Two Cases of Ectopic Gallstones Treated by Endoscopic Therapy / 대한소화기내시경학회지

Two cases are herein reported involving patients with ectopic gallstones which were discharged into the stomach and duodenum through a cholecystoduodenal fistula and successfully removed by endoscopic therapy. In the first case, a 75-year-old man was admitted with epigastric pain. Simple abdomen film demonstrated a round laminated calcification and air biliarygram in the RUQ. Endoscopic examination revealed a fistula on the posterior wall of the duodenal bulb and a brown stone (about 5 cm in diameter) was found in the second portion of the duodenum, It was demolished through endoscopic electrohydraulic lithotripsy (EEH1) and discharged with the stool. In the second case, a 55-year-old man was admitted with epigastric pain. A CT scan revealed an ovoid laminated calcification in the dependent portion of the stomach. Endoscopic examination revealed a fistula on the anterior wa11 of' the duodenal bulb and a black pigmented stone (about 2.5 cm in diameter) was found in the stomach. This stone was removed orally by an endoscopic snare. These patients were discharged and remained asymptomatic.

A Case Rhabdomyolysis by Rare Causes: After Consumption of Common Doses of Acetaminophen and Sauna / 대한신장학회잡지

A 21-year-young man had an episode of myalgia and chilling 3 days prior to hospital admission. He had consumed common doses of acetaminophen for one day, and was presented in the sauna room for an hour. On the next morning, he complained of dyspnea and was admitted. He presented in rhabdo-myolysis and acute renal failure with increased up-take in the proximal muscles by (99m)Tc-MPD bone scan. He was treated by hemodialysis and discharged on the twenty-eighth hospital day. Rhabdomyolysis has the variable causes. The causes of this case are two, the first cause is common doses of acetaminophen. But, there is no reports for rhabdomyolysis by common doses of acetaminophen only. However, we should consider that acetaminophen is a contributing factor in this case. The second cause is viral infection. Our patient had myalgia and chilling prior to hospital admission. Heat- stroke is well known cause of rhabdomyolysis. The mechnisms for rhabdomyolysis in this disease are hypovolemia, total body potassium deficit, and increased variable cytokines. Sauna, the last cause of our rhabdomyolysis case may have the same mechanisms with heatstroke. Our case had two causative factors, common doses of acetaminophen and sauna. These factors might be cooperated in our case of rhabdomyolysis and acute renal failure.