Eosinophilic Peritonitis in a Patient with Continuous Ambulatory Peritoneal Dialysis (CAPD)

Eosinophilic peritonitis is defined as when there are more than 100 eosinophils present per milliliter of peritoneal effluent, of which eosinophils constitute more than 10% of its total WBC count. Most cases occur within the first 4 weeks of peritoneal catheter insertion and they usually have a benign and self-limited course. We report a patient of eosinophilic peritonitis that was successfully resolved without special treatment. An 84-year-old man with end stage renal disease secondary to diabetic nephropathy was admitted for dyspnea and poor oral intake. Allergic history was negative. and physical examination was unremarkable. Complete blood count showed a hemoglobin level of 11.1 g/dL, WBC count was 24, 500/mm3 (neutrophil, 93%; lymphocyte, 5%; monocyte, 2%), platelet count was 216, 000/mm3, serum BUN was 143 mg/dL, Cr was 5.7 mg/dL and albumin was 3.5 g/dL. Creatinine clearance was 5.4 mL/min. Three weeks after peritoneal catheter insertion, he was started on peritoneal dialysis with a 6-hour exchange of 2L 1.5% peritoneal dialysate. After nine days, he developed turbid peritoneal effluents with fever (38.4degrees C), abdominal pain and tenderness. Dialysate WBC count was 180/mm3 (neutrophil, 20%; lymphocyte, 4%; eosinophil, 76% [eosinophil count: 136/mm3]). Cultures of peritoneal fluid showed no growth of aerobic or anaerobic bacteria, or of fungus. Continuous ambulatory peritoneal dialysis (CAPD) was commenced, and he was started on intraperitoneal ceftazidime (1.0 g/day) and cefazolin (1.0 g/day). After two weeksr, the dialysate had cleared up and clinical symptoms were improved. Dialysate WBC count decreased to 8/mm3 and eosinophils were not detected in peritoneal fluid. There was no recurrence of eosinophilic peritonitis on follow-up evaluation, but he died of sepsis and pneumonia fifteen weeks after admission.

The Relationship between the Serum Intercellular Adhesion Molecule-1 Level and the Prognosis of the Disease in Lung Cancer

BACKGROUND: Adhesion molecules are related to cell-to-cell interaction and inflammatory interaction. In addition, adhesive interactions between tumor cells and adjacent cells and/or extracellular matrix play important roles in the complex process of tumor growth and development. Among these adhesion molecules, expression of intercellular adhesion molecule-1 (ICAM-1) has been identified in colon cancer, bladder cancer, lung cancer, melanoma, pancreatic cancer and hepatocellular carcinoma. In the current study, we analyzed serum ICAM-1 concentrations to investigate the relationship between the serum ICAM-1 level and prognosis in patients with lung cancer METHODS: Serum ICAM-1 was measured in 84 patients with lung cancer according to the pathologic type and clinical stage using the ICAM-1 ELISA kit. The Kaplan-Meier method was used to analyse survival time. RESULTS: There was no difference in serum ICAM-1 concentration among the different stages of lung cancer. Furthermore, there was no difference observed between histologic tumor type with regard to serum ICAM-1 concentration. Although the difference was not significant, the overall survival times of patients with a low serum ICAM-1 concentration ( or=306 ng/mL) in non-small cell lung cancer patients. CONCLUSION: These results suggest that high levels of serum ICAM-1 reflect poor prognosis for patients with non-small cell lung cancer.

The Relationship between the serum intercellular adhesion molecule-1 level and the prognosis of the disease in lung cancer / 대한내과학회지

