Risk Factors of Delayed Bleeding after Colonoscopic Polypectomy: Case-Control Study / 대한소화기학회지

BACKGROUND/AIMS: Colonoscopic polypectomy is a valuable procedure for preventing colorectal cancer, but is not without complications. Delayed bleeding after colonoscopic polypectomy is a rare, but serious complication. The aim of this study was to identify risk factors of delayed bleeding after colonoscopic polypectomy. METHODS: A retrospective case-control study was conducted in a single university hospital. Forty cases and 120 controls were included. Data collected included comorbidity, use of antiplatelet agents, size and number of resected polyps, histology and gross morphology of resected polyps, endoscopist's experience, resection method, use of sedation, and use of prophylactic hemostasis. RESULTS: In univariate analysis, size, histology and number of resected polyps, endoscopist's experience, resection method and use of prophylactic hemostasis were significant risk factors for delayed bleeding after colonoscopic polypectomy. In multivariate analysis, risk of delayed bleeding increased by 11.6% for every 1 mm increase in resected polyp diameter (OR, 1.116; 95% CI 1.041-1.198; p=0.002). Number of resected polyps (OR, 1.364; 95% CI, 1.113-1.671; p=0.003) and endoscopist's experience (OR, 6.301; 95% CI, 2.022-19.637; p=0.002) were significant risk factors for delayed bleeding after colonoscopic polypectomy. CONCLUSIONS: Size and numbers of resected polyps, and endoscopist's experience were independent risk factors for delayed bleeding after colonoscopic polypectomy. More caution would be necessary when removing polyps with these factors.

Comparison of central venous pressure and the inferior vena cava/aorta diameter index for evaluation of body fluid status

PURPOSE: Central venous pressure (CVP) is used almost universally to evaluate patient body fluid status. But historical and more recent data suggest that this approach may be flawed. In this study, we compared the accuracy of CVP versus the inferior vena cava/aorta diameter index (IVC/Ao index), a new approach to assessing body fluid status. METHODS: This study was carried out prospectively with subjects over 18 years of age who visited the emergency department between November 2010 and January 2011. A central venous catheter (CVC) was inserted into patients undergoing computed tomography (CT). IVC and aortic diameter were measured below the renal vein using the CT in axial view. To determine the exact CVP, we measured the distance from the tip of the CVC to the superior vena cava/right atrium (SVC/RA) junction in coronal and axial CT views, and placed the tip of a CVC at the SCV/RA junction. We analyzed the correlation between the CVP, IVC diameter and the IVC/Ao index. RESULTS: A total of 65 patients were enrolled in this study. The mean CVP was 9.25+/-5.99 mmH2O, IVC diameter was 1.456+/-0.568 cm and IVC/Ao index was 0.854+/-0.316. The correlation coefficient for CVP and IVC diameter was 0.625 (p<0.01) and for CVP and IVC/aorta index it was 0.711 (p<0.01). Coefficient of variations (CVs) of the IVC/Ao index was 0.76 at CVP 5 mmH2O and 0.14 at CVP 17 cmH2O. The correlation coefficient for CVP and IVC/Ao index in the group with a CVP result of less than 8 cmH2O was 0.330, and in the group with a CVP result greater than 8 cmH2O, it was 0.660 (p<0.01). CONCLUSION: The CVP results had a higher correlation to the IVC/aorta index than to the IVC diameter. The coefficient of variant (CV) tended to increase as CVP decreased. It is best not to use a single value of CVP or IVC/Ao index to evaluate the body fluid state, as some kind of dynamic parameter should be used.

