The occurence of multiple primary malignant tumor is cansidered infrequent and the primary adenocarcinoma of the duodenal bulb is a rare conditian. The autopsy incidence of duodenal adenocarcinoma is between 0.019 and 0.5%. The first documented case of duodenal carcinoma was described by Hamburger in 1746. Increased awareness of the condition, improvement in diagnostic technics and a more aggressive surgical approach have changed this disease from a postmortem curiosity to a condition that can be treated with satisfactory results. There are several reports on the high incidence of second additinoal cancer in patients with small intestinal cancer. Recently, we have experienced a case of primary duodenal bulb adenocarcinoma with early gastric cancer in a 68 year old male patient with complaints of epigastric pain, diarrhea and body weight loss. So we report the case of primary duodenal bulb adenocarcinoma combined with early gastric cancer with a brief review of literature.
Adenocarcinoma ; Aged ; Autopsy ; Body Weight ; Diarrhea ; Exploratory Behavior ; Humans ; Incidence ; Intestinal Neoplasms ; Male ; Stomach Neoplasms*

BACKGROUND: Determination of vacA mosaicism may be important because specific Helicobacter pylori vacA genotype can be used to predict different clinical outcome. The aim of this study was to assess the relationship of vacA genotypes of Helicobacter pylori to cagA status and its development of peptic ulcer diseases in Korean patients. METHODS: Gastric biopsy specimens were obtained from 53 patients with gastric ulcer(GU), 57 with duodenal ulcer (DU) and 26 with chronic gastritis(CG) patients; all patients were infected with Helicobacter pylori. Bacterial mRNAs in the gastric mucosa were amplified by RT-PCR, using synthetic oligonucleotide primers specific for the vacA and the cagA gene. Patients with vacA s1 subtype were further examined to determine whether they had s1a or s1b subtype. RESULTS: There was no correlation in frequency of vacA s1 and/or s1a genotype between CG and either GU or DU, as the vacA s1 and s1a/m1 were present in the majority of strains independent of clinical status(s1 ; 100.0% versus 94.3 % or 93.0 % and s1a/m1 ; 76.9% versus 62.3% or 64.9%, res pectively). Likewise, there was no difference in the prevalence of the cagA gene between CG and either GU or DU patients (92.3% versus 90.6% or 98.2%, respectively). In addition, the cagA-negative status did not predict the presence of vacA s2 genotype. CONCLUSION: These results strongly suggest that either cagA or vacA s1 and/or s1a is not proved to be a useful marker to distinguish disease-specific Helicobacter pylori strains for the development of peptic ulcer diseases in Korean patients.
Adolescence ; Adult ; Aged ; Aged, 80 and over ; Bacterial Proteins/analysis* ; Base Sequence ; Biopsy, Needle ; Chi-Square Distribution ; Chronic Disease ; Duodenal Ulcer/pathology ; Duodenal Ulcer/genetics ; Female ; Gastritis/pathology ; Gastritis/genetics ; Genotype ; Helicobacter Infections/pathology ; Helicobacter Infections/genetics* ; Helicobacter pylori/genetics* ; Human ; Korea ; Male ; Middle Age ; Molecular Sequence Data ; Peptic Ulcer/pathology ; Peptic Ulcer/genetics* ; Polymerase Chain Reaction ; Probability ; Prognosis ; Sensitivity and Specificity ; Stomach Ulcer/pathology ; Stomach Ulcer/genetics ; Support, Non-U.S. Gov't ; Tissue Culture

