Delayed urticaria caused by lidocaine in a child

Lidocaine is a commonly used local anesthetic for dental treatment. Urticaria caused by lidocaine has seldom been reported. Generally, urticaria immediately develops after exposure to a causative agent and is considered a manifestation of IgE-mediated hypersensitivity. However, delayed urticaria caused by local anesthetics was reported to be related to cell mediated hypersenstivity. A 3-year old girl visited our allergy clinic due to delayed urticaria after local administration of lidocaine. Both skin prick and intradermal tests with lidocaine revealed negative reactions. However, the provocation test with subcutaneous injection of lidocaine showed urticaria 7 hours after test. In order to identify alternative local anesthetic for the subsequent dental procedure, we performed skin prick, intradermal and provocation tests with procaine, a local anesthetic of the other class, all of which showed negative results. Therefore, we recommended procaine as an alternative local anesthetic, and the patient was successfully treated with procaine. To the best of our knowledge, this is the first case of delayed urticaria caused by lidocaine in Korea.

Efficacy and Safety of Albis(R) in Acute and Chronic Patients with Gastritis: A Double-blind, Placebo-controlled, Randomized Multi-center Study / 대한소화기내시경학회지

BACKGROUND/AIMS: Albis(R) is a newly developed drug comprised of ranitidine, bismuth and sucralfate. The aim of the study was to demonstrate the efficacy and safety superiority of Albis(R) compared to Stillen(R) for treating erosive gastritis. METHODS: This study was a randomized, double-blind, multi-center trial. The primary endpoint was 2 weeks of treatment. RESULTS: Of the 229 patients in the intention-to-treat (ITT) population, 87 from the Albis(R), and 96 from the Stillen(R) group were included in the per protocol (PP) analysis. The endoscopic improvement rate was not different between the Albis(R)(R) group and the control in both the PP (42.5%, 39.6%) and ITT (35.3%, 34.5%) populations. The endoscopic cure of erosion was also not different in the Albis(R) group than that in the control group in both the PP (32.3%, 31.3%) and ITT (27.6%, 27.4%) populations. The endoscopic improvement rate for hemorrhage, edema, and erythema were also not different between the two groups in both the PP and ITT populations. No statistically significant differences were observed for adverse events between the two groups. CONCLUSIONS: Half of the approved dose of Albis(R) for peptic ulcers was superior to Stillen(R). A low dosage of Albis(R) is more cost efficient and safe than that of Stillen(R).

Self-Expandable Metallic Stent Therapy for a Gastrointestinal Benign Stricture / 대한소화기내시경학회지

BACKGROUND/AIMS: It is well known that self-expandable metallic stents are useful for the treatment of malignant strictures. Balloon and bougie dilation have received significant attention as a useful treatments for a gastriointestinal benign stricture, but the use of stents has some complications, including perforation and bleeding. We evaluated the clinical effectiveness and procedure- related complications of the use of self-expandable metallic stent therapy in gastrointestinal benign strictures. METHODS: We inserted self-expandable metallic stents in 11 patients with benign strictures during the period from January 2003 to May 2007. Eleven patients were included in this study (six males; mean age, 50.9 years). We observed clinical improvement, as well as complications and restenosis during follow-up. We defined "recurrence" as the return of symptoms. RESULTS: The causes of strictures were peptic ulcers (eight cases), corrosive esophagitis (two cases) and an anastomosis site stricture (one case). Three stents migrated within two weeks after placement. The mean length of time of a stent staying in a stricture was 16.1 days (3~35 days). After stent dilation, none of the patients had dysphagia to solid food or procedure- related complications. During a mean follow-up period of 12.8 months (3~35 months), the rate of restenosis was 36.4% (4/11 cases). All restenosis cases (two cases of peptic ulcer and two cases of corrosive esophagitis) occurred within three months after stent placement. CONCLUSIONS: We conclude that the use of self-expandable metallic stent therapy can be effective and safe for patients with gastrointestinal benign strictures. Restenosis (36.4%) occurred within three months. Future research on the management of gastrointestinal benign strictures is recommended.

