A Case Report of Tuberculous Brain Abscess and Tuberculous Peritonitis Developing Due to Paradoxical Reactions / 결핵및호흡기질환

While receiving appropriate treatment, patients with tuberculosis occasionally have unusual, paradoxical reactions, with transient worsening of lesions or the development of new lesions. This report is a case of tuberculosis brain abscess and tuberculosis peritonitis with intra-abdominal abscess that developed during appropriate anti-tuberculosis chemotherapy. A 45-year-old male patient had been diagnosed as with all-drug susceptible pulmonary tuberculosis with pleurisy. Subsequently, the patient underwent standard treatment with anti-tuberculosis therapy; the pulmonary lesions improved. Three months after initial treatment, the patient developed brain abscesses and peritonitis. With the addition of corticosteroid treatment, the patient's neurologic symptoms were relieved. Exploratory laparotomy with surgical drainage was performed and a diagnosis of tuberculosis peritonitis was confirmed on biopsy. Anti-tuberculosis therapy was continued for 19 months, the patient improved eventually without further complications, although the therapeutic regimen had not been altered. In this case, the paradoxical response to treatment may have been involved in the pathogenesis of disease.

ST-T Change on Electrocardigraphy in Old Diabetics Without Chest Pain

BACKGROUND: Silent myocardial ischemia is often found in old diabetics. Many diagnostic tools are used for diagnosis of angina. But these tools are difficult to use in primary care. Therefore we have planned to investigate the change of electrocardiography in old diabetics, using resting electrocardiogram which is available for primary care. METHOD: 67 patients with ST-T change group and 262 patients with control group were included in this study. Patients with chest pain or heart problem were excluded. The resting electrocardigraphy is examined by standard 12 lead electrocardiogram. RESULTS: There are differences of diabetes, HDL-cholesterol between ST-T change group and control group. Diabetes and HDL- cholesterol are significant factors that change ST-T wave in the resting electrocardigraphy. CONCLUSION: ST-T change of old diabetics without chest pain is more frequent than non diabetics. That means myocardial ischemia and requires treatment at secondary or third medical center. In conclusion, regular electrocardigraphy monitoring at primary care should be required in old diabetics.

A Case of Early Gastric Remnant Cancer Treated by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Patients who have undergone partial gastric resection are at an increased risk for the development of cancer and polyps in the gastric remnant, and this risk increases with time following gastrectomy. The prevalence of polypoid change at 15~20 years after surgery is approximately 10%, about four or five times higher as compared to nonoperated one. Hyperplastic polyps are encountered more frequently than adenomatous polyps. Surgical treatment for gastric remnant cancer has been regarded as standard method, but it was reported that endoscopic mucosal resection of early gastric remnant cancer could be performed under strict indication, as the incidence of lymph node metastasis was very low. Recently one adenomatous polyp with focally carcinoma in situ in the gastric remnant was removed by endoscopic mucosal resection in male patient who had undergone Billroth II gastrojejunostomy for gastric ulcer disease 12 years earlier.

Four Cases of Gastric Mucosal Tear after Blunt Abdominal Trauma / 대한소화기내시경학회지

The incidence of abdominal trauma has increased in recent decades as the frequency of traffic accidents increased. Early symptoms and signs of blunt abdominal trauma may be absent and associated injuries frequently detract physicians from early diagnosis of abdominal trauma. Delayed diagnosis has been shown to be associated with higher morbidity and mortality. Gastrointestinal tract is the third most commonly injured organ from blunt abdominal trauma. Gastric ruptures after blunt abdominal trauma were reported occasionally, but reports of upper gastrointestinal bleeding by gastric mucosal tear were very rare. Four cases of upper gastrointestinal bleeding due to gastric mucosal tear after blunt abdominal trauma are herein reported with a review of related literatures.