A Case of Fishbone-induced Esophageal Perforation Closed by Endoscopic Clipping / 대한소화기내시경학회지

Esophageal perforation continues to be associated with high mortality - 20% to 30% - despite advances in surgical techniques. Traditional surgery has been the mainstay of treatment for perforation, but recent advances in endoscopic closure devices has increased therapeutic options for selected patients. Our patient had a fishbone-induced esophageal perforation. He was treated successfully with endoscopic clipping, antibiotics and parenteral nutrition. We report this case and provide a review of the relevant literature.

The Prevalence of Metabolic Syndrome in Patients with Nonalcoholic Fatty Liver Disease / 대한간학회지

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) is associated with dyslipidemia, obesity, and insulin resistance, which are the main features of metabolic syndrome. First, we examined the prevalence of metabolic syndrome among patients with NAFLD. We then compared the prevalence of metabolic syndrome in simple steatosis with that in nonalcoholic steatohepatitis (NASH). Finally, we sought to identify clinical factors associated with the stage of liver fibrosis. METHODS: From November 2002 to March 2004, we enrolled consecutive 25 patients with NAFLD from patients visiting outpatient clinic. The 17 controls were healthy persons who visited our health promotion center. We compared the clinical and biochemical data of the NAFLD group with those of the control group. Using histologic findings, we divided NAFLD into simple steatosis and NASH. We then compared the clinical and biochemical data of the simple steatosis group with those of the NASH group. RESULTS: Fourteen patients (14/25, 56%) had metabolic syndrome in the NAFLD group. There was no difference in the prevalence of metabolic syndrome between the simple steatosis (5/10, 50%) and the NASH group (9/15, 60%). We found significant differences in cardiovascular risk factors between the two groups, but homeostasis model assessment insulin resistance was the only significantly different factor between the simple steatosis group and the NASH group. In addition, no difference in histological features was found between NASH with metabolic syndrome and without metabolic syndrome. CONCLUSIONS: A considerable number of patients with NAFLD had metabolic syndrome. There was a close correlation between NAFLD and metabolic syndrome. We could not find any cardiovascular risk factors that could predict a severe fibrosis.

Concurrent FP (5-fluorouracil, cisplatin) Chemoradiotherapy for Patients with Esophageal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The outcomes of a surgical approach for patients with an esophageal carcinoma remain unsatisfactory despite its high complication rates. We conducted a phase II trial, using combined FP (5-fluorouracil and cisplatin) chemotherapy and concurrent radiotherapy, as a definitive therapy for patients with esophageal cancer. MATERIALS AND METHODS: Patients with histologically proven esophageal cancer were enrolled onto this study. The treatment consisted of four courses of chemotherapy and six and a half weeks of radiotherapy. The patients received chemotherapy in weeks 1, 5, 12 and 16 (5-fluorouracil 1, 000 mg/m2 on days 1 to 4 and cisplatin 75 mg/m2 on day 1). Radiotherapy was administered at a dose of 59.4 Gy, in five 1.8 Gy fractions a week. RESULTS: A total of 22 eligible patients entered the study. Of the 19 evaluable patients, a complete response occurred in 7 (37%), and a partial response in 8 (42%). After a median follow-up of 35 months, the overall survival rate was 32% at three years and the median survival was 11 months. Fourteen (64%) received planned dose of radio-therapy and 13 (59%) received more than three courses of chemotherapy. However, there was no difference in three-year survival rates between the patients that received less than three courses of chemotherapy and those that received three or more courses (31% vs. 32%). The major treatment related toxicity was mucositis, which developed in every patient, with grades III or IV in thirteen (59%) patients. During the treatment, the patients lost, on average, 3.8% of their body weight. The mean hospital stay was 23 days, with a total duration of treatment of 74 days. CONCLUSIONS: Concurrent FP chemoradiotherapy was effective as a definitive therapy for patients with esophageal cancer. The major toxicity was mucositis. Although the treatment was relatively feasible, a randomized trial of reduced courses of chemotherapy is warranted.

