Two Cases of Electrocautery Incision Therapy Using an Insulated-tip Knife for Treatment of Symptomatic Benign Short-segment Colonic Stenosis Following Colonic Resection / 대한소화기학회지

Anastomotic stenosis of the colon is not an uncommon finding; however, its frequency varies from one study to another. Traditionally, postoperative colonic stenosis is managed surgically. However, endoscopic therapy has recently become the preferred treatment modality over traditional surgery. Good short-term success has been achieved with use of endoscopic balloon dilation; however, restenosis may occur over time in 14% to 25% of patients. The current report showed the effectiveness and usefulness of an insulated-tip knife (IT-knife) for electrocautery therapy of a patient with symptomatic anastomotic colonic stenosis.

Cut-Off Value and Factors Associated with a False Positive D-Dimer Result for Venous Thromboembolism in Koreans / 대한내과학회지

BACKGROUND/AIMS: The D-dimer value is a simple blood test used to evaluate venous thromboembolism (VTE). However, due to its low specificity, another test is needed for a definite diagnosis, such as a radiographic test. We evaluate the factors associated with a false positive D-dimer test and propose a new cut-off value for detecting VTE more effectively in Koreans. METHODS: This was a retrospective, observational study. From January 2009 to December 2009, 2,047 patients (988 men, 63 +/- 15 years) had the D-dimer value checked to evaluate VTE. The main outcome of interest was a positive D-dimer test. Odds ratio and 95% confidence intervals were determined using logistic regression analysis. The new D-dimer cut-off was evaluated using receiver operating characteristics (ROC) curves. RESULTS: The result was positive in 1,093 patients (53%), for a false positive percentage for VTE of 95% and a false negative percentage for VTE of 1%. Significant false positive predictors for a positive D-dimer were increasing age, trauma, postoperative, acute infection, tuberculosis, stroke, malignancy, chronic renal failure, acute coronary syndrome, heart failure, and lung disease. The discriminative value of the D-dimer test was assessed using ROC curve analysis. A D-dimer value of 0.68 mg/L on admission was the best cut-off value for predicting the development of VTE with a sensitivity of 95% and specificity of 57%. CONCLUSIONS: Many factors affect the D-dimer value and we must consider these factors before using the D-dimer value to evaluate VTE. A D-dimer value of 0.68 mg/L appears to be a good cut-off value for evaluating VTE more effectively in Koreans.

Anomalous Separate Origin of Left Anterior Descending Coronary Artery: Presented as Acute Anterior Myocardial Infarction

Coronary artery anomalies are rare presentations in primary percutaneous coronary interventions of acute myocardial infarction. Herein, we report the case of a 59-year-old man with acute anterior myocardial infarction who had anomalous separate origin of left anterior descending artery (LAD) and left circumflex artery (LCX) from the left coronary aortic sinus. Coronary angiography showed a normal right coronary artery and LCX, but no visualization of the LAD. After several unsuccessful attempts to cannulate the LAD, we found the LAD ostium located by the side of the LCX ostium. There was total occlusion at proxymal LAD. Coronary computed tomography angiography demonstrated the precise, separate origin of LAD and LCX from the left coronary aortic sinus.

A Case of Primary Gastric ALK-Positive Anaplastic Large-Cell Lymphoma / 대한내과학회지

Anaplastic large-cell lymphoma (ALCL) is a rare subgroup of non-Hodgkin's lymphoma. Primary gastric ALCL is extremely rare. Patients with anaplastic lymphoma kinase (ALK)-positive primary systemic ALCL are known to have better overall survival than those with ALK-negative ALCL. We herein report a case of primary gastric ALK-positive anaplastic large-cell lymphoma. A 37-year-old woman presented with postprandial epigastric pain for 2 months. Endoscopic examination of the upper gastrointestinal tract showed multiple variably sized, round, elevated lesions with friable crater-erosion on the body and fundus. Pathologic examination revealed atypical large lymphoid cell infiltration in the lamina propria; the cells were positive for CD3, CD30, and ALK. We diagnosed the patient with ALCL. She underwent a cycle of chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone. However, she developed brain metastases. Despite two cycles of palliative chemotherapy with high-dose methotrexate for brain metastases, she died due to ALCL progression.

A Case of a Mucinous Adenocarcinoma Arising from a Rectal Diverticulum

The occurrence of an adenocarcinoma arising from a rectal diverticulum that causes mechanical ileus is very rare. Recently, we diagnosed a case of a mucinous adenocarcinoma in a rectal diverticulum after an emergent abdominal perineal resection and permanent colostomy by laparotomy. Here, we present a case report and a review of the literature.

A Case of Gastrointestinal Stromal Tumor Mistaken for Abscess Following Embolization of Superior Mesenteric Artery

Bowel ischemia following embolization is the major complication of arterial embolization in gastrointestinal bleeding. Although mild ischemia recovers with conservative treatment, perforation should be treated surgically. We report a case of gastrointestinal stromal tumor mistaken for an abscess following embolization of superior mesenteric artery. A 72-year-old female was referred to the emergency room complaining of hematochezia and hematemesis. Endoscopic examination revealed a tiny mucosal defect with spurting bleeding at distal duodenum. Hemostasis could be achieved by embolization of superior mesenteric artery. After ten days, abdominal CT scan showed an abscess-like feature around distal duodenum, but the small bowel series did not show leakage of contrast. Endoscopy revealed round intestinal wall defect. She underwent laparotomy owing to the possibility of perforation and abscess, but surgical findings showed 5 cm mass based on the jejunum just caudal to ligament of Treitz. The mass was finally diagnosed as gastrointestinal stromal tumor combined with necrosis.

A Case of Gastrointestinal Stromal Tumor Mistaken for Abscess Following Embolization of Superior Mesenteric Artery

Bowel ischemia following embolization is the major complication of arterial embolization in gastrointestinal bleeding. Although mild ischemia recovers with conservative treatment, perforation should be treated surgically. We report a case of gastrointestinal stromal tumor mistaken for an abscess following embolization of superior mesenteric artery. A 72-year-old female was referred to the emergency room complaining of hematochezia and hematemesis. Endoscopic examination revealed a tiny mucosal defect with spurting bleeding at distal duodenum. Hemostasis could be achieved by embolization of superior mesenteric artery. After ten days, abdominal CT scan showed an abscess-like feature around distal duodenum, but the small bowel series did not show leakage of contrast. Endoscopy revealed round intestinal wall defect. She underwent laparotomy owing to the possibility of perforation and abscess, but surgical findings showed 5 cm mass based on the jejunum just caudal to ligament of Treitz. The mass was finally diagnosed as gastrointestinal stromal tumor combined with necrosis.

A Case of Lateral Abdominal Wall Hematoma Treated with Transcatheter Arterial Embolization / 대한소화기학회지

Paracentesis is a diagnostic, therapeutic procedure performed in patients with ascites. It is generally thought to be a safe procedure and transfusion of platelet concentrate or fresh frozen plasma is not recommended before the procedure, because the incidence of clinically significant bleeding is very low. We report a case of lateral abdominal wall hematoma due to the injury of the deep circumflex iliac artery after paracentesis in patient with alcoholic liver cirrhosis who was treated with transcatheter arterial embolization.