Endoscopic treatment of gastrointestinal carcinoid tumors / 대한내과학회지

BACKGROUND: The treatment of choice of gastrointestinal carcinoid tumors has been thought to be radical excision. However, surgical treatment has been substituted by endoscopic treatment in cases of small gastrointestinal carcinoid tumors. We evaluated the effectiveness of endoscopic treatment for gastrointestinal carcinoid tumors. METHODS: We reviewed the medical records and endoscopic findings of 50 cases of gastrointestinal carcinoid tumors diagnosed in St. Mary's Hospital, Holy Family Hospital, and Uijeongbu St. Mary's Hospital, all affiliated organizations of the Catholic University Medical Center of Korea, from January 2001 to December 2006. RESULTS: The mean age of the patients was 52.6+/-13.6 years-old. The mean tumor size was 10.1+/-5.6 mm. Thirty-eight cases were treated by endoscopy (mean tumor size: 8.6+/-4.5 mm), eleven cases were treated by surgery (mean tumor size: 13.5+/-6.1 mm), and one case with multiple metastases was untreatable by either endoscopy or surgery. Twenty five cases of endoscopic therapy were treated by endoscopic mucosal resection or endoscopic submucosal dissection. Thirteen cases were resected by use of a conventional polypectomy. Two cases of the conventional polypectomy were resected incompletely, and were treated with an additional endoscopy. No cases of endoscopic treatment have recurred during the follow-up period. CONCLUSIONS: Recently, the incidence of carcinoid tumors is on the increase in the gastrointestinal tract, as determined by performing frequent endoscopic examinations in Korea. If the gastrointestinal carcinoid tumor is limited to the submucosal layer, endoscopic treatment could be sufficient as the primary treatment in selected patients with a tumor diameter of 10 mm or less in the duodenum and 15 mm or less in the stomach and rectum.

A Case of Nonsurgical Treatment in Boerhaave's Syndorme during Diagnostic Endoscopy / 대한소화기내시경학회지

Boerhaave's syndrome is a rare spontaneous rupture of the esophagus that requires an immediate diagnosis and surgical repair. It might result from a severe and uncoordinated contraction of the esophagus and stomach. The rate of mortality and morbidity can increase with increasing time between the onset and treatment. In recent years, there have been some reports of non-surgical treatment in cases with perforation but with minimal symptoms and clinical evidence of the systemic effects such as sepsis. We experienced a case of Boerhaave's syndrome occurring during an endoscopic examination that was treated successfully using non-surgical measures.

Salmonella osteomyelitis with osteonecrosis in a patient with systemic lupus erythematosus / 대한내과학회지

Although infectious diseases are frequent in systemic lupus erythematosus, salmonella osteomyelitis is rarely reported. We here report an unusual case of salmonella osteomyelitis with osteonecrosis in a patient with systemic lupus erythematosus. A 29-year old woman with systemic lupus erythematosus was admitted to our hospital because of a painful swelling of right knee joint. She had been taking steroid and cyclophosphamide for 4 months because of diffuse membranous proliferative lupus nephritis. MRI showed both osteonecrosis of the right distal femur and osteomyelitis of the right proximal tibia. The abscess culture demonstrated almonella species (non typhoidal). The infection was treated successfully by a combination of surgical drainage and intravenous ceftriaxone.

A case of acute interstitial nephritis associated with cimetidine therapy / 대한내과학회지

Although cimetidine causes a transient rise in serum creatinine without reduction of renal function, acute renal failure due to acute interstitial nephritis is rare in patients after cimetidine treatment. We here present a case of acute renal failure and acute interstitial nephritis that occurred during cimetidine treatment. A 38-year old woman was referred to our hospital because of nausea and general weakness. She had been taking cimetidine for 3 weeks because of epigasric discomfort. On admission, serum creatinine was 3.9 mg/dL and urinalysis showed mild proteinuria and hematuria. There was no history of pyelonephritis, diabetes mellitus, hypertension, toxin exposure. Renal biopsy showed severe interstitial infiltration of lymphocytes without definite glomerular change. After withdrawal of cimetidine, renal function completely recovered.

A case of acute interstitial nephritis associated with cimetidine therapy / 대한내과학회지

Although cimetidine causes a transient rise in serum creatinine without reduction of renal function, acute renal failure due to acute interstitial nephritis is rare in patients after cimetidine treatment. We here present a case of acute renal failure and acute interstitial nephritis that occurred during cimetidine treatment. A 38-year old woman was referred to our hospital because of nausea and general weakness. She had been taking cimetidine for 3 weeks because of epigasric discomfort. On admission, serum creatinine was 3.9 mg/dL and urinalysis showed mild proteinuria and hematuria. There was no history of pyelonephritis, diabetes mellitus, hypertension, toxin exposure. Renal biopsy showed severe interstitial infiltration of lymphocytes without definite glomerular change. After withdrawal of cimetidine, renal function completely recovered.

A Case of Spontaneous Bacterial Peritonitis as the Presenting Feature in a Patient with Nephrotic Syndrome / 대한신장학회잡지

Although spontaneous bacterial peritonitis is a frequent complication in the childhood nephrotic syndrome, it is very rare in adults with nephrotic syndrome. It frequently develops when the patients are either in relapse or receiving steroid therapy at the time peritonitis is diagnosed. We report an unusual case of a spontaneous bacterial peritonitis as the presenting feature in a 15-year-old male patient with nephrotic syndrome. He presented with diffuse abdominal pain and distension for 15 days. Abdominal paracentesis revealed the diagnostic laboratory findings of peritonitis, and the bacterial culture of the ascites showed a mixed growth of Escherichia coli and Pseudomonas aeruzinosa. His serum albu- min level was 1.6gldL and the amount of 24 hours proteinuria was 21.0g/day. Although he was treated with adequate antibiotics for 3 weeks, the peritonitis was more aggravated. We decided to insert a catheter into the peritoneal cavity for continuous drainage of the intractable ascites. Two weeks after drainage, the peritonitis improved as the peritonitis subsided, the proteinuria disappeared completely without a steroid therapy. Six months after spontaneous remission, the proteinuria have recurred, and the kidney biopsy then showed focal segmental glomerulorsclerosis.