Incidental Diagnosis of Pediatric Arytenoid Cartilage Dislocation During Videofluoroscopic Swallowing Study: A Case Report

Arytenoid cartilage dislocation is one of the most common mechanical causes of vocal fold immobility. The most common etiologies are intubation and external trauma, but its incidence is lower than 0.1%. Its symptoms include dysphonia, vocal fatigue, loss of vocal control, breathiness, odynophagia, dysphagia, dyspnea, and cough. Although there are some reports of arytenoid cartilage dislocation in adults, there are only few reports on its occurrence in children. It is particularly difficult to detect the symptoms of arytenoid cartilage dislocation in uncooperative pediatric patients with brain lesions without verbal output or voluntary expression. We report a case of arytenoid cartilage dislocation with incidental findings in a videofluoroscopic swallowing study performed to evaluate the swallowing function.

Architectural Changes in the Medial Gastrocnemius on Sonography after Nerve Ablation in Healthy Adults

Architectural changes in healthy muscle after denervation have not yet been reported. This study aimed to investigate architectural changes in the medial head of the gastrocnemius muscle (GCM) after aesthetic tibial nerve ablation in healthy adults using ultrasonography (US). The effects of tibial nerve ablation were verified by visual observation and surface electromyography analysis. US images of medial GCMs were taken by one trained physician using B-mode and real-time US with a linear-array probe before nerve ablation, at 1 week after nerve ablation and at 3 months after nerve ablation in an anatomic standing position with the feet about shoulder-width apart in 19 healthy adults (17 females and 2 males). Muscle thickness was significantly reduced on the left side at 1 week and 3 months after the procedure and on the right side at 3 months after the procedure (p<0.050). Although fascicle length was not significantly changed, pennation angle was significantly reduced on both sides at 3 months after the procedure (p<0.050). Muscle thickness and pennation angle of the muscle fascicle were significantly reduced, although fascicle length was not significantly changed, after tibial nerve ablation in the medial GCM of healthy adults.

A Portulaca oleracea L. extract promotes insulin secretion via a K⁺(ATP) channel dependent pathway in INS-1 pancreatic β-cells

BACKGROUND/OBJECTIVE: This study was designed to investigate how a Portulaca oleracea L. extract (POE) stimulates insulin secretion in INS-1 pancreatic β-cells. MATERIALS/METHOD: INS-1 pancreatic β-cells were incubated in the presence of various glucose concentrations: 1.1 or 5.6, 16.7 mM glucose. The cells were treated with insulin secretagogues or insulin secretion inhibitor for insulin secretion assay using an insulin ELISA kit. In order to quantify intracellular influx of Ca2+ caused by POE treatment, the effect of POE on intracellular Ca2+ in INS-1 pancreatic β-cells was examined using Fluo-2 AM dye. RESULTS: POE at 10 to 200 µg/mL significantly increased insulin secretion dose-dependently as compared to the control. Experiments at three glucose concentrations (1.1, 5.6, and 16.7 mM) confirmed that POE significantly stimulated insulin secretion on its own as well as in a glucose-dependent manner. POE also exerted synergistic effects on insulin secretion with secretagogues, such as L-alanine, 3-isobutyl-1-methylxanthine, and especially tolbutamide, and at a depolarizing concentration of KCl. The insulin secretion caused by POE was significantly attenuated by treatment with diazoxide, an opener of the K+ ATP channel (blocking insulin secretion) and by verapamil (a Ca2+ channel blocker). The insulinotropic effect of POE was not observed under Ca2+-free conditions in INS-1 pancreatic β-cells. When the cells were preincubated with a Ca2+ fluorescent dye, Fluo-2 (acetoxymethyl ester), the cells treated with POE showed changes in fluorescence in red, green, and blue tones, indicating a significant increase in intracellular Ca2+, which closely correlated with increases in the levels of insulin secretion. CONCLUSIONS: These findings indicate that POE stimulates insulin secretion via a K+ ATP channel-dependent pathway in INS-1 pancreatic β-cells.

