There have been several reports of complications of small bowel lymphoma, such as bleeding, obstruction, and perforation, often require emergency surgery. It is hardly showed complications of bleeding and wound dehiscence for diffuse large B cell lymphoma with distal ileum involvement, which needed urgent surgery and medical management. A 65-year-old man with diffuse large B-cell lymphoma with distal ileum involvement experienced both intestinal bleeding and perforation during the course of treatment. As the patient was diagnosed with stage III disease, resection before chemotherapy was not considered due to the resulting delay in chemotherapy, which necessitated sufficient tissue healing. Chemotherapy is important when treating small bowel lymphoma, complications such as bleeding and perforation should always be considered for the treatment of small bowel lymphoma, and surgery is necessary in this situation. After surgery of the small bowel, subsequent chemotherapy could cause wound dehiscence and perforation; therefore, adequate recovery time should be given before chemotherapy.

The area of endoscopic application has been continuously expanded since its introduction in the last century and the frequency of its use also increased stiffly in the last decades. Because gastrointestinal endoscopy is naturally exposed to diseased internal organs and contact with pathogenic materials, endoscopy mediated infection or disease transmission becomes a major concern in this field. Gastrointestinal endoscopy is not for single use and the proper reprocessing process is a critical factor for safe and reliable endoscopy procedures. What needed in these circumstances is a practical guideline for reprocessing the endoscope and its accessories which is feasible in the real clinical field to guarantee acceptable prevention of pathogen transmission. This guideline contains principles and instructions of the reprocessing procedure according to the step by step. And it newly includes general information and updated knowledge about endoscopy-mediated infection and disinfection. Multiple societies and working groups participated to revise; Korean Association for the Study of the Liver, the Korean Society of Infectious Diseases, Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Society of Gastroenterology, Korean Society of Gastrointestinal Cancer, Korean Association for the Study of Intestinal Diseases, Korean Pancreatobiliary Association, the Korean Society of Gastrointestinal Endoscopy Nurses and Associates and Korean Society of Gastrointestinal Endoscopy. Through this cooperation, we enhanced communication and established a better concordance. We still need more researches in this field and fill up the unproven area. And our guidelines will be renewed accordingly.

Toxic megacolon is a rare clinical complication of fulminant Clostridium difficile infection. The mortality rate of fulminant C. difficile infection is reported to be as high as 50%. Fecal microbiota transplantation is a highly effective treatment in patients with recurrent or refractory C. difficile infection. However, there are few published articles on the use of such transplantation for fulminant C. difficile infection. Here, we report on a patient with toxic megacolon complicated by C. difficile infection who was treated successfully with fecal microbiota transplantation.
Aged ; *Clostridium difficile ; Enterocolitis, Pseudomembranous/*complications ; Fecal Microbiota Transplantation/*methods ; Feces/*microbiology ; Humans ; Male ; Megacolon, Toxic/*microbiology/*therapy

The incidence, recurrence, and mortality of Clostridium difficile infection are increasing and the standard therapy is oral metronidazole or vancomycin. Since treatment failure with standard therapy is increasing, an alternative therapy is needed. Fecal microbiota transplantation is one effective method in patients with refractory or recurrent C. difficile infection, including pseudomembranous colitis. Here, we report two cases of refractory pseudomembranous colitis treated with fecal microbiota transplantation.
Clostridium difficile ; Enterocolitis, Pseudomembranous ; Humans ; Incidence ; Metagenome ; Metronidazole ; Recurrence ; Transplants ; Treatment Failure ; Vancomycin

