An IgG4-Related Inflammatory Pseudotumor of the Greater Omentum / 대한내과학회지

IgG4-related sclerosing disease is a novel clinical disease entity characterized by an elevated serum IgG4 concentration and tissue infiltration by IgG4-positive plasma cells. Although this disease is a novel entity, it is not rare and is present in a proportion of patients with a wide variety of diseases, including autoimmune pancreatitis, sclerosing cholangitis, retroperitoneal fibrosis, and inflammatory pseudotumor. Despite the effectiveness of steroid therapy, IgG4-related sclerosing disease is often misdiagnosed as a malignant tumor. Here, we report an inflammatory pseudotumor of the great omentum that was misdiagnosed as a malignant tumor and subject to surgical resection.

A Case of Sarcomatoid Carcinoma Arising from Mucinous Cystadenocarcinoma of Appendix

Sarcomatoid carcinoma or carcinosarcoma is a very rare biphasic tumor characterized by a combination of malignant epithelial and mesenchymal cells. The pathogenesis of sarcomatoid carcinoma is not fully elucidated and the guideline of treatment has not been established yet. Although the upper aerodigestive tract, lung and female urogenital system are known to be the most frequently affected, this tumor also can occur in various sites, including the digestive tract. Since sarcomatoid carcinoma in colon was firstly reported in 1986, 24 cases have been reported to date. We report a rare case with sarcomatoid carcinoma of appendix. Interesting histologic feature of our case was the presence of mucinous cystadenocarcinoma with morphological "transition" between carcinomatous and sarcomatous tissue. To our knowledge, this is the first case of sarcomatoid carcinoma arising from mucinous cystadenocarcinoma of the appendix.

Acute Cholecystitis After a Colonoscopy

Acute cholecystitis after a colonoscopy is a rare event, and only eight documented cases are reported in the literature. A 35-year-old male underwent a screening colonoscopy. There was a 5-mm sessile polyp in the sigmoid colon, which was removed by using a hot snare polypectomy. Forty-eight hours after the colonoscopy, the patient visited our emergency department with epigastric pain and fever. Based on the clinical findings, laboratory data and radiologic imaging, our diagnosis was acute cholecystitis. Because no previous cases of this type have been reported to date in Korea, we publish the details of our patients who presented with a postcolonoscopy complication diagnosed as acute cholecystitis.

Acute Cholecystitis After a Colonoscopy

Acute cholecystitis after a colonoscopy is a rare event, and only eight documented cases are reported in the literature. A 35-year-old male underwent a screening colonoscopy. There was a 5-mm sessile polyp in the sigmoid colon, which was removed by using a hot snare polypectomy. Forty-eight hours after the colonoscopy, the patient visited our emergency department with epigastric pain and fever. Based on the clinical findings, laboratory data and radiologic imaging, our diagnosis was acute cholecystitis. Because no previous cases of this type have been reported to date in Korea, we publish the details of our patients who presented with a postcolonoscopy complication diagnosed as acute cholecystitis.

A Case of Endoscopic Treatment for Gastrocolocutaneous Fistula as a Complication of Percutaneous Endoscopic Gastrostomy

As a rare complication of percutaneous endoscopic gastroscopy (PEG), a gastrocolocutaneous fistula may occur after PEG placement. This paper reports an interesting case which PEG tube unintentionally penetrated transverse colon during PEG. A 72-year-old female patient who suffered from medullary infarction underwent PEG procedure for enteral nutrition, and fecal materials were observed 6 days after the procedure. Transverse colon located in antero-superior site of stomach was observed through abdominal computed tomography, and also the wrong inserted tube was found through gastroscopy and colonoscopy. Endoscopic treatment for the fistula was performed by the use of hemo-clip and detachable snare, closure of the fistula was finally confirmed 6 days after the endoscopic procedure. Therefore, the gastrocolocutaneous fistula should be considered as one of the complications of PEG when fecal material is observed through PEG tube in a few days after PEG procedure and endoscopic treatment can be feasible in this case.

A case of sinus node dysfunction and atrial tachycardia after the excision of a left atrial myxoma / 대한내과학회지

Atrial myxoma is the most common primary cardiac tumor, and surgical removal is the treatment of choice. Atrial flutter-fibrillation is common after the surgical excision of such tumors, whereas sinus node dysfunction is a rare complication. We detected postoperative sinus node dysfunction and atrial tachycardia after the excision of a left atrial myxoma in a 63-year-old woman. The patient underwent the implantation of a permanent pacemaker two weeks after the operation. The patient underwent successful catheter ablation of macroreentrant right atrial tachycardia 16 months after the operation with no recurrence of atrial tachycardia over the next four months.

