Biochemical assessment of protein-calorie malnutrition in hepatic encephalopathy / 대한내과학회지

BACKGROUND: Most patients with hepatic encephalopathy have their protein intake restricted. Therefore, protein-calorie malnutrition becomes more severe and may cause more serious problems, such as infection and poor prognosis. The aim of this study is to determine better biochemical parameters for the assessment of nutritional status in patients with hepatic encephalopathy. METHODS: A total 109 patients (30 normal controls and 79 chronic hepatitis B) were enrolled. 79 patients were divided into three groups: chronic HBV infection (hepatitis group, n=28), liver cirrhosis without past history of hepatic encephalopathy (cirrhosis group, n=27), liver cirrhosis with present or past history of hepatic encephalopathy (encephalopathy group, n=24). Serum albumin, total lymphocyte count, IGF-1, growth hormone, retinol binding protein, leptin and fibronectin were measured. RESULTS: Serum albumin level, total lymphocyte count, IGF-1, and growth hormone were significantly lower in encephalopathy group than other groups (p<0.001, p=0.003, p<0.001, and p<0.001, respectively). However, RBP, leptin, and fibronectin were not different among the groups. The level of serum albumin and IGF-1 were significantly lower in encephalopathy group than cirrhosis group (p=0.002, p<0.001, respectively), but growth hormone was not significantly different between cirrhosis group and encephalopathy group. CONCLUSIONS: The level of serum albumin and IGF-1 may be important parameter for nutritional support in chronic liver disease, especially in patients with hepatic encephalopathy, because the level of serum albumin and IGF-1 relate with hepatic encephalopathy as well as reflect the progression of chronic liver disease.

Small Bowel Metastasis from Breast Cancer: A Case Report / 대한소화기학회지

Breast cancer is a common malignancy in women and frequently metastasizes to various organs such as liver, lung, brain, bone and so on. But metastasis to gastrointestinal tract is rare. We describe a 73-year-old woman with small intestinal metastasis of breast cancer. She was diagnosed as right breast cancer in stage I, received modified radical mastectomy 6 years ago and had been followed up without any evidence of residual disease. During investigation for lower abdominal pain and weight loss of 9 kg, we found a small bowel mass. The histology of the tissue taken from small bowel mass was adenocarcinoma, poorly differentiated. The immunohistochemical stain of this specimen showed 75% positivity of estrogen receptor and 90% positivity of progesterone receptor. This is a case of small bowel metastasis from breast cancer and we report this case with a review of literatures.

A Case of Gastropericardial Fistula as a Complication after Esophagectomy with Esophagogastrostomy for Esophageal Cancer / 대한소화기내시경학회지

The gastric pedicle is commonly used for the reconstruction following the resection of esophageal cancer. We recently experienced a case in which gastric ulcer occurred eighteen months postoperatively. A 60 year-old man complaining of chest pain, dry cough, mild fever and chills was admitted to the emergency room. The patient had a history of esophagectomy and esophagogastrostomy because of esophageal cancer. Chest X-ray and CT scan showed pneumopericardium. Upper GI contrast study showed a fistulous tract between the stomach pedicle and the pericardium. Upper GI endoscopy showed beating heart through the fistulous opening. The patient expired with sepsis on the twenty second days after an emergent operation. Gastropericardial fistula caused by a peptic ulcer perforation after the esophgectomy and esophagogastrostomy operation is a very rare complication and brings a fatal result. Early detection using the chest radiography, electrocardiogram, echocardiography, upper GI study and physical examination, and an immediate treatment are therefore mandatory.

A Case of Metastatic Hepatocellular Carcinoma of the Ovary / 대한소화기학회지

Although advances in imaging technology have allowed for earlier detection of disease, hepatocellular carcinoma is usually asymptomatic and discovered at an advanced stage with metastasis. The most common sites of metastasis include lung, peritoneum, adrenal gland, and bone, but rarely, the nasal cavity, orbit, gallbladder, and ovary can be metastatic sites. We experienced a case of metastatic hepatocellular carcinoma of the ovary in a living patient. The differential diagnosis includes hepatoid yolk sac tumor of the ovary, primary or metastatic hepatoid carcinoma and primary or metastatic oxyphil cell tumor of the ovary. To the best of our knowledge, there have been eight cases of metastatic hepatocellular carcinoma of the ovary in the English literature and only six cases discovered in living patients. This is the first report of a metastatic hepatocellular carcinoma of the ovary in Korea.

