Percutaneous Trans-splenic Obliteration for Duodenal Variceal bleeding: A Case Report / 대한소화기학회지

Duodenal varices are a serious complication of portal hypertension. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). The patient no longer complained of melena after treatment. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding.

Percutaneous Trans-splenic Obliteration for Duodenal Variceal bleeding: A Case Report / 대한소화기학회지

Duodenal varices are a serious complication of portal hypertension. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). The patient no longer complained of melena after treatment. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding.

Erratum: Gastric Emptying in Migraine: A Comparison With Functional Dyspepsia

The word "Delayed" in the legend of Figure 2 should have been written as "Controls."

Gastric Emptying in Migraine: A Comparison With Functional Dyspepsia

BACKGROUND/AIMS: Gastric stasis in migraineurs remains controversial. The aim of this study is to investigate gastric emptying (GE) time, and any associations between GE parameters and dyspeptic symptoms among patients with functional dyspepsia (FD) and migraine without any gastrointestinal symptoms during the interictal period. METHODS: We enrolled 27 migraine patients, 32 FD patients and 12 healthy people as controls, and performed GE scintigraphy as gastric function test. Gastrointestinal symptoms were evaluated in the FD and migraine. RESULTS: The age-adjusted mean gastric half-emptying time in FD (125.51 +/- 52.55 minutes) patients was longer than in migraineurs (100.82 +/- 23.94 minutes, P = 0.035) and controls (95.25 +/- 23.29 minutes, P = 0.021). The percentage of gastric retention was higher in FD than in migraine. However, migraineurs did not show an obvious delayed gastric emptying or an increase of gastric retention when compared to the normal controls. The association between each dyspeptic symptom and GE parameters was not significant, but postprandial fullness and early satiety showed a tendency of delayed GE. In migraineurs, GE time did not show significant association with nausea and vomiting during interictal periods. CONCLUSIONS: Delayed GE does not appear to be a mechanism that patients with FD and migraine have in common. Migraineurs without dyspepsia during interictal period had normal GE, and further study for association with FD should be investigated.

A Case of Neuroendocrine Carcinoma Presenting as a Subepithelial Tumor Diagnosed by ESD / 대한소화기내시경학회지

A gastric neuroendocrine carcinoma is very rare, and the histological diagnosis is very difficult. These carcinomas result in a poor prognosis because they are preceded by severe lymphovascular invasion and early metastasis. In particular, it is difficult to distinguish between adenocarcinoma and neuroendocrine carcinoma by endoscopy when no specific symptoms are present (e.g., dyspepsia, nausea). According to published articles in Korea, most cases were diagnosed as adenocarcinoma initially; however, they were confirmed postoperatively as neuroendocrine carcinoma based on a histological examination using immunohistochemical staining. A case of a 55-year-old man, who had an incidental finding of a subepithelial tumor during his health check-up, was recommended for an endoscopic submucosal dissection (ESD). But the patient was lost to follow-up for 4 years. When he was examined again, the size of the tumor had increased from the previous exam. He underwent ESD and was diagnosed with a well-differentiated neuroendocrine carcinoma.

The Prevalence of Yersinia Infection in Adult Patients with Acute Right Lower Quadrant Pain / 대한소화기학회지

BACKGROUND/AIMS: Clinical manifestations of intestinal yersiniosis include enterocolitis, mesenteric adenitis, and terminal ileitis presenting with fever, right lower quadrant pain, and leukocytosis. According to a previous Korean study in 1997, Yersinia was revealed in two among 15 adult patients with mesenteric adenitis (13%). However, recent reports on the prevalence of Yersinia infection in adult patients are few. The aim of this study was to investigate the prevalence of Yersinia infection in adult patients with acute right lower quadrant pain. METHODS: Adult patients (>18 years) who visited Eulji medical center, due to acute right lower quadrant pain were enrolled prospectively from December 2007 to July 2009. Abdominal CT, stool culture, serologic test for Yersinia, and Widal test were performed. RESULTS: Among 115 patients, 5 patients were excluded due to positive Widal test or salmonella culture. In 110 patients, abdominal CT showed right colitis in 20 (18.2%), terminal ileitis in 16 (14.5%), mesenteric adenitis in 13 (11.8%), acute appendicitis in 10 (9.1%), acute diverticulitis in 7 (6.4%), non specific mucosal edema in 36 (32.7%) and no specific lesion in 8 (7.3%). Two (1.8%) of the 110 patients had antibodies to Yersinia. One patient showed acute enteritis and the other patient was diagnosed with acute appendicitis and underwent appendectomy. No Yersinia species were grown on stool or tissue culture. CONCLUSIONS: Nowadays, among adult Korean patients presenting with acute right lower quadrant pain, there have been few incidences of Yersinia infection.

