Two Cases of Aspiration Pneumonia after Endoscopic Submucosal Dissection / 대한소화기내시경학회지

The greatest advantage of endoscopic submucosal dissection (ESD) in the stomach is that it can be used to perform en bloc resection of a large gastric neoplasm. However, ESD is more technically difficult and more commonly associated with prolonged procedure time and complications than conventional endoscopic mucosal resection. Until now, only a few reports have considered aspiration pneumonia after ESD, which is rare, but can be fatal. We experienced two cases of aspiration pneumonia after ESD with a gastric neoplasm. One was treated by intensive care with mechanical ventilation, and the other by antibiotics only. Prevention is thought to be important for aspiration pneumonia after ESD; therefore, patients at high risk for aspiration pneumonia are urged to take precautions. We considered various factors contributing to aspiration under endoscopy, such as local pharyngeal anesthesia, procedural time, and bleeding.

Mutations within the interferon sensitivity determining region in Korean patients infected with hepatitis C virus genotype 1b / 대한간학회지

BACKGROUND/AIMS: The treatment response to interferon could differ with mutations in the interferon-sensitivity-determining region (ISDR) in patients infected with hepatitis C virus (HCV) genotype-1b (HCV-Ib). We examined the pattern of ISDR mutations and analyzed whether the number of amino acid substitutions influences the treatment response to peginterferon plus ribavirin in chronic hepatitis or cirrhotic patients infected with HCV-Ib. METHODS: The study population comprised 52 patients who visited Seoul Asan Medical Center and Seoul National University Bundang Hospital from January 2006 to December 2008 and who received peginterferon alpha-2a (n=37) or -2b (n=15) plus ribavirin, and whose serum was stored. We analyzed the early virologic response, end-of-treatment response, and sustained virologic response (SVR), and examined the ISDR using direct sequencing. RESULTS: The proportions of patients with ISDR mutation types of wild (0 mutations), intermediate (1-3 mutations), and mutant (> or =4 mutations) were 50.0%, 42.3%, and 7.7%, respectively, and the corresponding SVR rates were 63%, 50%, and 67% (p>0.05). The SVR rates were 59.4% and 50.0% in patients with or =2 mutations, respectively (p>0.05). On univariate analysis, age was the only predictive factor for SVR (p=0.016). The pretreatment HCV RNA titer tended to be lower in those with SVR, but without statistical significance (p=0.069). CONCLUSIONS: The frequency of ISDR mutations was low in our cohort of Korean patients infected with HCV-Ib. Therefore, ISDR mutations might not contribute to the response to treatment with peginterferon plus ribavirin.

Cavernous hemangioma in the ileum diagnosed at double balloon enteroscopy: A case report / 대한내과학회지

Hemangiomas of the small intestine are uncommon benign tumors, of which 90% present with symptoms such as acute or chronic recurrent gastrointestinal bleeding, while 10% of the cases are asymptomatic. The preoperative diagnosis is challenging. We report a case of ileal hemangioma detected incidentally on abdominopelvic computed tomography (CT). In this case, we performed double balloon enteroscopy to confirm the diagnosis before surgical resection, which helped with the therapeutic plan.

Lymphoepithelial cyst of the pancreas: A case report / 대한내과학회지

Lymphoepithelial cysts of the pancreas, which are lined by squamous epithelium and surrounded by mature lymphoid tissue, represent a rare clinicopathologic entity of cystic lesions of the pancreas and true pancreatic cysts. Here, we report a case of lymphoepithelial cyst of the pancreas and a review of the related Korean literature. A 58-year-old man presented to our hospital with an asymptomatic pancreatic mass and no remarkable medical history except hypertension. Physical examination and laboratory analyses showed no abnormalities. Ultrasonography (US) revealed a cystic lesion with heterogeneous internal echo within the body of the pancreas, and computed tomography (CT) revealed a low-density lesion (2.3*.5 cm) with well-defined margins and lobulating contour. To further characterize the mass, a biopsy was collected via endoscopic ultrasonography (EUS)-guided fine-needle aspiration. Histological examination revealed fibrous tissue and epithelial cells, but was insufficient for a definitive diagnosis. Laparotomy revealed that the mass was composed of keratinizing squamous epithelial cells surrounded by lymphoid tissue, thereby confirming the diagnosis of lymphoepithelial cyst of the pancreas

A Case of Cryptococcal Osteomyelitis with Paraspinal Abscess / 감염과화학요법

Cryptococcosis is a disseminated infection caused by Cryptococcus neoformans. It usually causes pulmonary infection and meningitis in immunocompromised patients. However, osteomyelitis due to C. neoformans is extremely rare. It is generally known that cryptococcal osteomyelitis is a complication of disseminated cryptococcosis, appearing in 5-10%. We experienced a case of cryptococcal osteomyelitis with paraspinal abscess in a liver transplant patient.

A Case of Cryptococcal Osteomyelitis with Paraspinal Abscess / 감염과화학요법

Cryptococcosis is a disseminated infection caused by Cryptococcus neoformans. It usually causes pulmonary infection and meningitis in immunocompromised patients. However, osteomyelitis due to C. neoformans is extremely rare. It is generally known that cryptococcal osteomyelitis is a complication of disseminated cryptococcosis, appearing in 5-10%. We experienced a case of cryptococcal osteomyelitis with paraspinal abscess in a liver transplant patient.