A Case of Midazolam Anaphylaxis

Midazolam is a type of anesthetic agent frequently used for conscious sedation during a variety of medical procedures. Anaphylactic reactions to midazolam are rarely reported. However, we observed a case of midazolam hypersensitivity in which emergency measures were required to ensure patient recovery after administration of midazolam as a sedative. The occurrence of the anaphylactic reaction to midazolam was confirmed by elevated serum tryptase levels. The current case report presents a discussion of our findings.

Primary Pure Squamous Cell Carcinoma Originating from the Stomach

Primary gastric squamous cell carcinoma represents a rare entity. Up to date, only seven cases have been reported in Korea. This paper reports a case of a 51-year-old male patient whose stomach cancer was diagnosed during general routine check-up. Upper gastrointestinal endoscopy showed a large ulcero-fungating mass on the body of the stomach. Histological examination of biopsy confirmed squamous cell carcinoma. An extended total gastrectomy including splenectomy and segmental resection of the large bowel was conducted. Postoperative adjuvant chemotherapy with capecitabine and oxaliplatin was followed. The patient has been following up the out patient's clinic after discharge.

Primary Pure Squamous Cell Carcinoma Originating from the Stomach

Primary gastric squamous cell carcinoma represents a rare entity. Up to date, only seven cases have been reported in Korea. This paper reports a case of a 51-year-old male patient whose stomach cancer was diagnosed during general routine check-up. Upper gastrointestinal endoscopy showed a large ulcero-fungating mass on the body of the stomach. Histological examination of biopsy confirmed squamous cell carcinoma. An extended total gastrectomy including splenectomy and segmental resection of the large bowel was conducted. Postoperative adjuvant chemotherapy with capecitabine and oxaliplatin was followed. The patient has been following up the out patient's clinic after discharge.

A Study of Complications Related to Percutaneous Endoscopic Gastrostomy

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a widely used method for providing nutritional support for patients who require prolonged tubal feeding. As survival times of PEG inserted patients increase, PEG related complications are also increasing. For this reason, we decided to review complications related to PEG. MATERIALS AND METHODS: A retrospective review of medical records was conducted for patients who received PEG placement between January 2004 and March 2013 in our hospital. Of the total 331 cases of PEG placement, 131 cases of PEG exchanges were excluded and a total of 200 cases were included in our review. We reviewed the baseline characteristics of all PEG inserted patients and complications related to PEG insertion. RESULTS: Complications related to PEG developed in 45 of 200 patients (22.5%). Peristomal infection occurred in 22 patients (11.0%) and buried bumper syndrome occurred in 10 patients (5.0%). Other complications that occurred in 13 patients were hemorrhage (3.0%), leakage (1.0%), aspiration pneumonia (1.0%), ileus (0.5%), necrotizing fasciitis (0.5%) and gastro-colo-cutaneous fistula (0.5%). The characteristics according to age, gender, procedure place and underlying disease were not different between the complication group and non complication group. The onset time to complication was significantly different between the buried bumper syndrome group and the other complication groups (P=0.035). CONCLUSIONS: Peristomal infection was the most common complication of PEG in our hospital. Late peristomal infection and buried bumper syndrome occurred more often than previous studies. Buried bumper syndrome was more likely to occur in later time compared with the other complications.

Acute Pancreatitis Due to a Duodenal Ulcer

Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar.

Successful Treatment of Duodenal Variceal Bleeding by Endoscopic Clipping

Duodenal varix bleeding is an uncommon cause of gastrointestinal bleeding in patients with portal hypertension but can cause severe and potentially fatal bleeding. However, the incidence is low and a good treatment method has not been well established yet. Duodenal variceal bleeding can be treated surgically or nonsurgically. We have successfully treated a patient with duodenal variceal bleeding secondary to liver cirrhosis using hemoclips to control the bleeding.

A Case of Portal Vein Thrombosis in Acute Necrotizing Pancreatitis Treated with Low-Molecular-Weight Heparin / 대한내과학회지

Portal vein thrombosis can result from the obstruction of blood flow, inflammation, and hypercoagulability of blood. Clinical symptoms include those of bowel ischemia caused by extension of the thrombus, portal hypertension, and gastrointestinal varix bleeding. Cases arising from complications of acute pancreatitis are very rare. The management of portal vein thrombosis varies, but spontaneous resolution of the thrombosis is uncommon. To prevent complications, anticoagulation therapy may be considered. We report a 51-year-old man who was treated successfully with low-molecular-weight heparin for portal vein thrombosis complicating acute necrotizing pancreatitis.

Case of Multiple Liver Lacerations Detected After Cardiopulmonary Resuscitation

The liver is one of the most commonly injured organs by blunt or penetrating abdominal trauma. The incidence of injuries is increasing annually as a result of the high number of traffic accidents. The mortality of this injury is almost 15% and the most common cause of death is hemorrhage. But, liver injuries during cardiopulmonary resuscitation are rare complications. These liver injuries can be managed and treated by non-operatively. We reported a case of multiple liver lacerations that was detected incidentally and was treated with non-operative management.

A Case of Liver Abscess and Bacteremia Caused by Vibrio cholerae Non-O1 / 대한소화기학회지

Vibrio cholerae non-O1 have caused several well-studied food-borne outbreaks of gastroenteritis and also have been responsible for sporadic cases of otitis media, wound infection, and bacteremia. Few cases of liver abscess caused by Vibrio cholerae non-O1 have been reported. A 73-year-old man with underlying diabetes mellitus was admitted with nausea, vomiting, dyspepsia and febrile sensation. We identified Vibrio cholerae non-O1 in his blood cultures and multiple hepatic microabscess on abdominal computed tomography. He was treated with systemic antibiotics and fluid therapy, but died due to septic shock on sixth day. We report here, a case of liver abscess with bacteremia due to Vibrio cholerae non-O1 in a patient with diabetes mellitus.

