The usefulness of endoscopic hemostasis with hemoclipping in acute colonic diverticular bleeding / 대한내과학회지

BACKGROUND/AIMS: Although colonoscopy is often used to diagnose and treat acute lower gastrointestinal bleeding, there have been few reports on outcomes of the management of colonic diverticular bleeding in Korea. This study evaluated the utility of colonoscopic hemoclipping for the control of diverticular bleeding. METHODS: We retrospectively reviewed the medical records of 13 patients with acute diverticular bleeding treated using endoclips at Uijeongbu St. Mary's Hospital between January 2004 and December 2009. RESULTS: Of the 13 patients, four had an actively bleeding vessel visible at colonoscopy, while nine had a non-bleeding vessel. Hemostasis with hemoclipping was successful in all patients without procedural complications. One patient (7.7%) had early recurrent bleeding and additional colonoscopic hemoclipping was successful. During a median follow-up of 34 months, late recurrent bleeding occurred in one patient (7.7%). CONCLUSIONS: Colonoscopic treatment of acute diverticular bleeding using endoclips is safe and effective, with high rates of immediate and long-term success.

Intestinal Helminthic Infections Diagnosed by Colonoscopy in a Regional Hospital during 2001-2008

The present study investigated characteristics of 24 parasite infection cases detected during colonoscopy in a regional hospital from January 2001 to December 2008. Sixteen patients were confirmed with Trichuris trichiura infection, 6 patients were with Ascaris lumbricoides infection, 1 patient with Enterobius vermicularis infection, and 1 patient with Anisakis infection. Among them, 7 patients (43.8%) were asymptomatic. Colonoscopy findings were normal in 18 patients (75.0%). Among the patients with T. trichiura infection, colonoscopy showed several erosions in 2 patients (8.3%) and non-specific inflammation of the affected segment of the colon in 3 patients (12.5%). In 1 patient with anisakiasis, colonoscopy revealed a markedly swollen colonic wall. Stool examinations were performed before treatment in 7 patients (29.2%) and were all negative for parasite eggs or worms. These results suggest that colonoscopy is a useful diagnostic approach for parasitic infections even for asymptomatic patients and for patients with negative stool examinations.

Noninvasive Pacemaker Stress Echocardiography as a Screening Test for Coronary Artery Disease in Patients With Atypical Angina and Permanent Pacemaker

BACKGROUND AND OBJECTIVES: Making the noninvasive diagnosis of coronary artery disease in patients with a permanent pacemaker is difficult because of the inability to interpret electrocardiograms and the low specificity of perfusion scintigraphy. We evaluated the diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE) as a screening test for coronary artery disease in patients with atypical angina and a permanent pacemaker. SUBJECTS AND METHODS: This a prospective study, and transthoracic stress-pacing echocardiography was performed on 15 patients (9 men and 6 women; age, mean age: 71.1+/-11.0 years) with atypical angina and a permanent pacemaker. All the patients underwent noninvasive pacemaker-stress echocardiography by external programming (pacing the heart rate up to 150 beats per minute). Coronary angiography was performed on the 8 patients with positive PASE results. Significant coronary artery disease was defined as > or =70% stenosis in at least one major coronary artery. RESULTS: The echocardiographic images were interpretable for all the patients. No significant side effects were observed. The left ventricular systolic function was preserved in all the patients (left ventricular ejection fraction; 63.5+/-8%). Only 5 (62.5%) of 8 patients showed significant coronary artery disease, as documented by coronary angiography. CONCLUSION: Noninvasive PASE is a simple, rapid, safe and diagnostically efficient test for detecting coronary artery disease in patients with atypical angina and a permanent pacemaker. Larger studies are necessary to validate our findings.

A case of congenital bilateral coronary-to-right ventricle fistula coexisting with variant angina

A coronary arteriovenous (AV) fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common anomaly that can affect coronary perfusion. Yet bilateral involvement of a coronary fistula, constitutes an uncommon subgroup of coronary AV fistulas. We herein report on a case of bilateral coronary AV fistula that was coexistent with variant angina originating from the distal right ventricular branch of the right coronary artery and the distal septal branch of the left anterior descending artery, and the latter drained into the right ventricle.

The Clinical and Radiology Characteristics of Diabetic or Non-diabetic Tuberculosis Patients: a Retrospective Study / 결핵및호흡기질환

BACKGROUND: Patients with diabetes mellitus are highly sensitive to infections, including tuberculosis, and the longer the duration of DM, the greater is the prevalance of tuberculosis. We studied the difference of the clinical manifestations, radiologic findings, resistance and others factors of patients with diabetic and non-diabetic pulmonary tuberculosis. METHODS: The patients we enrolled in this study were newly diagnosed with pulmonary tuberculosis from January 2003 to December 2005. RESULTS: 159 patients were enrolled in this study. There were 30 pulmonary tuberculosis patients with diabetic mellitus (DMTB) and 129 pulmonary tuberculosis patients without diabetic mellitus (non-DMTB). There was no difference in the basic characteristics and clinical manifestation between both the groups. For the chest X-ray findings, the moderately advanced tuberculosis patients were the most common (43.3% in the DMTB group and 49.6% in the non-DMTB group). There was no relation between the severity of tuberculosis activity on chest x-ray and the presence of diabetes. The prevalence of cavitory lesions in the DMTB group was significantly higher than that in the non-DMTB group, but the prevalence of atelectasis was higher in the non-DMTB group (p<0.05). There was no difference in the incidence of lower lung involvement, the number of involved lobes, the number of treatment days and the radiological sequelae in both groups. CONCLUSION: The DMTB patients had a higher incidence of cavitory lesions and a higher incidence of atelectasis than the non-DMTB patients.

Brain Tumor is a Rare Cause of both Bradycardia and Seizure

The association between brain tumors and cardiac asystole has rarely been reported in the medical literature. This potentially life-threatening symptom has usually been observed to arise from left temporal lobe brain tumors. Yet previously published papers have shown that cardiac asystole and bradycardia, as manifestations of epilepsy, originate from the frontal lobe of the brain. Although syncope is a common presenting symptom of a brain tumor, bradycardia and complete atrioventricular (AV) block, as the first signs of a brain tumor, have been only sporadically documented in the literature. We report here on a patient with recurrent complete AV blocks that were followed by syncope as an expression of seizures that may have arose from a brain tumor; this tumor was most likely a meningioma in the right frontal lobe. The patient required the subsequent placement of a permanent pacemaker. In conclusion, cardiac asystole may be a potentially life-threatening symptom of frontal lobe lesion of the brain. The frontal lobe may play a role in the autonomic regulation of cardiovascular responses.