A Case of Capsule Retention for 31 Days Due to Stricture of Crohn's Disease / 대한소화기내시경학회지

Conventional modalities for examination of the small bowel have significant limitations. Capsule endoscopy can allow visualization of areas of the small bowel, and is used to diagnose the etiology of gastrointestinal bleeding, small bowel involvement of Crohn's disease, small bowel tumors, polyposis syndromes as well as drug induced ulcers. The problems associated with capsule endoscopy are capsule retention after ingestion and inability to visualize an entire small bowel due to limitation of battery capacity and inadequate image generation. There are no guidelines for procedures to remedy capsule retention. We report a case of natural passage of a capsule after 31 days in a patient with small bowel ulcer due Crohn's disease using medical treatment.

A case of capsule endoscopic finding on Churg-Strauss syndrome with gastrointestinal involvement / 대한내과학회지

Churg-Strauss syndrome is a disorder of hypereosinophilia and systemic vasculitis in subjects with asthma and allergic rhinitis. Clinically, this syndrome can be involved with various manifestations of disease of lung, heart, skin, musculoskeletal system, nerve system, gastrointestinal and hepatobiliary tract. Gastrointestinal manifestations often occur in patients. However, endoscopic finding is rare because of risk on intestinal perforation and hemorrhage in vasculitis-phase. We experienced a case of Churg-Strauss syndrome in a 27-year-old male patient with severe abdominal pain and diarrhea. He also showed leukocytosis with peripheral eosinophilia, bronchial asthma, and chronic paranasal sinusitis. Based on findings, we suggested Churg-Strauss syndrome with gastrointestinal involvement and he received a capsules endoscopy and gastroduodenal endoscopy. Capsules endoscopy showed diffuse erythema and mucosal edema on proximal jejunum to ileum, which meant the Churg-Strauss syndrome with gastrointestinal involvement. We report this case with a review of the relevant literatures.

A Case of Pseudolipomatosis in the Gastric Mucosa / 대한소화기내시경학회지

Mucosal pseudolipomatosis is a recently described endoscopic finding consisting of benign transient lesions. This condition, resembling fatty infiltration, is characterized by the presence of small gas voids in the gastrointestinal wall, particularly in the mucosa. The frequency of colonic pseudolipomatosis is higher than the frequency of pseudolipomatosis of the stomach. Both mechanical and chemical theories have been offered to explain the pathogenesis of colonic pseudolipomatosis. The mechanical theory pertains to an air pressure-related complication of the colonoscopy procedure. The chemical theory concerns a drug-related complication of the detergent used during colonoscopies. However, the pathogenesis of gastric pseudolipomatosis is still unclear. Recently, we had a patient who experienced gastric pseudolipomatosis after endoscopoy and biopsy procedures. In the following report we discuss this interesting case of gastric pseudolipomatosis.

Incidence of Lymphocytic Gastritis in Endoscopic Corporeal Varioliform Gastritis / 대한소화기내시경학회지

BACKGROUND/AIMS: Lymphocytic gastritis is characterised by the accumulation of small lymphocytes in the surface and foveolar epithelium. It is a common finding in a subtype of gastritis characterized by the presence of nodules and erosions in the body, relative to which the antrum was spared-'varioliform gastritis'. Lymphocytic gastritis usually follows a chronic course and presents severe clinical symptoms including hypoproteinemia. The aim of this study was to investigate the incidence and clinical manifestations of lymphocytic gastritis in patients who showed endoscopic apprearance of enlarged folds, erosions, and aphthoid nodules in the body. Materials and METHODS: The clinical and histological findings of varioliform gastritis with presence of nodules and erosions in the body were analyzed. The ratio of 25 lymphocytes/100 epithelial cell was used as the criteria for the diagnosis of lymphocytic gastritis in the study. RESULTS: Twenty nine cases were classified as varioliform gastritis (there were 20 men/9 women and average age was 48.9 years). Among the 29 varioliform gastritis, 9 corresponded to lymphocytic gastritis. H. pylori infection rate was 44% (4/9) in lymphocytic gastritis and 65% in non lymphocytic gastritis. There was no difference in H. pylori infection rate between the lymphocytic gastritis and non lymphocytic gastritis. Clinical laboratory findings of lymphocytic gastritis were normal. The patients with lymphocytic gastritis had absence of mild degree of symptoms. Among 4 patients with follow-up endoscopy, erosions in body were completely disappreared in 3 patients. CONCLUSIONS: Lymphocytic gastritis occurred in about 30% of patients with varioliform gastritis. Most patients with lymphocytic gastritis had no symptoms or only mild symptoms and had no significant abnormality in clinical or laboratory finding.