Determinants of Hip and Femoral Deformities in Children With Spastic Cerebral Palsy

OBJECTIVE: To find factors affecting hip and femoral deformities in children with spastic cerebral palsy (CP) by comparing various clinical findings with imaging studies including plain radiography and computed tomography (CT) imaging. METHODS: Medical records of 709 children with spastic CP who underwent thorough baseline physical examination and functional assessment between 2 to 6 years old were retrospectively reviewed. Fifty-seven children (31 boys and 26 girls) who had both plain radiography of the hip and three-dimensional CT of the lower extremities at least 5 years after baseline examination were included in this study. RESULTS: The mean age at physical examination was 3.6 years (SD=1.6; range, 2–5.2 years) and the duration of follow-up imaging after baseline examination was 68.4 months (SD=22.0; range, 60–124 months). The migration percentage correlated with motor impairment and the severity of hip adductor spasticity (R1 angle of hip abduction with knee flexion). The femoral neck and shaft angle correlated with the ambulation ability and severity of hip adductor spasticity (R1 and R2 angles of hip abduction with both knee flexion and extension). CONCLUSION: Hip subluxation and coxa valga deformity correlated with both dynamic spasticity and shortening of hip adductor muscles. However, we found no correlation between femoral deformities such as femoral anteversion, coxa valga, and hip subluxation.

Diagnostic usefulness of the random urine Na/K ratio in cirrhotic patients with ascites: a pilot study / 대한간학회지

BACKGROUND/AIMS: Twenty-four hour urinary sodium excretion (24-h UNa) of greater than 78 mmol/day is important in the management of cirrhotic ascites. Although the random urine sodium-to-potassium ratio (UNa/K) is strongly correlated with 24-h UNa, and approximately 95% of patients with a random UNa/K greater than 1 have 24-h UNa greater than 78 mmol, few data have been published on the correlation between 24-h UNa and random UNa/K. We evaluated diagnostic value of morning and afternoon random UNa/K (AM UNa/K and PM UNa/K, respectively) with 24-h UNa. METHODS: A total of 42 male patients were enrolled from October 2007 to March 2008. Each patient collected 5 mL of urine twice at random times during 24-h urine collection (at 10-12 a.m. and 3-5 p.m.). ROC curve analysis was performed to evaluate the feasibility of AM and PM UNa/K for differentiating 24-h UNa greater than 78 mmol/day. RESULTS: Forty patients with a 24-h urinary creatinine of greater than 15 mg/kg were analyzed. The 24-h UNa, AM UNa/K, and PM UNa/K were 107.9+/-91.2 mmol (mean+/-SD), 3.44+/-3.64, and 3.97+/-4.60, respectively. When compared with 24-h UNa greater than 78 mmol, AUROC values for AM and PM UNa/K were 0.861 (95% CI, 0.715-0.950) and 0.929 (95% CI, 0.802-0.986), respectively (P=0.0001). No difference was found between the AUROC for AM and PM UNa/K (95% CI, -0.161-0.153, P=0.113). UNa/K greater than 1.25 was sensitive and specific for prediction of 24-h UNa greater than 78 mmol. CONCLUSIONS: The results suggest that anytime random UNa/K greater than 1.25 is an accurate, cost-effective, and convenient method for replacing 24-h UNa. Large multicentered cohort studies are needed to confirm our results.

A case of hypervascular hyperplastic nodules mimicking hepatocellular carcinoma in alcoholic liver cirrhosis / 대한간학회지

Benign hypervascular hyperplastic nodules (HHN) in liver cirrhosis are very rare. It is important to distinguish between regenerative nodules (hyperplastic nodules) and tumorous nodules (dysplastic or neoplastic nodules) in hepatocellular nodular lesions. The differential diagnosis between HHN and hepatocellular carcinoma on the basis of radiologic imaging is often difficult, and is clinically important when determining the therapeutic plan. Therefore, histological confirmation by needle biopsy sampling of the liver is necessary for a correct diagnosis of HHN. We report herein a case of benign HHN mimicking hepatocellular carcinoma in a 32-year-old male alcoholic liver cirrhosis patient without viral hepatitis infection.

