Metastatic endophthalmitis and thyroid abscess complicating Klebsiella pneumoniae liver abscess

The thyroid is resistant to infection due to its anatomical and physiological characteristics. We present a rare case of invasive liver abscess with metastatic thyroid abscess and endogenous endophthalmitis in a previously healthy 55-year-old female patient without diabetes or other medical illness. This report raises an important question of the virulence of Klebsiella pneumoniae as an increasingly common causative agent of liver abscess.

Amebic liver abscesses resulting in diagnosis of human immunodeficiency virus infection / 영남의대학술지

Amebic liver abscess (ALA) is the most common extraintestinal manifestation of amebiasis. Amebiasis, a parasitic infection caused by Entamoeba histolytica, used to be a prevalent protozoan disease in Korea, however, with an improving sanitary system, it has been among very uncommon etiology of liver abscess. A recent report suggested that ALA is an emerging parasitic infection in human immunodeficiency virus (HIV)-infected patients even in areas where the disease is not endemic and recommended HIV screening in patients in areas where ALA is not endemic, particularly those without history of travel to a disease-endemic area. We report on two patients who were admitted for treatment of ALA and then diagnosed as HIV infection. We also reviewed the etiology and characteristics of ALA in our hospital during the last 5 years.

Amebic liver abscesses resulting in diagnosis of human immunodeficiency virus infection / 영남의대학술지

Amebic liver abscess (ALA) is the most common extraintestinal manifestation of amebiasis. Amebiasis, a parasitic infection caused by Entamoeba histolytica, used to be a prevalent protozoan disease in Korea, however, with an improving sanitary system, it has been among very uncommon etiology of liver abscess. A recent report suggested that ALA is an emerging parasitic infection in human immunodeficiency virus (HIV)-infected patients even in areas where the disease is not endemic and recommended HIV screening in patients in areas where ALA is not endemic, particularly those without history of travel to a disease-endemic area. We report on two patients who were admitted for treatment of ALA and then diagnosed as HIV infection. We also reviewed the etiology and characteristics of ALA in our hospital during the last 5 years.

Clinical features of Bednar's aphthae in infants / 소아과

PURPOSE: Although Bednar's aphthae are common and regress spontaneously, these lesions may lead to feeding intolerance and are often misdiagnosed, rendering examinations useless. This study sheds new light on the clinical features of Bednar's aphthae. METHODS: Sixteen neonates and infants were newly diagnosed with Bednar's aphthae via routine health check-ups in an outpatient clinic. Medical records were retrospectively reviewed, and the following parameters were analyzed; sex, gestational age, birth weight, mode of delivery, and perinatal problems. A physical examination was carried out during the next outpatient visit to examine the healing process and check for the existence of scars or complications. RESULTS: Initial presentation included changes in feeding habits (n=10), longer feeding time, reduced intake, and increased irritability. In 6 patients, Bednar's aphthae were discovered incidentally, without prior symptoms. Feeding posture and method of feeding are important causes of Bednar's aphthae. Eleven patients were fed in a horizontal position, whereas 5 patients were fed in a semiseated position. Fifteen patients were bottle-fed, whereas 1 patient was exclusively breastfed. After correcting the feeding position, the ulcerative lesions disappeared within 1 month of diagnosis. During the follow-up period, lesions did not recur in any of the patients. CONCLUSION: This study suggests that Bednar's aphthae are caused by mechanical pressure. A diagnosis of Bednar's aphthae should be considered when lesions are found on the palate of infants and when symptoms seem to be feeding related. Proper education of parents can both treat Bednar's aphthae and easily prevent its recurrence.

