A Case of Argon Plasma Coagulation Therapy for Hemorrhagic Radiation-induced Gastritis / 대한소화기내시경학회지

Hemorrhagic radiation-induced gastritis is a rare but serious complication of upper gastrointestinal radiation treatment, and no simple and effective treatment method has yet been developed. Studies on effective treatment methods for achieving hemostasis in patients with hemorrhagic radiation-induced gastritis are necessary, because the new indications for upper gastrointestinal radiotherapy in the field digestive oncology can potentially lead to an increased incidence of radiation-induced gastric vasculopathy. For the first time in Korea and to the best of our knowledge, we report here on a 59-years-old male patient with hemorrhagic gastritis that was induced by external radiotherapy for ampullary adenocarcinoma. This was all well-treated using Argon plasma coagulation (APC).

A Case of Degos' Disease Presenting with Abdominal Angina and Widespread Skin Lesions

Malignant atrophic papulosis (MAP), also known as Degos' disease, is a rare and often fatal occlusive thrombotic vasculopathy, with fewer than seven cases reported in Korea. MAP is characterized by porcelain-white, atrophic, papular skin lesions and multi-organ system involvement, especially the gastrointestinal (GI) tract and nervous system. Involvement of the GI tract is usually associated with a poor prognosis. To date, no treatment has been shown to be effective in the treatment of MAP. We describe a 52-year-old man who presented with a 5-month history of abdominal angina and a 2-year history of multiple skin lesions on the trunk and extremities. The skin lesions were papules, 4-6 mm in diameter, with a porcelain-white center and a slightly raised erythematous telangiectatic rim. A biopsy of a skin lesion showed a wedge-shaped degeneration of collagen in the dermis and atrophic epidermis. An explorative laparoscopy revealed multiple, yellow-white plaques scattered throughout the small bowel. A biopsy of the small bowel showed sclerotic vascular alterations containing intravascular fibrin thrombi. He was started on aspirin (100 mg daily) and has survived for 24 months since the onset of gastrointestinal symptoms.

A Case of Degos' Disease Presenting with Abdominal Angina and Widespread Skin Lesions

Malignant atrophic papulosis (MAP), also known as Degos' disease, is a rare and often fatal occlusive thrombotic vasculopathy, with fewer than seven cases reported in Korea. MAP is characterized by porcelain-white, atrophic, papular skin lesions and multi-organ system involvement, especially the gastrointestinal (GI) tract and nervous system. Involvement of the GI tract is usually associated with a poor prognosis. To date, no treatment has been shown to be effective in the treatment of MAP. We describe a 52-year-old man who presented with a 5-month history of abdominal angina and a 2-year history of multiple skin lesions on the trunk and extremities. The skin lesions were papules, 4-6 mm in diameter, with a porcelain-white center and a slightly raised erythematous telangiectatic rim. A biopsy of a skin lesion showed a wedge-shaped degeneration of collagen in the dermis and atrophic epidermis. An explorative laparoscopy revealed multiple, yellow-white plaques scattered throughout the small bowel. A biopsy of the small bowel showed sclerotic vascular alterations containing intravascular fibrin thrombi. He was started on aspirin (100 mg daily) and has survived for 24 months since the onset of gastrointestinal symptoms.

Clinical Outcomes of Early Vancomycin Administration before Identification of Methicillin-resistant Staphylococcus aureus in Patients with Nosocomial Pneumonia / 대한구급학회지

BACKGROUND: The aim of this study is to determine the clinical outcomes of early vancomycin administration before identification of methicillin-resistant Staphylococcus aureus (MRSA) in patients with nosocomial pneumonia on a ventilator. METHODS: We retrospectively reviewed patients with nosocomial pneumonia in a 20-bed medical ICU during a period of 2 years and 2 months. This study included 52 inpatients, who were admitted for more than 72 hr and had a new or progressive lung infiltrate plus at least two of the following three criteria for pneumonia: abnormal body temperature (>38oC or 10,000/mm3 or <3,000/mm3), and purulent bronchial secretions. All of the MRSA were identified in tracheal aspirates during mechanical ventilation. RESULTS: A total of 23 patients who received vancomycin prior to identification of MRSA exhibited a 28-day mortality rate of 60%, while 29 patients who received vancomycin after identification of MRSA showed a 28-day mortality rate of 40% (p=0.17). There was no statistically significant difference in severity index and routine laboratory findings between the two groups. CONCLUSIONS: Early vancomycin administration before identification of MRSA does not appear to affect the mortality rate for patients with nosocomial pneumonia.

Factors Associated with Early Death in Patients with Community-Acquired Pneumonia / 결핵및호흡기질환

BACKGROUND: Early death is an important problem associated with the management of community-acquired pneumonia. However, there is little information on the risk factors associated with it. The aim of this study was to identify the factors associated with early death in community-acquired pneumonia patients. METHODS: From January 1999 to July 2004, 1,487 adult patients with community-acquired pneumonia who were admitted to the pulmonary department via emergency center were examined. Early death was defined as those who died within 2 days of hospitalization. The clinical and laboratory aspects of the patients who died early (n=30) were compared with those of an age and gender matched control population (n=60) . RESULTS: In the early death group, respiratory rate, heart rate, and blood urea nitrogen (BUN) were significant higher (p<0.05 for all), while the arterial pH, systolic pressure, and PaO2 were significant lower (p<0.05 for all) than the control. The independent factor significantly associated with early death was tachypnea (OR, 7.049). CONCLUSION: The importance of an early clinical assessment in emergency center with community-acquired pneumonia needs to be emphasized in order to recognize patients at risk of early death.