In Vitro Antibiotic Susceptibility of Orientia tsutsugamushi strain Boryong Measured by Flow Cytometry

BACKGROUND: Scrub typhus, an infectious disease caused by Orientia tsutsugamushi, is endemic in Korea. With the introduction of tetracycline and chloramphenicol in clinical practice, the mortality due to scrub typhus has markedly decreased. In 1995, scrub typhus poorly responsive to doxycycline was reported in Thailand; the need for safe antibiotics for the treatment of scrub typhus acquired during pregnancy or for children is emerging; also, broader spectrum antibiotics having anti-Orientia activity may be preferred for empirical therapy of enteric fever syndrome and for complicated scrub typhus. The anti-Orientia activities of various antibiotics, including recently licensed antibiotics, were investigated by flow cytometry. MATERIALS AND METHODS: O. tsutsugamushi strain Boryong was inoculated into the ECV304 cell line. The infected cells were stained with FS15, a monoclonal antibody reacting against a linear epitope on 56-kDa major outer membrane protein of O. tsutsugamushi. Then the antimicrobial susceptibilities were measured by flow cytometry and expressed as a growth index (total mass of Orientia). A concentration at which no further decrease in growth index occurred was defined as the minimal inhibitory concentration (MIC). Microbial susceptibilities to the following antibiotics were measured: quinupristin-dalfopristin (Synercid), levofloxacin, ciprofloxacin, moxifloxacin, metronidazole, linezolid, clindamycin, chloramphenicol, doxycycline, azithromycin, and rifampin. RESULTS: Considering the usual serum concentrations of rifampin (MIC=0.025-0.05 microg/mL), azithromycin (MIC=0.05-0.5 microg/mL) and doxycycline (MIC=0.05-0.1 microg/mL), these antibiotics exhibited very low MICs. Synercid (MIC=0.2-1.0 microg/mL), clindamycin (MIC=1.0 microg/mL) and chloramphenicol (MIC=1-2 microg/mL) exhibited moderately low MICs; moxifloxacin (MIC=8 microg/mL), ciprofloxacin (MIC=25.6 microg/mL or more) and levofloxacin (MIC=30 microg/mL) exhibited relatively high MICs; and cefotaxime (MIC>50 microg/mL), metronidazole (MIC>30 microg/mL) and linezolid (>30 microg/mL) exhibited high MICs. CONCLUSIONS: Among the new antibiotics, none was superior to doxycycline, azithromycin or rifampin with respect to anti-Orientia activity. Synercid, clindamycin, and moxifloxacin may show moderate therapeutic efficacies in human.

A Study of HHA-8 Seroprevalence in Korean Health Care Workers

HHV-8 virus is known to be associated with Kaposi's sarcoma (KS) in HIV seropositive patients and its seroprevalence has geographic difference. In South Korea, incidence of KS is low not only in general population but also in HIV patients compared to other countries. It is speculated that low seroprevalence of HHV-8 has contributed to the low incidence of KS in South Korea. We examined the seroprevalence of anti HHV-8 IgG of HIV seronegative health care workers in one University hospital. Enzyme-linked immunosorbent assay(ELISA) was used for diagnosis. One person (0.6%, 1/164) was seropositive, six were equivocal (3.7%, 6/164) and 157 people were seronegative (95.73%, 157/164). This study revealed that seroprevalence of HHV-8 in general population was low in South Korea. Further studies are needed to be carried out to evaluate the low HHV-8 seroprevalence in Korea.

