Predictors of Mortality in Korean Patients with Pyogenic Liver Abscess: A Single Center, Retrospective Study / 대한소화기학회지

BACKGROUND/AIMS: The mortality rate of pyogenic liver abscess (PLA) has decreased dramatically, but it remains a potentially life threatening disease. Most cases are cryptogenic or occur in elderly men with underlying biliary tract disease. Although several studies have addressed the characteristics and etiology of PLA, research on factors affecting PLA-associated mortality is lacking. This study intended to identify the clinical and radiological features, pathogens, complications, and predictors of mortality in Korean PLA patients. METHODS: The medical records of 231 PLA patients diagnosed at Yeungnam University Medical Center between January 2010 and January 2014 were analyzed. A diagnosis of PLA was made based on imaging studies and blood and abscess cultures. The clinical, radiological, and laboratory findings of patients were analyzed. RESULTS: The mean patient age was 64.0±12.9 years and the male to female ratio was 1.5:1. Klebsiella pneumoniae was the predominant organism isolated from hepatic abscesses (69.9%) and blood (74.2%). The most common complication was pleural effusion (35.8%) and most common co-infection was cholangitis (8.2%). The overall mortality rate of PLA was 6.9% (16/231), and was significantly higher in patients with a history of liver abscess (OR 5.970, 95% CI 1.207-29.529; p=0.028), bilirubinemia (>2 mg/dL) (OR 9.541, 95% CI 2.382-38.216; p=0.001), thrombocytopenia (<140×10(3)/µL) (OR 4.396, 95% CI 1.130-17.106; p=0.033), or anemia (<12 g/dL) (OR 13.277, 95% CI 1.476-119.423; p=0.021). CONCLUSIONS: The prognosis of PLA appears to be dependent on underlying pathologies and severity of condition. More aggressive treatment should be considered if a poor prognosis is expected.

Paratesticular Alveolar Rhabdomyosarcoma with Multiple Lymph Nodes Metastasis Successfully Treated with Chemotherapy / 영남의대학술지

Rhabdomyosarcomas are soft tissue sarcomas; while extremely rare in adults, they are one of the most common neoplasms in children and adolescents. Histologically, they can be classified into embryonal(ERMS), alveolar(ARMS), pleomorphic, and undifferentiated types. The ARMS type is very rare, and is associated with a poor prognosis. Common primary sites of ARMS are the trunk and extremities. We report on a case of paraaortic, supraclavicular, and axillary lymph node metastasis from paratesticular ARMS treated with VAC(vincristine, dactinomycin, cyclophosphamide)/ IE(ifosfamide, etoposide) chemotherapy in a young adult. Administration of six cycles of chemotherapy with VAC/ IE resulted in complete remission. The patient has maintained complete remission over the past 27 months.

Treatment of Hemangiopericytoma-Associated Hypoglycemia with Glucocorticoid Therapy / 영남의대학술지

Non-islet cell tumor-induced hypoglycemia (NICTH) is associated with mesenchymal tumor types, including hemangiopericytoma, fibrosarcoma, mesothelioma, and neurofibroma, as well as carcinoma of the liver, adrenal glands, and kidneys. Non-islet cell tumors induce hypoglycemia by overproducing an abnormal form of insulin-like growth factor II (IGF II). Complete removal of the tumor or reduction of the tumor mass is a successful therapeutic strategy in cases of NICTH. However, if the tumor re-grows, curative resection is nearly impossible, and hypoglycemia occurs repeatedly. Glucocorticoids are effective in terms of long-term relief from hypoglycemia through promotion of gluconeogenesis in the liver, tumor suppression, production of 'big'-IGF-II, and correction of the attendant biochemical abnormalities involving the growth hormone (GH)-IGF axis. We found that administration of corticosteroid therapy to a patient suffering from NICTH resulted in improvement of hypoglycemia associated symptoms.

Comparative Study on the Infection Rates of Protected Environment versus Non-Protected Environment in Acute Myeloid Leukemia during Remission Induction Chemotherapy / 영남의대학술지

BACKGROUND AND PURPOSE: Patients with acute leukemia experience prolonged periods of neutropenia due to their disease or its treatment. For this reason, they often develop serious infectious complications. Although antibiotic therapy has improved in recent years, the fatality rate from infection remains high. For the control of infection, protected environment was developed. But because of economic issue, most of chemotherapy with acute myeloid leukemia have conducted in non-protected environment. So this study compared the rate of complete remission, days with neutropenia, rate of fever, rate of positive culture, rate of overt infection and use of antibacterial and antifungal agents with patients within non-protected environment and protected environment, retrospectively. Patients with acute myeloid leukemia during first remission induction chemotherapy were eligible for this study. METHODS: Retrospective analysis was conducted between patients in non-protected (25 patients) and protected environment (14 patients) with acute myeloid leukemia during remission induction chemotherapy. RESULTS: Rate of overt infection, rate of fever, rate of positive culture and rate of use of antibiotics were significantly high in patients within non-protected environment compared with patients within protected environment. There were no differences in rate of complete remission and days of neutropenia. CONCLUSIONS: This study suggests protected environment for patients with acute myeloid leukemia during remission induction chemotherapy could reduce rate of overt infection, and rate of use of antibiotics.

