A case of acute hepatitis caused by ingesting Dictamnus dasycarpus / 대한내과학회지

Few cases of hepatitis related to Chinese medicine have been reported in Korea. In such instances, since herbal medicines contain many ingredients, the component that causes the hepatitis to develop is unclear. A 55-year-old man was admitted with sudden-onset jaundice after taking the herbal medicine Dictamnus dasycarpus. The patient had consumed 70 g of alcohol daily and stopped drinking about a month earlier. The physical examination revealed no abnormalities other than scleral icterus. The patient's blood chemistry showed a total bilirubin of 16.0 mg/dL, an ALP of 288 IU/mL, an AST of 1,369 IU/L, and an ALT of 1,660 IU/L. The viral studies were all negative. A liver biopsy showed acute cholestatic hepatitis superimposed on chronic alcoholic fibrosis. This case suggests the development of hepatitis due to an herbal medicine (Dictamnus dasycarpus). Moreover, we recently experienced a case of acute hepatitis that developed after the consumption of Dictamnus dasycarpus.

Anorectal Symtoms and Anorectal Pathophysiologic Findings in Patients with Levator Ani Syndrome and Protalgia Fugax / 대한소화관운동학회지

BACKGROUND/AIMS: Two most common functional anorectal pains, levator ani syndrome and proctalgia fugax, have a significant overlap in diagnosis and a controversy in pathogenic mechanism. Our aim was to evaluate the differences of anorectal symptoms and physiologic findings between the patients with levator ani syndrome and proctalgia fugax. METHODS: Eight patients and 10 patients, who fulfilled Rome II criteria for levator ani syndrome and proctalgia fugax respectively, were evaluated for the various anorectal symptoms using questionnaire and diary, anorectal manometry, balloon defecation, and defecography. RESULTS: Compared with patients with proctalgia fugax, the patients with levator ani syndrome showed higher percentage of symptoms of straining (87.5+/-30.6% vs. 40.5+/-44.9%, p<0.05), and tended to have higher percentage of the sensation of incomplete evacuation (88.1+/-26.4% vs. 53.0+/-41.9%, p=0.056). In anorectal manometric findings, squeezing pressure of the distal anal sphincter tended to be higher in patients with levator ani syndrome (201.7+/-127.7 mmHg vs. 113.0+/-43.9 mmHg, p=0.056). CONCLUSIONS: Levator ani syndrome may be related to the constipation and hyper-contractile external anal sphincter, suggesting that different mechanisms may play a role in the development of anorectal pains in patients with levator ani syndrome and proctalgia fugax.

Neurologic Sequelae Following Spinal Anesthesia / 대한마취과학회지

Spinal anesthesia is a safe anesthetic technique and relative easy to perform, but occasionally neurologic injuries after spinal anesthesia have been reported. A 53-year old female patient visited the emergency room due to abdominal pain and she was diagnosed with acute appendicitis. Thus, an emergent appendectomy was planned. During the preoperative evaluation, we noticed that she had a history of intermittent low back pain for the previous 5 years. However, because her stomach was not fully empty, we decided to administer spinal anesthesia. When the spinal needle passed the subarachnoid membrane, she suddenly complained of severe paresthesia on her right posterior thigh. However the parethesia subsided soon, and 2.2 cc of 0.5% bupivacaine was injected via a spinal needle, and aftewards, an appendectomy was done without any complications. As she recovered from the spinal anesthesia, she started complaining of shooting, stabbing and burning pain on her right buttock and posterior thigh Because a neurologic injury after spinal anesthesia was suspected, we inserted an epidural catheter to the same lumbar vertebral level for administering the mepivacaine and ketamine mixture and we also performed a right second sacral nerve root block and a lumbar sympathetic ganglion block. Magnetic Resonance Imaging showed spondylosis of lumbar spine and associated disc degeneration and a bulging disc at the L3-4, L4-5 and L5-S1 level. After treatments, her symptoms improved gradually. When she was discharged on the 16th hospital day, she complained of only minor discomfort on her right posterior thigh.

A Case Report of Intestinal Anisakiasis / 대한소화기내시경학회지

Anisakiasis refers to the infestation of humans by species of marine nematode larvae belonging to the subfamily Anisakiae. An acute abdominal symptom may occur after ingestion of raw marine fish containing nematode larvae of the genus Anisakis. Migration of the parasite into the wall of gtomach, small intestine or, less commomly, the colon elicits a striking eosinophilic granulomatous tissue response. A 39 year old man was visited St. Vincent Hospital because of abdominal distension and tenderness. The plain abdominal X-ray showed ileus pattern suggesting intestinal obstruction. Hence we presented a case of intestinal Anisakiasis combined with intstinal obstruction.