The intestine is the third most commonly injured abdominal organ in blunt trauma. But we had a paucity of experience with these injuries. We experienced bowel ischemia in 55 year-old woman after motor-vehicle accident. She complained nausea, vomiting and weight, loss after traffic accident. We found mucosal hyperemia and intraluminal stenosis of duodenal second portion by the gastroscopy. So, we performed hypotonic duodenography and SMA and celiac angiograpby. Hypotonie duodenography showed a luminal narrowing from duodenojejunal junction to proximal jejunum and proximal dilatation, and SMA angiography showed 10 cm segment hypervascular staining of contrast medium in proximal portion. Therefore we performed jejunal loop segmentectomy. After operation she was discharged without complication.
Accidents, Traffic ; Angiography ; Constriction, Pathologic ; Dilatation ; Female ; Gastroscopy ; Humans ; Hyperemia ; Intestines ; Ischemia* ; Jejunum ; Mastectomy, Segmental ; Middle Aged ; Nausea ; Phenobarbital ; Vomiting

Advanced gastric cancer simulating early gastric cancer is increasing tendcncy due to development of diagnostic technology. A 64-year-old woman was admitted for epigastric discomfort. Endoscopy showed a small white mucus coated erosion and peripheral mucosal nodurarity on greater curvature side of antrum. Biopsy was resulted in adenocarcinoma. An upper GI series and abdominal sonography were normal. At surgery, advanced gastric carcinoma, Borrmann localized type IV in background of early gastric carcinoma, prepyloric antrum along the greater curvature with infiltration to the muscle layer and multiple lymphatic tumor emboli in serosa and perigastric adipose tissue and neural invasion and metastasis to 12 out of 28 perigastric lymph nodes with extranodal extension. 3 months later, distant metastasis such as cervical lymph node, pleural effusion, pericardial effusion, peritoneal seeding and ascites were noticed.
Adenocarcinoma ; Adipose Tissue ; Ascites ; Biopsy ; Endoscopy ; Esophagus* ; Female ; Humans ; Intestines* ; Lymph Nodes ; Middle Aged ; Mucus ; Neoplasm Metastasis ; Pericardial Effusion ; Pleural Effusion ; Serous Membrane ; Stomach Neoplasms* ; Stomach*

BACKGROUND/AIMS: Helicobacter pylori is found in more than 90% of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Regression of lymphoma after H. pylori eradication was reported. Therefore, early detection of gastric MALT lymphoma is important. On reported several endoscopic findings, nonspecific gastritis with erosion and ulceration were common and there is no typical endoscopic findings. METHODS: Therefore we analyzed the endoscopic findings of 16 low-grade B-cell gastric MALT lymphoma confirmed by biopsy, PCR and immunostain and compared histologic change after eradicating H. pylori infection in patients who refused operation retrospectively from March 1995 to October 1996. RESULTS: The male: female ratio was 7:9 and mean age was 43,7 years ald (23-71 yr), On endoscopic findings of gastric MALT lymphoma, irregular shaped geographic superficial ulcer was 7 cases (43.7%), diffuse mucosal nodularity was 4 cases (25.0%) and erosion was 3 cases (18.7%). The most common site of MALT lymphoma was antrum and angle. H. pylori was positive in 87.5% (14/16 cases) and eradication of H. pylori was done in patients who refused operation and histologic improvement after H. pylori eradication was found in 62.5% (5/8 cases). CONCLUSIONS: The most common endoscopic findings of gastric MALT lymphoma was irregular geographic superficial ulcer but diffuse mucosal nodularity and erosions were also common. Therefore, biopsy must be taken, especially on the antrum and angle although nonspecific lesion may be suspected.
B-Lymphocytes ; Biopsy ; Endoscopy ; Esophagus* ; Female ; Gastric Mucosa* ; Gastritis ; Helicobacter pylori ; Humans ; Intestines* ; Lymphoid Tissue* ; Lymphoma* ; Lymphoma, B-Cell, Marginal Zone ; Male ; Polymerase Chain Reaction ; Retrospective Studies ; Stomach* ; Ulcer