A Case of Spontaneous Regression of Advanced Gastric Cancer / 대한소화기내시경학회지

Spontaneous regression may occur in malignancies such as hypernephroma, neuroblastoma, malignant melanoma, choriocarcinoma, and bladder tumor, but yet it is extremely rare in carcinoma of the stomach. So far, 19 cases have been reported in the English literature and the mechanisms underlying this intriguing phenomenon remain unknown. A 48-year-old man with histologically-verified advanced gastric carcinoma had received no treatment since its diagnosis. However, gastric carcinoma was no longer detectable by endoscopy and histology after 4 years. Thus, we report a case of spontaneous regression of carcinoma of the stomach with a brief review of relevant literatures.

A Case of Spontaneous Regression of Advanced Gastric Cancer / 대한소화기내시경학회지

Spontaneous regression may occur in malignancies such as hypernephroma, neuroblastoma, malignant melanoma, choriocarcinoma, and bladder tumor, but yet it is extremely rare in carcinoma of the stomach. So far, 19 cases have been reported in the English literature and the mechanisms underlying this intriguing phenomenon remain unknown. A 48-year-old man with histologically-verified advanced gastric carcinoma had received no treatment since its diagnosis. However, gastric carcinoma was no longer detectable by endoscopy and histology after 4 years. Thus, we report a case of spontaneous regression of carcinoma of the stomach with a brief review of relevant literatures.

Treatment with Embolization of Cobb's Syndrome Causing High-output Heart Failure

High-output heart failure may occur in anemia, thyrotoxicosis, Beriberi heart disease, arteriovenous fistula, congenital arteriovenous malformation, Paget's disease of the bone, fibrous dysplasia, polycythemia vera, multiple myeloma, and renal diseases such as glomerulonephritis, carcinoid syndrome, pregnancy and obesity. Among these conditions, reports on heart failure resulting from an arteriovenous malformation are rare. We report a case of high-output heart failure resulting from Cobb's syndrome (cutaneomeningospinal angiomatosis), which improved with spinal artery embolization.

Successful Treatment of Cerebral Aspergillosis with Liposomal Amphotericin B and Minimal Invasive Surgery in a Patient Who Received Renal Transplant 10 Year Ago / 대한신장학회잡지

Aspergillosis involving central nervous system is a rare but life-threatening complication in renal transplant recipients. Its mortality rate approaches almost 100% in spite of various therapeutic regimens. We here report a case of successful treatment of brain aspergillosis with liposomal amphotericin B and endoscopic surgery. A 58-year- old renal transplant recipient admitted due to headache which was developed 5 months ago. He received renal transplant 10 years ago. After admission, brain MRI revealed brain abscess on frontal lobe and this was treated with antibiotics and amphotericin B. On 20 th hospital day, endoscopic surgery via intranasal approach was performed and pathologic finding was consistent with aspergillosis. During treatment, his graft function was progressively deteriorated(serum creatinine level 2.27 mg/dL 4.1 mg/dL) and amphoterinc B was replaced with ambisome. Thereafter, renal function was improved(serum creatinine 2.0 mg/dL on 46 th hospital day). Second operation was performed on 50 th hospital day to remove remnant pathologic lesion, and ambisome was continously adminstered. The brain MRI which was performed on 70 th hospital day showed much improvement. He was discharged with oral antifungal drug(itraconazole). Our case demonstrates the successful treatment of brain aspergillosis with medial treatment and minimal invasive surgery.

A case of anterior tibial compartment syndrome induced by bilateral diabetic muscular infarction in hypothyroid state / 대한내과학회지

Acute compartment syndrome is usually caused by local vascular and traumatic involvement. Thyroid disease is not a common cause of compartment syndrome and only two cases of spontaneous compartment syndrome associated with hypothyroid myopathy have been reported. Diabetic muscular infarction is a rare microvascular complication usually occured in type 1 diabetes patients under pjoor diabetic control and intramuscular volume expansion caused by muscle necrosis and increased tissue fluid can iduce compartment syndrome. We report a case of atypical bilateral anterior tibial compartment syndrome and foot drop in a 51-year-old patient with type 2 diabetes in hypothyroid state.

A Case of Vacuolar Myelopathy in Patient with Acquired Immunodeficiency Syndrome / 감염

The spinal cord is a commonly affected site in human immunodeficiency virus (HIV) infection. Even though the most common disease of the spinal cord is vacuolar myelopathy, there is no case report yet in Korea. We experienced a case of suspicious vacuolar myelopathy in a 33 year-old male patient with acquired immunodeficiency syndrome. The patient presented with progressive paraparesis, gait disturbance, urinary difficulty, and the loss of sensation below thoracic spine 6~7 dermatome. Cerebrospinal fluid showed mild pleocytosis, increased protein level, and normal glucose content. The spine MRI showed extensive ill defined areas of increased signal intensity through the visualized lower cervical and thoracic spinal cord. Steroid therapy with antiretroviral drugs appeared to be ineffective to improve the symptoms of the patient.