A Case of Malabsorption Induced by Blind Loop Syndrome in a Patient with Liver Cirrhosis / 대한내과학회지

Of the various causes of malabsorption, to our knowledge, blind loop syndrome has been reported in Korea only rarely. Here, we report the case of a 63-year-old woman with hepatitis C virus-associated liver cirrhosis. The patient complained of abdominal distension and had an abnormal serum biochemistry caused by blind loop syndrome related to childhood abdominal surgery. Her laboratory findings showed an iron deficiency anemia, hypocholesterolemia, hypoproteinemia and hypoalbuminemia, and were confounded with those of liver cirrhosis. She underwent resection of the blind loop segment of the small intestine, after which her abdominal symptoms and abnormal laboratory findings improved, although they did not completely normalize due to her liver cirrhosis.

Clinical characteristics and the risk factors for rebleeding in patients with bleeding peptic ulcer / 대한내과학회지

BACKGROUND/AIMS: Bleeding is a serious complication of peptic ulcer. Although endoscopic therapy is effective for achieving hemostasis of active bleeding, rebleeding occurs in 10~30% of these patients. Recently, treatment with proton pump inhibitor (PPI) after hemostasis has decreased the rate of rebleeding. In this study, we analyzed risk factors of peptic ulcer rebleeding and we evaluated whether the rebleeding rate could be different depending on the PPI treatment method. METHODS: From March 2003 through February 2006, 639 patients visited the emergency room (ER) due to gastrointestinal hemorrhage. Among them, 191 patients were diagnosed to have peptic ulcer by endoscopy, and they were retrospectively analyzed for their clinical, laboratory and endoscopic findings. The PPI treatment method was categorized into the IV bolus group, the 8 mg/hr continuous infusion group and the others group. RESULTS: Emergency endoscopy was performed within 24 hours in 86.9% of the patients with bleeding peptic ulcer. Rebleeding occurred in 9 cases (4.7%) within 7 days after hemostasis. On the basis of univariate analysis, shock on ER arrival (p=0.013) and over 5 units of packed red cells (PRCs) transfusion (p=0.016) were significant risk factors for rebleeding, yet the PPI treatment method did not affect the rate of rebleeding. CONCLUSIONS: The rebleeding rate of peptic ulcer in our study was 4.7%, and this was lower than the previous reports, and the rebleeding rate in our report may have been caused by the early hemostatic therapy together with intravenous infusion of PPI. These approaches are necessary as soon as the patients are stabilized, and especially for the group of patients who are at a high risk for rebleeding, such as those who experience shock at the ER and those who need over 5 units of PRC transfusion.

A case of overwhelming postsplenectomy infection with purpura fulminans by Streptococcus pneumoniae / 대한내과학회지

The most serious problem after splenectomy is the increased risk of life-threatening infections caused by encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. Purpura fulminans, which is commonly associated with meningococcal sepsis, is characterized by disseminated intravascular coagulation and rapidly progressive purpuric skin lesions. Purpura fulminans can also develop in invasive pneumococcal infection especially after splenectomy, however, there has been no report in Korea. We report a case of overwhelming pneumococcal sepsis manifested as purpura fulminans in a splenectomized patient.

The Role of Respiratory Viral Infections in Exacerbation of Asthma and Chronic Obstructive Pulmonary Disease (COPD) / 결핵및호흡기질환