A Case of Double Pylorus Associated with Ectopic Pancreas Presenting with Gastric Ulcer Bleeding / 대한소화기내시경학회지

Duplication of the pylorus is one of the rare anormalies of the intestinal tract. Most of the reported cases are secondary double pylorus caused by peptic ulcer. However, double pylorus may be a congenital anomaly sometimes combined with ectopic pancreas. Recently, we experienced a case of double pylorus combined with ectopic pancreas in a 76-year-old man. The patient presented with gastric ulcer bleeding. An esophagogastroduodenoscopy confirmed the presence of double pylorus, but subsequent endoscopic hemoclipping failed to control bleeding from an ulcer on the lesser curvature of the prepyloric antrum. The microscopic examination of the surgically resected specimen showed an ectopic pancreatic tissue in the gastric wall near the ulcer lesion. We report this case with a collected review of the Korean literature.

Total Plasma Exchange in a Patient with HD-MTX-induced Acute Renal Failure: A Case Report / 대한혈액학회지

A 16-year-old male patient was diagnosed as chondroid osteosarcoma of the left humeral shaft. He showed normal serum creatinine level and no complications following the first course of high-dose methotrexate (HD-MTX) chemotherapy with a total dose of 12g/m2. After the 2nd HD-MTX chemotherapy with the same dosage as in the 1st course, plasma MTX levels soared up to 72micromol/L and serum creatinine level increased to 1.39mg/dL. We failed to lower the plasma MTX levels and to recover the renal function by high-dose leucovorin rescue and plasmapheresis. Plasma MTX level was successfully lowered after three consecutive total plasma exchanges and the withdrawal of aceclofenac which was suspected as an aggravating agent. No rebound in plasma MTX level was observed. We report that total plasma exchanges were effective in a patient with renal failure and delayed MTX excretion which occurred after HD-MTX chemotherapy.

Endoscopic Removal of a Metal Thread in the Duodenal Wall after Eating Raw Fish: A case report / 대한소화기내시경학회지

Foreign bodies in the stomach and duodenum are usually accidentally swallowed by children, mentally ill patients, alcoholics, or persons with dentures. Swallowed foreign bodies are usually asymptomatic, and moved down the alimentary tract to be passed spontaneously without discomfort. There had been reported many kinds of foreign bodies, for example, metal fragments, fish bones and so on. A metal thread, which looks like a fishing hook in gastrointestinal tract as a foreign body, has never been reported in humans. A 62-year-old male patient was admitted due to abdominal discomfort for five days after eating raw fish. We performed gastroduodenoscopy and could find a thread penetrating to the anterior wall of duodenal bulb. It was removed by biopsy forcep. Herein, we report a case of a metal thread in duodenal bulb, which looked like a fishing hook.

Fatal Cytomegalovirus Pneumonia in a Immunocompetent Patient / 감염

Serious cytomegalovirus (CMV) infection occurs frequently in immunocompromised patients and is a common cause of death. Although primary infection in immunocompetent hosts is normally subclinical, mononucleosis-like syndrome that is characterized by malaise, protracted fever, mild liver function abnormalities, and lymphocytosis with atypical lymphocytes occurs in -10% of patients. Rarely fulminant infection may develop. In both the United States and the United Kingdom, ganciclovir and foscarnet are recommended for the treatment of serious CMV infections in immunocompromised patients. In contrast, there are no recommendations for treatment of severe CMV disease in immunocompetent patients. We describe a case of 45-year-old woman with CMV pneumonia with a fatal outcome for whom there was no evidence of prior immunodeficiency.