Outcomes of patients treated with Sengstaken-Blakemore tube for uncontrolled variceal hemorrhage

BACKGROUND/AIMS: The aim of this study was to investigate the mortality, bleeding control rate, and their associated predictors in patients treated with Sengstaken-Blakemore (SB) tube for uncontrolled variceal hemorrhage associated with hemodynamic instability or failure of endoscopic treatment. METHODS: The clinical data of 66 consecutive patients with uncontrolled variceal hemorrhage treated with SB tube at Gyeongsang National University Hospital from October 2010 to October 2015 were retrospectively analyzed. RESULTS: The overall success rate of initial hemostasis with SB tube was 75.8%, and the independent factors associated with hemostasis were non-intubated state before SB tube (odds ratio, 8.50; p = 0.007) and Child-Pugh score < 11 (odds ratio, 15.65; p = 0.022). Rebleeding rate after successful initial hemostasis with SB tube was 22.0%, and esophageal rupture occurred in 6.1%. Mortality within 30 days was 42.4%, and the related independent factors with mortality were failure of initial hemostasis with SB tube (hazard ratio, 6.24; p < 0.001) and endotracheal intubation before SB tube (hazard ratio, 2.81; p = 0.018). CONCLUSIONS: Since the era of endoscopic band ligation, SB tube might be a beneficial option as a temporary salvage treatment for uncontrolled variceal hemorrhage. However, rescue therapy had a high incidence of fatal complication and rebleeding.

Severe Upper Gastrointestinal Bleeding in Patients on Antithrombotic Therapy

BACKGROUND/AIMS: As the elderly population taking antithrombotic therapy (ATT) increases, gastrointestinal (GI) bleeding risk during ATT may likely increase. This study was conducted to evaluate the clinical characteristics of severe upper GI bleeding (UGIB) during ATT. MATERIALS AND METHODS: Among patients on ATT at Gyeongsang National University Hospital between March 2005 and February 2010, those with severe UGIB requiring endoscopic hemostasis were selected for the study. Their medical records were retrospectively reviewed for clinical variables. RESULTS: Among 59,773 patients taking ATT, 125 (0.21%) developed severe UGIB and comprised 12.8% of the overall endoscopic hemostasis cases (125/978) during the same period. The patients with severe UGIB on ATT were older than the ones not on ATT (68.3 vs. 59.9 years, P<0.001). The common indications for ATT were cardiovascular (60.8%, 76/125) and cerebrovascular diseases (25.6%, 32/125). Fifty-nine patients (47.2%) were taking two or more agents, 36 (28.8%) were on aspirin monotherapy, while 22 (17.6%) were taking warfarin alone. Aspirin was involved in 68.8% (86/125) of severe UGIB. According to ATT type, the incidence of severe UGIB was 0.48% with warfarin, 0.38% with aspirin, and 0.33% with clopidogrel. The main causes of severe UGIB were gastric (78, 62.4%) and duodenal ulcers (15, 12.0%). UGIB recurred in 11 cases (8.8%), but all were successfully controlled with repeated hemostasis and there was no mortality. CONCLUSIONS: The frequency of severe UGIB during ATT was 0.21%. Aspirin was the most common agent leading to severe UGIB, but its incidence was highest with warfarin. Gastric ulcer was the most common focus. Endoscopic hemostasis was effective and safe for UGIB during ATT.

Conservative Care was Successfully Used to Manage Acute Hepatitis A Infection with Blindness / 대한내과학회지

Hepatitis A is usually a mild, self-limiting illness, but in certain cases it can develop into a severe or fatal disease. The most common symptoms of acute hepatitis A virus (HAV) infection are fever, myalgia, nausea, vomiting, jaundice, and abdominal pain. Extrahepatic symptoms are rare, especially neurologic manifestations. We investigated a 34-year-old male who presented after suffering two days of fever, chills and general myalgia. His condition gradually deteriorated and he developed sudden blindness on day nine. This blindness lasted for 20 min and at this point abnormal brain images were observed. Initial tests for immunoglobulin M anti HAV were negative. These tests were repeated, later confirming acute HAV infection. After conservative management, the individual fully recovered. We report this extremely rare acute HAV infection case with metabolic encephalopathy exhibiting transient blindness.

The Synchronous Prevalence of Colorectal Neoplasms in Patients with Stomach Cancer

PURPOSE: The association between stomach cancer and colorectal cancer is controversial. The purpose of this study was to determine the synchronous prevalence of colorectal neoplasms in patients with stomach cancer. METHODS: A total of 123 patients with stomach cancer (86 male) and 246 consecutive, age- and sex-matched persons without stomach cancer were analyzed from July 2005 to June 2010. All of them underwent colonoscopy within 6 months after undergoing gastroscopy. RESULTS: The prevalence of colorectal neoplasms was significantly higher in the stomach cancer group (35.8%) than in the control group (17.9%) (P < 0.001). Colorectal neoplasms were more prevalent in the patients with stomach cancer (odds ratio [OR], 3.10; 95% confidence interval [CI], 1.71 to 5.63). In particular, the difference in the prevalence of colorectal neoplasms was more prominent in the patients above 50 years old (OR, 3.54; 95% CI, 1.80 to 6.98). CONCLUSION: The results showed that the synchronous prevalence of colorectal neoplasms was higher in patients with stomach cancer than in those without stomach cancer. Therefore, patients with stomach cancer should be regarded as a high-risk group for colorectal neoplasms, and colonoscopy should be recommended for screening.