BACKGROUNDS: The exacerbations of asthma and chronic obstructive pulmonary disease (COPD) have been suggested to be associated with respiratory tract viral infections (RTVIs). However, the rates of virus detection in previous studies have been quite variable, with lower rates for the exacerbation of COPD. Therefore, the virus detection of patients with exacerbation of asthma and COPD were investigated. METHODS: 20 and 24 patients with exacerbation of asthma and COPD, respectively, were enrolled. Nasal and sputum samples were taken, and polymerase chain reaction (PCR) for rhinovirus and coronavirus and virus culture for influenza A, B, RSV and parainfluenza virus performed. RESULTS: The mean FEV1/FVC in the exacerbation of asthma and COPD patients were 1.9/2.9 L (65.5%) and 1.1/2.6 L (42.3%), respectively. Respiratory virus was detected in 13 (65%) patients with exacerbation of asthma and rhinovirus was detected in 9. Coronavirus, influenza A, RSV and parainfluenza virus were detected in 2, 2, 1 and 1 patients with asthma. Among patients with exacerbation of COPD, a virus was detected in 14 (58.3%) patients, with rhinovirus, coronavirus and influenza A detected in 10, 3 and 4, respectively. CONCLUSIONS: This study suggested that RTVIs may have a role in the exacerbation of COPD as well as asthma.

A Case of Spontaneous Perforation of the Common Bile Duct Associated with Cholangitis / 대한소화기학회지

Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.

A Case of Hashimoto's Thyroiditis with Transient T3-Thyrotoxicosis Induced by Hydatidiform Mole / 대한내분비학회지

Human chorionic gonadotropin(HCG) is a member of the glycoproteins family synthesized by the placenta, which consists of 2 noncovalently joined subunits(alpha(alpha) and beta(beta)). The alpha- and beta-subunits have a structural homology with the alpha- and beta-subunits of TSH and LH. The thyrotropic action of HCG results from its structural similarity to TSH, so beta-HCG can bind to the TSH receptor in the thyroid gland. A high level of HCG accompanied by an increased thyroid hormone level, can be observed in gestational trophoblastic disease (GTD), such as a hydatidiform mole or a choriocarcinoma, but the clinical symptoms of hyperthyroidism are rarely observed. We experienced a case of Hashimoto's thyroiditis, where the patient was diagnosed with T3-thyrotoxicosis, which had initially been induced by excess beta-HCG due to an H-mole; after evacuation of the H-mole, the condition was diagnosed as hypothyroidism. It has been speculated that a patient with Hashimoto's thyroiditis could have hyperthyroidism, induced by beta-HCG, due to an H-mole

A Case of Retroperitoneal Schwannoma of the Vagus Nerve / 대한소화기학회지

Schwannomas are benign nerve sheath tumors that originate from any anatomical site. Most schwannomas occur in the head, neck or limbs, but rarely occur in the retroperitoneal space. Furthermore, the schwannoma originating from the vagus nerve of retroperitoneal space is much rare. We experienced a case of retroperitoneal schwannoma of the vagus nerve. A 34-year-old male was refered to our hospital for the evaluation of abdominal mass on ultrasonography. Endoscopic examination revealed submucosal tumor-like lesion on high body of the stomach. Computed tomography (CT) revealed that the stomach was compressed by a solid tumor in the retroperitoneum. On exploratory laparotomy, this mass turned out to be a baseball sized mass in the retroperitoneal space. The mass was excised in an encapsulated state. Histological examination with immunohistochemical stains revealed a schwannoma of the vagus nerve.

Coronary Artery Size in Korean: Normal Value and its Determinants

BACKGROUND AND OBJECTIVES: Although the size of the coronary artery is known to be closely related to the outcome of coronary artery bypass grafting and percutaneous coronary intervention, its normal value and determinants have not been examined in Koreans. SUBJECTS AND METHODS: One hundred and twenty seven normal coronary arteriograms were carefully selected from 3,412 studied consecutively. Of these, 53 women and 23 men, with no abnormalities in their cardiac function and not using nitrates, were studied. The lumen diameter was measured at 10 segments in the epicardial coronary arteries. RESULTS: For men, the mean lumen diameter of the proximal left anterior descending and left circumflex coronary arteries were 3.88+/-0.39 and 3.45+/-0.47 mm, respectively, and were not affected by the anatomic dominance. However, the left main and proximal right coronary arteries varied between 4.44+/-0.49 and 5.18+/-0.32 mm (p<0.05) and 3.29+/-0.60 and 4.05+/-0.42 mm (p<0.05), respectively, by the anatomic dominance. Women had a smaller mean coronary artery size than men [for diameter, -7% (p<0.01);for cross-sectional area, -13% (p<0.01)], and the left ventricular (LV) mass was significantly associated with coronary artery diameter (p<0.05). From a multiple linear regression analysis, gender was an only independent predictor of the coronary artery size (p<0.05). CONCLUSION: We revealed normal coronary artery dimensions in Koreans. Although, body size, hypertension, use of calcium channel blockers, anatomic dominance and age had no effect on the size of the coronary artery, but the LV mass and gender were shown to have an effect. The multivariate regression analysis showed gender was an only independent predictor of the coronary artery size.

