A Case of Gastritis Cystica Profunda Associated with Gastric Perforation and Hypertrophic Gastric Folds / 대한소화기내시경학회지

Gastritis cystica profunda (GCP) is a rare disease in which cystically dilated gastric foveolae or glands extend into the muscularis mucosae or below. The pathogenesis of GCP has been described as an interruption of the muscularis mucosae and migration of epithelial elements to submucosa caused by presence of suture materials after surgery or erosion of the gastric mucosa in chronic gastritis and ischemia. Macroscopically, GCP may present not only as a giant gastric mucosal folds but also as a submucosal tumor or as solitary or diffuse polyps. An endoscopic ultrasonographic (EUS) findings clearly differ from findings in the other disordes. The combination of EUS and mucosectomy appears to be very useful for the diagnosis of GCP. Therefore, all unnecessary surgical procedures should be avoided in cases of GCP. We report a case of GCP associated with gastric perforation which presented as diffuse giant gastric folds and clinically advanced gastric cancer was suspected.

A case of infected abdominal aortic aneurysm associated with liver abscess treated by endovascular stent / 대한내과학회지

A 72-year-old diabetic male patient with high grade fever, right upper quadrant abdominal pain and Klebsiella pneumoniae septicemia is reported. He suffered from high fever and abdominal pain in spite of aspiration of liver abscess and antibiotic treatment. A few days later, we found a palpable pulsating abdominal mass on physical examination. Computed tomography and angiography revealed infected abdominal aortic aneurysm associated with pyogenic liver abscess. He was treated by antibiotics and Endovascular stent without surgical resection. He improved without complications and has been followed-up after discharge with excellent condition. To our knowledge, this is the first case of infected abdominal aortic aneurysm as a septic metastatic lesion secondary to liver abscess.

Three Case of Acute Pancreatitis Complicating Endoscopic Insertion of the Biliary Stent / 대한소화기내시경학회지

Acute pancreatitis is one of the major complications of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). Various etiology such as mechanical, chemical, hydrostatic, and thermal factor are thought to be involved for this procedure-related pancreatitis. However, acute pancreatitis can occur as a direct complication of endoscopic biliary drainage (EBD). Although the exact mechanism remains unclear, it is postulated that the stent compresses pancreatic ductal orifice and resultant pancreatic outflow obstruction actually provokes pancreatitis. Using the larger stent diameter over 10 Fr and a straight stent rather than curved one, proximal rather than distal bile duct obstruction are risk factors for stent-induced pancreatitis. We report on three cases of acute pancreatitis complicating the EBD with a plastic stent, nasobiliary catheter, and covered-metallic stent respectively.

Cerebrovascular complications in autosomal dominant polycystic kidney disease(ADPKD) / 대한내과학회지

BACKGROUND: ADPKD is one of the most common hereditary renal disease in adult and is a systemic disorder with a variety of cardiovascular manifestations. To elucidate the clinical characteristics of cerebrovascular complications in Korean ADPKD patients, we reviewed the medical records of ADPKD patients who was registered in ADPKD clinic of Seoul National University Hospital. METHODS: A total of 18 adult patients were included and their sex ratio was 8:10. The median age of ADPKD diagnosis was 45.5 year (range 19-85), and age at cerebrovascular accident(CVA) was 52 years(22-82). The median duration from hypertension to CVA was 8 years(0-30). RESULTS: There were 5 cases of infarction, 4 cases of intracerebral hemorrhage, 4 cases of subarachnoid hemorrhage, and 4 cases of transient ischemic attack. Other clinical parameters of ADPKD were not different from patients who were not complicated with CVA. Intracranial aneurysms were detected in 6 patients and their median age at diagnosis was 47.5 years(33-66). Four cases were manifested as subarachnoid hemorrhage. Five cases were diagnosed through TFCA, and two of them were revealed as multiple aneurysms. Five cases received surgical treatment and five of six cases improved without any neurologic sequeale. MR angiography(MRA) were taken in 16 asymptomatic patients, and multiple aneurysms were newly detected in one of them. CONCLUSION: Cerebrovascular complications in Korean ADPKD patients were not significantly different from western patients. Intracranial aneurysms must be included in differential diagnosis in ADPKD patients who manifest an acute neurologic symptoms, and high-risk group need to be screened selectively with MRA.

A Case of Acute Respiratory Distress Syndrome with Pulmonary Embolism induced by Injection of Silicone at Vaginal Wall / 결핵

Silicone fluid(polydimethylsiloxane) is widely used in breast augmentation and other cosmetic procedures because of little incidence of complications and low mortality rate. However, local reaction following silicone injections can be occurred sometimes leading to serious complications. Especially, illicit silicone injections have resulted in severe reactions within the pulmonary area, and some have resulted in acute respiratory distress syndrome subsequently. We experienced a case of acute respiratory distress syndrome induced by subcutaneous injections of silicone at vaginal wall. The patients was 39-year-old, previously healthy woman who had complained of dyspnea related to silicone injection at vaginal wall. Chest X-ray and chest CT scan show diffuse air consolidation with ground glass opacities and perfusion lung scan revealed likelihood of pulmonary embolism as showing multiple perfusion defects. We report a case of acute respiratory distress syndrome after silicone injection with review of literature.

