A 24-year-old pregnant woman started to have severe hyperemesis gravidarum at 6 weeks' gestation. Six weeks later, dizziness, ataxia, visual disturbance, diplopia and confusion were developed. On admission, she presented ophthalmoplegia, nystagmus, deaeased tendon reflex, intention tremor, ataxia, confusion and memory disturbance. She was diagnosed to Wernicke-Korsakoff syndrome and 100mg of thiamine was administered intravenously daily till 28 weeks gestation and then intramuscularly. Her ocular symptns, together with neurological signs, were gradually improved. Memory disturbance slightly improved but remained at the time of delivery. The case will be presented in more details with a brief revie of literatures.
Ataxia ; Diplopia ; Dizziness ; Female ; Humans ; Hyperemesis Gravidarum* ; Korsakoff Syndrome* ; Memory ; Ophthalmoplegia ; Pregnancy ; Pregnant Women ; Reflex, Stretch ; Thiamine ; Tremor ; Young Adult

Emphysematous gastritis is a rare form of gastritis caused by infection of the stomach wall by gas forming bacteria. It is a very rare condition that carries a high mortality rate. Portal venous gas shadow represents elevation of intestinal luminal pressure which manifests as emphysematous gastritis or gastric emphysema. Literature reviews show that the mortality rate is especially high when portal venous gas shadow is present on CT scan. Until recently, the treatment of emphysematous gastritis has been immediate surgical intervention. However, there is a recent trend of avoiding surgery because of the frequent occurrence of post-operative complications such as anastomosis leakage. In addition, aggressive surgical treatment has failed to show significant improvement in prognosis. Recently, the authors experienced a case of emphysematous gastritis accompanied by portal venous gas which was treated successfully by conservative treatment without immediate surgical intervention. Herein, we present a case of emphysematous gastritis with concomitant portal venous air along with literature review.
Aged, 80 and over ; Emphysema/complications/*diagnosis/drug therapy ; Female ; Gastritis/complications/*diagnosis/drug therapy ; Gastroscopy ; Humans ; Portal Vein ; Proton Pump Inhibitors/therapeutic use ; Tomography, X-Ray Computed

BACKGROUND: Significant aortic stenosis of various underlying etiologies presents with similar clinical characteristics and is usually treated with aortic valve replacement. We performed a clinical study to evaluate the clinical characteristics, changes of echocardiographic parameters before and after aortic valve replacement in adult aortic stenosis patients. METHODS: From January 1991 through December 1995, 159 patients underwent aortic valve replacement at Sejong General Hospital. Sixty-two cases(39%) of those patients were pure or predominant aortic stenosis. We observed the clinical characteristics, etiology, operative procedure, perioperative complication and mortality, And we observed the changes of echocardiographic parameters such as mean and peak pressure gradients at aortic valve, ejection fraction, systolic and diastolic left ventricular internal dimensions, left ventricular wall thickness, left ventricular mass index retospectively at preoperative and postoperative periods regularly within 1 month, 1 yr, 3 yrs after operation(mean follow up period : 16 months, 1-36 months). RESULTS: 1) The age of patients ranged from 31 to 71 years(mean 55+/-11), and 60%(37 cases) of them were men. 2) Regarding underlying heart disease, the most common etiology of aortic stenosis was rheumatic valvular heart disease(32 cases, 52%), followed by congenital bicuspid aortic valve(16 cases, 25%) and degenerative change(14 cases,23%). 3) 44 cases(77%) of the patients had dyspnea,12 cases(19%) had chest pain, and 5 cases(8%) had history of syncope at the time of operation. Asymptomatic patient was only 1 case. 4) Seven patients(11%) had associated coronary artery disease, and only 1 case(about 2%) underwent concomitant coronary bypass surgery. 5) Post-operative complications which developed within 1 month were bleedings(8 cases, 13%), arrhythmias(7 cases, 11%) and infections(4 cases, 6%). After 1 month, bleedings related with anticoagulation were most common(7 cases, 11%). Other complications were hemolytic anemia(1 case), and aortic dissection(1 case). There was one surgery related mortality(2%) which happened during operatin due to myocardial ischemia. 6) The size of implanted prosthetic valves ranged from 19 to 25mm(mean 22+/-2mm). Larger valves(23-25mm) showed lower peak(p=0.839) and mean pressure gradients(p=0.019) than smaller valves(19-21mm). 7) We observed that peak and mean pressure gradient, left ventricular internal dimension, and left ventricular mass index had decreased significantly after aortic valve replacement. 8) The average preoperative functional class(2.3) had improved significantly at 1 month after surgery(1.2), and 1 year after surgery(1.0). CONCLUSIONS: In our series, the most common etiology of aortic stenosis was rheumatic valvular disease(52%). The incidence of combined coronary artery disease was 11%, lower than other reports. And only 1 case(2%) underwent concomitant coronary artey bypass graft surgery. The average size of implanted valves was 22mm, and the larger size had lower transaortic peak and mean pressure gradients after operation. The most common perioperative complication was bleeding and mortality rate was about 2%. Echocardiography was useful for evaluation of postoperative changes, such as transaortic peak and mean pressure gradient, left ventricular internal dimension and left ventricular mass index.
Adult* ; Aortic Valve Stenosis* ; Aortic Valve* ; Bicuspid ; Chest Pain ; Coronary Artery Disease ; Echocardiography ; Follow-Up Studies ; Heart ; Heart Diseases ; Hemorrhage ; Hospitals, General ; Humans ; Incidence ; Male ; Mortality ; Myocardial Ischemia ; Postoperative Period ; Surgical Procedures, Operative ; Syncope ; Transplants

