Risk Factors for Local Recurrence of Early Gastric Cancer after Endoscopic Submucosal Dissection / 대한내과학회지

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is a widely accepted method of treatment for early gastric cancer (EGC) without lymph node metastasis. However, there have been few studies about factors associated with local recurrence. The aim of our study was to evaluate the risk factors for local recurrence in patients with EGC after ESD. METHODS: We retrospectively analyzed medical records of patients who underwent ESD of EGC at Gachon University Gil Medical Center. From February 2008 to July 2011, ESD for EGC was performed in 222 cases involving 214 patients. Patients with additional treatment after ESD, patients with recurred EGC, and patients with endoscopic follow-up of < 12 months were excluded. After exclusions, a total of 150 cases were included. RESULTS: The mean age of the patients was 63.9 +/- 9.8 years, and 74.3% were male. The en bloc resection rate was 139/150 (92.7%), and the complete resection rate was 131/150 (87.3%). Local recurrence at the ESD site was found in 5 cases (5/150, 3.3%) during a mean follow-up period of 24 months. In multivariate analysis, tumor involvement at the lateral resection margin [HR: 13.12 (1.19 - 145.10); p = 0.036], piecemeal resection [HR: 25.31 (1.24 - 517.57); p = 0.036], and lymphovascular invasion [HR: 485.06 (2.30 - 102449.79); p = 0.024] were associated with local recurrence after ESD. CONCLUSIONS: Local recurrence after ESD was significantly associated with involvement of the lateral resection margin, piecemeal resection, and lymphovascular invasion. Therefore, patients who have these risk factors should be followed up more carefully to detect local recurrence.

Spontaneous Healing of Gastric Perforation after Endoscopic Ligation for Gastric Varices

Endoscopic variceal ligation (EVL) can be performed as an optional therapy for gastric variceal bleeding if endoscopic sclerotherapy (ES) is not readily available or if practitioners lack experience. EVL using an endoscopic pneumo-activated ligating device was performed on a 53-year-old male patient with liver cirrhosis who presented with hematemesis. Follow-up esophagogastroduodenoscopy (EGD) performed two days after the EVL showed gastric perforation at the EVL-procedure site on the gastric fundus. However, the patient refused emergency surgery, and therefore received only supportive management, including intravenous antibiotics. EGD 10 days later showed healing of the perforation site. This is the first report of a case of gastric variceal bleeding with development of a gastric perforation soon after EVL, which showed complete recovery with conservative therapy and without surgical intervention.

A brain abscess caused by Porphyromonas gingivalis / 대한내과학회지

Porphyromonas gingivalis is a gram-negative, anaerobic, rod-shaped bacterium originally classified within the Bacteroides genus, and a major etiological agent in the initiation and progression of severe periodontal disease. P. gingivalis has occasionally been involved in otitis media, lung abscesses, gas gangrene, appendicitis, sinusitis, paranasal mucocele, peri-tonsillar abscesses, pleura-pulmonary infections, and thoracic empyema. We report the case of a 44-year-old male who presented with a brain abscess in which the organism, presumably originated from his poor dentition. He was successfully treated with surgical drainage and antibiotics.

A brain abscess caused by Porphyromonas gingivalis / 대한내과학회지

Porphyromonas gingivalis is a gram-negative, anaerobic, rod-shaped bacterium originally classified within the Bacteroides genus, and a major etiological agent in the initiation and progression of severe periodontal disease. P. gingivalis has occasionally been involved in otitis media, lung abscesses, gas gangrene, appendicitis, sinusitis, paranasal mucocele, peri-tonsillar abscesses, pleura-pulmonary infections, and thoracic empyema. We report the case of a 44-year-old male who presented with a brain abscess in which the organism, presumably originated from his poor dentition. He was successfully treated with surgical drainage and antibiotics.

Klebsiella pneumoniae Multi-organ Infection not Accompanied by Liver Abscess : Report of 2 Cases / 감염과화학요법

Klebsiella pneumoniae is a pathogen that causes a wide range of infections in human, and has a tendency to metastasize to multiple organs. We report two rare cases of K. pneumoniae infection that have spread to multiple organs without being accompanied by liver abscess. A 59-year-old man (case 1) was admitted due to left knee pain. Microbiologic and radiologic studies revealed bacteremia, septic arthritis, pneumonia, prostatitis, and endophthalmitis caused by K. pneumoniae. A 48-year-old man (case 2) was admitted due to febrile sensation. Microbiologic and radiologic studies revealed bacteremia, pneumonia, urinary tract infection, endophthalmitis, and cerebritis caused by K. pneumoniae. With appropriate use of effective antibiotics and therapeutic measures, the patients recovered but with some sequelae.

