Endoscopic Biliary Drainage Using Soehendra Stent Retriever in Difficult Malignant Biliary Stricture / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic biliary drainage (EBD) has been used effectively as the palliative treatment for malignant biliary obstruction. In high grade strictures, endoscopic stenting can be achieved by dilating devices such as dilating or balloon catheters. Subgroup of malignant biliary obstructions are too stenotic to allow passage of plastic or metal stents. In cases of failure of conventional stenting, we evaluated the efficacy and safety of the 7-Fr Soehendra stent retriever (SSR) used as a dilator. METHODS: From January 1999 to September 2001, 14 patients with malignant pancreaticobiliary stirictures (2 pancreatic, 12 biliary) that could not be traversed with plastic or metal stents, underwent stricture dilation with SSR. An endoscopic sphincterotomy was performed and a guide wire was inserted beyond the stricture. Then the SSR was introduced over the guide wire via duodenoscope. Then the stricture was traversed by torquing the SSR clockwise while pushing it. The SSR was removed and then the plastic or metal stents were inserted above the stricture. RESULTS: Of the 14 patients, 13 patients (93%) underwent successful stenting using SSR. Symptom relief was observed in all patients after endoscopic biliary stenting. One patient (7%) went on to percutaneous biliary drainage because we failed to insert the metal stent into the stenotic left hepatic duct after traversing the stricture with SSR. There were no significant complications such as bile duct or duodenal perforation and bleeding. CONCLUSIONS: The Soehendra stent retriever is useful and safe for dilation with subsequent stent placement of malignant pancreaticobiliary stirictures resistant to conventional stenting. However, this device may be difficult to pass a tortuous or small-diameter hilar stricture.

A case of pachydermoperiostosis with peptic ulcer disease / 대한내과학회지

We experienced a Korean patient with complete form of pachydermoperiostosis. He presented with typical features consisting of clubbing with spade like enlargement of the hand and feet, thickening of facial skin and scalp, irregular thickening of cortex with periosteal new bone formation involving radii, ulnae, tibiae, and fibulae. Classically, pachydermoperiostosis is characterized by a triad of finger clubbing, periostitis, skin and soft tissue changes, giving an acromegaloid look. A variety of associated abnormalities have been described such as cranial suture defects, female escutcheon, bone marrow failure. There are a few reports documenting gastric ulcer, hypertrophic gastropathy and Crohn's disease as accompanying diseases. The patient had upper gastrointestinal bleeding caused by hemorrhagic gastritis and duodenal ulcer. A case is herein reported of pachydermoperiostosis accompanied by peptic ulcer disease.

A case of primary nasopharyngeal tuberculosis with cervical lymphadenitis of immigrant woman from Vietnam / 대한내과학회지

Nasopharyngeal tuberculosis is a very rare condition and mainly secondary infection from pulmonary tuberculosis by contagious, hematogenous or lymphatic spread. However, nasopharyngeal tuberculosis may arise as a primary infection in adults without active pulmonary disease and is frequently associated with involvement of the cervical lymph node. The nasopharynx may be a portal entry for mycobacterium tuberculosis in patients who develop cervical lymphadenitis. But, involvement of the nasopharynx by tuberculosis may be underdiagnosed because it does not produce obvious symptoms or physical signs. Recently authors experienced a case of primary nasopharyngeal tuberculosis of immigrant woman from Vietnam. Here, we report a case that was confirmed by punch biopsy under telerhinoscopy and improved by combination chemotherapy.

Pseudoreticulocytosis in a Case of Myelodysplastic Syndrome / 대한혈액학회지

Myelodysplastic syndrome (MDS) is a group of hematopoietic disorders characterized by ineffective hematopoiesis and peripheral cytopenia associated with dysplastic hypercellular marrow. Anemia is a frequent finding and reticulocytes are usually normal or slightly decreased in the patients with MDS. "Pseudoreticulocytosis" is a rare abnormality of patients with MDS. In these patients, the delayed maturation of reticulocytes is revealed and unusual reticulocytosis occurs with the decreased red cell production. We report a case of MDS characterized by the anemia associated with high reticulocyte count. 'In vitro reticulocyte survival test' showed that the reticulocytosis was a consequence of delayed maturation.