Patients with inflammatory bowel disease (IBD) have an elevated risk of venous thromboembolism compared with the general population. The most common sites of venous thromboembolism in IBD patients are the deep veins of the legs, the pulmonary system, and portal and mesenteric veins. However, cerebral venous thrombosis is rarely associated with IBD. This report describes a case of cerebral venous thrombosis in a patient with Crohn's disease. A 17-year-old girl, diagnosed 4 years earlier with Crohn's disease, presented with headache and vomiting. Magnetic resonance imaging of the brain with venography showed venous thrombosis in the cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. The patient immediately started anticoagulation therapy with intravenous heparin infusion followed by daily oral rivaroxaban 10 mg. Follow-up imaging after 2 weeks showed resolution of the thrombosis, with recanalization of the cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. She continued rivaroxaban therapy for 6 months, and remained well, without neurologic sequelae. A high level of concern for cerebral venous thrombosis may be important when treating active IBD patients, because anticoagulation treatment can prevent fatal complications.
Adolescent ; Brain ; Crohn Disease* ; Female ; Follow-Up Studies ; Headache ; Heparin ; Humans ; Inflammatory Bowel Diseases ; Jugular Veins ; Leg ; Magnetic Resonance Imaging ; Mesenteric Veins ; Phlebography ; Rivaroxaban ; Superior Sagittal Sinus ; Thrombosis ; Veins ; Venous Thromboembolism ; Venous Thrombosis* ; Vomiting

Colonoscopy is the current standard method for evaluation of the colon. The diagnostic accuracy and therapeutic safety of colonoscopy depend on the quality of colonic cleansing and preparation. Generally, all these preparations have been demonstrated to be safe for use in healthy individuals without significant comorbid conditions. Based on safety and efficacy concerns, polyethylene glycol (PEG) is most commonly utilized as a bowel preparation solution for colonoscopy. Adverse events in patients receiving PEG are mostly clinically non-significant. However, fatal adverse events rarely have been shown to occur in the few individuals who experience vomiting or aspiration. Anaphylactic shock associated with ingestion of PEG electrolyte solution is an extremely rare fatal complication, and reported mainly in Western countries. Here, we report the first case of anaphylactic shock following the ingestion of PEG solution in Korea.
Anaphylaxis* ; Colon ; Colonoscopy ; Eating* ; Humans ; Korea ; Polyethylene Glycols* ; Shock ; Vomiting

Primary duodenal carcinoma is rare. Duodenal mucinous adenocarcinoma (DMA) is even rarer, and its associated manifestations and typical endoscopic or imaging findings are not well characterized. Herein, we report a case of primary DMA in an asymptomatic 58-year-old man who visited our hospital for a regular health screening. Upper endoscopy revealed an approximately 4-cm lesion in the second portion of the duodenum, but the mass was not visualized on computed tomography. Biopsies revealed a tubular adenoma that was subsequently resected. Frozen biopsies demonstrated DMA with a background of low-grade tubular adenoma for which we performed Roux-en-Y duodenojejunostomy and jejunojejunostomy. To our knowledge, this is the first report of a patient with DMA in Korea.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Adenoma ; Biopsy ; Duodenal Neoplasms ; Duodenum ; Endoscopy ; Humans ; Korea ; Mass Screening ; Middle Aged

