Complications of acute pancreatitis usually occur in pancreas and its contiguous organs. The prevalence of colonic invasion is rare, however, the consequence is fatal, with mortality above 50%. The initial symptoms and onset times are variable and major affected sites are transverse colon and splenic flexure. The spread of inflammatory exudates into the colon is the main mechanism of colonic invasion. If the colonic stenosis develops, it is necessary to manage it surgically. We report a case who arrived at the hospital with watery diarrhea and abdominal distension in the recovery period of acute alcoholic pancreatitis and was diagnosed as a colonic obstruction in the splenic flexure. The patient underwent loop ileostomy instead of the resection of the lesion because of severe adhesion around the splenic flexure. The patient died due to sepsis 5 days after the operation.
Acute Disease ; Colonic Diseases/*complications ; English Abstract ; Humans ; Intestinal Obstruction/*complications ; Male ; Middle Aged ; Pancreatitis/*complications

Patients with inflammatory bowel disease are at increased risk for thromboembolic complications. Its prevalence rate ranges from 1% to 7% in clinical studies and reaches 39% in autopsy series. The cause of thrombotic complications in inflammatory bowel disease is generally considered to be associated with hypercoagulability. We experienced a case of ulcerative colitis associated with Budd-Chiari syndrome and superior mesenteric vein thrombosis. This rare complication of ulcerative colitis was successfully managed by conventional treatment for ulcerative colitis and anticoagulation therapy.
Adult ; Colitis, Ulcerative/*complications ; English Abstract ; Female ; Hepatic Vein Thrombosis/*complications ; Humans ; Mesenteric Vascular Occlusion/*complications ; Mesenteric Veins ; Venous Thrombosis/*complications

Metronidazole is a 5-nitroimidazole compound known as an antimicrobial agent widely used for the treatment of protozoal infection, anaerobic infection, Helicobacter pylori infection and hepatic encephalopathy. It may produce a number of neurologic side effects including peripheral neuropathy, seizure, encephalopathy, ataxic gait and dysarthritic speech. There have been ten or more reports of metronidazole-induced encephalopathy in the literatures including a few reports of brain imaging changes by magnetic resonance images (MRI). However, none of the case of metronidazole-induced encephalopathy in patients with hepatic encephalopathy has been reported yet. Recently, we experienced two cases of metronidazole-induced encephalopathy in patients with liver cirrhosis caused by chronic hepatitis B, which were diagnosed by brain MRI and MR spectroscopy. In this report, we present 2 cases of metronidazole-induced encephalopathy with MR imaging and MR spectroscopic changes including follow- up imaging performed after the discontinuation of the metronidazole with a review of the literatures.
Anti-Infective Agents/*adverse effects ; Brain Diseases/*chemically induced/diagnosis ; English Abstract ; Female ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Male ; Metronidazole/*adverse effects ; Middle Aged

BACKGROUND/AIMS: Mucin-hypersecreting bile duct tumor is rare, and has an unusual histologic characteristic of having various degrees of cellular atypia ranging from dysplasia to invasive carcinoma in the same specimen. To gain insight into the role of p16, p14 and p53 in the carcinogenic process of bile duct tumor, we analyzed the expression status of these proteins in mucin-hypersecreting bile duct tumor. METHODS: Immunohistochemical staining of p16, p14 and p53 were performed in 34 paraffin embedded tissues obtained from 22 patients of mucin-hypersecreting bile duct tumor. RESULTS: Thirty-four specimens were categorized into low-grade dysplasia (9), high-grade dysplasia (4), carcinoma in situ (CIS, 11) and invasive carcinoma (10) based on the degree of cytologic and structural atypia. p53 overexpressions were found in 6 (17.6%, 3 in CIS, 3 in invasive carcinoma) and more frequently observed in the advanced histologic stages (p<0.05). Loss of p16 staining was found only in 2 (6%) of low-grade dysplasia specimen. Loss of p14 staining was found in 21 (61.7%, 7 in low-grade dysplasia, 2 in high-grade dysplasia, 8 in CIS, and 4 in invasive carcinoma) and was frequently observed in low-grade and high-grade dysplasia compared to p53 (p<0.05). CONCLUSIONS: In mucin-hypersecreting bile duct tumor, p14 and p53 may play a role in the early and advanced stage of carcinogenesis, respectively. Further study regarding genetic and epigenetic alterations in p14 and p53 gene may be needed.
Adult ; Aged ; Bile Duct Neoplasms/*genetics/secretion ; Carcinoma/*genetics ; Cyclin-Dependent Kinase Inhibitor p16/*genetics/secretion ; English Abstract ; Female ; *Genes, p16 ; *Genes, p53 ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Mucins/*secretion ; *Mutation ; Tumor Suppressor Protein p14ARF/*genetics

