A Case of Disseminated Intra-abdominal Gastrointestinal Stromal Tumor Managed with Low Dose Imatinib / 대한소화기학회지

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Imatinib mesylate is recommended as adjuvant therapy for GIST after surgical resection. However, drug-related adverse events are common. A 74-year-old female with metastatic GIST who was managed with imatinib experienced severe adverse events, including skin rashes, tremor, and alopecia, etc. The imatinib dose was reduced and the size of the metastatic GIST continued to decrease and adverse events showed significant improvement.

Removal of Rectal Foreign Bodies Using Tenaculum Forceps Under Endoscopic Assistance

The incidence of rectal foreign bodies is increasing by the day, though not as common as that of upper gastrointestinal foreign bodies. Various methods for removal of foreign bodies have been reported. Removal during endoscopy using endoscopic devices is simple and safe, but if the foreign body is too large to be removed by this method, other methods are required. We report two cases of rectal foreign body removal by a relatively simple and inexpensive technique. A 42-year-old man with a vibrator in the rectum was admitted due to inability to remove it by himself and various endoscopic methods failed. Finally, the vibrator was removed successfully by using tenaculum forceps under endoscopic assistance. Similarly, a 59-year-old man with a carrot in the rectum was admitted. The carrot was removed easily by using the same method as that in the previous case. The use of tenaculum forceps under endoscopic guidance may be a useful method for removal of rectal foreign bodies.

Annual Eradication Rates of Helicobacter pylori Infection over 9 Years in Incheon

BACKGROUND/AIMS: Failure of Helicobacter pylori eradication has increased over the past decade and is related to increased antibiotic resistance. The aim of this study was to estimate the eradication rates of H. pylori infection over the past 9 years in a single center. MATERIALS AND METHODS: From 2004 to 2013, a total of 5,715 patients were diagnosed with H. pylori infection and were prescribed first line triple regimens. 2,482 patients underwent tests for assessment of eradication by 13C-urea breath test, rapid urease test or histopathological examinations. RESULTS: The overall eradication rate of first line triple regimen was 80.4% and continually decreased during the study period (P=0.011). Among the triple regimens, the eradication rate of two-week and one-week regimens were 90.1% and 79.3%, each. The two-week regimen was superior to the one-week regimen (P=0.000). The overall eradication rates of second line quadruple regimen was 91.4% and there was no significant decrease in the annual eradication rates (P=0.708). The overall eradication rates of both first line and second line therapy were 81.9% and decreased gradually during the study period (P=0.011). Multivariate analysis revealed sex, age, type of proton pump inhibitor, and duration of eradication to be associated with eradication failure. CONCLUSIONS: The eradication rates of first line triple regimen has decreased gradually; however, the eradication rates of second line regimen remains unchanged. Triple regimens of two-weeks seem to be better than one.

A Case of Adipsic Hypernatremia Associated with Anomalous Corpus Callosum in Adult with Mental Retardation

Adipsic hypernatremia cause chronic hyperosmolality and hypernatremia through a combination of impaired thirst and osmotically stimulated antidiuretic hormone secretion. This syndrome can be grouped together as disorders of osmoreceptor dysfunction due to the various degrees of osmoreceptor destruction related with different types of intracranial lesions around the anterior hypothalamus, consistent with the location of primary osmoreceptor cells. Adipsic hypernatremia, associated with developmental disorder of corpus callosum, is very rare. Most cases are diagnosed at infancy and early childhood; the replacement of desmopressin is necessary. Herein, we report adipsic hypernatremia associated with anomalous corpus callosum in adult with mental retardation; they were treated with only free water without desmopressin.

A Case of Hemolytic Uremic Syndrome in a Lung Cancer Patient Treated with Gemcitabine / 결핵및호흡기질환

Hemolytic uremic syndrome (HUS) is a rare disorder characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. HUS arises from a wide spectrum of conditions, and chemotherapeutic agents have been reported to be associated with HUS, including Mitomycin, Cisplatin, Bleomycin, and Gemcitabine. A 76-year-old man treated with Gemcitabine due to non-small cell lung cancer developed clinical and laboratory findings compatible with HUS. Gemcitabine was ceased and hemodialysis and plasma exchange were utilized and he recovered. A high level of suspicion for HUS is necessary when cancer patients are treated with Gemcitabine, and prompt recognition and treatment are also essential.

Renal artery thrombosis secondary to sepsis-induced disseminated intravascular coagulation in acute pyelonephritis

There are some reports of renal vein thrombosis associated with acute pyelonephritis, but a case of renal artery thrombosis in acute pyelonephritis has not been reported yet. Here we report a case of renal artery thrombosis which developed in a patient with acute pyelonephritis complicated with sepsis-induced disseminated intravascular coagulation (DIC). A 65-year-old woman with diabetes was diagnosed with acute pyelonephritis complicated with sepsis. Escherichia coli was isolated from both blood and urine cultures. When treated with antibiotics, her condition gradually improved. She suddenly complained of severe right flank pain without fever in the recovery phase. A computed tomography scan revealed right renal artery thrombosis with concomitant renal infarction. Prophylactic anticoagulation therapy was not suggested because of sustained thrombocytopenia and increased risk of bleeding. Flank pain resolved with conservative treatment and perfusion of infarcted kidney improved at the time of discharge. To our knowledge, this is the first case of renal artery thrombosis related to acute pyelonephritis with sepsis-induced DIC.