Lung Abscess During the Treatment of Relapsed Churg-Strauss Syndrome / 대한내과학회지

Churg-Strauss syndrome (CSS) is a rare disease characterized by asthma, peripheral eosinophilia and vasculitis. A quarter of CSS patients with clinical remission have experienced a relapse. We report here a case of lung abscess in a patient with relapsed CSS. A 46-year-old man who achieved clinical remission of CSS was confirmed for relapse by the presence of peripheral eosinophillia, pulmonary lesions and perivascular infiltrate of eosinophils in colon pathology. After administration of systemic glucocorticoid and one cycle of cyclophosphamide pulse therapy, he complained of dyspnea, sputum and chest pain. There were necrotic masses containing internal air-fluid levels in the right upper and the left lower lobes of the lung on chest radiography. Percutaneous needle aspiration culture specimens revealed the presence of K. pneumoniae. The patient was successfully treated with a 5-week course of antibiotics.

A Case of Gastric Calcifying Fibrous Tumor Presenting as a Subepithelial Tumor

Gastric subepithelial tumor is a common finding of upper gastric endoscopy. Differential diagnosis is needed, sometimes a rare disease can be found. Calcifying fibrous tumor is a rare benign fibrous tumor, and mostly affects children and young adults. It can involve all over the body, and shows predilection for abdominal cavity and peritoneum. Stomach lesions are quite rare. We report a case of a 43-year-old woman with a calcifying fibrous tumor presenting as gastric subepithelial tumor. Initially, a subepithelial lesion measuring 8 cm in diameter was incidentally found on her gastric endoscopy, and she had no symptoms. Computed tomography showed an exophytic mass originating from the gastric wall. Laparoscopic wedge resection was performed on the suspicion of gastrointestinal stromal tumor. Pathologically, the tumor showed hypocellular and densely hyaline collagen. Psammomatous calcifications and fibroblastic spindle cells were also found. On the basis of pathological findings, calcifying fibrous tumor was diagnosed.

A Case of Gastric Calcifying Fibrous Tumor Presenting as a Subepithelial Tumor

Gastric subepithelial tumor is a common finding of upper gastric endoscopy. Differential diagnosis is needed, sometimes a rare disease can be found. Calcifying fibrous tumor is a rare benign fibrous tumor, and mostly affects children and young adults. It can involve all over the body, and shows predilection for abdominal cavity and peritoneum. Stomach lesions are quite rare. We report a case of a 43-year-old woman with a calcifying fibrous tumor presenting as gastric subepithelial tumor. Initially, a subepithelial lesion measuring 8 cm in diameter was incidentally found on her gastric endoscopy, and she had no symptoms. Computed tomography showed an exophytic mass originating from the gastric wall. Laparoscopic wedge resection was performed on the suspicion of gastrointestinal stromal tumor. Pathologically, the tumor showed hypocellular and densely hyaline collagen. Psammomatous calcifications and fibroblastic spindle cells were also found. On the basis of pathological findings, calcifying fibrous tumor was diagnosed.

A Case of Riata(R) Dual Coil Defibrillator Lead Failure in a Patient with Ventricular Fibrillation

A 50-year-old man, who underwent a procedure for an implantable cardioverter defibrillator (ICD), visited the outpatient department of our clinic after suffering multiple ICD shocks. The ICD interrogation revealed recurrent shock due to a high frequency of noise that is sensed by the device as ventricular fibrillation. Chest radiography revealed a significant split in the insulation of the lead allowing the inner wire to protrude. We considered the removal of the failed lead, but the removal of ICD lead is potentially a high risk procedure, so we cut and capped a proximal part of the failed lead and inserted a new lead. This is the first report of a St. Jude Riata(R) dual coil defibrillator lead failure with clinical and radiologic evidence of a defect in lead insulation in Korea.

Ethanol Lavage Therapy to Prevent Recurrent Pancreatitis in a Patient with Pancreatic Mucinous Neoplasm / 대한내과학회지

An 88-year-old woman diagnosed with recurrent pancreatitis and pancreatic cyst at a local clinic was admitted for upper abdominal pain. The pain was aggravated after a meal, and the patient had lost 3 kg over the past 6 months. MRCP examination revealed a 68 mm-sized septated pancreatic cyst compressing the main pancreatic duct. EUS-FNA to differentiate the cystic component retrieved a high viscosity fluid. A diagnosis of mucin-producing pancreatic cystic neoplasm was made. The patient refused surgical treatment, and alternative treatments, including methods to decompress the pancreatic cyst, were performed. The patient was treated with aspiration of cystic fluid, observation with diet control, and 99% ethanol lavage to ablate the pancreatic cyst. The treatment of 99% ethanol lavage provided the longest symptom-free period, ranging from 7 to 18 months without complications. The authors report that repeated ethanol lavage of a pancreatic cyst causing recurrent pancreatitis can be an effective treatment option for patients who are poor surgical candidates.