A Case of Isolated Leptomeningeal Carcinomatosis from Advanced Gastric Cancer / 대한소화기학회지

Leptomeningeal carcinomatosis (LMC) is rare metastatic form of gastric cancer. Most cases are diagnosed in the final stage after multiple distant metastasis. An 84-year-old woman was admitted with melena, headache and vomiting. Esophagogastro-duodenoscopy showed an ulceroinfiltrating lesion at the stomach (Borrmann class III), and biopsy revealed a signet ring cell carcinoma. The abdominal-pelvic CT showed no evidence of metastasis. A sudden decrease of consciousness was noted, but the brain CT showed no active lesion while the brain MRI revealed enhancement of leptomeninges. A lumbar puncture was performed and the cerebrospinal fluid study revealed malignant neoplastic cells. With family consent, no further evaluation and treatment were administered and she died six weeks after the diagnosis of gastric cancer. We report an extremely rare case of a patient who initially presented with neurologic symptoms, and was diagnosed LMC from advanced gastric cancer without any evidence of metastasis in abdomen and pelvis.

Acute Pancreatitis Induced by Quetiapine in an Elderly Patient

Quetiapine is an atypical antipsychotic that is frequently used to manage delirium in geriatric patients. Acute pancreatitis associated with quetiapine has rarely been reported. A 70-year-old male presented with severe abdominal pain a few hours after taking a dose of quetiapine prescribed for delirium. Despite the lack of risk factors of pancreatitis in his medical history, the patient had a slight increase of serum lipase and amylase levels. His general condition improved on discontinuation of quetiapine. A month later, quetiapine was readministered for the recurrence of delirium. Subsequently, the patient developed the same symptom with a significant increase in serum pancreatic enzyme levels, confirming that quetiapine induced the pancreatitis. We reported the first case of quetiapine-induced pancreatitis in Korea, together with a review of the literature.

Unusual Presentation of Calcinosis Cutis: Venous Calcification Following intravenous Calcium Gluconate Administration in a Preterm Baby

Neonatal hypocalcemia is not uncommon, especially in premature neonates. It is usually treated by intravenous calcium gluconate administration. However, complications caused by the extravasation of intravenous calcium gluconate include calcinosis cutis, calcium deposition in the dermis, which is irritating to soft tissues and can produce tissue necrosis. We report a case of iatrogenic calcinosis cutis in a 27-day-old preterm baby following the extravasation of calcium gluconate. In this case, calcinosis cutis occurred along the venous pathway in a rare vascular calcification pattern but spontaneously resolved 2 months later. Although iatrogenic calcinosis cutis is generally benign, early recognition of the extravasation of calcium gluconate is important to avoid severe complications. This report aimed to provide a warning about the risks associated with intravenous calcium gluconate and information about the course of a rare presentation of the common disease calcinosis cutis with vascular calcification.

The Incidence of Birthmarks in Korean Newborn Infants

PURPOSE: Birthmarks are commonly observed during neonatal period and its prevalence varies between races and countries. Most skin lesions are transient and not require medical treatment. But some birthmarks have potential medical significance and may be the first sign of systemic medical problems. We carried out a prospective study to determine the prevalence of birthmarks in Korean newborn infants. METHODS: From October 2012 to January 2013, 1,964 Korean newborn infants who were born in Cheil General Hospital, Kwandong University College of Medicine were evaluated for the presence of birthmarks within 48 hours after birth. RESULTS: Among 1,964 newborn infants, 980 (49.9%) infants were male and 984 (50.1%) were female. The most common pigmentary birthmark was Mongolian spot (97.1%), which was mostly presented on sacrogluteal area, and was followed by nevocellular nevi (0.8%), cafe-au-lait spot (0.8%), and sebaceous nevi (0.2%). Among vascular birthmarks, the most common lesion was salmon patch (30.8%), and followed by port-wine stain (0.2%) and hemangioma (0.2%). The common other lesions were sebaceous hyperplasia (37.4%), erythema toxicum neonatorum (10.2%), milia (4.1%), skin appendage (2.6%), anal dimple (1.2%), auricular pit (0.9%), miliaria (0.5%), aplasia cutis congenita (0.2%) in the order of frequency. CONCLUSION: We studied the prevalence of the birthmarks in Korean newborn infants. The most common pigmentary birth mark was mongolian spot, and the most common vascular birthmark was salmon patch in Korean newborn infants.

