A case of pemphigus vulgaris associated with ulcerative colitis

Pemphigus vulgaris is an autoimmune bullous disorder characterized by the production of autoantibodies against the intercellular space of the epithelium. It has rarely been reported in association with inflammatory bowel disease. Ulcerative colitis is one of the forms of inflammatory bowel disease. A 62-year-old woman who had been treated for ulcerative colitis for 16 years developed pruritic bullae on the skin of her face and body. Histological findings and direct immunofluorescence examination of the skin showed pemphigus vulgaris. She was treated with systemic steroids, mesalazine, and azathioprine. Her cutaneous lesions have remained in remission and her ulcerative colitis has remained well-controlled. The relationship between pemphigus vulgaris and ulcerative colitis is unclear. An autoimmune response has been suspected in the pathogenesis of ulcerative colitis. Pemphigus vulgaris is also associated with an autoimmune mechanism. To our knowledge, this is the first case of ulcerative colitis associated with pemphigus vulgaris reported in Korea. The association may be causal.

Ascending Colon Variceal Bleeding in Cirrhotic Patient with Emergent Endoscopic Variceal Obturation with N-butyl-2-cyanoacrylate / 대한소화기학회지

Ectopic varices are rare among patients with portal hypertension, especially in the ascending colon. It is difficult to evaluate massive lower gastrointestinal bleeding in patients with liver cirrhosis by colonoscopy due to hemodynamic instability and poor bowel preparation. In Korea, there has only been one case report about ascending colon variceal bleeding, in which hemostasis was performed by venous coil embolization. We report another rare case of ascending colon variceal bleeding in a patient with alcoholic cirrhosis, who was successfully treated via two sessions of N-butyl-2-cyanoacrylate injection through colonoscopy. This case suggests that the careful endoscopic approach and hemostasis with glue injection might be an option for treating massive bleeding in the lower gastrointestinal varix.

Usefulness of Plasma Procalcitonin to Predict Severity in Elderly Patients with Community-Acquired Pneumonia / 결핵및호흡기질환

BACKGROUND: Community-acquired pneumonia (CAP) is one of the leading causes of death among the elderly. Several studies have reported the clinical usefulness of serum procalcitonin, a biomarker of bacterial infection. However, the association between the levels of procalcitonin and the severity in the elderly with CAP has not yet been reported. The aim of this study was to evaluate usefulness of procalcitonin as a predictor of severity and mortality in the elderly with CAP. METHODS: This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010. Patients were divided into two groups (> or =65 years, n=99; <65 years, n=56) and were measured for procalcitonin, C-reactive protein (CRP), white blood cell, confusion, uremia, respiratory rate, blood pressure, 65 years or older (CURB-65) and pneumonia severity of index (PSI). RESULTS: The levels of procalcitonin were significantly correlated with the CURB-65, PSI in totals. Especially stronger correlation was observed between the levels of procalcitonin and CURB-65 in the elderly (procalcitonin and CURB-65, rho=0.408 with p<0.001; procalcitonin and PSI, rho=0.293 with p=0.003; procalcitonin and mortality, rho=0.229 with p=0.023). The correlation between the levels of CRP or WBC and CAP severity was low. The existing cut-off value of procalcitonin was correlated with mortality rate, however, it was not correlated with mortality within the elderly. CONCLUSION: The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP. However, there was no association between the levels of procalcitonin and mortality in the elderly.

A Case of Adrenal Cystic Pheochromocytoma with Contralateral Adrenocortical Adenoma Causing Subclinical Cushing's Syndrome

Bilateral adrenal neoplasms are associated with metastatic cancer, pheochromocytoma and lymphoma. The coexistence of a unilateral functioning adrenocortical adenoma with contralateral pheochromocytoma is extremely rare. A 52-year-old woman complained of fatigue, headache, palpitation, and progressive weight gain. Hormonal assessment demonstrated high 24 hours urine epinephrine, norepinephrine, and free cortisol. A dexamethasone suppression test (overnight 1 mg, low dose 2 mg) showed insuppressible cortisol. Computerized tomographic scanning revealed a bilateral adrenal tumor. To preserve adrenal function, right adrenalectomy along with left adrenal tumorectomy was performed. Histological finding of the right adrenal tumor was pheochromocytoma and the left adrenal tumor was adrenocortical adenoma. This patient was the first case of a functional adrenocortical adenoma with contralateral cystic pheochromocytoma in Korea. We report the case with a review of the literature.

