Pathophysiology-based Interpretation of Magnetic Resonance Imaging and Management of Cerebral Fat Embolism: Case Report and Review of Literature

Cerebral fat embolism (CFE) is a rare, albeit potentially lethal complication of long-bone fractures. All trauma patients who are initially lucid and subsequently experience mental status deterioration should undergo immediate evaluation of possible CFE. In the present case, magnetic resonance imaging (MRI) was the most sensitive technique for the diagnosis of CFE, particularly the use of diffusion-weighted images (DWI). The authors present this case to report a pathophysiology-based interpretation of the MR characteristics and treatment of CFE.

Pathophysiology-based Interpretation of Magnetic Resonance Imaging and Management of Cerebral Fat Embolism: Case Report and Review of Literature

Cerebral fat embolism (CFE) is a rare, albeit potentially lethal complication of long-bone fractures. All trauma patients who are initially lucid and subsequently experience mental status deterioration should undergo immediate evaluation of possible CFE. In the present case, magnetic resonance imaging (MRI) was the most sensitive technique for the diagnosis of CFE, particularly the use of diffusion-weighted images (DWI). The authors present this case to report a pathophysiology-based interpretation of the MR characteristics and treatment of CFE.

Endoscopic Removal of Fish Bones Impacted in the Rectosigmid Colon / 대한소화기내시경학회지

Impaction of an ingested foreign body in the colon is uncommon but surgical or endoscopic intervention is occasionally needed when serious complications such as perforation, obstruction or hemorrhage occur. Several factors may predispose a patient to ingestion and subsequent impaction of lower intestinal foreign body. It is more common in the elderly who wear dentures, in the mentally infirm, in chronic alcoholics or rapid eating. The majority of impaction occurs at narrowing and angulation such as ileocecal valve or rectosigmoid junction. The diagnosis of lower intestinal foreign body should be considered, among more common conditions, in the differential diagnosis of elderly patients who present with altered bowel habits. We report the case with a literature review that successfully endoscopically removed the fish bones impacted in the rectosigmoid colon complicated by rectal bleeding.

The Role of Helicobacter pylori and NSAID in Patients with Benign Gastric Ulcer / 대한내과학회지

OBJECTIVES: H. pylori infection and NSAID are very important risk factors for peptic ulcer. This study was conducted to investigate the H. pylori positivity rate and the rate of NSAID ingestion in the patients with benign gastric ulcer(BGU), to investigate which test and which site are the most adequate to reduce the false positivity rate of H. pylori, and finally to investigate the role of H. pylori and NSAID in BGU bleeding. METHODS: This study was conducted for the 180 patients with BGU, and H. pylori was diagnosed by any of CLO test, Gram stain of touch print and H&E stain in the antrum and body. In addition, age, sex, ingestion history of NSAID within 4 weeks before gastroscopy, past BGU history, smoking, alcohol and BGU bleeding were investigated. RESULTS: 1) The H. pylori infection rate of patients with BGU in Korea was 82.8%, and the rate of NSAID history was 26.1%. The patients with BGU who have only NSAID history were 8.3%, and the 91.1% of the patients had either H. pylori infection or NSAID history. 2) The most sensitive test for H. pylori infection among CLO test, Gram stain of touch print and H&E stain in the antrum or body was CLO test in the body. 3) Depending on H. pylori positivity, the rate of NSAID history in the H. pylori negative group was 48.4%, which was higher than that of H. pylori positive, 21.5%(p=0.002). In addition, the rate of past BGU history in the H. pylori positive group was 47.0%, which was higher than that of H. pylori negative, 12.9%(p<0.001). 4) Depending on the history of NSAID, the H. pylori positivity rate in NSAID positive group was 68.1%, which was lower than that of NSAID negative, 88.0%(p=0.002). The female percentage of NSAID positive was 40.4%, which was higher than that of NSAID negative, 16.5% (p<0.001). The rate of BGU bleeding in the NSAID positive was 27.7%, which was higher than that of NSAID negative, 14.3%(p=0.039). 5) The rate of NSAID history of bleeding group was 40.6%, which was higher than that of non-bleeding group, 23.0%(p=0.039). However, there was no signifi cance in the correlation of H. pylori positivity rate to the bleeding. 6) The H. pylori positivity and NSAID history showed no correlation with bleeding in the group below age sixty. While in the age over or equal to sixty the H. pylori positivity had no correlation with bleeding, but the rate of NSAID history was 72.7% for the patients with bleeding, which is in contrast with the 25.5% for the patients without bleeding(p=0.003). CONCLUSION: From these results, the H. pylori infection rate of the patients with BGU in Korea was 82.8%, and the best method for H. pylori detection was CLO test in the body. H. pylori infection had no corre lation with the bleeding, but NSAID ingestion increased bleeding tendency, particularly in the group of the age over or equal to sixty.

A Case of Tsutsugamushi Disease Presented with Granulomatous Pleural Effusion / 감염

Tsutsugamushi disease is one of the acute febrile diseases caused by Orientia tsutsugamushi that is transmitted to human by the bite of larval-stage trombiculid mite (chigger). The clinical illness is characterized by abrupt onset of fever, headache, rashes, myalgia and eschar. Chest radiologic findings show reticulonodular infiltration, cardiomegaly, lymphadenopathy and in a minority, pleural effusion. About pleural effusion, it is supposed to be caused by tsutsugamushi disease itself in most cases and no case has been reported that the pleural effusion confirmed by pleural biopsy and revealed granulomatous lesions. We experienced a case of tsutsugamushi disease with pleural effusion which was also confirmed to granulomatous lesion by pleural biopsy. So we report this case with a brief review of literatures.

A Case of Toxic Epidermal Necrolysis Concomittantly Presented with GI Bleeding and Its Gastrofiberscopic Findings / 대한소화기내시경학회지

Toxic epidermal necrolysis (T~EN) is a severe mucocutaneous disease characterized by epidermal necrosis possibly extended to the entire body surface and involving multiple internal organs. Digestive tract may be involved too, but there is few report about gastrointestinal lesion in patient with TEN. Recently we experienced a case of TEN with gastrointestinal bleeding in previously healthy 32-year-old woman. The condition developed three days after the initiation of treatment with NSAID and progressed caudally, involving 60 percent of the skin surfaces. During a period of admission gastrointestinal bleeding was noticed. The gastrofiberscopy showed diffuse superficial mucosal lesion with oozing from swollen friable and erythematous mucosa. The skin lesion was progressed inspite of withdrawal of causative agents. The patient was expired due to combined septic shock 10 days later. We report this case with gastrofiberscopic findings and a brief review of literature.