BACKGROUND: The aims of our study were to determine the correlation of the strain variation and degree of homogeneity of infecting Helicobacter pylori (H. pylori) with their disease outcomes, and the relevance of duodenal H. pylori expression of cagA and/or vacA gene to the development of duodenal ulcer in Korean patients. METHODS: One hundred and twenty bacterial colonies isolated from different anatomical sites of the stomach and duodenum were used. The study population was consisted of 40 Korean patients, 21 with duodenal ulcer, 7 with gastric ulcer, 3 with combined gastric and duodenal ulcer, and 9 with chronic gastritis. Genomic characteristics of each strain were analyzed by random amplified polymorphic DNA (RAPD) fingerprinting. The cagA and vacA genes were detected by polymerase chain reaction (PCR). RESULTS: PCR-based RAPD was proved to be a reliable method for the discrimination of individual bacterial genomic characteristics. Genomic fingerprinting showed a varying degree of inter- and intra-patient variation. Thirteen patients (32.5%) were colonized by a single strain throughout the corpus, antrum and duodenum, whereas the other 27 (67.5%) harbored multiple H. pylori strains. Thirty-six isolates (90.0%) each from the corpus and antrum, and 34 (85.0%) from the duodenum, expressed the cagA gene. The prevalence of duodenal H. pylori expression of the cagA gene was not different between patients with chronic gastritis and those with duodenal ulcer. All isolates were positive for both genes vacA s1 and vacA s1a. CONCLUSION: These results suggested that many of the H. pylori-infected Korean patients were actually colonized with mixed populations of different H. pylori strains and that the prevalence of duodenal H. pylori expression of the cagA and/or vacA gene was not correlated with the development of duodenal ulcer in Korean patients.
Adolescent ; Adult ; Aged ; Antigens, Bacterial/*analysis/genetics ; Bacterial Proteins/*analysis/genetics ; DNA, Bacterial/*analysis ; Female ; Genome, Bacterial ; Helicobacter Infections/epidemiology/*microbiology ; Helicobacter pylori/*genetics/isolation & purification ; Human ; Korea/epidemiology ; Male ; Middle Aged ; Peptic Ulcer/*microbiology ; Prevalence ; Random Amplified Polymorphic DNA Technique ; Support, Non-U.S. Gov't

BACKGROUND/AIMS: Treatment of chronic hepatitis B with interferon results in a sustained loss of hepatitis B virus DNA and hepatitis B e antigen (HBeAg) and remission of liver disease only in a proportion of cases. Recently, mutations of hepatitis B virus (HBV) core gene have been reported as being related to the failure of interferon treatment in chronic hepatitis B. This study investigated whether core gene mutations of HBV are related to non-response to interferon therapy and whether the recurrence of HBeAg and HBV DNA in initial responders to interferon therapy is associated with the emergence of HBV core gene mutants. METHODS: The precore/core gene sequence was determined by polymerase chain reaction (PCR) and direct sequencing of PCR product in serum samples obtained before interferon treatment from 10 responders and 10 non-responders to interferon therapy. In addition, precore/core gene sequence was determined in serum samples obtained before interferon treatment and after recurrence from 10 patients who showed recurrence of HBeAg and HBV DNA after initial response to interferon therapy. RESULTS: In samples from 10 responders, there were 7 missense mutations and 71 silent mutations. However, there were 43 missense mutations and 109 silent mutations in samples from 10 non-responders. In samples obtained before interferon treatment from the 10 patients who showed recurrence after initial response, 8 missense mutations and 74 silents mutations were found. The nucleotide sequences from the samples obtained after the recurrence showed 6 silent nucleotide substitutions compared with the sequences from the samples obtained before interferon treatment. CONCLUSIONS: Mutations in the core protein of HBV occur more frequently in non-responders than responders to interferon therapy of chronic hepatitis B and may be a factor responsible for the failure of interferon treatment. The recurrence of HBeAg and HBV-DNA in initial responders to interferon therapy is not associated with the emergence of the HBV core gene mutants.
Adolescent ; Adult ; Antiviral Agents/*therapeutic use ; DNA, Viral/genetics ; English Abstract ; Female ; Hepatitis B Virus/*genetics ; Hepatitis B, Chronic/*drug therapy/virology ; Human ; Interferon-alpha/*therapeutic use ; Male ; *Mutation ; Viral Core Proteins/*genetics

