ABSTRACT
Capsule endoscopy is being increasingly recognized as a gold standard for diagnosing small bowel disease, but along with the increased usage, capsule retention is being reported more frequently. We report a case of capsule endoscopy retention in a diverticulum of the duodenal proximal third portion, which we treated by esophagogastroduodenoscopy. A 69-year-old male visited hospital with hematochezia. He had hypertension and dyslipidemia for several years, and was taking aspirin to prevent heart disease. CT and colonoscopy revealed a diverticulum in the third portion of the duodenum, rectal polyps, and internal hemorrhoids. Capsule endoscopy was performed but capsule impaction occurred. The capsule was later detected by CT in the diverticulum. Endoscopy was performed a day later and the capsule was removed using a net. A small bowel series was conducted after capsule removal, and no stenosis was found. The patient fully recovered and no recurrence of hematochezia was observed at his one month exam. This is the first case in Korea of capsule retention in a duodenal diverticulum, with successful removal by endoscopy.
Subject(s)
Aged , Humans , Male , Abdomen/diagnostic imaging , Capsule Endoscopy , Diverticulum/diagnosis , Endoscopy, Digestive System , Tomography, X-Ray ComputedABSTRACT
We report herein a case of hepatoid adenocarcinoma of the stomach with liver metastasis. Gastric carcinoma generally presents as adenocarcinoma and rarely shows a hepatoid pattern, which can produce alpha-fetoprotein (AFP). The stomach is one of the common sites at which hepatoid adenocarcinoma has been detected. A 75-year-old female patient was admitted to the hospital with a symptom of epigastric discomfort. Gastrofibroscopy revealed a large tumor occupying the greater curvature of the stomach body. The level of serum AFP was markedly increased. Abdominal computed tomography revealed multiple liver masses. Biopsy samples of the gastric lesion and liver masses finally confirmed her case as hepatoid adenocarcinoma in the stomach with liver metastasis. The AFP-producing gastric carcinoma needs special attention because it often presents with early liver metastasis and has a poor prognosis.
Subject(s)
Aged , Female , Humans , Adenocarcinoma/diagnosis , Gastroscopy , Liver Neoplasms/diagnosis , Lymphatic Metastasis , Stomach Neoplasms/diagnosis , Tomography, X-Ray Computed , alpha-Fetoproteins/metabolismABSTRACT
Intussusception most commonly occurs in children, and in more than 90% of cases, no cause is found. In contrast, intussusception in adults is relatively rare but over 90% of patients have an organic lesion as the cause. Only 5% of cases of intussusception occur in adults and most involve the small intestine and are benign, whereas colonic intussusceptions are usually malignant. We report here a case of a 70-year-old man with intussusception who was referred with a one-day history of hematochezia and abdominal pain. The intussusception was caused by a sigmoid colonic tumor. The CT findings suggested that we could reasonably proceed to a sigmoidoscopy to confirm the site of obstruction. We speculated that the sigmoid colon tumor induced the anterograde intussusception. As with our patient, it is important to recognize the need to diagnose the primary lesion exactly and promptly.
Subject(s)
Adult , Aged , Child , Humans , Abdominal Pain , Colon , Colon, Sigmoid , Gastrointestinal Hemorrhage , Intestine, Small , Intussusception , Sigmoidoscopes , SigmoidoscopyABSTRACT
Bezoars are persistent concretions of indigestible material that are usually found in the stomach. With the significant development of endoscopic techniques, many authors have reported the removal of bezoars using methods such as endoscopic forceps, snares, electrohydraulic lithotripsy, laser. However, there are no reports of using argon plasma to remove a bezoar in Korea. Argon plasma coagulation is a non-contact electrosurgical technique, which is an inexpensive, easily learned, and effective method in gastrointestinal endoscopy. In addition, this method is associated with a decreased risk of perforation and tissue damage by maintaining a controllable depth of coagulation. We report a 71-year-old man with a 11x11x8 cm sized huge gastric phytobezoar found by endoscopy. The bezoar was broken into pieces using the argon plasma coagulator. Endoscopic forceps and a basket were then used to crush and extract its fragments. The bezoar was removed safely without any complications. We report this case with a review of the relevant literature.
