Patients with acromegaly have a reduced life expectancy rnainly due to cardiovascular, respiratory or cerebrovascular diseas-. Malignancy also seems to occur with greater than the expected incidence. In particular, the published retrospective or prospective studies have suggested a strong association of colonic neoplasia with acromegaly. But, there were a few reports of thyroid cancer in acrornegaly. We report a case of thyroid papillary cancer derived from diffuse goiter in acromegaly, sugge- sting the possible carcinogenic role of growth hormone.
Acromegaly ; Bites and Stings ; Colon ; Goiter ; Growth Hormone ; Humans ; Incidence ; Life Expectancy ; Prospective Studies ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms

PURPOSE: The biomechanical responses of degenerative porcine intervertebral disc were compared with those MATERIALS AND METHODS: Two groups were set; Group A (44.0+/-2.8 months old, female) and Group B (6.2 +/-1.3 months old, female). Histological (H&E stain) observations were carried out to see the degeneration for both groups. Then biomechanical responses were investigated by measuring height changes in disc, intradiscal pressure values and relaxation time for each specimen under axial compressive loads. RESULTS: Degenerative changes were confirmed through H&E staining in Group A. The ratios of the nucleus pulposus area to total area were 14.7+/-4.5% and 29.2+/-6.0% in Group A and B, respectively (p=0.000). The decrease rates in disc height were 12.1+/-3.3% and 21.6+/-7.6%, in Group A and B, respectively under the axial compression of 740 N (p=0.000). No significant difference in intradiscal pressure measured in anterior zone between-groups except at axial load of 740N (p> 0.05). However, significant difference in pressure was found in posterolateral zone when the load was 542 N and higher (542 N: p=0.015, 740 N: p=0.010). The average relaxation time for Group A was significantly longer than that for Group B at 740N, i.e., at maximum load (anterior: p=0.010, posterolateral: p=0.014). CONCLUSION: Different biomechanical responses in degenerative disc were confirmed. They are 1) less flexible, 2) slower in energy relaxation under axial loading, and 3) larger portion of the external load were taken up at posterior part of annulus fibrous, especially in degenerative disc.
Intervertebral Disc* ; Relaxation ; Spine*

Incidence of nontuberculous mycobacterium (NTM) pulmonary disease is increasing with the wider recognition and development of diagnostic technology. Mycobacterium kansasii is the second most common pathogen of NTM pulmonary disease in human immunodeficiency virus (HIV)-infected patients. However in Korea, the incidence of M. kansasii pulmonary disease is relatively low, and there has been no report of M. kansasii pulmonary disease with bronchial involvement in HIV patients, to the best of our knowledge. We report a case of M. kansasii pulmonary disease presenting with endobronchial lesions in an HIV-infected patient complaining of chronic cough with bilateral enlargements of hilar lymph nodes on chest X-ray.
Bronchial Diseases ; Cough ; HIV ; Humans ; Incidence ; Korea ; Lung Diseases* ; Lymph Nodes ; Mycobacterium kansasii* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Thorax

Hepatocellular carcinoma (HCC) is one of the most common fatal malignancies worldwide, especially in Korea. The recent advances in diagnostic techniques, such as serum tumor marker assay, ultrasonography, computerized tomography (CT), magnetic resonance imaging (MRI), and angiography, allow us to detect HCC at early stage. Even though, it remains difficult to distinguish malignant nodules from benign space-ccupying lesions of liver. Distinction of HCC from benign entities such as liver abscess is important because failure of prompt diagnosis could result in a missed opportunity for curative treatment. The differential diagnosis of HCC and liver abscess, especially HCC presenting as abscess, is sometimes very difficult. We report a case of HCC with liver abscess caused by secondary infection of CBD stone and cholangitis, that mimicked the dynamic CT findings of liver abscess, in an elderly patient with chronic hepatitis C virus infection.
Abscess ; Aged ; Angiography ; Carcinoma, Hepatocellular* ; Cholangitis* ; Coinfection ; Diagnosis ; Diagnosis, Differential ; Hepatitis C, Chronic ; Humans ; Korea ; Liver Abscess* ; Liver* ; Magnetic Resonance Imaging ; Ultrasonography

Ketoconazole, an imidazole derivative, is a broad spectrum antifungal agent which has been used widely in the treatment of systemic or local fungal infections. Mild asymptomatic elevation of plasma transaminase activities occurs in approximately 6% to 17.5% of patients who have used ketoconazole. However, the incidence of symptomatic hepatic injury is low and overt hepatitis develops in about 5% of the patients. Nausea and vomiting are the most frequent side reactions. Histopathological features of the reported ketoconazole induced hepatotoxicity are massive or submassive hepatocellular necrosis involving the acinar zone 3, destroyed lobular architecture with bridging necrosis and inflammatory cell infiltration on portal tracts. However, hepatic septal fibrosis with liver cirrhosis has not been reported yet. We experienced a case of hepatic septal fibrosis that developed after 9 months of ketoconazole administration.
Fibrosis* ; Hepatitis ; Humans ; Incidence ; Ketoconazole* ; Liver Cirrhosis ; Nausea ; Necrosis ; Plasma ; Vomiting