Comparison of Quality in Chest Compressions at Scene, in a Moving Ambulance by Student Nurses, the 119 Member Group, and an Automatic CPR Machine

PURPOSE: In an emergency, the quality of CPR prior to hospital arrival is a very important component for the survival of victims. We want to know differences in chest compression quality performed by groups that have variant experiences of CPR, and automatic CPR machine on the floor, or in an ambulance moving at 40 km/hr, or at 80 km/hr. METHODS: We analysed the chest compression quality of each group, and that performed on the floor, in an ambulance moving as 40 km/hr, and at 80 km/hr. We measured the following factors: mean compression depth; mean compression rate; exact performance percentile; and the compression error through too deep, too weak, wrong compression location, and no full recoil. RESULTS: In the student-nurse group, the quality of chest compression performed on the floor was better than that performed in a moving ambulance. In 119 member group, chest compression performed in an ambulance moving as 40 km/hr was better than that performed in an ambulance moving at 80 km/hr. The use of an automatic CPR machine, there were no differences in chest compression quality in all circumstances. In comparing each group, compression quality of the 119 member group and the automatic CPR machine group was better than that of the student nurses. CONCLUSION: In the group with real CPR experience, there were no differences between chest compression performed on the floor and that performed moving at 40 km/hr. Chest compression performed moving as 40 km/hr is better than that performed moving at 80km/hr. In the group without CPR experience, chest compression performed on the floor is better than that performed in a moving ambulance.

The endoscopic findings in patients with noncardiac chest pain who have a normal coronary angiogram / 대한내과학회지

BACKGROUND/AIMS: Noncardiac chest pain (NCCP) mainly results from esophageal lesions in the developed world. By contrast, gastroesophageal reflux disease (GERD) is a less frequent cause of NCCP than peptic ulcer disease in China and Japan. Therefore, both esophageal lesions and stomach and duodenal lesions are likely to be important causes of NCCP in Korea. We used upper gastrointestinal endoscopy to evaluate lesions of the esophagus, stomach, and duodenum in NCCP patients after cardiac chest pain was ruled out by coronary angiography (CAG). METHODS: From the patients who underwent CAG between 2004 and 2008, we identified 89 patients who had normal CAG or minimal disease. We retrospectively analyzed the endoscopic findings of these 89 patients who were diagnosed with NCCP. RESULTS: At endoscopy for the 89 patients, the percentages of GERD, gastric ulcer, and duodenal ulcer were 20.2% (n=18), 14.6% (n=13), and 3.3% (n=3) respectively. Of the 16 cases diagnosed as peptic ulcer, 11 were evaluated by biopsy or the Campylobacter-like organism (CLO) test for suspected Helicobacter pylori infection. Six (54%) cases were positive for H. pylori and five (46%) were negative. CONCLUSIONS: In Korea, the incidence of peptic ulcer disease (17.9%) as a cause of NCCP is similar to that of GERD (20.2%). Consequently, we should perform endoscopy to determine the cause of NCCP.

Sigmoid Colon Diverticular Bleeding in a 75-year-old Woman / 대한소화기학회지

Most common cause of brisk hematochezia is diverticular bleeding in Western countries. It occurs in 15% of patients with diverticulosis and one-third of them appear to be massive. Most of diverticulosis in Western countries occur in the left colon but the right colon is more common in Korea. Especially, the reports of diverticular bleeding on left colon are rare in Korea. We report a case presenting with multiple diverticuli complicated by recurrent massive bleeding restricted to the left colon. 75-year-old female was admitted due to hematochezia and dizziness. On past history, two years and two weeks ago respectively, she was treated of diverticular bleeding with and without diverticulitis. Hemoglobin level was 9.8 g/dL. On Colonoscopy, numerous diverticuli were seen at sigmoid colon upto splenic flexure which showed fresh blood clots in the lumen. We diagnosed her as recurrent massive diverticular bleeding on the sigmoid colon. She received elective laparoscopic left hemicolectomy.

