A Case of an Adrenocortical Carcinoma with Pulmonary Embolism as the Initial Manifestation

The annual incidence of a first episode of deep vein thrombosis or pulmonary embolism (PE) in the general population is 120 per 100,000. Cancer is associated with an approximately 4- to 7-fold higher risk of thrombosis. Adrenocortical carcinoma (ACC) is a rare type of malignancy, accounting for 0.02% of all cancers reported annually. Approximately 40% of ACCs are nonsecretory. Most patients with nonsecreting tumors have clinical manifestations related to tumor growth (e.g., abdominal or flank pain). Often the adrenal mass is detected by chance via radiographic imaging. As a result, most ACC patients are diagnosed at an advanced stage and have a poor prognosis. Herein, we report a case of a 54-year-old woman who was admitted to our emergency department complaining of dyspnea. She was diagnosed with ACC accompanied by thrombi in the pulmonary artery and inferior vena cava. We performed a left adrenalectomy and administered adjuvant radiotherapy. The patient is currently receiving warfarin and adjuvant mitotane therapy. She was incidentally diagnosed with ACC, with PE as the initial manifestation.

No title available in English / 대한내분비외과학회지

No abstract available.

Results of Surgical Correction in Patients with Vesicoureteral Reflux after Kidney Transplantation / 대한이식학회지

PURPOSE: The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation has been varies among authors. While these results suggested that VUR can be a source of repeated infections, which might be a prognostic factor impairing long-term graft function. We evaluated the prevalence, clinical manifestations and diagnostic methods of VUR after living donor kidney transplantation and their proper management with the results of each treatment. METHODS: We reviewed thirty-four patients among five hundreds and thirteen living donor kidney transplant recipients, who developed VUR after the transplantations at our center from June 1998 to June 2003. Twenty-three patients underwent a corrective surgical procedure, ureteroneocystostomy, and we excluded 3 patients who underwent the procedure less than 1 year. The patients were divided into three groups: those with severe VUR underwent a corrective surgical procedure with more than 1 year follow-up (group I, n=20), those with mild VUR underwent a conservative management (group II, n=8) and control group of patients without VUR (group III, n=20). The incidence of urinary tract infection (UTI) and graft function were assessed for 1~7 years. Voiding cystoureterography (VCUG) was performed in patients with recurrent urinary tract infections and reflux was classified from Grade I to Grade IV. RESULTS: We examined immunological and non-immunological risk factors such as age, sex, primary diseases, duration on dialysis, diuresis prior to the treatment, donor selection, the degree of HLA mismatches, cold ischemia time, the incidence of acute rejection. There was no significant demographic difference among study groups except sex (female). Analysis of patients and grafts survival rates revealed no statistical differences among three groups. CONCLUSION: VUR dose not seem to negatively affect graft function if surgical correction were performed in proper period after the diagnosis. The indication of surgical correction of VUR is clinically significant UTIs, UTI sepsis, Grade III or IV VUR. Close attention, proper diagnosis and prompt surgical correction are necessary to minimize the adverse influence of VUR after kidney transplantation.