BACKGROUND/AIMS: Endoscopic aspiration mucosectomy (EAM) can always lift up the lesion by suction regardless of its location and does not injure the mucosal surface. The clinical usefulness of this method was evaluated as follows. METHODS: Thirty two patients with gastric adenoma (35 lesions) and 6 patients with early gastric carcinoma were treated by EAM from March 1997 to February 1999. Their characteristics (diameter, macroscopic appearance, and histologic diagnosis) were verified at endoscopy with a biopsy specimen. The complete resection was defined as the presence of normal mucosa at the resected margin. RESULTS: The average size of the resected specimens was 17.8 mm in antrum and 16.5 mm in body. The ratio of complete resection by location was 67% in anterior wall, 88% in posterior wall, 86% in lesser curvature and 92% in greater curvature. The complete resection rate for smaller lesions (< or =15 mm) was highly distinguished from that of larger lesions (>15 mm). No serious complication was encountered. CONCLUSIONS: EAM is suitable for the treatment of gastric tumors. Lesions 15 mm or less in diameter can be resected easily by single procedure regardless of its location.
Adenoma* ; Biopsy ; Endoscopy ; Humans ; Mucous Membrane ; Stomach Neoplasms* ; Suction

BACKGROUND/AIMS: The cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS), the proteins that have the role in the gastric carcinogenesis, are stimulated by H. pylori infection in the gastric mucosa. The aim of this study was to evaluate the expression of COX-2 and iNOS proteins one year after the eradication of H. pylori. METHODS: Gastric antral mucosa from fifty eight patients with chronic gastritis who were all infected with H. pylori was examined for the expression of COX-2 and iNOS proteins before and one year after the eradication of H. pylori by immunohistochemical stain. RESULTS: COX-2 and iNOS proteins were expressed in the epithelial cells and interstitial inflammatory cells of gastric mucosa. Percent expressions of COX-2 and iNOS were significantly decreased one year after the eradication in the patients with cured infection, but not in those having persistent H. pylori. COX-2 and iNOS expressions were well correlated with H. pylori density, acute and chronic inflammation of gastric mucosa. CONCLUSIONS: The eradication of H. pylori can decrease the expression of COX-2 and iNOS in the gastric mucosa in long-term period. This seems to be due to the removal of H. pylori itself and related regression of gastric inflammation.
Cyclooxygenase 2/immunology/*metabolism ; Drug Therapy, Combination ; Gastric Mucosa/*enzymology ; Helicobacter Infections/drug therapy ; *Helicobacter pylori ; Humans ; Nitric Oxide Synthase Type II/immunology/*metabolism ; Time Factors

BACKGROUND/AIMS: There was some technical difficulty in applying the hemoclip on the posterior wall of the body, cardia of the stomach and posterior wall of duodenum because the angle of approach was tangential. Use of transparent cap on the tip of the endoscope could reduce some of these problems. The purpose of this study was to examine the efficacy of endoscopic hemoclipping using a transparent cap. METHODS: From August 1997 to July 2000, 74 patients with bleeding peptic ulcer and stigmata of recent hemorrhage were treated with endoscopic hemoclipping. There was technical difficulty in applying the hemoclip in 18 patients and the transparent cap was used. RESULTS: There was no statistically significant difference between the patients treated with cap and the patients treated without cap in initial hemostasis rate (91.1% vs 94.4%), rebleeding rate (11.8% vs 11.7%), and permanent hemostasis rate (92.9% vs 94.4%). CONCLUSIONS: Use of transparent cap on the tip of the endoscope was an efficient method when the angle of approach was tangential.
Cardia ; Christianity ; Duodenum ; Endoscopes ; Hemorrhage ; Hemostasis ; Humans ; Peptic Ulcer ; Stomach

Isolated infective endocarditis in the native pulmonary valve is unusual in non-intravenous drug user. Intravenous drug abuse, alcoholism, sepsis, catheter related infections and congenital heart diseases account for the majority of predisposing factors. We report a case of patent ductus arteriosus complicating infective endocarditis involving pulmonary valve. A 24-year-old female was admitted with fever of unknown origin Physical examination revealed continuous murmur at left 2nd intercostals space. Transthoracic and transesophageal echocardiography was performed and patent ductus arteriosus and vegetation at the pulmonary valve were noted. Chest CT scan revealed multiple patch infiltrate suggestive of septic emboli. After 4 weeks of antibiotic treatment, she had no clinical signs of fever, and blood culture be negative. Percutaneous trans-catheter closure of patent ductus arteriosus was done after 2 months.
Alcoholism ; Catheter-Related Infections ; Causality ; Drug Users ; Ductus Arteriosus, Patent* ; Echocardiography, Transesophageal ; Endocarditis* ; Female ; Fever ; Fever of Unknown Origin ; Heart Diseases ; Humans ; Physical Examination ; Pulmonary Valve* ; Sepsis ; Substance Abuse, Intravenous ; Tomography, X-Ray Computed ; Young Adult

Isolated infective endocarditis in the native pulmonary valve is unusual in non-intravenous drug user. Intravenous drug abuse, alcoholism, sepsis, catheter related infections and congenital heart diseases account for the majority of predisposing factors. We report a case of patent ductus arteriosus complicating infective endocarditis involving pulmonary valve. A 24-year-old female was admitted with fever of unknown origin Physical examination revealed continuous murmur at left 2nd intercostals space. Transthoracic and transesophageal echocardiography was performed and patent ductus arteriosus and vegetation at the pulmonary valve were noted. Chest CT scan revealed multiple patch infiltrate suggestive of septic emboli. After 4 weeks of antibiotic treatment, she had no clinical signs of fever, and blood culture be negative. Percutaneous trans-catheter closure of patent ductus arteriosus was done after 2 months.
Alcoholism ; Catheter-Related Infections ; Causality ; Drug Users ; Ductus Arteriosus, Patent* ; Echocardiography, Transesophageal ; Endocarditis* ; Female ; Fever ; Fever of Unknown Origin ; Heart Diseases ; Humans ; Physical Examination ; Pulmonary Valve* ; Sepsis ; Substance Abuse, Intravenous ; Tomography, X-Ray Computed ; Young Adult