Clinical Outcomes and Risk Factors of Rebleeding Following Endoscopic Therapy for Nonvariceal Upper Gastrointestinal Hemorrhage

BACKGROUND/AIMS: Rebleeding after endoscopic therapy for non-variceal upper gastrointestinal hemorrhage (NGIH) is the most important predictive factor of mortality. We evaluated the risk factors of rebleeding in patients undergoing endoscopic therapy for the NGIH. METHODS: Between January 2003 and January 2007, 554 bleeding events in 487 patients who underwent endoscopic therapy for NGIH were retrospectively enrolled. We reviewed the clinicoendoscopical characteristics of patients with rebleeding and compared them with those of patients without rebleeding. RESULTS: The incidence of rebleeding was 21.7% (n=120). In the multivariate analysis, initial hemoglobin level < or =9 g/dL (p=0.002; odds ratio [OR], 2.433), inexperienced endoscopist with less than 2 years of experience in therapeutic endoscopy (p=0.001; OR, 2.418), the need for more 15 cc of epinephrine (p=0.001; OR, 2.570), injection therapy compared to thermal and injection therapy (p=0.001; OR, 2.840), and comorbidity with chronic renal disease (p=0.004; OR, 2.908) or liver cirrhosis (p=0.010; OR, 2.870) were risk factors for rebleeding following endoscopic therapy. CONCLUSIONS: Together with patients with low hemoglobin level at presentation, chronic renal disease, liver cirrhosis, the need for more 15 cc of epinephrine, or therapy done by inexperienced endoscopist were risk factors for the development of rebleeding.

An adrenal gland abscess after N-butyl-2-cyanoacrylate (Histoacryl(R)) injection therapy for gastric varices bleeding / 대한내과학회지

N-butyl-2-cyanoacrylate (Histoacryl(R)) is used to obtain hemostasis in gastric variceal bleeding. Known complications of Histoacryl(R) injection therapy include bleeding, perforation, stenosis, and embolism. We report a case of adrenal abscess as a very rare complication of Histoacryl(R) injection. A 40-year-old male with liver cirrhosis was admitted with acute gastric variceal bleeding. Sclerotherapy using Histoacryl(R) mixed with lipiodol (3 mL) was successful. Twenty-seven months later, he was readmitted complaining of left flank pain and a fever of 39degreesC. Abdominal computed tomography (CT) showed a heterogeneous enhancing solid and cystic mass (6.1x3.0 cm) at the left adrenal gland. A left adrenalectomy was performed and the pathological examination confirmed a Histoacryl(R)-related adrenal abscess. We present this case along with a brief review of the literature

Measurement of hepatic venous pressure gradient in liver cirrhosis: Relationship with the status of cirrhosis, varices, and ascites in Korea / 대한간학회지

BACKGROUND/AIMS: The relationships between the hepatic venous pressure gradient (HVPG) and the status of cirrhosis, complications of portal hypertension and the severity of cirrhosis are not clear. The aim of this study was to determine the relationships between HVPG and the complications or status of cirrhosis. METHODS: The HVPG, gastroesophageal varices, Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, presence of ascites, recent bleeding history and the status of cirrhosis were assessed in a cohort of 172 patients (156 males, 16 females) with liver cirrhosis. RESULTS: The HVPG was 15.6+/-5.1 (mean+/-SD) mmHg (4-33 mmHg) and was significantly higher in patients in the decompensated stage than in those in the compensated stage (16.6+/-4.3 vs. 10.8+/-6.1 mmHg, respectively; P0.05). HVPG was significantly higher in Child's B cirrhosis (n=87, 15.6+/-4.7 mmHg) and Child's C cirrhosis (n=36, 18.4+/-4.7 mmHg) than in Child's A cirrhosis (n=49, 13.7+/-5.1 mmHg; P<0.01). HVPG also was strongly correlated with the MELD score (P<0.01). The time required to measure the HVPG was 11.2+/-6.4 min, and only three cases of minor complication occurred during the procedure. CONCLUSIONS: HVPG was correlated with the severity of liver cirrhosis, presence of ascites, and risk of variceal bleeding in patients with liver cirrhosis.

A Case of Successful Closure using Endoscopic Hemostatic Clips with a Detachable Snare and Fibrin Glue Injection for a Gastro-Cutaneous Fistula following Buried Bumper Syndrome / 대한소화기내시경학회지

The buried bumper syndrome is a well-recognized long-term complication of a percutaneous endoscopic gastrostomy (PEG). Most of the buried bumpers are removed by making an external incision over the PEG site under local anesthesia or during a laparotomy. Recently, endoscopic removal is usually attempted. While the removal of the PEG tube is usually followed by spontaneous closure of the gastrostomy tract, a non-healing gastro-cutaneous fistula is difficult to manage. The fistula is generally treated with bowel rest and total parenteral nutritional support, suppression of gastric acid secretion, and occasionally, surgical exploration and wedge excision of the fistula site are performed. However, in debilitated patients, surgical management is accompanied with high morbidity and mortality. Recently, the use of nonsurgical alternative methods, such as endoscopic therapy using tissue adhesives or hemostatic clips, has emerged with recent advances in endoscopic technology. We report a case of successful closure using endoscopic hemostatic clips with a detachable snare and fibrin glue injection for a gastro-cutaneous fistula following buried bumper syndrome.

