A Rare Case of Coil Migration into the Duodenum after Embolization of a Right Colic Artery Pseudoaneurysm

Transcatheter arterial embolization is a safe and effective treatment for visceral artery aneurysms; nevertheless, some complications can occur. Coil migration to other organs after embolization is extremely rare, and only 16 cases have been reported previously. We report a rare case of coil migration to the duodenal lumen after embolization of a right colic artery pseudoaneurysm. To the best of our knowledge, this is the first case of coil migration after a right colic artery embolization. The patient exhibited no symptoms and was treated conservatively without any intervention. Some previous reports have demonstrated spontaneous coil passage and successful conservative management. Our case supports conservative treatment as the primary treatment for asymptomatic patients. Clinicians should assess the risks and benefits of coil removal in asymptomatic patients before performing any intervention.

Clinical Interpretation of Elevated CA 19-9 Levels in Obstructive Jaundice Following Benign and Malignant Pancreatobiliary Disease / 대한소화기학회지

BACKGROUND/AIMS: Elevated carbohydrate antigen (CA) 19-9 level may be unable to differentiate between benign and malignant pancreatobiliary disease with obstructive jaundice. The study aims to determine the clinical interpretation and the diagnostic value of CA 19-9 level in pancreatobiliary diseases with coexistent obstructive jaundice. METHODS: We retrospectively reviewed the data of 981 patients who underwent biliary drainage due to obstructive jaundice following pancreatobiliary disease at Sanggye Paik Hospital for 5 years. 114 patients with serial follow-up data for CA 19-9 level were included in this study (80 patients with malignancy and 34 patients with benign diseases). We compared the levels of CA 19-9 levels and the biochemical value before and after biliary drainage. RESULTS: The rate of CA 19-9 elevation (>37 U/mL) was significantly different between the benign group and the malignant group (59% vs. 90%, p=0.001). Despite the decrease in serum bilirubin after biliary drainage, CA 19-9 levels remained elevated in 12% of patients in the benign group and in 63% of patients in the malignant group (p<0.001). Finally, 12% of patients in the benign group turned out to have malignant disease. A receiver operating characteristic analysis provided a cut-off value of 38 U/mL for differentiating benign disease from malignant disease after biliary drainage (area under curve, 0.787; 95% confidence interval, 0.703 to 0.871; sensitivity, 62%; specificity, 88%). CONCLUSIONS: This study suggested that we should consider the possibility of malignant causes if the CA 19-9 levels remain high or are more than 38 U/mL after resolution of biliary obstruction.

Non-umbilical Cutaneous Metastasis of Pancreatic Adenocarcinoma as the First Clinical Manifestation: A Case Report / 대한소화기학회지

Non-umbilical cutaneous metastases from pancreatic adenocarcinomas are extremely rare. Only a few cases have been reported in the literature. An 83-year-old Korean woman, with no previous medical history, presented with a painful nodule on her scalp. Histologic examination of the nodule revealed a metastatic adenocarcinoma, and immunohistochemical staining was positive for cytokeratin (CK) 7 and CK 19. These findings were consistent with a metastatic carcinoma of pancreatic origin. An abdominal computed tomography scan identified a mass on the pancreatic head and multiple enlarged lymph nodes. Pathological examination of an endoscopic ultrasound-guided fine needle biopsy of the pancreatic mass determined that it was a poorly differentiated carcinoma. The patient refused any treatment owing to her old age and short life expectancy. Four months later, the disease progressed rapidly, and the patient died.

Prolonged Motor Weakness With Syringomyelia in Japanese Encephalitis: A Case Study

Japanese encephalitis (JE) shows characteristic brain lesions, including bilateral thalamus, midbrain, internal capsule, basal ganglia, and occasionally involves an anterior horn cell. We encountered a case of a 44-year-old man who initially presented with encephalitis, which was finally diagnosed as Japanese encephalomyelitis with syringomyelia. The patient showed severe motor weakness followed by delayed recovery of functional motor activities. Cervical magnetic resonance imaging showed syrinx formation at the C5 level suggesting myelitis, and abnormal electromyographic findings were noted. Clinicians should consider the possibility that the spinal cord may be involved; an example would be syringomyelia due to myelitis in a case of JE presenting with severe and prolonged motor weakness.

Intractable Abdominal Pain in a Patient With Spinal Cord Injury: A Case Report

Patients with spinal cord injury (SCI) may experience several types of chronic pains. Abdominal pain in patients with SCI has gained limited attention and little is yet known about its characteristics and mechanisms. It often has been regarded as visceral pain associated with constipation and distention. Neuropathic pains localized in the abdomen have rarely been reported. We experience a case of intractable abdominal pain in a patient with SCI, neither of visceral pathology nor of musculoskeletal origin. The nature of pain fulfilled the diagnostic criteria for neuropathic pains. The pain was therefore regarded as neuropathic and managed accordingly. The first- and second-line oral drugs available were being performed, unfortunately, adequate pain control was not achieved. We tried an intrathecal lidocaine injection as another treatment option, and the injection had considerable effects.

