A Case of Successful Embolization with Superselection by Endoscopic Hemoclipping for Pseudoaneurysmal Bleeding in a Patient with Pylorus Preserving Pancreaticoduodenectomy / 대한소화기내시경학회지

Arterial bleeding after pancreaticoduodenectomy is a very serious complication with high mortality. Therefore, early diagnosis and treatment is essential. In particular, early detection and immediate embolization can be effectively used for the delayed massive bleeding that occurs from a pseudoaneurysmal rupture. However, sometimes intermittent bleeding or a vessel spasm can cause the bleeding focus to remain unidentified in spite of repeated angiography. We experienced a case of successful embolization with superselection by endoscopic hemoclipping in a patient who underwent pylorus preserving pancreaticoduodenectomy, and the patient's bleeding focus was not found after repeated angiography. Endoscopic hemoclip application can be useful for localizing a pseudoaneurysmal rupture in patients with pancreaticoduodenectomy.

A Case of Dual Malignancy in a Renal Transplanted Recipient / 대한신장학회잡지

Kidney transplantation is a ideal renal replacement therapy in the patient with end stage renal disease. It made improvement of the patients' life quality but made increase of the incidence of chances of malignant diseases of them. We report a 44-year-old male kidney recipient recently diagnosed as early gastric cancer, had diagnosed previously as malignant lymphoma 6 years ago. He received a kidney from his mother 13 years ago, and then 7 years later he was diagnosed as malignant lymphoma presented as 2.5 cm-sized solitary lung mass. Histologically, it was confirmed as diffuse large cell type lymphoma. After 2-year scheduled chemotherapy and radiation therapy, he achieved complete remission. He was diagnosed as early gastric cancer by routine Upper Gastro-Intestinal Series study. Histologically, it was defined as moderately differentiated adenocarcinoma. He underwent a subtotal gastrectomy (Billoth-II). After the operation, he preserved good graft function with no recurrence of malignancy until now. Briefing our case, a kidney recipient has been serially diagnosed different two kinds of malignancy, malignant lymphoma and early gastric cancer with interval of 7 years. He showed good responses to therapy of malignancies and excellent prognosis. We recommend specific schedule of regular malignancy screening test for kidney recipients with long duration of post-transplantation.

A Case of Fatal Multiple Cerebral Aspergillosis in a Patient with Acute Promyelocytic Leukemia during Complete Remission

Cerebral aspergillosis accounts for about 10% of all the cases of invasive aspergillosis. The brain is the only infected site in less than 10% of cases. The patients at high risk for of aspergillosis are immunocompromised patients such as those in a neutropenic state after chemotherapy, AIDS and etc. We experienced a case of cerebral aspergillosis in a patient with acute leukemia that was in complete remission. The patient visited our hospital's ER due to nasal bleeding, and then he was quickly diagnosed as having acute promyelocytic leukemia. After the first induction chemotherapy, he achieved a complete remission. Loss of consciousness developed on day 31 after chemotherapy. High signal intensity in the right temporooccipital lobe and multiple nodular lesions in both cerebral hemispheres were observed on the brain MRI. Stereotaxic biopsy showed septate aspergillus hyphae in the brain specimen. Despite of the use of amphotericin B deoxycholate, the patient died of recurrent grand mal seizure and multiple organ failure.

A Case of Gastric Lipoma with Early Gastric Cancer Removed by Subtotal Gastrectomy / 대한소화기내시경학회지

Gastric lipomas account for less than 3% of benign gastric tumor arising from the submucosal layer. Gastric lipomas are usually asymptomatic, but occasionally diagnosed from epigastric pain, obstruction and bleeding by their size and location. A 68-year-old female with melena was diagnosed as gastric lipoma, having a bleeding focus at endoscopy. Endoscopy with biopsy revealed a yellowish fat containing lipoma which was located prepyloric antrum and protruded to the duodenal lumen, and synchoronous adenocarcinoma which was located at the gastric angle and distal body. Adenocarcinoma was confined to the mucosa and seperated from lipoma by normal stomach tissue. The patient received Billroth-II subtotoal gastrectomy, and gastric lipoma and early gastric cancer were resected, completely.