Comparison of central venous pressure and the inferior vena cava/aorta diameter index for evaluation of body fluid status

PURPOSE: Central venous pressure (CVP) is used almost universally to evaluate patient body fluid status. But historical and more recent data suggest that this approach may be flawed. In this study, we compared the accuracy of CVP versus the inferior vena cava/aorta diameter index (IVC/Ao index), a new approach to assessing body fluid status. METHODS: This study was carried out prospectively with subjects over 18 years of age who visited the emergency department between November 2010 and January 2011. A central venous catheter (CVC) was inserted into patients undergoing computed tomography (CT). IVC and aortic diameter were measured below the renal vein using the CT in axial view. To determine the exact CVP, we measured the distance from the tip of the CVC to the superior vena cava/right atrium (SVC/RA) junction in coronal and axial CT views, and placed the tip of a CVC at the SCV/RA junction. We analyzed the correlation between the CVP, IVC diameter and the IVC/Ao index. RESULTS: A total of 65 patients were enrolled in this study. The mean CVP was 9.25+/-5.99 mmH2O, IVC diameter was 1.456+/-0.568 cm and IVC/Ao index was 0.854+/-0.316. The correlation coefficient for CVP and IVC diameter was 0.625 (p<0.01) and for CVP and IVC/aorta index it was 0.711 (p<0.01). Coefficient of variations (CVs) of the IVC/Ao index was 0.76 at CVP 5 mmH2O and 0.14 at CVP 17 cmH2O. The correlation coefficient for CVP and IVC/Ao index in the group with a CVP result of less than 8 cmH2O was 0.330, and in the group with a CVP result greater than 8 cmH2O, it was 0.660 (p<0.01). CONCLUSION: The CVP results had a higher correlation to the IVC/aorta index than to the IVC diameter. The coefficient of variant (CV) tended to increase as CVP decreased. It is best not to use a single value of CVP or IVC/Ao index to evaluate the body fluid state, as some kind of dynamic parameter should be used.

A Case of Coinfection of Hepatitis A and E Virus with Hepatic Encephalopathy / 대한내과학회지

With recent hygienic improvements in Korea, the occurrence of overt acute viral hepatitis A in adults is increasing. Acute viral hepatitis E, which has seldom been reported, has also been increasing in Korea over the past few years. Reports regarding coinfection of hepatitis A virus (HAV) and hepatitis E virus (HEV) and their clinical courses are very rare. Acute hepatitis A is usually improved by conservative management, but coinfection of HAV and HEV may lead to severe forms of disease. When a patient with acute hepatitis A presents with an atypical clinical course such as hepatic encephalopathy, HEV infection, which has identical transmission routes to HAV, must be considered. We report a case of coinfection of HAV and HEV with hepatic encephalopathy.

A Case of Primary Cardiac Non-Hodgkin's Lymphoma

Although 25 to 36% of systemic lymphoma patients develop cardiac involvement, a primary lymphoma involving only the heart or pericardium is much less common. We detected an intracavitary mass in the right atrium and right ventricle in a 73-year-old man with dyspnea on exertion and generalized edema using transthoracic and transesophageal echocardiography. A thoracotomy was performed due to a possible cardiac tamponade, and a myocardial biopsy showed a malignant non-Hodgkin's lymphoma of the diffuse large B cell type. We report a rare case of a primary cardiac lymphoma detected using a transthoracic and transesophageal echocardiography in patient presenting with a massive pericardial effusion.

Oxaliplatin and UFT, leucovorin combination chemotherapy in patients with advanced colorectal cancer / 대한내과학회지

BACKGROUND: UFT/oral leucovorin (LV) provided a safer, more convenient oral alternative to bolus i.v. 5-Fluorouracil/LV regimen for advanced colorectal cancer while producing equivalent survival. We evaluated the efficacy and safety of a combination of oxaliplatin and UFT/LV in patients with advanced colorectal cancer. METHODS: From January 1999 to December 2001, a total 28 patient with metastatic or relapsed colorectal cancer were enrolled in this study. Treatment was consisted of oxaliplatin 130 mg/m2 i.v. for 2 hours on day 1, and UFT 300 mg/m2 p.o. and LV 30 mg p.o. on day 1-21. Chemotherapy repeated every three weeks until disease progression. RESULTS: Of the 28 patients, 1 complete response and 10 partial responses were observed. The overall response rate was 39.3%. The estimated median time to progression and survival were 6.0 months and 18.2 months, respectively. Peripheral neuropathy was the most common adverse effect. But, peripheral neuropathy was mild (grade 1, 2) and reversible. From the 129 cycles analyzed, grade 3, 4 adverse effects were observed only 3% included neutropenia (1.5%), and thrombocytopenia (1.5%). There were no treatment-related deaths. CONCLUSION: This combination of oxaliplatin and UFT/oral leucovorin is active and feasible in patients with advanced colorectal cancer. The regimen deserve further evaluation in a phase III prospective study.