BACKGROUND/AIMS: Ciprofloxacin is considered to be a safe and effective treatment for acute infectious colitis. However, this drug may cause drug-induced pancreatitis, albeit rarely. METHODS: From March 2007 to February 2012, we studied 227 patients who were hospitalized for infectious colitis at St. Mary's Hospital. All of the patients received ciprofloxacin therapy for the treatment of infectious colitis. We observed a few cases of rare adverse events, including ciprofloxacin-induced acute pancreatitis diagnosed based on the Naranjo algorithm. RESULTS: During ciprofloxacin therapy, seven of 227 patients (3.1%) developed rare pancreatitis as defined by the Naranjo algorithm; pancreatic enzyme activity was sporadically elevated with ciprofloxacin use. After ciprofloxacin administration, the average interval until the development of pancreatitis was 5.5 days (range, 4 to 7 days). On abdominal computed tomography, pancreatic swelling and homogenous enhancement was noted in three of seven patients. Complicating acute pancreatitis was gradually but completely resolved after cessation of ciprofloxacin administration. The mean recovery time was 11.3 days (range, 8 to 15 days). CONCLUSIONS: We observed that ciprofloxacin-induced pancreatitis may occur with an incidence of approximately 3%. Ciprofloxacin-induced pancreatitis presents a short latency, suggesting an idiosyncratic hypersensitivity reaction. Practitioners should be aware that drug-induced pancreatitis can occur during ciprofloxacin therapy.
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*adverse effects ; Bacterial Infections/*drug therapy ; Ciprofloxacin/*adverse effects ; Colitis/*drug therapy ; Enzyme Inhibitors/therapeutic use ; Female ; Gabexate/analogs & derivatives/therapeutic use ; Humans ; Male ; Middle Aged ; Pancreatitis/*chemically induced/drug therapy ; Young Adult

We report the case of a 57-year-old woman with abdominal discomfort. The patient had anemia and hypoalbuminemia. Esophagogastroduodenoscopy and colonoscopy revealed diffuse infiltrative lesions at the stomach, duodenum, and ascending colon. Multiple biopsies were taken and histological examination of the biopsies from the stomach, duodenum and colon showed amyloid deposits stained positively with Congo red. Immunohistochemistry study showed positive sign of kappa and lambda chain at light chain stain. In addition, monoclonal components at serum electrophoresis confirmed the diagnosis of amyloid light-chain amyloidosis. The patient was treated with thalidomide and dexamethasone.
Amyloid ; Amyloidosis* ; Anemia ; Biopsy ; Colon* ; Colon, Ascending ; Colonoscopy ; Congo Red ; Dexamethasone ; Diagnosis ; Duodenum* ; Electrophoresis ; Endoscopy ; Endoscopy, Digestive System ; Female ; Humans ; Hypoalbuminemia ; Immunohistochemistry ; Middle Aged ; Plaque, Amyloid ; Stomach* ; Thalidomide

Sclerosing mesenteritis is a rare benign disease originated from the mesenteries. It can be related to autoimmune disease, vasculitis, ischemia, infection, trauma and operation, but most of cases are idiopathic. The overall prognosis of sclerosing mesenteritis is usually good with benign, course. However, no consensus of treatment has yet been established. We report a case of spontaneous partial regression of sclerosing mesenteritis presented as a huge mass and diagnosed by finding of contrast enhanced abdominal computed tomography and percutaneous ultrasonography guided needle biopsy.
Biopsy, Fine-Needle ; Diagnosis, Differential ; Humans ; Male ; Mesentery ; Middle Aged ; Panniculitis, Peritoneal/*diagnosis/pathology/ultrasonography ; Remission, Spontaneous ; Tomography, X-Ray Computed