BACKGROUND: Adhesion molecule is related to cell-cell interaction and inflammatory interaction. In addition, adhesive interactions between tumor cells and adjacent cells and/or extracellular matrix are important role in the complex process of tumor growth and develpment. Of these adhesion molecules, expression of intercellular adhesion molecule-1 (ICAM-1) have been identified in colon cancer, bladder cancer, lung cancer, melanoma, pancreatic cancer, hepatocellular carcinoma. In the current study, we analyzed serum ICAM-1 concentrations to investigate the relationship between the sICAM-1 level and the prognosis of the disease in patients with lung cancer METHODS: Serum sICAM-1 was measured in 84 patients with lung cancer according to the pathologic types and clinical staging using ICAM-1 ELISA kit. The Kaplan-Meier method was used to analyse survival time. RESULTS: There was no difference in sICAM-1 concentration among the stage of lung cancer. And no difference was observed among histologic tumor types with regard to sICAM-1 concentration. The overall survival of patients with low sICAM-1 concentration (or=306 ng/mL) in non-small cell lung cancer patients, but no difference was observed in small cell lung cancer patients. CONCLUSION: These results suggest that high levels of sICAM-1 reflect the poor prognosis of patients with non-small cell lung cancer.

Kaposi Sarcoma in Patient with Membranous Glomerulonephropathy during Corticosteroid Therapy / 대한신장학회잡지

Membranous glomerulonephropathy is a common cause of nephrotic syndrome in adults. Kaposi sarcoma is a well-known entity with distinct clinical forms such as nodular cutaneous lesions, generalized lymphadenopathy and visceral involvement. Incidence of Kaposi sarcoma is greater in patients with immunosuppression, particularly those having undergone renal transplantation, but also in patients with other underlying disorders treated with immunosuppressive therapy, notably, corticosteroids. We present a case of Kaposi sarcoma in patient with membranous glomerulopathy during corticosteroid therapy. A 49- year-old man was admitted with a complain of facial and leg edema, 5-kg weight gain for 1 month, and foamy urine. Kidney biopsy showed membranous glomerulopathy. We started corticosteroid therapy to the patient. Two month later, his 24 hr urinary protein was decreased to 2.1 g/day. But, the well defined, various-sized, purple-colored papules and plaque appeared on the both hands and feet. He underwent skin biopsy, which revealed abnormally proliferated and dilated vessels, vascular slits, spindle-shaped cells and extravasated erythrocytes in the dermis. The findings were in accordance with Kaposi sarcoma. So he received cryotherapy with discontinuing corticosteroid. Four months after cryotherapy, skin lesions were cleared leaving slight hypopigmentation and amount of proteinuria was preserved without definite aggravation.

Prevalence of the metabolic syndrome as defined by NCEP-ATPIII among the urban Korean population / 대한내과학회지

BACKGROUND: The definition of metabolic syndrome was different in each studies and thus the results of each studies were variable. In 2001 years, the third report of the national cholesterol education program expert panel on detection, evaluation and treatment of high blood cholesterol in adults (NCEP-ATP III) emphasized the importance of treating patients with the metabolic syndrome to prevent cardiovascular disease. In year 2000, the criteria to define obesity in Asia-Pacific region was proposed. However, limited information is available about the prevalence of the metabolic syndrome according to NCEP-ATP III in Korea. We compared the prevalence of the metabolic syndrome in the urban Korean population by criteria of ATP III report and Asia-Pacific region and estimated the effect of age and sex on the development of metabolic syndrome. METHODS: Total 40,698 participants (26,528 men, 14,170 women) underwent medical check-up from Jan. to Dec. 2001, aged 20-82 years (mean+/-SD: 41.2+/-9.2), were included in this study. Age, sex, height, body weight, waist circumference, blood pressure, blood cholesterol, triglyceride, HDL cholesterol and fasting glucose levels were measured. RESULTS: By the definition of ATPIII, the age-adjusted prevalence of metabolic syndrome for Koreans was 6.8% in total, 5.2% in men, 9.0% in women. In Asia-Pacific definition with waist circumference, 10.9% in total, 9.8% in men, 12.4%. In Asia-Pacific definition with body mass index (BMI) instead of waist circumference, 13.1% in total, 13.2% in men, 13.1% in women. By the definition of ATP III, the prevalence among participants aged 20 through 29 years, 30 through 39 years, 40 through 49 years, 50 through 59 years, 60 through 69 years, and over 70 years were 1.4%, 2.5%, 5.2%, 11.5%, 19.5% and 22.2%, respectively. By the Asia-Pacific definition with waist circumference, 2.4%, 5.4%, 9.4%, 18.2%, 27.5% and 31.3%, respectively. By the Asia-Pacific definition with BMI instead of waist circumference, 3.2%, 8.4%, 13.0%, 21.0%, 29.0% and 30.6%, respectively. With BMI-adjusted logistic regression analysis, the odds ratio of participants with the metabolic syndrome aged over 70 years against aged 20 through 29 years was 13.8(95% CI 8.2~23.2). With age and BMI-adjusted logistic regression analysis, the odds ratio of women with the metabolic syndrome for men was 1.4(95% CI 1.2~1.5). CONCLUSION: The prevalence of the metabolic syndrome on NHANES III (The Third National Health and Nutrition Examination Survey) report in USA displayed much difference with our report. Therefore, adequate criteria of the metabolic syndrome for Koreans should be needed.

