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A case of solitary rectal recurrence of gastric cancer.

Min Ho KANG ; Bae Whan KIM ; Seoung Wook YUN ; Soon IL LEE ; Jeong Eun SHIN ; Hwan NAM GOONG ; Won Ae LEE

Korean Journal of Medicine.2008;74(6):680-684.

The present research was conducted through the research fund of Dankook University in 2006. Rectal recurrence of gastric cancer is uncommon. A few cases have been reported, with the majority of them associated with peritoneal recurrence. A 71-year-old man visited our hospital complaining of bowel habit changes and fecal incontinence. He had undergone radical subtotal gastrectomy and postoperative adjuvant chemotherapy for advanced gastric cancer 9 years earlier. Colonoscopy showed a rigidly constricted and erythematous rectum. Abdominopelvic CT showed diffuse rectal wall thickening with enhancement. PET-CT showed a hot uptake in the corresponding area on abdominopelvic CT scan, with no evidence of distant metastasis. We performed transanal full thickness biopsy and confirmed a diagnosis of adenocarcinoma pathologically similar to the former gastric cancer. The patient was diagnosed with solitary rectal recurrence simulating linitis plastica, without gastric remnant recurrence. We report this case with a review of the literature.
Adenocarcinoma ; Aged ; Biopsy ; Chemotherapy, Adjuvant ; Colonoscopy ; Fecal Incontinence ; Financial Management ; Gastrectomy ; Gastric Stump ; Humans ; Linitis Plastica ; Neoplasm Metastasis ; Rectum ; Recurrence ; Stomach Neoplasms

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Pedunculated subpleural lipoma with incomplete torsion: A case report.

Hyoung Jong KWAK ; Eun Jung CHA ; Kyung Rak SOHN ; Ja Hong KUH ; Gong Yong JIN ; Myoung Ja CHUNG ; Kyu Yun JANG

Korean Journal of Medicine.2008;74(6):676-679.

Lipoma is a common benign neoplasm, but lipoma arising from the pleura is rare. Most pleural lipomas are asymptomatic and are discovered incidentally on chest radiographs. Here we report an unusual case of a pedunculated subpleural lipoma with incomplete torsion in a 29-year-old woman who presented with flank pain. On chest radiography, there was a well-defined, ellipsoidal, homogeneous, radioopaque mass in the left lower lobe. An intrathoracic tumor was suspected, and video-assisted thoracic surgery was performed to establish the final diagnosis. The resected tumor was a 10 X 5 cm sized pedunculated pleural mass. The cut surface showed a yellow, well-circumscribed mass with areas of hemorrhage. Histologically, the tumor was composed of mature adipose tissue with fibrous septae composed of fibroblasts. The outer surface of the tumor was covered by mesothelial cells. Some areas were hypercellular, and occasional mitoses were found, but neither lipoblasts nor atypical mitoses were identified.
Adipose Tissue ; Adult ; Benzeneacetamides ; Female ; Fibroblasts ; Flank Pain ; Hemorrhage ; Humans ; Lipoma ; Mitosis ; Piperidones ; Pleura ; Thoracic Surgery, Video-Assisted ; Thorax

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Two patients with acute myocardial infarction presenting with simultaneous acute ischemic stroke.

Jong Kyu PARK ; Sang Hak LEE ; Seonghoon CHOI ; Jae Hun JUNG ; Namho LEE

Korean Journal of Medicine.2008;74(6):672-675.

Myocardial infarction (MI) and stroke often share the same risk factors and pathogenic mechanism. Sometimes they can occur in the same patient proximately, occurring days or weeks apart. However, the simultaneous occurrence of MI and stroke is rare and presents a diagnostic and therapeutic challenge. Specifically, an acute stroke can alter typical features of MI. Thus, recognition of the coexistence of these two events requires a high threshold of suspicion. The authors describe two patients who presented with simultaneous stroke and MI development. The two events developed on the same day in both patients. The second patient did not have chest pain, whereas chest symptoms could not be assessed in the first patient secondary to altered mental status. After the diagnoses were made using clinical and laboratory findings, urgent percutaneous coronary intervention was performed in both patients.
Chest Pain ; Humans ; Infarction ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Risk Factors ; Stroke ; Thorax

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Mass-forming focal-type autoimmune pancreatitis difficult to differentiate from pancreatic cancer.

