A Case of Rectal Dieulafoy's Lesion Treated by Endoscopic Band Ligation / 대한소화기내시경학회지

Dieulafoy's lesion is a relatively uncommon disease which is minor cause of massive acute lower gastrointestinal bleeding. The lesion comprises mainly of an abnormally exposed submucosal artery associated with a minute mucosal defect on the top in the stomach, and it is a rare cause of profuse but intermittent gastrointestinal bleeding. Less commonly, similar lesions have also been identified in the duodenum, jejunum, colon, and in rare cases, the rectum. In this report, 70 year-old man is described, who has an massive hematochezia from a small rectal mucosal defect with an exposed vessel. Control of the bleeding was successfully achieved with endoscopic band ligation. The fact that rectal Dieulafoy's disease is rare but one of the causes of massive hematochezia should serve as a reminder in the future cases in the elderly.

Three Cases of Gastrointestinal Carcinoid Tumors / 대한소화기내시경학회지

Carcinoid tumors arise from enterochromaffin cells that are located predominantly in the gastrointestinal mucosa. Gastrointestinal carcinoids appear with equal frequency among men and women, most often during the fifth and sixth decades. A primary duodenal carcinoid is rare. Most carcinoid tumors of the appendix are incidentally discovered during other surgical procedures. Its natural course is usually benign and the size of the tumor is closely related with the liability of regional or distant metastasis. The vast majority of rectal carcinoid tumors are benign and can be safely treated by a local excision. Lesions larger than 2 cm that invade the muscular wall of the rectum should be considered as malignant and treated by a more radical procedure such as an abdominoperineal resection. Three cases are here in reported of gastrointestinal carcinoid tumors that were treated at presbyterian medical center.

A case of acute coma & respiratory arrest in Wernicke's encephalopathy caused by malnutrition / 대한내과학회지

We shoud give attention to Wernicke's encephalopathy as a cause of sudden coma & respiratory arrest in patients, who are not usually suspected to develop the disorder and empirical treatment with thiamine in cases of coma of unknown cause is recommended. Respiratory stimulants, doxapram & aminophylline have an effect in assisting ventilatory weaning in patient with central hypoventilation as a complication of acute Wernicke's encephalopathy No previous reports where doxapram had been used to assist weaning from mechanical ventilation in adults were noted. Nor has newly developed central hypoventilation been identified as an impediment to weaning in literature to date in Korea. We reported a rare case of Wernicke's encephalopathy caused by poor oral intake & inadequate nutritional suppliment after car accident, showing acute coma & respiratory arrest and treated adequately by thiamine replacement & mechanical ventilation with respiratory stimulant.

A Case of Isolated ACTH Deficiency Manifestated by Atrial Fibrillation and Hypoglycemia / 대한내분비학회지

Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency caused by the defect of synthesis or release of ACTH in pituitary gland. The clinical presentation can be simiilar to that of primary adrenal insufficiency, but there is a greater tendency for hypoglycemia and absence of hyperpigmentation. The patient, 80 year-old female, was admitted in chief complaint of deteriorated mental states. On admission, serum sodium was 127mEq/L, potassium 4.4mEq/L, blood glucose 27mg/dL and on routine E.C.G. was atrial fibrillation was revealed. The basal morning serum cortisol level was 9.97 pg/dL it dosent respond to insulin-induced hypoglycemia enoughly, but other pituitary functions were intact in pituitary cocktail stimulation test. In CRH stimulation test, there was no remarkable response in serum ACTH and cortisol level. Brain MRI failed to reveal any anatomic abnormalities of the sellar or suprasellar area consistent with the defect of pituitary ACTH secretion. This case was a isolated ACTH deficiency, So, we conclude that associated with atrail fibrillation and hypoglycemia.