Nonrotation of the intestine is a rare disorder mostly found in childhood. During adult life, nonrotation of the intestine is found either during surgery or during the evaluation of unrelated symptoms. A preduodenal portal vein is also a rare anomaly. These anomalies are associated with situs inversus, and duodenal, pancreatic, biliary and cardiovascular anomalies. A 21-year-old man presented with mild constipation. During the evaluation, we found multiple intraabdominal anomalies, including nonrotation of the intestine, a preduodenal portal vein, polysplenia, and an annular and short pancreas.
Adult ; Constipation ; Humans ; Intestines* ; Pancreas ; Portal Vein* ; Situs Inversus ; Young Adult

Melanosis ilei is an extremely rare condition in which black pigment, consisted of aluminum, magnesium, or silicon, accumulate in the terminal ileal mucosa. Medical treatment with charcoal enhances the neutralization of the toxic material and elimination of many drugs. In addition, it has been used as a traditional remedy in some oriental countries to relieve chronic diarrhea, abdominal pain, or acute enterocolitis, which is made up carbon, oxygen, aluminum, magnesium, silicon, calcium, and palladium. Two patients taking the charcoal for a long time underwent a colonoscopy to evaluate chronic diarrhea or abdominal pain. The colonoscopy revealed a normal colonic mucosa and multiple geographic black-pigmented mucosal changes at the terminal ileum. Therefore, it was assumed that melanosis ilei can develop in patients with long-standing charcoal ingestion. To the best of our knowledge, this is the first case of melanosis ilei associated with the ingestion of charcoal.
Abdominal Pain ; Aluminum ; Calcium ; Carbon ; Charcoal ; Colon ; Colonoscopy ; Diarrhea ; Eating ; Enterocolitis ; Humans ; Ileum ; Magnesium ; Melanosis ; Mucous Membrane ; Oxygen ; Palladium

OBJECTIVES: The purpose of this study is to evaluate the impact of delirium on clinical outcomes in intensive care unit (ICU) patients in a Korean general hospital. METHODS: All patients admitted to ICU from March 1, 2013 to October 31, 2013 were assessed by Confusion Assessment Method adapted for use in the ICU for delirium daily, and consistently comatose patients were excluded for analysis. Differences in clinical outcomes (mortality, length of hospital stay, length of ICU stay) were analyzed between delirious patients and non-delirious patients. Subsequently, the impact of delirium on clinical outcomes was analyzed with adjusting for covariates including surgery, age, emergent admission, presence of surgery, and severity of illness. RESULTS: The analysis included 129 delirious patients and 469 non-delirious patients. As primary outcome, mortality, length of stay (hospital day, ICU-stay) were significantly high in the delirious group. The association remained the same after adjusting for the covariates. CONCLUSION: The results correspond with those of previous research studies conducted in foreign ICU. Based on this observation that delirium also has an impact on clinical outcomes in Korean ICU, integrative and in-depth investigation on ICU delirium will be needed.
Coma ; Delirium* ; Hospitals, General* ; Humans ; Intensive Care Units* ; Length of Stay ; Mortality ; Observational Study*

BACKGROUND: The purpose of this study was to evaluate the association of physical distress and mental health characteristics with the willingness to repeat an esophagogastroduodenoscopic (EGD) examination. METHODS: A questionnaire survey was conducted on 137 patients who had an EGD procedure. The mental health status was evaluated with the Checklist-90-Revision tool, which is based on the Multidimensional Self Report Symptom Inventory. RESULTS: The results were as follows. 1) The elderly and those patients with two or more procedures had a significantly higher willingness to repeat the EGD examination. Those who were willing to repeat the examination had more EGD examinations than those who did not (p<0.05). 2) As for the mental health characteristics, persons with a willingness to repeat the EGD examination showed significantly lower scores on the interpersonal, sensitivity, depression, anxiety, hostility, and paranoid ideation than did those without a willingness. 3) As for the degree of physical distress during the EGD examination, persons with a willingness to repeat the EGD examination had significantly lower scores on the total symptom score and global discomfort score than those without a willingness (p<0.05). 4) The younger patients, under 30, had a significantly lower willingness to repeat the EGD examination than did the elderly patients over 60 (OR=86.03, 95% CI 2.11-999). According to patient occupations, homemakers showed a significantly higher willingness than did others (OR=16.24, 95% CI 1.69-156.23). CONCLUSIONS: The results of this study suggested that a willingness to repeat the EGD examination was closely associated with the mental health characteristics of the patients.
Aged ; Anxiety ; Depression ; Endoscopy, Digestive System ; Hostility ; Humans ; Mental Health ; Occupations ; Self Report ; Surveys and Questionnaires