OBJECTIVE: To validate the optimal cardiac phase and appropriate acquisition window for three-dimensional (3D) whole-heart coronary magnetic resonance angiography (MRA) with a steady-state free precession (SSFP) sequence, and to compare image quality between SSFP and Gd-enhanced fast low-angle shot (FLASH) MR techniques at 1.5 Tesla (T). MATERIALS AND METHODS: Thirty healthy volunteers (M:F = 25:5; mean age, 35 years; range, 24-54 years) underwent a coronary MRA at 1.5T. 3D whole-heart coronary MRA with an SSFP was performed at three different times: 1) at end-systole with a narrow (120-msec) acquisition window (ESN), 2) mid-diastole with narrow acquisition (MDN); and 3) mid-diastole with wide (170-msec) acquisition (MDW). All volunteers underwent a contrast enhanced coronary MRA after undergoing an unenhanced 3D true fast imaging with steady-state precession (FISP) MRA three times. A contrast enhanced coronary MRA with FLASH was performed during MDN. Visibility of the coronary artery and image quality were evaluated for 11 segments, as suggested by the American Heart Association. Image quality was scored by a five-point scale (1 = not visible to 5 = excellent). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were evaluated at the proximal coronary arteries. RESULTS: The SSFP sequence rendered higher visibility coronary segments, higher image quality, as well as higher SNR and CNR than the Gd-enhanced FLASH technique at 1.5T (p < 0.05). The visibility of coronary segments, image quality, SNR and CNR in the ESN, MDN and MDW with SSFP sequence did not differ significantly. CONCLUSION: An SSFP sequence provides an excellent method for the 3D whole-heart coronary MRA at 1.5T. Contrast enhanced coronary MRA using the FLASH sequence does not help improve the visibility of coronary segments, image quality, SNR or CNR on the 3D whole-heart coronary MRA.
Adult ; *Contrast Media ; Coronary Vessels/*anatomy & histology ; Female ; Gadolinium/diagnostic use ; Humans ; Image Processing, Computer-Assisted ; *Imaging, Three-Dimensional ; Magnetic Resonance Angiography/*methods ; Male ; Middle Aged ; Organometallic Compounds/*diagnostic use ; Reference Values ; Young Adult

PURPOSE: To evaluate the potential of prospective electrocardiography (ECG)-gated 64-slice multidetector computed tomography (MDCT) for evaluation of myocardial enhancement, infarct size, and stent patency after percutaneous coronary intervention (PCI) with stenting in patients with myocardial infarction. MATERIALS AND METHODS: Seventeen patients who were admitted with acute myocardial infarction were examined with prospective ECG-gated 64-slice cardiac MDCT and magnetic resonance (MR) imaging after reperfusion using PCI with stenting. Cardiac MDCT was performed with two different phases: arterial and delayed phases. We evaluated the stent patency on the arterial phase, and nonviable myocardium on the delayed phase of computed tomography (CT) image, and they were compared with the results from the delayed MR images. RESULTS: Total mean radiation dose was 7.7 +/- 0.5 mSv on the two phases of CT images. All patients except one showed good patency of the stent at the culprit lesion on the arterial phase CT images. All patients had hyperenhanced area on the delayed phase CT images, which correlated well with those on the delayed phase MR images, with a mean difference of 1.6% (20 +/- 10% vs. 22 +/- 10%, r = 0.935, p = 0.10). Delayed MR images had a better contrast-to-noise ratio (CNR) than delayed CT images (27.1 +/- 17.8% vs. 4.3 +/- 2.1%, p < 0.001). CONCLUSION: Prospective ECG-gated 64-slice MDCT provides the potential to evaluate myocardial viability on delayed phase as well as for stent patency on arterial phase with an acceptable radiation dose after PCI with stenting in patients with myocardial infarction.
Adult ; Aged ; Angioplasty, Transluminal, Percutaneous Coronary ; Electrocardiography/*methods ; Female ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Myocardial Infarction/*pathology/therapy ; Myocardial Reperfusion ; Prospective Studies ; Tomography, X-Ray Computed/*methods

OBJECTIVE: To prospectively assess the relationship between the two different measurement methods for the evaluation of left atrial (LA) volume using cardiac multidetector computed tomography (MDCT) and to compare the results between cardiac MDCT and echocardiography. MATERIALS AND METHODS: Thirty-five patients (20 men, 15 women; mean age, 60 years) underwent cardiac MDCT angiography for coronary artery disease. The LA volumes were measured using two different methods: the two dimensional (2D) length-based (LB) method measured along the three-orthogonal planes of the LA and the 3D volumetric threshold-based (VTB) method measured according to the threshold 3D segmentation of the LA. The results obtained by cardiac MDCT were compared with those obtained by echocardiography. RESULTS: The LA end-systolic and end-diastolic volumes (LAESV and LAEDV) measured by the 2D-LB method correlated well with those measured by the 3D-VTB method using cardiac MDCT (r = 0.763, r = 0.786, p = 0.001). However, there was a significant difference in the LAESVs between the two measurement methods using cardiac MDCT (p < 0.05). The LAESV measured by cardiac MDCT correlated well with measurements by echocardiography (r = 0.864, p = 0.001), however with a significant difference (p < 0.01) in their volumes. The cardiac MDCT overestimated the LAESV by 22% compared to measurements by echocardiography. CONCLUSION: A significant correlation was found between the two different measurement methods for evaluating LA volumes by cardiac MDCT. Further, cardiac MDCT correlates well with echocardiography in evaluating the LA volume. However, there are significant differences in the LAESV between the two measurement methods using cardiac MDCT and between cardiac MDCT and echocardiography.
Adult ; Aged ; Aged, 80 and over ; Atrial Function, Left ; *Cardiac Volume ; Contrast Media/diagnostic use ; Coronary Artery Disease/*radiography/ultrasonography ; Electrocardiography/methods ; Female ; Heart Atria/radiography/ultrasonography ; Humans ; Imaging, Three-Dimensional/methods ; Male ; Middle Aged ; Observer Variation ; Prospective Studies ; Radiographic Image Enhancement/methods ; Tomography, X-Ray Computed/*methods ; Triiodobenzoic Acids/diagnostic use