A Case of Primary Aldosteronism with Aortic Dissection / 대한내분비학회지

Hypertension and atherosclerosis are the most important factors contributing to the development of aortic dissection. Primary aldosteronism is a rare cause of hypertension. The concurrence of aortic dissection is very rare in primary aldosteronism. However, when aortic dissection is found as a life-threatening complication of primary aldosteronism, then the diagnosis of primary aldosteronism is important because the therapeutic intervention can be curative. Only 3 cases of primary aldosteronism with aortic dissection have been reported in the literature. We report here on a case of primary aldosteronism with aortic dissection, which was treated by laparoscopic adrenalectomy. We lowered the blood pressure with antihypertensive drugs and potassium replacement was done to treat the aortic dissection. After stabilization of aortic dissection, we removed his left adrenal mass by laparoscopic adrenalectomy. Postoperatively, the patient's blood pressure has been within normal limits and the serum potassium increased to a normal level without supplementation. The aortic dissection has remained in a stable state

A Case of Primary Aldosteronism with Aortic Dissection / 대한내분비학회지

Hypertension and atherosclerosis are the most important factors contributing to the development of aortic dissection. Primary aldosteronism is a rare cause of hypertension. The concurrence of aortic dissection is very rare in primary aldosteronism. However, when aortic dissection is found as a life-threatening complication of primary aldosteronism, then the diagnosis of primary aldosteronism is important because the therapeutic intervention can be curative. Only 3 cases of primary aldosteronism with aortic dissection have been reported in the literature. We report here on a case of primary aldosteronism with aortic dissection, which was treated by laparoscopic adrenalectomy. We lowered the blood pressure with antihypertensive drugs and potassium replacement was done to treat the aortic dissection. After stabilization of aortic dissection, we removed his left adrenal mass by laparoscopic adrenalectomy. Postoperatively, the patient's blood pressure has been within normal limits and the serum potassium increased to a normal level without supplementation. The aortic dissection has remained in a stable state

The Usefulness of Endoscopic Ultrasonography in the Diagnosis of Diseases of Liver, Biliary Tree, Gallbladder and around Distal Common Bile Duct / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) is now accepted as an essential tool for the diagnosis and the therapy of various gastrointestinal diseases. With regard to the biliary system, its high diagnostic sensitivity and specificity were reported recently. We assessed the clinical usefulness of EUS for the diagnosis of diseases of the liver, biliary tree, gallbladder and distal common bile duct. METHODS: We sent questionnaires about the clinical usefulness of EUS to the doctors who requested EUS examination for 32 patients with suspected diseases of the liver, gallbladder and around extrahepatic biliary tree from Aug. 2001 to Aug. 2002. We evaluated the answers and clinical characteristics of the patients. RESULTS: Patients were 17 males and 15 females with mean age of 61.8 years old. All received abdominal computed tomography (CT) before EUS and some had abdominal ultrasonography (USG) or endoscopic retrograde cholangiopancreatography (ERCP). EUS was more accurate and informative than other imaging modalities and gave definite final diagnosis for 31.2%. In 40.6%, EUS was helpful as an additional diagnostic tool. CONCLUSIONS: EUS was useful in 71.8% of the cases for the diagnosis of diseases of the liver, biliary tree, gallbladder and around distal common bile duct. EUS can be used as an important adjunct to USG, CT and ERCP.