A Case of Hepatic Involvement in Hereditary Hemorrhagic Telangiectasia Presenting as High Output Heart Failure / 계명의대학술지

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is a rare autosomal dominant vascular disorder involving arteriovenous malformation. HHT is characterized by recurrent epistaxis, cutaneous telangiectasia, and visceral arteriovenous malformations. Hepatic arteriovenous malformation can lead to high output heart failure. We report a case of hereditary hemorrhagic telangiectasia patient who complained dyspnea and edema on both lower extremity.

A Case of Systemic Inflammatory Response Syndrome Secondary to an Acute Polyarticular Gout

Gout occurs as a response to monosodium urate crystal, that is present in joints, bones and soft tissue. The classic symptoms of gouty arthritis are recurrent attacks of acute, markedly painful monoarticular or oligoarticular inflammation; but polyarthritis and chronic arthritis can also occur. Differential diagnosis from infectious arthritis is important. A definitive diagnosis requires the direct identification of urate crystals in the joint, and the exclusion of infection. We report the case of systemic inflammatory response syndrome (SIRS), developed from acute polyarticular gout. SIRS is characterized by loss of local control of inflammation, or an overly activated response resulting in an exaggerated systemic response. The SIRS was presumably due to systemic effects of a localized inflammatory response to urate crystals.

Role of Multi-detector Row Computed Tomography for Localization of Acute Lower Gastrointestinal Bleeding / 대한소화기학회지

BACKGROUND/AIMS: Recent studies have shown good performance for the detection of sources of gastrointestinal bleeding using multi-detector row computed tomography (MDCT). However, there are limited reports about the role of MDCT for localization of acute lower gastrointestinal (GI) bleeding. The purpose of this study was to evaluate the role of MDCT for detection and localization of acute lower gastrointestinal bleeding. METHODS: A total of 49 patients underwent MDCT examination for the evaluation of acute lower GI bleeding were investigated prospectively. Sensitivity, specificity, positive and negative predictive values of MDCT for the detection of acute lower GI bleeding were assessed. Colonoscopy, angiography, RBC scan or postoperative results were adopted as the reference standard. RESULTS: Sensitivity, specificity, positive and negative predictive values of MDCT for the detection of acute lower GI bleeding were 72.7%, 80%, 93.9% and 25%, respectively. Eighteen patients experienced massive bleeding and 5 of them could not undergo the colonoscopic examination due to massive bleeding. MDCT detected the bleeding focuses in all of 5 patients. CONCLUSIONS: MDCT is useful for the localization of acute lower GI bleeding. The procedure is brief, less invasive, and relatively accurate diagnostic method. Moreover, positive finding will allow directed therapeutic procedure such as angiography.

Uncovered Self-expandable Metal Stents (SEMS) for Gastric Outlet Obstruction Caused by Stomach Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: The use of self-expandable metal stents (SEMS) is a safe and efficacious method for palliating malignant gastric outlet obstruction. However, few reports have assessed clinical outcome after the insertion of SEMS for malignant gastric outlet obstruction caused by stomach cancer. The aim of this study was to assess the usefulness of uncovered SEMS in patients with malignant gastric outlet obstruction caused by stomach cancer. METHODS: We evaluated 62 patients with gastric outlet obstruction caused by stomach cancer treated by the implantation of uncovered SEMS. A total of 62 patients (43 males, 19 females) were treated between August 2000 and March 2007. A scoring system was used to grade the ability to eat. RESULTS: Stent implantation was successful in 61 (98.4%) patients. Relief of obstructive symptoms was achieved in 49 (80.3%) patients. The mean survival duration was 143 days. The mean stent patency time was 103.5 days. An improvement in the ability to eat using the scoring system was statistically significant (p<0.05). CONCLUSIONS: Endoscopic placement of uncovered SEMS is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.

