A case of a huge gastric bezoar treated with an endoscopic Coca-cola injection and an Argon plasma beam / 대한내과학회지

Bezoars are persistent concretions of indigestible materials found in the stomach. They can cause mucosal ulceration or wall perforation, gastritis, gastric outlet obstruction, or gastrointestinal bleeding. With the significant development of endoscopic techniques, many authors have reported the removal of bezoars using methods such as endoscopic mechanical lithotomy and chemical dissolution however, the outcomes differ according to the treatment method. We report a case treated successfully with an endoscopic Coca-cola injection and an argon plasma beam for 90 minutes. A 61-year-old man was admitted with a 4-day history of upper abdominal pain. A bezoar was detected by upper gastrointestinal endoscopy. The bezoar (10x8x6 cm) was dark brown in color and extremely hard. Attemptat endoscopic removal using a polypectomy snare failed. We then injected Coca-cola directly into the bezoar mass and sprayed it with an Argon plasma beam. Ninety minutes later, the bezoar was broken into pieces and removed. The bezoar was absent at the follow up endoscopy 2 weeks later.

A case report of concurrent leptospirosis and salmonellosis infection / 대한내과학회지

A 37-year-old male patient presented with a fever, chills, and abdominal pain. The patient was diagnosed with Typhoid fever based on blood culture, but did not clinically respond to standard antibiotic (Ceftriaxone) therapy. On day 9, leptospira serology was positive and doxycycline was added to the treatment strategy. With combination therapy, the patient recovered from the infection. In most cases, similar clinical presentations make the diagnosis of concurrent infections of febrile diseases difficult, and serious complications can develop as a consequence of delayed treatment. As with this case, if the patient initially has serious a medical condition caused by complications, and does not clinically respond to initial standard antibiotics therapy or has an unusual course of disease, concurrent infection must be considered.

Analysis of Urine Iodine Excretion Decrease by Two-Week Stringent Low Iodine Diet for Remnant Thyroid Ablation with Radioactive Iodine in Korean Patients with Thyroid Cancer; Prospective Study / 핵의학분자영상

A low iodine diet (LID) is the recommended preparation for radioactive iodine treatment. However, the recommended duration and stringency of LID are different among each recommendation. More stringent LID is expected in Korea because Korea is a iodine-rich region. We investigated the decrement of urine iodine excretion by two-week stringent LID for remnant thyroid ablation with radioactive iodine in Korean patients with thyroid cancer, prospectively. MATERIAL AND METHOD: From November 2006, patients who referred to our hospital for remnant ablation after total thyroidectomy were included in this study. To decrease total body iodine, our protocol included three strategies. First, we checked medication which could inhibit the radioactive iodine uptake. Second, the date of I-131 treatment was scheduled at least 3 months later if contrast agent had been used. The last strategy was two-week stringent LID education by specialized nutritionist. Before and after two-week stringent LID, 24hr-urine iodine was analyzed respectively. 24hr-urine creatinine was also analyzed for determining more valid 24hr urine sampling subgroup. RESULTS: Total 51 patients were finally enrolled. Average of 24hr-urine iodine excretion was significantly lowered (787+/-2242 -> 85+/-85 microgram/d, p=0.03) after LID and 74.4% of patients reached below the recommended urine iodine excretion level ( 99+/-116 microgram/d, p=0.05) and 78.6% of patients met the criteria. CONCLUSION: Most patients could reach below the recommended urine iodine level after two-week stringent LID. Therefore, in our opinion, at least two-week stringent LID should be recommended in Korea.