A Case of Functionary Cystic Parathyroid Adenoma with Papillary Thyroid Carcinoma / 영남의대학술지

Cystic parathyroid adenoma is one of rare causes of hyperparathyroidism, and tends to cause increased serum level of parathyroid hormone, alkaline phosphate and serum calcium level similar to when compared to those of solid adenoma.

A case of posttransplantation lymphoproliferative disorder in hematopoietic stem cell transplantation / 대한내과학회지

Posttransplantation lymphoproliferative disorder (PTLD) is a potentially fatal complication of hematopoietic stem cell transplantation (HPSCT) that occurs relatively early after the transplantation. The occurrence of PTLD is usually associated with Epstein-Barr virus (EBV) infection in patients who are treated by aggressive immunosuppressive therapy. PTLD presents as diverse manifestations, ranging from reactive lymphoid hyperplasia to high grade malignant lymphoma. In the present work, we describe a case of PTLD that was successfully treated with R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone) chemotherapy in a 21-year-old female who received HLA-matched sibling HPSCT for severe aplastic anemia. At 120 days after transplantation, she had symptoms of dysphagia and a foreign body sensation in the throat and was diagnosed as PTLD, diffuse large B cell lymphoma involving a tonsil, cervical lymph nodes, an adrenal gland, and the liver. Three courses of R-CHOP resulted in complete remission.

A case of posttransplantation lymphoproliferative disorder in hematopoietic stem cell transplantation / 대한내과학회지

Posttransplantation lymphoproliferative disorder (PTLD) is a potentially fatal complication of hematopoietic stem cell transplantation (HPSCT) that occurs relatively early after the transplantation. The occurrence of PTLD is usually associated with Epstein-Barr virus (EBV) infection in patients who are treated by aggressive immunosuppressive therapy. PTLD presents as diverse manifestations, ranging from reactive lymphoid hyperplasia to high grade malignant lymphoma. In the present work, we describe a case of PTLD that was successfully treated with R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone) chemotherapy in a 21-year-old female who received HLA-matched sibling HPSCT for severe aplastic anemia. At 120 days after transplantation, she had symptoms of dysphagia and a foreign body sensation in the throat and was diagnosed as PTLD, diffuse large B cell lymphoma involving a tonsil, cervical lymph nodes, an adrenal gland, and the liver. Three courses of R-CHOP resulted in complete remission.

A Case of Spine Origin Chondroblastoma Metastasis to Lung / Journal of the Korean Cancer Association, 대한암학회지

Chondroblastoma is a rare benign cartilaginous neoplasm that accounts for approximately 1% of all bone tumors and characteristically arises in the epiphysis of a long bone, particularly the humerus, tibia, and femur. Chondroblastoma can affect people of all ages. It is, however, most common in children and young adults between the ages of 10 and 20 years. Although most chondroblastomas are cured by limited surgical procedures, occasional lesions behave more aggressively and may even metastasis. In this case a young man with pulmonary metastatic chondroblastoma on spine is presented. Unlike previously published examples of metastatic chondroblastoma, these metastasis developed before any operative manipulation of the primary tumor. And primary tumor site was also unusual. The histologic characteristics of the primary, metastatic tumors were those of a conventional chondroblastoma.

Inpatient consultations by the hematology department over a 1-year period / 대한내과학회지

BACKGROUND/AIMS: Although inpatient hematology consultations have recently increased, the reasons for consultation, as well as the impact of inpatient hematologic consultations, are not clear. Therefore, we assessed patient profiles, the reasons for hematology consultations, and diagnoses at our hospital. METHODS: We evaluated 177 consecutive patients with hematology problems seen between March 2004 and February 2005. For each, we assessed the reason for the consultation, patient diagnosis, and outcome. RESULTS: Of 28,854 inpatients in our hospital, 177 (0.6%) required consultations for hematology problems. Of these 177 inpatients, 85 (48%) were male and 92 (52%) were female; their median age was 55 years (range 16-85 years), with the most frequent age group being patients 61-70 years old. Hematology consultations were requested by the neurosurgery (25%), general surgery (11%), internal medicine (10%), neurology (10%), and orthopedics (9%) departments. The most common reasons for consultation were anemia (29%), thrombocytopenia (21%), pancytopenia/bicytopenia (16%), coagulation abnormalities (14%), and thrombocytosis (5%). In one-third of these consultations, the hematologic abnormality was detected after admission and most were resolved successfully. The most common cause of anemia was iron deficiency (43%). Drug-induced thrombocytopenia and pancytopenia were also common (20%), and were thought to be due to anticonvulsants and antibiotics. Bone marrow examination was required in 19 patients (11%). Careful examination detected bleeding of the gastrointestinal tract, or liver or hematologic diseases, such as chronic myeloproliferative disorders, in some of these patients. CONCLUSIONS: Although it provides a small cross-sectional survey of the types of patient and problems seen by hematologists during in-patient consultations, this information may help to improve patient care and the quality of hematology consultations.