Middle Cerebral Artery Infarction Associated with Osler-Weber-Rendu Disease

Osler-Weber-Rendu disease is characterized by epistaxis, cutaneous telangiectasia, and visceral arteriovenous malformations (AVMs). A 65-year-old male with recurrent epistaxis, old infarction and recent multiple rib fractures caused by a bicycle accident had middle cerebral thromboembolic infarctions when he stopped taking clopidogrel due to massive epistaxis and hemopneumothorax. On examinations, there was no focal cerebral stenosis, but there were telangiectasia, pulmonary and hepatic AVMs. A suspicious Osler-Weber-Rendu disease patient should be evaluated by proper screening and regular follow-up to minimize serious sequelae such as thromboembolic stroke.

Gabapentin-induced Myoclonus in a Patient with End-stage Renal Disease

Myoclonus manifests in a variety of situations including epilepsy, metabolic derangements, brain lesions, and toxicity of drugs. A 57-year-old woman with end-stage renal disease was given gabapentin 900 mg/day for legs' paresthesia. Two days after taking gabapentin, multifocal myoclonus developed involving all extremities. Three days after discontinuation of gabapentin, myoclonus resolved completely. No deterioration of renal function was noted before and after the occurrence of myoclonus. Administration of gabapentin should be performed with caution in patients with impaired renal function.

A Case of Double Pylorus Associated with Ectopic Pancreas Presenting with Gastric Ulcer Bleeding / 대한소화기내시경학회지

Duplication of the pylorus is one of the rare anormalies of the intestinal tract. Most of the reported cases are secondary double pylorus caused by peptic ulcer. However, double pylorus may be a congenital anomaly sometimes combined with ectopic pancreas. Recently, we experienced a case of double pylorus combined with ectopic pancreas in a 76-year-old man. The patient presented with gastric ulcer bleeding. An esophagogastroduodenoscopy confirmed the presence of double pylorus, but subsequent endoscopic hemoclipping failed to control bleeding from an ulcer on the lesser curvature of the prepyloric antrum. The microscopic examination of the surgically resected specimen showed an ectopic pancreatic tissue in the gastric wall near the ulcer lesion. We report this case with a collected review of the Korean literature.

A Case of Bleeding from Rectal Dieulafoy-like Lesion Treated by Endoscopy / 대한소화기내시경학회지

Dieulafoy-like lesion is a relatively uncommon disease which is a potential source of life-threatening gastrointestinal bleeding. The lesion comprises mainly of an abnormally large submucosal artery that protrudes through a small mucosal defect. The lesion is frequently found at distal portion of gastroesophageal junction but may occur anywhere in gastrointestinal tract including small bowel, colon and rectum. Moreover bleeding from dieulafoy-like lesion of rectum is very reae. It has been reported that rectal Dieulafoy-like lesion is very rare source of lower gastrointestinal bleeding and its pathogenesis may be associated with constipation. Recently, endoscopy has an important role in the diagnosis and treatment (including injection and coagulation therapy) of bleeding from Dieulafoy-like lesion. We herein report a case of a patient who presented wih massive hemorrhage from a small rectal ulcer with adherent blood clots. Bleeding was controlled with endoscopic treatment by utilizing bipolar electrocoagulation without complication and recurrence.

A Small Rectal Carcinoid Tumor with Liver Metastasis / 대한소화기내시경학회지

Carcinoid tumors are originated from the enterochromaffin cells in the gastrointestinal mucosa. The incidence of rectal carcinoid tumors is more than 10 percent of gastrointestinal tract carcinoid. The tumor has naturally the benign character that does not develop symptoms and it is found incidentally. The tumor may infrequently have a malignant behavior such as invasion to muscle wall, obstruction of bowel lumen and metastasis to distant organ (especially, liver) almost when its size is larger than 2 cm. We have experienced a case of rectal carcinoid tumor smaller than 1 cm in its size with huge metastatic mass of liver.

The Efficacy of Benexate HCI Betadex in Treatment of Gastric Ulcer / 대한소화기내시경학회지

Benexate HCl betadex (Ulgut) is a newly introduced antiulcer agent which stimulates production of mucus and enhanced mucosal blood flow on, gastric mucosa. This agent is known to have efficacy in treatment of peptic ulcer. This study was designed to evaluate the efficacy and safety of Benexate HCl betadex in treatment of gastric ulcer. Thirty-three patients with endoscopically diagnosed gastric ulcer were treated with Benexate HCl betadex 400 mg twice daily per os for 4 ar 8 week. Among them 3 patients were excluded due to missed during follow-up in two patients and one with gastric cancer, Every patients were assessed clinically and endoscopically before treatment, at 1 week, 2 weeks, 4 weeks, 6 weeks and 8 weeks after treatment. The result were as follows. 1) The rate of completely healing of gastric ulcer was 36.7% at 4 weeks and 76.7% at 8 weeks after the treatment. 2) Clinical symptoms(epigastric pain) disappeared in 96.7% of patients with gastric ulcer at 1 week. 3) Three patients developed side effects of drug including constipation, skin rash and liver function abnormality, respectively. These results demonstrated that Benexate HCl betadex 400 mg twice daily p.o. could be effective and safe in treatment of gastric ulcer patients.