A Case of Massive Hemobilia after a Long Period of Time Since Open Cholecystectomy / 대한췌담도학회지

A 77-year-old woman was admitted with 5 days history of melena. She had an open cholecystectomy 30 years ago. Abdominal computed tomography and duodenoscopy revealed massive hemobilia. Angiography showed right hepatic arterial fistula to common bile duct near the surgical clip. Embolization was done successfully and the patient recovered. We experienced a case of a massive hemobilia which was occurred after a long period of time since open cholecystectomy without pseudoaneurysmal change of the right hepatic artery. And we suggest the direct vessel injury and fistula between the bile duct and a blood vessel as a possible cause of hemobilia in this case.

One Case of Common Bile Duct Cancer Mimicking Cystic Neoplasm of the Pancreas, Arising 9 Years after Excision of a Choledochal Cyst

A 42-years-old woman had undergone operation for cholecochal cyst with gallbladder cancer 9 years ago. Pathology revealed a polypoid mass in the gallbladder with liver infiltration as poorly differentiated adenocarcinoma. Computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasound showed a newly developed suspected solid nodule in the peripheral portion of cystic lesion in the pancreas head. She underwent a pylorus preserving pancreaticoduodenectomy for the suspected mucinous cystic neoplasm of the pancreas. Pathology revealed poorly differentiated adenocarcinoma. The remnant choledochal cyst had developed to cholangiocarcinoma, which mimicked cystic neoplasm of the pancreas.

A Case of Small Bowel Intussusception Caused by Jejunal Hamartoma Confused as Hepatitis A in an Adult / 영남의대학술지

Intussusception in adult is a rare disease and laparotomy is usually considered because of the probability of malignancy. Especially with obstruction symptom or sign, it might be needed emergency operation. This case was a simultaneous development of small bowel intussusception and acute hepatitis A. The patient had abdominal pain and vomiting. Intitial laboratory examination with elevated aminotransferase revealed that the diagnosis was acute hepatitis. As managing acute hepatitis, the abdominal pain was not improved and the patient had tenderness on periumbilical area on physical examination. A jejunal intussusception with a lead point was proved on the abdominal computed tomography scan. Fortunately, symptom of intussusception was relieved while nulli per os (NPO) and intravenous hydration. After recovery of acute hepatitis, laparotomy was done. The lead point was 2.5x3.0 cm sized hamartoma. This was the case that the symptom of intussusception was confused with that of acute hepatitis.

Comparison between Conventional 4 L Polyethylene Glycol and Combination of 2 L Polyethylene Glycol and Sodium Phosphate Solution as Colonoscopy Preparation / 대한소화기학회지

BACKGROUND/AIMS: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. METHODS: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. RESULTS: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group's compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. CONCLUSIONS: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method.

A case of stomach metastasis from breast cancer / 대한내과학회지

Metastatic cancer from breast cancer is not uncommon and it often involves multiple organs. Gastric metastasis from breast cancer is much rarer than lung, bone and lymph node metastasis. Most of the symptoms are nonspecific, so it is not easy to differentiate primary gastric cancer from gastric metastasis from the breast. In particular, gastric and breast cancers are the two most common cancers among Korean women, so efforts should be made to distinguish primary gastric cancer from gastric metastasis because treatment and prognosis are very different between two. A few cases have been reported in Korea concerning gastric metastasis from breast cancer. We report here a case of gastric metastasis from infiltrating duct carcinoma of the breast.

A Case of Acute Renal Failure after Application of Mercury to the Skin / 대한신장학회잡지

Mercury is one of the heavy metals that cause intoxications. Mercury can cause muscular tremor, psychic irritability, renal toxicity and so on. Mercury intoxications usually occur chrough chronic respiratory ingestion. We describe a case in that a woman had applicated inorganic mercury to her whole body and developed mercury intoxications which can be characterized by the whole body skin rash, fever, acute renal failure and the hepatotoxicity appeared. We managed the patient with diuretics, antibiotics and continuous veno-venous hemodiafiltration. On the 6th hospital day, serum creatinine was normalized. Since then, the skin rash and hepatotoxicity were gradually alleviated.

A Case of Acute Renal Failure Caused by Cresol Ingestion / 대한신장학회잡지

Cresol, a commonly used disinfectant, is an extremly toxic material and can cause systemic effects such as respiratory, neurological, gastrointestinal, hepatic and renal damage. Cresol intoxication can be caused by inhalation, cutaneous adsorption or oral ingestion. Cresol denatures and precipitates cellular proteins, thus exer ts their toxic effects directly on all cells. There is only one case of cresol intoxication in Korea, but a case of chemical burn. We report a case of acute renal failure caused by cresol ingestion. A 39-year-old male attempted suicide by ingesting 200 mL of 50% cresol solution. Acute renal failure developed, but he recovered by only supportive care. It was reported that the lethal dose of saponated cresol solution is approximately 60-120 mL and the lethal blood level is 71-190 microgram/mL. The amount of cresol ingested by the patient far exceeded the reported lethal dose. This is the first case of acute renal failure caused by cresol ingestion successfully treated with only supportive care in Korea.

Combination Chemotherapy of Oxaliplatin, 5-Fluorouracil and Low Dose Leucovorin in Patients with Advanced Colorectal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to evaluate the efficacy and tolerability of the oxaliplatin, 5-fluorouracil (5-FU) and low dose leucovorin (LV) combination in patients with advanced colorectal cancer. MATERIALS AND METHODS: Patients with unresectable or recurrent colorectal carcinomas were prospectively accrued. Up to one prior chemotherapy regimen was allowed. Patients received oxaliplatin, 85 mg/m2, administered as a 2-hour infusion on day 1, followed by LV, 20 mg/m2, as a bolus and 5-FU, 1, 500 mg/m2, via continuous infusion for 24 hours on days 1 and 2. Treatment was repeated every 2 weeks until disease progression or adverse effects prohibited further therapy. RESULTS: Between August 1999 and May 2004, 31 patients were enrolled in this study. Of the patients enrolled, 24 and 31 were evaluable for tumor response and survival analysis, respectively. The patients' characteristics included a median age of 59, with 6 (19%) having had prior chemotherapy. No patient achieved a complete response, but nine (38%) attained a partial response. Seven (29%) patients maintained a stable disease and 8 (33%) experienced increasing disease. The median duration of the response was 6 months. After a median follow-up of 9.6 months, the median time to progression was 3.8 months, with a median survival of 10.7 months. The hematological toxicities were mild to moderate, with no treatment-related mortality or infection. The major non-hematological toxicity was gastrointestinal toxicity. CONCLUSIONS: The combination chemotherapy of oxaliplatin, low dose LV and continuous infusion of 5-FU is safe and has a cost-benefit, but is a moderately effective regimen in advanced colorectal cancer. A randomized trial comparing low and high dosages of leucovorin in the FOLFOX regimen is warranted.