Management of Severe Bilateral Ptosis in a Patient With Midbrain Infarction: A Case Report

Ptosis could be caused by oculomotor nerve palsy in the midbrain infarction. Bilateral ptosis has been reported in several reports, which focused on clinical characteristics of midbrain infarction. Little research attention has been paid to the treatment of patients with bilateral ptosis in midbrain infarction. We experienced a case of severe bilateral ptosis occurring after midbrain infarction. The patient could not open her eyes, perform basic activities or achieve effective rehabilitation. Neurogenic ptosis can improved after the underlying cause is treated. However, in this case, bilateral ptosis was not improved after conservative care for 6 months and the patient remained limited in activities of daily living and mobility. Surgical correction of bilateral ptosis was done by the resection of both Muller's muscles. After surgical correction, the bilateral ptosis was much improved and the effect persisted for at least 6 months.

Esophageal Ulcer by Thermal Injury from Steamed Egg / 대한소화기내시경학회지

The common causes of esophageal ulcers include severe reflux esophagitis, carcinomas, pill-induced esophagitis, viral diseases, caustic injury, foreign bodies and radiation injury. In rare cases, they can also be caused by Crohn's disease, Behcet's disease, syphilis and idiopathic causes. A thermal injury caused by the ingestion of hot food has not been reported to be a cause of esophageal ulcers. We report an alcoholic who developed an esophageal ulcer and odynophagia after ingesting part of an extremely hot steamed egg with a review of the few available reports regarding such injuries. We suggest that the ingestion of extremely hot food should also be considered a cause of esophageal ulcers.

Mutational Analysis of Growth Differentiation Factor-9 Gene in Korean Women with Premature Ovarian Failure / 대한산부인과학회잡지

The clinical models for studying ovary-determining genes may be premature ovarian failure (POF). POF is a condition causing amenorrhea, hypoestrogenism, and elevated gonadotropins in women under 40 years old. FSH receptor, LH receptor, inhibin, GDF-9 (growth differentiation factor-9), BMP-15 (bone morphogenetic protein-15), DIAPH2 (diaphanous gene) and XPNPEP2 (X-prolyl aminopeptidase) genes were proposed as a possible candidate gene, but until recently, only mutations in FSH receptor, LH receptor and inhibin genes have been identified in POF patients. Therefore mutation screening of another POF gene necessary to reveal the principal causative genes of POF. OBJECTIVE: The present study was performed to analyze the mutation of GDF-9 gene in Korean patient with POF and to investigate whether mutation of these gene is a likely main cause of POF. METHODS: Eighty-six women with POF were studied and thirty-six normal women were enrolled as control. Mutation screening of these genes were performed by denaturing HPLC and were confirmed by automatic sequencing. RESULTS: Three different mutations of GDF-9 gene were identified in Korean women with POF; Arg3Cys mutation in one patient, Leu40Val mutation in one patient, Asp57Tyr mutation in 10 patients and 5 normal controls. Arg3Cys mutation and Leu40Val mutation were likely cause of disease. Frequencies of Arg3Cys mutation and Leu40Val mutation were 1.2%, respectively. Asp57Tyr mutation was common polymorphism in Korean women. All mutations was a novel mutation found in the present study. CONCLUSION: POF was resulted by mutations of GDF-9 gene, but mutations of GDF-9 gene are not likely main causes of POF because of low frequency of mutations.