A Case of Endoscopic Drainage of Pancreatic Abscess with Biliary Stent / 대한내과학회지

Pancreatic abscess is a highly lethal infectious complication of acute pancreatitis despite a wide variety of operative approaches and percutaneous drainage for the treatment. Surgical drainage has its limitation because of high postoperative mortality, recurrence, operative hemorrhage and/or gastrointestinal fistula. Percutaneous drainage has been used only as a temporizing measure prior to operation in critically ill patient or as additional modality for a postoperative recurrent abscess. Endoscopic drainage can be indicated as a primary therapy for the well-localized paraintestinal pancreatic abscess bulging into the duodenal or gastric lumen, as it has been proven successful in patients with pancreatic pseudocyst compressing duodenum or stomach. However, the report is rare. We report a case of pancreatic abscess successfully treated with endoscopic drainage without any complications.

Lymphocyte Subsets in Patients with Hepatitis B Virus Associated Glomerulonephritis / 대한신장학회잡지

Immune complex formation has been recently emphasized as an important pathogenetic mechanism of hepatitis B virus associated glomerulonephritis (HBGN), but little are known on the role of cell- mediated immunity in that disease. In this study, we measured lymphocyte subsets of the blood samples from three groups(HBGN group, healthy control group, hepatitis B group without renal disease) by flow cytometry in order to clarify abnormalities in immune regulatory system of HBGN. The results were as follows: 1) To compare between HBGN and healthy control group, the proportion of CD4+ cells were higher for HBGN than for healthy control but that of B lymphocytes were lower for HBGN than for healthy control. Between HBGN and hepatitis B group without renal disease, the proportion of B lymphocytes were higher for HBGN but that of NK cells were lower for HBGN(P<0.05). 2) To compare the male data of the three groups, the percentage of CD4+ cells in HBGN group were higher and the percentage of B lymphocytes were lower than healthy control. Between HBGN group and hepatitis B group without renal disease, no significant difference were noted in CD4+ cells, CD8+ cells, B lymphocytes, NK cells and CD4/CD8 ratio (P<0.05). 3) HBGN patients with membraneous nephropathy (MN) showed higher proportion of CD4+ cells than those with membranoproliferative glomerulonephritis (MPGN)(P<0.05). But, no difference was observed between HBGN patients with and without nephrotic syndrome. Nor between HBGN patients with and without HBe antigenemia. In conclusion, above result implies the pathogenetic role of cell-mediated immunity in HBGN. Analysis of lymphocyte subsets for each stage of HBGN, together with the assay of lymphocyte activation markers is required in the future.

Complete Remission in a Patient with Multiple Myeloma after High Dose Melphalan and CD34+ Selected Autologous Transplantation / 대한혈액학회지

Multiple myeloma is characterized by long clinical course and drug resistance. Conventional chemotherapy results in modest survival benefit. High dose therapy with autologous stem cell transplantation results in markedly increased response rate and survival, confirmed by a randomized study. But there are any evidences yet this approach confers cure. To decrease relapse rate, several approaches are ongoing. Among them, purified CD34+ selected transplantation is an attractive approach because of reduced contamination of myeloma cells. Recently we have experienced CD34+ selected autologous transplantation in a multiple myeloma patient. After VAD induction chemotherapy, high dose melphalan (200mg/m2) with CD34+ selected autotransplantation was followed. Immunoadsorption using CeprateSC resulted in 81% purity and 42% yield. Infused CD34+ cell number was 3.1x106/kg. Absolute granulocytopenic and thrombocytopenic period was less than a week. Grade lll or more extramedullary toxicities were not observed. After high dose therapy, complete remission by immunofixation was achieved. We have experienced a case of CD34+ selected transplantation in multiple myeloma and found that it was safe in terms of short term engraftment.

Rifampin Induced Rapidly Progressive Glomerulonephritis / 대한신장학회잡지

Most cases of acute renal failure induced by rifampin are due to acute tubulointerstitial nephritis and usually resolve spontaneously after discontinuation of rifampin. But there were a few reports that rifampin could cause crescentic glomerulonephritis. We present a 67 year-old male patient who has suffered from pulmonary tuberculosis and taken antituberculosis drugs including rifampin. The medication was interrupted two times because of anorexia and nausea. Azotemia, lower extremity edema and palpable purpura on both legs developed after administering antituberculosis drugs for two months. We performed the skin and kidney biopsy. The skin biopsy showed necrotizing vasculitis and kidney biopsy showed crescentic IgA nephropathy. He was tentatively diagnosed as rifampin induced rapidly progressive glomerulonephritis and underlying Henoch-Sch nlein purpura. The antituberculosis regimen was switched excluding rifampin and prednisolone was administered orally. His renal function was improved slowly over 4 months.

