Effect of Intravenous High-Dose Selenium Supplementation in Patients with Systemic Inflammatory Response Syndrome: A Pilot Study / 대한내과학회지

BACKGROUND/AIMS: Systemic inflammatory response syndrome (SIRS) can induce occurrence of oxidative stress. Several reports have evaluated selenium supplementation in SIRS patients with encouraging results. Therefore, we evaluated the effect of intravenous high-dose selenium supplementation in patients with SIRS. METHODS: Patients were randomly assigned to one of two groups: the selenium group (800 microg/day of selenoic acid by intravenous bolus injection for 7 days) or the placebo group. Physical and biochemical measurements were used to assay acute phase reactants, severity of illness index and serum selenium concentration. RESULTS: A total of 23 patients classified as mild-to-moderate severity of illness index were enrolled between March 2010 and October 2011. Serum selenium concentration increased in the selenium group after intervention, but there was no significant change in the placebo group. In the selenium group, the white blood cell (WBC) count, serum level of c-reactive protein (CRP), Acute Physiology and Chronic Health Evaluation II (APACHEII) score and Sequential Organ Failure Assessment (SOFA) score improved significantly by days 7 and 14 compared with day 0. In the placebo group, only the serum CRP level at day 14 and APACHE II score at days 7 and 14 improved significantly compared to day 0. CONCLUSIONS: Intravenous supplementation with high-dose selenium improved acute phase reactants and the severity of illness index in patients with SIRS. However, larger prospective clinical trials are required to determine the efficacy of selenium supplementation in SIRS patients.

Successful treatment of type I endoleak of common iliac artery with balloon expandable stent (Palmaz XL stent) during endovascular aneurysm repair / 대한외과학회지

Type 1 endoleak of common iliac artery (type Ib endoleak) should be treated during endovascular aneurysm repair (EVAR). An 86-year-old female was diagnosed with abdominal aortic aneurysm measuring 6.6 cm in diameter and right internal iliac artery aneurysm measuring 4.0 cm in diameter. She underwent EVAR after right internal iliac artery embolization. There was type Ib endoleak, which was repaired by balloon-expandable stent, Palmaz XL stent (Cordis). We report successful treatment of type Ib endoleak with Palmaz XL stent, which may be considered as an alternative option for type Ib endoleak after EVAR.

A Case of Acute Phlegmonous Gastritis Causing Gastroparesis and Cured with Medical Treatment Alone / 대한소화기학회지

Acute phlegmonous gastritis is an uncommon disease, often fatal condition characterized by suppurative bacterial infection of the gastric wall. It has a high mortality rate mainly because the diagnosis is usually made late. Until recently, gastrectomy in combination with antibiotics was recommended. We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. At upper gastrointestinal endoscopy, the gastric lumen was narrow, and the mucosa was severely inflamed, which was erythematous, swelled, and showed necrotic areas covered with purulent exudate. Klebsiella oxytoca and Acinetobacter lwoffii were isolated in the gastric tissue culture. Contrast-enhanced computerized tomography scan of abdomen demonstrated diffuse gastric wall thickening and an intramural abscess in the gastric antral wall. Although delayed gastric emptying by gastroparesis prolonged the in-hospital period, the only medical treatment with antibiotics alone successfully cured the patient without gastrectomy.

A Case of Multiple Organ Failure Complicating Hepatitis A Virus Superinfection in a Chronic Hepatitis B Patient / 대한내과학회지

Hepatitis A virus is a major cause of viral hepatitis worldwide. The prevalence of hepatitis A in young adults has recently been increasing in Korea. Hepatitis A infection rarely complicates fulminant hepatitis, acute pancreatitis, and acute renal failure. We experienced a case of multiple organ failure involving fulminant hepatitis, acute pancreatitis, and acute renal failure complicating a hepatitis A superinfection in a chronic hepatitis B patient. The patient was a 38 year old man who presented with febrile sense and myalgia. He was initially alert, but became confused and developed acute renal failure and acute pancreatitis. He received continuous renal replacement therapy and conservative treatment and completely recovered from the multiple organ failure. It is important to consider a variety of potential complications in hepatitis A patients, especially in those with underlying chronic liver disease.

Combination treatment with intrahepatic arterial infusion and intratumoral injection chemotherapy in patients with far-advanced hepatocellular carcinoma and arterioportal or arteriovenous shunts: preliminary results / 대한간학회지

BACKGROUND/AIMS: Combination treatment consisting of hepatic arterial infusion chemotherapy with epirubicin and cisplatin (HAIC-EC) and systemic infusion of low-dose 5-fluorouracil (5-FU) are sometimes effective against advanced hepatocellular carcinoma (HCC). However, there is no effective treatment for advanced HCCs with arterioportal shunts (APS) or arteriovenous shunts (AVS). METHODS: We investigated a response and adverse events of a new combination protocol of repeated HAIC-EC and percutaneous intratumoral injection chemotherapy with a mixture of recombinant interferon-gamma (IFN-gamma) and 5-FU (PIC-IF) in patients with far-advanced HCCs with large APSs or AVSs. RESULTS: There was a complete response (CR) for the large vascular shunts in all three patients and for all tumor burdens in two patients. Significant side effects were flu-like symptoms (grade 2) and bone marrow suppression (grade 2 or 3) after each cycle, but these were well-tolerated. CONCLUSIONS: These results suggest that the combination of HAIC-EC and PIC-IF is a new and promising approach for advanced HCC accompanied by a large APS or AVS.