Change of Autonomic and Peripheral Nerve Function after the First Twelve Months of Dialysis in End-stage Renal Disease / 대한신장학회잡지

BACKGROUND: The efficacy of dialysis on the autonomic and peripheral nerve function has been a subject of considerable debate. In addition, no longitudinal study on the course of uremic neuropathy in end-stage renal disease (ESRD) during dialysis has been reported. We carried out a prospective study to investigate the effect of dialysis on the autonomic and peripheral nerve function during the first 12 months of dialysis. METHODS: Twenty-five patients with ESRD (14 on HD and 11 on CAPD; 11 diabetic and 14 non- diabetic) were enrolled. Autonomic nerve function test and median nerve conduction velocity study were done at the initiation of dialysis and then repeated after 12 months of dialysis. RESULTS: At the initiation of dialysis, sympathetic nerve function and parasympathetic nerve function were abnormal in all HD and CAPD patients. After 12 months of dialysis, no significant changes occurred in autonomic function test. There was no significant difference in autonomic function test between HD and CAPD patients. There was no significant difference in median nerve conduction velocity between HD and CAPD patients after 12 months of dialysis. At the initiation of dialysis, 6 of 11 diabetic and 4 of 14 non-diabetic patients had abnormal median nerve conduction velocity. After 12 months of dialysis, normalization of median nerve conduction velocity occurred only in 3 non-diabetic patients. There was a singinficant difference in median nerve conduction velocity between diabetic and non-diabetic patients after 12 months of dialysis. CONCLUSION: We conclude that dialysis does not significantly alter the autonomic nerve function during the first 12 months of dialysis, but may improve the peripheral nerve function in non-diabetic uremic patients.

A case of hepatic veno-occlusive disease / 대한내과학회지

Veno-occlusive disease of the liver was first reported by Chiari in 1899. Pyrrolizidine-containing substances, chemotherapeutics and hepatic radiation injury can cause this disorder. Bone marrow and renal allograft recipients are at risk for the development of veno-occlusive lesions. Veno-occlusive disease produces a syndrome of painful hepatomegaly, jaundice and fluid accumulation. The disease affects central vein and zone 3 of the liver acinus. We discuss a patient with tender hepatomegaly and high fever due to veno-occlusive lesion. We mis-diagnosed this case as acute cholecystitis because of clinical symptoms and radiological findings of GB wall thickening. During the laparotomy, she was found to have a congested liver and dilatation of superficial lymphatics of the liver surface. The Liver biopsy showed centrilobular congestion and hepatocyte necrosis in acinar zone 3. We could not determine the etiological factor in this patient. We considered that she suffered a mild form of veno-occlusive disease and recovered spontaneously within 1 month.

A Case of Watermelon Stomach Treated by Hemigastrectomy / 대한소화기내시경학회지

Gastric antral vascular ectasia (watermelon stomach) is a rare cause of chronic gastrointestinal bleeding, characterized endoscopically by a distinctive appearance of prominent red vascular folds traversing the gastric antrum and radiating to the pyloric sphincter; this appearance has been likened to the dark stripes on the surface of a watermelon. The etiology is unknown, and the usual presentations are iron-deficiency anemia and melena due to chronic gastric blood loss. Diagnosis is made by the characteristic endoscopic appearance and histologic findings. The treatment of choice is not known yet; surgical resection is curative method, but results from endoscopic treatment with heat probes or lasers are promising. We experienced a case of gastric antral vascular ectasia presenting with epigastric pain and melena in a 34-year-old female. The patient was treated with hemigastrectomy and Billroth II anastomosis.

A Case of Gastrointestinal Amyloidosis Presenting with Hematochezia / 대한소화기내시경학회지

Amyloidosis is a disorder of protein metabolism that leads to extracellular deposition of amyloid in tissues and organs. Multiple organ dysfunction can be induced by deposition of amyloid. Diagnosis is established by histologic demonstration of amyloid protein in involved tissue using Congo red staining. A 72 year-old woman was admitted due to mild abdominal pain, diarrhea and hematochezia. Duodenoscopic and colonoscopic findings were nonspecific, however, multiple biopsies showed amyloid deposits characterized by green birefringence under polarized light. The findings of small bowel series and abdominal CT were compatible with amyloidosis. We experienced a case of amyloidosis with involvement of the whole bowel.

A Case of Spontaneous Hemoperitoneum due to Gastroepiploic Vein Rupture in Alcoholic Cirrhosis / 대한간학회지

Portal hypertension often leads to the development of several collateral vessels that shunt blood flow from the portal to the systemic circulation. The rupture of intra-abdominal varix is an unusual complication of portal hypertension that can lead to life-threatening hemoperitoneum. If the patient is hemodynamically unstable due to massive intra-abdominal bleeding, exploratory laparotomy should be performed on the patient. There are several reported cases of intra-abdominal variceal bleeding such as paraumbilical varix, the varix from the small intestine and proximal colon etc. Spontaneous hemoperitoneum caused by the rupture of gastroepiploic vein varix, however, has not been reported in Korea, to the best of our knowledge. We will discuss a patient with portal hypertension due to liver cirrhosis who presented with acute intra-abdominal bleeding. During the laparotomy, he was found to have a rupture of the gastroepiploic vein. The vessel was ligated, and the patient recovered uneventfully by operative variceal ligation.