A Case of Spontaneous Hemoperitoneum Due to Rupture of Visceral Artery Aneurysm

We introduce a case of middle colic artery rupture due to medial degeneration which progressed to hemoperitoneum. Visceral artery aneurysm is an uncommon form of vascular disease that has a significant potential for rupture or erosion into an adjacent viscera, resulting in life-threatening hemorrahge. The case involved a 58-year old man with abdominal pain who admitted to our hospital with a diagnosis of hemoperitoneum due to bleeding of omentum. At surgery, a large amount of hematoma was found in lesser sac which was removed totally. The bleeding focus was middle colic artery. Histological examination showed medial degeneration of unknown origin. The postoperative course was uneventful, and the patient discharged with good condition.

A Case of Nonbacterial Thrombotic Endocarditis in Small Ventricular Septal Defect

Nonbacterial thrombotic endocarditis is characterized by the presence of valve-leaflet or endocardial vegetation composed chiefly of fibrin and trapped platelets, without an associated inflammatory reaction or evidence of microorganism. Recent emphasis has been affixed to the significant morbidity and mortality rates as a results of major systemic arterial embolization and infective endocarditis. It is seen most commonly in patients with malignant neoplasms, disseminated intravascular coagulopathy, uremia, burn, SLE, cardiac valve disease. We experienced a case of nonbacterial thrombotic endocarditis developed in patient with small congenital ventricular septal defect, and vegetation on the left ventricular septum other than right ventricle as known most commonly affected.

Outbreak of Nosocomial Urinary Tract Infections caused by Multidrug-Resistant Pseudomonas aeruginosa / 병원감염관리

BACKGROUND: Nosocomial urinary tract infection (UTI) accounts for 35% of the nosocomial infection and 80-90% of them are associated with urethral catheters. Recently, we experienced an outbreak of nosocomial UTI caused by multidrug-resistant Pseudomonas aeruginosa in neurosurgical intensive care unit (NSICU). METHODS: We investigated clinical records of the patients and observed the methods of care of urethral catheters in NSICU. Identification of P. aeruginose was done by API NE (API system; bioMerieux, France) and antibiotic susceptibility tests were done by disk diffusion method. Random Amplification of Polymorphic DNA (RAPD) assay was used as a genotyping method. RESULTS: Between November 1997 and January 1998, 11 P. aeruginosa strains were isolated from the urine of 11 patients hospitalized in NSICU of Kangnam St. Mary's Hospital. Routine regular bladder irrigation, and emptying urine with common urinal had been done falsely. Antibiogram of the isolates showed resistance to multiple antibiotics including imipenem, gentamicin. amikacin, piperacillin, ciprofloxacin, ceftazidime, and cefoperazone/sulbactam. RAPD of the outbreak strains showed clonal relatedness, which was different from those of other clinical strains, We instructed all the health care workers to stop bladder Irrigation, and to use the separate urinals for each patient. Thereafter, no further case of P. aeruginosa UTI has occurred. CONCLUSION: An outbreak of UTI, caused by a single clone of P. aeruginosa, was confirmed by RAPD and was eradicated after correction of false practice on care-of urinary catheter.

A Case of Primary Bilateral B-cell Renal Lymphoma / 대한신장학회잡지

Non-Hodgkin's lymphoma frequently involves the kidneys, with previous reports demonstrating approximately a 48 Yo incidence at autopsy. In contrast, lymphoma originating within the kidneys is a rare event, because the renal parenchyma does not have lymphatics. Most common type of primary renal lyrnphoma that calssified by Working formulation and irnmunohistochemistry was diffuse large B-cell, intermediate grade. A 43-year-old woman presented with epigastric discomfort, anorexia, fever, and weight loss. The past rnedical history was unremarkable. On physical examination, she was febrile, and conjunctiva was pale. Lymph node was enlarged and palpated at right inguinal area. But no other lymphadenopathy or hepatosplenomegaly was found. Laboratory study showed WBC 6,900/mm, hemoglobin 6.7g/dL, serum LDH 783IU/L, GFR 31.45 ml/min. The chest X-ray was within normal limit; no mediastinal lympha- denopathy was present. The abdominal X-ray revealed enlargement of right kidney. The abdominal CT scan showed markedly enlarged both kidneys containing inhomogeneous solid masses with poor excretion of intravenous contrast, a few small paraaortic lymphadenopathies, and contour bulging on the pancreas body. A percutaneous renal biopsy was obtained from this patient at the right kidney. Microscopic exarnination showed a diffuse infiltrate of predominantly large lymphoid cells having round to oval vescicular nuclei. Immunohistochemical studies revealed a B-cell-type lymphoma. The tumor was judged to be an intermediate-grade, large-cell, diffused, B-cell-type non-Hodgkin's lymphoma. We report a case of primary bilateral B-cell renal lymphoma in a 43-year-old female patient with review of the literature.

A Case of MALToma Involving Stomach and Small Intestine / 대한소화기내시경학회지

A 74-year old male was admitted to St. Mary's Hospital due to symptoms of diarrhea and fever. He was diagnosed with MALToma in the jejunum 6 months previously, but had refused any treatment. This time, an endoscopy revealed multiple erosions and nodular mucosa in the body, fundus of the stomach and 3rd portion of duodenum. Abdominal computed tomography showed wall thickening in 3rd portion of the duodenum and upper jejunum with multiple lymph nodes enlargement. Additionally, an endoscopic biopsy revealed MALToma in the stomach and duodenum. Salmonella group B grew in a blood culture and a chest PA determined pneumonic infiltration in the left lower lobe. He received sulperazone for 7 days, but again refused any further treatment and was thereby discharged after had improved condition.