Prevalence of the metabolic syndrome as defined by NCEP-ATPIII among the urban Korean population / 대한내과학회지

BACKGROUND: The definition of metabolic syndrome was different in each studies and thus the results of each studies were variable. In 2001 years, the third report of the national cholesterol education program expert panel on detection, evaluation and treatment of high blood cholesterol in adults (NCEP-ATP III) emphasized the importance of treating patients with the metabolic syndrome to prevent cardiovascular disease. In year 2000, the criteria to define obesity in Asia-Pacific region was proposed. However, limited information is available about the prevalence of the metabolic syndrome according to NCEP-ATP III in Korea. We compared the prevalence of the metabolic syndrome in the urban Korean population by criteria of ATP III report and Asia-Pacific region and estimated the effect of age and sex on the development of metabolic syndrome. METHODS: Total 40,698 participants (26,528 men, 14,170 women) underwent medical check-up from Jan. to Dec. 2001, aged 20-82 years (mean+/-SD: 41.2+/-9.2), were included in this study. Age, sex, height, body weight, waist circumference, blood pressure, blood cholesterol, triglyceride, HDL cholesterol and fasting glucose levels were measured. RESULTS: By the definition of ATPIII, the age-adjusted prevalence of metabolic syndrome for Koreans was 6.8% in total, 5.2% in men, 9.0% in women. In Asia-Pacific definition with waist circumference, 10.9% in total, 9.8% in men, 12.4%. In Asia-Pacific definition with body mass index (BMI) instead of waist circumference, 13.1% in total, 13.2% in men, 13.1% in women. By the definition of ATP III, the prevalence among participants aged 20 through 29 years, 30 through 39 years, 40 through 49 years, 50 through 59 years, 60 through 69 years, and over 70 years were 1.4%, 2.5%, 5.2%, 11.5%, 19.5% and 22.2%, respectively. By the Asia-Pacific definition with waist circumference, 2.4%, 5.4%, 9.4%, 18.2%, 27.5% and 31.3%, respectively. By the Asia-Pacific definition with BMI instead of waist circumference, 3.2%, 8.4%, 13.0%, 21.0%, 29.0% and 30.6%, respectively. With BMI-adjusted logistic regression analysis, the odds ratio of participants with the metabolic syndrome aged over 70 years against aged 20 through 29 years was 13.8(95% CI 8.2~23.2). With age and BMI-adjusted logistic regression analysis, the odds ratio of women with the metabolic syndrome for men was 1.4(95% CI 1.2~1.5). CONCLUSION: The prevalence of the metabolic syndrome on NHANES III (The Third National Health and Nutrition Examination Survey) report in USA displayed much difference with our report. Therefore, adequate criteria of the metabolic syndrome for Koreans should be needed.

