Temporary homonymous hemianopsia after epidural blood patch.

We describe a case in which homonymous hemianopsia developed abruptly following an epidural blood patch procedure. The procedure was performed in a patient complaining of post-dural puncture headache after an emergency Cesarean section under spinal anesthesia. Computed tomography and magnetic resonance imaging demonstrated that air bubbles had moved from the prepontine and premedullar cisterns toward the left retrochiasmal region. The homonymous hemianopsia resolved rapidly with conservative management including oxygen, intravenous fluid, and antibiotics. We report on this case with a brief review of the related literature.

Prospective multi-center trial for the efficacy of ecabet sodium on the relief of dyspepsia in korean patients with chronic gastritis.

Anti-peptic and anti-inflammatory actions of ecabet sodium might be beneficial in either improving gastritis or relieving dyspeptic symptoms. This study was designed to evaluate the clinical efficacy of ecabet sodium on dyspeptic symptoms and to elucidate the molecular mechanism attributable to symptom relief in patients with chronic gastritis. Two hundred and sixty eight chronic gastritis patients with persistent dyspepsia received ecabet sodium 1 g b.i.d. for 2 weeks, after which dyspeptic symptoms were reassessed with a questionnaires as before. The changes of interleukin-8 (IL-8), inducible nitric oxide synthase (iNOS), prostaglandin E(2) (PGE(2)), and vascular endothelial growth factor (VEGF) levels in gastric juices were measured by ELISA. The changes of nitrotyrosine in gastric mucosa were measured by immunohistochemical staining. The most common dyspeptic symptom in Korean patients with chronic gastritis was epigastric soreness (76.8%), which was improved significantly after ecabet sodium treatment (81.7%, p<0.001). Ecabet sodium was more effective in patients with epigastric pain than vague abdominal discomfort (p = 0.02), especially in patients with old age. Complete relief of discomfort was more highly achieved in patients with positive Helicobacter pylori than without (p = 0.01). In spite of clear tendency that the decreased levels of IL-8, iNOS, and PGE(2) and increased levels of VEGF were measured in gastric juices after ecabet sodium treatment, no statistical significance was noted, which might be due to high inter-individual variations. The nitrotyrosine expressions were significantly decreased after ecabet sodium treatment than before (p<0.01). In conclusion, ecabet sodium treatment was very useful for the relief of dyspeptic symptoms in chronic gastritis, to which both attenuated inflammatory and enhanced regenerative mechanisms were contributive.

Comparison of Prevention of NSAID-Induced Gastrointestinal Complications by Rebamipide and Misoprostol: A Randomized, Multicenter, Controlled Trial-STORM STUDY.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have gastrointestinal side effects such as dyspepsia, peptic ulcer, hemorrhage, and perforation. Misoprostol and PPIs have been used to prevent NSAID-induced gastroduodenal injury. Rebamipide increases gastric mucus and stimulates the production of endogenous prostaglandins. The prophylactic effect of rebamipide on NSAID-induced gastrointestinal complications is unknown. The aim of this study was to compare NSAID-induced gastrointestinal complications in rebamipide- and misoprostol-treated groups. Patients were randomized to two groups and took a conventional NSAID plus rebamipide or misoprostol for 12 weeks. Gastric mucosal damage was evaluated by endoscopy at screening and the end of the study. The prevalences of active gastric ulcer were 7/176 (3.9%) in the rebamipide group and 3/156 (1.9%) in the misoprostol group. The prevalences of peptic ulcer were 8/176 (4.5%) in the rebamipide group and 7/156 (4.4%) in the misoprostol group. The cumulative incidences of peptic ulcer in the high-risk subgroup were 6/151 (4.0%) for rebamipide and 6/154 (3.9%) for misoprostol. In conclusion, rebamipide prevented NSAID-induced peptic ulcer as effectively as misoprostol in patients on long-term NSAID therapy. Rebamipide may be a useful therapeutic option for the prevention of NSAID-induced gastrointestinal ulcer because of its therapeutic effect and safety.

Food intolerance and skin prick test in treated and untreated irritable bowel syndrome.

AIM: To correlate the clinical features of treated and untreated patients with irritable bowel syndrome (IBS) to the results of skin prick test (SPT) for food and inhalant allergens. METHODS: We recruited 105 subjects to form three different target groups: treated group (n=44) undergoing treatment for IBS, untreated group (n=31) meeting the Rome II criteria without treatment for IBS, control group (n=30) with no IBS symptoms. RESULTS: SPT results were different among the three groups in which SPT was positive in 17 (38.6%) treated patients, in 5 (16.1%) untreated patients and in 1 (3.3%) control (P<0.01). The number of positive SPTs was greater in the IBS group than in the control group (P<0.001). The number of positive food SPTs was higher in the treated IBS group than in the untreated IBS group (P=0.03). CONCLUSION: Positive food SPT is higher in IBS patients than in controls.

Chest wall metastasis from unknown primary site of hepatocellular carcinoma.

Previous reports of a solitary metastatic hepatocellular carcinoma have been rare. Because this tumor has a different treatment modality and prognosis, an accurate differential diagnosis is essential. Here we report a rare case of a solitary chest wall metastasis from unknown primary site of hepatocellular carcinoma. It involves a 51-year-old man who was admitted to our hospital because of a palpable left upper chest wall mass. The mass was resected and pathologic examination confirmed a diagnosis of metastatic hepatocellular carcinoma. Despite our investigation, no evidence was found that indicated the primary origin of the hepatocellular carcinoma. Four months later, the patient was admitted again because of spinal cord compression at the third and fourth thoracic vertebrae. Emergent decompressive laminectomy was performed and microscopic features revealed the same pathology as the initial chest wall mass resected 4 months earlier. After one year, a follow-up abdominal computed tomography (CT) still revealed no evidence of primary hepatocellular carcinoma.

Nutritional status of Korean male patients with alcoholic and viral liver cirrhosis.

This descriptive cross-sectional study aimed to investigate whether malnutrition occurs in outpatients with liver cirrhosis, and to compare the nutritional status of patients with alcoholic and viral liver cirrhosis using a variety of objective measures. This study also aimed to provide useful information about nutritional education and nutritional therapies for medical teams and patients with liver cirrhosis. Sixty-six Korean men between the ages of 30 and 69 with liver cirrhosis (24 alcohol-related and 42 virus-related) were recruited from the Internal Medicine Centres, Hanyang University Hospital, Seoul, Korea. The results showed that patients with alcoholic liver cirrhosis (ALC) were significantly lower in socio-economic status than patients with viral liver cirrhosis (VLC) (P<0.05). The energy intakes (excluding alcohol-derived energy) were 1448kcal and 1769kcal in the ALC and the VLC groups, respectively (P<0.05). As well, vitamin C intake was found to be higher in the VLC group than the ALC group, yet still more than 125% of the RDA for both groups (P<0.05). Among nutritional indices, only the TSF thickness showed interaction with the aetiology and the severity of the cirrhosis (P<0.05). Thus, these findings indicate that outpatients with liver cirrhosis in this study, particularly those with alcoholic liver cirrhosis, consumed a lower energy intake than suggested, but may not have been in a status of malnutrition. Body fat is more affected than other nutritional parameters in patients with liver cirrhosis.