Familial Mediterranean Fever With Complete Symptomatic Remission During Pregnancy

Familial Mediterranean fever (FMF) is an inherited autosomal recessive disorder, ethnically restricted and commonly found among populations surrounding the Mediterranean Sea. FMF is the most prevalent autoinflammatory disease; is characterized by recurrent, self-limited episodes of fever with serositis; and is caused by Mediterranean fever gene (MEFV) mutations on chromosome 16. We describe a case of adult-onset FMF with complete symptomatic remission during pregnancy, without the use of colchicine. A 25-year-old woman had presented with periodic fever, abdominal pain, and vomiting since she was 21. Her abdominal computed tomography scan showed intestinal nonrotation. She underwent exploratory laparotomy and appendectomy for her symptoms 1 year prior. She had a symptom-free pregnancy period, but abdominal pain and fever recurred after delivery. Mutation analysis of the MEFV gene revealed two point mutations (p.Leu110Pro and p.Glu148Gln). We report an adult female patient with FMF in Korea with complete symptomatic remission during pregnancy.

A Case of Acute Cholecystitis Caused by Stenotrophomonas maltophilia Bacteremia / 대한췌담도학회지

Stenotrophomonas maltophilia is an ubiquitous aerobic Gram-negative bacillus. Hospitalization and prior antibiotic therapy are risk factors for S. maltophilia infection. This organism is isolated with increasing frequency from hospitalized patients and may cause therapeutic problems because of its intrinsic resistance to common antibiotics and the immunodeficiency status of the affected host. S. maltophilia has been reported to be commonly associated with pneumonia and urinary tract infection. However, biliary infection caused by S. maltophilia is very rare. Herein, we report on a case of acute cholecystitis that developed secondary to S. maltophilia bacteremia in a patient with hepatitis-B related liver cirrhosis and gallbladder stone.

A Large Hemorrhagic Pseudocyst in Patient with Valproic Acid-Induced Severe Acute Pancreatitis: A Case Report / 대한췌담도학회지

The occurrence of valporic acid (VPA)-induced pancreatitis is a rare condition, predominantly observed in adolescent. Also, the occurrence of VPA-associated with hemorrhagic pseudocyst is extremely rare. We report the case of a 54-year-old man who had been taking VPA for uncontrolled seizures. He was admitted to our hospital with complaints of abdominal pain and diagnosed with acute on chronic pancreatitis. There were no other causes explaining pancreatitis, and it was thought to be due to VPA therapy. Despite of cessation of VPA, there was ongoing severe abdominal pain with fever. The patient underwent follow-up CT, which revealed a large loculated fluid collection that was observed with intra-cystic hemorrhage. After treatment with percutaneous catheter drainage, he was discharged with regression of the pancreatic pseudocyst. VPA-associated pancreatitis with hemorrhagic pseudocyst is rare but possible. Therefore, this possibility should be considered in the cause of hemorrhagic pseudocyst in a patient taking VPA.

Eosinophilic cholecystitis: A rare manifestation of hypereosinophilic syndrome

Eosinophilic cholecystitis (EC) is a rare form of acute cholecystitis, of which diagnosis is based on classical symptoms of cholecystitis with a presence of >90% eosinophilic infiltration within the gall bladder. EC rarely manifests in idiopathic hypereosinophilic syndrome (IHES). Here, we report two cases of EC with IHES. One is a 57-year-old male who presented with acute right upper quadrant (RUQ) pain, jaundice and fever. The initial peripheral blood eosinophil count was 2,070/mm3, and further elevated to 12,590/mm3. Acute acalculous cholecystitis with cholangitis was confirmed by computed tomography (CT). He improved with endocopic nasobiliary drainage and antibiotic therapy. The other is a 64-year-old female who presented with acute RUQ pain. She also complained of dyspnea and tingling sensation of both hands and feet. The initial peripheral blood eosinophil count was 10,400/mm3. Abdominal CT revealed findings suggestive of acute acalculous cholecystitis. She improved with systemic glucocorticosteroid therapy. No other causes of hypereosinophilia were found in either patients. Thus, cholecystectomy may not be mandatory for the treatment of EC with IHES.