Jae Keun LEE ; Myung Hwan KIM ; Jeung Hye HAN ; Tae Yoon LEE ; Sang Su LEE ; Dong Wan SEO ; Sung Koo LEE

Korean Journal of Medicine.2008;74(6):667-671.

Autoimmune chronic pancreatitis (AIP) typically manifests as diffuse pancreatic swelling and diffuse irregular narrowing of the main pancreatic duct. Recently, mass-forming focal-type AIP, which shows focal pancreatic swelling with mass and focal narrowing of the main pancreatic duct, has been reported. Since this type of AIP is difficult to differentiate from pancreatic cancer, the greater part of these cases have been treated surgically, with the diagnosis confirmed thereafter. Here we report a case of mass-forming focal-type AIP detected in the head of the pancreas; it has been successfully treated with steroids.
Head ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatitis ; Pancreatitis, Chronic

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A case of asymptomatic gastric ectopic pancreas associated with elevated serum CA 19-9.

Hyung Il KIM ; Chang Hwan PARK ; Chung Hwan JUN ; Gi Hoon LEE ; Hyun Soo KIM ; Sung Kyu CHOI ; Jong Sun REW

Korean Journal of Medicine.2008;74(6):663-666.

Ectopic pancreas is an uncommon clinical finding, and it is rare for heterotopic pancreatic tissue to cause symptoms. The most common sites for ectopic pancreas are the submucosal layer of the stomach and the small intestine. An ectopic pancreas is subject to various pathological changes occurring in the pancreas itself, namely cyst, pancreatitis, hemorrhage, abscess, necrosis, and neoplastic changes. We report a case of a gastric ectopic pancreas associated with elevated serum carbohydrate antigen 19-9 (CA 19-9). We performed endoscopic submucosal dissection for histologic diagnosis and removal of the submucosal tumor in the stomach, and histological examination confirmed ectopic pancreas tissue. One months later, serum CA 19-9 declined to a normal level.
Abscess ; Hemorrhage ; Intestine, Small ; Necrosis ; Pancreas ; Pancreatitis ; Stomach

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A case of concomitant epstein-barr virus-induced hepatitis on chronic autoimmune hepatitis.

Jae Gu JUNG ; Dong Gyu MOON ; Hong Jun YANG ; Jung Hyun KWON ; Jin Han KANG ; Eun Sun JUNG ; Seung Kew YOON

Korean Journal of Medicine.2008;74(6):658-662.

Autoimmune hepatitis (AIH), a rare cause of chronic liver disease in Korea, is a chronic, predominantly periportal hepatitis characterized by hypergammaglobulinemia, tissue autoantibodies, and responsiveness to immunosuppressive therapy. Here we report a rare case of Epstein-Barr virus (EBV) hepatitis in the presence of a previous diagnosis of AIH. A 25-year-old woman was admitted to the hospital with fever and myalgias. Laboratory data showed elevated aminotransferases, hypergammaglobulinemia, increased anti-nuclear antibody (ANA) titer, positive anti-smooth muscle antibody (ASMA) test, negative anti-mitochondrial antibody (AMA) test, and negative antibody against liver kidney microsome-1 (anti-LKM-1) test. Serologic viral markers of EBV indicated a recent EBV infection. Liver biopsy was performed to search for evidence of accompanying autoimmune liver disease. Liver biopsy findings were consistent with chronic active hepatitis. In-situ hybridization performed on the liver tissue confirmed the presence of EBV DNA. The patient has been treated with prednisolone and has shown subsequent improvement in clinical symptoms and liver function tests.
Adult ; Autoantibodies ; Biomarkers ; Biopsy ; Chimera ; DNA ; Epstein-Barr Virus Infections ; Female ; Fever ; Hepatitis ; Hepatitis, Autoimmune ; Hepatitis, Chronic ; Herpesvirus 4, Human ; Humans ; Hypergammaglobulinemia ; Kidney ; Korea ; Liver ; Liver Diseases ; Muscles ; Prednisolone ; Transaminases

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The clinical feature and pathogenesis of gastroduodenal lesion in patients with scrub typhus.

Ji Young PARK ; Min Sun CHO ; Ki Nam SHIM ; You Jin LEE ; Hee Jung CHOI

Korean Journal of Medicine.2008;74(6):648-657.

