A Case of Huge Gastric Bezoar Removed by Endoscopic Combination Therapy with Coca-Cola Injection / 영남의대학술지

Gastric bezoars are concretion of undigested material in the gastrointestinal tract. In the past, gastric bezoars were generally treated with surgical management. Recently, the efficacy of oral intake or endoscopic injection therapy with Coca-Cola has been reported. We report a case of a 47-year-old-man with huge gastric bezoar (4x2.5 cm) that was successfully removed by endoscopic fragmentation with Coca-Cola injection. Compared with a single endoscopic fragmentation therapy, the combination therapy with Coca-Cola injection shortened the procedure time and reduced the complication associated with fragmented bezoar.

Portal Vein Thrombosis with a Lung Abscess / 대한내과학회지

Portal vein thrombosis (PVT) is an uncommon cause of presinusoidal hypertension and can result from cirrhosis, malignancy, infection, inflammation, and congenital and acquired thrombophilic states. Infectious and inflammatory causes include pylephlebitis, omphalitis, diverticulitis, pancreatitis, cholecystitis, appendicitis, and inflammatory bowel disease. However, PVT induced by a lung abscess has not been reported. We experienced a 50-year-old male complaining of right upper quadrant pain, fever, and coughing. A lung abscess and PVT were revealed by computed tomography and abdominal Doppler ultrasonography. The PVT resolved, in part, after an 8-day course of antibiotic therapy. We report a case of PVT as a complication of a lung abscess and review the literature.

Pneumothorax, Pneumomediastinum, Subcutaneous Emphysema, Pneumoretroperitoneum Secondary to Colonoscopic Perforation / 대한소화기내시경학회지

A colonoscopic perforation is rare but can cause a fatal outcome. A perforation can be intraperitoneal or retroperitoneal. Air in the retroperitoneal space by perforation can spread to the mediastinum, pleura, and subcutaneous tissue through the visceral space. Therefore, a colonoscopic perforation may manifest as a pneumomediastinum, a pneumothorax, or subcutaneous emphysema without a peritoneal irritation sign. Although a colonoscopic perforation is treated mainly with an operation, medical treatment may be possible in selected cases, especially for a perforation to the retroperitoneal area or that under peritoneal reflexion. Clipping of a perforation is effective for medical treatment. We experienced a case of pneumothorax, pneumomediastinum, subcutaneous emphysema and pneumoretroperitoneum without peritoneal irritation following a diagnostic colonoscopy, which was diagnosed after 3 days because of atypical symptoms but was successfully managed with medical treatment and clipping.

A Case of Bell's Palsy Associated with Peginterferon Alfa-2a and Ribavirin Therapy for Chronic Hepatitis C Virus Infection / 대한간학회지

Pegylated interferon alfa-2a (PEG-IFN) and ribavirin combination therapy is the first line treatment for chronic HCV infection. There are four reports of Bell's palsy associated with interferon-alpha (IFN-alpha) and ribavirin therapy. We report here a case of Bell's palsy that occurred in a patient with chronic HCV infection during combination PEG-IFN and ribavirin therapy. The patient was 49-year-old man with chronic hepatitis C for 2 years. The liver biopsy showed grade 1 and stage 1. Therapy with PEG-IFN (Pegasys) 180 microgram/week and ribavirin 1200 mg/day was initiated. After 3 weeks of treatment, the patient showed a loss of muscular tone on the left side of his face. A diagnosis of Bell's palsy was made, and the PEG-IFN and ribavirin therapy was stopped. Prednisolone 45 mg/d was given and then tapered for 8 weeks. His palsy improved over 6 weeks.

