A case of aorto-colonic fistula due to aortic pseudoaneurysm presented by massive gastrointestinal bleeding / 대한내과학회지

The aorto-enteric fistula is rarely occurred in patients, however it is clinically important since it is a life threatening condition in association with a massive gastrointestinal bleeding. It is classified as the primary type associated with aortic aneurysm and the secondary type which is complicated with vascular surgery. The fistula is mainly found between the aorta and the third portion of duodenum, and rarely occurred on the other part of gastrointestinal tract. In particular, to our knowledge the fistula between the aorta and transverse colon has not been reported. We report the aorto-transverse colon fistula in a 37 years old man who presented a massive lower gastrointestinal bleeding. Past history revealed that he had been stabbed in the abdomen 18 years ago, suggesting the pseudoaneurysm of aorta with fistula formation could be related. The aorto-transverse colon fistula was diagnosed by abdominal angiography and the fistula was repaired by operation.

A Case of Small Bowel Obstruction due to Multiple Trichobezoars / 대한소화기내시경학회지

Trichobezoars are gastric concretions that are composed of hair or fibers. They are more common in children and adolescents and are usually associated with a pica, emotional disturbance, or mental retardation. Trichobezoar is quite rare in Korea. In most cases, trichobezoars tend to form a cast of the stomach. However, in rare cases, portions of the trichobezoar may separate from the gastric mass, migrate distally, and obstruct the small bowel. We report a case of small bowel obstruction due to multiple trichobezoars in a 14 year-old-girl who had a habit of swallowing hairs until 12 years of age. The patient was treated successfully surgically.

A case of bleeding from the accessory pancreatic duct associated with aneurysmal dilatation of pancreaticoduodenal artery / 대한내과학회지

Gastrointestinal bleeding through the pancreatic duct especially from the minor papilla through the accessory duct is a very rare event. It has rarely been demonstrated to be associated with pancreatic pseudocyst, arteriovenous malformation, pancreas divisum, and duodenal duplication cyst. We have experienced a 51-year old man having sudden onset melena. He had been recovered from a recent myocardial infarction and was on the aspirin treatment. Upper gastrointestinal endoscopic examination revealed bleeding through minor papilla from the accessory duct but no bleeding was observed through the ampulla of Vater. Angiogram demonstrated two sites of aneurysmal dilatation of pancreaticoduodenal artery and these were obliterated by selective embolization. Thereafter the bleeding was controlled and patient was recovered.

A case of bleeding from the accessory pancreatic duct associated with aneurysmal dilatation of pancreaticoduodenal artery / 대한내과학회지

Gastrointestinal bleeding through the pancreatic duct especially from the minor papilla through the accessory duct is a very rare event. It has rarely been demonstrated to be associated with pancreatic pseudocyst, arteriovenous malformation, pancreas divisum, and duodenal duplication cyst. We have experienced a 51-year old man having sudden onset melena. He had been recovered from a recent myocardial infarction and was on the aspirin treatment. Upper gastrointestinal endoscopic examination revealed bleeding through minor papilla from the accessory duct but no bleeding was observed through the ampulla of Vater. Angiogram demonstrated two sites of aneurysmal dilatation of pancreaticoduodenal artery and these were obliterated by selective embolization. Thereafter the bleeding was controlled and patient was recovered.

A Case of Inflammatory Fibroid Polyp Presenting with Jejunal Bleeding / 대한소화기학회지

Inflammatory fibroid polyp occurs very rarely in the jejunum and gastrointestinal bleeding as an initial manifestation of inflammatory fibroid polyp has not been reported. We report a case of a jejunal inflammatory fibroid polyp presenting with melena for 10 days. Upper gastrointestinal endoscopic examination was negative for any active bleeding lesions and abdominal angiography failed to localize the bleeding site as well. In contrast, computed tomography of the abdomen demonstrated a segmental wall thickening of the jejunum with a tumor-like mass lesion associated with dense contrast enhancement. Consistent with this, technetium 99m red blood cells scintigraphy exhibited red cell pooling at the right upper quadrant. On exploratory laparotomy, there was an active bleeding from the site of the jejunal tumor and a segmental resection was performed. Histologically, the tumor lesion of the jejunum was consistent with inflammatory fibroid polyp. Thus, we conclude that the tumor lesion was a cause of the gastrointestinal bleeding.

A Case of Early Gastric Remnant Cancer Treated by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Patients who have undergone partial gastric resection are at an increased risk for the development of cancer and polyps in the gastric remnant, and this risk increases with time following gastrectomy. The prevalence of polypoid change at 15~20 years after surgery is approximately 10%, about four or five times higher as compared to nonoperated one. Hyperplastic polyps are encountered more frequently than adenomatous polyps. Surgical treatment for gastric remnant cancer has been regarded as standard method, but it was reported that endoscopic mucosal resection of early gastric remnant cancer could be performed under strict indication, as the incidence of lymph node metastasis was very low. Recently one adenomatous polyp with focally carcinoma in situ in the gastric remnant was removed by endoscopic mucosal resection in male patient who had undergone Billroth II gastrojejunostomy for gastric ulcer disease 12 years earlier.

