Brace Compression for Treatment of Pectus Carinatum

BACKGROUND: Surgery has been the classical treatment of pectus carinatum (PC), though compressive orthotic braces have shown successful results in recent years. We propose a non-operative approach using a lightweight, patient-controlled dynamic chest-bracing device. MATERIALS AND METHODS: Eighteen patients with PC were treated between July 2008 and June 2009. The treatment involved fitting of the brace, which was worn for at least 20 hours per day for 6 months. Their degree of satisfaction (1, no correction; 4, remarkable correction) was measured at 12 months after the initiation of the treatment. RESULTS: Thirteen (72.2%) patients completed the treatment (mean time, 4.9+/-1.4 months). In patients who completed the treatment, the mean overall satisfaction score was 3.73+/-0.39. The mean satisfaction score was 4, and there was no recurrence of pectus carinatum in patients who underwent the treatment for at least 6 months. Minimal recurrence of pectus carinatum after removal of the compressive brace occurred in 5 (38.5%) patients who stopped wearing the compressive brace at 4 months. CONCLUSION: Compressive bracing results in a significant improvement in PC appearance in patients with an immature skeleton. However, patient compliance and diligent follow-up appear to be paramount for the success of this method of treatment. We currently offer this approach as a first-line treatment for PC.

Detection of Helicobacter pylori Antigen in Stool by Enzyme Immunoassay

Invasive techniques for diagnosis of Helicobacter pylori (H. pylori) infection require an endoscopic examination which is expensive and inconvenient and may cause complications. Stool cultures for H. pylori or a direct detection of H. pylori antigen in stools by PCR are expensive, tedious, and have a low sensitivity. We recently used an enzyme immunoassay (EIA) to detect H. pylori antigen in stool specimens. A total of 41 patients were seen at Inha University Hospital, Inchon, Korea between September and October 1998. There were 26 men and 15 women who had an average age of 37.6 years which ranged from 5 to 71 years in the present study. All of these patients came to the hospital complaining of an upper abdominal discomfort and were subjected to endoscopy and biopsies. Fifteen had a gastric ulcer, 13 had a duodenal ulcer, 1 had an early gastric cancer, and there were 12 chronic gastritis patients as shown by endoscopy. The biopsy specimens were examined by histology, CLOTM test, and cultures and these results were used as gold standards. Stool specimens were tested for the H. pylori antigen by EIA. A dual wavelength cut-off of 0.100 that was recommended by the manufacturer gave a good performance (87.1% sensitivity, 100% specificity, 100% positive predictive value, 71.4% negative predictive value, and a 90.2% efficiency). But the adjusted cut-off value using the receiver operating characteristic curve improved the performance of the test (using the cut-off value of 0.024, the sensitivity, specificity, PPV, NPV, and efficiency were 100%, 90.0%, 96.9%, 100%, and 97.6% respectively). Re-evaluation of the cut-off value may be needed for Korean patients. This technique is non-invasive, rapid, easy-to-use, and shows good performance characteristics for diagnosis of H. pylori infections. Therefore, this technique may be a substitute for gastric endoscopy especially in children and some patients who are unable to tolerate an endoscopic examination and it may be substituted for a serologic test in epidemiological research.

A Case of Behcet's Disease with Gastric Involvement / 대한소화기내시경학회지

Behcet's disease is characterized by mucocutaneous-ocular symptoms, namely recurrent stomatitis aphthosis, genital ulcer and ocular symptoms. Gastrointestinal tract involvement is common in Behcet's disease. In Korea, incidence of gastrointestinal tract involvement is 4.0~7.3% and the most common manifestation is ulceration of the bowel, localized to the terminal ileum, ileocecal vlave, and cecum, but gastric involvement is very rare. We experienced a case of Behcet's disease with gastric ulcer perforation and recurrent gastric ulcer after primary suture, selective vagotomy and pyloroplasty. We failed to improve the recurrent active gastric ulcers with Helicobacter pylori eradication and antiulcer medication. So we tried steroid and azathioprine therapy for 3 months and active ulcers were healed to multiple scarring ulcers. We would like to suggest this case as a Behcet's disease with gastric involvement.

A case of ciliated hepatic foregut cyst treated by laparoscopic excision / 대한내과학회지

Ciliated hepatic foregut cysts are uncommon lesions of the liver. They arise from remnants of the embryonic foregut, and are usually asymptomatic and benign. They are lined with a layer of ciliated columnar cells and contain mucoid material and debris. Ciliated hepatic foregut cysts are not malignant neoplasms and must be differentiated from cystic neoplasms and hypovascular solid tumors. We experienced a case of ciliated hepatic foregut cyst, which was successfully removed by laparoscopic excision, so we report the case with review of the literature.

Bronchobiliary Fistula as a Late Complication of Hepatic Resection / 대한소화기내시경학회지

A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hemihepatectomy, trauma, hydatid disease, choledocholithiasis, and other causes of biliary obstruction. BBF are rare complication of hepatic resection that can present from days to years after operation. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) are the diagnostic studies of choice and offer the possibility of therapeutic intervention. Although large series in the literature emphasize the surgical management of BBF, the reoperative procedures tend to be complicated, with a significant morbidity and mortality. Nonsurgical intervention via ERCP or PTC are more recently notably successful when resolution of a distal biliary obstruction is accomplished. Only after aggressive attempts at nonoperative, interventional techniques have failed should operative approaches be entertained. We are reporting a case of BBF secondary to hepatic resection of hepatocellular carcinoma which was managed by surgical operation.

A Case of Streptococcal Toxic Shock Syndrome with Myonecrosis / 감염

Invasive infections by group A streptococci have reemerged as a global public health problem since the middle of the 1980s. Streptococcal toxic shock syndrome (StrepTSS) is one manifestation of invasive streptococcal infections, and it is characterized by necrotic infection of soft tissue. Myonecrosis can occur in StrepTSS, but the clinical features of this subset of StrepTSS are not clearly defined. A previously healthy 38-year-old woman was hospitalized because of pain and edema of both legs, which had developed one day prior to admission. Six hours after admission, the swelling of the patient's left leg became more severe and areas of well-demarcated violescent discoloration of the skin and hemorrhagic bullae developed. A further ten hours later, she was in shock and exhibited signs of disseminated intravascular coagulation and multiple organ failure. Gram stain of an aspirate from the bulla revealed short chains of gram-positive cocci. Streptococcus pyogenes was isolated from blood culture and the presence of streptococcal exotoxins (speA gene) and M-protein type 3 were confirmed using the polymerase chain reaction. Muscle biopsy showed extensive myonecrosis and hemorrhage without infiltration of leukocytes. Despite intensive treatment with antibiotics (including clindamycin), debridement, and intravenous gamma globulin, the patient died four days after admission to the hospital.