The Effect of Intra-coronary Nicorandil Prior to Reperfusion in Acute ST Segment Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: Intravenous nicorandil infusion with percutaneous coronary intervention (PCI) has been reported to reduce reperfusion injury events and to improve cardiac function in patients with an acute myocardial infarction. However, there is limited information on the use of intra-coronary nicorandil. A prospective randomized single center study was designed to evaluate the efficacy of the use of intra-coronary nicorandil. SUBJECTS AND METHODS: Seventy-three patients with an acute ST segment elevation myocardial infarction were randomly assigned to the nicorandil group (n=37) or a control group (n=36); all patients received a PCI. In the nicorandil group of patients, 4 mg of intra-coronary nicorandil was infused directly into the infarct area prior to reperfusion (2 mg before ballooning, 2 mg before stenting). The composite endpoint was the incidence of ventricular arrhythmia, no-reflow and slow flow. We estimated the post thrombolysis in myocardial infarction (TIMI) grade, the myocardial perfusion grade after PCI and the short-term clinical outcome. RESULTS: The baseline characteristics were similar in both groups of patients. A significant difference was observed in the composite endpoint in the nicorandil group of patients as compared to the control group of patients (p=0.037). The achievement rate of post TIMI grade 3 was significantly higher in the nicorandil group of patients (p=0.019). The myocardial perfusion grade 1 was not observed in the nicorandil group of patients; however, it was observed in five patients in the control group (p=0.019). Major adverse cardiac events in hospital and in 30 days were similar between the two groups. CONCLUSION: Intra-coronary nicorandil infusion reduced the occurrence of no-reflow, slow reflow, reperfusion arrhythmia and improved the myocardial perfusion grade and TIMI flow during PCI. The results of this study showed that the use of intracoronary nicorandil improved the clinical outcome in patients with an acute myocardial infarction.

Two Cases of an Implantation of a Permanent Pacemaker Using a Transaxillary Incision

In surgeries that require the implantation of a pacemaker, the endocardial pacemaker leads are introduced into the cardiac chambers through subclavian or axillary venous catheterization or cephalic vein cutdown. The drawback of this type of surgery is scarring of the pectoral area, which can be a serious cosmetic problem especially for young women. In this study, we report on 2 cases where a permanent pacemaker in two young women with symptomatic bradycardia was implanted using a transaxillary incision. Both patients successfully recovered with no complications and were asymptomatic for more than 17 months after the procedure. Therefore, we found that implantation of a pacemaker via transaxillary incision provided excellent cosmetic results and should be considered in young women that require this type of surgery.

An esophageal duplication cyst that presented with sudden-onset dysphagia / 대한내과학회지

Esophageal duplication is a rare congenital disorder. Although infrequent, complications such as infection, bleeding, and perforation have been reported. Surgical resection is the standard treatment for esophageal duplication cysts. We report the case of a 45-year-old female with an esophageal duplication cyst that presented with dysphagia, with a review of the literature.

Marked QT prolongation and T inversion in a patient with acute pulmonary thromboembolism / 대한내과학회지

No abstract available.

Prognosis According to the Timing of Percutaneous Coronary Intervention in an Acute Non-ST Segment Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: An early invasive strategy with coronary angiography and revascularization is currently the recommended treatment for patients at high risk with an acute non-ST-segment elevation myocardial infarction (NSTEMI). In this early invasive strategy, percutaneous coronary intervention (PCI) is generally recommended within 48 hours, but there is little data on earlier intervention in intermediate risk patients. SUBJECTS AND METHODS: We studied retrospectively the past medical records of 118 patients at intermediate risk that were admitted at Pusan National University Hospital and were stratified by the time interval from chest pain onset to PCI (Group I: 48 h). Clinical outcomes were evaluated in terms of in-hospital and 12 months follow-up of a major adverse cardiac event (MACE). RESULTS: Baseline characteristics were not different statistically among the three groups, except for the use of tirofiban. There were no in-hospital deaths or myocardial infarctions (MI) in Group I and Group II patients, but there were three cases of in-hospital deaths in Group III patients. The incidence of a 12-month MACE was 0% in Group I patients, 6.7% (one revascularization) in Group II patients and 17.1% (3 deaths, 3 MIs, 7 revascularizations) in Group III patients (p=0.043). CONCLUSION: In acute NSTEMI, the incidence of a 12-month MACE was lower in the intermediate risk group when PCI was performed in the early period. Early PCI could be recommended in acute NSTEMI on the basis of the status of individual patients.

