Two cases of massive duodenal variceal bleeding successfully controlled with endoscopic injection sclerotherapy / 대한내과학회지

Duodenal variceal bleeding is rare and difficult to diagnose. The rupture of duodenal varices leads to massive and often fatal bleeding. However, there is currently no definitive conservative therapy for duodenal varices, such as the methods used for treating esophageal and gastric varices. Endoscopic treatment of variceal hemorrhage has been implemented as an initial single, minimally invasive method for treatment. However, this approach has limited success in the treatment of duodenal variceal hemorrhage. We report two cases of massive duodenal variceal bleeding successfully controlled with endoscopic injection sclerotherapy.

Minute-depressed Type of Submucosal Colon Cancer / 대한소화기내시경학회지

The development of colorectal cancer has been known as the adenoma-carcinoma sequence. Yet another route for cancer development has recently been proposed, which is call the de novo pathway based on the reports of the depressed-type early colorectal cancers. Early colorectal cancer is defined as invasive tumor limited to the colorectal mucosa or submucosa, regardless of the presence or absence of lymph node metastasis. Especially, depressed type colorectal cancers have a much higher rate of submucosal invasion and rapid progression despite of their relatively small sizes. Our case displayed a depressed type tumor that was only 5mm in diameter and it had invaded the deep submucosal layer (SM3); this was resected by operation with no predictive endoscopic finding. So, the depressed type tumor can show deep invasion or lymph node metastasis despite of its small size.

A case presentation of renal involvement in MCTD / 대한내과학회지

MCTD (Mixed Connective Tissue Disease) is a rare disease characterized by clinical characteristics of patients with overlapping features of SLE (systemic lupus erythematosus), SS (systemic sclerosis), and PM (polymyositis), and serologically characterized by high titers of Anti U1 RNP Ab. At early stage, finger swelling or Raynaud's phenomenon with high titers of Anti U1 RNP Ab are only apparent. Proteinuria and membranous nephropathy are characteristic renal manifestation of MCTD. Recently we had the opportunity to observe patient with Raynaud's phenomenon, finger swelling, high titers of Anti U1 RNP Ab, and asymptomatic proteinuria who underwent a renal biopsy. The patient was diagnosed as early MCTD and renal histology revealed membranous nephropathy. Our purpose is to report this patient and to review the literature.

Application of Multi-frequency Bioelectrical Impedance Analysis for Body Water Evaluation in Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: It is necessary to measure total body water (TBW) in evaluation of the hemodialysis adequacy. Waston's equation has been used clinically. And it is important to measure adequate dry body weight to avoid fluid overloading after hemodialysis. But there was no objective method to measure dry body weight, it was estimated subjectively by clinicians (doctors and nurses). Multi-frequency bioelectrical impedance analysis (MFBIA) has emerged as a clinical tool of the measurement of total body water (TBW) and body fluid compartment (ICW, ECW). The purpose of this study is to investigate the correlation MFBIA-TBW and Watson equation, Then intracellular water (ICW)/extracellular water (ECW) ratio (I/E ratio) usefulness in the evaluation of dry body weight. METHODS: 20 HD patients treated 3 times/week and 21 sex and age adjusted normal control subjects were studied. We measuerd and compared MFBIA-TBW to Waston equation, estimate reproducibility MFBIA-TBW measurement. Then MFBIA-ECW, ICW and I/E ratio were measured and compared dialysis patients both pre- and post dialysis to control group. RESULTS: The correlation between Wastron-TBW and MFBIA-TBW for patients was 0.948 (p<0.001). The closeness of agreement between MFBIA-TBW and Waston-TBW is shown Bland-Altman plots. There was no difference in post-dialysis patient's ICW/ECW ratio compared to control group. CONCLUSION: MFBIA is useful tool for dialysis patients' TBW measurements. Also ICW/ECW ratio measurement by MFBIA may be used to estimate the adequate ultrafiltration.

A Case of Anticonvulsant Hypersensitivity Syndrome with Subcarinal Lymph node Enlargement and Eosinophilic Pneumonia Induced by Carbamazepine / 결핵및호흡기질환

Anticonvulsant hypersensitivity syndrome (AHS) is an uncommon, but potentially fatal and mutilsystemic disorder that occurs after exposure to the arene oxide-producing anticonvulsants-carbamzepine, phenobarbital and phenytoin. The multisystemic reactions include fever, skin eruptions, lymphadenopathy, hematologic abnormality and hepatitis. The diagnosis of AHS is made by history of drug exposure and clinical course. No specific treatments are proved as benefit except discontinuing the offending drug and trying the steroids in some severe cases. We report a case of carbamazepine induced anticonvulsant hypersensitivity syndrome characterized by skin rash, eosinophilia, subcarinal lymphadenopathy and eosinophilic pneumonia. The patient was resolved completely after only discontinuing carbamazepine.

A Case of Acute Respiratory Distress Syndrome Induced by Injection of Silicone Fluid for Colpoplasty / 결핵및호흡기질환

Acute respiratory distress syndrome after silicone fluid injection is uncommon. Reasons that organic silicone is inactive in the human body and has low surface tension and is not affected by physical factors such as time or temperature make this material to be widely used as a medical product. However, lately some of its side effects have been noted and also cause respiratory problems in rare occasions. The mechanism is not clear but silicone injection cause one to cough, produce hemoptysis, fever, pleuritic chest pain, and dyspnea, and may even lead to acute respiratory failure. In other countries, these side effects were reported from 1970s and several cases started to appear in Korea from 1990s. We report a 58 years-old female who recovered from acute respiratory distress syndrome after injection of silicone fluid into vaginal wall by a conservative therapy.

A case of idiopathic hypoparathyroidism combined with hypothyroidism diagnosed by tetanic symptom during treatment for idiopathic epilepsy / 대한내과학회지

Idiopathic hypoparathyroidism is activating mutation of the calcium sensor receptor lead to inhibition of parathyroid hormone (PTH) secertion at inappropriately low serum ionized calcium levels and are a cause of autosomal dominant hypoparathyroidism. This disease often show slight mental retardation and associated endocrine abnormalities, most commonly hypothyroidism (without goiter) and hypogonadism. We diagnosed this in 20 year old male who presented with left foot pain with rigidity during he was treated for idiopathic epilepsy and had goiter. We report this case with a review of the literature.

A case of idiopathic hypoparathyroidism combined with hypothyroidism diagnosed by tetanic symptom during treatment for idiopathic epilepsy / 대한내과학회지

Idiopathic hypoparathyroidism is activating mutation of the calcium sensor receptor lead to inhibition of parathyroid hormone (PTH) secertion at inappropriately low serum ionized calcium levels and are a cause of autosomal dominant hypoparathyroidism. This disease often show slight mental retardation and associated endocrine abnormalities, most commonly hypothyroidism (without goiter) and hypogonadism. We diagnosed this in 20 year old male who presented with left foot pain with rigidity during he was treated for idiopathic epilepsy and had goiter. We report this case with a review of the literature.