No abstract available.
Pyoderma Gangrenosum* ; Pyoderma* ; Ulcer*

OBJECTIVES: Helicobacter pylori infection induces selective reduction of the number of antral D-cells and results in abnormal regulation of serum gastrin secretion. The purpose of this study was to investigate the relationship between H. pylori infection and the numbers of G-cells and D-cells. METHODS: The numbers of antral G-cells and D-cells, the ratio of G-cells to D-cells and fasting serum gastrin concentrations were compared between 37 patients with (29 with duodenal ulcers and 8 with gastric ulcers) and 33 without H. pylori infection (22 with duodenal ulcers and 11 with gastric ulcers). Serum gastrin concentrations were measured using the radioimmunoassay technique. Antral mucosal biopsy specimens were examined using immunohistochemical staining with antibodies specific for gastrin and somatostatin and the numbers of G-cells and D-cells per gastric gland were counted. RESULTS: Fasting serum gastrin concentrations were significantly higher in patients with H. pylori infection compared to patients without infection (80.3 +/- 23.5 vs 47.6 +/- 14.1 pg/ml, p < 0.001). The number of G-cells per gastric gland was similar in infected and uninfected patients (7.1 +/- 3.1 vs 7.3 +/- 3.9, respectively, p > 0.5). The number of D-cells was significantly lower in patients with H. pylori infection than in uninfected patients in both duodenal and gastric ulcer patients (1.3 +/- 0.4 vs 2.5 +/- 1.6, respectively, p < 0.001). The ratio of G-cells to D-cells was also significantly higher in infected patients compared with uninfected patients for both gastric and duodenal ulcers (5.7 +/- 2.7 vs 3.5 +/- 1.9, respectively, p < 0.001). CONCLUSIONS: These results strongly suggest that Helicobacter pylori infection induces reduction of the number of antral D-cells. The resulting relative hypofunction of the inhibitory action of D-cells against G-cells may be responsible for increased serum gastrin secretion.
Case-Control Studies ; D Cells/pathology ; D Cells/metabolism ; G Cells/pathology ; G Cells/metabolism ; Gastrins/metabolism ; Gastrins/blood ; Gastritis/pathology ; Gastritis/metabolism* ; Helicobacter Infections/pathology ; Helicobacter Infections/metabolism* ; Helicobacter pylori* ; Human ; Somatostatin/metabolism

BACKGROUND: Helicobacter pylori-induced destruction of the gastroduodenal mucosal barrier is initiated with mucosal infiltration of inflammatory cells. Cytokines and chemokines have been suggested to play important roles in the migration and activation of these inflammatory cells into the mucosa. The present study aimed to investigate expression rates of cyto-chemokine mRNAs using gastric mucosal biopsy specimens. METHODS: In 98 patients infected with Helicobacter pylori, mucosal mRNA expression rates of cytokines (IL-1beta, IL-6, and IL-10), C-C chemokines (macrophage inflammatory protein 1alpha [MIP-1alpha], and macrophage inflammatory protein 1beta [MIP-1beta], monocyte chemotactic and activating factor [MCAF], regulated on activation, normal T cell expressed and presumably secreted [RANTES]) and C-X-C chemokines (IL-8 and growth regulated alpha [GRO-alpha]) were examined using reverse transcription polymerase chain reaction (RT-PCR). RESULTS: The expression rates of mRNA for IL-8, GRO-alpha, MIP-1alpha and RANTES were significantly more increased in H. pylori-positive patients than in H. pylori- negative patients. However, the expressions of IL-1beta, IL-6 and IL-10 mRNA were statistically not different between two groups. After eradication of H. pylori, expressions of mRNA for three cytokines (IL-1beta, IL-6 and IL-10), four C-C chemokines (MIP-1alpha, MIP-1beta, MCAF and RANTES) and two C-X-C chemokines (IL-8 and GRO-alpha) were significantly decreased. CONCLUSION: These results suggest that C-X-C chemokines and some C-C chemokines play important roles in H. pylori-associated peptic ulcer diseases.
Adult ; Aged ; Aged, 80 and over ; Chemokines, CC/metabolism ; Chemokines, CXC/metabolism ; Chi-Square Distribution ; Cytokines/*metabolism ; Female ; Gastric Mucosa/*immunology/metabolism ; Helicobacter Infections/*immunology/metabolism ; *Helicobacter pylori ; Human ; Male ; Middle Age ; Prospective Studies ; RNA, Messenger/metabolism