BACKGROUND: Depletion of nutritional reserves and significant weight loss can lead to an increased risk of morbidity, reduced chemotherapy response, and shorter survival in patients with cancer. Numerous methodologies are used for the assessment of nutritional status. However, it remains unclear which of these tools is the most appropriate in the setting of cancer chemotherapy. The PINI (prognostic inflammatory nutritional index) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill patients. The aim of this study was designed to investigate the relationship between nutritional status after the palliative chemotherapy and prognosis in advanced metastatic cancer. METHODS: This study included 130 patients with ECOG PS (Eastern Cooperative Oncology Group performance status) 1~3 in advanced metastatic cancer following the palliative chemotherapy. ECOG PS, body mass index, alpha 1-acid glycoprotein, C-reactive protein, albumin, prealbumin, transferrin, protein, lactate dehydrogenase, PINI ratio, and survival time were evaluated. RESULTS: In 130 patients, the median age was 57 years. The ECOG PS was 1 68 patients, 2 43, 3 19. The mean value of PINI was PS 1 16.0+/-47.8, PS 2 55.6+/-106.9, PS 3 106.3+/-141.6. The mean survival was PS 1 144.0+/-71.8, PS 2 68.9+/-41.2, PS 3 32.0+/-6.9 days. In the PS 3 group, the mean values of alpha 1-acid glycoprotein, C-reactive protein, and lactate dehydrogenase were significantly higher than in the PS 1 group. In the PS 3 group, the mean values of albumin, prealbumin, and transferrin were significantly lower than in the PS 1 group. The survival time was correlated with the ECOG PS (r=-0.602, p<0.001,), PINI (r=-0.318, p<0.001,), alpha 1-acid glycoprotein (r=-0.265, p=0.002), C-reactive protein (r=-0.345, p<0.001), albumin (r=0.324, p<0.001), prealbumin (r=0.260, p=0.003) and transferrin (r=0.277, p=0.001). CONCLUSIONS: The PINI may be a useful scoring system for the assessment of nutritional status and prognosis in advanced metastatic cancer following palliative chemotherapy, but the ECOG PS is most strong correlation with the survival time.
Body Mass Index ; C-Reactive Protein ; Critical Illness ; Drug Therapy ; Humans ; L-Lactate Dehydrogenase ; Nutrition Assessment ; Nutritional Status* ; Orosomucoid ; Prealbumin ; Prognosis* ; Transferrin ; Weight Loss

BACKGROUND/AIMS: Because colonoscopy is a painful procedure, analgesics and sedatives may be necessary as premedication. Midazolam reacts quicker, has a more excellent amnesic effect and fewer complications compared to diazepam. The effects of midazolam depend on dose, age, and rapidity of injection. According to several studies, side effects of midazolam were more common in high-dose injections (more than 5 mg) compared to low dose injections (0.03-0.05 rng/kg). Moreover, low dose injections were found to be as effective as high dose injections. However, there was no report about the effect and the side effects of midazolam in Korea. Therefore, we performed this study to determine the effect of low dose midazolam as premedication for colonoscopy. METHODS: We performed colonoscopy in 99 consecutive patients who were randomly selected (midazolam group: 50, placebo group: 49) prospectively from July 1996 to September 1996. Premedication was administered through intravenous injection of midazolam or saline 0.03 mg/kg, combined with intramuscular injections of meperidine 50 mg, and intravenous injections of Buscopan 20 mg in all patients. Blood pressure, puise rate, and O2 saturation by oxymeter were checked before, during, and 30 minutes after colonoscopy. The degree of amnesia, discomfort, cooperation and acceptance of the re-examination were checked.
Amnesia ; Analgesics ; Blood Pressure ; Butylscopolammonium Bromide ; Colonoscopy* ; Diazepam ; Humans ; Hypnotics and Sedatives ; Injections, Intramuscular ; Injections, Intravenous ; Korea ; Meperidine ; Midazolam* ; Premedication ; Prospective Studies

BACKGROUND AND AIMS: There has been a lot of controversy regarding the significance of hyperplastic or diminutive polyps found during sigmoidoscopy, as markers for synchronous adenomatous polyps. Therefore, prospective colonoscopy was performed in subjects with distal polyps found using sigmoidoscopy to determine the association between synchronous polyps with distal polyps. METHODS: A sigmoidoscopy was performed in 2,895 subjects out of 10,705 who visited Samsung Medical Center for a routine check up from Aug. 1994 to Nov. 1995. Distal polyps were found in 590 of 2,895 and colonoscopy was performed in 280 of 590. RESULTS: Of 280 subjects, 73 (26.1%) subjects had synchronous polyps and 55 subjects (19.6%) had synchronous adenomatous polyps. 134 polyps were found during colonoscopy; adenomatous polyps were most common (70.1%): Hyperplastic polyps (18.7%) and inflammatory polyps (11.2%) were also found. A greater percentage of subjects with distal adenomatous polyps had synchronous adenomatous polyps compared with those with distal hyperplastic polyps (25.1% vs. 6.3%, p<0.05). A greater percentage of subjects with distal large polyps (>0.5 cm) had synchronous adenomatous polyps compared with those with distal diminutive polyps (<=0.5 cm) (50.0% vs. 16.1%, p<0.05). CONCLUSIONS: Adenomatous polyps found during sigmoidoscopy justify colonoscopy for synchronous polyps. However, diminutive hyperplastic polyps are not significant indicators of risk for synchronous adenomatous polyps.
Adenoma* ; Adenomatous Polyps ; Colon* ; Colonic Polyps* ; Colonoscopy ; Polyps ; Prospective Studies ; Sigmoidoscopy

