Endoscopic Extraction of Biliary Fascioliasis Diagnosed Using Intraductal Ultrasonography in a Patient with Acute Cholangitis

Fasciola hepatica infection may result in biliary obstruction with or without cholangitis in the chronic biliary phase. Because clinical symptoms and signs of F. hepatica are similar to other biliary diseases that cause bile duct obstruction, such as stones or bile duct malignancies, that are, in fact, more common, this condition may not be suspected and diagnosis may be overlooked and delayed. Patients undergoing endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the evaluation of bile duct obstruction may be incidentally detected with the worm, and diagnosis can be confirmed by extraction of the leaf-like trematode from the bile duct. Intraductal ultrasonography (IDUS) can provide high-resolution cross-sectional images of the bile duct, and is useful in evaluating indeterminate biliary diseases. We present a case of biliary fascioliasis that was diagnosed using IDUS and managed endoscopically in a patient with acute cholangitis.

The Early Onset of Disease May Be a Risk Factor for Decreased Bone Mineral Density in Patients with Inflammatory Bowel Disease

BACKGROUND/AIMS: The pathogenesis of bone loss in patients with inflammatory bowel disease (IBD) is complex, multifactorial, and only partly understood. We aimed to examine the extent and risk factors of bone mass reduction and to analyze the impact of early onset of a disease before attaining peak bone mass in IBD patients. METHODS: We compared the risk factors for osteoporosis and BMD at the lumbar spine and the hip bone in IBD patients. RESULTS: A total of 44 patients with IBD were enrolled. Twenty-one and 23 patients were diagnosed as IBD before and after the age of 30 and designated as group A and group B, respectively. Group A had significant bone mass reduction at the lumbar spine than group B (BMD, 1.01+/-0.10 vs. 1.14+/-0.17, p<0.01; T-score, -1.22+/-0.84 vs. -0.08+/-1.39, p<0.01; Z-score, -1.11+/-0.81 vs. -0.03+/-1.32, p<0.01, respectively). Multivariate analysis showed that patients diagnosed as IBD before the age of 30 had possible risk factor of bone mass reduction (hazard ratio, 3.96; p=0.06). CONCLUSIONS: Bone mass reduction was more severe in patients who were diagnosed with IBD before the age of 30 than in those diagnosed after the age of 30.

Aortoenteric Fistula Diagnosed by Double Balloon Enteroscopy: A Case Report

A secondary aortoenteric fistula (AEF) is a direct communication between the gastrointestinal tract and the aorta in a patient who has undergone major surgery on the aorta, often an aorta graft operation. We experienced a patient who had undergone graft interposition for abdominal aortic aneurysm and was admitted due to three episodes of hematemesis and following hamatochezia. Gastroscopy, colonoscopy, and radioactive iodine scan failed to identify the bleeding site in the patient. He was diagnosed with AEF by double balloon enteroscopy and recovered after surgical intervention.

A Case of Guillain-Barre Syndrome Following Plasmodium vivax infection / 감염과화학요법

A 28-year-old male was admitted to our medical center with general myalgia and fever. After a series of tests, he was diagnosed with P. vivax malaria. On the 5th hospital day, the patient complained of tingling sensation on both hands and feet, which acutely progressed to ascending symmetric motor paralysis. Nerve conduction velocity test and cerebrospinal fluid analysis showed albumino-cytologic dissociation, suggesting polyradiculopathy, and thus he was diagnosed with Guillain-Barre syndrome. After 5-day treatment with intravenous immunoglobulin, and antificial ventilator therapy the patient fully recovered. In the literature, only 22 cases of Guillain-Barre syndrome associated with Plasmodium have been reported; 19 cases were caused by Plasmodium falciparum and 3 were by P. vivax. Herein, we report the first case of Guillain-Barre Syndrome associated with P. vivax malaria in Korea.

A case of a huge gastric bezoar treated with an endoscopic Coca-cola injection and an Argon plasma beam / 대한내과학회지

Bezoars are persistent concretions of indigestible materials found in the stomach. They can cause mucosal ulceration or wall perforation, gastritis, gastric outlet obstruction, or gastrointestinal bleeding. With the significant development of endoscopic techniques, many authors have reported the removal of bezoars using methods such as endoscopic mechanical lithotomy and chemical dissolution however, the outcomes differ according to the treatment method. We report a case treated successfully with an endoscopic Coca-cola injection and an argon plasma beam for 90 minutes. A 61-year-old man was admitted with a 4-day history of upper abdominal pain. A bezoar was detected by upper gastrointestinal endoscopy. The bezoar (10x8x6 cm) was dark brown in color and extremely hard. Attemptat endoscopic removal using a polypectomy snare failed. We then injected Coca-cola directly into the bezoar mass and sprayed it with an Argon plasma beam. Ninety minutes later, the bezoar was broken into pieces and removed. The bezoar was absent at the follow up endoscopy 2 weeks later.

Two Cases of Spontaneous Pneumomediastinum Complicating Viral Pneumonia Caused by Influenza A Virus, (H1N1 Subtype): A Case Report / 대한구급학회지

Influenza A virus, (H1N1 Subtype), was identified as the cause of outbreaks of febrile respiratory infection in Mexico, the US, Canada and elsewhere during the spring of 2009. In Korea, a novel virus infection showing many variable complications was also pandemic. We report two cases of spontaneous pneumomediastinum, complicating viral pneumonia, caused by Influenza A virus, (H1N1 Subtype).