Treatment of Massive Hemoptysis Occurred from Destroyed Lung: Prevention of Contralateral Aspiration Using Endobronchial Blocker Followed by Pneumonectomy / 결핵및호흡기질환

Untreated massive hemoptysis, especially in patients with tuberculous-destroyed lung, is a serious complication resulting in considerable morbidity and mortality. We report a case of a patient who had active tuberculosis and a destroyed left lung with massive bleeding. He was transferred to our clinic with intubation of a right-sided Robertshaw double lumen tube and right upper lobe collapse likely due to tube malposition that was presented on chest X-ray. Because hemoptysis had persisted after bronchial arterial embolizaton, we replaced the double lumen tube with a conventional endotracheal tube and inserted an endobronchial blocker into the left main bronchus through an endotracheal tube guided by bronchoscopy to prevent aspiration of blood into the right lung. Left pneumonectomy was performed and hemotpysis was ceased. We suggest that the use of an endobronchial blocker followed by surgery may be a safe and effective modality of treatment in patients with persistent bleeding after bronchial arterial embolization.

Predictors of Steroid Treatment Failure and Validation of Previous Models for Severe Attacks of Ulcerative Colitis

BACKGROUND/AIMS: Some clinical and laboratory parameter are predictors to determine steroid treatment failure in patients acute severe ulcerative colitis. We aimed to validate previous models in the Korean patients. METHODS: This study was conducted retrospectively with 70 patients who were diagnosed with severe ulcerative colitis (UC) between January 2001 and June 2011. The rate of treatment failure was investigated using predictors or numerical scoring systems from prior studies. RESULTS: Twelve (17.2%) patients failed to respond to steroid therapy. The logistic regression analysis revealed that stool frequency on the fifth day and colonic dilatation were the only independent predictive factors related to treatment failure. Formulated numerical risk scores based on mean stool frequency, colonic dilatation, and hypoalbuminemia were significantly higher in the non-responding group than those in the responding group (P8 than in the group with a score 8 plus CRP >4.5 mg/dL or bloody stool plus CRP >4.3 mg/dL) than those of the other group at the third day (40% vs. 7.3%, P=0.004; 33.3% vs. 5.2%, P=0.014, respectively). CONCLUSIONS: Stool frequency and CRP level were the meaningful parameters among the predictors for steroid treatment response. Furthermore, several predictive models for steroid treatment failure in western countries seem to be of value for use in the Korean population.

Drug Rash with Eosinophilia and Systemic Symptoms Syndrome in a Patient on Sulfasalazine for Ulcerative Colitis

Drug rash with eosinophilia and systemic symptoms (DRESS) is a life-threatening systemic drug reaction characterized by fever, rash, hematological abnormalities, lymphadenopathy, and multiple internal organ involvement. Unfortunately, a long latency period as well as clinicians' unawareness of the disease entity often results in a delay of prompt diagnosis and treatment in clinical practice. A search of the literature revealed only few reports on DRESS in patients with inflammatory bowel diseases. The pathogenesis of the disease is not clearly understood, although several possible mechanisms, such as drug detoxification, slow acetylation, and reactivation of human herpes viruses, have been proposed in its development. Here, we present a rare case of DRESS associated with viral reactivation and defects in drug metabolism in a 22-year-old man who had been on sulfasalazine for 6 weeks to treat ulcerative colitis.

A Case of Biliary Cast Syndrome in a Non-liver Transplatation Patients / 대한소화기내시경학회지

The development of total biliary casts is very unusual, and especially in patients who have not undergone liver transplantation. There are only a few reports of total biliary casts in non-liver transplantation patients who have antiphospholipid antibody syndrome, B-cell non-Hodgkin's lymphoma, cholecystectomy or allogenic hematopoietic stem cell transplantation. Here we present the case of a previously well 77-year-old man who developed a total biliary casts without any risk factors and there was no obvious liver insult. The casts were managed endoscopically.