A case of small intestinal obstruction due to phytobezoar, revealed after operation in elderly / 대한내과학회지

The major causes of small bowel obstruction are postoperative adhesion, hernia, intussusception and malignancies. However, in cases of uncommon causes of small bowel obstruction, surgeons are in a dilemma because the preoperative diagnosis and making a decision to operate are frequently difficult and delayed. Phytobezoars are unusual cause of small bowel obstruction. They are mostly due to ingestion of stringent immature fruits following gastric surgery. They are usually formed in stomach and do not migrate to the other intestinal tract, but can lead to the serious complication of acute small bowel obstruction. We are reporting a case of acute small bowel obstruction due to phytobezoar about 2x2x3 cm3 size in a 90 year old female.

A Case of Spontaneous Renal Rupture Associated with Right Renal Cyst in A Patient Receiving Chronic Hemodialysis

Spontaneous renal rupture with diversion of blood into the subcapsular and/or perinephric spaces in a patient on chronic hemodialysis is a rare clinical entity. The underlying causes found by various authors were tumours, vascular diseases, inflammatory process and cysts. Rupture of renal cysts is another complication that can be life-threatening when it gives rise to subcapsular and/or perinephric hematomas. Screening has been recommended with ultrasound for hemodialysis patients of longer than 3years'duration. We are report a case of spontaneous renal rupture associated with right renal cyst in a patient receiving chronic hemodialysis.

A Case of Spontaneous Renal Rupture Associated with Right Renal Cyst in A Patient Receiving Chronic Hemodialysis

Spontaneous renal rupture with diversion of blood into the subcapsular and/or perinephric spaces in a patient on chronic hemodialysis is a rare clinical entity. The underlying causes found by various authors were tumours, vascular diseases, inflammatory process and cysts. Rupture of renal cysts is another complication that can be life-threatening when it gives rise to subcapsular and/or perinephric hematomas. Screening has been recommended with ultrasound for hemodialysis patients of longer than 3years'duration. We are report a case of spontaneous renal rupture associated with right renal cyst in a patient receiving chronic hemodialysis.

A case of cervical lymphadenitis by toxoplasmosis / 대한내과학회지

Toxoplasma lymphadenitis is the most common clinical manifestation of toxoplasmosis in an immunocompetent host. The cervical lymph nodes are the most commonly involved, whereas systemic manifestations are rare. The most common clinical presentations are asymptomatic or subclinical, with fever, maculopapular rash, and general malaise. In immunocompromised patients, the presentations may be devastating with disseminated disease resulting in encephalitis, myocarditis, and pneumonia. We are reporting a case of toxoplasma lymphadenitis in an immunocompetent host diagnosed by histologic and serologic evaluation.

An elderly patient with gastric adenocarcinoma developing multiple metastasis in skeletal muscle / 대한내과학회지

Gastric cancer occurs with high frequency and is a significant cause of cancer motality in Korea. The most common metastatic sites of gastric cancer are liver, lung, bone and adrenal gland. Intramuscular metastasis from gastric cancer is an rare case. Skeletal muscle is one of the most unusual sites of metastasis from any malignancy. We report an elderly patient with gastric cancer developing multiple metastasis in skeletal musle.

A case of ischemic colitis in ascending colon mimicking colon cancer / 대한내과학회지

Ischemic colitis is recognized as the most common vascular disorder of the intestines in the elderly. Correct diagnosis is usually made after the ischemic episide is over and ischemic colitis is frequently misdiagnosed. A case is presented in which an initial diagnosis of appendicitis was made. On operation, a tumor like mass was found in ascending colon. Pathological examination revealed ischemic colitis. We report a case of ischemic colitis in ascending colon mimicking colon cancer.

A case of jejunal angiodysplasia is diagnosed by capsule endoscopy in a patient with hypertrophic cardiomyopathy / 대한내과학회지

A 79-year-old woman with a known history of hypertrophic cardiomyopathy presented with severe anemia of unknown origin. She had also suffered from repeated episodes of upper gastrointestinal bleeding for the previous 2-3 years. Despite small bowel series and panendoscopic and angiographic studies, the origin of anemia remained undefined until a small multiple bleeding site was found during capsule endoscopy. The lesion proved to be angiodysplasia in jejunum. We report a case of jejunal angiodysplasia is diagnosed by capsule endoscopy in a patient with hypertrophic cardiomyopathy.

