A case of intraluminal gallbladder hematoma and subsequent cholecystitis after percutaneous liver biopsy / 대한내과학회지

The liver biopsy has been well established for the diagnosis and prognosis of many liver diseases. The percutaneous liver biopsy is generally considered a safe procedure, especially under ultrasonography guidance. Known complications of percutaneous liver biopsy include hemoperitoneum, subcapsular hematoma, hypotension, pneumothorax, and sepsis. We report the case of a 45?year?old woman who developed an intraluminal gallbladder hematoma and subsequent cholecystitis after a percutaneous liver biopsy. The patient underwent a laparoscopic cholecystectomy and her postoperative course was uneventful.

Benign Schwannoma of the Liver: A Case Report

A primary benign schwannoma of the liver is extremely rare. Only nine cases have been reported in the medical literature worldwide and no case has been reported in Korea previously. A 36-yr-old woman was admitted to our hospital with vague epigastric pain. The ultrasound and computed tomography scan revealed a multiseptated cystic mass in the right lobe of the liver. The mass was resected; it was found to be a 5x4x2 cm mass filled with reddish yellow fluid. The histological examination confirmed the diagnosis of a benign schwannoma, proven by positive immunoreaction with the neurogenic marker S-100 protein and a negative response to CD34, CD117 and smooth muscle actin. This is the first report of a benign schwannoma of the liver parenchyma in a Korean patient.

A Case of Tuberculosis of the Esophagus and Duodenum Associated with Pulmonary Tuberculosis / 대한소화기내시경학회지

Esophageal and duodenal tuberculosis are rare form of gastrointestinal tuberculosis. The common complications due to esophageal and duodenal tuberculosis are fistulous communications with the adjacent structures, perforation, obstruction, and upper gastrointestinal bleeding. Massive bleeding in esophageal and duodenal tuberculosis is quite rare. We encountered a case of a 55-year-old male who presented with hematemesis and melena. Esophageal and Duodenal tuberculosis with a duodenal fistula was diagnosed by an endoscopic and radiology examination. He improved after treatment with anti-tuberculosis medication over a 9 month period. We report this case of esophageal and duodenal tuberculosis associated with pulmonary tuberculosis with a review of the relevant literature.

The Prevalence of Esophageal Disorders in the Subjects Examined for Health Screening / 대한소화기학회지

BACKGROUND/AIMS: Various disorders can be developed in the esophagus. However, esophagus has been less well focused than other gastrointestinal (GI) tracts since the esophageal disorders are relatively uncommon. There has been no report on the prevalence of overall esophageal disorders in Korea. The aim of this study was to evaluate the prevalence of esophageal disorders in health examinee. METHODS: We reviewed retrospectively the endoscopic reports of 6,683 subjects who underwent upper GI endoscopy for screening purpose at Gyeongsang National University Hospital from March, 2005 to May, 2006. RESULTS: Among 6,683 health examinee, 1,154 (17.26%) had esophageal diseases. Gastro-esophageal reflux diseases (GERD) were the most common diseases (14.66%). The prevalence of erosive reflux esophagitis, minor change esophagitis, and Barrett's esophagus was 8.45%, 5.01% and 1.12%, respectively. Hiatal hernia and esophageal submucosal tumor were 2nd and 3rd common diseases (2.0% and 0.6%, respectively). A variety of other esophageal disorders were seen as well. The esophageal disorders with over 0.1% of prevalence were esophageal varices (0.37%), esophageal squamous papilloma (0.31%), esophageal candidiasis (0.25%), nonspecific esophagitis (0.16%), heterotopic gastric mucosa (0.16%), and esophageal vascular ectasia (0.12%) in order. CONCLUSIONS: The overall prevalence of esophageal disorders among health examinee was 17.3%. The GERD was the main esophageal disease and a variety of esophageal diseases were identified. The endoscopists need to take an interest in the esophageal disorders and a community-oriented well organized study should be warranted.

Upper Gastrointestinal Bleeding due to Direct Invasion of Hepatocellular Carcinoma to the Duodenum / 대한소화기내시경학회지

Although a metastasis to the gastrointestinal tract (GI) is rare in patients with hepatocellular carcinoma (HCC), it can occur by hematogenous or lymphatic spread, or by direct invasion of a tumor. A 61-year old woman who had a progressing large primary liver cancer presented with upper gastrointestinal (UGI) bleeding. UGI endoscopy showed a large duodenal submucosal tumor-like mass with a central ulcer and adherent blood clots. Endoscopic biopsy and coagulation using argon plasma probe were performed. The microscopic examination revealed a HCC. We report this unusual case of HCC with direct invasion of the duodenum.