Prevalence and Risk Factors of Silent Cerebral Infarction in Normal Adults: Single Institute Study

BACKGROUND: Silent cerebral infarcts (SCI) are commonly seen in the elderly and are associated with clinically apparent stroke and vascular dementia. Known cardiovascular risk factors, such as arterial hypertension, diabetes mellitus, smoking, hypercholesterolemia and heart disease may increase the risk of SCI. We investigated the prevalence of, and risk factors for, SCI in an apparently normal adult population. METHODS: Two hundred eighty seven neurologically normal adults (mean age, 51.3 +/- 10.4; 145 men) underwent brain magnetic resonance imaging (MRI) at the Center for Health Promotion at Kangnam St. Mary Hospital and cardiovascular risk factors were assessed by interview and physical examination. We performed chi-square test and 2-sample t-test for univariate analysis and multiple logistic regressions for multivariate analysis to evaluate the prevalence and risk factors of SCI. RESULTS: SCI lesions were observed in 84 subjects (29.8%). Univariate analysis showed that old age, hypertension and abnormal pulmonary function tests were associated with SCI. Old age (over 55) (OR 4.521; 95%CI, 2.631~7.768), and an abnormal pulmonary function test (OR, 3.100; 95%CI, 1.267~7.587) were demonstrated to be independent risk factors for SCI on multivariate analysis. CONCLUSIONS: Silent brain infarcts commonly affect the elderly, especially those over 55. Old age, hypertension, and abnormal pulmonary function tests are associated with SCI.

Analysis of the Nursing Interventions Performed by Home Health Care Nurses in a Hospital: An Application of NIC / 성인간호학회지

The purpose of the study was to investigate the characteristics of the clients registered in the department of home health care nursing in a hospital and to analyze nursing intervention activities recorded in charts by application of Nursing Intervention Classification (NIC) system. For the descriptive survey study, data were collected by reviewing charts of 572 home health care clients between May, 1997 and July, 2000 at K hospital in Seoul. The average age of the clients was 66 years and the number of clients in their 70s ranked first with 28.2 percent(158 people). The mean length of home care service was 47 days with the highest frequency of less than four weeks (56 %). With regard to medical diagnosis, cancer showed the highest frequency (48%, 271 people), followed by cerebrovascular disease (19%), and pulmonary disease (6.9%). According to analysis of nursing interventions by the NIC system, the most frequently used nursing interventions in level 1 were interventions in the Physiological: Complex domain which were used 3,663 times (33%) among 11,107 total interventions. The Safety domain was the second most frequently used intervention, followed by the Physiological: Basic, and the Behavioral domains. In level 2, the Risk Management class was the most frequently used interventions with 3,108 interventions (27.9%), followed by Drug Management, and Tissue Perfusion Management classes. In level 3 interventions, Vital Sign Monitoring was the most frequently used intervention, 569 times (5.1%), followed by Health Screening, and Neurological Monitoring interventions. In sum, half of the clients in the study had cancer and were in their 70s. The most frequent reason for ending home care was death (40%), followed by readmission (28%). These findings represent clients with severe conditions referred to the home care nursing department as it was a University teaching hospital. Further research on analyzing nursing interventions performed in each institution needs to be conducted to develop a standardized list of nursing interventions to use in home health care settings.