In vitro Study on the Dose and Duration of Doxycycline Treatment against Orientia tsutsugamushi

BACKGROUND: Doxycycline, azithromycin, and chloramphenicol have been used for the treatment of scrub typhus; however, the duration of treatment for this disease is still controversial. Most clinical studies on the treatment of scrub typhus focus on the effectiveness of antibiotics; few studies have focused on the duration of the treatment. There has been no in vitro evaluation of the optimal duration of treatment of scrub typhus. We performed an experiment to evaluate the regrowth of Orientia tsutsugamushi after exposure to doxycycline of various concentration and exposure time. MATERIALS AND METHODS: O. tsutsugamushi strain Boryong was inoculated into the ECV304 cell line. The infected cells were stained with FS15, a monoclonal antibody reacting against a linear epitope on the 56-kDa major outer membrane protein of O. tsutsugamushi; thereafter, the antimicrobial susceptibilities were measured by flow cytometry and expressed as a growth index (total mass of Orientia). Incubation in media containing 0.1 (the minimal inhibitory concentration of doxycycline against O. tsutsugamushi strain Boryong), 0.2, and 2 microg/mL doxycycline for 1, 3, 5, and 7 day was followed by incubation in antibiotic-free media for 5 day. Two inocula sizes were employed; low inoculum (45.18% of cells were infected) and high inoculum (87.21% of cells). RESULTS: The incubation with 0.1 microg/mL doxycycline resulted in O. tsutsugamushi regrowth irrespective of doxycycline treatment duration. When the concentration of doxycycline was increased to 0.2 or 2 microg/mL, regrowth was observed in short duration treatments (1-5 day at 0.2 microg/mL; 1 day at 2 microg/mL). Higher inoculum size of O. tsutsugamushi increased regrowth (1 day at the low inoculum; 1-5 day at the high inoculum). Conclusions: The regrowth of O. tsutsugamushi after doxycycline treatment depends on the doxycycline dose; the higher the dose, the lower the relapse rate. If this result is extrapolated to humans, higher dose of doxycycline might be preferred to lower the relapse rate. The inoculum effect in O. tsutsugamushi infection needs further investigations.

In Vitro Antibiotic Susceptibility of Orientia tsutsugamushi strain Boryong Measured by Flow Cytometry

BACKGROUND: Scrub typhus, an infectious disease caused by Orientia tsutsugamushi, is endemic in Korea. With the introduction of tetracycline and chloramphenicol in clinical practice, the mortality due to scrub typhus has markedly decreased. In 1995, scrub typhus poorly responsive to doxycycline was reported in Thailand; the need for safe antibiotics for the treatment of scrub typhus acquired during pregnancy or for children is emerging; also, broader spectrum antibiotics having anti-Orientia activity may be preferred for empirical therapy of enteric fever syndrome and for complicated scrub typhus. The anti-Orientia activities of various antibiotics, including recently licensed antibiotics, were investigated by flow cytometry. MATERIALS AND METHODS: O. tsutsugamushi strain Boryong was inoculated into the ECV304 cell line. The infected cells were stained with FS15, a monoclonal antibody reacting against a linear epitope on 56-kDa major outer membrane protein of O. tsutsugamushi. Then the antimicrobial susceptibilities were measured by flow cytometry and expressed as a growth index (total mass of Orientia). A concentration at which no further decrease in growth index occurred was defined as the minimal inhibitory concentration (MIC). Microbial susceptibilities to the following antibiotics were measured: quinupristin-dalfopristin (Synercid), levofloxacin, ciprofloxacin, moxifloxacin, metronidazole, linezolid, clindamycin, chloramphenicol, doxycycline, azithromycin, and rifampin. RESULTS: Considering the usual serum concentrations of rifampin (MIC=0.025-0.05 microg/mL), azithromycin (MIC=0.05-0.5 microg/mL) and doxycycline (MIC=0.05-0.1 microg/mL), these antibiotics exhibited very low MICs. Synercid (MIC=0.2-1.0 microg/mL), clindamycin (MIC=1.0 microg/mL) and chloramphenicol (MIC=1-2 microg/mL) exhibited moderately low MICs; moxifloxacin (MIC=8 microg/mL), ciprofloxacin (MIC=25.6 microg/mL or more) and levofloxacin (MIC=30 microg/mL) exhibited relatively high MICs; and cefotaxime (MIC>50 microg/mL), metronidazole (MIC>30 microg/mL) and linezolid (>30 microg/mL) exhibited high MICs. CONCLUSIONS: Among the new antibiotics, none was superior to doxycycline, azithromycin or rifampin with respect to anti-Orientia activity. Synercid, clindamycin, and moxifloxacin may show moderate therapeutic efficacies in human.