A Case of Humeral Osteomyelitis and Soft Tissue Abscess Accompanied with Streptococcus anginosus Bacteremia / 감염과화학요법

Streptococcus anginosus is a normal flora found in multiple body sites and belongs to the Streptococcus milleri group. It has often been associated with pyogenic infection, such as perio-dontitis, endocarditis, pulmonary abscess and abdominal or cerebral abscess. Also uncommonly, it can cause osteomyelitis. A 42-year-old man was admitted due to gastric ulcer perforation. At 12th hospital day, left humeral osteomyelitis and soft tissue abscess developed. Streptococcus anginosus grew in blood culture. He was treated with intravenous penicillin and surgical debridement of the necrotic tissue which lead to a satisfactory result. We report a rare case of Streptococcus anginosus-induced humeral osteomyelitis and soft tissue abscess.

A Case of Vertebral Osteomyelitis with Spinal Epidural Abscess Caused by Streptococcus constellatus / 감염과화학요법

We report a case of vertebral osteomyelitis with epidural abscess caused by Streptococcus constellatus. The patient was present with fever, back pain, and dyspnea for 1 week. The patient was previously healthy and did not have any predisposing factor. After evaluation, the patient was diagnosed as Streptococcus constellatus vertebral osteomyelitis. He was successfully treated with surgical debridement and antibiotic therapy. To the best of our knowledge, this is the first case of S. constellatus vertebral osteomyeltis with epidural abscess to be reported in Korea.

Klebsiella pneumoniae Multi-organ Infection not Accompanied by Liver Abscess : Report of 2 Cases / 감염과화학요법

Klebsiella pneumoniae is a pathogen that causes a wide range of infections in human, and has a tendency to metastasize to multiple organs. We report two rare cases of K. pneumoniae infection that have spread to multiple organs without being accompanied by liver abscess. A 59-year-old man (case 1) was admitted due to left knee pain. Microbiologic and radiologic studies revealed bacteremia, septic arthritis, pneumonia, prostatitis, and endophthalmitis caused by K. pneumoniae. A 48-year-old man (case 2) was admitted due to febrile sensation. Microbiologic and radiologic studies revealed bacteremia, pneumonia, urinary tract infection, endophthalmitis, and cerebritis caused by K. pneumoniae. With appropriate use of effective antibiotics and therapeutic measures, the patients recovered but with some sequelae.

A Case of Humeral Osteomyelitis and Soft Tissue Abscess Accompanied with Streptococcus anginosus Bacteremia / 감염과화학요법

Streptococcus anginosus is a normal flora found in multiple body sites and belongs to the Streptococcus milleri group. It has often been associated with pyogenic infection, such as perio-dontitis, endocarditis, pulmonary abscess and abdominal or cerebral abscess. Also uncommonly, it can cause osteomyelitis. A 42-year-old man was admitted due to gastric ulcer perforation. At 12th hospital day, left humeral osteomyelitis and soft tissue abscess developed. Streptococcus anginosus grew in blood culture. He was treated with intravenous penicillin and surgical debridement of the necrotic tissue which lead to a satisfactory result. We report a rare case of Streptococcus anginosus-induced humeral osteomyelitis and soft tissue abscess.

A Case of Vertebral Osteomyelitis with Spinal Epidural Abscess Caused by Streptococcus constellatus / 감염과화학요법

We report a case of vertebral osteomyelitis with epidural abscess caused by Streptococcus constellatus. The patient was present with fever, back pain, and dyspnea for 1 week. The patient was previously healthy and did not have any predisposing factor. After evaluation, the patient was diagnosed as Streptococcus constellatus vertebral osteomyelitis. He was successfully treated with surgical debridement and antibiotic therapy. To the best of our knowledge, this is the first case of S. constellatus vertebral osteomyeltis with epidural abscess to be reported in Korea.