Propofol as Premedication for Upper Gastrointestinal Endoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Benzodiazepine is generally used when sedation is required for endoscopy, while propofol, a phenol-derived intravenous anesthetic agent, appears to have a more suitable phamacokinetic profile. The aim of this study was to evaluate the effectiveness and safety of propofol as premedication for upper gastrointestinal endoscopy. METHODS: Between July 1998 and October 1998, 44 male patients and 70 female patients were involved in this study. The relative ease of upper gastrointestinal endoscopy, patient's tolerance, and amnestic effects on 64 patients with propofol was compared with 50 patients with non-sedation. Pulse rate and arterial oxygen saturation was monitored. The endoscopist and patients replied to a questionnaire. RESULTS: Patients receiving propofol tolerated endoscopy much more than patients with non-sedation (p<0.01). The change in pulse rate was less variable but arterial oxygen saturation showed a statistically significant decrease in patients receiving propofol (p<0.01). Propofol induced complete amnesia in 93.7% of the patients and partial anesthesia in 4.7%. Most of the patients receiving propofol accepted the same sedative methods in their next endoscopy (p<0.01). CONCLUSIONS: Propofol is highly effective, with a short recovery time and satisfaction of the patients, but careful monitoring is recommended because of its untoward effect of hypoxia. It is recommended that propofol be used as a premedication especially in patients who are apprehensive about a repeated endoscopy.

Four Cases of Gastric Mucosal Tear after Blunt Abdominal Trauma / 대한소화기내시경학회지

The incidence of abdominal trauma has increased in recent decades as the frequency of traffic accidents increased. Early symptoms and signs of blunt abdominal trauma may be absent and associated injuries frequently detract physicians from early diagnosis of abdominal trauma. Delayed diagnosis has been shown to be associated with higher morbidity and mortality. Gastrointestinal tract is the third most commonly injured organ from blunt abdominal trauma. Gastric ruptures after blunt abdominal trauma were reported occasionally, but reports of upper gastrointestinal bleeding by gastric mucosal tear were very rare. Four cases of upper gastrointestinal bleeding due to gastric mucosal tear after blunt abdominal trauma are herein reported with a review of related literatures.

A Case of Retrograde Jejunogastric Intussusception Diagnosed by Endoscopy / 대한소화기내시경학회지

Retrograde jejunogastric intussusception defined as a segmental invagination of jejunal loop into stomach through stoma is a rare complication following partial gastric resection. Endoscopy and UGI series is very helpful in the diagnosis of this disease. Although the management of this disease is usually surgical, an endoscopic reduction can alternatively be attempted. If endoscopic reduction was failed, operation should be immediately per-formed in the acute type because of its high mortality. When anatomical reduction is done on due time, the prognosis is fairly good. We report a case of retrograde jejunogastric intussusception with a brief review of the literature. There was a 56 year old male patient who visited the hospital with chief complaints of severe epigastric pain and vomiting. He had subtotal gastrectomy for gastric carcinoma 6 years ago. On emergency endoscopy the type IIa jejunogastric intussusception was found. As the patient was suspected to be incar-cerated, surgical reduction was performed without delay. He was discharged on the 8th admission day.

Measurement of inferior vena cava diameter, alpha-human-atrial natriuretic peptide and cyclic guanosine 3':5'-monophosphate for estimation of dry weight and intravascular volume change in hemodialysis patients / 대한내과학회지

BACKGROUND: A correct estimation of volume status and dry weight in dialysis patients remains a difficult clinical problem. Clinical status and chest X-ray are not sensitive enough, while invasively measured central venous pressures are not routinely available. Recently, the ultrasonographic determination of the diameter and collapse index of the inferior vena cava has been proposed as a noninvasive method for estimating intravascular volume. We tried to evaluate the clinical relevance of this method in dialysis patients by comparing it with alphahuman-atrial natriuretic peptide (alpha-h-ANP) and cyclic guanosine 3:5-monophosphate (cGMP) levels. METHODS: Using echocardiography, the diameter of the inferior vena cava (VCD) and its decrease on deep inspiration (collapse index : CI) were evaluated in 27 hemodialysis patients. Echocardiography of the inferior vena cava (IVC) was performed in the supine position after 10 minutes rest. The transducer was placed in the subxiphoid region and long and short axis views of the IVC were obtained just below the diaphragm in the hepatic segment. VCD was measured before the P-wave on the electrocardiogram to avoid interference with A-wave and V-wave on the venous pressure curve, and corrected for body surface area. Preand post-hemodialysis levels of the plasma alpha-h-ANP and cGMP were measured by radioimmunoassay. The relationship between VCD, CI determined by echocardiography, and alpha-h-ANP and cGMP concentrations were studied. RESULTS: The levels of alpha-h-ANP and cGMP were markedly elevated before hemodialysis and significantly lower values were found after hemodialysis (alpha-hANP : 162.7 102.6 pg/ml vs 90.6 61.0 pg/ml , cGMP : 35.3 8.8 pmol/ml vs 21.3 6.2 pmol/ml). A significant correlation was found between VCD and alpha-h-ANP before (r=0.81, p 0.05) and also no relation was observed between the decrease of cGMP during hemodialysis and VCD before hemodialysis (r=0.12, p > 0.05). A significant correlation between the percent change in body weight and the percent change in VCD during hemodialysis (r=0.91, p<0.05) and also significant relation was observed between the pecent change in body weight and the percent change in alpha-h-ANP levels (r=0.40, p , 0.05). CONCLUSION: Echocardiography of the inferior vena cava allow an estimation of changes of intravascular volume in ESRDpatients without cardiac filling impairment as shown by the correlation to other indices of intravascular volume, such as alpha-h-ANP. In this study, CI and cGMP levels were less informative. Inferior vena cava echocardiography is noninvasive and easily available and serial measurements of VCD and alphah-ANP levels allow an estimation of chages of intravascular volume in ESRD patients on maintenance hemodialysis.

