Successful Surgical Treatment of Trombus in the Aortic Arch / 대한내과학회지

Thrombi within the aortic arch are rare, and are generally detected after cerebral, visceral, or peripheral embolization. Although the indications for treatment remain controversial, there is increasing interest in the etiopathogenesis of this rare clinical entity and the development of appropriate diagnostic and therapeutic approaches. We report a case in which a thrombus was detected in the proximal aortic arch on echocardiography and computed tomography angiography as the origin of upperextremity ischemia. This pedunculated thrombus was attached to the atherosclerotic aortic wall and was removed surgically.

Successful Surgical Treatment of Trombus in the Aortic Arch / 대한내과학회지

Thrombi within the aortic arch are rare, and are generally detected after cerebral, visceral, or peripheral embolization. Although the indications for treatment remain controversial, there is increasing interest in the etiopathogenesis of this rare clinical entity and the development of appropriate diagnostic and therapeutic approaches. We report a case in which a thrombus was detected in the proximal aortic arch on echocardiography and computed tomography angiography as the origin of upperextremity ischemia. This pedunculated thrombus was attached to the atherosclerotic aortic wall and was removed surgically.

Efficacy of Ecabet Sodium for Helicobacter pylori Eradication, Combined with Lansoprazole-Based Triple Regimen: A Prospective Study / 대한내과학회지

BACKGROUND/AIMS: Ecabet sodium is used for treating gastric ulcers and gastritis. It exhibits a bactericidal effect against Helicobacter pylori by inhibiting bacterial urease activity. Thus, ecabet sodium has been suggested to improve the efficacy of the H. pylori eradication in patients with peptic ulcers. The aim of this study was to compare the H. pylori eradication rate of lansoprazole-based triple therapy versus lansoprazole-based triple therapy plus ecabet sodium. METHODS: The subjects consisted of 363 H. pylori-positive patients who had undergone eradication therapy from February 2007 to February 2010. In total, 363 patients with H. pylori-positive peptic ulcer disease or symptomatic erosive gastritis received LAC (lansprazole 30 mg b.i.d., amoxicillin 1.0 g b.i.d., clarithromycin 500 mg b.i.d.) or LACE (lansoprazole 30 mg b.i.d., amoxicillin 1.0 g b.i.d., clarithromycin 500 mg b.i.d., ecabet sodium 1 g b.i.d.) for 1 week. Successful eradication was defined as a negative 13Curea breath test 4-5 weeks after treatment completion. RESULTS: H. pylori eradication rates were 81.4% (166/204) in the LAC group and 86.2% (137/159) in the LACE group (p = 0.159). No significant difference in eradication was observed. No significant difference was observed in the side effects experienced by the patients in the two treatment groups. CONCLUSIONS: Our results suggest that adding ecabet sodium did not improve the H. pylori eradication rate significantly in standard lansoprazole-based triple therapy for H. pylori.

A Case of Paradoxical Renal Embolism through Patent Foramen Ovale / 대한신장학회지

Paradoxical embolism is a kind of stroke caused by embolism of thrombus of venous origin through a lateral opening in the heart, such as a patent foramen ovale (PFO). Although the most frequent manifestation of paradoxical embolism is cryptogenic stroke, noncerebral paradoxical embolism is also associated with PFO. We experienced a case of cryptogenic renal infarction in a previously healthy 70-year-old man. He had no cardiac thrombus on transthoracic echocardiography and electrocardiogram revealed a normal sinus rhythm. Because it was cryptogenic renal infarction, we performed transesophageal echocardiography with microbubble test. Microbubble test using agitated saline proved the presence of right-to-left shunt and patent foramen ovale was diagnosed. We also performed lower leg doppler ultrasonogram, but there was no evidence of deep vein thrombosis. Although only the presence of a right-to-left shunt is not enough to establish the diagnosis of paradoxical embolism, it is uncommon for the source of the embolism to be identified. In this case, we concluded that paradoxical embolism is the cause of renal embolism. We report paradoxical renal embolism through PFO with review of relevant literatures.

A Case of Guillain-Barre Syndrome Following Plasmodium vivax infection

A 28-year-old male was admitted to our medical center with general myalgia and fever. After a series of tests, he was diagnosed with P. vivax malaria. On the 5th hospital day, the patient complained of tingling sensation on both hands and feet, which acutely progressed to ascending symmetric motor paralysis. Nerve conduction velocity test and cerebrospinal fluid analysis showed albumino-cytologic dissociation, suggesting polyradiculopathy, and thus he was diagnosed with Guillain-Barre syndrome. After 5-day treatment with intravenous immunoglobulin, and antificial ventilator therapy the patient fully recovered. In the literature, only 22 cases of Guillain-Barre syndrome associated with Plasmodium have been reported; 19 cases were caused by Plasmodium falciparum and 3 were by P. vivax. Herein, we report the first case of Guillain-Barre Syndrome associated with P. vivax malaria in Korea.

A Case of Pyelonephritis Accompanied by Enterococcus hirae Bacteremia

Enterococcus hirae infection is rare in humans. We describe a case of pyelonephritis that was caused by Enterococcus hirae in a 57-year-old woman. E. hirae was isolated from both blood and urine. This is the 2nd case report on bacteremia caused by E. hirae in Korea.

A Case of Pyelonephritis Accompanied by Enterococcus hirae Bacteremia

Enterococcus hirae infection is rare in humans. We describe a case of pyelonephritis that was caused by Enterococcus hirae in a 57-year-old woman. E. hirae was isolated from both blood and urine. This is the 2nd case report on bacteremia caused by E. hirae in Korea.