An Elderly Man with Fatal Respiratory Failure after Eating a Poisonous Mushroom Podostroma cornu-damae / 결핵및호흡기질환

A 73-year-old, previously healthy man presented with nausea, vomiting, diarrhea, dry mouth and febrile sensation 3 hours after eating boiled wild mushrooms. After admission, he showed progressive severe respiratory distress, pancytopenia, azotemia, hypotension, hypoxemia and consolidation of the entire left lung on chest radiography. With a preliminary diagnosis of necrotizing pneumonia, he underwent left pneumonectomy in order to remove all necrotic lung tissue. Lung histology showed extensive hemorrhagic necrosis, massive inflammatory cell infiltration, prominent proliferation of young fibroblasts and the formation of an early-stage hyaline membrane along the alveolar wall. Despite aggressive treatment, including mechanical ventilation, continuous renal replacement therapy and administration of granulocyte colony stimulating factor and broad spectrum antibiotics, he died on hospitalization day 13. Subsequently, the mushroom was identified as Podostroma cornu-damae. This is the first case of a histological evidence of lung involvement by Podostroma cornu-damae poisoning in Korea.

Elementary, Middle and High School Teachers' Opinions of School Foodservice Programs

This study investigated elementary, middle, and high school teachers' satisfaction, nutrition education, workload changes, and demands in school foodservice programs (SFPs). The subjects were 630 teachers at 12 elementary, 9 middle, and 9 high school within the nation. Ninety five percent of the teachers felt that there was a necessity for SFPs. Middle school teachers (MTs) and high school teachers (HTs) thought that it was necessary in order to reduce the students'burden of carrying lunch boxes. The teachers were relatively satisfied with their school's foodservice management types, food distribution types, meal quality, and sanitation. Elementary teachers (ETs) and HTs had a higher satisfaction than MTs. Teachers thought that SFPs had positive effects on their students' nutrition and health, enhancing desirable eating habits, and socialization. ETs had more positive opinions than MTs or HTs. ETs and MTs thought that their workload had been increased by SFPs more than HTs, but they had relatively positive opinions on the workload change. ETs taught nutrition and health through SFPs more frequently than MTs or HTs. Many teachers thought that there was a lack of appropriate teaching materials. Some teachers thought that the problems in the present SFPs were: a lack of cafeteria facilities, poor quality of meals, and management of leftovers. Their demands for SFPs were a improvement of meal quality and the establishment of cafeterias. In conclusion, MTs had more negative opinions than ETs or HTs. ETs perceived that SFPs had a function as an important educational activity as well as the supply of nutritional meals. MTs or HTs tended to consider only a meal. It is suggested that teachers, especially MTs and HTs, should modify their attitudes and recognize the educational functions of SFPs. Training programs should be developed under government auspices.

Comparisons of Student Satisfaction with the School Food Service Programs in Middle and High Schools by Food Service Management Types

This study on satisfaction with school food service (FS) programs was conducted with 485 middle school students and 515 high school students based on FS management type. There were four types of FS management: independent-conventional (IC), independent-commissary (ICM), contract-conventional (CC), and contract-delivery (CD). About seventy percent of the students expressed satisfaction with the food quantity of the school lunches. But one third of the students, who felt the quantity was insufficient, cited the small size of the rice serving. Many high school students cited the small size of the side dishes as well as the rice serving. It is suggested that the meal quantity should be determined in consideration of the students' physical development. The satisfaction with FS sanitation was lower than that with the meal quality, eating environment, and environment of dining room with respect to all four types of FS management, and was lowest in the CD. It is suggested that FS sanitation should be managed more thoroughly for the students' safety, and that the school FS Committee should carefully monitor the sanitary management of the contract FS companies by means of a well-designed and monitored management system. Most of middle and high school students expected good taste and a diversity of foods in their school lunches. Food taste should be improved, and various food materials and cooking methods should be used for balanced nutrition and greater student satisfaction, particularly in contract FS types (CC and CD).