A Case of Formation of Interbronchial Fistula Complicated by Long-standing Bronchial Foreign Body / 결핵

In healthy adults, diagnosis of aspiration of foreign body into tracheobronchial tree is not difficult because various symptoms such as dyspnea, coughing, or cyanosis develop when foreign b~y is aspirated into tracheobronchial tree. But unless a clear history of an aspiration event can be obtained diagnosis will be delayed. Early complications of tracheobronchial foreign body aspiration include asphyxia, cardiac arrest, dyspnea, laryngeal edema, and cyanosis. Late complications include pneumonia, lung abscess, bronchiectasis, hemoptysis, bronchial stenosis, arid polyp. Treatment is removal of foreign body by operation or bronchoscopy. Currently, flexible bronchoscopy is preferred in adults than rigid bronchoscopy. A 36-year-old male visited to Dongkang hospital due to productive coughing and dyspnea On auscultation, focal inspiratory wheezing was heard. On chest PA, mild emphysematous change was seen. Flexible bronchoscopy was done. Bronchoscopically, mucoid impaction, surrounding inflammation, foreign body lodged in the right lower lobe bronchus, and interbronchial fistula(between right middle and lower lobe bronchus) were seen Foreign body(2.4 x 1.3cm sized antacid package) was removed by flexible bronchoscopy. Later, history of aspiration of a piece of antacid package was found. We report a case of recurrent bronchitis with interbronchial fistula as a result of occult aspiration of foreign body with review of the literatures.

Listerial peumonia and bacteremia in pregnant woman / 대한내과학회지

No abstract available.

A Case of Clonorchiasis with Clinical Presentation of Eosinophilic Pneumonia / 결핵

Although clonorchiasis is one of the most common parasitic infections in Korea, it is unusual that the disease presents peripheral eosinophilia and pulmonary infiltrations.( eosinophilic pneumonia) A case of clonorchiasis manifested as diffuse nodular pulmonary infiltrations was presented. The patient had a mild to moderate pain on the right upper quadrant of the abdomen, cough, dyspnea, and unknown cause of marked eosinophilia (up to 71.4% of total white blood cell count). The causal organism, clonorchis sinensis was found by the identification of parasite ova in the stooL We confirmed eosinophuic pneumonia with bronchoalveolar larvage analysis and transbronchial lung biopsy. With corticosteroid and praziquantel treatment, clinical symtoms and pulmonary infiltrations on the chest roentgenograms had rapidly improved. We report a case of eosinophilic pneumonia related to clonorchiasis and review the pertinent literature.

A Case of Gastric Actinomycosia after Gastrectomy for Early Gastric Cancer / 대한소화기내시경학회지

Primary gastric actinomycosis is an extremely rare disease and less than 20 cases are reported in literature. We experienced a case of gastric actinomycosis in the 63-year-old woman who had subtotal gastrectomy for early gastric cancer(type IIc) 7 month ago. Endoscopic biopsy from elevated lesion on stoma was found to show the neutrophilic infiltration and sulfur granule. She placed on tetracycline for 30 days. Follow up endoscopy showed no abnormality. We report this case with literature review. (Koresn J Gastrointest Endosc 18: 757~ 760, 1996)

A Case of Insulinoma Diagnosed as Epilepsy for 7 Years / 대한내분비학회지

Insulinoma is rare functioning islet cell tumor of pancreas and its main feature is frequent attacks of hypoglycemia. Because of frequent seizure, the disease is occasionally mistook as epilepy. We experienced a case of insulinoma with dilantin toxicity in a 45 year old patient who had been treated with dilantin for 7 years. Selective splenic arteriogram showed 0.8cm mass in the tail of pancreas which was proven insulin secreting tumor on histiopathological examination. After operation no more seizure attack was detected and her blood sugar level was well maintained within normal range. This case might provide an insight that the possibility of insulinoma should be considered in patient with episodic neurobehavioral dysfunction such as epilepsy.

Prevalence of anti-HCV in healthy subjects in Ulsan area / 대한내과학회지

No abstract available.

Serotype of rickettsia Tsutsugamushi isolated in Ulsan area / 감염

No abstract available.

The antibody responses to newly isolated strain(R19) in Korea & three major serotypes and clinical features of Tsutsugamushi disease / 감염

No abstract available.