Background/Aims:To validate the AIMS65 score for predicting mortality of patients with nonvariceal upper gastrointestinal bleeding and to evaluate the effectiveness of urgent (<8 hours) endoscopic procedures in patients with high AIMS65 scores.Methods:This was a 5-year single-center, retrospective study. Nonvariceal, upper gastrointestinal bleeding was assessed by using the AIM65 and Rockall scores. Scores for mortality were assessed by calculating the area under the receiver-operating characteristic curve (AUROC). Patients with high AIMS65 scores (≥2) were allocated to either the urgent or non-urgent endoscopic procedure group. In-hospital mortality, success of endoscopic procedure, recurrence of bleeding, admission period, and dose of transfusion were compared between groups.Results:A total of 634 patients were analyzed. The AIMS65 score successfully predicted mortality (AUROC=0.943; 95% confidence interval [CI], 0.876 to 0.99) and was superior to the Rockall score (AUROC=0.856; 95% CI, 0.743 to 0.969) in predicting mortality. The group with high AIMS65 score included 200 patients. The urgent endoscopic procedure group had reduced hospitalization periods (p<0.05)Conclusions:AIMS65 score may be useful in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding. Urgent endoscopic procedures in patients with high scores may be related to reduced hospitalization periods.

In September 2005, a 44-year-old woman was admitted to the hospital for a therapeutic abortion. She was at 18 weeks gestation. She had undergone hemodialysis for five years, and had taken carvedilol, nifedipine and valsartan for hypertension. She had no history of smoking or hormonal replacement therapy. The induction of abortion was attempted using a total of five vaginal prostaglandin E (PGE) pessaries (synthetic PGE 1 analogue misoprostol 200 mg, 400 mg and 400 mg) during a 20 h period. On vaginal examination, the cervix was unchanged. Subsequently, she was given intravenous PGE (synthetic PGE 2 analogue sulprostone, maximum dose 42 μg/h). Approximately 8 h after administration, she complained of acute left-sided chest pain and nausea. Her blood pressure was 120/80 mmHg. A physical examination produced normal results. An electrocardiogram (ECG) showed a regular sinus rhythm at 82 beats/min. ST elevation was seen in leads II, III and aVF, with reciprocal depression in the anterior leads ( Figure 1A). Serum creatine kinase MB isoenzyme (CK-MB) was 2.9 ng/mL (normal less than 5 ng/mL). The patient was diagnosed with acute inferior myocardial infarction. The pain was subsided slightly by administering sublingual nitroglycerin and an ECG indicated an accelerated idioventricular rhythm ( Figure 1B).A right coronary angiogram showed multiple luminal narrowing lesions ( Figure 2A). A total of 400 μg of intracoronary nitroglycerin was administered. Repeat angiography after administration of nitroglycerin revealed a disappearance of the lesions ( Figure 2B). Left coronary angiography showed normal findings. An ECG showed complete resolution of ST elevation. The patient was given nitrates, nifedipine and diltiazem. Ten hours after the incident, a fetus with no signs of life was delivered. Within 24 h, CK-MB reached a maximum concentration of 267.5 ng/mL and CK-MB was normalized three days later. She recovered without complications and was discharged. When last seen in July 2008, the patient reported no complaints. DisCussionVasospastic (also known as Prinzmetal's or variant) angina may be associated with acute myocardial infarction and severe cardiac arrhythmias, including ventricular tachycardia and fibrillation, as well as sudden death. Although responses to various vasoconstrictor substances, including catecholamines, serotonin, endothelin, thromboxane A 2 and arginine vasopressin, are greater in spastic segments of the coronary arteries, hypersensitivity to vasoconstrictor stimuli also occurs throughout the entire coronary trees in patients with vasospastic angina. PGE 2 and its analogues have been used therapeutically for their stimulant actions on the pregnant uterus for approximately 40 years (1). PGE 2 is the preferred agent for second trimester pregnancy termination and severe cardiovascular complications associated with PGE 2 cAse report ©2009 Pulsus Group Inc. All rights reserved Prostaglandin E (PGE) is the preferred agent for second-trimester pregnancy termination. Hypotension, bradycardia, ventricular arrh...

The feasible timing of NCP after discontinuation of APAs showed less than 5 days. VerifyNow is useful in the evaluation of antiplatelet reversal after discontinuation of APAs. .

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Spontaneous gastric perforation is a rare complication of gastric lymphoma that is potentially life threatening since it can progress to sepsis and multi-organ failure. Morbidity also increases due to prolonged hospitalization and delay in initiating chemotherapy. Therefore prompt diagnosis and appropriate treatment is critical to improve prognosis. A 64-year-old man presented to the emergency department with severe abdominal pain. Chest X-ray showed free air below the right diaphragm. Abdominal CT scan also demonstrated free air in the peritoneal cavity with large wall defect in the lesser curvature of gastric lower body. Therefore, the patient underwent emergency operation and primary closure was done. Pathologic specimen obtained during surgery was compatible to diffuse large B cell lymphoma. Fifteen days after primary closure, the patient received subtotal gastrectomy and chemotherapy was initiated after recovery. Patient is currently being followed-up at outpatient department without any particular complications. Herein, we report a rare case of gastric lymphoma that initially presented as peritonitis because of spontaneous gastric perforation.