BACKGROUND: One of simple, inexpensive, readily available treatments for treating peptic ulcer bleeding is injection of the lesion with a sclerosing substance such as ethanol and hypertonic saline-epinephrine. The aim of this study was to compare the hemostatic efficacy of endoscopic injection therapy with ethanol, hypertonic saline-epinephrine, and ethanol plus hypertonic saline- epinephrine. METHODS: 173 patients with active bleeding or nonbleeding visible vessels were classified into three groups based on treatment modality as follows; ethanol injection group (n=67), hypertonic saline-epinephrine injection group (n=16) or ethanol plus hypertonic saline-epinephrine injection group (n=33). RESULTS: No difference in initial hemostasis, rebleeding, need for operation, transfusion requirement, hospital stay and mortality was observed among the ethanol, hypertonic saline-epinephrine and ethanol plus hypertonic saline-epinephrine group. The rate of initial hemostasis in patients with Dieulafoy ulcer bleeding was significantly lower than patients with non-Dieulafoy ulcer bleeding. The rate of initial hemostasis failure, rebleeding rate, need for operation, transfusion requirement and mortality were higher in patients with spurting hemorrhage than patients with visible vessels. Hypertension, diabetus mellitus, smoking and alcohol drinking did not influence therapeutic effect of injection therapy. CONCLUSION: There is no difference in the therapeutic effect of endoscopic injection for peptic ulcer bleeding among ethanol, hypertonic saline-epinephrine and ethanol plus hypertonic saline-epinephrine group, but the therapeutic effect of injection therapy is low in patients with Dieulafoy ulcer bleeding and spurting hemorrhage. Therefore, combination therapy with injection therapy and another endoscopic therapy or another endoscopic therapy alone should be considered.
Alcohol Drinking ; Epinephrine ; Ethanol* ; Hemorrhage* ; Hemostasis ; Humans ; Hypertension ; Length of Stay ; Mortality ; Peptic Ulcer Hemorrhage ; Peptic Ulcer* ; Smoke ; Smoking ; Sodium Chloride ; Ulcer

BACKGROUND: Some studies have reported that bacterial infection is more common in alcoholic compared to non-alcoholic liver cirrhosis such as viral liver cirrhosis. However, other studies reported no significant differences in the bacterial infection rate between alcoholic and non-alcoholic liver cirrhosis. This study was performed to compare the frequency of bacterial infection between alcoholic and viral liver cirrhosis. METHODS: We analyzed 190 cirrhotic patients (alcoholic 83, viral 107) with 539 hospitalized cases (alcoholic 242, viral 297) who were followed for more than 12 months. RESULTS: During the follow up period, 82 patients (43.2%) presented with bacterial infectionsthat developed in 34 (41.0%) patients with alcoholic liver cirrhosis and 48 (44.9%) patients with viral liver cirrhosis. There was no significant difference in the frequency of bacterial infection including community acquired and nosocomial infection between alcoholic and viral cirrhotic patients regarding the Child-Pugh class, various laboratory parameters and site of infection. Gram-negative and enteric bacterial strains were the most frequently isolated pathogens in both groups. CONCLUSIONS: There was no significant difference in the frequency of infection between patients with alcoholic and viral liver cirrhosis. Further efforts are needed to reduce bacterial infection by gram negative and enteric bacteria in patients with both alcoholic and viral cirrhosis.
Alcoholics* ; Bacterial Infections* ; Cross Infection ; Enterobacteriaceae ; Fibrosis ; Follow-Up Studies ; Humans ; Liver Cirrhosis* ; Liver Cirrhosis, Alcoholic* ; Liver*

Antiphospholipid syndrome (APS) has received considerable attention due to its association with a thrombophilic disorder. Thrombotic events associated with this syndrome most often involve the venous system and occasionally the arterial system such as the cerebral, coronary, renal, and retinal arteries. Few reports on mesenteric artery thrombosis associated with APS are documented. We report a case of a 45 year old male diagnosed with superior mesenteric artery thrombosis associated with APS. The patient had symptoms of chronic mesenteric ischemia including postprandial abdominal pain, weight loss and diarrhea, and was positive for lupus anticoagulant antibody. An abdominal CT showed superior mesenteric arterial thrombosis and luminal narrowing. Symptoms were improved after anticoagulant therapy.
Abdominal Pain ; Antiphospholipid Syndrome ; Diarrhea ; Humans ; Ischemia ; Lupus Coagulation Inhibitor ; Male ; Mesenteric Arteries ; Mesenteric Artery, Superior ; Phenobarbital ; Retinal Artery ; Thrombosis ; Vascular Diseases ; Weight Loss