A Case of Successful Colonoscopic Treatment of Acute Appendiceal Bleeding by Endoclips

Lower gastrointestinal bleeding is a common disease among elderly patients. The common sources of lower gastrointestinal bleeding include vascular disease, Crohn's disease, neoplasm, inflammatory bowel disease, hemorrhoid, and ischemic colitis. However, bleeding from the appendix has been reported very rarely in patients with lower gastrointestinal tract bleeding. In general, after a colonoscopic diagnosis of appendiceal bleeding, a laparoscopic or surgical appendectomy would be recommended. We report a case of successful colonoscopic treatment of appendiceal bleeding without complications by endoclips. This report suggests that colonoscopic clipping is a safe and effective means to treat bleeding from appendiceal lesions. Further study is needed to evaluate procedure-related complications and to confirm the procedure's safety and efficacy.

Analysis of the Clinicopathologic Features of Eosinophilic Esophagitis: Comparative Study with Nonobstructive Dysphagia / 대한소화기내시경학회지

BACKGROUND/AIMS: Eosinophilic esophagitis (EoE) has emerged as one of the most common causes of dysphagia and esophageal food impactions. However, it is doubtful that gastroenterologists and pathologists make the correct diagnosis of EoE because of the insufficient recognition of EoE based on the endoscopic and pathological findings. This study was performed to investigate the symptoms and the endoscopic and pathologic findings of EoE as compared with those of nonobstructive dysphagia (NOD). METHODS: We retrospectively reviewed the medical records and the endoscopic and pathologic findings from 12 patients who were diagnosed with EoE based on an eosinophil count of > or =20 per high-power field (HPF) and 13 patients diagnosed with NOD, and these patients were treated at our hospital from June 2006 till October 2010. RESULTS: The endoscopic findings of EoE included rings (41.7%), furrows (75.0%), exudates (33.3%), mucosal friability (8.3%) and multi-findings (6.7%). Furrows and multi-findings were identified more frequently in EoE as comparison to that in NOD. The pathologic findings revealed that the maximal eosinophil counts/HPF were 87.2 (range 20~232) and 2.2 (0~1) in EoE and NOD, respectively. Moreover, eosinophil microabscess (58.3%), degranulation (100%) and spongiosis (91.7%) were more significantly observed in EoE compared with that in NOD. CONCLUSIONS: EoE had specific endoscopic and clinicopathologic features that distinguish it from NOD. For patients with dysphagia, the endoscopic and pathologic findings of EoE should be kept in mind.

The Relationship between the Early Follow-Up BNP Level and Congestive Status or Prognosis in Acute Heart Failure

BACKGROUND AND OBJECTIVES: A correlation between the BNP reduction ratio and prognosis could be expected to be found by evaluating the BNP reduction depending on the volume status during the early period. SUBJECTS AND METHODS: Between October 2002 and June 2004, 120 patients with acute heart failure (AHF)(<1 month) were included. The patients were divided into three groups according to their volume status, as follows. Group I: patients with clinical & radiological wet status, Group II: clinical dry & radiological wet status and Group III: clinical & radiological dry status. The blood BNP (Triage(r)) level and clinical parameters were analyzed. The bad prognostic parameters were defined as readmission due to heart failure, a major adverse cardiac event or cardiovascular death. RESULTS: The mean patient age was 68.0+/-12.7 years, and 50.0% of the subjects were male. The most frequent etiology of AHF was ischemic heart disease (35.8%). There were 61.7, 24.1 and 14.2% in Groups I, III and III, respectively. The baseline BNP level was higher in group I and II than in group III patients (I: 1540.4+/-1202.8, II: 1482.8+/-1281.6, III: 666.4+/-827.9 pg/mL, p=0.036) as was the early BNP reduction ratio (I: 69.8+/-27.1, II: 67.4+/-32.8, III: 1.3+/-144.9%, p=0.007). Sixteen (13.3%) patients had a poor prognosis. From a logistical analysis, the early BNP reduction ratio (p=0.004) and creatinine level (p=0.029) were significant predictors of the clinical outcomes. CONCLUSION: The early change in the BNP level varied depending on the degree of congestive status, and was also correlated with the level of clinical outcomes. Therefore, in our opinion, the early monitoring of the BNP level will provide significant clinical information in AHF patients.