Pathogenic Classification and Clinical Characteristics of Nontuberculous Mycobacterial Pulmonary Disease in a National Tuberculosis Hospital / 결핵및호흡기질환

BACKGROUND: It has been reported that nontuberculosis mycobacterium(NTM) isolates account for approximately 10% of patients with a positive Acid-Fast Bacilli(AFB) smear. Therefore, it is necessary to consider NTM pulmonary disease when such a positive test is encountered. The aim of this study was to evaluate the etiologies and clinical characteristics of patients with NTM pulmonary disease who had been treated at a national tuberculosis hospital. METHODS: The NTM isolates were recovered from the sputum or bronchial washing specimens submitted to a clinical laboratory of National Masan TB Hospital from August 2002 to July 2003. All samples were identified using a polymerase chain reaction-restriction fragment length polymorphism analysis method, which amplifies the rpoB gene. The patients were diagnosed with NTM disease according to the American Thoracic Society diagnostic criteria. RESULTS: One hundred NTM isolates were recovered from 57 patients. Of the 100 isolates, M. avium complex(MAC) was the most common species, which was found 55%(n=55) of patients, followed by M. abscessus(n=25), and M. fortuitum(n=9). 26(45.6%) patients had NTM disease. Twenty-six (45.6%) patients had NTM disease according to The American Thoracic Society classification. The main organisms involved in NTM disease were MAC(n=19, 73.1%) and M. abscessus(n=5, 19.2%). The pathogenic potential was 67.9% in M. intracellulare and 41.7% in M. abscessus. The predictive factors related to NTM disease were a positive sputum smear (OR 6.4, p=0.02) and the isolation of either MAC or M. abscessus(OR 6.9, p=0.007). Fifteen patients(57.7%) were cured. There were no significant factors associated with the treatment success. CONCLUSION: There was a relatively high proportion of NTM disease in NTM isolates and the common species were MAC and M. abscessus. The predictive factors for NTM disease were a positive sputum smear and the isolation of either MAC or M. abscessus.

Placement of Tunneled Cuffed Hemodialysis Catheters Via Internal Jugular Vein by an Interventional Radiologist and a Vascular Surgeon Together / 대한신장학회잡지

BACKGROUND: The use of dacron-cuffed tunneled double-lumen catheters for hemodialysis has become more common as patients wait for creation and maturation of a permanent access. Placement of the catheters is done by interventional radiologists, vascular surgeons or nephrologists, and the differences in success rates, complications, blood flow rates and the durations of catheter uses are reported. This study evaluated the usefulness, complications, blood flow rates and duration of use of tunneled cuffed hemodialysis catheters implanted via the internal jugular veins by an interventional radiologist and a vascular surgeon together. METHODS: The outcomes were retrospectively analyzed of 31 hemodialysis catheters placed from December 1999 through January 2001. We investigated age, sex, indications and locations of insertion, catheter performance, complications and causes of catheter removal. All the catheters were placed via the internal jugular veins by an interventional radiologist and a vascular surgeon together. RESULTS: Catheter placements were successful in all patients. Procedural complication was limited to clinically unimportant minor local bleeding. No instances of pneumothorax, hemothorax, vessel injury, substantial bleeding, obstruction, malposition or stenosis occurred. The blood flow rate on the first hemodialysis after placement of the catheter was 230+/-35.5 mL/min and that after 1 month was 248+/-18.6 mL/min. Late complications included catheter breakage in two cases (6.5%) and bacteremia in four cases (12.9%). Catheters were removed because of catheter-related bacteremia in four cases (12.9%) and death of patients in three cases (9.7%). In 22 cases (71.0%) the catheters were removed because the A- V vascular accesses were available for hemodialysis. Mean duration of the catheter use before removal was 134+/-96 days. CONCLUSION: Tunneled cuffed catheters inserted via the internal jugular veins are safe and durable vascular accesses for hemodialysis with good blood flow rate and long duration of use, especially placed by the co-operation of an interventional radiologist and a vascular surgeon.

Purulent Pericarditis Caused by Group G Streptococcus as an Initial Presentation of Colon Cancer

Bacterial pericarditis has been recognized as a rare disease since the development of antibiotics. Usually, the disease is associated with underlying conditions or a seeding of infection elsewhere to the pericardium. Here we describe a case of group G streptococcal pericarditis as an initial presentation of colon cancer. A 52-yr-old man was admitted because of dyspnea. An electrocardiogram showed a diffuse ST-segment elevation and a two-dimensional echocardiogram showed a large amount of pericardial effusion. A pericardiocentesis was done and purulent fluid was drained. Group G streptococci was cultured in pericardial fluid. The patient was treated with antibiotics and pericardiostomy with saline irrigation. A colonoscopy revealed a small mass with moderately differentiated adenocarcinoma in rectosigmoid colon. He underwent a mucosectomy and was recovered without any complication.