A Case of Malabsorption Induced by Blind Loop Syndrome in a Patient with Liver Cirrhosis / 대한내과학회지

Of the various causes of malabsorption, to our knowledge, blind loop syndrome has been reported in Korea only rarely. Here, we report the case of a 63-year-old woman with hepatitis C virus-associated liver cirrhosis. The patient complained of abdominal distension and had an abnormal serum biochemistry caused by blind loop syndrome related to childhood abdominal surgery. Her laboratory findings showed an iron deficiency anemia, hypocholesterolemia, hypoproteinemia and hypoalbuminemia, and were confounded with those of liver cirrhosis. She underwent resection of the blind loop segment of the small intestine, after which her abdominal symptoms and abnormal laboratory findings improved, although they did not completely normalize due to her liver cirrhosis.

Development of ocular myasthenia during pegylated interferon and ribavirin treatment for chronic hepatitis C / 대한간학회지

A 63-year-old male experienced sudden diplopia after 9 weeks of administration of pegylated interferon (IFN) alpha-2b and ribavirin for chronic hepatitis C (CHC). Ophthalmologic examinations showed ptosis on the right upper lid and restricted right eye movement without any other neurological signs. A brain imaging study and repetitive nerve stimulation test indicated no abnormality. The acetylcholine receptor antibody titer and response to acetylcholinesterase inhibitors were negative, and the results of thyroid function tests were normal. The patient's ophthalmological symptoms improved rapidly 3 weeks after discontinuation of pegylated IFN alpha-2b and ribavirin. The ocular myasthenia associated with combination therapy of pegylated IFN alpha-2b and ribavirin for CHC is very rarely reported; therefore, we present this case with a review of the various eye complications of IFN therapy.

Clinical characteristics and the risk factors for rebleeding in patients with bleeding peptic ulcer / 대한내과학회지

BACKGROUND/AIMS: Bleeding is a serious complication of peptic ulcer. Although endoscopic therapy is effective for achieving hemostasis of active bleeding, rebleeding occurs in 10~30% of these patients. Recently, treatment with proton pump inhibitor (PPI) after hemostasis has decreased the rate of rebleeding. In this study, we analyzed risk factors of peptic ulcer rebleeding and we evaluated whether the rebleeding rate could be different depending on the PPI treatment method. METHODS: From March 2003 through February 2006, 639 patients visited the emergency room (ER) due to gastrointestinal hemorrhage. Among them, 191 patients were diagnosed to have peptic ulcer by endoscopy, and they were retrospectively analyzed for their clinical, laboratory and endoscopic findings. The PPI treatment method was categorized into the IV bolus group, the 8 mg/hr continuous infusion group and the others group. RESULTS: Emergency endoscopy was performed within 24 hours in 86.9% of the patients with bleeding peptic ulcer. Rebleeding occurred in 9 cases (4.7%) within 7 days after hemostasis. On the basis of univariate analysis, shock on ER arrival (p=0.013) and over 5 units of packed red cells (PRCs) transfusion (p=0.016) were significant risk factors for rebleeding, yet the PPI treatment method did not affect the rate of rebleeding. CONCLUSIONS: The rebleeding rate of peptic ulcer in our study was 4.7%, and this was lower than the previous reports, and the rebleeding rate in our report may have been caused by the early hemostatic therapy together with intravenous infusion of PPI. These approaches are necessary as soon as the patients are stabilized, and especially for the group of patients who are at a high risk for rebleeding, such as those who experience shock at the ER and those who need over 5 units of PRC transfusion.

