Two Cases of Wernicke's Encephalopathy That Developed during Total Parenteral Nutrition in Colon Cancer Patients Treated with 5-Fluorouracil-based Chemotherapy / 대한소화기학회지

Wernicke's encephalopathy (WE) caused by thiamine deficiency is an acute neurological disorder. Clinically, the classic triad of WE consists of ophthalmoplegia, ataxia, and mental status changes. Thiamine deficiency is known to occur commonly in chronic alcoholic patients. Sometimes, it can occur in patients after gastrointestinal surgery and in those with malabsorption. In addition, patients undergoing renal dialysis, suffering from hyperemesis gravidarum, receiving total parenteral nutrition (TPN), and being treated with chemotherapeutic agents are also prone to develop thiamine deficiency. Herein, we report two cases of WE that developed following simultaneous 5-fluorouracil (5-FU) chemotherapy and TPN in colon cancer patients which was successfully treated with thiamine administration.

Portal and Splenic Vein Thrombosis Successfully Treated with Anticoagulants in Acute Pancreatitis / 이화의대지

Splanchnic vein thrombosis arising from complications of acute pancreatitis is very rare. It usually occurs as a form of portal, splenic and superior mesenteric vein thrombosis, either in combination or separately. It could develop portal hypertension, bowel ischemia and gastrointestinal variceal bleeding. Treatment of splanchnic vein thrombosis includes anticoagulants, thrombolysis, insertion of shunts, bypass surgery and liver transplantation. In some cases, anticoagulation therapy may be considered to prevent complications. However, the standard protocol for anticoagulation in splanchnic vein thrombosis has not been determined yet. We report a case of 43-year-old man who had portal and splenic vein thrombosis in acute pancreatitis. The patient was successfully treated with oral anticoagulants following low molecular weight heparin therapy.

Differences in Bacterial Species and Their Resistance Rates based on Sputum Cultures between Tertiary Hospitals and Smaller Medical Institutions / 이화의대지

OBJECTIVES: Since the 1990s, drug-resistant bacteria have become common pathogens of hospital-acquired infections. In recent years, healthcare-associated infections have come to the fore, and it is reported that distribution rates of these bacteria are comparable to those of hospital-acquired infections. However, there have been few studies on differences in resistant bacteria depending on the size of hospitals. Thus, the authors studied differences in drug-resistant bacteria between a tertiary hospital and smaller medical institutions. METHODS: We retrospectively analyzed the clinical findings and sputum culture results of patients transferred from tertiary hospitals (group A, n=74) and those transferred from smaller medical institutions (group B, n=65). RESULTS: The number of patients with malignancy was higher in group A than in group B. The length of intensive care unit stay was longer in group A than in group B. Antibiotic therapy and mechanical ventilation were more frequently used in group A than in group B. There were no significant differences between the 2 groups in bacterial species (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa) and their resistance rates to carbapenem, while there were significant differences between the 2 groups in the bacterial species (Acinetobacter baumannii) and its resistance rate to carbapenem. CONCLUSION: In this study, there were significant differences between the 2 groups in the bacterial species and resistance rates to carbapenem for A. baumannii infection unlike other bacterial infections. Further studies on risk factors and patient classification are needed to confirm our results.

A Case of Successful Treatment for Acute Complication Caused by Ingestion of a Large Amount of Glacial Acetic Acid

Glacial acetic acid, a caustic substance of strong acidity, can easily be found in our daily lives; sometimes, it is drunk for the purpose of suicide, or it can be misjudged as a beverage. Glacial acetic acid is corrosive and toxic, therefore, even a tiny amount may cause fatal damage, such as gastrointestinal injury and systemic complication. A 66-year-old male patient, based on the wrong information, that glacial acetic acid is a healthy beverage, ingested 250 mL of 99% glacial acetic acid. Complications included gastric perforation, hemolysis, disseminated intravascular coagulation, acute renal failure, and liver dysfunction. We achieved successful treatment through performance of emergency surgery and hemodialysis on the patient, who had ingested a more than fatal dose of glacial acetic acid; herein, we would like to report on the case along with a review of the literature.

A Case of Ectopic Sebaceous Glands in the Esophagus

Most ectopic sebaceous glands have been reported in the organs of ectodermal origin such as the lips, oral cavity, salivary glands, nipples, palms & soles, and genitals. Ectopic sebaceous glands in the esophagus are extremely rare conditions, because esophagus is an organ of endodermal origin. Whether the histogenesis of these lesions are embryological misplacement or acquired metaplasia remains unclear. We report a case of ectopic sebaceous glands in the esophagus diagnosed by endoscopic biopsy, with a brief review of the histogenesis. This case was followed up after 1 year. There were no significant changes, but the lesions had increased slightly in number compared with the last examination. When the number of lesions increase as in our case, acquired metaplasia is the most likely cause.

A Case of Ectopic Sebaceous Glands in the Esophagus

Most ectopic sebaceous glands have been reported in the organs of ectodermal origin such as the lips, oral cavity, salivary glands, nipples, palms & soles, and genitals. Ectopic sebaceous glands in the esophagus are extremely rare conditions, because esophagus is an organ of endodermal origin. Whether the histogenesis of these lesions are embryological misplacement or acquired metaplasia remains unclear. We report a case of ectopic sebaceous glands in the esophagus diagnosed by endoscopic biopsy, with a brief review of the histogenesis. This case was followed up after 1 year. There were no significant changes, but the lesions had increased slightly in number compared with the last examination. When the number of lesions increase as in our case, acquired metaplasia is the most likely cause.