Catheter Probe Endoscopic Ultrasonography Using the Jelly-Filled Method for Esophageal Subepithelial Lesions / 대한소화기내시경학회지

BACKGROUND/AIMS: The catheter probe endoscopic ultrasonography (EUS) system is widely used to evaluate upper gastrointestinal tract lesions. The depiction of the esophageal wall by probe EUS remains problematic due to the difficulty of the filling of water in the esophageal lumen. In addition, filling the esophagus with water can be associated with an increased risk of aspiration. To resolve such problems, we recently applied the use of probe EUS with the jelly-filled method for the evaluation of subepithelial lesions. The procedure is characterized by filling the esophageal lumen with jelly. In this study, we evaluated the efficacy of probe EUS by using the jelly-filled method for esophageal subepithelial lesions. METHODS: We analyzed the records of the patients with suspected subepithelial lesions at the time of endoscopy that was performed from November 2005 to June 2007. Esophageal subepithelial lesions with both EUS findings and pathological reports were retrospectively compared. RESULTS: The study included 181 patients (96 males, 85 females), with an average age of 55.5 years (age range, 29~78 years). Sixty-eight patients had lesions in the upper esophagus, 60 patients had lesions in the middle esophagus and 53 patients had lesions in the lower esophagus. Secondary layers of esophageal lesions were predominant (91/181) in the cases. Pathological findings were available for 34 patients. Compared with the pathological findings, the diagnostic accuracy of EUS was 91.1%. CONCLUSIONS: Probe EUS by using the jelly-filled method is convenient and safe to perform and provides clear and full-circumferential imaging of a lesion. It is an alternative method to use in place of previously used probe-EUS procedures for the assessment of esophageal subepithelial lesions.

Treatment of Gastric Outlet Obstruction by Stomach Cancer with using Double-layered Pyloric Stent / 대한소화기내시경학회지

Backgroud/Aims: Endoscopic stent placement is widely used to treat an unresectable malignant gastric outlet obstruction. The covered stent has the disadvantage of an increased risk of migration, and the uncovered stent has an increased risk of ingrowth. This study examined the technical and clinical efficiency of stent placement of a double-layered combination pyloric stent that was newly designed to reduce tumor ingrowth and stent migration. METHODS: Fifteen patients with a gastric outlet obstruction caused by unresectable stomach cancer were treated with the endoscopic placement of a double-layered combination pyloric stent (an outer uncovered stent to reduce migration and an inner PTEF-covered stent to prevent tumor ingrowth). The technical success, clinical success, and complication especially tumor ingrowth and stent migration were analyzed. RESULTS: Technical success was achieved in 15 out of 15 (100%) patients. Among the 15 patients in whom endoscopic stenting was placed successfully, the clinical success rate was 93.3%, the incidence of tumor ingrowth was 0%, the rate of migration was 6.7%, and tumor overgrowth was observed in 13.3%. The median stent patency period was 105 days. CONCLUSIONS: The placement of a double- layered pyloric combination stent appears to be effective in overcoming the disadvantage of the increased migration observed for a covered stent and the increased ingrowth observed for the uncovered stent.

Clinical Applications of Three-Dimensional Echocardiography

BACKGROUND: Three-dimensional echocardiography has good feasibility and real image display in dynamic and spatial cardiac structures. So we designed this study to assess both the feasibility and potential role of three-dimensional echocardiography for the evaluation of cardiac structures and adjacent relationships. METHOD: We studied 25 patients with various heart structures. Cross-sectional images of specific interesting region were acquired from multiplane transesophageal echocardiography and reconstructed to three-dimensional images by TomTec image processing system. These images were presented in volume-rendered dynamic display for assessing of additonal informations. RESULTS: Three-dimensional reconstructions of usual viewpoints and interesting cut planes were possible in all patients. When compared with standard two dimensional images, additional informations were provided in all reconstructed cases. Among these images, mitral valve morphology, aortoseptal continuity and interatrial septum were the structures for which three-dimensional echocardiography were most useful. CONCLUSION: Although it was preliminary datas which needs large-scale randonmized prospective studies, three-dimensional echocardiograpy may be most potent and promising methods in evaluating anatomic and functional assessment of heart structures.