Seung Goun Hong

The relationship between hepatitis B virus infection and the incidence of pancreatic cancer: a retrospective case-control study

BACKGROUND/AIMS An association between past history of hepatitis B virus (HBV) infection and pancreatic cancer (PC) has recently been reported. We investigated whether HBV and hepatitis C virus (HCV) infections are associated with the development of PC in Korea. METHODS We retrospectively recruited patients with PC and sex- and, age-matched control patients with stomach cancer (SC) during the previous 5 years. Serum HBsAg and anti-HCV were examined, and data on smoking, alcohol intake, diabetes, and the history of chronic pancreatitis (CP) were collected. RESULTS A total of 506 PC and 1008 SC were enrolled, with respectively 58.1% and 97.3% of these cases being confirmed histologically. The mean age and sex ratio (male:female) were 63.5 years and 1.5:1 in the PC patients and 63.9 years and 1.5:1 in the SC patients respectively (P>0.05). The odds ratios (95% confidence interval, 95% CI) in univariate analysis were 0.90 (0.52-1.56; P=0.70) for HBsAg, 1.87 (0.87-4.01; P=0.11) for anti-HCV, 2.66 (2.04-3.48; P<0.001) for the presence of diabetes, 2.30 (1.83-2.90; P<0.001) for smoking, 1.14 (0.89-1.46; P=0.31) for alcohol intake, and 4.40 (1.66-11.66; P=0.003) for the history of CP. Independent risk factors for PC were presence of diabetes (OR, 2.67; 95% CI, 2.00-3.56; P<0.001), smoking (OR, 2.49; 95% CI, 1.93-3.21; P<0.001) and history of CP (OR, 4.60; 95% CI, 1.56-13.53; P=0.006). CONCLUSIONS There was no significant association between seropositivity for HBsAg or anti-HCV and PC. Further studies are warranted to clarify the association between HBV infection and PC in regions where HBV is endemic.

A case of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis

Allopurinol-induced hypersensitivity syndrome is characterized by an idiosyncratic reaction involving multiple-organs, which usually begins 2 to 6 weeks after starting allopurinol. In rare cases, the adverse reactions to allopurinol are accompanied by a variety of liver injury, such as reactive hepatitis, granulomatous hepatitis, vanishing bile duct syndrome, or fulminant hepatic failure. Here we report a case with granulomatous hepatitis and ductopenia. A 69-year-old man with chronic renal failure, hyperuricemia, and previously normal liver function presented with jaundice, skin rash, and fever 2 weeks after taking allopurinol (200 mg/day). In histopathology, a liver biopsy specimen showed mild spotty necrosis of hepatocytes, marked cholestasis in parenchyma, and some granulomas in the portal area. There were vacuolar degeneration in the interlobular bile ducts and ductopenia in the portal tracts. Pathologic criteria strongly suggested the presence of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis. The patient fully recovered following the early administration of systemic corticosteroid therapy.

A Case of Malignant Granular Cell Tumor in the Sigmoid Colon

Granular cell tumor (GCT) is an uncommon, usually benign neoplasm; however, a malignant potential has been described. Malignant GCT is an extremely rare neoplasm showing rapid growth and invasion into adjacent muscles, lymph nodes, or vessels, or even distant metastasis. We recently experienced a case of a histologically benign or atypical but clinically malignant GCT, with invasion of the lymph nodes and vessels in the sigmoid colon, diagnosed by segmental colon resection with lymph node dissection. We also performed a review of relevant medical literature.

Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion

Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.

A Case of Large Fibrovascular Polyp of the Stomach

A fibrovascular polyp is a rare benign disease of the upper digestive tract and is usually located in the esophagus. To our knowledge, this is the first case of gastric fibrovascular polyp presenting with melena reported in the English literature. The polyp was well visualized on endoscopy and removed with laparoscopic wedge resection. Histology confirmed fibrovascular polyp of the stomach.

Effects of sphingolipid synthesis inhibition on cholesterol gallstone formation in C57BL/6J mice

Background:  Sphingolipids play a very important role in cell membrane formation, signal transduction and plasma lipoprotein metabolism. The first rate‐limiting step in the sphingolipid biosynthetic pathway is catalyzed by serine palmitoyltransferase (SPT), and myriocin is a potent and specific inhibitor of SPT. We investigated the impact of SPT inhibition on cholesterol gallstone formation in C57BL/6J mice.

S2043 Anticancer Effects of Astaxanthin in Stomach Cancer Cell Lines

Src activity might induce the recruitment of Dyn2, we first tested the role of the adaptor protein Grb2 which is known to bind to the proline-rich domain (PRD) of Dyn2 at the plasma membrane during endocytosis. Surprisingly, Grb2 was also recruited to FAs following Src activation, and knockdown of Grb2 inhibited Dyn2s FA targeting. To test if Src might activate Dyn2 to alter FA dynamics, we mutated specific Src substrates on Dyn2 to mimic either phosph-active Dyn2 (Dyn2 Y231, 597E), or phospho-defective Dyn2 (Dyn2 Y231, 597F). Interestingly, expression of the Dyn2 YE form greatly increased internalization of an FA component β1-integrin (compared to WT cells) that potentiated the neoplastic potential of these cells as they became substantially more rounded and poorly adherent with more dynamic FAs. Together, we conclude that Src kinase acts to regulate FA dynamics in two related but distinct ways; first, by increasing Dyn2 recruitment to adhesion sites via the Grb2 adaptor, and second, via phospho-activation of Dyn2 leading to increased endocytic turnover of FA components. These findings provide a novel mechanistic insight into how EGFR/Src signaling promotes pancreatic cancer cell migration and metastasis.