A Case of F-18 FDG PET-CT Detection of Sporadic Medullary Thyroid Carcinoma and Cervical Lymph Node Metastasis of Ovarican Cancer / 고신대학교의과대학학술지

Medullary thyroid carcinoma (MTC) is derived from the parafollicular or C-cells. As surgical resection is the only curative therapy for MTC, the early diagnosis is important for the patient's survival. F18-Fluorodeoxyglucose positron emission tomography-computed tomography (F-18 FDG PET CT) is a noninvasive imaging method which can be used to diagnose malignant thyroid tumors including recurrent or residual MTC. However, due to the limitations of this technique, it is difficult to differentiate benign from malignant thyroid tumors. We herein present a 47-year-old woman with ovarian cancer history who was found to have thyroid incidentaloma with metastatic cervical lymph node through F-18 FDG PET CT. Thyroid incidentaloma of the patient was examined by fine needle aspiration and the result of this diagnostic procedure showed suspicious MTC. The patient was subsequently diagnosed as having sporadic medullary thyroid carcinoma and metastatic cervical lymph node due to ovarian cancer.

A Case of Immunoglobulin G4-Related Tubulointerstitial Nephritis with Extrarenal Involvement / 대한신장학회지

Immunoglobulin G4-related sclerosing disease is a novel clinicopathological disease entity known to involve various organs including the pancreas, bile ducts, gall bladder, retroperitoneum, kidney, salivary gland, lung and prostate. The most common organ involved is the pancreas and cases without pancreatic involvement are uncommon. Positive response to steroids is an important characteristic of this disease and this enables early diagnosis, which is required for good prognosis. We demonstrate a case of immunoglobulin G4-related tubulointerstitial nephritis in a 59-year-old male accompanied by sclerosing cholangitis and sialadenitis without any evidence of pancreatic infiltration. The patient was treated with prednisolone and was fully recovered in 6 months.

Robot-assisted Laparoscopic Partial Nephrectomy / 대한비뇨기과학회지

PURPOSE: Laparoscopic partial nephrectomy is a treatment option for small renal masses. However, such time-consuming techniques such as tumor excision, hemostasis and intracoporeal suturing are still challenging procedures even for experienced laparoscopists. Incorporation of a robotic system would facilitate tumor excision, hemostasis and intracoporeal suturing. Herein, we review our technique and the short term outcomes for robot-assisted laparoscopic partial nephrectomy(RLPN). MATERIALS AND METHODS: Eleven patients underwent RLPN for small renal masses. RLPN were performed with the da Vinci(R) robot system(Intuitive Surgical, Sunnyvale, USA) with three robot arms. In 7 cases, the renal hilum was clamped. Tumor excision and intracorporeal suturing were performed entirely with the robotic system. The specimen was extracted through the extended umbilical port incision. RESULTS: The mean tumor diameter was 2.5+/-1.5cm. The mean operative time was 179.5+/-49.4 minutes and the mean estimated blood loss was 354.5+/-440.7ml. The mean warm ischemia time was 30.4+/-5.9 minutes for 7 patients. There were no major complications. The surgical pathology showed clear cell type renal cell carcinoma in 7, papillary type renal cell carcinoma in 1, angiomyolipoma in 2 and lipoma in 1. There were no positive surgical margins. The mean hospital stay was 4.2+/-1.3 days. No recurrence had been observed after 3 to 18 months of follow-up. CONCLUSIONS: We were able to verify the feasibility and safety of using a RLPN in the management of small renal masses. Longer follow-up data and larger prospective studies are necessary to confirm these results.

