A Fatal Case of a Large Abdominal Wall Muscle Hematoma Secondary to Low-Molecular-Weight Heparin Injections / 대한구급학회지

The use of low-molecular-weight heparin (LMWH) can lead to major life threatening complications, including hematomas. Abdominal wall muscle hematomas are rarely fatal, and encompass a wide spectrum of severity depending on size, etiology, and associated complications; but because of their rarity may be misdiagnosed clinically. We report a fatal case of an 80-year-old female who received LMWH after an episode of pulmonary thromboembolism and was subsequently diagnosed with a large right abdominal wall hematoma complicated with hypovolemic shock and acute kidney injury.

The Trend of First-Line and Second-Line Eradication Rates for Helicobacter pylori Infection in a Single Institute in Seoul / 이화의대지

OBJECTIVES: To investigate the rate of first-line eradication and the rate of second-line eradication of Helicobacter pylori (H. pylori) from 2001 to 2010 in a single institute in Seoul. METHODS: Among the 2,717 patients who received H. pylori eradication treatment from 2001 to 2010 at Ewha Womans University Mokdong Hospital, the medical records of 1,466 patients who satisfied the condition of execution of upper gastrointestinal endoscopy, positive H. pylori eradication results at 6~8 weeks after eradication therapy were reviewed retrospectively. Then the first-line and second-line eradication rates and the eradication rates according to endoscopy findings were also compared. RESULTS: The first-line eradication rate was 77% H. pylori eradication rate for the last 5 years was continuously increasing and no sign of decline was observed even for the whole 10 years. The rates of eradication related to endoscopic findings showed statistical significance (P<0.001) of 79.8% and 70.1% each for peptic ulcer and non-ulcerative gastric diseases, respectively. CONCLUSION: In this study, no decrease in tendency of first-line eradication rate could be found. In addition, the patients with the non-ulcerative gastric disease seemed to show significantly lower eradication rate. This finding suggests eradication treatment may be affected by the category of gastric diseases, and careful considerations should be taken assessing the effects and needs for the H. pylori eradication treatment.

Toxic Megacolon Associated with Secondary Amyloidosis: An Unusual Complication of Clostridium difficile Colitis / 이화의대지

Amyloidosis is characterized by extracellular deposition of protein fibrils in one or multiple organs. AA amyloidosis is secondarily occurred to be related with chronic infections or inflammatory diseases. We report a 67-year-old man suffered from secondary AA amyloidosis related with chronic Clostridium difficile colitis after repeated total hip replacement surgery. Infection control is the most important treatment of AA amyloidosis secondary to chronic infection. However, the patient's C. difficile colitis was not controlled well, eventually toxic megacolon with sepsis was developed. Consequently, he had to take total colectomy, but he expired with multi-organ failures. We suggested that early surgical procedure might be one option for intractable C. difficile colitis complicated with secondary amyloidosis.

A Case of Endoscopic Closure to Postoperative Leak after Laparoscopic Sleeve Gastrectomy in Patient with Morbid Obesity / 이화의대지

Laparoscopic sleeve gastrectomy can reduce morbidity and mortality in patients with morbid obesity, but it can cause complications such as a gastrointestinal leak. A 30-year-old morbidly obese female who had type 2 diabetes mellitus and hypertension with estimated body mass index of 40.2 kg/m2 was admitted. Laparoscopic sleeve gastrectomy was performed. On postoperative day 19, a leak was suspicious on physical examination and radiologic findings. Conservative management was performed, but the patient was hemodynamically unstable and imminently septic. After laparoscopic drainage procedure, esophagogastroduodenoscopy was performed and revealed the fistula opening at staple line just below gastroesophageal junction. Fibrin tissue adhesive was injected around the fistula and the esophageal covered stent was inserted to cover the leak. At 14th days after stent insertion, the barium study confirmed no more leak. In this case, we experienced that the esophageal stent insertion with fibrin tissue adhesive injection may reduce recovery time of the fistula developed after laparoscopic sleeve gastrectomy.

Antiphospholipid Syndrome Presenting Variceal Bleeding in Patient with Systemic Anaerobic Bacterial Infection / 이화의대지

Antiphospholipid antibody syndrome (APS) is characterized by raised levels of antiphospholipid antibodies (aPL), in association with thrombosis, recurrent fetal loss, and thrombocytopenia. Development of APS is related with idiopathic origin, autoimmune disease, malignancy and, on rare occasions, infection. However, in secondary APS combined with bacterial infections, aPL is usually shown with low titer and rarely associated with thrombotic events. A 52-year-old male was admitted due to pneumonia and multiple hepatosplenic abscesses. He had been treated with proper antibiotics, but he presented ascites and sudden variceal bleeding because of portal vein thrombosis. The bleeding was controlled by endoscopic variceal ligation. Acute portal vein thrombosis was successfully managed by low molecular weight heparin and hepatosplenic abscesses were completely resolved by antibiotics. This case suggests that systemic bacterial infection in immunocompetent patients possibly develops into secondary APS.

Observation of trabecular changes of the mandible after orthognathic surgery using fractal analysis

OBJECTIVES: This study sought to evaluate trabecular changes in the mandible using fractal analysis and to explain the transient osteopenia related to rapid orthodontic tooth movement after orthognathic surgery. MATERIALS AND METHODS: Panoramic radiographs were taken of 26 patients who underwent bilateral sagittal split ramus osteotomy. Radiographs taken before the surgery and 1 month after surgery were overlapped, and 40x40 pixel square regions of interest were selected near the mandibular canines and 1st molars. After the image processing procedure, the fractal dimension was calculated using the box-counting method. RESULTS: Fractal dimension after orthognathic surgery decreased in a statistically significant manner (P<0.05). The change in fractal dimension on the canine side had greater statistical significance as compared to that seen on the 1st molar side. CONCLUSION: This study found that bone density decreases after orthognathic surgery due to transient osteopenia related to the regional acceleratory phenomenon. This result can provide a guide to evaluating orthodontic tooth movement after orthognathic surgery.