Effect of All - trans Retinoic Acid ( ATRA ) on the Remission Induction and Coaguloyathy in Acute Promyelocytic Leukemia ( APL ) / 대한내과학회지

OBJECTIVES: APL, which characteristically shows t(15:17), accompanies fatal coagulopathy during remission induction with systemic chemotherapy alone. ATRA, a derivative of vitamin A, can differentiate APL cells as well as HL-60 cells in vitro and induce higher rate of complete remission(CR). Hence, we assessed the effect of ATRA on remission induction and coagulopathy in APL patients. METHODS: (1) 42 patients diagnosed histologically in St. mary's hospital from June 1991 to June 1994 were included. (2) We compared the CR rate, the time required for restoration of derranged coagulation profiles, and the amount of coagulation factors including platelets among the chemotherapy group (control) and ATRA group. RESULTS: 1) There was no difference in CR rate between the control group and ATRA group [84.2%(16 out of 19) vs 87.0%(20 out of 23), p>0.05)] and also no difference between two subgroups of ATRA [ATRA with chemotherapy; 83.3%(10 out of 12) vs ATRA without chemotherapy; 90.9%(10 out of 11), p>0.05] 2) In the ATRA group, the CR rate of newly diagnosed patients was 82.4%(14 out of 17). The first relapsed patients (4) and the second (2) were all achieved CR. 3) The mean duration of coagulopathy, time to normalization of PT, aPTT, FDP, fibrinogen level, was 12.0+/-10.4, 11.1+/-10.2, 16.5+/-9.3, 15.4+/-10.2 days after chemotherapy alone and 4.5+/-4.4, 3.7+/-3.7, 8.9+/-6.1, 8.1+/-6.5 days in the ATRA group(p<0.05). The amount of fresh frozen plasma used in the ATRA group for the purpose of correction of coagulopathy were significantly lower than the control group(p<0.05). The incidence of profound coagulopathy during the remission induction treatment in the ATRA group was significantly lower than the control group[40% (8 out of 20) vs 96.7%(13 out of 15), p

Esophagus, Stomach & Intestine; A Case of Duodenal Leiomyoma Presenting with Upper Gastrointestinal Bleeding / 대한소화기내시경학회지

Leiomyoma is a neoplasm of smooth muscle relatively common in the stomach, but very rare in the duodenal location. Recurrent bouts of severe melana remain the most frequent presenting symptom for leiomyoma. A 69-year-old man presented to us with a 4-day history of melena. Endoscopy revealed norinal mucosa covered ovoid elevated lesion with central linear depression and ulcer at the second portion of duodenum. Endoscopic biopsy showed chronic inflammation only. Duodenal mass was excised through a duodenotomy. Pathological diagnosis was leiomycena.

Genital Mycoplasmas in the Newborn Infants: Colonization, Prevalence and Clinical Significance

PURPOSE: The genital mycoplasmas: Ureaplasma urealyticum and Mycoplasma hominis have recently assumed an increasing importance as neonatal pathogens especially in preterm infants. The aim of the present study was to determine the prevalence of infections with these organisms in newborn infants who were admitted in Neonatal Intensive Care Unit(NICU) and who were suspected having infection in newborn nursery METHODS: Sixty four inborns who were hospitalized in the NICU of Seoul National University Children's Hospital and Fourty seven term newborns who were born in Seoul National University Hospital and were evaluated for sepsis in the nursery due to high risk mother and baby's clinical symptoms from May 1994 through August 1994 were included in this study. Blood during the first hour of life and throat swabs during the second hours of life of the baby were collected. Tracheal aspirates were collected in the mechanically ventilated infants during the first day of life. Transport media for genital mycoplasma, urea and mycoplasma broth, and urea agar were used for isolation of genital mycoplasmas. RESULTS: In 64 inborns of NICU included in this study U. urealyticum was isolated in five(11.1%) out of 45 throat swab cultures, one(1.7%) out of 60 blood cultures and one(7.1%) out of 14 tracheal aspirates. M. hominis was isolated in 2 throat cultures. So total 14.3% of these infants harbored genital mycoplasmas. Among 47 term newborns included in this study from nursery, U. urealyticum was isolated 3(8.6%) out of 35 throat swab cultures and one (2.2%) out of 45 blood cultures shortly after birth. M. hominis was not isolated among them. Genital mycoplasma-positive infants in NICU had lesser gestatonal age and lower birth weight than genital mycoplasma- negative infants. Isolation of genital mycoplasmas was also associated with maternal clinical chorioamnionitis. No evidences that neonatal disease such as suspected sepsis, chronic lung disease of prematurity and neonatal outcome such as duration of hospital stay and mortality were related to genital mycoplasmas were noted. Cultures for genital mycoplasmas in amniotic fluid were performed in 26 preterm infants' mothers whose babies hospitalized in NICU and 11 had positve results. Acquisition rate of genital mycoplasmas in their neonates was 54.5%(6/11). One preterm infant who harbored U. urealyticum in the blood exhibited suspected congenital pneumonia. CONCLUSIONS: Our results demonstrate that colonization with genital mycoplasmas is not uncommon in the newborn infants in Korea and genital mycoplasma-positive preterms had lesser gestational age and lower birth weight than genital mycoplasma- negative preterms. Further study about the relation of genital mycoplasmas to neonatal morbidity will be needed.