Acute phlegmonous gastritis is an uncommon disease, often fatal condition characterized by suppurative bacterial infection of the gastric wall. It has a high mortality rate mainly because the diagnosis is usually made late. Until recently, gastrectomy in combination with antibiotics was recommended. We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. At upper gastrointestinal endoscopy, the gastric lumen was narrow, and the mucosa was severely inflamed, which was erythematous, swelled, and showed necrotic areas covered with purulent exudate. Klebsiella oxytoca and Acinetobacter lwoffii were isolated in the gastric tissue culture. Contrast-enhanced computerized tomography scan of abdomen demonstrated diffuse gastric wall thickening and an intramural abscess in the gastric antral wall. Although delayed gastric emptying by gastroparesis prolonged the in-hospital period, the only medical treatment with antibiotics alone successfully cured the patient without gastrectomy.
Acinetobacter/isolation & purification ; Acute Disease ; Aged ; Anti-Bacterial Agents/*therapeutic use ; Anti-Infective Agents/therapeutic use ; Cefotaxime/therapeutic use ; Ceftriaxone/therapeutic use ; Ciprofloxacin/therapeutic use ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Gastritis/*diagnosis/drug therapy/microbiology ; Gastroparesis/*diagnosis/microbiology ; Gastroscopy ; Humans ; Imipenem/therapeutic use ; Klebsiella oxytoca/isolation & purification ; Male ; Ofloxacin/therapeutic use ; Pneumonia/diagnosis/drug therapy ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Dual-focus two-stage optical lens technology has been introduced recently. In near-focus mode (NFM), endoscopists can easily examine the mucosal tissue and capillary networks. This study compared the magnified images obtained using NFM and the conventional magnification method (CMM) under narrow-band imaging in patients with gastric epithelial tumors. MATERIALS AND METHODS: An experienced endoscopist performed endoscopy using NFM and CMM in patients with gastric epithelial tumors. We studied 40 images from 40 endoscopy sessions in 20 selected patients. Ten endoscopists rated the image quality independently on a 5-point Likert scale (from poor=1 to excellent=5) in terms of microsurface structure, microvascular structure, and the demarcation line. RESULTS: The gastric epithelial tumors comprised 10 cases of early gastric cancer, 2 of high-grade dysplasia, and 8 of low-grade dysplasia. The median number of magnified images for each method was 11. The mean observation time (+/-SD) for magnification was 99.9+/-64.1 s in NFM and 91.5+/-64.6 s in CMM (P=0.54). The image quality score for the microsurface structure was higher with NFM than CMM (4.09+/-0.39 vs. 3.73+/-0.40, P=0.015), while that for microvascular structure was lower with NFM than in CMM (3.53+/-0.45 vs. 4.29+/-0.45, P=0.001). CONCLUSIONS: Magnification using NFM provides higher-quality images of the microsurface structure, although its optical zoom is limited compared with CMM. Since NFM can obtain magnified images easily by pushing a button on the scope, it is useful for evaluating gastric epithelial tumors.
Capillaries ; Endoscopy ; Humans ; Mucous Membrane ; Stomach ; Stomach Neoplasms

Hepatitis A virus is a major cause of viral hepatitis worldwide. The prevalence of hepatitis A in young adults has recently been increasing in Korea. Hepatitis A infection rarely complicates fulminant hepatitis, acute pancreatitis, and acute renal failure. We experienced a case of multiple organ failure involving fulminant hepatitis, acute pancreatitis, and acute renal failure complicating a hepatitis A superinfection in a chronic hepatitis B patient. The patient was a 38 year old man who presented with febrile sense and myalgia. He was initially alert, but became confused and developed acute renal failure and acute pancreatitis. He received continuous renal replacement therapy and conservative treatment and completely recovered from the multiple organ failure. It is important to consider a variety of potential complications in hepatitis A patients, especially in those with underlying chronic liver disease.
Acute Kidney Injury ; Hepatitis ; Hepatitis A ; Hepatitis A virus ; Hepatitis B ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Korea ; Liver Diseases ; Multiple Organ Failure ; Pancreatitis ; Prevalence ; Renal Replacement Therapy ; Superinfection ; Young Adult

BACKGROUND/AIMS: Combination treatment consisting of hepatic arterial infusion chemotherapy with epirubicin and cisplatin (HAIC-EC) and systemic infusion of low-dose 5-fluorouracil (5-FU) are sometimes effective against advanced hepatocellular carcinoma (HCC). However, there is no effective treatment for advanced HCCs with arterioportal shunts (APS) or arteriovenous shunts (AVS). METHODS: We investigated a response and adverse events of a new combination protocol of repeated HAIC-EC and percutaneous intratumoral injection chemotherapy with a mixture of recombinant interferon-gamma (IFN-gamma) and 5-FU (PIC-IF) in patients with far-advanced HCCs with large APSs or AVSs. RESULTS: There was a complete response (CR) for the large vascular shunts in all three patients and for all tumor burdens in two patients. Significant side effects were flu-like symptoms (grade 2) and bone marrow suppression (grade 2 or 3) after each cycle, but these were well-tolerated. CONCLUSIONS: These results suggest that the combination of HAIC-EC and PIC-IF is a new and promising approach for advanced HCC accompanied by a large APS or AVS.
Aged ; Angiography ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Carcinoma, Hepatocellular/*drug therapy/pathology/radiography ; Cisplatin/administration & dosage ; Epirubicin/administration & dosage ; Fluorouracil/administration & dosage ; Hepatic Artery ; Humans ; Infusions, Intra-Arterial ; Injections, Intramuscular ; Interferon-gamma, Recombinant/administration & dosage ; Liver Neoplasms/*drug therapy/pathology/radiography ; Male ; Tomography, X-Ray Computed ; Tumor Burden

Septic pulmonary embolism is the process in which an infected thrombus becomes detached from its site of origin and lodges in a pulmonary artery, and is usually associated with infective endocarditis, especially right-sided, or infection-associated with indwelling catheters, peripheral septic thrombophlebitis, and periodontal diseases, etc. Here, we report a case of septic pulmonary embolism associated with tricuspid valve infective endocarditis. A 23-year-old female was admitted to our hospital, due to fever, sore throat, and myalgia. In her past medical history, she had undergone a surgical operation for closure of a ventricular septal defect, but was informed that the operation resulted in an incomplete closure. The initial chest radiograph demonstrated multiple rounded, parenchymal nodules in various sizes; several nodules had central lucency suggesting cavitations. Echocardiography demonstrated a large vegetation attached to the septal tricuspid valve leaflet, extending from right ventricular inflow tract to outflow tract. Computed tomography of thorax revealed bilateral peripheral nodules and wedge-shaped consolidation at various sizes, mostly accompanied by cavitations.
Catheters, Indwelling ; Echocardiography ; Endocarditis ; Female ; Fever ; Heart Septal Defects, Ventricular ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Periodontal Diseases ; Pharyngitis ; Pulmonary Artery ; Pulmonary Embolism ; Thorax ; Thrombophlebitis ; Thrombosis ; Tricuspid Valve ; Young Adult