Ethanol Lavage Therapy to Prevent Recurrent Pancreatitis in a Patient with Pancreatic Mucinous Neoplasm / 대한내과학회지

An 88-year-old woman diagnosed with recurrent pancreatitis and pancreatic cyst at a local clinic was admitted for upper abdominal pain. The pain was aggravated after a meal, and the patient had lost 3 kg over the past 6 months. MRCP examination revealed a 68 mm-sized septated pancreatic cyst compressing the main pancreatic duct. EUS-FNA to differentiate the cystic component retrieved a high viscosity fluid. A diagnosis of mucin-producing pancreatic cystic neoplasm was made. The patient refused surgical treatment, and alternative treatments, including methods to decompress the pancreatic cyst, were performed. The patient was treated with aspiration of cystic fluid, observation with diet control, and 99% ethanol lavage to ablate the pancreatic cyst. The treatment of 99% ethanol lavage provided the longest symptom-free period, ranging from 7 to 18 months without complications. The authors report that repeated ethanol lavage of a pancreatic cyst causing recurrent pancreatitis can be an effective treatment option for patients who are poor surgical candidates.

Is the Quality of Internet Medical Information Improving?: A Case Study on Endoscopy under Sedation

BACKGROUND/AIMS: The rate of internet utilization has been gradually increased especially due to recent introduction of mobile devices. In 2005, we evaluated the quality of medical information on the internet about endoscopy under conscious sedation. In the present study, we tried to find out whether there was a significant change in the quality of medical information between 2005 and 2012. MATERIALS AND METHODS: Using the five most frequently used internet search engines, we found top 20 internet sites with the key word 'sleeping endoscopy' and 'endoscopy under conscious sedation'. The quality of information was evaluated by the same checklist used in the previous study. RESULTS: With the key word 'sleeping endoscopy', 69 sites were found. Among them, 58 sites (84.1%) were made by general hospitals or private clinics. The definition of sleeping endoscopy was accurately mentioned in 50.7% (n=35) of the sites, whereas the rate was 57.1% in 2005. In 2012, information on sedative agents were mentioned in only 16 sites (23.2%) which was lower than 42.9% in 2005 (P<0.05). There were more information on complications of endoscopy in 2012. Using the key word 'endoscopy under conscious sedation', only 13 sites were found, and the quality of information in these sites was generally better than sites found with 'sleeping endoscopy'. CONCLUSIONS: Between 2005 and 2012, the quantity of information on endoscopy under sedation has increased. However, there were no definite improvement in the quality of information.

Is the Quality of Internet Medical Information Improving?: A Case Study on Endoscopy under Sedation

BACKGROUND/AIMS: The rate of internet utilization has been gradually increased especially due to recent introduction of mobile devices. In 2005, we evaluated the quality of medical information on the internet about endoscopy under conscious sedation. In the present study, we tried to find out whether there was a significant change in the quality of medical information between 2005 and 2012. MATERIALS AND METHODS: Using the five most frequently used internet search engines, we found top 20 internet sites with the key word 'sleeping endoscopy' and 'endoscopy under conscious sedation'. The quality of information was evaluated by the same checklist used in the previous study. RESULTS: With the key word 'sleeping endoscopy', 69 sites were found. Among them, 58 sites (84.1%) were made by general hospitals or private clinics. The definition of sleeping endoscopy was accurately mentioned in 50.7% (n=35) of the sites, whereas the rate was 57.1% in 2005. In 2012, information on sedative agents were mentioned in only 16 sites (23.2%) which was lower than 42.9% in 2005 (P<0.05). There were more information on complications of endoscopy in 2012. Using the key word 'endoscopy under conscious sedation', only 13 sites were found, and the quality of information in these sites was generally better than sites found with 'sleeping endoscopy'. CONCLUSIONS: Between 2005 and 2012, the quantity of information on endoscopy under sedation has increased. However, there were no definite improvement in the quality of information.

Clinical outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage in Korean patients with liver cirrhosis: a retrospective multicenter study

BACKGROUND/AIMS: This study evaluated the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hemorrhage from gastric varices (GV) in Korean patients with liver cirrhosis (LC). METHODS: We retrospectively analyzed data from 183 LC patients who underwent BRTO for GV bleeding in 6 university-based hospitals between January 2001 and December 2010. RESULTS: Of the 183 enrolled patients, 49 patients had Child-Pugh (CP) class A LC, 105 had CP class B, and 30 had CP class C at the time of BRTO. BRTO was successfully performed in 177 patients (96.7%). Procedure-related complications (e.g., pulmonary thromboembolism and renal infarction) occurred in eight patients (4.4%). Among 151 patients who underwent follow-up examinations of GV, 79 patients (52.3%) achieved eradication of GV, and 110 patients (72.8%) exhibited marked shrinkage of the treated GV to grade 0 or I. Meanwhile, new-appearance or aggravation of esophageal varices (EV) occurred in 54 out of 136 patients who underwent follow-up endoscopy (41.2%). During the 36.0+/-29.2 months (mean+/-SD) of follow-up, 39 patients rebled (hemorrhage from GV in 7, EV in 18, nonvariceal origin in 4, and unknown in 10 patients). The estimated 3-year rebleeding-free rate was 74.8%, and multivariate analysis showed that CP class C was associated with rebleeding (odds ratio, 2.404; 95% confidence-interval, 1.013-5.704; P=0.047). CONCLUSIONS: BRTO can be performed safely and effectively for the treatment of GV bleeding. However, aggravation of EV or bleeding from EV is not uncommon after BRTO; thus, periodic endoscopy to follow-up of EV with or without prophylactic treatment might be necessary in LC patients undergoing BRTO.