A Case of Non-Hodgkin's Lymphoma in Patient with Coombs' Negative Hemolytic Anemia and Idiopathic Thrombocytopenic Purpura / Journal of the Korean Cancer Association, 대한암학회지

Coombs' negative autoimmune hemolytic anemia (AIHA) is a rare disease which shares similar clinical and hematological features with Coombs' positive AIHA, but its exact frequency remains unknown. There have been few reports of idiopathic thrombocytopenic purpura (ITP) and Coombs' negative AIHA associated with other lymphoproliferative disorders (LPDs). Since there is a well known association between LPDs and autoimmune phenomena, it is important to investigate the possibility of an underlying malignancy. We report a case of ITP and Coombs' negative AIHA associated with diffuse large B-cell lymphoma.

Causes and clinical characteristics of syncope in combat and auxiliary police in Korea / 대한내과학회지

BACKGROUND/AIMS: The most common type of syncope in young adults is neurocardiogenic in origin, which is not related to organic problems and has a benign nature. Therefore, there have been few reports regarding syncope in young Korean adults. Here, we examined the causes of syncope and its clinical characteristics in young combat and auxiliary police in Korea. METHODS: We performed a retrospective study of the medical records of 193 combat and auxiliary police in Korea admitted to the National Police Hospital for syncope or presyncope between January 2004 and December 2007. RESULTS: The subjects' mean age was 21+/-1.2 years, and there were 2.8+/-2.9 episodes of syncope (mean+/-SEM). The first syncope occurred after enlistment in the police in 102 patients (52.8%). Basic diagnostic studies showed two cases of elevated creatine phosphokinase and one case of anemia to be related to syncope. Syncope-related traumatic injuries occurred in 38 patients (19.7%), and syncope was more prevalent in the summer. Head-up tilt test was performed in 175 of the 193 patients, and 123 showed a positive response. Other evaluations, including brain magnetic resonance imaging, electroencephalography, and echocardiography, were not helpful for diagnosis. Syncope was neurocardiogenic in origin in the majority of cases. Other causes of syncope were exhaustion (n=2), hyperventilation syndrome (n=2), Meniere's disease (n=1), anemia (n=1), and psychiatric problems (n=5). The causes of syncope could not be identified in 59 patients (30.5%). CONCLUSIONS: Neurocardiogenic syncope was the most common type in our study population. More than half of our patients experienced their first episode after enlisting with the police. Further studies in these groups are necessary.

AIDS Diagnosed in the Course of Managing Duodenal Fistula Caused by Tuberculosis: A Case Report / 감염과화학요법

Extrapulmonary tuberculosis, such as intestinal tuberculosis, has become more common with the increase in human immunodeficiency virus infection. However, the diagnosis and treatment of intestinal tuberculosis are often delayed because the symptoms are nonspecific and diverse. We experienced a case of AIDS with intestinal tuberculosis that manifested as a duodenal fistula. The presence of AIDS should be suspected in patients who have extrapulmonary tuberculosis with atypical presentations.

AIDS Diagnosed in the Course of Managing Duodenal Fistula Caused by Tuberculosis: A Case Report / 감염과화학요법

Extrapulmonary tuberculosis, such as intestinal tuberculosis, has become more common with the increase in human immunodeficiency virus infection. However, the diagnosis and treatment of intestinal tuberculosis are often delayed because the symptoms are nonspecific and diverse. We experienced a case of AIDS with intestinal tuberculosis that manifested as a duodenal fistula. The presence of AIDS should be suspected in patients who have extrapulmonary tuberculosis with atypical presentations.

Two Cases of Peritoneal Tuberculosis Mimicking Peritoneal Carcinomatosis on F-18 FDG PET/CT / 핵의학분자영상

F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET/CT) plays an important role in diagnosis of malignant tumors and adds to conventional imaging in the staging of pertoneal carcinomatosis. However, false positive cases resulting from benign disease such as tuberculosis may occur. We report two cases of peritoneal tuberculosis on F-18 FDG PET/CT which showed multiple hypermetabolic foci in the mesentery and peritoneum with increased serum cancer antigen 125 (CA 125). Subsequent F-18 FDG PET/CT showed a disappearance of pathologic uptake following treatment with anti-tuberculosis drugs.

