A Case of Pulmonary Cryptococcosis by Capsule-deficient Cryptococcus neoformans

Pulmonary infection by capsule-deficient Cryptococcus neoformans (CDCN) is a very rare form of pneumonia and it is seldom seen in the immunocompetent host. The authors experienced a case of pulmonary cryptococcosis by CDCN in 25-year-old woman who was without any significant underlying disease. The diagnosis was made from the percutaneous lung biopsy and special tissue staining, including Fontana-Masson silver (FMS) staining. Fungal culture confirmed the diagnosis afterward. Her clinical and radiologic features improved under treatment with fluconazol. It's known that CDCN is not so readily confirmed because fungal culture does not always result in growth of the organism and the empirical fungal stain is not helpful for the differentiation between CDCN and the other infections that are caused by the nonencapsulated yeast-like organisms. In this report, we emphasize the diagnostic value of performing FMS staining for differentiating a CDCN infection from the other confusing nonencapsulated yeast-like organisms.

A Case of Spontaneous Perforation of the Common Bile Duct Associated with Cholangitis / 대한소화기학회지

Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.

Risk Factors of Deep Vein Thrombosis and Pulmonary Embolism in Korean

BACKGROUND AND OBJECTIVES: Deep vein thrombosis and pulmonary embolism are both associated with a high mortality. However, in Korea, they are known as relatively rare diseases and are not sufficiently evaluated, so there is limitations in the proper approach toward their diagnosis and management. SUBJECTS AND METHODS: The risk factors, accompanying illness and family history of patients with deep vein thrombosis and pulmonary embolism, treated at Hallym University Sacred Heart Hospital, between January 1999 and July 2002, were analyzed. RESULTS: There were 113 patients with deep vein thrombosis and pulmonary embolism, comprised of 45 men and 68 women, 31 being older than 70 years of age (the largest portion). Of the 113 patients, 101 had identified causal illness causative diseases, but the other was no obvious risk factors. Overweight and obese turned out to be the most frequent risk factor. While there were 35% with one risk factor, 51.3, 10 and 3.7% had two, three or four risk factors, respectably. The recurrence rate was 20.3%, and that of women was 1.2 fold that of men, irrespectively of the risk factor. There were also two patients with a positive family history. CONCLUSION: The freguent risk factors and underlying diseases for deep vein thrombosis and pulmonary embolism were over-weight/obesity, antiphospholipid syndrome, cancer and a bed ridden state, in that order of frequency. As the individual risk factors of the patients overlapped in 61.5% cases, attention should be paid to overlapping risk factors. In order to reduce the complications of these diseases, each patient's risk factors should be carefully evaluated, and some patients should be advised to take life-long care.

A Case of Retroperitoneal Schwannoma of the Vagus Nerve / 대한소화기학회지

Schwannomas are benign nerve sheath tumors that originate from any anatomical site. Most schwannomas occur in the head, neck or limbs, but rarely occur in the retroperitoneal space. Furthermore, the schwannoma originating from the vagus nerve of retroperitoneal space is much rare. We experienced a case of retroperitoneal schwannoma of the vagus nerve. A 34-year-old male was refered to our hospital for the evaluation of abdominal mass on ultrasonography. Endoscopic examination revealed submucosal tumor-like lesion on high body of the stomach. Computed tomography (CT) revealed that the stomach was compressed by a solid tumor in the retroperitoneum. On exploratory laparotomy, this mass turned out to be a baseball sized mass in the retroperitoneal space. The mass was excised in an encapsulated state. Histological examination with immunohistochemical stains revealed a schwannoma of the vagus nerve.