Two Cases of Benign and Malignant Lesion Caused Ileocolic Intussusception: Preoperative Colonoscopic Reduction was Attempted for These Patients / 대한소화기내시경학회지

In contrast to the idiopathic cause of intussusception in children, adult intussusception in most patients is associated with organic causes. The majority of these patients are brought to the operating room with the preoperative diagnosis of bowel obstruction, and the surgeon discovers an intussusception intraoperatively. But the increasing use of abdominal CT may improve the ability to diagnose intussusception. There is no universal agreement upon the correct treatment of adult intussusception, although most authors agree that surgical intervention is necessary. In the more recent reports, colonoscopic reduction of intussusception has been reported for selected patients. For patients in whom the involved ileum is extremely long, it is advisable to attempt an operative reduction or colonoscopic reduction selectively. Thus, we report here on two patients with benign and malignant lesion, respectively, that caused ileocolic intussusception; preoperative colonoscopic diagnosis and reduction were attempted for these patients, although the patients were not reduced by colonoscopic procedure.

A Case of Small Bowel Obstruction due to a Mushroom Bezoar / 대한소화기내시경학회지

A mushroom bezoar is an unusual type of bezoar and a rare cause of small bowel obstruction, with the only cases being previously described in the foreign literature. Common sites of obstruction are the gastric outlet, the terminal ileum as well as segments of pre-existing gastrointestinal stenosis of various etiologies. Predisposing factors include a high fiber intake, inadequate chewing, gastric hyposecretion and hypomotility, and a previous gastrectomy and vagotomy. Computed tomography has the capability of directly showing the bezoar and displaying the resulting small bowel obstruction. We report a case of incomplete small bowel obstruction in a 38-year-old woman, caused by a mushroom bezoar in the terminal ileum.

Deep Venous Thrombosis and Heterotopic Ossification in the Patients with Traumatic Spinal Cord Injury

OBJECTIVE: To investigate the incidence, time of onset, and risk factors of deep vein thrombosis asssociated with heterotopic ossification in patients with spinal cord injury. METHOD: The medical records of 201 patients with spinal cord injury were reviewed. Duplex ultrasound and/or venography were used for the diagnosis of deep vein thrombosis and 3 phase bone scan and/or plain radiologic studies were used for the diagnosis of heterotopic ossification. RESULTS: Whereas the incidence of heterotopic ossification and deep vein thrombosis in this population were 10.0% and 4.5%, respectively, 55.5% of the individuals with deep vein thrombosis developed heterotopic ossification. The overall incidence of coexistence of deep vein thrombosis and heterotopic ossification was 2.5%. The significant difference between the occurrence of heterotopic ossification and deep vein thrombosis in this SCI population reached statistical significance (Fisher's exact test p<0.005). CONCLUSION: The results of this study suggest that there exists an association between the occurrence of deep vein thrombosis and heterotopic ossification following SCI.

A Study of Standards and Norms Used for Electrodiagnosis in Korea

In clinical settings, electrodiagnosis is used for the differential diagnosis of neuropathy and myopathy, as well as detremining severity and localization of lesions in the neuromuscular system. By many authors, various methods of the study and factors influencing the results were verified so far. However, the results vary according to methods or influencing factors during electrodiagnostic studies. Since there has been no standardization in methods of the study and study environment, we sometimes feel difficulties in interpretation of study results and in exchage of findings of study among laboratories. In this study, we have collected standards and norms used by different electrodiagnostic laboratories in Korea, hoping that we can come up with one nationwide standards and norms in Korea.

Recent Results of Quantitative Culture and Sensitivity Test of Urine / 대한비뇨기과학회지

This paper is presented to report the results of urinary quantitative culture and sensitivity tests of certain antibiotics. Studies were done on 331 cases from the Department of Urology. Woo Sok University Medical College Hospital during the period from May 1962 up to September 1970. 1) Urine specimens from 331 cases were cultured and, of these, 115 cases grew micro-organism while the remaining 216 cases showed no growth. Among the 115 cases, 84 cases(73%) revealed significant bacteriuria with counts over 10s/ml. colonies in urine while 31 cases(27%) were below 10(5)/ml. 2) Only 74 cases(88. 1%) among the 84 cases with significant bacteriuria could the bacteria be identified after centrifuging the specimens and doing a smear and Gram stain. 68 cases(81%) of the total 84 significant bacteriuria cases had shown urinary leukocyte count of more than 4/HPF while 16 cases(19%) were below 4/HPF. 3) 77 cases(92%) of the total 84 cases with significant bacteriuria had Gram negative bacilli while 4 cases had Gram positive cocci by direct smear. 4) There were no significant differences between male and female patients in colony counts except the female group revealed some preponderance of E. coli. 5) In the sensitivity testing if the cultured significant bacteriuria in the group with Gram negative bacilli, 36 cases(49.3%) were sensitive to Kanamycin and 22 cases(30.1%) were resistant, while all cases were resistant to leucomycin and only one case was sensitive to penicillin among the total 73 cases of Gram negative bacilli cultured.