Cases of extramedullary relapse after alloBMT in AML1/ETO positive AML / 대한내과학회지

The occurrence of granulocytic sarcoma as a pattern of relapse after allogenic bone marrow transplantation (allo-BMT) is rare. We report two AML1/ETO positive patients with granulocytic sarcoma as a pattern of relapse after allo-BMT. The first case is 39-year-old woman who had lower back pain without any abnormal peripheral blood exam. MRI showed a paraspinal mass, and the pathologic report was granulocytic sarcoma. The second case is 34-year-old woman who had breast humps without any abnormal peripheral blood exam. CT showed multiple breast masses, and the pathologic report was granulocytic sarcoma. We believe that this is the first cases report of extramedullary relapse after allo-BMT in AML1/ETO positive AML in Korea. These cases suggest that we should be aware of the possibility of an extramedullary relapse in bone marrow transplant recipients with AML1/ETO positive AML.

A Case of Gastric Cancer Presenting Acute Disseminated Intravascular Coagulation Palliated with Combination Chemotherapy of Irinotecan and Cisplatin

Acute disseminated intravascular coagulation (DIC) associated with gastric cancer is not common and has short survival of 1 to 3 weeks. Systemic chemotherapy in spite of hematologic unstability for gastric cancer may prolong survival time. A 47-year-old woman who complained of dyspnea, vaginal bleeding and easy bruisibility was diagnosed to stage IV gastric cancer with acute disseminated intravascular coagulation based on the laboratory data. She also had multiple bone metastases and bone marrow involvement. This is the first case treated with combination chemotherapy of irinotecan and cisplatin for advanced gastric cancer complicated by disseminated intravascular coagulation at the time of diagnosis. With systemic chemotherapy, some of the bleeding symptoms and the DIC process improved, even not completely recovered. However the patient died of disease progression and survival time was 12 weeks.

A Case of Paragonimiasis in the Abdominal Subcutaneous Tissue with Pleural Effusion / 결핵

A paragonimiasis infestation is caused by the paragonimus species. It is commonly found in the lung but has also been found to exist extrapulmonary infestations including cerebral, spinal, subcutaneous, hepatic, splenic, abdominal, urinary, and gynecologic infestation. On the other hand, a cutaneous infestation is extremely rare. Human infestation is caused by ingesting raw or undercooked intermediate hosts. Because paragonimus westermani larva mature to an adult worm in the lung, the possibility of identifying the adult worm of paragonimus westermani at extrapulmonary region is very rare. CASE: After ingesting a fresh-water crab 1 month prior to the hospital visit, a 45-year old female patient was suffering from right pleuritic chest pain during that 1 month. The patient also complained of a palpable mass that was movable and migrating, and it was localized at the right upper quadrant of the abdomen. The eosinophil fraction of the white blood cell of peripheral blood and pleural fluid was elevated to 55.1% and 90%, respectively. Parasite eggs were not found in her sputum and stool examination. By using the enzyme-linked immunosorbent assay (ELISA), the paragonimus-specific IgG antibody titer was elevated to 0.28. During incisional biopsy, we were able to find the young adult worm of paragonimus westermani. We experienced the rare case of ectopic paragonimiasis with pleural effusion that was confirmed by identifying the adult worm of paragonimus westermani within the abdominal subcutaneous tissue. We report a case with brief literature reviews.

Correlation of srum collagen type IV levels with histo-pathological findings assessed by liver biopsy in hepatitis B carrier with normal liver function test / 대한내과학회지