Usefulness of cyfra 21-1 as a tumor marker of lung cancer / 대한내과학회지

BACKGROUND: Cytokeratins are epithelial markers whose expressions are not lost during malignant transformation. The utility of cytokeratin fragment (Cyfra) 21-1, a new tumor marker, was investigated in 110 patients with lung cancer. The aims of this study were to confirm sensitivity of Cyfra 21-1 in detecting non-small cell cancer, to assess the potential relationship between Cyfra 21-1 and disease stage of the lung cancer. METHODS: We measured serum levels of four tumor marker (NSE, CEA, SCC Ag, Cyfra 21-1) in 110 patients with lung cancer. The measurement of serum level of Cyfra 21-1 was performed with a cut off value of 3.3 ng/mL. An immunoradiometric assay was used to detect a fragment of the cytokeratin 19. The patients were grouped according to the stage of the disease and tumor type. RESULTS: Overall sensitivity of Cyfra 21-1 was relatively high (51.8%) than others tumor markers. Sensitivity of this marker was especially high for adenocarcinoma (63.2%) and squamous cell carcinoma (54.1%). In contrast, sensitiviy of Cyfra 21-1 was relatively low for small cell lung carcinoma (40.0%). Serum levels of Cyfra 21-1 were higher in advanced nonsmall cell lung cancer than early stage disease. CONCLUSION: We conclude that Cyfra 21-1 is a sensitive tumor marker of nonsmall cell lung cancer, especially adenocarcinoma and also may be a useful adjunctive marker for disease monitoring.

Relationship between body fat distribution and atherosclerotic risk factors in Korean populations / 대한내과학회지

BACKGROUND: Obesity is an independent risk factor for the development of coronary artery disease and associated with insulin resistance, hyperlipidemia and hypertension. In many studies, visceral adipose tissue is highly correlated with adverse coronary risk profile. Left ventricular (LV) hypertrophy also is an independent risk factor for cardiovascular mortality and morbidity. However, few data are available concerning the relations of LV hypertrophy to body fat composition, especially in Korean subjects. Therefore, this study was intended to evaluate the relation between body fat distribution and atherosclerotic risk factors including metabolic parameters and LV mass. METHODS: Total 138 subjects who visited the healthy promotion center in Kangbuk Samsung hospital (97 men, 41 women) were to recruited to the study. Body fat distribution was assessed by Abdomial CT (computer tomography) and Bioelectrical impedance analysis (Body Composition Analyzer Inbody 2.0, Biospace, Seoul, Korea) RESULTS: Visceral adipose tissue volume was higher in male subjects while subcutaneous adipose tissue volume and % body fat were higher in female subjects (p<0.05). Serum triglyceride and uric acid level were elevated in male subjects but HDL-cholesterol level was elevated in female subjects (p0.05). Increasing age was correlated with waist-hip ratio, visceral adipose tissue volume, abdominal fat/total body fat ratio, LV mass (p0.05). Visceral adipose tissue volume was positively correlated with body mass index, waist-hip ratio, blood pressure, total cholesterol, triglyceride, uric acid and negatively correlated with HDL-cholesterol (p0.05). After adjustment for age and sex, this correlation was significantly remained. LV mass was positively correlated with body mass index, waist-hip ratio, visceral adipose tissue volume, abdominal fat/total body fat ratio (p0.05). In the multiple regression analysis, the independent predictor for LV mass was visceral adipose tissue volume (beta=0.252, p0.05). CONCLUSION: Body fat distribution is associated with traditional cardiovascular risk factors. Especially, visceral adipose tissue is correlated with the components of metabolic syndrome and LV mass which is independent risk factor of cardiovascular morbidity and mortality.

A case of eosinophilic gastroenteritis with diffuse small bowel edema and ascites / 대한내과학회지

Eosinophilic gastroenteritis is an uncommon disorder of stomach, small bowel and colon characterized by peripheral blood eosinophilia, eosinophilic infiltration of the gut wall, and variable clinical symptoms. This disease was first described by Kaijser in 1937, and its cause was poorly understood. It may be related to allergy, which combines allergic rhinitis, allergic asthma, atopic dermatitis, food allergy and elevated IgE. The clinical symptoms and signs are variable according to the extents and depths of the eosinophilic infiltration. Endoscopic findings may show normal, nodular, ulcerative, or hemorrhagic mucosal changes, and biopsy findings reveal eosinophilic infiltration of mucosal and muscular layer. We diagnosed and treated a case of diffuse serosal eosinophilic gastroenteritis associated with ascites in a patient with allergic asthma who had severe abdominal pain, distention and watery diarrhea, and she dramatically responded to corticosteroid therapy.