A Case of Podostroma Cornu-Damae Intoxication Induced Pancytopenia and Skin Desquamation: Successful Treatment with Granulocyte Colony Stimulation Factor (G-CFS)

Podostroma cornu-damae is a rare species of fungus belonging to the Hyocreaceae family. Its fruit body is highly toxic, as it contains trichothecene mycotoxins. The morphology is similar to that of immature Ganoderma lucidum, making identification difficult for non-experts. We experienced such a case of a 56- year-old male who picked and consumed podostroma cornu-damae, and consumed. Later that day, he developed digestive system symptoms, including nausea, vomiting, and abdominal pain. He presented to the emergency room (ER), there were no abnormal physical findings, symptoms improved after gastric lavage, and the patient voluntarily discharged himself on the same day. The following day, as the symptoms gradually deteriorated, he was admitted via the ER. He was presented with severe pancytopenia, alopecia, desquamation of skin, and acute renal failure. He recovered without any complications after conservative care, antibiotics therapy, and granulocyte colony stimulating factor administration. The most commonly reported complications of podostroma cornu-damae intoxication were reported pancytopenia, infection, disseminated intravascular coagulation, acute renal failure, etc. since Prevention is especially important because its toxicity can be lethal and there is no particular treatment to date, prevention is especially important. Promotion and education for the public are needed.

Successful Removal of a Screw Nail in the Jejunum Using Double-Balloon Enteroscopy

The vast majority of foreign bodies (FBs) that enter the stomach pass through the gastrointestinal tract spontaneously. When the FB enters the small bowel-beyond the reach of conventional endoscopy-daily radiographs are needed to ensure its safe passage. However, endoscopic intervention is an appropriate management strategy for a sharp-pointed FB, because sharp FBs have a higher risk of intestinal perforation. We describe here a case in which a 1.5-cm, sharp-pointed screw nail in the proximal jejunum was removed successfully by double-balloon enteroscopy from a 19-year-old-male with autism. This case adds to the growing body of evidence demonstrating the value of therapeutic double-balloon enteroscopy in the field of FB ingestion

Airway Hyperresponsiveness to Hypertonic Saline as a Predictive Index of Exercise-Induced Bronchoconstriction

BACKGROUND: Changes in airway mucosal osmolarity are an underlying mechanism of bronchoconstrictive responses to exercise and hypertonic saline (HS). The purpose of this study was to examine whether an osmotic challenge test using HS can predict exercise-induced bronchospasm (EIB) in asthma patients. METHODS: Thirty-six young male asthmatic patients underwent bronchial challenge tests based on 4.5% HS, exercise (> 24h later), and methacholine (MCh) at the Chonnam National University Hospital. The relationships between responses to HS and exercise, and between MCh and exercise were evaluated. RESULTS: The maximal fall in forced expiratory volume in one second following exercise was significantly higher in the HS-responders (n=19) than in the HS-nonresponders (n=17, 35.9+/-4.1% vs. 17.9+/-2.7%, p< 0.001), and there was a significant correlation between the severity of EIB and HS-airway hyperresponsiveness (AHR). When compared with the MCh-AHR test in terms of predicting EIB, the HS-AHR test showed higher specificity (71.4% vs. 42.9%), but a lower sensitivity (58.6% vs. 89.7%) and negative predictive value (29.4% vs. 50.0%). At the moderate AHR cutoff value, the MCh-AHR test had a specificity that was comparable with and predictive values that were higher than those of the HS-AHR test. CONCLUSIONS: The HS-AHR test was more specific than the MCh-AHR test, but was less sensitive and had a poorer negative predictive value, which in combination preclude the use of the HS-AHR test as a screening tool for EIB. The MCh-AHR test had a cutoff value for moderate AHR that may be more useful for predicting EIB in asthmatic patients.

