Accurate diagnosis of gastric intestinal metaplasia is important; however, conventional endoscopy is known to be an unreliable modality for diagnosing gastric intestinal metaplasia (IM). The aims of the study were to evaluate the interobserver variation in diagnosing IM by high-definition (HD) endoscopy and the diagnostic accuracy of this modality for IM among experienced and inexperienced endoscopists. Selected 50 cases, taken with HD endoscopy, were sent for a diagnostic inquiry of gastric IM through visual inspection to five experienced and five inexperienced endoscopists. The interobserver agreement between endoscopists was evaluated to verify the diagnostic reliability of HD endoscopy in diagnosing IM, and the diagnostic accuracy, sensitivity, and specificity were evaluated for validity of HD endoscopy in diagnosing IM. Interobserver agreement among the experienced endoscopists was "poor" (kappa = 0.38) and it was also "poor" (kappa = 0.33) among the inexperienced endoscopists. The diagnostic accuracy of the experienced endoscopists was superior to that of the inexperienced endoscopists (P = 0.003). Since diagnosis through visual inspection is unreliable in the diagnosis of IM, all suspicious areas for gastric IM should be considered to be biopsied. Furthermore, endoscopic experience and education are needed to raise the diagnostic accuracy of gastric IM.
Adult ; Aged ; Endoscopy, Gastrointestinal ; Female ; Humans ; Intestinal Mucosa/*pathology ; Male ; Metaplasia/*diagnosis/epidemiology ; Middle Aged ; Observer Variation ; Physicians ; Stomach/*pathology

Previously, we have reported that p-chlorophenylalanine (PCPA), a serotonin depletor, profoundly increased pancreatic fluid and bicarbonate secretion but remarkably inhibited pancreatic amylase secretion in anesthetized rats. The present study was performed to verify the detailed effects of PCPA on pancreatic amylase synthesis that is directly related to amylase exocrine secretion. PCPA significantly decreased pancreatic RNA and protein contents as well as the amylase activity. However, pancreatic DNA content, trypsin and chymotrypsin activities were not influenced by the treatment of PCPA. The rate of pancreatic amylase synthesis, which was assessed by the amount of incorporated (35S)-methionine into amylase for 1 h, was also significantly decreased by 44% in PCPA-treated rats. In order to determine whether the PCPA-induced decrease of amylase synthesis resulted from change in the level of amylase mRNA, Northern blot analysis was performed. The mRNA expression level of amylase was also decreased by 48% in the PCPA-treated rats, indicating that the inhibitory effect of PCPA on the synthesis of pancreatic amylase was mainly regulated at a step prior to translation. It was also revealed in SDS-polyacrylamide gel electrophoresis that the qualitative change of amylase was induced by PCPA. The 54 KDa amylase band seems to be degraded into small molecular weight protein bands in PCPA-treated rats, suggesting that the PCPA-induced decrease of amylase may be partly attributed to the degradation of synthesized amylase.
Amylases* ; Animals ; Blotting, Northern ; Chymotrypsin ; DNA ; Electrophoresis ; Fenclonine* ; Molecular Weight ; Pancreas ; Rats* ; RNA ; RNA, Messenger ; Serotonin ; Trypsin

CMV is common cause of life-threatening opportunistic viral infection in immunocompromised patients, especially in transplant recipients and those who are infected with HIV. Although CMV infection is generally asymptomatic in healthy adults, CMV colitis can occur in immunocompetent adults. While the right colon is the most common site of gastrointestinal CMV infection, it is extremely rare for it to involve the whole colon. We report a rare case of cytomegalovirus (CMV) colitis in an immunocompetent adult presenting as pancolitis. The usual course of gastrointestinal CMV infection is self limited in an immunocompetent adult, but our case revealed that conservative treatment was not enough, and the administration of ganciclovir was essential for the improvement of disease.
Adult* ; Colitis* ; Colon ; Cytomegalovirus* ; Ganciclovir ; HIV ; Humans ; Immunocompetence ; Immunocompromised Host ; Transplantation

Staphylococcus aureus (S. aureus) is occasionally a normal inhabitant of the gastrointestinal tract, and rarely considered a cause of enterocolitis. Methicillin-resistant Staphylococcal enterocolitis may cause persistent diarrhea leading to severe complications and even death, without appropriate treatment. Lymphocytic colitis (LC), a subtype of microscopic colitis, is a relatively common cause of chronic watery diarrhea. We report the case of a 73-year-old woman with profuse watery diarrhea caused by methicillin-resistant S. aureus. Soon after treatment of her enterocolitis with vancomycin the patient's general condition and symptoms improved, although the diarrhea persisted. Through colonoscopic biopsy and immunohistochemical staining, overt LC was diagnosed, and prompt therapy with budesonide was initiated.
Aged ; Biopsy ; Budesonide ; Colitis, Lymphocytic ; Colitis, Microscopic ; Diarrhea ; Enterocolitis ; Female ; Gastrointestinal Tract ; Humans ; Methicillin Resistance ; Staphylococcus aureus ; Vancomycin

Hepatitis A virus (HAV) infection is common in developing countries, including Korea. It can be accompanied by extrahepatic complications such as renal failure, arthritis, and vasculitis. Pleural effusion is a very rare complication of HAV infection, which has been reported usually in children, and has benign clinical courses. Here we report a case of pleural effusion with ascites which occurred in an adult hepatitis A patient. A 26-year-old-woman presented generalized myalgia and fever and was diagnosed as acute hepatitis A. Despite of the improvement of laboratory findings, fever and cough persisted. Pleural effusion newly appeared on the serial chest radiologic images. After the fever settled down, the pleural effusion resolved spontaneously at 13th day of admission.
Acute Disease ; Adult ; Female ; Hepatitis A/complications/*diagnosis ; Humans ; Pleural Effusion/complications/*diagnosis/radiography ; Tomography, X-Ray Computed

