A Case of Acute Myocardial Infarction in a Patient Whose Initial Complaints Were Hematemesis and Epigastric Discomfort

The patient was a 64-year-old woman with systemic lupus erythematosus, thrombophlebitis of the lower legs, cerebral infarction with left hemiparesis, and colostomy after perforation of the sigmoid colon. On the morning of her presentation, the patient felt epigastric abnormality. Thereafter, hematemesis occurred twice, leading her to call an ambulance in the afternoon. Upon arrival, electrocardiography before securing a venous route and obtaining blood samples revealed ST segment elevation in leads II, III, and aVF. As her vital signs were stable and her hemoglobin level had decreased by just 1.1 g/dl in comparison to the previous day, emergency coronary angiography (CAG) was performed. CAG revealed complete occlusion at section #4. She underwent right coronary angioplasty with stent placement. The patient’s course after angioplasty was uneventful. On the 15th hospital day, esophagogastroduodenoscopy revealed esophageal erosion and superficial gastritis. She was discharged on foot the following day. When physicians treat patients with hematemesis, electrocardiography and the measurement of troponin are essential before esophagogastroduodenoscopy.

THE COMPARISON OF THE EFFECT BETWEEN ALGINATE-BASED RAFT-FORMING LIQUID AND ALGINATE LIQUID ON GASTROESOPHAGEAL REFLUX DISEASE AND GASTRIC ULCER IN RATS

Objective: The objective of the study was to compare the effect between alginate (Alg)-based raft-forming and Alg liquid on healing gastroesophageal reflux disease (GERD) and gastric ulcer in rats.Methods: Each of the 18 fasted rats was given 1 ml acidified pepsin. Then, rats were divided into three groups. Each group consisted of six rats. Group 1 (negative control) was orally given 1 ml distilled water, Group 2 was given 1 ml Alg-based raft-forming liquid, and Group 3 was given 1 ml Alg liquid. Then, the abdomen of rats was incised under anesthesia with ketamine, and then both their pylorus and the forestomach were ligated to form gastric reflux. After 4 hrs, all rats were killed with chloroform and their esophagus and stomach were examined macroscopically and microscopically (histopathology).Results: On macroscopic observation, all of the Group 1 rats (negative control) showed esophageal lesions and gastric lesions. Four rats of Group 2 (given Alg-based raft-forming) showed no esophageal lesion and two more rats showed a slight lesion, but all of the tested rats showed gastric lesions. All of the rats of the Group 3 (given Alg liquid) showed esophageal lesions, but no gastric lesion on four rats and slight lesion on two rats. Microscopic observations showed that all of the Group 1 rats (negative control) showed esophageal erosion and gastric mucosa lesions. Rats of the Group 2 (given Alg-based raft-forming) showed almost no esophageal erosion, but all of them showed erosion of gastric mucosa. Rats of the Group 3 (given Alg liquid) showed esophageal erosion in all tested rats, but almost no gastric mucosa lesion.Conclusion: Alg-base raft-forming liquid is more effective in healing of GERD than Alg liquid. However, Alg-liquid is more effective in healing of gastric ulcer than Alg-based raft-forming liquid.

Resorbable Synthetic Mesh Supported With Omentum Flap in the Treatment of Giant Hiatal Hernia

Covering a large hiatal hernia with a mesh has become a basic procedure in the last few years. However, mesh implants are associated with high complication rates (esophageal erosion, perforation, fistula, etc.). We propose using a synthetic resorbable mesh supported with an omental flap as a possible solution to this problem. A 54-year-old female patient with a large hiatal defect (9 cm) was laparoscopically implanted with a synthetic resorbable mesh supported with an omental flap. The surgical procedure was successful and the patient was discharged on postoperative day 2. On a follow-up examination 6 months after surgery, she remained free of relapse or complication signs. Supporting an implanted resorbable mesh with an omental flap may be a solution to the problems posed by large esophageal hiatus defects. However, more studies based on larger patient samples and longer follow-up periods are necessary.