Minimal Resection of Jejuna Dieulafoy's Lesion Using an Intraoperative Fluoroscopic Localization of the Metallic Coils Used in Angiography / 대한소화기학회지

Dieulafoy's lesions of the Jejunum are extremely rare. Therefore, localization of lesions is very difficult due to their small size and tendency of occasional bleeding. However, it is important to mention the location of the Dieulafoy's lesions to prevent excessive intestinal resections or, even worse, resection of the normal intestine. We report a case of preoperative localization of a Dieulafoy's lesion embolized by a metallic coil that allows a surgeon to accurately identify the bleeding, permitting a minimally invasive surgical treatment. A 25-year-old man presented with massive hematochezia. There was no definite bleeding focus on the upper gastrointestinal endoscopy and colonoscopy. An angiography found a persistent extravasation of the contrast media at the end of straight artery of the mid-jejunal branch, around the terminal ileum, embolized with metallic coils immediately. The combination of embolized metallic coils and intraoperative fluoroscopy allowed accurate identification and minimal laparotomy. Consequently, a highly selective and minimal resection of the jejunum containing the dieulafoy lesion was possible without any postoperative complications.

Correction: Minimal Resection of Jejuna Dieulafoy's Lesion Using an Intraoperative Fluoroscopic Localization of the Metallic Coils Used in Angiography / 대한소화기학회지

This correction is being published to correct the 6th author's English name in the article.

FOLFOX-4 Combination Chemotherapy as a First-line Treatment in Patients with Advanced Gastric Cancer / 대한내과학회지

BACKGROUND/AIMS: This study examined the efficacy and safety of oxaliplatin-5-fluorouracil-leucovorin (FOLFOX-4) combination chemotherapy as first-line treatment in patients with advanced gastric cancer. METHODS: This retrospective study enrolled 35 patients diagnosed with pathologically proven surgically unresectable gastric cancer who received FOLFOX-4 combination chemotherapy between August 2006 and February 2009, using medical records. The administered dose of oxaliplatin was 85 mg/m2 for 2 hrs and leucovorin 200 mg/m2 for 2 hrs on day 1, 5-fluorouracil 400 mg/m2 as a bolus and 5-fluorouracil 600 mg/m2 for 22 hrs on days 1 and 2, every 2 weeks. The response was assessed every three cycles. Toxicity was evaluated for every course of chemotherapy according to the NCI toxicity criteria ver. 2.0. RESULTS: The median patient age was 61 (range 27-77) years. The median overall survival was 8.50 (6.23-10.90) months and the median time to progression was 4.50 (0.38-9.75) months. With FOLFOX-4, there was no complete remission and 19 partial responses, for a response rate of 54.3%. Over 298 cycles, anemia worse than NCI toxicity grade 3 occurred in 1.3%, leukopenia in 1.6%, neutropenia in 9%, and thrombocytopenia in 3.2%. Grade 1-2 neuropathy occurred in 14.7% of the cycles. Neutropenic fever occurred in two cycles and the regimen was changed because of side effects in one cycle. CONCLUSIONS: FOLFOX-4 has a very high response rate with mild toxicity in patients with advanced gastric cancer as a first-line treatment.

A Case of Superior Mesenteric Artery Syndrome Caused by Anorexia Nervosa / 대한소화기학회지

Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by compression of the third segment of the duodenum by the mesenteric artery at the level of the SMA, resulting in duodenal dilatation. Precipitating factors of the SMA syndrome include prolonged bed rest, weight loss, abdominal surgery, and increased lordosis of the spine. We report a case of SMA syndrome caused by anorexia nervosa in a 15-year-old adolescent girl. CT and an upper gastrointestinal contrast series revealed partial obstruction of the third portion of duodenum and decreased aortomesenteric distance. The patient's symptoms were successfully treated with total parental nutrition and psychiatric treatment including supportive, cognitive behavioral therapy and antidepressant medication. This case shows that SMA syndrome is an unusual gastrointestinal complication that may occur in patients with anorexia nervosa.