Subject(s)
Aged , Humans , Argon Plasma Coagulation , Argon , Bezoars , Endoscopes , Endoscopy , Endoscopy, Gastrointestinal , Korea , Lithotripsy, Laser , Plasma , SNARE Proteins , Stomach , Surgical InstrumentsABSTRACT
Approximately 100 drugs have been reported to affect the lungs adversely. Among these, pulmonary toxicity caused by antieneoplastic agent is being recognized more frequently. Cyclophosphamide is an immunosuppressive alkylating agent used for the treatment of a wide variety of malignant and nonmalignant diseases. The incidence of pulmonary toxicity is probably less than 1 percent The first case was reported in 1967. Since then, more than 20 well-documented cases of pulmonary toxicity associated with cyclophosphamide have been reported in the literature. In Korea, three patients were identified with cyclophosphamide-induced lung disease. The typical features of toxicity include dyspnea, fever, cough, new parenchymal infiltrates, gas exchangs abnormalities on pulmonary function tests, and pleural thickening on chest roentgenogram. The best approach to management is early diagnosis, discontinuation of the offending drug and administration of corticosteroid therapy. Recently, we experienced a case of diffuse alveolar damage induced by cyclophosphamide. The patient presented with early-onset pulmonary toxicity and died of repiratory failure despite early use of corticosteroid.
Subject(s)
Humans , Cough , Cyclophosphamide , Dyspnea , Early Diagnosis , Fever , Incidence , Korea , Lung , Lung Diseases , Respiratory Function Tests , ThoraxABSTRACT
We encountered a case of renal hypouricemia and absorptive hypercalciuria. Although renal hypouricemia is asymptomatic as usual, it is rarely complicated with acute renal failure and urolithiasis. A 43-year-old man had hypouricemia (serum uric acid, 0.6-1.0mg/dl) with an increased renal uric acid clearance (69.4ml/min), hypercalciuria (367.2mg/day). In present case, there was no response of uric acid excretion to either pyrazinamide or probenecid and hypercalciuria disappeared after calcium restriction diet. These results suggest that the present case had the defect of both pre-and postsecretory reabsorption of uric acid and absorptive hypercalciuria.
Subject(s)
Adult , Humans , Acute Kidney Injury , Calcium , Diet , Hypercalciuria , Probenecid , Pyrazinamide , Uric Acid , UrolithiasisABSTRACT
The immunosuppressive agent, cyclosporine (CSA), has improved the success rate of organ transplantation due to its effectiveness in treating graft versus host diseases. However, as its use has increased, so has the variety of toxicities associated with it, including in the kidney, liver, and central nervous system. The spectrum of neurotoxcity ranges from mild tremor and blurred vision to seizures, ataxia, mental status changes, peripheral neuropathy, and paraparesis. Cortical blindness, an extremely rare form of CSA neurotoxicity, has previously been described in only 15 patients after a bone marrow transplant (BMT). We have experienced a rare case of CSA induced cortical blindness in a 15 year-old girl receiving a bone marrow transplantation for aplastic anemia. Tests showed a high cyclosporine level, a low serum magnesium level, and a low cholesterol. In a brain MRI, we found a diffuse high signal intensity in the parieto-occipital lobe on T2-weighted images. In an awake EEG, there were diffuse slowing waves. A visual evoked potential, performed at the time of initial evaluation, when patient was cortical blind, showed no wave formation in the left occipital recording. After discontinuation of CSA, there was significant improvement of cortical blindness, much improvement in the brain MRI, the brain EEG, and the visual evoked potential.
Subject(s)
Adolescent , Female , Humans , Anemia, Aplastic , Ataxia , Blindness, Cortical , Bone Marrow , Bone Marrow Transplantation , Brain , Central Nervous System , Cholesterol , Cyclosporine , Electroencephalography , Evoked Potentials, Visual , Kidney , Liver , Magnesium , Magnetic Resonance Imaging , Organ Transplantation , Paraparesis , Peripheral Nervous System Diseases , Seizures , Transplants , TremorABSTRACT
Intravascular lymphomatosis(IVL) which was first described by pfleger and Tappeiner in 1959 is rare malignancy characterized by neoplastic proliferation of lymphoid cell lineage within the vascular lumen with little or no adjacent parenchymal involvement. Its usual sites of involvement are central nervous system and skin or infrequently heart, lungs, pancreas, liver, spleen, kidney, adrenal glands, genitourinary tract, and bone marrow. Pulmonary involvement of IVL is not common. Symptoms of pulmonary involvement include dyspnea, cough and fever. Radiologicially, the disease is manifested with diffuse interstitial infiltrates. We report a recently experienced case of pulmonary intravascular lymphomatosis which was manifested with fever and chest pain.