A Study of HHA-8 Seroprevalence in Korean Health Care Workers

HHV-8 virus is known to be associated with Kaposi's sarcoma (KS) in HIV seropositive patients and its seroprevalence has geographic difference. In South Korea, incidence of KS is low not only in general population but also in HIV patients compared to other countries. It is speculated that low seroprevalence of HHV-8 has contributed to the low incidence of KS in South Korea. We examined the seroprevalence of anti HHV-8 IgG of HIV seronegative health care workers in one University hospital. Enzyme-linked immunosorbent assay(ELISA) was used for diagnosis. One person (0.6%, 1/164) was seropositive, six were equivocal (3.7%, 6/164) and 157 people were seronegative (95.73%, 157/164). This study revealed that seroprevalence of HHV-8 in general population was low in South Korea. Further studies are needed to be carried out to evaluate the low HHV-8 seroprevalence in Korea.

In vitro Study on the Dose and Duration of Doxycycline Treatment against Orientia tsutsugamushi

BACKGROUND: Doxycycline, azithromycin, and chloramphenicol have been used for the treatment of scrub typhus; however, the duration of treatment for this disease is still controversial. Most clinical studies on the treatment of scrub typhus focus on the effectiveness of antibiotics; few studies have focused on the duration of the treatment. There has been no in vitro evaluation of the optimal duration of treatment of scrub typhus. We performed an experiment to evaluate the regrowth of Orientia tsutsugamushi after exposure to doxycycline of various concentration and exposure time. MATERIALS AND METHODS: O. tsutsugamushi strain Boryong was inoculated into the ECV304 cell line. The infected cells were stained with FS15, a monoclonal antibody reacting against a linear epitope on the 56-kDa major outer membrane protein of O. tsutsugamushi; thereafter, the antimicrobial susceptibilities were measured by flow cytometry and expressed as a growth index (total mass of Orientia). Incubation in media containing 0.1 (the minimal inhibitory concentration of doxycycline against O. tsutsugamushi strain Boryong), 0.2, and 2 microg/mL doxycycline for 1, 3, 5, and 7 day was followed by incubation in antibiotic-free media for 5 day. Two inocula sizes were employed; low inoculum (45.18% of cells were infected) and high inoculum (87.21% of cells). RESULTS: The incubation with 0.1 microg/mL doxycycline resulted in O. tsutsugamushi regrowth irrespective of doxycycline treatment duration. When the concentration of doxycycline was increased to 0.2 or 2 microg/mL, regrowth was observed in short duration treatments (1-5 day at 0.2 microg/mL; 1 day at 2 microg/mL). Higher inoculum size of O. tsutsugamushi increased regrowth (1 day at the low inoculum; 1-5 day at the high inoculum). Conclusions: The regrowth of O. tsutsugamushi after doxycycline treatment depends on the doxycycline dose; the higher the dose, the lower the relapse rate. If this result is extrapolated to humans, higher dose of doxycycline might be preferred to lower the relapse rate. The inoculum effect in O. tsutsugamushi infection needs further investigations.