PURPOSE: Stem cell-based therapies represent new promises for the treatment of urinary incontinence. This study was performed to assess optimized cell passage number, cell dose, therapeutic efficacy, feasibility, toxicity, and cell trafficking for the first step of the pre-clinical evaluation of human amniotic fluid stem cell (hAFSC) therapy in a urinary incontinence animal model. MATERIALS AND METHODS: The proper cell passage number was analyzed with hAFSCs at passages 4, 6, and 8 at week 2. The cell dose optimization included 1x10(4), 1x10(5), and 1x10(6) cells at week 2. The in vivo cell toxicity was performed with 0.25x10(6), 0.5x10(6), and 1x10(6) cells at weeks 2 and 4. Cell tracking was performed with 1x10(6) cells at weeks 2 and 4. RESULTS: The selected optimal cell passage number was smaller than 6, and the optimal cell dose was 1x10(6) for the mouse model. In our pre-clinical study, hAFSC-injected animals showed normal values for several parameters. Moreover, the injected cells were found to be non-toxic and non-tumorigenic. Furthermore, the injected hAFSCs were rarely identified by in vivo cell trafficking in the target organs at week 2. CONCLUSION: This study demonstrates for the first time the pre-clinical efficacy and safety of hAFSC injection in the urinary incontinence animal model and provides a basis for future clinical applications.
Amniotic Fluid/*cytology ; Animals ; Cell Movement ; Disease Models, Animal ; Humans ; Injections ; Mice ; Stem Cell Transplantation/*methods ; Stem Cells/*cytology ; Treatment Outcome ; Urinary Incontinence/*therapy

Lymphangioma is a benign vascular lesion with characteristics of subepithelial tumor which can proliferate in the lymphatic system. Lymphangioma of the small-bowel mesentery is rare, having been reported in less than 2% of all lymphangiomas. Lymphangioma does not require any specific treatment because it is absolutely a benign tumor. However, surgical exploration is rarely required for cases with disease-related symptoms or complications, or for those misdiagnosed as a malignant lesion. We recently experienced a case of mesenteric cavernous lymphangomas in a 53-year-old female who was misdiagnosed as having a liposarcoma. The final diagnosis was confirmed by a pathologic examination of the specimen that was obtained via laparoscopic exploration. Herein, we report a very rare case of mesenteric cavernous lymphangioma along with a brief review of relevant literature.
Female ; Humans ; Intestine, Small/pathology ; Laparoscopy ; Lymphangioma/*diagnosis/pathology/surgery ; Mesentery/pathology ; Middle Aged ; Peritoneal Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Vasculopathy is rarely reported in neurofibromatosis type 1, but when it occurs it primarily involves the aorta and its main branches. Among vasculopathies, aneurysmal dilatation is the most common form. Although several case reports concerning aneurysms or pseudoaneurysms of visceral arteries in neurofibromatosis type 1 patients have been reported, there are no reports describing gastroduodenal artery aneurysms associated with neurofibromatosis type 1. We experienced a case of life-threatening duodenal ulcer bleeding from a ruptured gastroduodenal artery aneurysm associated with neurofibromatosis type 1. We treated our patient by transarterial embolization after initial endoscopic hemostasis. To our knowledge, this is the first reported case of its type. High levels of suspicion and prompt diagnosis are required to select appropriate treatment options for patients with neurofibromatosis type 1 experiencing upper gastrointestinal bleeding. Embolization of the involved arteries should be considered an essential treatment over endoscopic hemostasis alone to achieve complete hemostasis and to prevent rebleeding.
Adult ; Aneurysm/*diagnosis/etiology ; Arteries ; Embolization, Therapeutic ; Gastroscopy ; Head and Neck Neoplasms/complications/*diagnosis ; Hepatic Artery/diagnostic imaging ; Humans ; Male ; Neurofibromatosis 1/complications/*diagnosis ; Peptic Ulcer Hemorrhage/*etiology ; Radiography

