A Case of SMA Syndrome after Stenting at the Isolated Dissection of SMA / 대한내과학회지

Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by a decreased aortomesenteric angle that causes a duodenal obstruction. Various medical and psychiatric conditions may result in the initial rapid weight loss that causes narrowing of the aortomesenteric angle. Isolated dissection of the superior mesenteric artery (DSMA) is an uncommon cause of acute mesenteric ischemia. Several literature reports suggest that medical treatment in combination with close observation is reasonable in uncomplicated dissection with stable hemodynamic status. Recently, as several reports describe, rapid revascularization by percutaneous angioplasty and endovascular stent insertion can prevent bowel ischemia that progresses to irreversible bowel necrosis. However, the stability of endovascular stents at the DSMA has not been confirmed, because its use is reasonably infrequent. Here, we report a case of SMA syndrome, as a complication of endovascular stent placement at the DSMA.

Asan Medical Information System for Healthcare Quality Improvement / 대한의료정보학회지

OBJECTIVES: This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. METHODS: Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. RESULTS: AMIS consisted of several distinctive systems: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. CONCLUSIONS: AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.

A Case of Esophageal Anisakiasis Presenting as Chest Pain Mimicking Angina / 대한소화기내시경학회지

Chest pain of a non-cardiac origin is frequently seen in medical practice. This kind of chest pain is often difficult to differentiate from chest pain of a cardiac origin. Esophageal anisakis is a rare finding, but it can cause chest pain. We report here on a patient who had a history of acute myocardial infarction and who also had one stent inserted in his left anterior descending coronary artery two month previously. The patient presented with substernal chest pain that mimicked anginal chest pain. Endoscopic examination revealed a whitish linear worm that had had invaded the esophagogastric junction, and we removed the worm with biopsy forceps. We report here on a patient with an esophageal anisakiasis as a rare cause of noncardiac chest pain that mimicked anginal chest pain.

A case of recurred malignant melanoma of the stomach and peritoneum / 대한내과학회지

Malignant melanoma may spread through the lymphatic channels or via the bloodstream. The lung, liver, bone and brain are common sites of hematogenous metastases. Malignant melanoma that has recurred to the stomach or peritoneum is not common. An 83-year old male patient was admitted to the Department of Oncology due to abdominal distension; 13 years ago, the patient had previously received a complete surgical resection for malignant melanoma of the right heel. According to a computed tomography (CT) scan of the abdomen, peritoneal carcinomatosis was suggested. Under a gastrofiberoscopic examination, two small sized polyps with central umbilication were found on the midbody of the stomach. The gastric polyps were histopathologically confirmed as metastatic melanoma. We report a rare case of metastatic malignant melanoma that has recurred to the stomach and peritoneum 13years after its initial diagnosis.

A Case of Non-Hodgkin's Lymphoma in a Patient with Crohn's Disease / 대한소화기학회지

Although adenocarcinoma is a well known complication of chronic inflammatory bowel disease, primary gastrointestinal lymphoma occurring in Crohn's disease is rare. A 40-year-old man with 10 year-history of Crohn's disease had multiple longitudinal ulcerative lesions on descending colon in follow-up colonoscopic examination. Microscopic examination of proximal descending colon revealed peripheral T cell lymphoma and other site of the descending colon was consistent with Crohn's disease. The patient reached complete remission of malignant lymphoma after three cycles of combined chemotherapy. He has been well for 10 months with sulfasalazine maintenance therapy but was admitted to the hospital due to spontaneous bowel perforation of ascending colon. Right hemicolectomy was done, but the patient died of post-surgical recurrent mesenteric abscess and sepsis. To the best of our knowledge, this is the first case of Non-Hodgkin's lymphoma complicating Crohn's disease in Korea which was confirmed by immunohistochemical studies.

Conservative Treatment of Colonoscopic Perforations / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonoscopic perforation can be treated by both operative or non-operative methods. Non-operative management, and especially conservative management, may be appropriate for selected individuals. We wanted to verify the usefulness of performing conservative management for treating colonoscopic perforations. METHODS: We reviewed the medical records of the colonoscopic perforation cases that occurred in the recent 5 yrs. 11 cases of perforation occurred from among 8,536 colonoscopic procedures. RESULTS: Ten cases occurred from a therapeutic procedure (five from polypectomy and another five occurred from an endoscopic (submucosal dissection) and one case occurred from a diagnostic procedure. The perforation sites were the ascending colon (three cases), transverse colon (two cases), descending colon (one case), sigmoid colon (two cases), and rectum (three cases). There were five intraperitoneal perforations and five retroperitoneal perforations. All the cases were detected within 12 hours and all the cases had received good bowel preparation. 10 cases were managed conservatively (nothing by mouth, broad spectrum antibiotics and, Levin tube suction). One case was managed by an operative procedure due to the large size of the defect and the patient's wish. All the patients recovered without complications. The mean hospital stay was 9.5 days. CONCLUSIONS: Colonoscopic perforation can managed conservatively in selected cases, such as for those cases that will undergo post-therapeutic colonoscopy and those cases that have undergone good bowel preparation.