Ipsilateral Testicular Catch-up Growth after Varicocelectomy in Adolescents / 대한비뇨기과학회지

PURPOSE: After adolescent varicocelectomy, there is a lack of standards for the follow-up and evaluation of the catch-up growth. We investigated the time to achieve catch-up growthaccording to the difference in testicular volume as compared to the contralateral testis. MATERIALS AND METHODS: From 1997 to 2004, 51 patients with at least a 1cc difference in testicular volume, as compared to the contralateral testis, and for whom the follow up was longer than 6 months were the subjects of this study. Testicular volume was measured using a Prader orchidometer and catch-up growth was defined as the equalization of testicular volume to the contralateral testis. The time to catch-up growth was investigated. RESULTS: 47 of 51 patients had a GIII varicocele and 4 had a GII varicocele. The mean difference in testicular volume was 2.9+/-1.8cc. Catch-up growth was noted in 33(64.7%) and the mean time to catch-up growth was 14.7 months. Catch-up growth occurred in 52.2%, 67.8 and 74.3% of the patients at 1, 2 and 3 years, respectively(the Kaplan-Meier). The time to catch-up growth was significantly shorter in those with a testicular volume difference of less than 3cc prior to operation(p=0.02, the log-rank test). There was no significant difference according to the age when surgery was performed(or=12 years, p>0.05, the log-rank test). CONCLUSIONS: Catch-up growth following varicocelectomy in adolescents can be expected in about 65% of patients and this occurs within 2 years for most patients. The preoperative testicular volume difference is associated with the speed of the catch-up growth. However, whether recovery of testicular volume means recovery of testicular function needs further study.

Discrepancy of Measured Renal Length between Ultrasonography and Dimercaptosuccinic Acid (DMSA) Scintigraphy / 대한비뇨기과학회지

PURPOSE: An inter-observer variability exists in the measurement of the renal length during ultrasonography, but dimercaptosuccinic acid (DMSA) scintigraphy allows greater objectivity. Thus, the aim of this study was to evaluate the discrepancy of the renal length measured using the two methods. MATERIALS AND METHODS: Between January 2003 and June 2005, 249 consecutive patients underwent DMSA scintigraphy and ultrasonography. Due to the exclusion of kidneys where a photon defect was observed during DMSA scintigraphy, the number of kidney enrolled in this study was 439. The renal length measurements in any plane were longest using ultrasonography. The renal lengths were measured using DMSA scintigraphy by assessing the maximum pixel length, which was then converted to centimeters. RESULTS: The mean renal lengths measured by DMSA scitigraphy and ultrasonography were 8.06+/-1.49 and 6.80+/-1.38cm, respectively. The mean difference in the renal length measured between the two methods was 1.26+/-0.84cm. The sonographic renal length was significantly shorter than that found via scintigraphy (Student's t-test, p<0.001). CONCLUSION: Our results were similar to those of previously reported studies, where the scintigraphic renal length exceeded that obtained sonographically. Due to the possibility of underestimating the renal length when using ultrasonography, clinicians must be cautious when following up pediatric patients using ultrasonography.

The Effect of Oral Prednisolone on Pseudo-tumor following Bacillus Calmette Guerin Intravesical Instillation / 대한비뇨기과학회지

Herein, the case of a patient where a pseudo-tumor on the bladder wall, with irritable bladder symptoms following a Bacillus Calmette Guerin (BCG) intravesical instillation, was treated by prednisolone administration is reported. A 40-year-old female underwent a transurethral resection for a bladder carcinoma, with subsequent BCG intravesical instillation. After the final BCG intravesical instillation, the patient presented with lower urinary tract symptoms. A mass on the lateral wall of the bladder, reported as a granuloma formation, was treated with oral prednisolone, after which the symptoms and cystoscopic finding were dramatically improved. Finally, all bladder lesions and irritable bladder symptoms disappeared.