A left-sided gallbladder accompanying atrophy of the lateral inferior segment of the liver / 대한내과학회지

A left-sided gallbladder occurring in the absence of situs inversus is a rare anomaly. This anomaly was found in a 50-year-old man without any evidence of pancreatobiliary disease. Epigastric transverse ultrasonography showed a normal gallbladder with its fundus extending past the left lateral end of the liver. Abdominal computed tomography (CT) revealed that the gallbladder was located beneath the quadrate lobe (S4) of the liver to the left of the left branch of the portal vein, and S4 was hypertrophied to compensate for atrophy of the lateral inferior segment (S3) of the liver. Magnetic resonance cholangiopancreatography (MRCP) showed that the gallbladder and pancreatobiliary tree were normal, and that the cystic duct joined the common bile duct from the right side making a characteristic U-shaped hairpin bend.

A case of desmoplastic small round cell tumor with Down's syndrome / 대한내과학회지

A desmoplastic small round cell tumor (DSRCT) is a rare, aggressive neoplasm that occurs predominantly in children and young men. It presents as a large mass inside the abdomen, particularly within the pelvis, and may be accompanied by extensive tumor implants throughout the peritoneum. Microscopically, it typically appears as nests of small undifferentiated cells within a desmoplastic stroma. A DSRCT shows a special immunohistochemical staining pattern, expressing epithelial, neural, and muscle markers. A DSRCT is associated with a specific chromosomal translocation, t (11;22) (p13;q12), resulting in a chimeric EWS/WT1 transcript that is helpful for diagnosing this tumor. We experienced a case of DSRCT in a 19-year-old man who had been diagnosed with Down's syndrome.

A Case of Extensive Necrosis of the Gastric Mucosa Following Ethanol Injection Therapy / 대한소화기내시경학회지

A bleeding peptic ulcer is the most common cause of upper gastrointestinal bleeding as well as for hospitalization and death. Many endoscopic methods of treating bleeding peptic ulcers are currently being studied and developed. Among them, the endoscopic pure ethanol injection therapy is favored because of its high efficacy, low cost, and rapid administration. Pure ethanol is an excellent agent to stop bleeding and manifests itslef by inducing tissue dehydration, fixation and vessel compression, which in turn causes arterial coagulation and tissue necrosis. However, an excessive injection volume may bring about extensive mucosal necrosis; hence, caution should be taken when deciding upon the injection volume and depth. We report a case of extensive necrosis of the gastric mucosa following endoscopic ethanol injection therapy of a bleeding peptic ulcer along with a review of the relevant literature.

Two Cases of Sigmoid Volvulus Treated by Emergency Colonoscopic Reduction Procedure / 대한소화기내시경학회지

A volvulus of the colon is a twisting of a redundant segment of the colon at its narrow mesentery. A sigmoid volvulus is the most common type. This disorder may spontaneously reduce and recur as a chronic problem. However, it more frequently becomes acute as a result of an obstruction, which can lead to strangulation and gangrene with a high mortality if not treated promptly. Colonoscopic reduction and decompression is the preferred initial treatment for patients with a sigmoid volvulus who show no signs of bowel strangulation, which may be the cause of the high mortality associated with emergency surgery. We experienced 2 cases of a sigmoid volvulus in a 44-year-old female and a 51-year-old male. The sigmoid volvulus was diagnosed by simple abdominal film and treated successfully by an emergency colonoscopic reduction. We report our experience on the use of colonoscopy to treat sigmoid volvulus with a reviews of the relevant literlature.

A Case of Systemic Sclerosis Combined with Ovarian Cancer / 대한류마티스학회지

We report a 54-year old female who had mild dyspnea, coughing, abdominal distension, tightening and thickening of the skin, and Raynaud's phenomenon. Clinical manifestations, laboratory and radiologic examinations were compatible with systemic sclerosis. She was also diagnosed to have ovarian cancer on histopathologic study. The possible causative relation between systemic sclerosis and malignant neoplasms is a controversial issue, but several studies have demonstrated an increased frequency of cancer in patients with systemic sclerosis, especially lung and breast cancers. Ovarian cancer was rarely reported in association with systemic sclerosis. We present this case with a review of literatures.

Comparision of Prevention Effect of Lidocaine Pretreatment on Pain and Withdrawal Assosiated with Injection of Rocuronium / 대한마취과학회지

BACKGROUND: Rocuronium bromide is a new steroidal nondepolarizing neuromusular blocking drug characterized by a rapid onset and intermediate duration of action. I.V. rocuronium produces intense discomfort at the site of injection, so many trials have been conducted on prevention of pain induced by I.V. rocuronium. This study evaluate venous retension induced forearm was squeezed with a tourniquet, affect lidocaine efficacy. METHODS: Test was performed alert patients and unconscious patients. One group received lidocaine (0.5 mg/kg) and the other forearm was squeezed with tourniquet keeping the lidocaine (0.5 mg/kg) within the vein. After 30, 60 seconds rocuronium (0.6 mg/kg) was injected. propofol (2 mg/kg) induce patients unconsiousness. RESULTS: There was statistical difference in reduction pain and withdrawal among groups. Squeezing group showed less pain and withdrawal than no squeezing group. CONCLUSION: Venous retension induced forearm was squeezed with a tourniquet, lidocaine reduce pain and withdrawal movement more effectively.