A case of spontaneous bladder rupture after a bout of heavy drinking / 대한내과학회지

Spontaneous urinary bladder rupture is uncommon, but is associated with significant morbidity and mortality because of delayed diagnosis. A 65-year-old man was admitted to the emergency room because of low abdominal pain and abdominal distention of sudden onset. The previous night, he had consumed a bottle of alcohol and fallen asleep. Diagnosed as peritonitis of unknown origin, he was prescribed antibiotics empirically. However, the ascites progressed and oliguric acute renal failure developed. On the fifth day, we measured the creatinine level in the ascitic fluid and performed retrograde cystography. He was diagnosed as idiopathic spontaneous bladder rupture and underwent a primary repair successfully. When a patient presents with acute abdominal pain, ascites, and oliguric acute renal failure without definite causes, physicians should consider idiopathic spontaneous bladder rupture, measure the creatinine level in the ascitic fluid immediately, and perform retrograde cystography to obtain an early diagnosis.

Paradoxical Response Developed during the Antituberculous Treatment in Tuberculous Pleurisy / 결핵및호흡기질환

BACKGROUND: A paradoxical response is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion after initial improvement during theprocess of antituberculous treatment. The related factors for the development of a paradoxical response in patients with tuberculous pleurisy are not certain. METHODS: We selected patients with tuberculous pleurisy who had been treated for more than 4 months. The changes onthe serial chest X-ray findings before and after treatment were reviewed. Paradoxical responses were regarded as any worsening or development of new lesion at least 2 weeks after the initiation of treatment. The baseline clinical characteristics and laboratory findings of the peripheral blood and pleural fluid were compared between the patients with a paradoxical response and the patients without a paradoxical response. RESULTS: Paradoxical responses appeared in sixteen patients (21%) among the 77 patients.It took a mean of 38.6 days after the treatment and the time to resolve the paradoxical response was a mean of 32.1 days. For the patients with a paradoxical response, the median age was younger (30.5 years vs 39.0 years, respectively) and the lymphocytic percentage of white blood cells in the pleural fluid was higher (82.1% vs 69.6%, respectively) than for the patients without a paradoxical response. CONCLUSION: The development of a paradoxical response during the treatment of patients with tuberculous pleurisy was not rare and this was related with the age of the patients and the percentage of lymphocytic white blood cells in the pleural fluid.

A Case of Mucinous Noncystic Carcinoma of the Pancreas / 대한소화기학회지

Mucinous (colloid) carcinoma is defined as pools of stromal extracellular mucin containing scanty, floating carcinoma cells. It is a well-defined entity in breast or large bowel. However, mucinous noncystic carcinoma of the pancreas (MNCC) is uncommon, comprising between 1% and 3% of all carcinomas of the pancreas. In the past, MNCC generally had been categorized together with ordinary ductal adenocarcinoma or misdiagnosed as mucinous cystadenocarcinoma or signet-ring cell carcinoma. The new WHO classification lists MNCC as a variant of ductal adenocarcinoma. Herein, we report a 32-year-old woman with incidentally found pancreatic body mass who underwent subtotal pancreatectomy. She was diagnosed as MNCC histologically.

Giant Hyperplasia of the Caudate Lobe in a Patient with Liver Cirrhosis: Case Report and Literature Review

The caudate lobe often exhibits enlargement and nodularity in cases of cirrhosis, which makes differentiation of hepatocellular carcinoma from other mass-like lesions of the caudate lobe difficult in cirrhotic patients. A 12x6 cm mass-like enlargement of the caudate lobe was incidentally found by computed tomography in a 38-year-old man suffering from alcoholic liver cirrhosis. Magnetic resonance imaging, liver colloidal scan, and sonoguided liver biopsy were used for the differential diagnosis. A literature review revealed two case reports, all of which (like ours) presented with an enlarged caudate lobe supplied with blood via a branch of the portal vein. Therefore, in cases of giant hyperplasia of the caudate lobe, confirmation of the caudate lobe blood supply and the enhancement pattern might be important for the differentiation.