Diagnosis ; Gastrointestinal Tract ; Humans ; Ileum ; Incidence ; Mouth ; Nausea ; Stomach* ; Upper Gastrointestinal Tract ; Vomiting

29 isoniazid (INH) resistant isolated strains and INH sensitive reference strain (H37Rv) of Mycobacterium tuberculosis were analysed by polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) and NciI restriction mapping for the detection of mutations in katG gene and inhA gene. The katG gene was divided into 3 parts (Akat, Bkat, Ckat; each part is about 800 bp) and amplified, inhA gene was amplified as a whole. Each of the amplified 800 bp DNA was digested into small fragments of less than 400 bp with restriction enzymes for the direct PCR-SSCP analysis. Firstly, 10 strains were analysed. All the 10 isolates showed clearly distinct SSCP patterns in Bkat from that of the reference strain, but only two isolates showed distinct SSCP patterns in Akat, and no isolated strain showed any distinct SSCP patterns in Ckat. 10 isolates also showed distinct SSCP patterns in inhA. NciI restriction mapping of Bkat showed mutation in codon 463 in 7 strains among 10 isolated strains. With these results an early detection strategy for the INH resistant M. tuberculosis was applied to the rest of 19 isolated INH resistant strains. Firstly, isolates were screened by Ncsl mapping in Bkat, and 13 strains showed mutations in codon 463. Secondly, the rest of 6 INH resistant isolates were analysed by PCR-SSCP with restriction enzyme digestion (PCR-SSCP-RE) in Bkat, and all the strains showed distinct SSCP patterns from that of the INH sensitive reference strain. This proved our strategy as effective and economic and time saving method in early detection of INH resistant M. tuberculosis.
Codon ; Diagnosis* ; Digestion ; DNA ; Isoniazid* ; Korea* ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymorphism, Single-Stranded Conformational ; Restriction Mapping ; Tuberculosis

Clostridium perfringens is an anaerobe responsible for a wide range of diseases in animals and humans. Symptoms associated with C. perfringens food poisoning are caused by enterotoxin expressed only during sporulation of C. perfringens. It has been known that only 6% of global C. perfringens isolates carry the enterotoxin gene. We found 2 strains of enterotoxigenic C. perfringens out of 33 strains isolated from various sources in Korea using PCR. It was also found that these two strains were both type A that were strongly associated with food poisoning by checking the presence of four major lethal toxins (a-, B-, e-, l-toxin) using PCR. These results suggest that foodborne illness caused by C. perfringens may be common in Korea and that public education is necessary to prevent contamination of foods by this organism.
Animals ; Clostridium perfringens* ; Clostridium* ; Education ; Enterotoxins* ; Foodborne Diseases ; Humans ; Korea* ; Polymerase Chain Reaction

Solid and papillary epithelial neoplasm of the pancreas(SPENP) is an uncommon low grade malignant tumor histologically distinct from the usual ductal adenocarcinoma and amenable to cure by surgical excision. The main features of SPENP are a peculiar morphology, favorable prognosis, and prediction for women 10 and 40 years of age. In men, the occurrence of SPENP seems to be exceedingly rare. The tumor is usually large at the time of presentation, and surgical excision is the treatment of choice. Gross pathologic examination revealed apparent encapsulation, cystic degeneration, and hemorrhagic necrosis. Microscopically, the tumor was characterized by distinctive solid and papillary patterns. This benign or low-grade malignant epithelial tumor is composed of monomorphous cells variably expressing epithelial, mesenchymal, and endocrine markers. The tumor is known to have good prognosis; although local invasion and infiltration of the capsule may occur. Despite growing recognition of this tumor, its histogenesis remains a matter of controversy i.e. pancreatic ductal cell origin, acinar cell origin, pluripotential cell origin. A 44-year-old male presented with an one-year history of postprandial abdominal pain. Following abdominal ultrasonography, computed axial tomography and angiography, a SPENP suspected. The patient underwent exploratory laparotomy. The tumor was located in the head of pancreas. And thus the patient underwent a pylorus-preserving pancreaticoduodenectomy. His postoperative course was uneventful, and he remains well.
Abdominal Pain ; Acinar Cells ; Adenocarcinoma ; Adult* ; Angiography ; Carcinoma ; Female ; Head ; Humans ; Laparotomy ; Male* ; Necrosis ; Neoplasms, Glandular and Epithelial* ; Pancreas* ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Prognosis ; Ultrasonography

