Submucosal Tunneling Endoscopic Resection of a Leiomyoma Originating from the Muscularis Propria of the Gastric Cardia (with Video) / 대한소화기학회지

While endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal tumors, it is rarely used for subepithelial tumors (SETs) originating from the muscularis propria of the esophagus and gastric cardia because of the risk of perforation and problems with inadequate space and field of view during procedures. Submucosal tunneling endoscopic resection (STER) is a new therapeutic method for treating SETs in specific locations in the esophagus and stomach. This technique is highly skill-dependent, using a mucosal flap that covers a deeper part of the gut wall, but is safe and minimally invasive compared with conventional endoscopic approaches such as ESD in SETs originating from the muscularis propria.We report a patient who underwent STER to remove a SET located at the gastric cardia. The patient recovered without any complications. We believe that our case shows the efficacy and safety of the STER technique for patients with a SET originating from the muscularis propria.

Clinical Outcomes of the Endoscopic Treatments for the Early Esophageal Carcinoma and Dysplasia

BACKGROUND/AIMS: Esophageal cancer and dysplasia are relatively rare in Korea, compared to other Far Eastern countries. So, the feasibility and safety of endoscopic treatments for these diseases is not well established in Korea. This study aimed to assess the technical feasibility, safety and the clinical outcomes of endoscopic treatment for esophageal epithelial lesions. MATERIALS AND METHODS: Between April 2005 and March 2013, 25 esophageal epithelial lesions from 22 patients were treated with endoscopic treatment such as endoscopic submucosal dissection or endoscopic mucosal resection. RESULTS: Of the 25 lesions, 11 lesions were treated with endoscopic submucosal dissection (ESD) (ESD group) and 14 lesions with endoscopic mucosal resection (EMR group). In the ESD group, the diagnosis was squamous cell carcinoma in 7 patients (64%), high grade dysplasia in 3 patients (27%), and low grade dysplasia in 1 patient (9%). In the EMR group, thediagnosis was squamous cell carcinoma in 8 patients (57%), high grade dysplasia in 2 patients (14%), and low grade dysplasia in 4 patients (29%). En bloc resection rates were 100% in ESD and 42.9% in EMR, respectively. For the median 12 months follow up period, there was no recurrence in the ESD group. However, there were three recurrences in the EMR group. CONCLUSIONS: Endoscopic treatment for esophageal epithelial lesions is safe and feasible therapeutic modalities. Especially, ESD can provide higher rate of en bloc and curative resection for early esophageal cancer and dysplasia.

Intramural Hematoma of the Esophagus after Endoscopic Pinch Biopsy

Intramural hematoma of the esophagus (IHE) is an uncommon form of esophageal injury, which may be an intermediate of mucosal tear (Mallory-Weiss syndrome) or transmural rupture (Boerhaave's syndrome). To date, the pathogenesis of IHE has not been well documented. IHE may occur within the submucosal layer of the esophagus following dissection of the mucosa. The most commonly presented symptoms are sudden retrosternal pain, dysphagia and hematemesis. The disorder can occur spontaneously or secondarily to trauma. In this report, we present a case of IHE which occurred after endoscopic biopsy and was recovered following conservative management in a patient who was taking long-term aspirin medication.

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.

Two Cases of Spontaneous Pneumomediastinum Complicating Viral Pneumonia Caused by Influenza A Virus, (H1N1 Subtype): A Case Report / 대한구급학회지

Influenza A virus, (H1N1 Subtype), was identified as the cause of outbreaks of febrile respiratory infection in Mexico, the US, Canada and elsewhere during the spring of 2009. In Korea, a novel virus infection showing many variable complications was also pandemic. We report two cases of spontaneous pneumomediastinum, complicating viral pneumonia, caused by Influenza A virus, (H1N1 Subtype).

A case report of concurrent leptospirosis and salmonellosis infection / 대한내과학회지

A 37-year-old male patient presented with a fever, chills, and abdominal pain. The patient was diagnosed with Typhoid fever based on blood culture, but did not clinically respond to standard antibiotic (Ceftriaxone) therapy. On day 9, leptospira serology was positive and doxycycline was added to the treatment strategy. With combination therapy, the patient recovered from the infection. In most cases, similar clinical presentations make the diagnosis of concurrent infections of febrile diseases difficult, and serious complications can develop as a consequence of delayed treatment. As with this case, if the patient initially has serious a medical condition caused by complications, and does not clinically respond to initial standard antibiotics therapy or has an unusual course of disease, concurrent infection must be considered.