Usefulness of PIVKA-II for diagnosis and evaluation of recurrence of hepatocellular carcinoma / 대한내과학회지

BACKGROUND: Although alpha-fetoprotein (AFP) is most widely used tumor marker for hepatocellular carcinoma (HCC), the sensitivity is about 60~70% in advanced HCC. Furthermore, the specificity of AFP is relatively low. The aim of this study was to evaluate the usefulness of prothrombin-induced by vitamin K absence or antagonist-II (PIVKA-II) in diagnosis of HCC, and of recurrence after curative surgical resection. METHODS: Between April 2001 and March 2004, a total of 245 patients with pathologically confirmed HCC and a total of 267 patients with non-HCC, chronic liver diseases were enrolled. RESULTS: With cutoff-value 20 ng/mL for AFP and 40 mAU/mL for PIVKA-II, the sensitivity of AFP and PIVKA-II was 48.6% (119/245) and 75.1% (184/245), respectively. The specificity of them was 81.3% (217/267) and 94.8% (253/267), respectively. When AFP and PIVKA-II were combined, the sensitivity and specificity was 83.3% (204/245) and 77.2% (206/267), respectively. For HCC

Efficacy of Repeated Hepatic Arterial Infusion Chemotherapy in Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis / 대한간학회지

BACKGROUND/AIMS: The aim of this study is to elucidate the efficacy of repeated hepatic arterial infusion chemotherapy (HAIC) and different chemotherapeutic regimens for treating patients having advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). METHODS: From Jan. 1999 and Dec. 2003, a total of 103 patients diagnosed as having HCC with PVTT, but without extrahepatic spreading, were enrolled in this study. They were stratified into two groups. Group I (67 patients) received intraarterial cisplatin (CDDP, 80 mg/m2 for 2 hours on Day 1), Group II (36 patients) received intraarterial CDDP (60 mg/m2 for 2 hours on Day 2) and 5-fluorouracil (5-FU, 500 mg/m2 for 5 hours on Day 1-3). They were scheduled to receive at least three consecutive courses of the HAIC at 1 month intervals. RESULTS: Among the 66 patients who completed the protocol, one (2.5%) and seven (17.5%) patients of group I, and one (3.8%) and four (15.4%) of group II, exhibited complete and partial responses, respectively. The median survival period of all the patients was 6 months. Group II showed a tendency to improve the median survival compared to group I (8.5 vs 5.0 months, respectively, P=0.45). The most common adverse reaction was nausea (58.2%). However, an elevation of the total bilirubin level was more frequent in Group I than in Group II (61.3% vs 20.7%, respectively, P<0.05). CONCLUSIONS: Repeated HAIC using CDDP achieved favorable results in a few patients with HCC with PVTT, and additional 5-FU may be useful.

Reappraisal of HBV Genotypes and Clinical Significance in Koreans Using MALDI-TOF Mass Spectrometry / 대한간학회지

BACKGROUND/AIMS: Recent studies have shown that the genotype of hepatitis B virus (HBV) may correlate with the disease natural history and treatment outcome. However, several of these studies used low sensitivity assays in a small number of patients, and this has precluded an accurate evaluation of Korean HBV genotypes. We analyzed Korean HBV genotypes in a large population by employing a new technology, restriction fragment mass polymorphism (RFMP) using MALDI-TOF mass spectrometry, in a sensitive and specific manner. METHODS: Between February 1995 and December 2003, a total of 475 patients with chronic HBV infection were enrolled. The assay is based on the mass measurement of oligonucleotides having genotypic variations of the S gene. Clinical features including the virologic status and disease progression were also evaluated. RESULTS: The median age of the total patients was 35.5 years. Out of 475 patients, there were 162 (34.1%) inactive carriers, 172 (36.2%) had chronic hepatitis, 77 (16.2%) had liver cirrhosis and 64 (13.5%) had hepatocellular carcinoma (HCC). There were 454 patients (95.6%) with genotype C, 4 patients (0.8%) with genotype A, 16 patients (3.4%) with the mixed A and C genotype [7 patients (1.4%) with AA], and 1 patient (0.2%) with B genotype. Comparing genotype A and C, genotype A patients were all inactive carriers without HCC, whereas genotype C patients included those with chronic hepatitis, liver cirrhosis and HCC. CONCLUSIONS: HBV genotype C is highly prevalent in Korea. Although it is a small percentage, genotype A also exists and it seems to take a more benign clinical course than genotype C. Further studies are necessitated to assess the relationship between HBV genotypes and the various aspects of the diseases' clinical course.