The Usefulness of the Chronic Obstructive Pulmonary Disease Assessment Test / 결핵및호흡기질환

BACKGROUND: A chronic obstructive pulmonary disease (COPD) assessment test (CAT) has recently been developed as a short and simple method for assessing the quality of life in COPD patients. The object of this study was to assess the usefulness of the Korean version of the CAT for assessing COPD patients in an outpatient clinic. METHODS: The study included 60 COPD patients in a stable state from an outpatient clinic. The authors investigated the frequency of acute exacerbation during aprevious year through reviewing medical records. We evaluated the spirometry test, a 6-min walk distance test, and obtained the MMRC dyspnea scale, the Korean version of the CAT, and the BODE index at the time of visit. To assess the usefulness of the CAT, correlations between the CAT and other methods were evaluated. RESULTS: The mean age of patients was 68.3+/-8.6 years and 95% of patients were male. There was a significant correlation between the CAT score and FEV1% (r=-0.323, p=0.012), the frequency of acute exacerbation (r=0.292, p=0.024), the MMRC dyspnea scale (r=0.554, p<0.001), the BODE index (r=0.380, p=0.003), and 6 MWD (r=-0.372, p=0.004). The mean CAT score increased according to the GOLD stage (stage 1, 10.7+/-4.5; stage 2, 13.1+/-7.9; stage 3, 16.3+/-6.2; stage 4, 16.5+/-14.8; p=0.746). CONCLUSION: The CAT was shown to be useful for the assessment of COPD severity. Therefore, the CAT is an easily applied and simple method for assessing COPD severity in an outpatient clinic.

Bowel Perforation after Erlotinib Treatment in a Patient with Non-Small Cell Lung Cancer

Erlotinib is accepted as a standard second-line chemotherapeutic agent in patients with non-small cell lung cancer who are refractory or resistant to first-line platinum-based chemotherapy. There has been no previous report of bowel perforation with or without gastrointestinal metastases related to erlotinib in patients with non-small cell lung cancer. The exact mechanism of bowel perforation in patients who received erlotinib remains unclear. In this report, we report the first case of enterocutaneous fistula in a female patient with metastatic non-small cell lung cancer 9 months, following medication with erlotinib as second-line chemotherapy.

Late Adverse Reaction to Iodixanol (Visipaque(R)) / 대한내과학회지

Late adverse reactions to iodinated contrast medium are defined as reactions occurring 1 hour to 1 week after contrast medium injection. The majority of late adverse reactions are cutaneous reactions, and include itching, maculopapular rash, urticaria, erythematous patches, and angioedema. We report a patient with an iodixanol (Visipaque(R))-induced late adverse reaction. She was admitted for evaluation of nephrotic range proteinuria and edema. Abdomen and chest enhanced computed tomography was performed as a malignancy work-up. Sixteen hours after radiocontrast exposure, her entire body felt itchy. A maculopapular rash was first detected on her back and abdomen 24 hours after exposure, and spread over her entire body, including her face. Her skin lesions resolved completely in 5 days after administering steroid and antihistamine. We should consider late adverse reactions of iodinated contrast medium when we detect skin lesions late after radiocontrast use.

Late Adverse Reaction to Iodixanol (Visipaque(R)) / 대한내과학회지

Late adverse reactions to iodinated contrast medium are defined as reactions occurring 1 hour to 1 week after contrast medium injection. The majority of late adverse reactions are cutaneous reactions, and include itching, maculopapular rash, urticaria, erythematous patches, and angioedema. We report a patient with an iodixanol (Visipaque(R))-induced late adverse reaction. She was admitted for evaluation of nephrotic range proteinuria and edema. Abdomen and chest enhanced computed tomography was performed as a malignancy work-up. Sixteen hours after radiocontrast exposure, her entire body felt itchy. A maculopapular rash was first detected on her back and abdomen 24 hours after exposure, and spread over her entire body, including her face. Her skin lesions resolved completely in 5 days after administering steroid and antihistamine. We should consider late adverse reactions of iodinated contrast medium when we detect skin lesions late after radiocontrast use.

A Case of a Collision Tumor in the Ampulla of Vater with an Adenocarcinoma and a Large Cell Neuroendocrine Carcinoma / 대한소화기내시경학회지

Most tumors affecting Vater's ampulla are adenocarcinomas, but a neuroendocrine carcinoma in the ampulla of Vater is extremely rare. The coexistence of these two tumors has been reported in only a few cases. Here, we report a rare case of a collision tumor of the ampulla of Vater with an adenocarcinoma and a large cell neuroendocrine carcinoma.