A Case of Pai Syndrome: First Reported Case in Korea / 대한주산의학회잡지

Pai syndrome is a rare disorder, first described in 1987. Diagnostic criteria are the presence of the nasal polyp and one of the following: midline cleft lip, congenital polyp of mid-anterior alveolar process, and pericallosal lipoma. Thirty-six cases of Pai syndrome have been described so far. We report 1 case of Pai syndrome accompanied by congenital nasal polyp and callosal lipoma with partial agenesis of corpus callosum, the first time in Korea.

Paroxysmal Supraventricular Tachycardia at 1-Month Age and Transient Thyroid Dysfunction in a Preterm Baby Treated for Fetal Tachycardia with Amiodarone / 대한주산의학회잡지

Fetal tachycardia is mostly benign, but sometimes results in serious consequences such as fetal hydrops and fetal death. To decrease cardiovascular burden, fetuses could be treated with transplacental administration of antiarrhythmic drugs such as digoxin, amiodarone. Although amiodarone has been proven to be effective against fetal tachycardia, it is also known to cause transient neonatal thyroid dysfunction and neurodevelopmental delay in some patients. Nonetheless, there has been only few postnatal follow-up studies with the patients who were diagnosed and treated for fetal tachycardia although majority of postnatal arrhythmias occurred within the first 48 hours of life in a recent report. We report a newborn with transient thyroid dysfunction and late-onset supraventricular tachycardia at 1 month age, who had fetal tachycardia treated with amiodarone at the 25th week of pregnancy.

A Fatal Case of Pulmonary Embolism after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma / 대한내과학회지

Transcatheter arterial chemoembolization (TACE) is one of the most common palliative treatment modalities for patients with advanced hepatocellular carcinoma (HCC). TACE is an invasive procedure associated with several potential complications of varying severity. A pulmonary embolism after TACE for HCC is a rare complication. We report a case of pulmonary Lipiodol embolism after a third TACE resulting in death.

A Case of Cytomegalovirus Enterocolitis and Jejunal Perforation During Immune Reconstitution with Highly Active Antiretroviral Treatment / 감염과화학요법

Immune reconstitution syndrome (IRS) in HIV-infected patients is an adverse consequence of the restoration of pathogen-specific immune responses during the initial months of highly active antiretroviral treatment(HAART). Previously subclinical infections are unmasked or pre-existing opportunistic infections clinically deteriorate as host immunopathological inflammatory responses are switched on. While the eye is the area where Cytomegalovirus(CMV)-associated IRS occurs most often in patients with AIDS, it also can present with intestinal or pulmonary involvement. We present a case report of an HIV-infected patient in whom CMV enterocolitis and jejunal perforation developed after HAART.

A Case of Cytomegalovirus Enterocolitis and Jejunal Perforation During Immune Reconstitution with Highly Active Antiretroviral Treatment / 감염과화학요법

Immune reconstitution syndrome (IRS) in HIV-infected patients is an adverse consequence of the restoration of pathogen-specific immune responses during the initial months of highly active antiretroviral treatment(HAART). Previously subclinical infections are unmasked or pre-existing opportunistic infections clinically deteriorate as host immunopathological inflammatory responses are switched on. While the eye is the area where Cytomegalovirus(CMV)-associated IRS occurs most often in patients with AIDS, it also can present with intestinal or pulmonary involvement. We present a case report of an HIV-infected patient in whom CMV enterocolitis and jejunal perforation developed after HAART.

Association of the myeloperoxidase-463G->A polymorphism with development of atrophy in Helicobacter pylori-infected gastritis / 대한내과학회지

