Predictors for the need for endoscopic therapy in patients with presumed acute upper gastrointestinal bleeding

BACKGROUND/AIMS@#Selecting patients with an urgent need for endoscopic hemostasis is difficult based only on simple parameters of presumed acute upper gastrointestinal bleeding. This study assessed easily applicable factors to predict cases in need of urgent endoscopic hemostasis due to acute upper gastrointestinal bleeding.@*METHODS@#The consecutively included patients were divided into the endoscopic hemostasis and nonendoscopic hemostasis groups. We reviewed the enrolled patients’ medical records and analyzed various variables and parameters for acute upper gastrointestinal bleeding outcomes such as demographic factors, comorbidities, symptoms, signs, laboratory findings, rebleeding rate, and mortality to evaluate simple predictive factors for endoscopic treatment.@*RESULTS@#A total of 613 patients were analyzed, including 329 patients in the endoscopic hemostasis and 284 patients in the non-endoscopic hemostasis groups. In the multivariate analysis, a bloody nasogastric lavage (adjusted odds ratio [AOR], 6.786; 95% confidence interval [CI], 3.990 to 11.543; p < 0.0001) and a hemoglobin level less than 8.6 g/dL (AOR, 1.768; 95% CI, 1.028 to 3.039; p = 0.039) were independent predictors for endoscopic hemostasis. Significant differences in the morbidity rates of endoscopic hemostasis were detected between the group with no predictive factors and the group with one or more predictive factors (OR, 2.677; 95% CI, 1.920 to 3.733; p < 0.0001).@*CONCLUSIONS@#A bloody nasogastric lavage and hemoglobin < 8.6 g/dL were independent predictors of endoscopic hemostasis in patients with acute upper gastrointestinal bleeding.

Healthcare-associated Endocarditis by PVL-negative ST 72 SCCmec Type IV MRSA / 대한내과학회지

The prevalence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has been increasing worldwide. In Korea, the most common genotype of CA-MRSA is the Panton-Valentine leukocidin-negative, sequence type 72 Staphylococcal cassette chromosome (SCC) mec type IV clone. However, within Korean hospitals, this strain is still not commonly reported. In this study, we describe a case of infective endocarditis caused by Panton-Valentine leukocidin-negative MRSA (ST72-SCCmec type IV A clone). Infection occurred after open reduction and internal fixation due to a right humerus fracture with cerebral hemorrhage. Initially, the patient was treated with linezolid, but with the onset of severe thrombocytopenia, the patient was switched to vancomycin therapy.

Systemic Lupus Erythematosus Presenting with Idiopathic Retroperitoneal Fibrosis / 대한내과학회지

Retroperitoneal fibrosis (RPF) is a rare inflammatory fibrotic condition affecting the peri-aortic retroperitoneum in which fibrosis of the surrounding tissue can encase the ureters, resulting in obstructive uropathy. RPF is generally idiopathic in nature, but may also arise in response to other conditions, such as malignancies, infections, surgery, radiotherapy, or drugs. Idiopathic RPF is commonly seen in association with various autoimmune diseases, such as autoimmune thyroiditis, autoimmune pancreatitis, rheumatoid arthritis, and systemic lupus erythematosus (SLE). Here, we describe the first case of RPF in Korea. A 44-year-old man with SLE presenting with pain in both flanks due to RPF is discussed, along with a review of the relevant literature.

Resolution of Type 2 Diabetes Mellitus Following Interferon-alpha Therapy for Chronic Hepatitis C / 임상당뇨병

Hepatitis C virus (HCV) mainly affects the liver, but several tissues outside the liver have also been reported to be involved. It has been hypothesized that diabetes could be one of these extrahepatic conditions attributable to HCV infection. The specific mechanisms by which HCV leads to type 2 diabetes are not fully understood, but it seems that an increase in insulin resistance associated with both steatosis and overproduction of proinflammatory cytokines could play a crucial role. We report a patient whose type 2 diabetes that was resolved following interferon-alpha (IFN-alpha) therapy for HCV. A 57-year-old man presented with fatigue, polyuria, and polydipsia. He was newly diagnosed as type 2 diabetes and chronic hepatitis C. He was started on subcutaneous insulin and IFN-alpha. After 24 weeks of treatment with IFN-alpha, the results of HCV polymerase chain reaction were negative, and his diabetes had resolved. Our case shows a resolution of diabetes after IFN-alpha therapy for chronic hepatitis C. Although it is unclear whether the resolution of diabetes in this case occurred as an effect of IFN-alpha or as a result of becoming HCV RNA-negative, our finding suggest roles of IFN-alpha and HCV infection in the pathogenesis of diabetes.

Myocardial Ischemia by Aggravation of Myocardial Bridging

Myocardial bridging (MB) occurs when the myocardium covers a segment of a major epicardial coronary artery, resulting in a tunneled arterial segment. Although MB is generally considered benign, it has been associated with myocardial ischemia. A 70-year-old man with MB (50% luminal narrowing during systole) at the mid-left anterior descending artery (LAD) on previous coronary angiography (CAG) visited our hospital with worsening chest pain. His blood pressure (BP) was not well controlled because of poor compliance. Follow-up CAG showed that MB at the mid-LAD progressed to severe stenosis (>90% luminal narrowing during systole) and the total length of tunneled artery extended from 22.5 to 23.9 mm. His chest pain was relieved by BP control. This is the first report of myocardial ischemia secondary to progression of MB demonstrated by CAG in Korea.

Intramural Hematoma with Air Density on Computed Tomography after Percutaneous Kyphoplasty

Iatrogenic aortic dissection occurs in association with diverse invasive procedures. It occurs primarily as a complication of cardiac surgery or after catheterization procedure. We found a case of iatrogenic abdominal aortic dissection caused by traumatic needle injury. The patient complained of abdominal pain after balloon kyphoplasty. Abdominal computed tomography (CT) showed intramural hematoma with air density suggestive of an iatrogenic cause. The patient was managed conservatively, and no lesion progression was noted in the follow-up CT. To the best of our knowledge, this is the first case of iatrogenic aortic dissection associated with kyphoplasty.

A Case of Acute Cholecystitis Caused by Plasmodium vivax Infection / 대한췌담도학회지

Acute cholecystitis as a complication of malarial disease is a rare condition, especially with Plasmodium vivax infection. A 62 year-old-female was admitted via emergency room (ER) due to high fever (40.3degrees C) and epigastric pain. Initial abdominal ultrasound and computed tomography (CT) scan showed edematous gallbladder with stone, which suggested acute calculous cholecystitis. Emergency percutaneous transhepatic gallbladder drainage (PTGBD) was done with systemic antibiotic therapy. The clinical course, however, unusually worsened with hypotension and intensive care unit (ICU) management was done. Four days after admission multi-focal splenic infarction was developed and Plasmodium vivax infection was diagnosed afterward. The clinical symptoms and laboratory results, including fever and epigastric pain, improved dramatically after anti-malarial treatment and cholecystectomy was done. The resected gallbladder (GB) specimen shows vasculitis pattern with capillary red blood cell (RBC) engorgement, which suggests the cause of cholecystitis was due to Plasmodium vivax rather than GB stone.