Correlation of Apoptosis with HPV, p53 Expression, and PCNA Expression in Laryngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Programmed cell death (apoptosis) is distinctive form of cell death manifested by characteristic chromatin condensation and DNA fragmentation, whose function is the deletion of cells in normal development, organogenesis, immune function, and tissue growth, but which can also be induced by pathologic stimuli. The purpose of this study was to analyze the relationship between apoptotic index and HPV, p53 and PCNA expression, and clinicopathological findings in laryngeal squamous cell carcinomas. MATERIALS AND METHODS: Fourty-one cases of laryngeal squamous cell carcinomas were analyzed for the detection of HPV DNA by in situ hybridization, the expression of p53 and PCNA by immunohistochemical technique, and detection of apoptotic bodies by in situ hybridization. RESULTS: HPV DNA was detected in 8 (19.51%), p53 was expressed in 26 (63.41%) out of 41 cases, and the PCNA expression rate was 48.39+/-21.06%. The average apoptotic index was 9.38+/-2.89, there was no relationship between apoptotic index and HPV and p53 expression (p>0.05). The apoptotic indices were 11.26+/-1.86, 8.17+/-2.55, and 4.32+/-2.41 in well differentiatied, moderately differentiatied and poorly differentiatied carcinoma, respectively. The histopathological differences were statistically significant (p<0.05). Also there was an inverse proportion between apoptotic index and PCNA expression. CONCLUSION: The apoptotic index was related to cellular differentiation regardless of HPV and p53 expression. Also these results suggest that the numbers of apoptotic bodies in the tumor tissues can make it possible to presume indirectly the malignant potentiality of the tumor and will help us to understand the biologic behavior of head and neck cancer.

Analysis of 15 Cases of Ischemic Colitis Induced by Increased Abdominal Pressure / 대한소화기내시경학회지

It was suggested that temporary vascular insufficiency within the wall of the colon causes iachemic colitis. So, motivated by this fact, we studied and analyzed 15 cases of iachemic colitis, which were confirmed by the diagnostic criteria of Nagasako(1982), through 32 months from January, 1993 to August, 1995 at Our Lady of Mercy Hospital, Incheon.(continue...)

Analysis of 15 Cases of Ischemic Colitis Induced by Increased Abdominal Pressure / 대한소화기내시경학회지

It was suggested that temporary vascular insufficiency within the wall of the colon causes iachemic colitis. So, motivated by this fact, we studied and analyzed 15 cases of iachemic colitis, which were confirmed by the diagnostic criteria of Nagasako(1982), through 32 months from January, 1993 to August, 1995 at Our Lady of Mercy Hospital, Incheon.(continue...)

Teleradiology(TELEACE) system: Results of field trial

We report the results of field operation of TELEACE system between Kyung-Pook National University Hospital and Ul-Jin Goon Health Care Medical Center from December, 1990 to September, 1991, which had been operated as a kind of Integrated Services Digital Nework projects by KOREA TELECOMMUNICATION Inc. Ul-Jin Goon Health Care Medical Center transmitted 414 plain radiographs to our hospital in speed of 9600BPS. Each image was composed of 1024X1024 pixelsX8 bits/pixel. In our hospital, the image files were displayed on high resolution monitor (1280×1024 pixets). Text files of image interpretations were transmitted to the health care medical center. The two radiologists who had interpreted the transmitted images, went to the health care medical center and read radiographic film with blind test method. We obtained the following results: false negative rate of 6.3%, false postitve rate of 2.4%, mean sensitivity of 81.4%, mean specificity of 96.3%, and mean accuracy of 91.3%. In predictive value of 0.05, there was no significant difference between results of these two types of radiographs. In conclusion, TELEACE system was valuable to the clinicians isolated from services of radiologists.

US findings of thyroid carcinomas developed in multinodular goiters

Primary role of ultrasound in patients with thyroid nodule is to determine the multiplicity and detect occult carcinoma. We analyzed US findings of 53 thyroid carcinomas with multiple nodular lesions from january 1988 to december 1991. The results were as follows: 1. 109 malignant nodules in 53 cases and 24 benign in 23 were comfirmed. 2. The nature of the masses were solid in 72 malignant nodules (74.2%), and complex in 25 (25.8%) of which 19 were predominantly solid. 3. The echo pattern of the solid and solid predominant masses were hypoechoic in 78 malignant nodules (80.4%), hyperechoic in 10 (10.3%), and isoechoic in 3 (9.3%) 4. Internal punctate calcifications within the masses were observed in 31 malignant nodules (31.9%). 5. Halo sign was present in 16 malignant nodules(16.5%). 6. The preoperative sonographic diagnosis of thyroid carcinoma was made in 39.4% of 53 cases with multiple nodules on US. In conclusion, the number, and halo formation of nodules were insignificant to differentiate the benign nodule from the malignant. The heterogeneous hypoechoic nodules with size greater than 4cm, multiple stippled calcifications, displacement of the trachea or other surrounding structures of combined lymph node enlargements seem to indicate the possibility of malignancy.