The Use of Palliative Endoscopic Ultrasound-guided Enterostomy to Treat Small Bowel Obstruction in Two Patients with Advanced Malignancies / 대한내과학회지

Recurrent or refractory small bowel obstruction in postsurgical patients with advanced malignancies poses therapeutic dilemmas. Although some promising results have been achieved as small bowel endoscopic techniques advanced, palliative stent placement is both challenging and complex. Endoscopic ultrasound (EUS)-guided anastomosis using a lumen-apposing metal stent has been recently used during gastroenterostomy to treat benign or malignant gastric outlet obstruction. Data on the outcomes of EUS-guided enterostomy in patients with recurrent small bowel obstruction are lacking, although the technique is applicable throughout the entire gastrointestinal tract. We recently encountered recurrent or refractory small bowel obstruction in two poor surgical candidates. For the first case, we performed EUS-guided enterostomy to treat a recurrent obstruction after conventional stent insertion. The second case underwent EUS-guided transenteric stent placement to treat refractory small bowel obstruction associated with diffuse peritoneal carcinomatosis after failure of a conventional “push” endoscopic procedure.

Comparison Analysis of Dietary Behavior and Nutrient Intakes of the Elderly according to Their Family Status: The Korea National Health and Nutrition Examination Survey 2013–2016 / 대한지역사회영양학회지

OBJECTIVES: This study was undertaken to compare dietary life of the elderly living alone and in a family, and to compare differences based on gender, for the 2013-2016 Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: The subjects included 2,612 elderly people aged over 65 years who participated in the health survey, health examination and nutrition survey. Subjects on a diet therapy were excluded. This study analyzed the general characteristics, dietary habits, daily energy and nutrient intakes, CPF ratio, estimated average requirement (EAR), nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR), index of nutrient quality (INQ), and food consumption of the elderly living alone and in a family. We also compared the differences based on gender. RESULTS: Daily intake of food, water, dietary fiber, potassium, retinol, and riboflavin were low in the male elderly subjects living alone. The elderly living with family revealed higher NAR and MAR as compared to the elderly living alone. Although all MAR values were <1, the elderly living alone had lower values. Considering the intake of food, the consumption of seaweed, fish and shellfish, and oils (animal) was higher in elderly men living with families, whereas women living with families consumed more vegetables, fruits, seaweeds and seafood, as compared to their counterparts living alone. Furthermore, analyzing the foods consumed by the elderly people living alone, female subjects consumed more seaweed, milk and animal oil as compared to male subjects. CONCLUSIONS: The results of this study indicate that the elderly living alone have poor nutrient intake as compared to the elderly living with families. Based on this research data, we recommend that it is necessary to improve the health and nutritional status of the elderly living alone.

Eosinophilic Myocarditis-Associated Toxocariasis / 대한내과학회지

Human toxocariasis is a common helminthozoonosis due to the infestation of toxocara canis or toxocara cati larvae, and is a common cause of blood eosinophilia in Korea. Toxocariasis has various clinical manifestations depending on the involved organ, and cardiac involvement can range from asymptomatic to fulminant myocarditis with cardiogenic shock. Treatment of toxocariasis is based on corticosteroid and anthelmintic therapies. Here, we report a case of a 57-year-old male with eosinophilic myocarditis caused by toxocariasis as diagnosed via serial echocardiography follow up.

Tranexamic Acid-Induced Acute Renal Cortical Necrosis in Post-Endoscopic Papillectomy Bleeding

Acute renal failure can be the result of acute renal cortical necrosis (RCN), which commonly occurs from complications occurring during pregnancy. RCN is rarely caused by medications, although tranexamic acid, which is used in patients with acute bleeding for its antifibrinolytic effects, reportedly causes acute RCN in rare cases. An 82-year-old woman experienced gastrointestinal bleeding after endoscopic papillectomy of an ampullary adenoma. The bleeding was controlled with tranexamic acid administration; however, 4 days later, her urine volume decreased and she developed pulmonary edema and dyspnea. Serum creatinine levels increased from 0.8 to 3.9 mg/dL and dialysis was performed. Abdominal pelvic computed tomography with contrast enhancement revealed bilateral RCN with no renal cortex enhancement. Renal dysfunction and oliguria persisted and hemodialysis was continued. Clinicians must be aware that acute RCN can occur after tranexamic acid administration to control bleeding.