BACKGROUND/AIMS: Anti-HCV positivity suggests past or present infection of HCV, or false positivity. The positive predictability of this test can differ according to the subjects. This study examines the positive predictability of the third generation anti-HCV ELISA and factors predicting HCV infection with special emphasis on the significance of the anti-HCV sample/cut-off (S/CO) ratio. METHODS: One hundred and ninety patients who were anti-HCV positive were enrolled, from November 1998 to January 2002 in Kyung Hee University Hospital. RT-PCR was performed to confirm HCV infection. RESULTS: One hundred and seven patients were RT-PCR positive (56.3% positive predictability). The positive predictability changed with the S/CO ratio: 17.9% in cases below 6, 58.3% between 6 and 50, 78.6% between 51 and 75, and 60% over 75. Those with the S/CO ratio more than 6 showed significantly higher predictability, but it did not increase further when the ratio got higher. Factors predicting HCV infection were the presence of liver cirrhosis (OR 5.5, p=0.000), hepatocellular carcinoma (OR 11.67, p=0.004), liver diseases (OR 2.99 p=0.001), and increase of AST (OR 2.49, p=0.002), ALT (OR 2.32, p=0.005), alpha-FP (OR 3.49, p=0.040), and the S/CO ratio of more than 6 (OR 7.82, p=0.000). However, liver cirrhosis was the sole factor in multivariate analysis (OR 8.32, p=0.02). CONCLUSIONS: The positive predictability of the third generation anti-HCV test was 56.3% with a significant difference between those with the S/CO ratio below 6 (18%) and above 6 (63%). In liver cirrhosis, positive predictability of anti-HCV test was relatively high as 85%.
Adult ; Aged ; Aged, 80 and over ; English Abstract ; *Enzyme-Linked Immunosorbent Assay ; Female ; Hepacivirus/immunology ; Hepatitis C/*diagnosis ; Hepatitis C Antibodies/*blood ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Reverse Transcriptase Polymerase Chain Reaction ; Risk Factors

BACKGROUND/AIMS: Anti-viral therapy using hepatitis B immune globulin and lamivudine could not prevent HBV recurrence after liver transplantation (LT) completely. Adefovir dipivoxil is a acyclic nucleotide phosphate analogue and known to have potent anti-HBV effect. In this study, we analyzed the therapeutic effect of adefovir for recurrent or de novo HBV infection after LT. METHODS: From December 2002 to October 2004, adefovir was administered in 12 post-LT patients of HBV infection (11 recurrent and 1 de novo infection). In these patients, lamivudine and other combined therapies were used before the introduction of adefovir. Thereafter, adefovir combined with lamivudine was administered to all patients. RESULTS: The duration of adefovir administration was 5.5-18 (median, 15.5) months. The median values of serum AST and ALT levels were significantly reduced from 86+/-80 IU/L and 140+/-103 IU/L, respectively before the adefovir administration to 42+/-19 IU/L and 38+/-33 IU/L after 2 months of administration. This trend of improved liver function persisted throughout the follow-up period. HBeAg seroconversion was achieved in 4 of 10 patients (40%) and HBsAg seroconversion was observed in 1 of 10 patients (10%). HBV DNA levels have decreased to undetectable levels by hybridization assay in 6 of 7 patients within the first 2 months of therapy. Nephrotoxicity and hypophosphatemia were not found in all of these patients. CONCLUSIONS: Based on this preliminary result, adefovir dipivoxil seems to be an effective and safe antiviral agent leading to viral inhibition and clinical improvement in post-LT patients with recurrent or de novo HBV infection.
Adenine/administration & dosage/*analogs & derivatives ; Adult ; Antiviral Agents/*administration & dosage ; Drug Therapy, Combination ; English Abstract ; Female ; Hepatitis B, Chronic/*drug therapy ; Humans ; Lamivudine/administration & dosage ; *Liver Transplantation ; Male ; Middle Aged ; Phosphonic Acids/*administration & dosage ; Recurrence ; Reverse Transcriptase Inhibitors/administration & dosage