Recent Etiology and Clinical Features of Acute Viral Hepatitis in a Single Center of Korea / 대한간학회지

BACKGROUND AND AIMS: The etiology of acute viral hepatitis in Korea has been dynamically changing during the recent years. The aim of this study was to investigate the recent etiology and the clinical features of acute viral hepatitis in a single center of Korea. METHODS: We performed a retrospective analysis of a prospective cohort of 55 patients who were diagnosed with acute viral hepatitis A to E during the period from May 2005 to August 2006. In addition to the clinically acute manifestations, the confirmatory serological tests were performed for the diagnosis of acute hepatitis A, B, C and E. RESULTS: The proportion of patients with acute viral hepatitis A, B, C, E and others were 56.4% (n=31), 12.7% (n=7), 18.2% (n=10), 9.1% (n=5) and 3.6% (n=2), respectively. The mean age of the patients with acute hepatitis A, B, C and E were 29.1+/-4.38, 38.7+/-11.72, 45.3+/-17.62 and 32.4+/-6.58 years, respectively. There was no fatal case. All cases of acute hepatitis B and six out of ten cases of acute hepatitis C recovered spontaneously. Four out of the five patients with acute hepatitis E had no history of travel to endemic area. CONCLUSIONS: The most common etiology of acute viral hepatitis in Korea is hepatitis A virus, and hepatitis C and B virus were the next most common causes. The sporadic cases of acute hepatitis E were not rare, and coinfection of HAV and HEV was observed. A multicenter, prospective study is warranted in the future.

A case of Burkholderia cepacia peritonitis in a patient on CAPD / 대한내과학회지

Burkholderia cepacia is an important opportunistic pathogen in immunocompromised and nosocomial patients, but this bacterial infection is rare in Korea. We report a case of Burkholderia cepacia peritonitis in a patient on CAPD. A 69-year-old male on CAPD for 5 years was presented with turbid peritoneal dialysate, diffuse abdominal pain and diarrhea. He was treated initially with intraperitoneal cefazolin and ceftazidime, and then intraperitoneal meropenem and oral TMP/SMX. His symptoms had improved with antibiotic treatment, but white blood cell counts of dialysate increased, instead. Burkholderia cepacia was isoloated from peritoneal fluid culture. The patient refused catheter removal in spite of our recommendation. He died of suddenly developed acute myocardial infarction and upper gastrointestinal bleeding. Catether tip culture also revealed Burkholderia cepacia.

A Case of Intramural Duodenal Hematoma Presenting with Acute Duodenal Obstruction

Intramural duodenal hematoma (IDH) is a quite rare disese entity which results from the collection of blood and body fluid between mucosa and serosa. Various degrees of duodenal obstruction may be caused by IDH as it gradually enlarges and compresses the mucosa against the opposite side of duodenum. The most common cause of IDH is blunt abdominal trauma and the spontaneous IDHs are generally casused by coagulation disorder such as blood dyscrasia, anticoagulation treatment or pancreaticoduodenal aneurysm. The diagnosis is usually made by the typical imaging on abdominal computed tomographic scan with a previous history of blunt abdominal trauma. For spontaneous IDH without coagulation disorder, an abdominal angiogram may be considered to exclude vascular anomalies. Medical treatment is recommended unless the associated visceral injuries require immediate laparotomy. Here, we report a case of acute duodenal obstruction due to IDH which had resolved completely without an operative management.

A case of secondary amyloidosis presenting acute renal failure in rheumatoid arthritis patient / 대한내과학회지

Amyloidosis is a heterogenous group of often fatal disorders characterized by extracellular deposition of a proteinaceous material with a unique fibrillar form in various tissues and organs. Deposition of amyloid may cause widespread dysfunction of the involved organs. A secondary amyloidosis is AA amyloidosis and rheumatoid arthritis is one of the main underlying disease. We report a case of secondary amyloidosis in a 52 year old woman with rheumatoid arthritis. She had suffered from rheumatoid arthritis for 17 years and her hands and feet were deformed. She was presented with oliguric acute renal failure. She was confirmed by showing apple green birefringence under the polarized microscope with Congo-red stain through renal and rectal biopsy. We couldn't find any previous report of the secondary amyloidosis among the patients presenting oliguric acute renal failure without proteinuria in the Korean literatures.