The pneumoretroperitoneum has many etiologies. These range from the clinically insignificant to the potentially fatal, if not recognized promptly. Spontaneous pneumoretroperitoneum can develope from ulcerative colitis, colonic diverti-culitis, or duodenal ulcer perforation. It can be associated with pneumothorax, pneumomediastinum, respiratoy tract rupture, etc. An isolated pneumoretroperitoneum are a more obscure symptom than a pneumoperitoneum. Mostly, the diagnosis of retroperitoneal air depends of radiologic methods, such as simple X-ray, ultrasound (US), or computerized tomography (CT) measurements. In this case, we diagnosed a pneumoretroperitoneum from CT and found that it caused the perforation of the colon spontaneously, without any underlying diseases, due to chronic constipation without underlying diseases
Colitis, Ulcerative ; Colon ; Constipation ; Diagnosis ; Duodenal Ulcer ; Mediastinal Emphysema ; Pneumoperitoneum ; Pneumothorax ; Retropneumoperitoneum* ; Rupture ; Ultrasonography

PURPOSE: Humans have been poisoned by carbon monoxide(CO) ever since they first discovered hydrocarbon fuels, incomplete combustion of which is the usual cause of the poisoning. The early symptoms of CO poisoning are usually variable, vague, and nonspecific, which can lead to thewrong diagnosis. METHODS: This study reviewed 42 cases of CO poisoning that occurred from January 1, 1995, to December 31, 2001. The study was conducted retrospectively to discover the patients' age distribution, sex ratio, the time of exposure, the site of exposure, and the cause of exposure. RESULTS: The ratio of males to females was 1:2.9. Age distribution was broad: 8 of below 18 years old, 9 between 19 and 39 years old, 9 between 40 and 59 years old, and 16 over 60 years old. In terms of seasonal difference, 28 cases happened during the heating season whereas 13 cases occurred in non-heating season. Twenty-three (23) cases happened in the early morning, 12 during the day time, 3 in the evening, and 4 during night. Of the exposures, 27 occurred in the home, 8 in the workplace, and 7 in hotels. Faulty heating systems caused 31 exposures, fires 2 exposures, stoves 4 exposures, and generators 5 exposures. Fifteen patients were repoisoned by CO, and of these, 9 patients had been misdiagnosed in the past exposures. CONCLUSION: The sources of CO are variable, so humans are poisoned often. It is common to see that the victim - sometimes even several members of the same family - had already visited a doctor with symptoms of CO toxicity before the severe exposures or death. The doctor strongly needs to pursue the possibility of victim poisoning when patients have recurrent or vague symptoms similar to those associated with CO exposure.
Adolescent ; Adult ; Age Distribution ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Diagnosis ; Female ; Fires ; Heating ; Hot Temperature ; Humans ; Male ; Middle Aged ; Poisoning ; Retrospective Studies ; Seasons ; Sex Ratio

No abstract available.
Alcoholism/complications/*diagnosis ; Endoscopy, Digestive System ; Humans ; Male ; Middle Aged ; Pancreatic Pseudocyst/*diagnosis/diagnostic imaging ; Pancreatitis/*diagnosis/diagnostic imaging/etiology ; Tomography, X-Ray Computed