There have been a few reports on rhabdomyolysis caused by thyroid storm, but no cases of thyrotoxicosis related rhabdomyolysis have been reported until now. Here, a rare case of rhabdomyolysis, accompanied by thyrotoxicosis, is reported. A 21-year-old man was admitted to our hospital with severe pain and weakness in both legs. The initial laboratory findings revealed a high muscle enzyme level and severe hypokalemia. In evaluation of the rhabdomyolysis, the thyroid function test was compatible with that of Graves' disease, with the rhabdomyolysis subsequently diagnosed, presenting as thyrotoxicosis. The possible mechanisms for this complaint were hypokalemia-induced muscle ischemia, a thyrotoxicosis-induced excessive hypermetabolic state and pressure-induced muscle ischemia. Therefore, the work up for the cause of rhabdomyolysis should include thyrotoxicosis. The management of rhabdomyolysis is hydration, prevention of acute renal failure, correction of aggravating factors and treatment of the underlying cause, for example, thyrotoxicosis.
Acute Kidney Injury ; Graves Disease ; Humans ; Hypokalemia ; Ischemia ; Leg ; Rhabdomyolysis* ; Thyroid Crisis ; Thyroid Function Tests ; Thyrotoxicosis* ; Young Adult

Suppurative sialadenitis is rare in the neonate and usually involves the parotid glands. Isolated suppurative submandibular sialadenitis in the neonatal population is extremely rare. There are only 11 cases found in the literature of suppurative submandibular sialadenitis occurring as an isolated lesion. We describe a case of isolated submandibular sialadenitis progressing to submandibular abscess requiring incision and drainage in a term neonate. Pus culture yielded methicillin-resistant Staphylococcus aureus (MRSA). A brief review of literature is included.
Abscess* ; Drainage ; Humans ; Infant, Newborn ; Methicillin-Resistant Staphylococcus aureus ; Parotid Gland ; Sialadenitis ; Suppuration

Sparganosis is a zoonosis caused by sparganum. Humans can be exposed to sparganum by ingesting undercooked snakes or drinking infected copepods harboring sparganum. Sparganosis commonly manifests as migrating subcutaneous masses and may involve multiple organ systems such as the musculoskeletal system, central nervous system, the eyes, and the genitourinary system. We report here a case of laparoscopically confirmed sparganosis caused by ingestion of undercooked snakes. The sparganosis involved the liver and peritoneum and was initially difficult to differentiate from peritoneal carcinomatosis.
Carcinoma ; Central Nervous System ; Copepoda ; Drinking ; Eating ; Eye ; Humans ; Laparoscopy ; Liver ; Musculoskeletal System ; Peritoneum ; Snakes ; Sparganosis ; Sparganum ; Urogenital System

Anatomic variation in the hepatobiliary tract is relatively common, although bile duct duplication is rare. Detection of biliary tract variation is important because it is closely related to complications such as cholangitis, cholecystitis, pancreatitis, stone formation, and gastrointestinal tract malignancy. Therefore, preoperative imaging and a high index of suspicion are required to make an accurate diagnosis of a biliary tract anomaly. A 44-year-old woman presented with a 2-year history of epigastric pain after eating a meal and gallbladder sludge with chronic cholecystitis. The presumed diagnosis was gallbladder duplication. However, during surgery it was observed that the tubular structure was parallel with the fissure for the ligamentum venosum and ended at the lesser curvature of the stomach. The pathologic diagnosis was bile duct duplication. We report a case of a unique variant of bile duct duplication arising from the hepatic hilum.
Adult ; Anatomic Variation ; Bile ; Bile Ducts ; Biliary Tract ; Biliary Tract Diseases ; Cholangitis ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Digestive System Abnormalities ; Eating ; Female ; Gallbladder ; Gastrointestinal Tract ; Humans ; Meals ; Pancreatitis ; Sewage ; Stomach

Hepatosplenic T-cell lymphoma is a rare histologic type of peripheral T-cell lymphoma that usually presents with hepatosplenomegaly, B-symptoms, and often with rapid and aggressive progression. There have been no previous domestic reports of a hepatosplenic T-cell lymphoma involving the colon. We report a case of a 61-year old man with colonic invasion of a hepatosplenic T-cell lymphoma. He presented the sudden onset of fever accompanied by severe pancytopenia and rapid liver enzyme elevation without evidence of lymphadenopathy. Multiple tiny erosions were noted during colonoscopy. In addition, many immature lymphocytes with vague nucleoli, abundant eosinophilic cytosol, and nuclei of small-to-medium size were seen within the sinusoids on liver biopsy. A similar pattern existed on colonic mucosa obtained from colonoscopic biopsy. Thus, with the aid of such a specific clinical presentation and the results of immunohistochemical staining, we made a definitive diagnosis of hepatosplenic T-cell lymphoma with colonic involvement.
Biopsy ; Colon ; Colonoscopy ; Cytosol ; Eosinophils ; Fever ; Liver ; Lymphatic Diseases ; Lymphocytes ; Lymphoma ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral ; Mucous Membrane ; Pancytopenia ; T-Lymphocytes