BACKGROUND/AIMS: The aim of the study was to investigate the gastric involvement of Orientia tsutsugamushi and the relationship between the clinical features and gastritis in patients with scrub typhus. METHODS: The study included 98 patients who had been diagnosed with scrub typhus between January 2003 and December 2006. Sixteen patients were selected to undergo gastroduodenoscopy with endoscopic biopsy for molecular study. The clinical severity index score (CSIS) was evaluated. Rickettsial DNA was amplified using the paraffin- embedded biopsy tissue by performing nested PCR. The expressions of ICAM-1 and VCAM-1 were investigated by immunohistochemistry to evaluate their roles in the pathogenesis of scrub typhus. RESULTS: The endoscopic findings were gastritis (n=1), erosion (n=4) and ulcer (n=11). The average CSIS was 3.65+/-1.09. Four cases of nested PCR of the 16 gastric mucosal biopsies were positive. The gastric samples that were taken earlier after therapy tended to be PCR-positive (2.00+/-00 days vs. 3.83+/-1.27 days, p<0.001). There was no difference of the clinical features and the CSISs between the PCR-positive and PCR-negative patients. The biopsied tissue revealed no vasculitis findings. Staining for ICAM-1 was more expressed in the scrub typhus group as compared with the normal control group. Staining for VCAM-1 was sporadically expressed in the scrub typhus group and normal control group. In comparison with the patients with Helicobacter pylori-associated gastritis, the immunohistochemical staining showed no difference of expression in the patients with O. tsutsugamushi-infected gastritis. CONCLUSIONS: The gastritis seen in scrub typhus patients could be typhus that is related to the direct involvement of O. tsutsugamushi. The increased expression of ICAM-1 may be related with gastric mucosal endothelial injury due to direct infection.
Biopsy ; DNA ; Gastritis ; Helicobacter ; Humans ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; Orientia tsutsugamushi ; Polymerase Chain Reaction ; Scrub Typhus ; Typhus, Epidemic Louse-Borne ; Ulcer ; Vascular Cell Adhesion Molecule-1 ; Vasculitis

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A comparison study between mycophenolate mofetil and cyclophosphamide for treatment of proliferative lupus nephritis.

Sung Jin MOON ; Dong Ki KIM ; Sun Young PARK ; Jae Hyun CHANG ; Hyun Wook KIM ; Jung Eun LEE ; Seung Hyeok HAN ; Kwang Il KO ; Dong Hyun KIM ; Chan Ho KIM ; Sang Won LEE ; Beom Suk KIM ; Shin Wook KANG ; Dae Suk HAN ; Ho Yung LEE ; Yong Beom PARK ; Soo Kon LEE ; Kyu Hun CHOI

Korean Journal of Medicine.2008;74(6):640-647.

BACKGROUND/AIMS: Our study aimed to evaluate the efficacy of MMF as compared with intravenous cyclophosphamide as induction therapy for proliferative lupus nephritis in Koreans. METHODS: Forty-three patients who were diagnosed with proliferative lupus nephritis (WHO Class III and IV) between Jan 2000 and Dec 2006 were included in this study. Nineteen patients were treated with oral MMF (initial dose: 1.0 g/day and then it was increased to 2.0 g/day) and 24 patients were treated with 0.75-1.0 g/m2 of monthly intravenous cyclophosphamide (CP) followed by subsequent treatment with oral corticosteroid (initial dose 1 mg/kg/day and then it was slowly tapered down) for 6 months. The demographic and laboratory findings, the response rate and the adverse events were reviewed retrospectively and these were compared between the two groups. RESULTS: A complete response occurred in 7 out of the 19 patients (36.8%) treated with MMF and in 8 out of the 24 patients (33.3%) treated with CP, and the difference was not significantly different between the two groups (p=0.66). A partial response was achieved in 52.6% and 45.8%, respectively. There were no significant differences of the laboratory findings such as serum albumin, C3, C4, the urine protein/creatinine ratio and serum creatinine after treatment for 6 months. In addition, both groups had similar rates of adverse events. CONCLUSIONS: Our study showed that for the treatment of lupus nephritis, MMF was as effective as IV cyclophosphamide with similar adverse events. This finding suggests that MMF could be an alternative treatment for active lupus nephritis as induction therapy.
Creatinine ; Cyclophosphamide ; Humans ; Lupus Nephritis ; Mycophenolic Acid ; Retrospective Studies ; Serum Albumin

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Impact of ST segment deviation in patients with acute myocardial infarction and left ventricular systolic dysfunction.

