A Nasogastric Tube Inserted into the Gastrocutaneous Fistula

We reported a case in which a nasogastric tube was inserted into the gastrocutaneous fistula, diagnosed by abdominal computed tomography. A 78-year-old man with a history of recurrent cerebral hemorrhage had a percutaneous endoscopic gastrostomy tube due to dysphagia for 2 years. However, soft tissue infection at the gastrostomy site caused the removal of the tube. Immediately, antibiotic agents were infused. For appropriate hydration and medication, a nasogastric tube was inserted. However, there was no significant improvement of the soft tissue infection. Moreover, the amount of bloody exudate increased. Abdominal computed tomography revealed the nasogastric tube placed under the patient's skin via gastrocutaneous fistula. The nasogastric tube was removed, and an antibiotic agents were maintained. After 3 weeks, the signs of infection fully improved, and percutaneous endoscopic gastrostomy was performed again. This case shows necessities of an appropriate interval between removal of the gastrostomy tube and insertion of a nasogastric tube, and suspicion of existence of gastrocutaneous fistula.

A Case of Conversion Disorder Presenting Hemiplegia

Patients with conversion disorder are often presented with critical symptoms or signs which could suggest severe organic disorders. Hysterical hemiparesis is a relatively rare presentation and it is difficult to diagnose because it is displayed as a unilateral motor weakness with or without sensory deficits. A previously healthy 23-years-old woman developed sudden onset of hemiplegia and hemianesthesia with loss of anal tone. Before the onset, she had a traffic accident. A through medical workup including X-rays, MRI, CT scans, EMG, and brain SPECT revealed no organic causes for such neurologic deficits. She gradually regained neurologic function over 2 months from the onset. Conversion disorder should be considered when symptom- related anatomic or physiologic abnormalities could not be proven with appropriate workup. Medical evaluation must be performed in advance to the diagnosis of conversion disorder to avoid misdiagnosis.

Persistent Autonomic Dysfunction in Guillain-Barre Syndrome: A case report

Autonomic dysfunction is a common manifestation in Guillain-Barre syndrome (GBS), but it rarely persists. We report a case involving a 22-year-old man who presented with glove-and-stocking type sensory loss, symmetric weakness, urinary distension, orthostatic hypotension, decreased perspiration, and the syndrome of inappropriate secretion of antidiuretic hormone. He was subsequently diagnosed as having GBS with autonomic failure that persisted for more than six months, despite regaining muscle strength. Orthostatic hypotension progressively improved after rehabilitation and administration of midodrine and fludrocortisone. Extensive evaluation and management should be performed in patients with GBS because severe autonomic dysfunction is a major source of disability.