Is B-type Natriuretic Peptide(BNP) Measurement Useful Test for Diagnosing Systolic Heart Failure in Patients with Moderate to Severe Renal Insufficiency?

BACKGROUND AND OBJECTIVES: Plasma B-type natriuretic peptide (BNP) can be increased in patients with renal insufficiency (RI). The aim of this study was to evaluate the diagnostic value of BNP for systolic heart failure (HF) in patients with moderate to severe RI. SUBJECTS AND METHODS: Between Aug 2002 and May 2004, 433 patients found to have systolic HF or moderate to severe RI were included. The patients were divided into 3 groups (group I; only HF, group II; only RI, group III; HF and RI). The severity of RI was graded according to the calculated creatinine clearance (Ccr); moderate 30< or =Ccr<60, severe 15< or =Ccr<30 or end stage renal disease (ESRD) Ccr<15 mL/min. RESULTS: The mean age of the patients was 67.6+/-12, and 49% were male. There were significant differences in the mean BNP levels between group III and the other two groups (p<0.001); group I (n=65, 837.3+/-884), group II (n=137, 1049.4+/-1332) and group III (n=231, 1738.3+/-1501 pg/mL). A weak negative correlation was note between BNP and Ccr (r=-0.335, p<0.001) in patients with RI. As the renal function deteriorated, the mean BNP of groups II and III was found to be elevated (moderate 625.5+/-574, 1183.0+/-1056; severe 760.5+/-1211, 2205.4+/-1470; ESRD 2157.6+/-1831, 3209.9+/-1900 pg/mL, p<0.05), with the mean BNP of group III being higher than that of group II for each grade (p<0.05). From the ROC curve, the optimal cut-off point of BNP for the diagnosis of systolic HF in patients with RI was 829 pg/mL (accuracy 68%, sensitivity 66% and specificity 70%, p<0.001). CONCLUSION: In the case of patients with moderate to severe RI, a higher BNP cut-off point for the diagnosis of systolic HF and a relatively lower diagnostic accuracy of BNP should be considered.

A Case of Percutaneous Aspiration Thromboembolectomy of the Common Femoral Artery, Using the PercuSurge GuardWire(TM) System, with a 7 Fr. Guiding Catheter

An acute thromboembolism of the peripheral artery is a common complication in patient with inappropriately treated atrial fibrillation. A case of successful recanalization of a thromboembolic occlusion of the left common femoral artery, using the PercuSurge GuardWire(TM) System, with a 7 Fr. guiding catheter, was experienced in a patient with atrial fibrillation.

Two cases of self expandable stent implantation in patient with occlusive restenosis of brachiocephalic vein stent / 대한내과학회지

Percutaneous venous angioplasty and stent placement is a effective procedure in the treatment of central venous stenosis and occlusion. But multiple repeat interventions are occasionally required due to restenosis. Self expandable stent is preferred to balloon expandable stent in case of brachiocephalic vein stenting due to anatomic consideration and veinous characteristics. We reported two cases of successful recanalization using self expandable stent of the occlusive kinked in-stent restenosis of the previous balloon expandable stent at left brachiocephalic vein occlusion.

A case of two consecutive deliveries in a woman with acromegaly / 대한내과학회지

Acromegaly is a rare pituitary disorder and usually results from GH hypersecretion by a somatotroph adenoma. Disturbed pituitary function might lead to infertility or early pregnancy termination. Pregnancy in acromegaly is very rare. GH is a potent insulin antagonist, and pregnant patients with GH hypersecretion are prone to added glucose intolerance and diabetes. Pregnancy itself may impact the course of a pituitary tumor. In our case, pregnancy was uneventful and normal full-term infant was delivered at 1993 by vaginal delivery after transsphenoidal surgery and bromocriptine therapy. After delivery, GH and IGF-I level wasn't normalized. Postoperative pituitary MRI scan showed residual tumor. Therefore she received subsequent postoperative pituitary radiation (total dose : 5000 cGy). Next year, despite elevated GH and IGF-I, she delivered normal full-term infant. We report a case of two consecutive deliveries in a woman with acromegaly despite elevated GH and IGF-I levels after transsphenoidal surgery and radiation therapy.