A Case of Rifampicin Induced Pseudomembranous Colitis in Elderly Patient

Nowadays, the increasing use of antibiotics induces many complications including pseudomembranous colitis. Isolates of toxigenic Clostridium difficile, the most frequent cause of antibiotic-associated pseudomembranous colitis, are almost always highly susceptible to rifampicin. However, resistant isolates exist and have been associated with colitis in humans. We report a case of pseudomem- branous colitis associated with rifampicin administration.

A Case of Paroxymal Ventricular Tachycardia Improved due to Electrical Defibrillation was done Repeatedly in Patient with Ce rebral Infarction

Paroxymal ventricular tachycardia occurs most frequently during the first several months following myocardial infarction, although the risk of arrhythmia development continues for many years. Underlying disease was coronary artery disease, dilated or hypertrophic cardiomyopathy, valvular heart disease, myocarditis, and idiopathic. Idiopathic ventricular tachycardia may be the most common type in Korea and usually originates from either right ventricular outflow tract or left ventricular septum. For the emergency treatment of sustained, hemodynamically stable ventricular tachycardia, antiarrhythmic drugs are the therapy of choice(choice of therapy). Mostly class I antiarrhythmic drugs, such as lidocaine, are preferred. In hemodynamically unstable ventricular tachycardia, electrical defibrillation should be applied, in case of recurrences, followed by pharmacological treatment with class I antiarrhythmic drugs or amiodarone. We report a case of paroxymal ventricular tachycardia improved due to(by) electrical defibrillation was done repeaedly in patient with cerebral infarction.

A Case of Sick Sinus Syndrome Derived in Elderly Patient on Hemodialysis

Sick sinus syndrome comprises a variety of conditions involving sinus node dysfunction and commonly affects elderly persons. Though sudden cardiac death accounts for as much as 15% of all cause mortality in uremia, requiring permanent cardiac pacing in end-stage renal disease hemodialysed patients are very few. Most cases of sick sinus syndrome are idiopathic, and the cause can be multifac- torial. A-V conducton defects were attributed to extensive metastatic calcifications, involving the cardiac skeleton, conservative to severe hyperparathyroidism and inadvertent use of calcitriol and calcium carbonate as phosphate binders. If optimal hemodialysis is provided, benefits of permanent pacing are equal in uremic or non uremic patients and pacemaker implantation should be instituted. We report a case of sick sinus syndrome derived in elderly patient on hemodialysis.

A case of localized fibrous tumor of the pleura presenting with hypoglycemia / 대한내과학회지

Localized fibrous tumor of the pleura is rare, slowly growing, benign tumor. Most of these tumors clinically behave asymptomatically, although tumor-associated hypoglycemia occurs in a few cases and lead to hypoglycemic coma. Laboratory investigations show elevation of IGF-II with a 2-3 times higher effect on the blood glucose level than insulin. Surgical resection of the tumor is recommended. We report on the case of a 81-year-old man, who complained of hypoglycemic episodes. Diagnostic evaluation showed a fibrous tumor of pleura attached to the right diaphragm.

A Case of Polymyos itis Associated with Liver Cirrhosis

Polymyositis is uncommon connective tissue disease of autoimmune etiology in which the skeletal muscle is damaged by a inflammatory process dominated by lymphocytic infiltration. Polymyositis has been associated with several viral infections, and a spectrum of immune-related diseases may occur with hepatitis C virus(HCV) infection. However, no association between polymyositis and HCV infection has been reported previously. We report a case of polymyositis combined with liver cirrhosis who had evidence of HCV infection.

Outcome of Early Diagnos is and Hemodialys is in Acute Renal Failure due to Metformin-associated Lactic Acidosis in Elderly Type 2 Diabetes Mellitus Patient

Metformin is a biguanide oral hypoglycemic agent commonly used in the treatment of diabetes mellitus. Metfofmin is excreated largely by the kidney and binds only negligibly to plasma proteins. Toxicity is usually seen when metformin is prescribed to patients with renal insufficiency. Lactic acidosis in diabetics on metformin therapy is rare but still associated with poor prognosis. For an early diagnosis, clinical symptoms of intoxication should be well known by physicians and patients. First-line therapy for correction of lactic acidosis and effective elimination of metformin is bicarbonate hemodialysis. We report a case of acute renal failure due to metformin-associated lactic acidosis in elderly type 2 diabetes mellitus patient and she was successfully treated by hemodialysis with bicarbonate buffer.