Hepatocellular Carcinoma with Right Atrial Invasion Detected by PET/CT / 핵의학분자영상

The role of positron emission tomography (PET) with F-18 fluorodeoxyglucose (F-18 FDG) in the diagnosis of hepatocellulcar carcinoma (HCC) has been limited because of a variable FDG uptake in HCC. However, the usefulness of PET/CT for detecting extrahepatic metastasis and monitoring of the treatment response in HCC has been reported. A 55-year-old man with a hepatitis B surface antigen-positive, was admitted to our hospital due to dyspnea, general weakness and body weight loss for one month. Chest X-ray showed multiple reticulo-nodular densities on both lower lung fields, which implies metastatic lesions. F-18 FDG PET/CT revealed consecutively intense hypermetabolic mass in right hepatic lobe, inferior vena cava and right atrium. We report a case of HCC with IVC and right atrium invasion identified by F-18 FDG PET/CT.

Diagnostic Approach to a Patient with a Pleural Effusion Including Ultrasound-guided Paracentesis Performed by a Medical Resident / 결핵및호흡기질환

BACKGROUND: A patient with a pleural effusion that is difficult to safely drain by a "blind" thoracentesis procedure is generally referred to a radiologist for ultrasound-guided thoracentesis. But such a referral increases the cost and the patient's inconvenience, and it causes delay in the diagnostic procedures. If ultrasound-guided thoracentesis is performed as a bedside procedure by a medical resident, then this will reduce the previously mentioned problems. So these patients with pleural effusions were treated by medical residents at our medical center, and the procedures included bedside ultrasound-guided thoracenteses. METHODS: We studied 89 cases of pleural effusions from March 2003 to June 2005. A "blind" thoracentesis was performed if the amount of pleural effusion was moderate or large. Bedside ultrasound-guided thoracentesis was performed for small or loculated effusions or for the cases that failed with performing a "blind" thoracentesis. RESULTS: "Blind" thoracenteses were performed in 79 cases that had a moderate or large amount of uncomplicated pleural effusions and the success rate was 93.7% (74/79 cases). Ultrasound-guided thoracentesis by the medical residents was performed in 15 cases and the success rate was 66.7% (10/15 cases). The 5 failedcases included all 3 cases with loculated effusions and 2 cases with a small amount of pleural effusion. All the failed cases were referred to one radiologist and they were then successfully treated. If we exclude the 3 cases with loculated pleural effusions, the success rate of ultrasound-guided thoracentesis by the medical residents increased up to 83% (10/12 cases). Two cases of complications (1 pneumothorax, 1 hydrohemothorax) occurred during ultrasound-guided thoracentesis. CONCLUSION: Ultrasound-guided thoracentesis performed as a bedside procedure by a medical resident may be relatively effective and safe. If a patient has a loculated effusion, then it would be better to first refer the patient to a radiologist.

A Case of Medullary Thyroid Carcinoma in which the Skin Metastasis was Concurrently Present and Response Occurred to Chemotherapy / Journal of the Korean Cancer Association, 대한암학회지

Medullary thyroid carcinoma accounts for 3% of all thyroid gland malignancies. It commonly metastasizes to liver, lung, and bone. It rarely metastasizes to skin, and only a few such cases have been documented. Cutaneous metastasis suggests a poor prognosis, with a mean survival of 7.5-19 months. The most effective treatment for skin metastasis is complete surgical removal of all local and regional lesions. The response to systemic chemotherapy is typically poor. We report a case of medullary thyroid carcinoma with cutaneous metastases, which responded to chemotherapy.