Electrical Storm Late after Surgery for a Double-Chambered Right Ventricle, Aortic Regurgitation and a Ventricular Septal Defect: A Case of Successful Catheter Ablation

An electrical storm is defined as multiple occurrences of ventricular tachycardia/fibrillation (VT/VF) within a single day; this is a medical emergency and a poor prognostic marker in patients with an implantable cardioverter-defibrillator (ICD). We report here on the occurrence of electrical storms in a 35-year-old man with a repaired DCRV and ICD. He had recurrent VT and electrical storms that were refractory to amiodarone and beta-blocker. A cardiac electrophysiologic study was performed 11 months after the ICD was implanted and two forms of VT were induced. After the catheter ablation of the VTs, the monomorphic VT became non-inducible. The frequency of the VT decreased from 35 per month before the catheter ablation to 1.1 times per month after the procedure. Catheter ablation of VT could be an effective treatment for patients with electrical storms refractory to antiarrhythmic drugs.

Risk factors for reflow disturbance phenomenon during percutaneous coronary intervention in patients with acute myocardial infarction / 대한내과학회지

BACKGROUND/AIMS: The reflow disturbance phenomenon is associated with poor functional and clinical outcomes for patients suffering with acute myocardial infarction (AMI). In the era of primary coronary intervention (PCI), accurately identifying those lesions that are at a high risk of no-reflow is of crucial importance. Therefore, we investigated the risk factors of the reflow disturbance phenomenon in AMI patients who underwent PCI. METHODS: From February 2003 to June 2005, the clinical and angiographic characteristics of 475 patients who had undergone PCI were reviewed retrospectively. RESULTS: 65 patients (13.7%) showed the reflow disturbance phenomenon and the reperfusion times of the reflow disturbance group ranged from 1 hour to 142 hours. On univariate analysis, an older age (p<0.001), low systolic blood pressure (p=0.01), no thrombolysis followed by PCI (p<0.001), primary PCI (p<0.001), less time to PCI (p=0.001), a high peak serum CK-MB level (p=0.013), angiographically visible thrombus (p=0.016), a low pre-TIMI grade (p=0.021) and ST segment elevation on the ECG (p=0.002) were the significant risk factors of the reflow disturbance phenomenon. An older age, a low systolic BP and angiographically visible thrombus were significant risk factors on multivariate analysis. CONCLUSION: An older age, low systolic blood pressure and angiographically visible thrombus were the independent risk factors for the reflow disturbance phenonmenon in AMI patients who undergo PCI.

Two Cases of Gastric Schwannomas: with Ulcer and without Ulcer / 대한소화기내시경학회지

A Schwannoma is a benign tumor that originates from Schwann cells in the gastric wall. The tumor is mainly asymptomatic but sometimes can cause bleeding of the upper GI tract. We encountered a Schwannoma that was identified by gastroscopy as a submucosal mass that might be malignant. Therefore, surgery was considered as the primary treatment. The Schwannoma was confirmed retrospectively by a pathologic examination after excising the mass. This case report is a comparative study into Schwanoma with and without central ulceration. Pathologically, atypia of the cell was discovered in the case accompanied by an ulcer, which is a secondary phenomenon caused by the degeneration that does not indicate the malignancy.

Acute Hydrothorax Due to HCC Involving Diaphragm during Peritoneal Dialysis / 대한신장학회잡지

Massive hydrothorax is uncommon but well recognized complication of peritoneal dialysis. Possible mechanisms include a disorder of lymphatic drainage, pleuro-peritoneal pressure gradient, and congenital diaphragmatic defects. Hydrothorax in a CAPD patient caused by infiltrative disease or malignancy is very rare. Recently, two cases of hydrothorax in CAPD patients caused by systemic amyloidosis involving diaphragm were reported. However, no case of pleuro-peritoneal communication secondary to HCC infiltrating diaphragm was reported. This case was of a hydrothorax due to HCC in a CAPD patient. We performed video-assited thoracoscopic resection of diaphragmatic mass, diaphragmatic repair and thoracoscopic talc pleurodesis. This case showed that malignancy might be considered as a cause of a hydrothorax in a CAPD patient.