BACKGROUND/AIMS: Spontaneous esophageal rupture is a life-threatening injury because of delay in diagnosis and rapid progression to septic condition. But acceptable standard treatment strategy has not been established yet. This may be due to its low incidence and lack of published literature. In this study, we evaluated the proper treatment strategy as to decide when and how to manage spontaneous esophageal rupture by analyzing our experiences. METHODS: Eleven patients who were diagnosed as spontaneous esophageal perforation in Dongsan Medical Center from 1993 to 2003 were analyzed. Patients were divided into survival and death group. Clinical manifestations, rupture site and size, treatment methods and complications were compared. RESULTS: All patients were male and alcoholics. Six patients had survived and five patients died. Age, sites and sizes of ruptures, operation methods were not different in both groups. Before operation, septic condition was present in all patients of death group and more common than survival group (p=0.015). Survival group showed shorter time interval from rupture to initial treatment (p=0.021) and to operation (p=0.019). CONCLUSIONS: Early diagnosis and initial aggressive treatments such as nothing per oral, pleural and mediastinal drainage are important factor for better prognosis. If possible, early operation such as primary repair must be done. Although any difference according to types of operation method was not found in this study, further study with larger groups seems to be necessary.
Adult ; Alcoholism/complications ; English Abstract ; Esophageal Diseases/complications/diagnosis/*surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Rupture, Spontaneous

BACKGROUND/AIMS: Several studies from Western populations have recently shown that three mutations in NOD2 gene (C2104T, G2722C, and 3020insC) are associated with susceptibility to Crohn's disease (CD). However, three mutations were shown not to be associated with CD in Japanese and Chinese population. Here, we have analyzed the frequency of three NOD2 mutations in Korean patients to determine whether the NOD2 mutations are associated with susceptibility to CD in Korean population. METHODS: Blood samples were obtained from 128 patients with CD, 47 patients with ulcerative colitis, 19 Behcet's colitis, and 200 healthy controls. DNA in the region of three NOD2 mutations was sequenced by single base extension method, and the frequency of mutations were analyzed. RESULTS: Among the subjects in our study groups, including patients with CD, ulcerative colitis, Behcet's colitis, and healthy controls, none had NOD2 mutations. CONCLUSIONS: Our results indicate that although three NOD2 mutations are associated with susceptibility to CD in Western populations, these might be rare and may not be associated with susceptibility to CD in Korean patients.
Adolescent ; Adult ; Aged ; Child ; Crohn Disease/*genetics ; English Abstract ; Female ; Genotype ; Humans ; Intracellular Signaling Peptides and Proteins/*genetics ; Korea ; Male ; Middle Aged ; *Mutation ; Polymorphism, Single Nucleotide

Photodynamic therapy (PDT) was first used for the treatment of esophageal cancer in early 1980s, Since then, numerous applications have been reported for its use in gastrointestinal tract including Barrett's esophagus, gastric, duodenal, biliary, pancreatic and colorectal lesions. PDT in gastroenterology has made tremendous progress over the last decade but its clear role is yet to be proved. Now, there is an increasing need for less invasive methods of treatment in patients with pre-malignant disease, early cancer or those who are unfit for surgery. It is one of a number of ablative techniques currently under investigation and appears to have a number of potential advantages over other forms of treatment in the alimentary tract. The development of newer potent, highly efficient photosensitizers, as well as endoscopic imaging techniques and light delivery systems, are continuing to expand the clinical uses of PDT. As data from additional clinical trials become available, we will gain a clearer perspective of where PDT fits in the treatment of cancers.
Digestive System Diseases/*drug therapy ; English Abstract ; Humans ; *Photochemotherapy ; Photosensitizing Agents/administration & dosage

Usual sources of subphrenic abscess with intestinal fistula are previous abdominal operation, inflammatory bowel disease and malignancy. Reported cases of intestinal fistula caused by adenocarcinoma were complicated by direct invasion. In this report, a 70-year-old male had a subphrenic abscess with intestinal fistula and the cause was a metastatic adenocarcinoma of unknown origin. As far as we know, this has not been reported previously in the literatures. The abscess went on chronic course for six months because intermittent administration of antibiotics modified its clinical presentation. The fistulous tract between the abscess and ileum was demonstrated by tubogram via the drainage catheter in abscess. The patient underwent surgical treatment because the cause of fistula was obscure. Invasion of the ileum by metastatic adenocarcinoma was diagnosed by the histologic examination of surgical specimen. Therefore, when a fistula develops without any apparent cause, there is a possibility of malignancy, and surgical approach must be considered. An early surgical approach will prevent the delay in treatment and reduce the mortality.
Adenocarcinoma/complications/diagnosis/*secondary ; Aged ; English Abstract ; Humans ; Ileal Diseases/diagnosis/*etiology ; Ileal Neoplasms/complications/diagnosis/*secondary ; Intestinal Fistula/diagnosis/*etiology ; Male ; *Neoplasms, Unknown Primary ; Subphrenic Abscess/diagnosis/*etiology