Severe Paradoxical Reaction Requiring Tracheostomy in a Human Immunodeficiency Virus (HIV)-negative Patient with Cervical Lymph Node Tuberculosis

During drug treatment of tuberculous lymphadenitis, paradoxical response (PR) may occasionally occur. Continued treatment or lymph node aspiration improves PR without severe sequelae. However, we report a case of severe PR in a patient with cervical lymph node tuberculosis causing airway obstruction due to retropharyngeal lymph node swelling during antituberculous treatment. Tracheostomy and drainage of the node were performed to secure the airway. Possible airway obstruction due to PR must be suspected when cervical lymph node tuberculosis involves the retropharyngeal lymph node.

An Imported Case of Typhoid Fever Refractory to Ciprofloxacin Treatment

Salmonella enterica serovar Typhi infection is widely prevalent in developing countries; its treatment has been complicated by the emergence of resistance to antimicrobial agents. Fluoroquinolones are orally administered antimicrobials effective against typhoid fever, including that caused by the multidrug-resistant S. Typhi. They are relatively inexpensive and more convenient to administer com pared to third-generation cephalosporins; hence, they constitute the drugs of choice for the treatment of typhoid fever in developing countries. In Asian countries, however, resistance to nalidixic acid-a prototype of quinolone antibiotics-diminishes the value of fluoroquinolones with regard to the treatment of typhoid fever. We experienced a case of nalidixic acid-resistant S. Typhi infection imported from Pakistan that was clinically refractory to ciprofloxacin treatment. A 31-year-old male presented with a fever of 14 days' duration after returning from his native Pakistan. Oral ciprofloxacin was empirically administered for three days without any beneficial effect. His illness, however, improved after the administration of ceftriaxone for three days. Blood culture revealed the presence of S. Typhi that was resistant to nalidixic acid (minimal inhibitory concentration > or =32 microgram/mL) but susceptible to ciprofloxacin (minimal inhibitory concentration=1.0 microgram/mL) in vitro.

An Imported Case of Typhoid Fever Refractory to Ciprofloxacin Treatment

Salmonella enterica serovar Typhi infection is widely prevalent in developing countries; its treatment has been complicated by the emergence of resistance to antimicrobial agents. Fluoroquinolones are orally administered antimicrobials effective against typhoid fever, including that caused by the multidrug-resistant S. Typhi. They are relatively inexpensive and more convenient to administer com pared to third-generation cephalosporins; hence, they constitute the drugs of choice for the treatment of typhoid fever in developing countries. In Asian countries, however, resistance to nalidixic acid-a prototype of quinolone antibiotics-diminishes the value of fluoroquinolones with regard to the treatment of typhoid fever. We experienced a case of nalidixic acid-resistant S. Typhi infection imported from Pakistan that was clinically refractory to ciprofloxacin treatment. A 31-year-old male presented with a fever of 14 days' duration after returning from his native Pakistan. Oral ciprofloxacin was empirically administered for three days without any beneficial effect. His illness, however, improved after the administration of ceftriaxone for three days. Blood culture revealed the presence of S. Typhi that was resistant to nalidixic acid (minimal inhibitory concentration > or =32 microgram/mL) but susceptible to ciprofloxacin (minimal inhibitory concentration=1.0 microgram/mL) in vitro.

A case of Burkholderia cepacia peritonitis in a patient on CAPD / 대한내과학회지

Burkholderia cepacia is an important opportunistic pathogen in immunocompromised and nosocomial patients, but this bacterial infection is rare in Korea. We report a case of Burkholderia cepacia peritonitis in a patient on CAPD. A 69-year-old male on CAPD for 5 years was presented with turbid peritoneal dialysate, diffuse abdominal pain and diarrhea. He was treated initially with intraperitoneal cefazolin and ceftazidime, and then intraperitoneal meropenem and oral TMP/SMX. His symptoms had improved with antibiotic treatment, but white blood cell counts of dialysate increased, instead. Burkholderia cepacia was isoloated from peritoneal fluid culture. The patient refused catheter removal in spite of our recommendation. He died of suddenly developed acute myocardial infarction and upper gastrointestinal bleeding. Catether tip culture also revealed Burkholderia cepacia.