Importance of Carbon Monoxide Transfer Coefficient (KCO) Interpretation in Patients with Airflow Limitation / 결핵및호흡기질환

BACKGROUND: The single-breath carbon monoxide diffusion capacity (DLCO) and the per unit alveolar volume (KCO; DLCO/VA) gave discordant values when there was an abnormal alveolar volume (VA). However, the clinical significance of the discordant values in patients with airflow limitation has not been examined. This study investigated the DLCO and KCO changes after improving the airflow limitation. METHOD: The baseline DLCO and KCO with lung volume were measured in patients with an airflow obstruction. The effective alveolar volume was measured using the single-breath CH4 dilution method. The patients divided into two groups according to the baseline values: (1) increased KCO in comparison with the DLCO (high discordance) (2) decreased or not increased KCO in comparison with the DLCO (low discordance). The diffusion capacity and lung volume were measured after treatment. RESULTS: There was no significant difference in the baseline lung volumes including the FEV1 and FVC between the two groups. The FEV1 and FVC were significantly increased in the high discordance group compared with the low discordance group after treating the airflow limitation. The DLCO and alveolar volume were significant higher in the high discordance group compared with the low discordance group while the TLC was not. CONCLUSION: The discordance between the DLCO and KCO could be translated into an airflow reversibility in patients with an airflow limitation

The Time Responses of Spirometric Values in Response to Single Doses of Inhaled Salbutamol / 결핵

BACKGROUND: An assessment of the presence and the degree of reversibility of airflow obstruction is clinically important in patients with asthma or chronic obstructive pulmonary disease. However, the time responses of spirometric parameters in response to bronchodilator have not been well investigated. METHODS: We studied 15 patients with asthma. Spirometric and mini-Wright peak expiratory flow measurements were performed at 15, 30, 45, and 60 minutes after using single dose(200 micro gram) of inhaled bronchodilator, salbutamol. RESULTS: The mean values of forced expiratory volume in one second(FEV1) and forced vital capicaty(FVC) were significantly increased at 60 minutes after using bronchodilator in comparison to 15 minutes. And peak expiratory flow rate measured by either mass flow sensor or mini-Wright peak flow meter were significantly increased at 45 minutes after using bronchodilator in comparison to 15 minutes. CONCLUSIONS: To appropriate evaluation of the bronchodilator response in patients with reversible airflow limitation, it would be useful measuring either FEV1 or PEF at the later time point 60 or 45 minutes in comparison to 15 minutes after using bronchodilator.

Change of Lung Volumes in Chronic Obstructive Pulmonary Disease Patients with Improvement of Airflow Limitation after Treatment / 결핵및호흡기질환

BACKGROUND: It is important to predict the exercise capacity and dyspnea, as measurements of lung volume, in patients with COPD. However, lung volume changes in response to an improvement in airflow limitation have not been explored in detail. In the present study, it is hypothesized that lung volume responses might not be accurately predicted by flow responses in patients with moderate to severe airflow limitations. METHODS: To evaluate lung volume responses, baseline and follow up, flow and lung volumes were measured in moderate to severe COPD patients. The flow response was defined by an improvement in the FEV1 of more than 12.3%; lung volume changes were analyzed in 17 patients for the flow response. RESULTS: The mean age of the subjects was 66 years; 76% were men. The mean baseline FEV1, FEV1/FVC and RV were 0.98L (44.2% predicted), 47.5% and 4.65 L (241.5%), respectively. The mean follow up duration was 80 days. The mean differences in the FEV1, FVC, TLC and RV were 0.27 L, 0.39 L, -0.69 L and -1.04 L, respectively, during the follow up periods. There was no correlation between the delta FEV1 and delta RV values(r=0.072, p=0.738). CONCLUSION: To appropriately evaluate the lung function in patients with moderate to severe airflow limitations; serial lung volume measurements would be helpful.

Validity of peak expiratory flow for assessing the presence of airflow obstruction / 대한내과학회지

BACKGROUND: Since there has been strong correlation between peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1), assessing the presence of airflow obstruction by PEF measurements would be useful in general practice, but its usefulness has not been well investigated. We hypothesize that PEF would be practicable for assessing the presence of airflow obstruction. METHODS: PEF measurements were performed mini-Wright peak flow meter in 106 patients (aged 19-82) with a history of asthma or chronic obstructive lung disease. The change in PEF (% predicted value) was compared with the change in FEV1 and forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC). Airflow obstruction was analyzed according to European Community for Coal and Steel criteria. When defined as an FEV1 and FEV1/FVC ratio both below the 90% confidence interval of predicted values before bronchodilator. RESULTS: Airflow obstruction was observed in 76.4% (81) of patients. Relative operating characteristic analysis showed that an below in PEF of 60% of predicted value gave optimal discrimination between patients with no airflow obstruction and airflow obstruction (the sensitivity and specificity of below 60% of predicted value in detecting FEV1 and FEV1/FVC ratio both below the 90% confidence interval of predicted values were 86.4% and 83.0% respectively, with a positive predictive value of 94.5%) CONCLUSION: Percentage of predicted value in PEF could be used to diagnose airflow obstruction.