Predictors of Rebleeding after Hemoclip Therapy for Treating High-risk Bleeding Ulcers: Hemoclip Therapy Alone was Comparable to Combination Treatment with Epinephrine Injection / 대한소화기내시경학회지

BACKGROUND/AIMS: Active bleeding and non-bleeding visible vessels in patients with bleeding peptic ulcer are associated with a high risk of rebleeding. The aim of our study was to define the risk factors associated with failure of endoscopic hemostasis and rebleeding in patients with active peptic ulcer bleeding. METHODS: We retrospectively reviewed 119 patients (90 men and 29 women; mean age, 60.14+/-14.67 years) with active peptic ulcer bleeding (spurting, oozing and/or non-bleeding visible vessel) and who were treated in Wonkwang Medical Center from January 2002 to January 2007. They were classified to endoscopic hemoclipping alone group (n=75) or endoscopic hemoclipping combined with epinephrine injection group (n=44), according to the therapeutic modality. RESULTS: Initial hemostasis was achieved in the two groups (100%), and permanent hemostasis was achieved 71.4% in all the patients. Operation was done in eight patients (6.7%), and six patients (5%) in the two groups, respectively, died within 1 month after initial hemostasis because of bleeding related complications. Recurrent bleeding, the duration of the hospital stay, blood transfusion requirements, complications and the operation and mortality rates were not statistically different between the hemoclip alone and combination groups. Univariate analysis showed that rebleeding was related to the presence of shock on admission (p=0.01), complication (p=0.00), the pulse rate (<100/min) on admission (p=0.04), single ulcer (p=0.032), the level of hemoglobin (<8 g/dL) (p=0.02) and the volume of transfusion (<3 units) after the procedure (p=0.005) in all the patients. On the multivariate analysis that was adjusted for age and gender, the hemoglobin level (<8 g/dL) (odds ratio = 10.5) was the only significant predictor for early rebleeding. CONCLUSIONS: This result may suggest that the combination method does not provide a substantial advantage over hemoclipping alone for the hemostatic management of active peptic ulcers bleeding. A low hemoglobin level on admission may be useful to predict rebleeding after initial endoscopic hemostasis in patients with active peptic ulcer. However, this study was designed retrospectively, so the comparison between these two groups should be re-evaluated prospectively in a large, multicenter trial.

A Case of Transverse Colon Perforation after Colonoscopy in a Patient withEnterocolitis Caused by Non-typhoidal Group D Salmonella / 대한소화기내시경학회지

Clinical manifestations of Salmonella infection are variable such as enterocolitis, bacteremia, enteric fever, focal infection and asymptomatic carrier status. Among these presentations, enterocolitis is the most common clinical manifestation and can be diagnosed by the use of fecal specimens. Patients with severe infectious colitis are at increased risk of developing a colon perforation after colonoscopy due to colon trauma. We report a case of a 31-year-old woman with transverse colon perforation after colonoscopy that was diagnosed with enterocolitis caused by infection with non-typhoidal group D Salmonella.

Comparison of pyogenic liver abscesses based on the origin of infection / 대한내과학회지

BACKGROUND/AIMS: The aim of this study was to evaluate the clinical features, radiologic findings, treatment modalities, and outcomes based on the origin of infection in patients with pyogenic liver abscesses. METHODS: We retrospectively analysed the medical records of 118 patients who were treated for pyogenic liver abscesses between January 2004 and December 2006. Of the 118 patients, 56 patients had biliary risk factors. RESULTS: The clinical characteristics were similar between the two groups, but the biliary risk group was characterized by an older age and the presence of jaundice. The size of the abscess was smaller in the group with biliary risk factors than in the cryptogenic group (p=0.02). Klebsiella pneumonia was the most common organism overall; however, Escherichia coli was more prevalent in the biliary risk group than in the cryptogenic group (p=0.03). Comparing the treatment modalities between the two groups, antibiotic therapy alone was more frequently used in the biliary group (p<0.01). The death rate was higher in the biliary group than in the non-biliary group (7.1 vs. 0.0%, p=0.04). The higher death rate in the biliary group was associated with multi-organ failure, absence of biliary drainage, and underlying diseases. CONCLUSIONS: There were differences between the two groups with respect to the size of the abscess, patient age, cultured organisms, and treatment modalities. The death rate was higher in the biliary group than the cryptogenic group.

A Case of Duodenal GIST Accompanied with Neurofibromatosis-1, Presenting with Gastrointestinal Bleeding / 대한소화기내시경학회지

Gastrointestinal stroma tumors (GISTs) are CD117- positive primary mesenchymal tumors of the gastrointestinal tract and are noted to have a possible non-random association with neurofibromatosis-1 (NF-1, Von Recklinghausen disease). We report a case of a duodenal GIST presenting with gastrointestinal bleeding in a 74-year-old female, and this condition was accompanied with NF-1. A upper gastrointestinal endoscopy and abdominal computed tomography scan revealed several submucosal tumors in the duodenum, jejunum and ileum. Histological and immunohistochemical studies on the surgical resection specimen revealed gastrointestinal stromal tumors of an uncommitted type. The patient was treated with local excision of the tumors and is now in a favorable state.

A case of nickel-induced eosinophilic pneuminia / 대한내과학회지

Eosinophilic lung diseases are a heterogeneous group of disorders characterized by eosinophilic pulmonary infiltrates and, commonly peripheral blood eosinophilia. A vast number of drugs have been associated with eosinophilic pneumonia and drug reactions are one of the most commonly reported causes of pulmonary infiltrates with blood and/or alveolar eosinophilia. Nickel exposure may occur in occupations including nickel maker, nickel smelters, stainless steel makers, battery makers, electroformer, electroplater, refining operations etc, and has been associated with an increased risk of lung and nasal cancers. Nickel dust has been reported to induce eosinophilic pneumonia, infrequently. We experienced a case of nickel-induced eosinophilic pneumonia in a 55 years old male patient who has been working at a stainless press factory for 25 years until retirement at January 1998. He complained of dry cough and exertional dyspnea, and presented peripheral eosinophilia and multiple small nodular opacities on chest radiograph. Pathological examination of open lung biopsy revealed diffuse vasculitis involving variable-sized vessels with diffuse infiltration of inflammatory cells, particulary eosinophils. Nickel concentration measured from two dried lung tissue was 39.66 microgram/g and 25.14 microgram/g, respectively.