A Case of Sarcoidosis Combined with Massive Ascites

Sarcoidosis is a multi-systemic granulomatous disease of unknown cause, which most commonly involves lung, skin, eye, liver and lymph nodes. Herein, we report a case of sarcoidosis presented with massive ascites. A 47-year-old male patient visited our hospital with symptoms of general weakness and weight loss from past 4 months. Abdomen computed tomography showed multiple lymphadenopathy and hepatosplenomegaly. Lymph node biopsy demonstrated non-caseating granulomas. After biopsy, development of massive uncontrolled ascites was noted. Liver biopsy showed non-cirrhotic hepatic and portal fibrosis and omental biopsy showed submesothelial diffuse fibrosis and focal chronic inflammation, which were suggestive of hepatic and peritoneal involvement in sarcoidosis. Ascites was controlled after subsequent treatment with corticosteroids and methotrexate.

Comparison of Somatostatin and Vasopressin in the Control of Acute Esophageal Variceal Hemorrhage: A Prospective Randomized Trial / 대한간학회지

BACKGROUND/AIMS: Although endoscopic band ligation or injection sclerotherapy are the current standard therapies for bleeding esophageal varices, the best method for initial control is unclear. The aim of this prospective study was to compare the efficacy and toxicity of somatostatin and vasopressin in the management of esophageal variceal hemorrhage. METHODS: From March, 1997 to September, 1998, 28 consecutive cirrhotic patients admitted to the Yonsei Medical Center because of active variceal bleeding were included in this trial. The patients were randomized to receive either somatostatin (15 patients) or vasopressin (13 patients) for 48 hours. RESULTS: There were no significant differences between the two treatment groups in relation to Child's classification, amount of bleeding before randomization and units of blood transfused during therapy. Initial control of bleeding was achieved in 13 (86.7%) patients receiving somatostatin and in 10 (76.9%) of those treated with vasopressin. However, two patients in the somatostatin group and two in the vasopressin group bled again during treatment. Therefore complete control of bleeding during the 48 hours of therapy was achieved in 11 (73.4%) patients treated with somatostatin and in eight (61.5%) of those receiving vasopressin. Differences were observed in complications associated with each therapy. Vasopressin produced complications in four patients (chest pain in two, hypertension in one and hyponatremia-induced seizure in one) while somatostatin produced minor complication in one patient. CONCLUSIONS: This study suggests that somatostatin is efficacious in controlling acute hemorrhage from esophageal varices and has a lower risk of adverse effects than vasopressin.

A Case of Behcet's Disease Involving Stomach and Entire Small Intestine Tereminal Ileum Perforation / 대한소화기내시경학회지

Behcet's syndrome is a multisystemic, chronic inflammatory disease with triad of oral ulcer, genital ulcer and inflammatory ocular lesion. Intestinal Behcet's disease accounts for 1-2% of Behc'ets disease and most commonly affects the ileocecal region as ulcerations. A 70-year-old male patient was admitted to this hospital because of melena for 5 days. There was a history of recurrent aphthous stomatitis and genital ulcer. Colonoscopy showed multiple, irregularly, rnarginated, ellipsoid ulcers surrounded by hyperemic mucosa with vessel exposure on terminal ileum. Esophagogastroduodenoscopy showed multiple, round punched out ulcers on antrum and duodenal bulb. He was taken the near total small bowel resection, right hemicolectomy and ileotransverse colostomy because of hemorrhage and terminal ileal perforation. Three days after operation, melena reappeared and esopbagogastoduodenascopy revealed bleeding from duodenal ulcers and impending perforation of antral ulcer. He was reoperated with antrectomy, truncal vagotomy and gastroduodenostomy. Resected small bowel was 510 cm in length and there were multiple small round transverse ulcers surrounded by hyperemic edematous elevated rnucosa. Three 'punch-out ulcers' were also found on resected gastric antrum. So, we report a case of gastrointestinal Behcet's disease involving stomach, duodenum, jejunum and ileum with terminal ileum perforation.