A Case of Septic Pulmonary Embolism Associated with MRSA Infective Endocarditis / 결핵및호흡기질환

Septic pulmonary embolism is the process in which an infected thrombus becomes detached from its site of origin and lodges in a pulmonary artery, and is usually associated with infective endocarditis, especially right-sided, or infection-associated with indwelling catheters, peripheral septic thrombophlebitis, and periodontal diseases, etc. Here, we report a case of septic pulmonary embolism associated with tricuspid valve infective endocarditis. A 23-year-old female was admitted to our hospital, due to fever, sore throat, and myalgia. In her past medical history, she had undergone a surgical operation for closure of a ventricular septal defect, but was informed that the operation resulted in an incomplete closure. The initial chest radiograph demonstrated multiple rounded, parenchymal nodules in various sizes; several nodules had central lucency suggesting cavitations. Echocardiography demonstrated a large vegetation attached to the septal tricuspid valve leaflet, extending from right ventricular inflow tract to outflow tract. Computed tomography of thorax revealed bilateral peripheral nodules and wedge-shaped consolidation at various sizes, mostly accompanied by cavitations.

CMV Bronchiolopneumonia Presenting as a Cystic Lesion in the Lung / 대한흉부외과학회지

Cytomegalovirus (CMV) pneumonitis leading to inflammation and obstruction of the tracheobronchial tree may cause the cystic changes in the lung. We performed segmentectomy of lung under the diagnosis of congenital cystic lung disease in an infant of 2 weeks presenting severe respiratory failure. Histology and serology confirmed congenital CMV bronchiolopneumonitis.

The Comparison of VATS Ramicotomy and VATS Sympathicotomy for Treating Essential Hyperhidrosis

This study was undertaken to determine if better results could be achieved by comparing the results of a thoracic sympathetic ramicotomy (division of rami communicantes) with a conventional thoracic sympathicotomy (division of sympathetic trunk) for treating essential hyperhidrosis. From August 2001 to February 2002, 29 consecutive patients underwent surgery of the sympathetic nerves in order to treat severe essential hyperhidrosis. Of these patients, a ramicotomy was performed under VATS (VATS-R) in 13 patients, sympathicotomy under VATS (VATS-S) in 13, a unilateral ramicotomy and contralateral sympathicotomy under VATS (VATS-RS) in 2 and a sympathicotomy via a thoracotomy (T-S) in 1. There was no significant difference between the VATS ramicotomy group (VATS-R, n=13) and VATS sympathicotomy group (VATS-S, n=13) in terms of gender, pleural adhesions or comorbidities. However, the age of the VATS-S group at surgery was higher than that of the VATS-R group (p=0.050). The operation times, and hospital stays of the groups were 51.5 and 41.9 minutes, and 2.0 and 2.3 days, respectively. The recurrence rate of the operated sites according to the surgical methods (ramicotomy and sympathicotomy regardless of VATS) was 21.4% (6/28) in the ramicotomy group and 6.7% (2/30) in the sympathicotomy group, but there was no statistical significance (p=0.101). This study compared the dryness of the enervated sites and the severity of compensatory sweating among the ramicotomy (n=11, excluded 2 re-operated cases from 13 VATS-R), sympathicotomy (n=14, VATS-S 13 and T-S 1) and the synchronous or metachronous ramicotomy/sympathicotomy groups (n=4, included 2 reoperated cases of VATS-R). The sympathicotomy group had an over-dryness of the enervated sites (dryness 1.4, from 1 to 3; 1: over-dried, 2: humid, 3: persistent sweating) and complained of severe compensatory sweating (severity 3.5, from 1 to 4; 1: absent, 2: mild, 3: embarrassing, 4: disabling). However, the patients whounderwent a ramicotomy maintained some humidity of the enervated sites (dryness 2.0, p=0.012) and showed milder compensatory sweating (severity 2.7, p=0.056) than those in the sympathicotomy group. Furthermore, the dryness of the ramicotomy side was different from that of the sympathicotomy side in 3 out of 4 ramicotomy / sympathicotomy (R+S) patients (the side of the ramicotomy was humid and that of the sympathicotomy was over-dried). The average dryness and the compensatory sweating at these sites were in the midst of the two groups (dryness and severity 1.6 and 3.0, respectively). A ramicotomy can prevent over-dryness of the enervated area and decrease the severity of compensatory sweating through the selective division of the rami communicantes of the thoracic sympathetic ganglia. Postoperatively, almost all ramicotomy patients had no functional problems in daily life or in their occupational activity, because they could maintain hand humidity. Moreover, they showed no more than a mild degree of compensatory sweating and reported high long-term satisfaction rates. Therefore, a sympathetic ramicotomy rather than a conventional sympathicotomy is recommended as a more selective and physiologic modality for treating essential hyperhidrosis.

Evaluation of Integrated Lectures at Korea University, College of Medicine / 한국의학교육

With the class of 2000, the College of Medicine at Korea University instituted a revised curriculum. The new revision combined the traditional, and discipline-oriented, curriculums into a newly integrated curriculum. The purpose of this study is to identify the problems of the newly introduced integrated lectures, and how to find ways to improve this curriculum. Overloaded lecture hours and content, insufficient functional integration between disciplines, unstructured handout, deficiency in reference material and lack of motivation were identified as problems for students. Most of the participants urged a more effective collaboration between the faculty members of individual disciplines. Basic and clinical disciplines must be integrated as thoroughly as possible to improve and stabilize the new curriculum. Also, overall lecture time should be diminished, thereby allowing students to actively pursue their own learning.