BACKGROUND/AIMS: Gallbladder polyps and colorectal adenomas share many common risk factors; however, their association has never been studied. The aim of this study was to investigate this association in asymptomatic healthy subjects. METHODS: Consecutive asymptomatic subjects who underwent both screening colonoscopy and abdominal ultrasonography at Kyung Hee University Hospital in Gang Dong between July 2010 and April 2011 were prospectively enrolled. The prevalence of colorectal adenoma was compared between subjects with or without gallbladder polyps. Furthermore, a logistic regression analysis was performed to determine the independent risk factors for colorectal adenoma in these subjects. RESULTS: Of the 581 participants, 55 presented with gallbladder polyps and 526 did not have gallbladder polyps. Participants with gallbladder polyps showed a trend toward a higher prevalence of colorectal adenoma than those without gallbladder polyps (52.7% vs. 39.2%, P=0.051). Although the result was not statistically significant, gallbladder polyps were found to be a possible risk factor for colorectal adenoma (odds ratio=1.796, 95% confidence interval=0.986-3.269, P=0.055), even after adjusting for potential confounding factors. There was no difference observed in colorectal adenoma characteristics between the two groups. CONCLUSIONS: Our results suggest a possible association between gallbladder polyps and colorectal adenomas. Future studies with larger cohorts are warranted to further investigate this matter.
Adenoma* ; Cohort Studies ; Colonoscopy ; Colorectal Neoplasms ; Gallbladder* ; Logistic Models ; Mass Screening ; Polyps* ; Prevalence ; Prospective Studies ; Risk Factors ; Ultrasonography

PURPOSE: This study was conducted in order to evaluate the effect of a newly developed explanation handout in the emergency department (ED) between patient and guardian. METHODS: From August 24, 2013 to September 24, 2013, interviews were conducted to patient accompanying guardian, discharged from Seoul Medical Center ED. Four groups were divided according to non-handout or handout in addition to patient or guardian. Each group consisted of 50 candidates and allocated according to a random table. The explanation handout could be easily applicable automatically through the Electronic Medical Record. It contains the results of laboratory tests along with cautions by diagnosis. After discharge explanation, a survey was conducted in each group using questionnaires for evaluation of the effect on medical service satisfaction. RESULTS: A total of 97 candidates(49 patients, 48 guardians) in the non-handout group, and 99 candidates(50 patients, 49 guardians) in the handout group were enrolled. No statistical difference in epidemiology, except explanation time, was observed between the two groups. The handout group showed a higher score in all factors, however, explanation by physician (p<0.001), mean 3.61(+/-0.72) to 3.87(+/-0.73), understanding of medical status (p<0.001), mean 3.51(+/-0.75) to 4.11(+/-0.71), medical evaluation and treatment (p=0.001), mean 3.59(+/-0.72) to 3.92(+/-0.75), kindness of physician (p<0.001), mean 3.74(+/-0.81) to 4.09(+/-0.67), overall satisfaction (p<0.001), mean 3.60(+/-0.75) to 3.97(+/-0.75), willingness of revisit (p=0.023), mean 3.87(+/-0.73) to 4.09(+/-0.61), and willingness of recommendation (p<0.001), mean 3.66(+/-0.82) to 4.09(+/-0.66) showed statistically meaningful results. In a sub-analysis, statistically meaningful results were reanalyzed between patient and guardian. In the non-handout group, guardian showed higher scores in mean value in all factors, however, statistically meaningful results were observed for all factors, except understanding of medical status and medical evaluation and treatment. By application of the handout, 99 patients and 97 guardians showed higher scores in mean value in all factors. Patients showed statistically meaningful results in all factors but just in understanding of medical status in guardian. CONCLUSION: Results of this study showed that the explanation handout effectively increased medical service satisfaction. The effect of the explanation handout was more prominent in patients than guardians.
Diagnosis ; Electronic Health Records ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Humans ; Patient Satisfaction ; Surveys and Questionnaires ; Seoul