PURPOSE: We wanted to evaluate the effectiveness of stent placement on the superior mesenteric artery as a treatment for chronic mesenteric ischemia. MATERIALS AND METHODS: Seven patients (mean age: 55 years, age range: 43-66 years) with chronic mesenteric ischemia were enrolled between March 2000 and September 2003. All the patients underwent pre-procedure contrast enhanced computerized tomography to evaluate for occlusion or stenosis of the mesenteric arteries and they then underwent an angiographic procedure. A balloon-expandable metal stent was placed in the superior mesenteric artery, and this was combined with balloon angioplasty and thrombolysis. We evaluated the angiographic and procedural success after the procedures. RESULTS: Angiographic and procedural success was obtained in 100% of the patients and the clinical symptoms improved in 100% of the patients. The patency at 6-months and 1-year was 85% and 71%, respectively. The mean follow-up period was 12 months (range: 1-25 months). During the follow-up period, ischemic symptoms recurred in 2 patients, and restenosis in a stent was confirmed with angiography; one patient was successfully treated by stent placement in the celiac artery and the other patient died due to extensive mesenteric thrombosis. CONCLUSION: For the treatment of chronic mesenteric ischemia, percutaneuos stent placement on the superior mesenteric artery showed a favorable result and it was an effective alternative to surgery for the high-risk patients.
Angioplasty, Balloon ; Celiac Artery ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Ischemia ; Mesenteric Arteries ; Mesenteric Artery, Superior ; Mesenteric Vascular Occlusion ; Stents ; Vascular Diseases

OBJECTIVE: To examine the effects of coculture with human oviductal cells regarding the development of 1-cell stage ICR mouse embryos and to investigate the effects of duration and start time of coculture. MATERIALS AND METHODS: ICR mice were superovulated with PMSG/hCG and 1-cell stage mouse embryos were recruited. 1-cell mouse embryos were cocultured on human oviductal cells in a CO2 incubator(coculture group) and were cultured on 0.4 % BSA+HTF media(control group)(Experiment 1). 1-cell mouse embryos were cocultured on human oviductal cells for 36, 44, 52, 60 hours after hCG IP respectively, and then were transferred to 0.4 % BSA+HTF media(Experiment 2). In comparison, 1-cell mouse embryos were cultured by using 0.4 % BSA+HTF media, and then were transferred to human oviductal cell coculture system using the same schedule(Experiment 3). Afterward, they were examined regarding the development to 2-cell, 4~8 cell stage mouse embryos, morulas and blastocysts. RESULTS: In experiment 1, the developmental rates to 2-cell embryos of coculture group and control group were 97.3 % and 98.7 %, respectively. After 2-cell embryos, coculture group showed significantly higher developmental rate than control group (p<0.05). In experiment 2, the developmental rates after 2-cell embryos showed the significant differences. The groups with coculture effects removed before post-hCG 60 hours showed significantly lower developmental rates (p<0.05). In experiment 3, the developmental rates after 2-cell embryos were higher when the coculture started at an earlier stage. Furthermore, the groups which were cocultured from post-hCG 52 hours exhibited significant lower developmental rate than the groups which were cocultured continuously (p<0.05). CONCLUSION: The coculture with human oviductal cell could improve the development of the embryos in vitro and might mimic the natural physiological condition better than media environment. The degree of improvement was more pronounced when the coculture started at an earlier stage and the duration of coculture was longer. More importantly, the changes of culture condition at post-hCG 52 hours in which secondary mitosis occurs, have significant detrimental effects on growth and development of mouse embryos.
Animals ; Blastocyst ; Coculture Techniques* ; Embryonic Structures* ; Growth and Development ; Humans* ; Mice ; Mice, Inbred ICR* ; Mitosis ; Morula ; Oviducts*