In Korea, careinoma of the cervix is the most common malignancy in women annually affecting 25 per every 100,000 female. The widespread use of the Papanicolaou smear has resulted in earlier detection of the tumor and a reduction in the number of patients with advanced disease, but the incidence of cervix. carcinoma is still the fifth most common malignancy in the world. Cervical carcinoma spreads to the small bowel primarily by direct extension from involved lymph nodes, most commonly from peraaortic or mesenteric nodes to the serosa of the bowel. But, the involvement of small bowel by cervical carcinoma is so rare, and shows a maximum incidence of small bowel involvement of less than 1.5%. We report a patient with squamous cell carcinoma of the cervix metastases to the second portion of the duodenum in whom the diagnosis was made by endoscopic biopsy of the lesion.
Biopsy ; Carcinoma, Squamous Cell ; Cervix Uteri ; Diagnosis ; Duodenum* ; Esophagus* ; Female ; Humans ; Incidence ; Intestines* ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Papanicolaou Test ; Serous Membrane ; Stomach*

Heterotopic pancreas, a developmental anomaly uncommonly noted both during operations and autopsies, is usually described in each instance as an incidental finding, Precise diagnosis can be made more often now by endoscopy. Rarely heterotopic pancreas can cause intra-abdominal hemorrhage or obstruction. We experienced a very rare case in which aberrant pancreas located at the Ampulla of Vater was found to be the cause of partial obstruction of the comon bile duct. Diagnosis was done by duodenoscopy and biopsy. So, we report a case of heterotopic pancreas at the Ampulla of Vater diagnosed by endoscopy with a review of relevant literatures.
Ampulla of Vater* ; Autopsy ; Bile Ducts ; Biopsy ; Diagnosis ; Duodenoscopy ; Endoscopy* ; Hemorrhage ; Incidental Findings ; Jaundice, Obstructive ; Pancreas*

BACKGROUND/AIMS: Dyspepsia is very common in the community. The aim of this study was to assess the frequency of various causes of dyspepsia. METHODS: Two hundreds nine patient with dyspepsia were investigated. Basic laboratory screening, ECG, Upper gastrointestinal endoscopy or upper gastrointestinal barium study, upper abdominal ultrasound were performed in every dyspeptic patients. RESULTS: Functional dyspepsia was the cause of symptoms in 92.3%, peptic ulcer in 2.9% (duodenal ulcer in five patients, gastric ulcer in one patient), reflux esophagitis in 0.5%, esophageal ulcer in 0.5%. Of dyspeptic patients, gallstone was found in 1.4%, gastric submucosal tumor in 1.0%, fatty liver in 1.9% (two of four patients with fatty liver had elevated transaminase), upper gastrointestinal cancer in 0%. Of functional dyspepsia patients, women was 60.3%, men was 39.7%. CONCLUSIONS: The most common cause of dyspepsia was functional dyspepsia. Various causes of organic dyspepsia was peptic ulcer, reflux esophagitis, and esophageal ulcer.
Barium ; Dyspepsia* ; Electrocardiography ; Endoscopy, Gastrointestinal ; Esophagitis, Peptic ; Fatty Liver ; Female ; Gallstones ; Gastrointestinal Neoplasms ; Humans ; Male ; Mass Screening ; Peptic Ulcer ; Stomach Ulcer ; Ulcer ; Ultrasonography

BACKGROUND: The contraction of smooth muscle depends on an increase in the concentration of intracellular calcium ion and the source of this increase to various stimuli is different according to organs or species. Nevertheless, there have been only a few studies on human stomach smooth muscle. This study was designed to identify the source of the calcium utilized in the muscle contraction induced by carbachol, which is an important factor among various stimuli. METHODS: After the administration of carbachol with various conditions in cultured human stomach smooth muscle cells, fura-2-acetoxymethyl ester was used to measure the increase in the intracellular calcium concentration. RESULTS: (1) The carbachol-induced increase in the intracellular calcium concentration was not attenuated after removal of extracellular calcium. (2) Carbachol induced a small increase in the intracellular calcium concentration even after the depletion of intracellular calcium store. (3) Repeated histamine administration blocked the carbachol-induced increase in the intracellular calcium concentration in calcium-free extracellular solution. CONCLUSION: The main source of calcium utilized in human stomach smooth muscle contraction by carbachol is intracellular calcium store, particularly inositol triphosphate(IP3)-sensitive calcium stores. However, extracellular calcium also contributes to the carbachol-induced increase in the intracellular calcium concentration.
Calcium* ; Carbachol* ; Histamine ; Humans* ; Inositol ; Muscle Contraction ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; Stomach