Comparison of Clinical Outcomes Associated with Pull-Type and Introducer-Type Percutaneous Endoscopic Gastrostomies

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a method of providing enteral nutrition using endoscopy. The PEG techniques differ according to the insertion method, and include the pull type, push type, and introducer type. The aim of this study was to compare the clinical outcomes associated with the pull-type and introducer-type PEG insertion techniques, which included the adverse events, at our tertiary care center in Korea. METHODS: We retrospectively reviewed 141 cases that had undergone PEG insertion at our center from January 2009 to June 2012. The indications for PEG insertion and the acute and chronic complications caused by each type of PEG insertion were analyzed. RESULTS: The indications for PEG insertion in our cohort included neurologic disease (58.7%), malignancy (21.7%), and other indications (19.6%). Successful PEG insertions were performed on 136 cases (96.5%), and there were no PEG-associated deaths. Bleeding was the most frequent acute complication (12.8%), and wound problems were the most frequent chronic complications (8.8%). There were no statistically significant differences between the pull-type and introducer-type PEG insertion techniques in relation to complication rates in our study population. CONCLUSIONS: PEG insertion is considered a safe procedure. The pull-type and introducer-type PEG insertion techniques produce comparable outcomes, and physicians may choose either of these approaches according to the circumstances.

A Needle Penetrating the Stomach Cavity after Acupuncture

Although acupuncture is known as a safe procedure that is widely used in many countries, complications including infection, hemorrhage, hematoma, pneumothorax, nerve damage, and cardiac tamponade have been reported. A needle penetrating the stomach after acupuncture, however, is very rare. Here, we report the case of 47-year-old woman who experienced abdominal pain 2 days after receiving acupuncture. Upper gastrointestinal endoscopy identified an approximately 2.5-cm long needle in the posterior wall of the antrum. The needle was removed endoscopically using rat tooth forceps with no complications.

A Case of Sunitinib-Associated Thrombotic Thrombocytopenic Purpura / 대한내과학회지

Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome (TTP-HUS) is an acute condition with abnormalities of multiple organ systems. It is characterized by microangiopathic hemolytic anemia and thrombocytopenia. Several chemotherapeutic agents have been implicated in causing TTP-HUS. We report a case of TTP-HUS during treatment with sunitinib in a patient with metastatic renal cell carcinoma. A 53-year-old woman visited our hospital for fever and cough. She was diagnosed with sunitinib-induced TTP. Discontinuation of sunitinib and plasmapheresis improved her TTP. When she experienced disease progression after a prolonged period without treatment, sorafenib was tried, resulting in a partial response without recurrence of TTP-HUS.

A Case of Inferior Mesenteric Arterial Thrombosis with Bowel Infarction Successfully Treated by Conservative Treatment / 대한내과학회지

Acute mesenteric thrombosis accounts for 25-30% of acute mesenteric ischemia and occurs usually alongside severe atherosclerotic disease. Acute mesenteric thrombosis primarily affects the superior mesenteric artery; thus, inferior mesenteric arterial thrombosis is an extremely rare form of the condition. Surgical treatment is mandatory to resolve impending or overt bowel infarction in acute mesenteric ischemia patients. However, here we report a case of colonic infarction caused by acute inferior mesenteric thrombosis successfully treated by conservative management.

The characteristics of non palpable thyroid nodule and relation to prediction of malignant nodule / 대한내과학회지

BACKGROUND: Thyroid nodules are commonly encountered in clinical practice and a p revalence of general population is 19~67% by ultrasonography. We made a study to investigate clinical characteristics, malignancy ratio of thyroid incidentalomas and predicting factors for diagnosis of malignancy, to provide recommendation for evaluation. METHODS: We retrospectively evaluated the medical records of 320 patients who visited Kyungpook National University Hospital from July 2001 to December 2003 with non palpable thyroid nodules. We reviewed physical examination, ultrasonographic findings, laboratory findings, histology of thyroid nodules and did statististic analysis to examine relationship to malignancy. RESULTS: 52 patients revealed papillary carcinomas and malignancy rate whin incidentalomas is 9.3%. Sonographic findings of solid structure, hypoechogenecity, punctate calcification, ill defined margin, irregular shape showed meaningful diagnostic value for malignancy. CONCLUSIONS: Combination of meaningful sonographic findings increased possibility of maliganancy and require active mangements including recurrent fine needle aspiration and surgery if needed.

