A Case of Bleeding Duodenal Varices in a Patient with Idiopathic Portal Hypertension / 대한소화기내시경학회지

Bleeding duodenal varices are a rare complication in patients with portal hypertension. Cirrhosis followed by portal vein obstruction and splenic vein obstruction are the most common causes. Although the prognosis of bleeding duodenal varices is usually poor, an awareness of its characteristic presentation may enable diagnostic and therapeutic proce- dures to be performed rapidly with an increased likelihood of a reaching successful out- come. In this study, we report a case of bleeding duodenal varices in a 23-year-old woman with idiopathic portal hypertension who was also suffering with recurrent melena. Panendoscopy identified prominant tortuous varices with central erosion in the 3rd portion of the duodenum and no esophageal and gastric varices. The varices were successfully treated by distal splenorenal shunt.

Two Cases of Pancreatic Pseudocyst Treated with Endoscopic Cystogastrostomy throughout Stent and ENPD Catheter / 대한소화기내시경학회지

Pancreatic pseudocysts were complicated in 10-27% of acute pancreatitis and 11-41% of chronic pancreatitis. Asymptomatic pseudocysts require no treatment, but symptomatic pseudocysts should be decompressed. Surgical management had been the traditional approach to treating pancreatic pseudocysts. Endoscopic transpapillary or transduodenal cystoenterostomy were recently suggested as an alternative to surgery in order to avoid surgical complications. The success rates of endoscopic treatment was 65-94%, procedure related morbidity was 6-21% and mortality was 0-5%. We reported two cases of patients with pancreatic pseudocysts which were treated with endoscopic cystogastrostomy and proceeded to drain through stent and ENPD catheter.

Analysis of Hypokalemia in Emergency Patients / 대한신장학회잡지

OBJECTIVES: Hypokalemia is one of the most common electrolyte disorders encountered in clinical medicine. It is important electrolyte disorder because it is account for neuromuscular, cardiovascular and renal disturbance. But there are few studies to evaluate the incidence and cause of hypokalemia in emergency patients. Present study was performed to evaluate the incidence and cause of hypokalemia and coincidental changes of other electrolyte and chemical parameters of blood and urine. METHODS: Hypokalemia was defined as a serum potassium concentration less than 3.5mEq/L. A total 80 medical patient without renal failure were prospectively studied for 62 days. Electrolytes and chemical parameters of the blood and urine were determined at emergency room. RESULTS: 1) Of medical inpatients through emergency room, hypokalemia was detected in high frequency(32%) and mild degree(mean; 3.1+/-0.1mEq/L). 2) The most common cause of hypokalemia was diuretics(23%), other causes were vomiting, SIADH, diarrhea, alkalemia, and unidentified cause(each; 15.4%). 3) Compared to the normokalemic group, the hypokalemic group showed significant decrease in urinary anion gap(P=0.003). 4) There was no significant difference of spot urine potassium concentrations between renal and extrarenal origin of hypokalemia. CONCLUSION: The hypokalemia in emergency patients was detected in high frequency and mild degree. Urine anion gap was significantly decreased in hypokalemic group than normokalemic group. Spot urine potassium concentration was less effective in differentiation of renal and extrarenal origin of hypokalemia.

A Case of Recovery from Suspended Animation caused by Puffer fish Poisoning: a case report

Tetrodotoxin is a neurotoxin produced by about 90 species of puffer fish and causes paralysis of central nervous system and peripheral nerves by blocking the movement of all monovalent cations. Ingestion of tetrodotoxin produces clinical manifestations such as paresthesias(within 10-45 min), vomiting, lightheadedness, salivation, muscle twitching, dysphagia, difficulty in speaking, convulsion and death that expressed by cardiopulmonary arrest with loss of brain stem reflex sometimes. Tetrodotoxin prevents or delays ischemia induced neuronal death by way of following 3 mechanisms. Firstly, it reduces the energy demand of the brain tissues. Secondly, it delays or even prevents anoxic depolarization. Finally, it diminishes ischemia induced cell swelling and cerebral edema. We report a case of puffer fish poisoning which presented with cardiopulmonary arrest and loss of brain stem reflex, but completely recovered by aggressive cardiopulmonary resuscitation.

Initial Transient Neurologic Recovery Followed by Delayed Deterioration of Osmotic Demyelination Syndrome: A Case Report / 대한신장학회잡지

In literatures, most of the studies of severe hyponatremia during or following its treatment has been concentrated with special references to the rate of correction and its neurologic outcomes. But, there is relatively few ones analyzing the diverse clinical manifestations of neurologic symptorns or complications during the course of treating severe hyponatremia. We experienced a catastrophic course related to hyponatremia in a 51 year woman with severe rheumatoid arthritis, who underwent knee joint replacement, and this case revealed the initial transient neurologic recovery for 3 days by the initial rapid correction of hyponatremia, then followed by delayed deterioration of osmotic demyelination syndrome leading to locked-in syndrome. Reported cases with similar clinical course (biphasic course) in the world lituratures were reviewed with special interests in the initial maximum rate of correction of hyponatremia and radiologic findings. This review suggests that clinicians treating the patients with severe symptomatic hyponatremia should be aware of the possibility of delayed neurologic sequelae despite the recovery of neurologic status as well as the degree of hyponatremia in the early treatment course of hyponatremia.