The 3 cases of colonic diverticular bleeding treated by colonoscopic hemostatic procedures / 대한내과학회지

Recently, aging process and westernization of life style are increasing the incidence of colonic diverticulum. About 30% of colonic diverticulm result in diverticular bleeding, which often causes acute lower gastrointestinal bleeding. In most cases, the bleeding stops spontaneously. But when relapsing or causing massive bleeding, it sometimes needs emergent surgery. Generally, treatments for colonic diverticular bleeding consist of conservative ones. But recently, urgent colonoscopy is important procedure since it estimates the needs for surgery, or when bleeding foci being identified, endoscopists frequently can stop the bleeding by only colonoscopic procedures such as injection therapy, band ligation, hemoclipping and argon plasma coagulation, etc. In patients with hematochezia, we made early detection of diverticular bleeding foci by urgent colonoscopy, and then we were able to treat them successfully by argon plasma coagulation and hemoclipping. Thus we report these with literature review.

A case of pericardial actinomycosis with acute myocardial infarction and cerebral infarction: mimicking pericardial tuberculosis / 대한내과학회지

Actinomycosis infection can involve most part of the human body including mouth, cervicoface, chest, abdomen and pelvis. Cardiac involvement occurs in less than 2 percent of the infection of actinomyces israelii and pericardial involvement is rare. 34 year male was admitted because of chest pain and general weakness for several months. Echocardiography revealed akinesia of apex suggesting myocardial infarction and large pericardial effusion. Under the impression of pericardial effusion from tuberculosis infection, the patient was started on anti-tuberculosis medicine. Pericardial window operation with pericardial biopsy was performed 7 days later when the patient failed to show a significant improvement. Pericardial biopsy confirmed actinomycosis infection. During admission, the patient had a cerebral infarction with left hemiparesis. The patient was treated with high dose penicillin and improved symptomatically. Echocardiography showed resolution of pericardial effusion.

A Case of Intramural Duodenal Hematoma Presenting with Acute Duodenal Obstruction

Intramural duodenal hematoma (IDH) is a quite rare disese entity which results from the collection of blood and body fluid between mucosa and serosa. Various degrees of duodenal obstruction may be caused by IDH as it gradually enlarges and compresses the mucosa against the opposite side of duodenum. The most common cause of IDH is blunt abdominal trauma and the spontaneous IDHs are generally casused by coagulation disorder such as blood dyscrasia, anticoagulation treatment or pancreaticoduodenal aneurysm. The diagnosis is usually made by the typical imaging on abdominal computed tomographic scan with a previous history of blunt abdominal trauma. For spontaneous IDH without coagulation disorder, an abdominal angiogram may be considered to exclude vascular anomalies. Medical treatment is recommended unless the associated visceral injuries require immediate laparotomy. Here, we report a case of acute duodenal obstruction due to IDH which had resolved completely without an operative management.

A Case of Inflammatory Fibroid Polyp in the Duodenum / 대한소화기내시경학회지

Inflammatory fibroid polyp is a relatively uncommon, localized benign lesion of the gastrointestinal wall. It is seen mostly as a single entity and the majority of inflammatory fibroid polyps have been reported with pathologic examination in the stomach but rarely in small intestines. A 70-year-old woman was presented with intermittent epigatric discomfort and gastroduodenoscopy showed a polypoid lesion with oval shaped, central depression, and normal mucosal covering. Endoscopic ultrasonography showed 8x6 mm sized hypoechoic tumor which was located mainly in the third layer of the duodenal wall with indistinct margin. The tumor was successfully removed by endoscopic resection after the injection of hypertonic saline solution with epinephrine and banding. The tumor consisted of loose fibrous stroma, small blood vessels and inflammatory cells. We present a case of inflammatory fibroid polyp of the duodenum with review of the literatures.