BACKGROUND: We compared the results of liver biopsy and the levels of serum type IV collagen of the hepatitis B carriers with normal liver function test (LFT) to evaluate the clinical usefulness of serum type IV collagen in predicting the progression of histopathological findings. METHODS : Thirty one chronic hepatitis B carriers with normal LFT and no significant clinical symptoms, who were Korean combat police, were classified into three groups according to their histologic results of the liver biopsies. The classification followed the standard proposed by Korean Society of Pathology. Blood samplings for serum type IVcollagen (reference : less than 5 ng/mL) were done in the morning of the same day of the liver biopsy. RESULTS: Of thirty one patients, thirteen patients showed normal histologic findings (41.9%, Group A), eleven patients revealed histologic abnormalities without fibrosis (35.5%, Group B) and seven patients were with fibrosis on liver biopsy (22.6%, Group C). Serum type IV collagen levels of Group A, B and C were 3.53 +/- .57 ng/mL, 3.56 +/- .17 ng/mL and 3.97 +/- .88 ng/mL, respectively. The average of serum type IV collagen levels of Group C was higher than of Group B and the average of Group B higher than that of Group A without any statistical significance (p > 0.05). The averages of serum type IV collagen of eighteen patients with histologic abnormalities (Group B and C) and twenty four patients without fibrosis (Group A and B) were 3.73 +/- 1.06 ng/mL and 3.55 +/- .88 ng/mL respectively. Upon comparison of these averages with the those of Group A and C, no statistical significance was established (p > 0.05). CONCLUSION : In chronic hepatitis B carriers with normal LFT findings, levels of serum type IV collagen were elevated along with histologic severities without statistical significance, therefore can not represent the changing degree of the histologic findings. Liver biopsy is considered to be one of the most accurate tool to assess the histologic status of the liver.

Acute renal failure and delayed neuropathy due to anti-freeze ingestion / 대한내과학회지

Antifreeze contains ethylene glycol up to ninty five percent. Ethylene glycol is colorless, odorless, sweet-tasting and water-soluble compound and has been widely used as a chemical solvent. Ethylene glycol has been reported as a common cause of incidental poisoning all over the world because of its easy access. However, in Korea, it is not easy to find statistical references on incidences of ethylene glycol intoxication, except two reported cases. Ethylene glycol itself is not toxic substance. But, many other daughter metabolites are very toxic and lethal. Acid metabolites among them can cause metabolic acidosis. Oxalate, end-product of ethylene glycol, is quickly transformed to calcium oxalate crystals, which precipitate in body tissues such as brain, kidney, heart, liver, and pancreas. We report a case of acute renal failure and neuropathy due to ethylene glycol intoxication along with a review of toxic effects of ethylene glycol.

An epidemiological and clinical study of leptospirosis acquired by twelves combat policemen in september, 2000 / 대한내과학회지

BACKGROUND: There were two occurrences of typhoon and the floods in Korea from early to late September, 2000. The Korean Combat Police and policemen participated in cleaning activities at the flooded area. Leptospirosis broke out among these participants. This study describes the epidemiological and clinical characteristics of leptospirosis patients among policemen. METHODS: Of 16,750 individuals involved, 3,752 subjected to passive hemagglutination antibody (PHA) test at the Regional Health Care Units or the National Police Hospital. With 1 case of dead plus 12 cases which were turned out to be seropositive by PHA test and confirmed by microagglutination (MA) test, epidemiological and clinical characteristics were studied by questionnaire survey, laboratory test, and history of treatment while being hospitalized. RESULTS: The seropositive rate of leptospira antibody was 0.3% (12/3,752). All 12 seropositives were bare-footed while working at the flooded area and of these, 8 patients (67%) were noticed abrasions either on hand or feet. However, no statistically significant correlation was found between the duration of outdoor activity and the seropositive rate (r=-0.46, p=0.36). There were clinical difference among patients who has the same serotype of leptospirosis, physical conditions, circumstance and the same work area. Two abnormal EKG results are present, the one who complained of chest pain is myocardial ischemia and the other who didn't complain of any symptoms is sinus pause. Correlation between the febrile period before and the duration of fever after the use of antibiotics was estimated as; febrile period after antibiotics use = 0.102804 + 0.995327 x febrile period before antibiotics use (p=0.058). CONCLUSION: When leptospirosis is related to group activities, it is possible to educate in advance and to manage systematically afterwards, it may prevent the occurrence of leptospirosis or the related complications.