Tranexamic Acid-Induced Acute Renal Cortical Necrosis in Post-Endoscopic Papillectomy Bleeding

Acute renal failure can be the result of acute renal cortical necrosis (RCN), which commonly occurs from complications occurring during pregnancy. RCN is rarely caused by medications, although tranexamic acid, which is used in patients with acute bleeding for its antifibrinolytic effects, reportedly causes acute RCN in rare cases. An 82-year-old woman experienced gastrointestinal bleeding after endoscopic papillectomy of an ampullary adenoma. The bleeding was controlled with tranexamic acid administration; however, 4 days later, her urine volume decreased and she developed pulmonary edema and dyspnea. Serum creatinine levels increased from 0.8 to 3.9 mg/dL and dialysis was performed. Abdominal pelvic computed tomography with contrast enhancement revealed bilateral RCN with no renal cortex enhancement. Renal dysfunction and oliguria persisted and hemodialysis was continued. Clinicians must be aware that acute RCN can occur after tranexamic acid administration to control bleeding.

Butterfly in the Esophagus: What Is Wrong?

A 55-year old man was referred for an esophageal manometry after cardiologic evaluation due to chest pain. High resolution manometry was performed with ManoScan 360™ High-Resolution Manometry System (Sierra Scientific Instruments, Los Angeles, CA, USA) using a catheter with 36 pressure channels and the finding looked like flying butterflies with their wings fully spread (Fig. 1A). Considering a possibility of a U-shaped bending of the catheter in the esophagus, the catheter was removed and re-inserted and then the butterflies disappeared (Fig. 1B). The manometric diagnosis of this case was mild peristaltic dysfunction according to the Chicago classification of esophageal motility1 and ineffective esophageal motility according to the conventional criteria.2 In conclusion, although not frequently experienced, a high resolution manometry catheter can also be hooked in the esophagus like a conventional manometry catheter3 and care should be taken not to push a catheter with an excess force if resistance is felt during insertion. Figure 1 High resolution manometry findings with 30 mmHg isobaric contour in a same case before (A) and after (B) reinsertion of the manometry catheter. (A) Each wet swallow evoked a primary peristalsis ending with two closely fused high pressure zones to which ...

T1081 The Effect of PPI (Proton Pump Inhibitor) on the Bone Mineral Density, Bone Microstructure and Bone Metabolism of Rat

G A A b st ra ct s test day arterial oxygen saturation (sO2) was measured and preprandial AMS scores were assessed by self assessment questionnaires (Lake Louise Score (LLSAS), AMS-C). Gastroparesis cardinal symptom index (GCSI), dyspeptic symptoms and hunger scores (10cm visual analogue scale) were recorded. Mucosal lesions were treated with high doses of a proton pump inhibitor (PPI). Dexamethasone 8mg bid was administered if LLSAS in the evening of d2 was >4 or >2 in HAPE susceptible individuals. Results: 23/26 mountaineers who underwent UTF-EGD at ground level had at least one endoscopy at 4559m (d4). 18/23 also had UTF-EGD on d2. The procedure was generally well tolerated and safe. Arterial sO2 was lower on d2 and d4 than in Zurich (75±1 and 80±1 vs. 96±1; p<0.001). Mild reflux esophagitis was observed in one at ground level. Of those that underwent UTF-EGD on d2, 5/18 (28%) had peptic mucosal lesions: duodenal erosions/ulcers (4), hemorrhagic gastritis after 500mg aspirin intake (1). On d4 lesions were found in 14/23 (61%); duodenal erosions/ ulcers (5), gastric erosions/ulcers (5), hemorrhagic gastritis/duodenitis (5), reflux esophagitis (1). Peptic lesions diagnosed on d2 resolved on d4 under PPI in 1 subject. AMS-C scores on d2/d4 were higher than in Zurich (0.99±0.14/0.39±0.14 vs. 0.05±0.14; p<0.03). Subjects with peptic lesions on d4 had lower hunger scores than those with normal UTF-EGD (37±7 vs. 67±9mm; p<0.02). Lesions were not associated with nausea, fullness, AMS and GCSI scores, the arterial sO2 or with the use of dexamethasone. Conclusions: GI mucosal lesions are common findings in healthy mountaineers after rapid ascent to high altitude independent of dexamethasone use. The presence of mucosal disease was associated with the loss of appetite, a key symptom of AMS. Patho-physiological mechanisms might include hypoxia and disturbed GI microcirculation in a hostile environment.