BACKGROUND: Helicobacter pylori (H. pylori) infection is characterized by extensive infiltration of neutrophils and induces atrophic gastritis, however, the host factors governing the development of atrophy have not been defined. Myeloperoxidase (MPO) in neutrophils amplifies the oxidative potential, thus MPO is suspected to play a role in H. pylori-induced gastric atrophy. Therefore, we explored the association of host MPO genetic polymorphism with atrophic gastritis upon H. pylori infection. METHODS: Biopsy specimens taken from the gastric mucosa were examined histologically in 127 patients. The PCR-RFLP assay was used to characterize MPO genotypes. RESULTS: The distributions of MPO genotypes were MPO (G/G) 81.9% and MPO (G/A) 18.1%. None of MPO (A/A) genotype was observed in 127 patients studied. The degree of active inflammation increased with the increase in H. pylori colonization. A strong positive correlation between the levels of neutrophil infiltration and gastric atrophy was found only in MPO (G/G) but not in MPO (G/A) genotype. CONCLUSION: MPO G/G genotype may be a critical determinant in the pathogenesis of atrophic gastritis subsequent to H. pylori infection.

Development of Efficient Screening Methods for Hazardous HBV Virus in Vaccine Preparation

As viral vaccines sometimes induce the side effects which intimidate humans, it is urgently required to study about the side effects of viral vaccines. Most vaccines are derived from the biological forms. Hence it should be established the efficient and sensitive evaluation methods for the possibility of dangerous contaminants such as viruses and the stability of vaccines. A lots of vaccine products have been imported, or in sale or being developed in nation. Some of products may be mixed with the hazardous viruses derived from animal or human resources. Such hazardous viruses should be identified specifically and efficiently. Biological products are not permitted to distribute or obtain without presenting the result of absence experiment of hazardous viruses and prion and the validation data of inactivation experiment during processes. In order to detect viruses, there were TEM for viral particles, infectivity assays and detection methods for nucleic acids. However, these methods have defects such as insensitivity and inaccuracy. It should be considered to detect only the hazardous viruses with specificity, precision and accuracy during the processes of preparation, transportation and storage. It is noted to increase the detection limit in order to detect the minute hazardous factors during preparation processes for viral vaccines. This study is focused on the establishment of various sensitive PCR/ELISA methods for HBV virus which enhance the detection limit in order to detect the minute hazardous factors during preparation processes for viral vaccines.

Association of the myeloperoxidase -463GfwdarwA polymorphism with Helicobacter pylori-induced atrophic gastritis

Although only a minority of the infected individuals develops atrophic gastritis and the malignancy, factors governing clinical outcomes subsequent to Helicobacter pylori (H. pylori) infection have not yet been defined. H. pylori infection is characterized by extensive infiltration of neutrophils. Myeloperoxidase (MPO) in neutrophils amplifies the oxidative potential of hydrogen peroxides that induce gastric mucosal damage, thus MPO is suspected to play a role in H. pylori-induced gastric injury. Therefore, we explored the association of host MPO genetic polymorphism with atrophic gastritis upon H. pylori infection. Biopsy specimens taken from the gastric mucosa were examined histologically in 87 patients. The PCR-RFLP assay was used to characterize MPO genotypes. The distributions of MPO genotypes were MPO (G/G) 82% and MPO (G/A) 18%. None of MPO (A/A) genotype was observed. A strong positive correlation between the levels of neutrophil infiltration and gastric atrophy found only in MPO (G/G) but not in MPO (G/A) genotype. These results suggest that MPO genotype is a critical determinant in the pathogenesis of atrophic gastritis subsequent to H. pylori infection. Further works need to clarify the functional relevance of MPO genetic polymorphisms on gastric cell injury.

The relationship of bacterial and Helicobacter infection to composition of bile acid in biliary tract diseases / 대한내과학회지