Disulfiram, or antabuse, is used in the treatment of chronic alcoholism since it causes an unpleasant aversive reaction to alcohol. It works by inactivating hepatic aldehyde dehydrogenase, leading to a pronounced rise in the acetaldehyde concentration when ethanol is metabolized. Acetaldehyde causes alcohol sensitivity, which involves vasodilation associated with increased skin temperature, subjective feelings of hotness and facial flushing, increased heart and respiration rates, lowered blood pressure, a drymouth or throat sensation associated with bronchoconstriction and allergy reactions, nausea, and headache. One of its metabolites, diethyldithiocarbamate (DDC) can inhibit the enzyme dopamine beta-hydroxylase (DBH) through copper chelation. This may account for the profound refractory hypotension seen with the disulfiram-ethanol reaction (DAR), resulting from norepinephrine depletion. This report is presents the case of a patient we met, who presented with severe hypotension caused by the disulfiram-alcohol reaction, and along with a brief review of the subject.
Acetaldehyde ; Alcoholism ; Aldehyde Dehydrogenase ; Blood Pressure ; Bronchoconstriction ; Copper ; Disulfiram ; Ditiocarb ; Dopamine beta-Hydroxylase ; Ethanol ; Flushing ; Headache ; Heart ; Humans ; Hypersensitivity ; Hypotension* ; Nausea ; Norepinephrine ; Pharynx ; Respiratory Rate ; Sensation ; Skin Temperature ; Vasodilation

Acute renal infarction is an uncommon disease which is often delayed or missed due to its rarity and unspecific clinical presentations. Most patients have an underlying disease or embolic event that can be detected easily by history and physical examination. The frequently noted symptoms include flank, abdominal, and back pain, as well as nausea. The pain is usually acute, severe, and sharp in nature without radiation. The most sensitive laboratory test is lactate dehydrogenase. Angiography, renal scintigraphy, IVP (intravenous pyelography), sonography and, CT (computed tomography) can be used in diagnosing renal infarction. However, CT is more preferred for the diagnosis of renal infarction because it has the advantages of easy accessability and noninvasiveness. Once diagnosed, conservative treatment with intra-arterial infusion of thrombolytics or heparin appears to be the most favorable modality. We report a 82-year-old male with asynchronous bilateral renal infarctions associated with atrial fibrillation and coronary artery disease. His clinical status improved during admission without any events.
Aged, 80 and over ; Angiography ; Atrial Fibrillation* ; Back Pain ; Coronary Artery Disease ; Diagnosis ; Heparin ; Humans ; Infarction* ; Infusions, Intra-Arterial ; Korea* ; L-Lactate Dehydrogenase ; Male ; Nausea ; Physical Examination ; Radionuclide Imaging

PURPOSE: Colonic diverticulitis with right lower quadrant pain presents clinical symptoms and signs indistinguishable from those of appendicitis. This study was conducted to evaluate the clinical features, the laboratory findings, and the usefulness of sonography as a diagnostic tool forcolonic diverticulitis. METHODS: A total of 561 patients with acute right lower quadrant pain was referred for ultrasound (US) examination. The US studies were performed with a 4.0-to 8.0-MHzlinear transducer and an 8.0-to 5.0-MHz convex transducerusing the graded compression method. Thirty-seven (37)patients were finally diagnosed to have diverticulitis. We retrospectively evaluated the age distribution, the sex ratio, the clinical symptoms, the duration of illness before hospital adimission, and the US findings for those 37 patients. RESULTS: The average age of the patients was 33+/-16.1 years old. The ratio of males to females was 1.1 : 1. The mean duration of illness prior to seeking medical attention was 49.2+/-9.3 hours. Nausea, vomiting, and anorexia were seen in 29.7%, 10.8%, and 27.0% of the patients, respectively. Sonography detected 30 patients with diverticulitis with 2 false positive and 7 false negative results. The most typical sonographic feature of an inflamed diverticulum was a round or oval-shaped hypoechoic structure (86.5%) protruding from the colonic wall. Regional pericolic or peridiverticular fat thickening was noted in 81.1% of the patients, and segmental colon wall thickening in 70.8%. US examination yielded a sensitivity of 81.1%, a specificity of 99.6%, an overall accuracy of 98.4%, a positive predictive value of 93.7%, and a negative predictive value of 98.7%. CONCLUSION: This study will be useful in the diagnosis of right colonic diverticulitis, in particular, by using abdominal sonograms in patients who have atypical clinical symptoms or signs of appendicitis.
Age Distribution ; Anorexia ; Appendicitis ; Colon ; Diagnosis ; Diverticulitis* ; Diverticulitis, Colonic ; Diverticulum ; Female ; Humans ; Male ; Nausea ; Retrospective Studies ; Sensitivity and Specificity ; Sex Ratio ; Transducers ; Ultrasonography* ; Vomiting