Incidence and Seroprevalence of Hepatitis A Virus among Korean Auxiliary Police Officers / 감염과화학요법

BACKGROUND: In Korea, cases with hepatitis A have been reported to Korea Centers for Disease Control and Prevention through the sentinel surveillance system. However, it was difficult to study the exact nation-wide incidence of hepatitis A infection. We studied the incidence of clinically apparent hepatitis A infection and the seroprevalence of anti-HAV IgG among auxiliary police officers. MATERIALS AND METHODS: We analyzed clinically apparent and hospitalized hepatitis A patients from 2002 to 2006 in National Police Hospital via medical records. We also measured anti-HAV IgG antibody from 507 auxiliary police officers. RESULTS: The estimated annual incidence of clinically apparent hepatitis A infection among auxiliary police officers was 10.6-14.8 cases per 100,000 population from 2002 to 2006. The overall anti-HAV IgG seropositive rate among auxiliary police officers was 0.6% (3/507). CONCLUSION: Among auxiliary police officers, the estimated annual incidence of clinically apparent hepatitis A infection was above 10 cases per 100,000 population and the positive rate of anti-HAV IgG was very low. The results were comparable to those in the low endemicity countries. The routine HAV vaccination among auxiliary police officers might be suggested.

Incidence and Seroprevalence of Hepatitis A Virus among Korean Auxiliary Police Officers / 감염과화학요법

BACKGROUND: In Korea, cases with hepatitis A have been reported to Korea Centers for Disease Control and Prevention through the sentinel surveillance system. However, it was difficult to study the exact nation-wide incidence of hepatitis A infection. We studied the incidence of clinically apparent hepatitis A infection and the seroprevalence of anti-HAV IgG among auxiliary police officers. MATERIALS AND METHODS: We analyzed clinically apparent and hospitalized hepatitis A patients from 2002 to 2006 in National Police Hospital via medical records. We also measured anti-HAV IgG antibody from 507 auxiliary police officers. RESULTS: The estimated annual incidence of clinically apparent hepatitis A infection among auxiliary police officers was 10.6-14.8 cases per 100,000 population from 2002 to 2006. The overall anti-HAV IgG seropositive rate among auxiliary police officers was 0.6% (3/507). CONCLUSION: Among auxiliary police officers, the estimated annual incidence of clinically apparent hepatitis A infection was above 10 cases per 100,000 population and the positive rate of anti-HAV IgG was very low. The results were comparable to those in the low endemicity countries. The routine HAV vaccination among auxiliary police officers might be suggested.

A Significant Discrepancy of Uptake between I-131 MIBG and F-18 FDG in a Patient With Malignant Paraganglioma / 핵의학분자영상

A 38-year-old man who was diagnosed with malignant paraganglioma underwent computed tomography (CT) and I-131 metaiodobenzylguanidine (MIBG) san. CT showed extensive lymph node enlargement in right iliac area and retroperitoneum with severe hydronephrosis and mass on posterior bladder wall. However, I-131 MIBG scan didn't showed abnormal uptake. He also underwent F-18 fluorodeoxyglucose (FDG) positron emisson tomography/CT for localizing accurate tumor site. F-18 FDG PET/CT showed multiple metastases of left supraclavicular, hilar, mediastinal para-aortic, inguinal, right iliac lymph nodes, lung, vertebrae, and pelvis. There are a few reports showing that the F-18 FDG PET/CT is helpful for staging and localizing tumor site of patients who are diagnosed with negative on the MIBG scans. Thus, we report a case with paraganglioma which showed negative I-131 MIBG scan, but revealed multiple intense hypermetabolic foci in F-18 FDG PET/CT.