Sang Hoon SEOL ; Eun Ju LEE ; Young Jin PARK ; Hwan Jin CHO ; Tae Hyun YANG ; Seong Man KIM ; Dae Kyeong KIM ; Doo Il KIM ; Dong Soo KIM

Korean Journal of Medicine.2008;74(6):632-639.

BACKGROUND/AIMS: Although the impact of ST segment elevation in patients with acute myocardial infarction (MI) has been studied, little information is available on the impact of ST segment elevation in the patients with acute MI and left ventricular systolic dysfunction. METHODS: We retrospectively analyzed the baseline clinical and angiographic characteristics and the in-hospital and 1- year clinical outcomes of 117 consecutive patients who were diagnosed with acute MI and who had a left ventricular ejection fraction of less than 40%, and these patients were treated from January 2004 to June 2006 at Busan Paik Hospital. Coronary angiography at the index hospitalization and the major adverse cardiac events (MACEs), including cardiac death, non-fatal reinfarction, target vessel revascularization (TVR), and heart failure, were compared between the 77 patients with ST segment elevation myocardial infarction (STEMI) and the 40 patients with non-ST segment elevation myocardial infarction (NSTEMI). RESULTS: Overall, the baseline clinical characteristics were similar between the two groups. On the coronary angiography, thrombolysis in myocardial infarction 0 flow was more common in the STEMI group as compared to the NSTEMI group (p<0.01) and the NSTEMI group had more frequent multivessel disease compared to the STEMI group (p=0.01). However, the in-hospital cardiac deaths and MACEs were not different on comparison between the two groups (p=0.66, p=0.81, respectively). The one-year cardiac deaths and MACEs were not significantly different on comparison between the two groups (p=0.37, p=0.68, respectively). CONCLUSIONS: This study demonstrated that ST segment elevation had no influence on in-hospital and the long term outcomes of patients with acute MI and left ventricular systolic dysfunction.
Coronary Angiography ; Death ; Glycosaminoglycans ; Heart Failure ; Hospitalization ; Humans ; Myocardial Infarction ; Prognosis ; Retrospective Studies ; Stroke Volume ; Ventricular Dysfunction, Left

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The etiology of acute viral hepatitis for the last 3 years at a single institution in Seoul.

Jang Sik MUN ; Hyung Joon KIM ; Hue CHAE ; Sang Joong KIM ; Hong Ju MOON ; Hyun Woong LEE ; Chang Hwan CHOI ; Jae Hyuk DO ; Sae Kyung CHANG

Korean Journal of Medicine.2008;74(6):624-631.

BACKGROUND/AIMS: Hepatitis A is increasing during the recent years in Korea, and sporadic cases of hepatitis E are not rare. We investigated the etiology of acute viral hepatitis, including 27 cases of coinfection with hepatitis A and E, during the last 3 years. METHODS: Retrospective analysis of one hundred eleven patients with acute viral hepatitis at Chung-Ang University Hospital was done from January 2005 to July 2007. The patients were positive for any one of the following tests: IgM anti-HAV, IgM anti-HBc, HCV RNA and IgM anti-HEV. RESULTS: The proportions of acute viral hepatitis A, B and C were 94.6% (105/111), 4.5% (5/111) and 0.9% (1/111), respectively. Among the patients with hepatitis A, 27 patients (24.3%) were positive for IgM anti-HEV. We analyzed 105 patients with either hepatitis A only or they had coinfection of hepatitis A and E. The mean age, the duration of the hospital stay, the mean levels of serum transaminase, bilirubin and albumin and the protrombin time were similar between the patients with hepatitis A only and those with coinfection of hepatitis A and E. All the patients were discharged without serious complication such as fulminant hepatic failure. The biochemical liver function tests were normalized in all patients within 8 weeks. CONCLUSIONS: The most common etiology of acute viral hepatitis in Koreans was the hepatitis A virus. Patients coinfected with hepatitis A and E were observed. The patients with coinfection of hepatitis A and E showed no significant difference in their clinical features and laboratory parameters, as compared to the patients with hepatitis A only.
Bilirubin ; Coinfection ; Hepatitis ; Hepatitis A ; Hepatitis A Antibodies ; Hepatitis A virus ; Hepatitis E ; Humans ; Immunoglobulin M ; Korea ; Length of Stay ; Liver Failure, Acute ; Liver Function Tests ; Retrospective Studies ; RNA

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