The effect of propofol for conscious sedation during colonoscopy-A Prospective, Randomized Study / 대한내과학회지

BACKGROUND: The objectives of this study were to assess propofol as sedative agents for colonoscopy in the safety and efficacy, compared with midazolam plus meperidine. METHODS: 120 patients undergoing colonoscopy in a prospective study were randomly assigned to one of three medication regimens. Patients in group A (n=42) received i.v. 25 mg of meperidine and 2.5 mg of midazolam. Patients in group B (n=41) received i.v. a median dose of 96.59 mg of propofol (range 40-180) and patients in group C (n=37) received i.v. 25 mg of meperidine and a median dose of 77.03 mg of propofol (range 40-150), administered by a nurse with endoscopist supervision. Endpoints were patient satisfaction, procedure and recovery times and complications. RESULTS: The mean time to sedation was much faster in 2 groups using propofol (group A: 152+/-105.9 sec, group B: 52.9+/-46.5 sec, group C: 56+/-63.7sec; p<0.001). The mean time to reach the cecum was not different among the 3 groups. There were total 3 episodes of oxygen desaturation to <90%, as one in each group, but the patients were spontaneously recovered with only increasing O2 concentration and arousal. Patients in group C expressed better overall mean satisfaction than patients in group A (p=0.049), but difference was not found between group A and group B. The amnestic effect was better in two groups using propofol than group A (p=0.017) The mean dose of propofol was lower in the patients who received propofol combined with low dose of meperidine than those with propofol only (77.03 mg vs 96.59 mg, p=0.009). CONCLUSION: Nurse-administered propofol sedation with endoscopist supervision is believed to be safe and useful for colonoscopy with careful monitoring.

A Case of Multiple Pedunculated Polypoid Gastric Carcinoids / 대한소화기내시경학회지

Gastric carcinoids usually appear as a single polypoid tumor or yellowish rounded submucosal tumor in the fundus or body of the stomach. Multiple gastric carcinoids are associated with pernicious anemia, chronic atrophic gastritis and Zollinger-Ellison syndrome. These are believed to be due to hypergastrinemia. In Korea, carcinoids usually appear as single round-based submucosal tumor or sessile polyps. Multiple pedunculated polypoid carcinoids were rarely reported. A 27-year old woman was admitted to our hospital due to melena. The endoscopy revealed multiple pedunculated polypoid lesions in the fundus and body, predominantly in Yamada type III and IV. The histopathologic examination revealed the diagnosis of gastric carcinoid tumors. Serum fasting gastrin level was normal. We report a case of multiple pedunculated polypoid gastric carcinoids without atrophic gastritis or hypergastrinemia with a review of relevant literatures.

A Case of Large Hepatic Cyst Infected with Salmonella paratyphi A / 감염과화학요법

Salmonellae cause a number of characteristic clinical infections in humans, including gastroenteritis, enteric fever, bacteremia, focal metastatic infection and an asymptomatic chronic carrier state. We report a case of large hepatic cyst infected with Salmonella paratyphi A. A 47-year-old woman was admitted, because of abdominal complains (fullness and pain) and fever. On physical examination, a mass was palpated on right upper quadrant of the abdomen. The computerized tomography of the abdomen showed a large hepatic cyst, but not cystic infection. Aspiration and percutaneous drainage of the hepatic cyst were perfomed for the therapeutic decompression under fluoroscopic guidance. Cultures of the cyst fluid revealed growth of Salmonella paratyphi A. Radiologic contrast media after draining of the cyst fluid revealed no communication between the cyst and bile ducts. Infected hepatic cyst appeared to result from hematogenic seeding. One month later, the patient improved and was discharged without any complication.

A Case of Large Hepatic Cyst Infected with Salmonella paratyphi A / 감염과화학요법

Salmonellae cause a number of characteristic clinical infections in humans, including gastroenteritis, enteric fever, bacteremia, focal metastatic infection and an asymptomatic chronic carrier state. We report a case of large hepatic cyst infected with Salmonella paratyphi A. A 47-year-old woman was admitted, because of abdominal complains (fullness and pain) and fever. On physical examination, a mass was palpated on right upper quadrant of the abdomen. The computerized tomography of the abdomen showed a large hepatic cyst, but not cystic infection. Aspiration and percutaneous drainage of the hepatic cyst were perfomed for the therapeutic decompression under fluoroscopic guidance. Cultures of the cyst fluid revealed growth of Salmonella paratyphi A. Radiologic contrast media after draining of the cyst fluid revealed no communication between the cyst and bile ducts. Infected hepatic cyst appeared to result from hematogenic seeding. One month later, the patient improved and was discharged without any complication.