Airway hyperresponsiveness to hypertonic saline as a predictive index of exercise-induced bronchoconstriction / 대한내과학회지

BACKGROUND: Altered airway mucosal osmolarity is an underlying mechanism of bronchoconstrictive response to both exercise and hypertonic saline (HS). The purpose of this study was to examine whether the osmotic challenge test using HS could predict the exercise-induced bronchospasm (EIB) in asthma. METHODS: Thirty-six consecutive young male patients with asthma visited Chonnam National Univertisy Hospital underwent bronchial challenge tests using 4.5% HS, exercise (>24 hours later), and methacholine (MCh). The relationship in the responses between HS and exercise was observed in comparison with that between MCh and exercise. RESULTS: The maximal fall in forced expiratory volume in one second following exercise was significantly higher in the HS-responders (n=19) than that in the HS-nonresponders (n=17)(35.9 +/- 4.1% vs. 17.9 +/- 2.7%, p<0.001). There was a significant correlation between the severity of EIB and HS-airway hyperresponsiveness (AHR). Compared with the MCh-AHR test in diagnosing for EIB, the HS-AHR test showed a higher specificity (71.4% vs. 42.9%), but a lower sensitivity (58.6% vs. 89.7%) and a lower negative predictive value (29.4% vs. 50.0%). At the cutoff value for moderate AHR, the MCh-AHR test had specificity comparable with and predictive values higher than those of the HS-AHR test. CONCLUSION: The HS-AHR test was more specific than the MCh-AHR test, but less sensitive and had poor negative predictive value precluding from use of it as a screening test for EIB. The MCh-AHR test at the cutoff value for moderate AHR may be more useful in predicting EIB in asthma.

Steroid-induced delirium in a patient with asthma: report of one case

Systemic steroids are highly effective for patients with moderate-to-severe asthma exacerbations. Steroid-induced psychosis is known to be one of the adverse effects of steroid therapy, although infrequent. However, there is no reliable method of predicting steroid psychosis. We experienced the case of a 40-year-old asthmatic man who had previously taken steroids without any psychological side effect, but became acutely delirious after receiving some doses of steroids, higher than the previous doses, under a condition of emotional stress. The mean dose of prednisolone administered was 82 mg/day (1.37 mg/kg/day) for 10 days but the patient had taken two courses of steroids (0.82 mg/kg/day and 0.5 mg/kg/day, respectively) for asthma exacerbations without any psychiatric episodes during the previous year.At this time, the patient was under a condition of emotional stress related to family reasons. The asthmatic exacerbation of this case may be precipitated from sudden emotional stress and the following treatment with a high dose of steroida should be used cautiously due to the possibility of psychotic side reactions.

A Case of Toxoplasmic Encephalitis in an Advanced AIDS Patient / 감염

Toxoplasmic encephalitis (TE) is the most common cause of opportunistic central nervous system infection in advanced acquired immunodeficiency syndrome (AIDS) patients. The incidence of TE has fallen markedly after the availability of highly active antiretroviral therapy and cotrimoxazole chemoprophylaxis. TE linked to AIDS is a rare entity in Korea, but we must consider TE in the differential diagnosis of the opportunistic infections in AIDS patients. We report a case of toxoplasmic encephalitis in an advanced AIDS patient presenting as progressive right facial palsy.