A case of improved Menetrier's disease after the eradication of Helicobacter pylori and treatment with a proton pump inhibitor / 대한내과학회지

Menetrier's disease is a protein-losing hypertrophic gastropathy characterized by diffuse tremendous thickening of the gastric wall caused by excessive proliferation of the mucosa. Although the cause of Menetrier's disease is unknown, an association with Helicobacter pylori has been reported. A 42-year-old man was hospitalized for the evaluation of progressive body weight loss and indigestion for 6 months, with recently aggravated epigastric discomfort. Gastroscopy revealed prominent mucosal folds in the body and fundus. The histological findings revealed gastritis with erosions and foveolar hyperplasia. After eradicating the Helicobacter pylori and treatment with a proton pump inhibitor, clinical and endoscopic resolution ensued.

N-Terminal Pro-B-Type Natriuretic Peptide in Overweight and Obese Patients With and Without Diabetes: An Analysis Based on Body Mass Index and Left Ventricular Geometry

BACKGROUND AND OBJECTIVES: Several recent studies have shown that there is an inverse relationship between plasma B-type natriuretic peptide (BNP) and body mass index (BMI) in subjects with and without heart failure. Obesity frequently coexists with diabetes, so it is important to consider the relationship between diabetes and natriuretic peptide levels. We evaluated the influence of diabetes on the correlation of BNP and BMI. SUBJECTS AND METHODS: We examined 933 patients with chest pain and/or dyspnea undergoing cardiac catheterization between Feb. 2006 and Nov. 2007 in the Maryknoll cardiac center who had creatinine levels or =25 kg/m2) showed a significant negative correlation with increasing BMI (856.39+/-237.3 pg/mL, 601.69+/-159.6 pg/mL, 289.62+/-164.9 pg/mL, respectively, p<0.0001). However, in 200 diabetic patients, the correlation between BMI and NT-proBNP was not significant (r=-0.21, p=0.19), and NT-proBNP did not correlate with mitral E/Ea in obese diabetic patients (r=0.14, p=0.56). NT-proBNP was significantly correlated with mitral E/Ea in the non-obese (r=0.24, p=0.008) and non diabetic (r=0.32, p=0.003) groups. Left ventricular (LV) mass index was significantly correlated with NT-proBNP in all BMI groups (r=0.61, p<0.001), and patients with concentric cardiac hypertrophy showed the highest NT-proBNP levels. CONCLUSION: The present study demonstrates that obese patients have reduced concentrations of NT-proBNP compared to non obese patients despite having higher LV filling pressures. However, NT-proBNP is not suppressed in obese patients with diabetes. This suggests that factors other than cardiac status affect NT-proBNP concentrations.

The Usefulness of Three-Dimensional Spiral CT Angiography in the Evaluation of Atherosclerotic Diseases Involving the Arteries of the Lower Extremity

PURPOSE: To assess the usefulness of three-dimensional spiral CT angiography in the diagnosis and as a guide for the treatment of arteriosclerosis obliterans of the lower extremity. MATERIALS AND METHODS: During a recent one-year period, CTA and conventional angiography were performed in 12 patients with suspected ASO. From the upper margin of the third lumbar vertebral body to below the knee joint, helical CT scanning was performed 30-45 seconds after the injection of Ultravist 370(150-180ml) by a power injector at the rate of 2.5-3.0ml/sec via the antecubital vein. The resulting data were reformatted by SSD after reconstruction of 5mm intervals, and CTA was compared with CA for site and degree of stenotic or occlusive lesion. RESULTS: On CTA and CA, twenty-three occlusive lesions above the tibioperoneal artery were detected in 12 patients. On CA, three mild seven moderate and eight severe stenoses were seen, as well as five occlusions. There were three cases of overgrading and three of undergrading. Overall diagnostic accuracy was 73.9%(17/23). Calcifications were detected at on axial CT scanning in the two of three underestimated lesions. Migration of the thrombi was noted in one case. CONCLUSION: CTA may be useful in the evaluation of the arteries of the lower extremities, and valuable in the planning and follow-up of treatment.

Percutaneous Drainage of Abscess in the Treatment of Emphysematous Pyelonephritis

PURPOSE: To assess the usefulness of percutaneous drainage of abscess in the treatment of emphysematous pyelonephritis. MATERIALS AND METHODS: Ten cases of nine patients with emphysematous pyelonephritis were percutaneously drained. All were suffering from diabetes mellitus. The procedure was performed under fluoroscopic guidance in nine cases and US guidance in one case in which bilateral multiloculated abscesses were present in the perirenal spaces. The results were classified as cure, partial success, recurrence, or failure. The mean drainage period and complication were analyzed. RESULTS: Eight cases were cured, and there was one partial success. In one case, who had diffuse renal parenchymal destruction without perirenal fluid collection, the treatment failed. The longest drainage period was 45 days, in a case of re-insertion due to incidental catheter removal ; the mean was 23 days. Bacteremia in one case was cured with antibiotic therapy which lasted two days. CONCLUSION: In diabetic patients, percutaneous drainage of abscess is thought to be a safe and effective method for the treatment of emphysematous pyelonephritis, and is one that does not involve diffuse destruction of renal parenchyma.