A Case of Cytomegalovirus Gastric Ulcer Mimicking Gastric Cancer in an Immunocompetent Host / 대한소화기내시경학회지

A 27-year-old woman presented with epigastric pain. Abdominal computed tomography revealed an irregular ulcer with circumferential thickening of the gastric antral wall. An endoscopy suggested advanced gastric cancer or gastric lymphoma. Biopsy of the lesion showed an inclusion body of the cytomegalovirus and positive immunohistochemical staining of the infected cell for cytomegalovirus. A thorough evaluation of her immune system revealed no abnormality. General supportive treatment for gastric ulcer did not relieve her symptoms. Intravenous infusion of ganciclovir improved her symptoms and healed the ulcer. We report a case of cytomegalovirus-associated gastric ulcer mimicking malignancy in an immunocompetent woman.

Clinical usefulness of Clinical Pulmonary Infection Score of ICU Patients with Sputum Culture positive for Multi-drug resistant Acinetobacter baumannii / 결핵

BACKGROUND: The hospital-acquired pneumonia is the most common nosocomial infection. Recently, the Acinetobacter baummannii infections are rapidly increasing, especially the frequency of Multi-drug resistant A. baumannii. Therefore we assessed clinical features and prognosis of patients in the ICU with Multi-drug resistant A. baumannii from the sputum culture using the Clinical Pulmonary Infection Score(CPIS). METHODS: The medical records of 43 patients with Multi-drug resistant A. baumannii from sputum culture who were suspected had clinically pneumonia and admitted to the ICU from January 2000 to July 2002 were retrospectively analyzed. RESULT: 19 patients were CPIS greater than 6 and 24 patients were CPIS less than or equal to 6. Mean age for the former was 71+/-11 years old, and the latter was 61+/-19 years old. The mean APACHE II score on admission and on sputum study was not different between two groups(17.4+/-5.7 vs 18.5+/-6.1, p=0.553, 20+/-6 vs 17+/-8, p=0.078). But the mortality rate was 73.7% for the former, and 16.7% for the latter(p<0.001). CONCLUSION: In ICU patients who had clinically suspected pneumonia with sputum culture positive for Multi-drug resistant A. baumannii, the mortality was significantly higher if CPIS was greater than 6.

A Case of Aortic Dissection with Compromised Superior Mesenteric Artery Treated with Stents Insertion at Origin of the Artery

The treatment of a thoracic aortic dissection is guided by prognostic and anatomical information. Stanford type A aortic dissection requires surgery, but the appropriate treatment of a Stanford type B aortic dissection has not been determined, especially in patients with visceral artery compromise associated with the aortic dissection due to the failure of surgery to improve the prognosis.We report a case of a 35-year-old man, with a Stanford type B aortic dissection, where the superior mesenteric artery was obstructed. This condition was successfully treated with stents inserted at the origin of the artery.

Helical CT Angiography of the Whole Aorta and Iliac Arteries by Injection of Split Bolus Contrast Media: Comparison with single Bolus Injection Technique

PURPOSE: To compare the efficacy of the split-bolus contrast media injection technique in helical CTangiography(CTA) of the whole aorta and iliac arteries with that of the single-bolus technique. MATERIALS AND METHODS: Using the split bolus technique in 23 patients, 90 ml of contrast medium (Ultravist 300) was injected ata rate of 3ml/sec;this was followed by an 8-sec pause and the subsequent injection of 30ml. Using the single bolustechnique in another 23 patients, 120ml of contrast medium was injected for 40sec. continuously. CT angiography ofthe thoracic aorta (slice thickness/pitch=3mm/2:1) was performed, first followed by an interscan delay of 8sec,and the abdominal aorta and iliac arteries were then scanned(slice thickness/pitch=3mm/2:1 or 5mm/1.5:1). In allpatients, CT density was measured in the aortic lumen at eight levels, from the origin of the aorta to the iliacbifurcation. RESULTS: Using the split bolus technique, visual assessment revealed second density peak in theaortic lumen of the upper abdomen in 15 of 23 patients(65%), while the use of the single bolus technique revealedno second density peak in any patient. CT density in the aortic lumen at the level of the esophagogastricjunction, and at all levels below this except the abdominal aortic bifurcation, was significantly higher using thesplit bolus technique than with the single bolus technique (t-test, p<0.05). CONCLUSION: For CTA of the wholeaorta and iliac arteries, the split bolus technique is more effective than the single bolus technique.