PURPOSE: This study was conducted in order to evaluate the effect of a newly developed explanation handout in the emergency department (ED) between patient and guardian. METHODS: From August 24, 2013 to September 24, 2013, interviews were conducted to patient accompanying guardian, discharged from Seoul Medical Center ED. Four groups were divided according to non-handout or handout in addition to patient or guardian. Each group consisted of 50 candidates and allocated according to a random table. The explanation handout could be easily applicable automatically through the Electronic Medical Record. It contains the results of laboratory tests along with cautions by diagnosis. After discharge explanation, a survey was conducted in each group using questionnaires for evaluation of the effect on medical service satisfaction. RESULTS: A total of 97 candidates(49 patients, 48 guardians) in the non-handout group, and 99 candidates(50 patients, 49 guardians) in the handout group were enrolled. No statistical difference in epidemiology, except explanation time, was observed between the two groups. The handout group showed a higher score in all factors, however, explanation by physician (p<0.001), mean 3.61(+/-0.72) to 3.87(+/-0.73), understanding of medical status (p<0.001), mean 3.51(+/-0.75) to 4.11(+/-0.71), medical evaluation and treatment (p=0.001), mean 3.59(+/-0.72) to 3.92(+/-0.75), kindness of physician (p<0.001), mean 3.74(+/-0.81) to 4.09(+/-0.67), overall satisfaction (p<0.001), mean 3.60(+/-0.75) to 3.97(+/-0.75), willingness of revisit (p=0.023), mean 3.87(+/-0.73) to 4.09(+/-0.61), and willingness of recommendation (p<0.001), mean 3.66(+/-0.82) to 4.09(+/-0.66) showed statistically meaningful results. In a sub-analysis, statistically meaningful results were reanalyzed between patient and guardian. In the non-handout group, guardian showed higher scores in mean value in all factors, however, statistically meaningful results were observed for all factors, except understanding of medical status and medical evaluation and treatment. By application of the handout, 99 patients and 97 guardians showed higher scores in mean value in all factors. Patients showed statistically meaningful results in all factors but just in understanding of medical status in guardian. CONCLUSION: Results of this study showed that the explanation handout effectively increased medical service satisfaction. The effect of the explanation handout was more prominent in patients than guardians.
Diagnosis ; Electronic Health Records ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Humans ; Patient Satisfaction ; Surveys and Questionnaires ; Seoul

BACKGROUND/AIMS: Several factors affecting the severity and outcomes of diverticulitis have been reported, but there is little research on physician specialty related with this disease. Therefore, we evaluated the clinical characteristics and outcomes of diverticulitis depending on physician's specialty. METHODS: Medical records of 239 patients, who had been hospitalized with first-diagnosed acute colonic diverticulitis at Kyung Hee University Hospital in Gang Dong (Seoul, Korea) from June 2006 to December 2012, were retrospectively analyzed. The patients were classified according to whether they had been managed by gastroenterologists or not. Clinical characteristics and treatment outcomes were compared between two groups. RESULTS: Of these 239 patients, 38 (15.9%) patients were treated by a gastroenterologist and 201 (84.1%) patients by a non-gastroenterologist. Clinical characteristics such as age, gender, body mass index, comorbidity, medication, laboratory results, recurrence and complication were not significantly different between two groups. However, right-sided diverticulitis predominated in the non-gastroenterologist group (79% vs. 91%, P=0.028). From the sub-group analysis of uncomplicated diverticulitis, intravenous antibiotics was used for a shorter period of time by gastroenterologists than non-gastroenterologists (3.3+/-1.9 days vs. 4.4+/-2.8 days, P=0.032). Multivariate logistic regression analysis showed that the 3 day administration of intravenous antibiotics significantly depended on the physician's specialty (odds ratio 7.984, 95% confidence interval 1.990-32.043, P=0.003). CONCLUSIONS: The results suggest that the duration of intravenous antibiotics for treating uncomplicated colonic diverticulitis was shortened by gastroenterology specialists without increasing operation or recurrence.
Anti-Bacterial Agents ; Body Mass Index ; Colon ; Comorbidity ; Diverticulitis ; Diverticulitis, Colonic ; Gastroenterology ; Humans ; Logistic Models ; Medical Records ; Recurrence ; Retrospective Studies ; Specialization ; Specialty Boards ; Treatment Outcome