Three Cases of Ticlopidine-induced Cholestatic Hepatitis

Ticlopidine hydrochloride is world-wide used antiplatelet agent that inhibit ADP pathway. Its clinical side effects are the change of the blood picture, allergic skin reaction and gastrointestinal symptoms. We report three patients with severe cholestatic hepatitis caused by ticlopidine. They developed jaundice about 20days after taking ticlopidine (500 mg/day). Infectious and immunological etiologies were excluded by serology. There was no history of alcohol or drug abuse. Their symptoms were gradually subsided for a few months after discontinuing ticlopidine.

Value of Colonoscopy and Salmonella-Shigella Culture Using Biopsy Specimens and Intraluminal Fluid Obtained During Colonoscopy in Patients with Acute Diarrhea / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to investigate the value of colonoscopy for Salmonella-Shigella culture of biopsy specimen and intraluminal fluid during colonoscopy in patients with acute diarrhea. METHODS: From March 2001 to August 2001, sixty-six patients with watery or bloody diarrhea lasting less than 15 days were participated after exclusion of the patients with previous history or presumption of inflammatory bowel disease, radiation colitis, ischemic colitis, or pseudomembranous colitis. The biopsy specimen was taken and colonic luminal fluid was aspirated during colonoscopy for Salmonella-Shigella cultures. RESULTS: Male and female ratio was 1:1.3 and mean age was 45 17 years. The normal colonoscopic finding was showed in twelve cases (18.2%). The severity of acute colitis was mild in 25 cases (25/54, 46.3%), moderate in 9 cases (9/54, 16.7%), and severe in 20 cases (20/54, 37.0%). The extent of acute colitis was as followed: involvement of one segment in 9 cases (16.7%), involvement of two or more segments in 26 cases (48.1%), pancolitis in 7 cases (13.0%), and pancolitis with involved terminal ileum in 12 cases (22.2%). In culture study, identification of Salmonella species was in 11 cases (16.7%). Salmonella species were identified in 6.0% (3/50) with stool specimen, 18.0% (9/50) with biopsy specimen, and 4.0% (2/50) with intraluminal fluid, but without statistical significance. CONCLUSION: The culture using biopsy specimens and intraluminal fluid obtained during colonoscopy may be helpful in diagnosis of cases of suggesting Salmonella-Shigella infection.

Analysis of causative agents using biopsy specimens and intraluminal fluid obtained during colonoscopy in patients with acute diarrhea / 대한내과학회지

BACKGROUND: The aim of this study was to investigate the value of colonoscopy for assessment of colonic mucosal lesions and for microbial identification in patients with acute diarrhea. METHODS: From March 2000 to August 2000, forty-one patients with watery or bloody diarrhea lasting less than 15 days were participated after the exclusion of patients who had previous history or presumption of inflammatory bowel disease, radiation colitis, ischemic colitis, or pseudomembranous colitis. Both biopsy specimens and colonic luminal fluid were taken during the colonoscopy and used for bacterial cultures. RESULTS: Male and female ratio was 22:19 and mean age was 45+/-20 years. The extent of acute colitis was as followed: the normal colonoscopic finding in five cases (12.2%), involvement of one segment in 3 cases (7.3%), involvement of two or more segments in 14 cases (34.1%), pancolitis in 10 cases (24.4%) and pancolitis with terminal ileitis in 9 cases (22.0%). In culture study, identification of more than one pathogen was in 19/41 (46.3%) and the common pathogens were Enterobacter (11 cases), Salmonella species (6 cases), Citrobacter freundii complex (2 cases), Klebsiella oxytoca (2 cases) and Morganella morganii (1 case). Pathogen could be identified in 11.8% with stool specimen, 46.2% with biopsy specimen and 62.5% with intraluminal fluid, but without statistical significance. CONCLUSION: Colonoscopy was useful in the evaluation of extent and severity of acute infectious colitis. Obtaining the biopsy specimens and intraluminal fluid during colonoscopy seemed to assist in identifying the pathogen in patients with acute diarrhea.

Development of Systemic Lupus Erythematosus after Total Resection of a Thymoma for Myasthenia Gravis / 대한내과학회지

Systemic lupus erythematosus and myasthenia gravis are autoimmune disorders in which genetic, environmental and hormonal as well as immunological factors have been implicated. We experienced a case of 24 year-old female patient developed SLE(anemia, leukopenia, facial malar rash, high titers of anti-DNA and anti-nuclear antibody) 3 years following successful therapeutic thymectomy for myas thenia gravis. A review of the world-wide literature revealed 8.3% to 24.3% association between myasthenia gravis and SLE. However there has been no controlled epidemiological study to prove a real association between these two disease. The differential diagnosis of fatigue and fever in patient with SLE should always include the possibility of myasthenia gravis.

Clinical Investigation of 11 Cases of Chronic Eosinophilic Pneumonia Reported in Korea / 결핵

BACKGROUND: Chronic eosinophilic pneumonia(CEP) presents with profound systemic symptoms, including fever, malaise, night sweats, weight loss, and anorexia together with localized pulmonary manifestations such as cough, wheeze, and sputum. It is an illness occurring predominantly in women. The chest radiogragh shows fluffy opacities that often have a characteristic peripheral configuration. The hallmark of CEP is the peripheral blood eosinophilia and a prompt response to oral corticosteroid therapy. We investigated characteristics of eleven patients of chronic eosinophilic pneumonia, reported in Korea. METHOD: There were eleven reports of CEP from 1980 to 1996, including three cases experienced in our hospital. The journals were analysed in respects of clinical history, laboratory, and radiographic findings. RESULTS: 1) Male vs. female ratio is 3 : 8. The peak incidence occurred in forty and fifty decades. The atopic diseases were present in 6 cases. Asthma was the commonest manifestation. 2) The presenting symptoms were as follows: cough, dyspnea, sputum, weight loss, fever, general weakness, night sweats, urticaria with the descending incidence. 3) Peripheral blood eosinophilia was present in all patients(mean; 38.4%) and serum Ig E level was elevated in nine patients(mean; 880IU/ml). CONCLUSION: The diagnosis of chronic eosinophilic pneumonia is based on classic symptoms, including fever, night sweats, weight loss with a typical roentgenogram of peripheral pulmonary infiltrates and peripheral blood eosinophilia, and that is confimed by lung biopsy and/or bronchoalveolar lavage. Chronic eosinophilic pneumonia is responsive to corticosteroid promptly and recommended at least 6 months of therapy to prevent relapse.