A Case of Ischemic Colitis Mimicking Malignancy / 대한소화기내시경학회지

Ischemic colitis is the most common vascular disorder of intestines, and usually affects older patients. Many predisposing conditions have been implicated in the pathogenesis of colonic ischemia, although many occurrences are spontaneous in nature. Ischemic colitis can induce a wide spectrum of radiological or endoscopic features, depending on the site, extend, and timing of its onset. The coexistence of colonic ischemia with carcinoma of large bowel is well documented. However It is less well recognized that a localized segment of ischemic colon can mimic a carcinoma. Here, we report a case of ischemic colitis mimicking colon cancer in a 66 year-old man.

The Effects of Endoscopic Sodium Alginate Powder (Alto Shooter(TM)) in Peptic Ulcer Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Peptic ulcer bleeding can be treated by endoscopic laser, argon plasma coagulation, heater probe, or electrocoagulation. However, techinical difficulties and significant rebleeding rate after such endoscopic hemostasis, offer some beneficial effect of Alto Shooter(TM) as an adjuvant therapy in active peptic ulcer bleeding. METHODS: Twenty-three patients with active peptic ulcer bleeding were randomized to Alto Shooter(TM) & argon plasma coagulation therapy (ALTO+APC) or argon plasma coagulation therapy alone (APC). Forrest classifications were used to compare the effect of bleeding control. RESULTS: The Forrest classifications in two groups before treatment were Ib (6 patients), IIa (11 patients) in "ALTO+APC", Ib (2 patients) and IIa (4 patients) in "APC". The Forrest classifications of two groups at follow-up endoscopy were Ia (1 patient), Ib (1 patient), IIc (14 patients), III (1 patient) in "ALTO+APC" and IIc (6 patients) in "APC". There was no significant difference in hemostatic effect between "ALTO+APC" (p=0.001) and "APC" (p=0.001) groups. CONCLUSIONS: Alto Shooter(TM) offers no advantage over conventional endoscopic argon plasma coagulation therapy in controlling active peptic ulcer bleeding. Therefore routine addition of Alto ShooterTM treatment may not be recommended after initial successful endoscopic argon plasma coagulation therapy in active peptic ulcer bleeding.

A case of early gastric cancer with IgA nephropathy and minimal change nephrotic syndrome / 대한내과학회지

The nephrotic syndrome has been reported in association with a wide variety of neoplastic disease. The relationship between early gastric cancer and glomerulonephritis has not been well elucidated. Only 6 cases (5 cases in Korea and 1 case in Japan) have been reported associated with glomerulonephritis by this time. 5 cases in Korea included three cases of membranous glomerulonephritis, one case of IgA nephropathy and membranoproliferative glomerulonephritis. Four out of six cases including presented case were mucin secreting adenocarcinomas of stomach. Minimal change disease associated with solid tumors has been reported very rarely. Three cases of colon adenocarcinoma have been reported in association with minimal change disease by this time. Complete remission of nephrotic syndrome with tumor resection without corticosteroid therapy was reported in one of three cases, but two of them had to be on corticosteroid therapy in addition to tumor resection to get complete remissions. We report a 44-year-old man case with nephrotic syndrome associated with early gastric cancer. Renal biopsy findings were indicative of minimal change disease but with scanty IgA deposition. Low grade IgA nephropathy was suggested. Endoscopic biopsy on stomach demonstrated the adenocarcinoma with signet ring cells. Serum IgA concentration was 543 mg/dL, and decreased to 336 mg/dL after tumor resection. But, owing to persistent proteinuria and acute renal failure complicated, corticosteroid therapy was applied on the 30th day after operation. So we could not prove definite relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease. But, it is regarded that normalized serum IgAlevel and the complete remission of nephrotic syndrome with tumor resection and corticosteroid therapy can be indirect evidences for the relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease.

Fluoxetine-induced Acute Toxic Hepatitis / 대한간학회지

Fluoxetine (Prozac ) is a antidepressant that inhibits the reuptake of serotonin in central nervous system, and has lesser adverse effects than the tricyclic antidepressants. The adverse effects of this drug are various, and the most common side effects are headache and nausea. The hepatic injury caused by fluoxetine is reported but very rare and not well known. Literature review has shown only 3 cases of hepatotoxicity from fluoxetine. We regard our case as the first of the hepatotoxicity from fluoxetine in Korea. The patient that we experienced showed normal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values before fluoxetine administration. 15 days after she took fluoxetine, AST and ALT values were increased and gradually increased as she took fluoxetine daily. We studied about viral hepatitis, metabolic liver disease, and autoimmune liver disease, but the cause of hepatic injury was not established. After the patient stopped to take fluoxetine, AST and ALT values decreased. A liver biopsy showed a moderate infiltration within the portal tracts with lymphocytes and ballooning degeneration of hepatocytes. We concluded fluoxetine-induced acute toxic hepatitis had occured. We must keep in mind that fluoxetine may cause hepatitis without cholestasis and suggest taking liver function tests regularly.

A Case of Trichinosis caused by eating a wild badger / 대한내과학회지

Trichinosis is a worldwide parasitic infection developed after the ingestion of uncooked meat containing viable larvae of the nematode Trichinella spiralis. Fever, myalgia, periorbital edema and eosinophilia are characteristic features and most infections are mild and asymptomatic, but a few cases have a severe clinical course due to cardiac or cerebral complications. This parasitic infection is spread in nature among a large number of carnivorous animals, human being an incidental host. While the highest prevalence is in North America and Europe, some outbreaks of trichinosis have been reported in the areas of Southeast Asia, China and Japan recently, but it has not been reported in Korea yet. We experienced a case of trichinosis with typical clinical features and laboratory findings of trichinosis after eating a raw liver and blood of wild badger which was poached in Chi-ri mountain.