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Acute Renal Failure in a Renal Allograft Recipient Caused by a Post-Biopsy Renal Arteriovenous Fistula with Transplant Renal Artery Stenosis Jin-Ho Lee, M.D., Hee-Ryong Lee, M.D., Seung-Ho Choi, M.D., Peel Jung, M.D., Joon-Seok Oh, M.D., Seung-Min Kim, M.D., Yong-Hun Sin, M.D., Yeon-Soon Jung, Ph.D., Gyoo-Sik Jung, Ph.D. and Joong-Kyung Kim, M.D. Department of Internal Medicine, Bong Seng Memorial Hospital, Departments of Internal Medicine, Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea

Transmesenteric hernias have bimodal distribution and occur in both pediatric and adult patients. In the adult population, the cause is iatrogenic, traumatic, or inflammatory. We report a case of transmesocolic hernia in an elderly person without any preoperative history. An 84-year-old Korean female was admitted with mid-abdominal pain and distension for 1 d. On abdominal computed tomography, we diagnosed transmesocolic hernia with strangulated small bowel obstruction, and performed emergency surgery. The postoperative period was uneventful and she was discharged 11 d after surgery. Hence, it is important to consider the possibility of transmesocolic hernia in elderly patients with signs and symptoms of intestinal obstruction, even in cases with no previous surgery.

of the varices with endoscopy probe was considered as an indicator of that gastric varices were not eradicated. But if pillow sign was negative, it was thought that the varices were eradicated. With EUS doppler examination of the same varices, if there was flow, it was decided that the varices were not eradicated. Except the experienced endoscopist who performed the gastroscopy and EUS, the varicose veins were visualized by two other experienced endoscopists. Kappa statistics were used to evaluate the interobserver agreement. Results: Eighteen patients were included, 10 men (%55) and 8 women (%45) with an average age of 53.4 years (range 19 to 74 years). The etiology of the portal hypertension was splenic vein thrombosis in 2 (% 11.1) patients, portal vein thrombosis in 1 (%5.5) patient, and cirrhosis in other 15 (%83.3) patients. The mean injection session number was 2 (range 1 to 5). Seven (% 38.8) patients who had pillow sign in gastroscopy, had also flow in EUS doppler examination and it was repeated the cyanoacrylate injection. Eleven (%61.2) patients with negative pillow sign that were thought to have successful eradication, had no flow in EUS doppler examination. Conclusion: Endoscopically negative pillow sign is adequate for the eradication decision of the gastric varices which were enjected cyanoacrylate, examination with EUS does not contribute an additional benefit.

Background/Aims: Heart rate variability (HRV) is a method for evaluation of autonomic nervous system activity by expressing the balance of sympathetic and parasympathetic tones. Some studies of HRV in patients with end-stage renal disease (ESRD) have been performed in Korea. However, few have examined kidney transplantation (KT) patients. Therefore, we investigated autonomic nervous system activity by means of HRV in patients with KT due to ESRD. Methods: We compared the pattern of cardiac sympathetic and parasympathetic activity by time- and frequency-domain analysis of HRV with 24-h Holter monitoring of 23 KT and 56 dialysis patients. Patients underwent KT between January, 2008 and June, 2011. Results: The mean ages of KT and dialysis patients were 54.2 ± 12.3 and 53.7 ± 12.6 years, respectively. The KT group showed increased time- and frequency-domain HRV (including HRV index), very low frequency (VLF), means and standard deviations of all normal R-R intervals for all 5-min segments of the entire recording (SDNNi), low frequency (LF), LF in normalized units (LF norm), and LF to high-frequency power ratio, compared with the dialysis group. Conclusions: Autonomic tone in patients with KT is higher than that in patients with ESRD on dialysis. (Korean J Med 2012;83:606-612)

Tuberculosis of the sigmoid colon is a rare disorder. An 80-year-old man visited Bongseng Memorial Hospital for medical examination. A colonoscopy was performed, and a lesion in the sigmoid colon that was suspected to be colon cancer was found. A biopsy was performed, and tuberculous enteritis with chronic granulomatous inflammation was diagnosed. Intestinal tuberculosis is most frequent in the ileocecal area, followed by the ascending colon, transverse colon, duodenum, stomach, and sigmoid colon, in descending order. Hence, we report a case of intestinal tuberculosis in the sigmoid colon, which is rare and almost indistinguishable from colon cancer.