Idiopathic Retroperitoneal Hematoma with Spontaneous Resolution / 대한소화기학회지

A 54-year-old man was transferred from another hospital due to a hematoma in the third portion of the duodenum on abdomen CT. He had been admitted for 2 weeks due to vomiting at another hospital. He had abdominal discomfort and nausea without abdominal pain when he visited the Gwangyang Sarang Hospital. Other than a distended abdomen and mild general abdominal tenderness, the results of physical examination were unremarkable. Abdominal CT revealed an approximately 9 cm thick walled hematoma at the anteroinferior site of the duodenal third portion. Upper endoscopy revealed stenosis of the third portion of the duodenum without mucosal lesions. The endoscope was not advanced through the narrowed duodenal lumen. A retroperitoneal hematoma was diagnosed, and his state was classified as subacute rather than acute based on the duration. The surgeon did not recommend surgical treatment. Urgent treatment was unnecessary; he was managed conservatively. The size of the hematoma decreased from 9.0 cm to 5.8 cm on the following CT. He could begin to eat food on the 26th admission day, and he was discharged on the 31st admission day. The hematoma disappeared entirely on the following CT. This paper describes a rare case of idiopathic retroperitoneal hematoma with a spontaneous resolution.

A Case of Acute Hyperglycemia Induced by Jerusalem Artichoke in a Patient with Type 2 Diabetes Mellitus / 임상당뇨병

Jerusalem artichoke (JA) mainly consists of inulin. In many experimental studies, inulin has been shown to be beneficial for decreasing glucose level. Therefore, JA is lately attracting wide attention as an anti-diabetic food. Therefore, many patients ingest JA in extract form. However, there are no published clinical studies in patients with diabetes to demonstrate benefit from the use of inulin-type fructans. We experienced a diabetes inpatient with acute hyperglycemia associated with JA. We could not control the patient's blood glucose in spite of addition and increment of insulin. We found that she had taken extracts of JA and recommended cessation. After discontinuing JA extracts, her blood glucose was well controlled in spite of discontinuation of insulin. Thus, in this patient, JA had actually increased blood glucose. We suggest that JA may be dangerous for use in diabetic patients.

Aorta-right Atrial Tunnel Accompanying Infective Endocarditis / 대한내과학회지

Aorta-right atrial tunnel is a vascular anomaly that originates from the aortic sinus and terminates in either the superior vena cava or the right atrium. The patency of the tunnel can result in volume overload in both ventricles, bacterial endocarditis, aneurysm formation, and spontaneous rupture. Transesophageal echocardiography was performed in a 42-year-old male patient diagnosed with infectious endocarditis, and vegetation of the mitral and aortic valves, right atrial enlargement, and an extracardiac blood vessel connecting the aorta to the right atrium were discovered. Therefore, we were able to diagnose an aorta-right atrial tunnel leading to infectious endocarditis and proceeded with surgical treatment. Together with a review of the literature, we present a case report of a patient with aorta-right atrial tunnel accompanied by infectious endocarditis.

Endoscopic Removal of Tangled Plastic Wires in the Stomach Using an Argon Plasma Coagulation and Endoscopic Scissors

Plastic wires are uncommonly swallowed and subsequently may be tangled in the stomach. Although endoscopy with accessories is effective for removal of most wires, sometimes it is hard to remove tangled plastic wires. Early diagnosis and immediate retrieval of ingested wires are important. Mentally impaired adults have a relatively high rate of surgical intervention and complications due to delayed diagnosis. A twenty-one year old woman visited our hospital with foreign bodies in the stomach. She was mentally retarded and had swallowed plastic wires frequently. Esophagogastro-duodenoscopy revealed tangled plastic wires. We cut three wires with argon plasma coagulation and endoscopic scissors to unwind the bundle of wires. We removed the remaining 17 wires one by one. The total length of the wires were 496 cm. We report this unusual case of tangled plastic wires in the stomach removed endoscopically without surgical intervention.

Comparison of Safety after Percutaneous Coronary Intervention Between Octogenarians and Counterparts with Coronary Artery Disease

BACKGROUND: Elderly patients usually have comorbid and poor general conditions. They are more likely to have complex coronary lesions with cardiac dysfunction. Percutaneous coronary intervention (PCI) in octogenarians remains controversial. In this study, we determined the safety after PCI for octogenarians and their younger counterparts with coronary artery disease. METHODS: We reviewed 1,057 patients (110 octogenarians vs. 947 younger counterparts) who underwent PCI for coronary artery disease at Saint Carollo Hospital. We analyzed the baseline characteristics, angiographic findings, in hospital mortality, and post procedural complications between the two groups. RESULTS: The mean ages of octogenarians and younger counterparts were 83.1+/-4.5 years and 62.6+/-10.3 years, respectively. The octogenarian group had a significantly (p<0.001) higher ratio of female patients compared to their younger counterpart group (57.3% vs. 27.5%). However, the octogenarian group had a significantly (p=0.035) lower ratio of patients with history of diabetes mellitus compare to their younger counterpart group (22.7% vs. 32.6%). Incidence of acute myocardial infarction in octogenarians was significantly (p<0.001) higher than that in the younger counterparts (43.7% vs. 18.0%). There was no significant difference in admission duration, major complication, or in-hospital mortality between two groups. CONCLUSION: Our results revealed that hospital mortality and incidence of major complications in octogenarians who underwent invasive PCI were not higher than those in their younger counterparts, suggesting that PCI could be safely used in patients aged 80 years or older. However, long-term follow-up data are needed.