A Case of Functioning Paraganglioma in Posterior Mediastinum / 대한내분비학회지

Paraganglioma is an extraadrenal pheochromocytoma originating from chromaffin cells distributed in the sympathetic nervous systems. Functioning extraadrenal paragangliomas represent more than 10% of all pheochromocytomas, and seems to be highly malignant tumor in comparison to intraadrenal pheochromocytomas. Recently, we experienced a case of a paraganglioma in the posterior mediastinum. A 32-year-old woman was admitted to hospital due to dyspnea on exertion, and intractable hypertension. A chest X-ray showed a well-defined mass density on the right cardiac border, and biochemical studies showed characteristic findings of pheochromocytoma. A solitary pheochromocytoma was located in the posterior mediastinum using 131I-MIBG scintigraphy. The clinical manifestations, including hypertension and dyspnea were improved after operation.

A Case of Calciphylaxis Mimicking Dermatomyositis / 대한내분비학회지

Calciphylaxis is a rare, but fatal, condition that is characterized by a rapidly progressive ischemic necrosis of the skin, underlying tissue and other organs, as well as rapid vascular calcification. It results in death due to sepsis, heart or respiratory failure. A 67-year old female was admitted to hospital with the chief complaint of constant pain to both lower legs of 1 week duration. She was treated with calcitonin-salmon due to a prior unexplained hypercalcemia of 2 weeks. On the third day post admission. pain and weakness in the lower legs were aggravated, became painful, with violaceous skin lesions developing on the thigh with findings similar to those of rhabdomyolysis. Because she was suspected of having dermatomyositis, she was treated with methylpredrisolone. However, the skin lesions and symptoms were aggravated, and she died of sepsis due to a skin infection. About 160 cases of calciphylaxis have been reported, with most of these cases being associated with secondary hyperparathyroidism due to end-stage renal disease, but cases of calciphylaxis without renal failure are very rare. We now report a case of calciphylaxis without renal failure, mimicking dermatomyositis, and present a brief review of the pathophysiology and treatments of calciphylaxis inform the relevant literature.

Evaluation of Gross findings of Cystoscopy in Staging Cervical Cancer / 대한비뇨기과학회지

To assess the importance of cystoscopic gross finding in staging cervical cancer, a clinical observation was performed on 97 cases Of cystoscopy in cervical cancer. The results were as follows: 1. Of 97 cases of cystoscopy, 26 cases were suspected as tumor invasion to the bladder mucosa. The majority of these cases were distributed over initial stage III. 2. Of 26 suspected tumor invasion, ultrasound and CT revealed positive findings in 75%, respectively. Ultrasound and/or CT revealed in 85.7%. 3. Of 26 cases, 25 cases (96.2%) were impressed as final stage TV and 15 cases (15.5%) were upstaged. 4. Among 97 cases of cystoscopy, 40 cases were upstaged in final stage. Fourty percents of 40 cases were contributed by cystoscopy.

Evaluation of Gross findings of Cystoscopy in Staging Cervical Cancer / 대한비뇨기과학회지

To assess the importance of cystoscopic gross finding in staging cervical cancer, a clinical observation was performed on 97 cases Of cystoscopy in cervical cancer. The results were as follows: 1. Of 97 cases of cystoscopy, 26 cases were suspected as tumor invasion to the bladder mucosa. The majority of these cases were distributed over initial stage III. 2. Of 26 suspected tumor invasion, ultrasound and CT revealed positive findings in 75%, respectively. Ultrasound and/or CT revealed in 85.7%. 3. Of 26 cases, 25 cases (96.2%) were impressed as final stage TV and 15 cases (15.5%) were upstaged. 4. Among 97 cases of cystoscopy, 40 cases were upstaged in final stage. Fourty percents of 40 cases were contributed by cystoscopy.