Diffe rentiation of Pneumonic-Type Bronchioloalveolar Carcinoma and Infectious Pneumonia in Clinical, Radiologic Findings

Bronchioloalveolar carcinoma may present with a variety of clinical and radiographic findings. It is originated from the periphery of the lung and can be mistaken for lobar pneumonia or atypical pneumonia. The most frequent symptoms and signs are cough, sputum, shortness of breath, weight loss, hemoptysis, and fever. Brochorrhea is unusual and a late manifestation. We conclude that early diagnosis of disease will increase operability and improve chances of survival and that aggressive diagnostic workup for suspicious pulmonary infiltrate is essential as early operation offers the best chances of cure.We report two cases of brochioloalveolar carcinoma presenting as proper clinical and radiological findings.

A case of parsely dependent sxercise-induced anaphylaxsis / 천식및알레르기

Exercise-induced anaphylaxis can be associated with ingestion of a specific food. We experienced a case of exercise-induced anaphylaxis followed by ingestion of parsely. A 22- year old female patient was presented with angioedema of the face and chest tightness induced by running after ingestion of parsley within 15 minutes. She had suffered from allergic rhinitis. She had positive reactions to mugwort pollen and parsely extract on skin prick test in a dose dependent manner. Although the oral provocation test with parsely could not induce bronchoconstriction, we could diagnosed as parsely dependent exercise induced anaphylaxis based upon skin prick test and history.

A Large Gastric Duplication Cyst Resembling a Pancreatic Pseudocyst in an Adulf: Report of one case / 대한소화기내시경학회지

Duplication of the alimentary tract is an unusual congenital anomaly which may occur at any level, from the oral cavity to the rectum. Gastric duplication cyst is quite rare and most of them are presented in infancy with the sypmtoms of vomiting, abdominal pain, weight loss, gastrointestinal bleeding resulting from partial or complete obstruction. Some cases have not been diagnosed until adult when duplication cyst is not large enough to cause acute obstruction in infancy. Our case is more unusual in the aspect of its presence in adult and its nature resembles huge pancreatic pseudocyst. A 18-year man came to our hospital with complaint of epigastric pain for three days. A gastrofiberoscopy revealed a round protruding mass with smooth surface of normal mucosa at the fundus and computed tomography of the abdomen revealed the presence of 6.0 X 6.0 cm sized cystic mass between posterior wall of stomach and pancreas, and another 2.0 x 2.0 cm sized mass in ant. wall of stomach, which were regarded as mutiple pancreatic pseudocysts in perigastric region. Endoscopic retrograde cholangiopancreatography did not disclose any pancreatic ductal abnormality or communication with the cyst. Endoscopic ultrasonography showed anechoic cystic mass under 3rd layer of stomach wall, which was removed by surgical resection. Postoperative pathologic examination disclosed multiple gastric duplications.

A Comparison of the Acute Antiemetic Effect of Tropisetron with Ondansetron in Patients Receiving Cisplatin / 대한암학회지

PURPOSE: Tropisetron, a new specific 5-hydroxytryptamine3 (5-HT3) receptor antagonist, is an effective antiemetic agent in the control of chemotherapy induced emesis with a long half life and bioavailablity. We compared the efficacy and safefy of Tropisetron and ondansetron to control emesis induced by highly emetogenic chemotherapeutics (cisplatin > or = 50 mg/m(2)). MATERIALS AND METHODS: Twenty-one patients were administered in a randomized, open, crossover study and received either tropisetron plus dexamethasone or ondansetron plus dexamethasone during two successive cycles of chemotherapy. RESULTS: Control of acute emesis with either tropisetron or ondansetron was 100% vs 95.2%, and 80.9% vs 76.2% in control of delayed emesis. Both severity and duration of nausea showed no statistically significant difference between tropisetron and ondansetron. Poor appetite and headache were most common side effects in both groups. CONCLUSION: There was no significant difference in efficacy for control of emesis and nausea between tropisetron and ondansetron in cisplatin-based chemotherapy.

A Case of Atrial Septal Aneurysm with Recurrent Atrial Fibrillation and Cerebellar Infarction

An atrial septal aneurysm is well recognized abnormality of uncertain clinical relevance. An intraatrial aneurysm was demonstrated in the fossa ovalis of a 41-year-old woman who suffered an episode of cerebellar infarction with recurrent atrial fibrillation. The disorder is rarely treated surgically. Most patients with this condition are given life-long anticoagulation, a treatment that may have serious complications. We report a rare case of atrial septal aneurysm with recurrent atrial fibrillation and cerebellar infarction which receiving an appropriate diagnosis and curative treatment.