A Case of an Acute Huge Hemorrhagic Gastric Ulcer after an Endoscopic Mucosal Biopsy / 대한소화기내시경학회지

Although most diagnostic upper gastrointestinal endoscopic procedures are performed on an outpatient basis with relatively low risk, complications related with these procedures can occur. The reported complications are cardiopulmonary complications, drug side effects, perforation, hemorrhage and infection. Hemorrhage may occur from the site of biopsy or polyp removal. It is usually minimal and heals spontaneously with or without endoscopic treatment and rarely requires transfusion or surgery. Acute hemorrhagic ulceration associated with endoscopic mucosal biopsy is very rare. We report a case of a 46-year-old woman with an acute hemorrhagic gastric ulcer after an endoscopic mucosal biopsy. She has been receiving upper gastrointestinal endoscopic examinations annually for the gastric polyp detected 4 years ago. Endoscopic mucosal biopsy was performed without complications. Twelve hours later, she admitted to the emergency room because of melena. Emergent upper gastrointestinal endoscopy showed an acute huge hemorrhagic ulceration along the antrum. She was treated conservatively and discharged 5 days later.

A Case of Lupus Nephritis Associated with Transiently Decreased C1 Inactivator Activity and Angioedema / 대한신장학회잡지

C1 esterase inhibitor deficiency with consequent angioedma is an uncommon condition. Nonhereditary C1 inhibitor deficiency includes underlying disorders; lymphoproliferative disorder, autoimmune disease, hypereosinophilia, drug-induced, allergic, and idiopathic forms. The as sociation of hereditary C1 esterase inhibitor deficiency with systemic lupus erythematosus has been previously described. We experienced a case with transiently decreased C1 inactivator activity and angioedema in lupus nephritis. This present case is a previously healthy 22-year-old woman, who developed intermittent facial angioedema and decreased urine amount. After steroid treatment, the C1 inactivator activity was recovered and angioedema was disappeared.

Bioavailability of EVA-Coated Metallic Stents Implanted in the Rabbit Iliac Artery

BACKGROUND AND OBJECTIVES: Coronary artery stenting actually shows a high efficacy in the treatment of coronary heart disease, but has the major limitation of restenosis. The ethylene-vinyl acetate copolymer (EVA), a biocompatible nondegradable copolymer, has been employed as a rate-controlling membrane in several drug delivery systems. Herein, the feasibility of an EVA-coated coronary stent was evaluated as a possible route for localized drug delivery. MATERIALS AND METHODS: A total of 15 rabbits were employed in this study. An uncoated stent was implanted into the non-diseased iliac artery in six rabbits, and an EVA-coated stent into a further nine. On the 30th day following the stent implantations, stented segments of the iliac arteries were removed for histological processing and morphometric analysis. RESULTS: The mean neointimal area of the uncoated and coated groups were 1.009 and 1.011 mm2 (p=0.56), respectively. No inflammatory cells were found in coated group. There were no apparent differences between the two groups. CONCLUSION: The results from this study have demonstrated that an EVA-coated coronary stent might be an appropriate method for the controlled-release of a drug.

A Case of Ischemic Colitis as a Complication of Colonoscopy / 대한소화기내시경학회지

A 50-year-old man was undergone colonoscopy because of chronic lower abdominal pain for six months. No significant abnormalities was found through colonoscopy. Two days later, the patient returned to the hospital, complaining severe lower abdominal pain with hematochezia. On physical examination, his abdomen was soft to palpation, with mild tenderness on lower abdomen. Colonoscopy was performed again, which showed segmentally diffuse hyperemic and hemorrhagic mucosa resembling ischemic colitis in the sigmoid colon. He was put under our conservative treatment. Following up the colonoscopy on the third day of hospitalization, mucosal lesion displayed a remarkable improvement. Currently, he was discharged and is now under observation as an outpatient. The case of patient status complication with ischemic colitis after atraumatic colonoscopy was previously found only in caucasian patients. We are hereby reporting same case of a patient.