BACKGROUND: Bacterial and Helicobacter gene were commonly detected in diseased human bile, although the meaning of the presence of Helicobacter in biliary tract is still unclear. The aim of this study was to evaluate the changes of bile acid composition in bacterial and Helicobacter infected bile, and to determine whether Helicobacter pylori might grow in human bile or not. METHODS: Thirty bile samples were obtained by percutaneous transhepatic biliary drainage or gallbladder puncture during cholecystectomy. According to the polymerase chain reaction analysis using bacterial 16S rRNA and Helicobacter genus specific 16S rRNA primers, 3 groups were divided; Group I; no presence of any bacterial DNA, Group II; positive bacterial DNA only, Group III; positive bacterial and Helicobacter DNA. Bile acid analysis for deoxycholic acid (DCA), chenodeoxycholic acid (CDCA), lithocholic acid (LCA), and ursodeoxycholic acid (UDCA) was performed by high performance liquid chromatography. And then Helicobacter pylori was tried to culture in broth mixed with human bile at a final bile concentration of 50%. RESULTS: The concentrations of DCA in group II and III were very low and significantly reduced compared to group I (p<0.01, respectively). The concentrations of LCA or UDCA were not shown any relationships between groups. Helicobacter pylori has grown actively in the broth mixed with human bile containing both of less than 0.1 gm/L of DCA and CDCA, compared to no growth in media mixed with human bile containing more than 3.0 gm/L of DCA and/or CDCA. CONCLUSION: DCA seems to have the strongest antibacterial effect. Helicobacter pylori is likely to grow in human bile containg very low concentrations of CDCA and DCA.

Eosinophilic Gastroenteritis Involving Entire Gastrointestinal Tract with Eosinophilic Ascites / 대한소화기내시경학회지

Eosinophilic gastroenteritis is a rare disease of unknown cause characterized by eosinophilic infiltration in various areas of gastrointestinal tract with gastrointestinal symptoms such as abdominal pain, vomiting, diarrhea and rarely ascites. Its clinical feature depends on the type of layer and location involved. Serosal eosinophilic infiltration, the rarest form of presentation, may result in development of eosinophilic ascites. We experienced a case of eosinophilic gastroenteritis involving entire gastrointestinal tract with eosinophilic peritoneal fluid in a 38-year-old female with abdominal distension and abdominal pain. Upper gastrointestinal endoscopy, colonoscopy, small bowel series, abdominal CT showed diffuse wall thickening from esophagus to rectum. The eosinophilic peritoneal fluid and peripheral eosinophilia were confirmed by multiple biopsies of the gastrointestinal tract. She was treated with corticosteroid and responded dramatically. We report this case with a brief review of the literatures.

What is the Usefulness and Problem of Magnifying Colonoscopy? / 대한소화기내시경학회지

No abstract available.

A prospective study of therapeutic effect of 1 year trial with lamivudine in patients with chronic viral hepatitis B / 대한내과학회지

BACKGROUND: The aims of our study was to explore the effectiveness of 1 year treatment of lamivudine in Korean patients with chronic liver disease caused by chronic infection of HBV. METHODS: Thirty patients with chronic infection of HBV were included in this study who were diagnosed at Hanyang University Hospital from January 1998 to August 1999. They received 150mg of lamivudine per oral once daily for 1 year with follow-up of liver function test, serum HBV-bDNA and serologic markers for hepatitis B virus every two months. RESULTS: The mean values of ALT, AST, and GGT decreased significantly after 6 months treatment, but after 10-12 months treatment, 6 out of 30 cases(20%) tended to flare-up or return to pretreatment state. Nevertheless, their levels revealed no statistically significant changes after 12 months. No case show disappearance of HBsAg. HBeAg seroconversion occurred in 10 among 27 patients(37%). The mean of HBV-bDNA decreased from 1,776.0 pg/mL(2.5-17,000) to 10.8 pg/mL (2.5-67) after 6 months, but tended to rise to 317.9 pg/mL(2.5-5,900) after 12 months. After 10-12 months treatment, 11 cases out of 30 showed breakthrough or incomplete suppression of HBV DNA replication. Stepwise-logistic regression analysis proved the high baseline ALT was the only predictable factor for loss of HBeAg by lamivudine with an odds ratio of 1.0518(95% confidence interval: 1.0052-1.1007)(p=0.0291). CONCLUSION: Treatment of lamivudine showed improvement in normalization of ALT and reduction of HBV-bDNA after 6months. But after 10-12 months treatment, one third cases of them tended to flare-up or return to pretreatment state. And the group with high baseline ALT is not only suitable for indication of lamivudine therapy but also predictable factor of disappearance of HBeAg after 12months treatment with lamivudine.