Effects of Kanagawa Hemolysin on Blood Pressure and Arterial Tone in Rats

Kanagawa hemolysin (KH), an exotoxin produced from Kanagawa phenomenon-positive Vibrio parahemolyticus, has been shown to possess various biological activities including hemolysis, enterotoxicity, cytotoxicity, and cardiotoxicity. The aim of this study was to investigate the effect of KH on the cardiovascular system and its mechanism, employing in vivo and in vitro experiments of the rat. Intracerebroventricular (icv) administration of 100 mHU KH produced a marked and continuous pressor effect (icv KH-pressor effect), and the icv pressor effect was not repeatable. However, intravenous (iv) injection of the same dose of KH induced a prominent depressor effect (iv KH-depressor effect). The icv KH-pressor effect was inhibited by acid-denaturation, while the iv KH-depressor effect was not. Simultaneous icv administration of the three agents (ouabain, diltiazem, or bumetanide: 10ng/kg each) significantly reduced the pressor effect. The icv KH-pressor effect was inhibited by treatment with iv phentolamine or chlorisondamine, but was not affected by iv candesartan. The iv KH-depressor effect was repeatable and was attenuated by treatment with iv NAME or methylene blue. In vitro experiments using isolated thoracic aorta, 10(-6) M phenylephrine (PE) and 50 mM KCl produced a sustained contraction. In rings contracted with either agents, KH showed relaxant responses in a concentration- dependent fashion and the relaxation (KH-vasorelaxation) was not dependent on the existence of the endothelium. The KH-vasorelaxation in the endothelium-intact rings contracted by PE was abolished by methylene blue treatment. In summary, the present findings suggest that in the icv KH-pressor effect the cation leak-inducing action of KH is implicated, which leads to the increased central sympathetic tone, that the iv KH-depressor effect results from the vasorelaxation via NO-guanylate cyclase system, and that the KH-vasorelaxation is independent of the endothelium and the guanylate cyclase system is involved in it. In conclusion, the mechanism of KH producing the icv pressor effect may not be identical to that of KH producing the iv depressor effect.

Analysis of Tumor Angiogenesis in Invasive Cervical Cancer / 대한산부인과학회잡지

OBJECTIVE: Tumor angiogenesis is believed to conelate with tumor growth, progression and metastasis. Studies of angiogenesis in breast, prostate and melanoma have shown that angiogenesis, the induction of new capillaries and venules, is associated with tumor metastases and recurrences. The purpose of this study was to investigate the angiogenesis as a prognostic factor in invasive cervical cancer. METHODS: Forty-three formalin fixed embedded blocks of invasive cervical cancers were examined using immunohistochemical staining with a monoclonal antibody against factor VIII-related antigen. RESULTS: The miaovessel counts were 53.50+/-20,07 in patients with lymph node metastasis, and 45.97+/-28.12 in those without such metastasis. There was a trend for the microvessel count to increase with lymph node metastasis. However, thae was no significant difference in microvessel counts regarding node status. There was no significant difference between microvessel counts in patients with stage I(47.90+/-25.89) and those with stage Il(45.50+/-29.27), The microvessel counts in squamous cell carcinoma(46.54+/-27.79) were not significantly different from those in adenocarcinoma(47,50+/-27.05), The microvessel count in patients with tumor size >-4 cm(53.00+/-21.17) was not significantly higher than in those with tumar size <4 cm(46.20+/-27.94). CONCLUSION: There was no significant correlation between microvessel counts and clinical stage of disease, pathological type, tumor size or lymph node metastasis in patients with invasive cervical cancer. There was a trend for the microvessel count to increase with lymph node etastasis.

A Case of Unsuspected Malignant Melanoma of the Choroid

The authors presented a case of malignant melanoma of the choroid which had been unsuspected clinically. The patient, 38-year-old female, came to Korea General Hospital on Dec. 5-1973 because of blind painful eye and white pupil in the left side. And she was told at local clinic that she had retinal detachment in that eye about 3 years ago. We thought of this case as secondary glaucoma due to swollen lens behind at first. Therefore cryoextraction of the lens was performed for relieving the ocular pain, on Dec. 5-1973. Increased I.O.P., however, had been persisted and ocular pain had not been improved until the patient entered this hospital again on Jan. 25-1974. Enucleation was performed and choroidal malignant melanoma (spindle type) was proven by histopathological study. The patient was instructive to us that we should always remind the possibilities of intraocular tumor behind the opaque media, in cases of unilateral glaucomatous blind eye with shallow anterior chamber.

A Case of Ocular Cysticercosis

A case of ocular cysticercosis which was successfully treated by surgical removal was presented in a 43-year-old man. Intractable diplopia and localized palpable mass in the nasal portion of the right upper eyelid were his chief complaints, that had been persisted for about 6 months. It was interesting that there were several episodes of dramatic improvement of those symptoms, and this delayed the decision of surgical treatment and its diagnosis.

Two Cases of Stevens-Johnson Syndrome

The authors presented two cases of Stevens-Johnson syndrome in each 27-and 30-year old male, aad the review of the literature was given. In both patients, there were acute onset of fever followed by erythematous and bullous lesions on the skin and involvement of the mucous membranes, including the eyes. Ocular manifestations were those of pseudomembranous form such as severe conjunctivitis with conjunctival scarring, symblepharon, and superficial punctate corneal opacity. Although there left mild superficial punctate opacity of the cornea. visual acuity was almost unchanged in case I. However, in case II, the patient continued to complain of disabling photophobia and severe irritation possibly due to punctate corneal infiltrations and conjunctival dryness. We considered that decreased conjunctival and lacrimal secretion caused by conjunctival scarring had contributed to keratitis. In this patient, the vision was also decreased in some degree.