A comparative study of the clinical features and hematobiochemical indices between the lung-uptake group and the non-lung-uptake group of malarial patients undergoing liver scanning / 대한내과학회지

BACKGROUND: Lung uptake during liver scanning has been considered as a passing phenomenon related to several diseases, and especially infectious diseases and malignancy. Some reports have shown diffuse lung uptake during liver scanning of malarial patients. Therefore, we tried to determine the relationship between the abnormalities of the clinical features, including the hematobiochemical indices and the lung uptake during liver scanning, by analyzing the information of the malarial patients. METHODS: We performed 99mTechnethium(Tc)-sulfur colloid liver scanning on 20 of the 45 malarial patients who were admitted from 1999 to 2004. We divided them into two groups, the Lung-Uptake (LU) group and the Non-Lung-Uptake (NLU) group. We analyzed the hematobiochemical indices and clinical features, including the respiratory symptoms, between the two groups. RESULTS: 10 of the 20 malarial patients showed lung uptake on the liver scan. The mean platelet counts were 74,000/L and 165,000/L, respectively, in the LU group and the NLU group (p=0.012). Also, the mean total cholesterol levels were 80.3 mg/dL and 105.7 mg/dL, respectively, in the LU group and the NLU group (p=0.033). The scores ofthe bone marrow (BM) uptake in the LU group were higher than those in the NLU group (p=0.008). Yet the other values such as Hb, ALT, albumin and total bilirubin were not statistically significant, nor were the peak body temperatureand other features. CONCLUSIONS: Half of the patients had lung uptake on the liver scanning, and this may be considered as a characteristic of vivax malaria. The BM uptake during liver scanning in the LU group was more increased, and this is supposed to be a consequence of hyperstimulated reticuloendothelial system, which was accompanied by thrombocytopenia and a lower level of total cholesterol in malarial patients.

A case of food-dependent exercise-induced anaphylaxis developed only in winter / 대한내과학회지

Food-dependent exercise-induced anaphylaxis has been recognized a variant of exercise-induced anaphylaxis charaterised by symptoms occuring on exertion after certain meal. We experienced a patient who developed an anaphylaxis induced by wheat flour made food followed by exercise only in cold temperature. A 22-year-old male patient was presented urticaria, angioedema, dyspnea, and loss of consciousness induced by exercise after ingestion of wheat flour made food only in winter. Skin prick test was negative for wheat or bread but positive for mushroom. By contrast, RAST was positive for wheat and negative for mushroom. In order to confirm the diagnosis exercise challenge test was done. The attack developed after ingestion of wheat flour made food and 10 min of outdoor jogging in temperature about 10 degrees C, but not by indoor treadmill test in temperature about 20 degrees C or ingestion of mushroom. This is the first case of food-dependent exercise-induced anaphylaxis developed only in cold temperature in Korea.

A Case of Liddle's Syndrome in a Seventy One-year Old Woman / 대한신장학회잡지

Liddle's syndrome is a rare inherited disease with characteristic clinical manifestations of hypertension and hypokalemic metabolic alkalosis. Markedly suppressed serum aldosterone and renin levels are important laboratory findings to differentiate this disorder from primary hyperaldosteronism. When Liddle et al. reported the disorder in 1963, they proposed aggressive Na+ absorption and increased excretion of K+ as the pathogenesis of the syndrome. Since then, specific mutation in the epithelial Na+ channel located in the collecting duct of the kidney has been elucidated as a disease mechanism. Liddle's syndrome is inherited by an autosomal dominant trait and generally the onset of the syndrome is before the age of 20 with increased risk of premature death due to stroke or heart failure. Recently, however, a few cases of late onset and genetically proven nonfamilial cases with de novo mutation of beta or gamma Na+ channel have been reported. We report a case of seventy-one year old woman who had hypertension with hypokalemic metabolic alkalosis and was diagnosed as Liddle's syndrome. Further evaluation revealed low serum renin and aldosterone levels. Primary aldosteronism, Cushing's syndrome, glucocorticoid remediable aldosteronism and deficiency of 11beta-OHase and 17alpha-OHase were ruled out based on her laboratory data and history. Her hypertension and hypokalemia responded to amiloride treatment but not to spironolactone.

A case of polycythemia vera with liver cirrhosis / 대한혈액학회지

No abstract available.