Hepatic Hydatid Cyst: A Case Report / 대한소화기학회지

Hydatid cysts are caused by an infestation with larval tapeworms of the genus Echinococcus. The disease is endemic in developing countries but has rarely been reported from immigrant workers in Korea. This paper reports a case of hepatic hydatid cyst in a 27-year-old female. She was referred with abdominal pain that had persisted for the past 2 months. The patient was a foreign worker from Mongolia. The physical examination was unremarkable, and blood tests showed peripheral blood eosinophilia and elevated liver enzymes. Abdominal ultrasonography showed a well-circumscribed cystic mass with septation in the liver. A surgical resection was performed for complete removal. After uncomplicated postoperative recovery, the patient was discharged with albendazole 400 mg twice daily. The hydatid cyst is an important disease that should be considered in the differential diagnosis of cystic lesions in the liver, particularly in those who have lived in endemic areas. A correct early diagnosis based on the typical image findings is important for early treatment before the rupture of the cyst, which is associated with low morbidity and mortality. A current surgical resection combined albendazole are effective treatments for hepatic hydatid cysts, associated with low recurrence rates.

A Case of Intramural Hematoma of the Esophagus Mimicking Acute Coronary Syndrome / 대한소화기학회지

Intramural hematoma of the esophagus is a rare condition that can be spontaneous or secondary to trauma, toxic ingestion, or intervention. If it is the spontaneous type, it usually presents initially with epigastric pain, hematemesis or dysphagia. We present a case of intramural hematoma of the esophagus mimicking acute coronary syndrome. A 63-year-old man presented with severe acute chest pain. He has four coronary stents that were inserted five years ago, from a different hospital, and is on dual antiplatelet agents. Coronary angiography was performed immediately under the suspicion of acute coronary syndrome, and we found that there was no obvious clogging of the coronary arteries. Next, chest computed tomography was performed due to suspected aortic dissection, and the result was also negative. Four days later, endoscopy was performed and intramural hematoma covered with large ulcers was diagnosed.

A Case of Recurrent Spontaneous Hypoglycemia in a 73-year-old Woman with Congestive Heart Failure / 대한내과학회지

Hypoglycemia in adults without diabetes can be caused by drugs, critical illness, hormone deficiency, and hyperinsulinism. Spontaneous hypoglycemia in congestive heart failure has been reported rarely in adults. We report a case of spontaneous hypoglycemia in congestive heart failure in a 73-year-old woman with mitral stenosis and atrial fibrillation who had been receiving treatment for 6 years. She had two episodes of low serum glucose with unconsciousness, but there was no evidence of diabetes. Heart failure with concomitant hepatic dysfunction was presumed to have caused the hypoglycemia. She underwent mitral valve replacement after being diagnosed with severe mitral stenosis. There was no episode of hypoglycemia during follow-up.

Clinical Characteristics of the Development of Pneumothorax in Mechanically Ventilated Patients in Intensive Care Units / 대한구급학회지

BACKGROUND: Pneumothorax (PTX) can occur as a complication of positive pressure ventilation in mechanically ventilated patients. METHODS: We retrospectively reviewed the clinical characteristics of patients who developed PTX during mechanical ventilation (MV) in the intensive care unit (ICU). RESULTS: Of the 326 patients admitted (208 men and 118 women; mean age, 65.3 +/- 8.74 years), 15 (4.7%) developed PTX, which was MV-associated in 11 (3.3%) cases (6 men and 5 women; mean age, 68.3 +/- 9.12 years) and procedure-associated in 4. Among the patients with MV-associated PTX, the underlying lung diseases were acute respiratory distress syndrome in 7 patients, interstitial lung disease in 2 patients, and chronic obstructive pulmonary disease in 2 patients. PTX diagnosis was achieved by chest radiography alone in 9 patients and chest computed tomography alone in 2 patients. Nine patients were using assist-control mode MV with the mean applied positive end-expiratory pressure, 9 +/- 4.6 cmH2O and the mean tidal volume, 361 +/- 63.7 ml at the diagnosis of PTX. Two patients died as a result of MV-associated PTX and their systolic pressure was below 80 mmHg and heart rates were less than 80/min. Ten patients were treated by chest tube insertion, and 1 patient was treated by percutaneous pigtail catheter insertion. CONCLUSIONS: PTX can develop in patients undergoing MV, and may cause death. Early recognition and treatment are necessary to prevent hemodynamic compromise in patients who develop PTX.

Isolated Left Ventricular Noncompaction with a Congenital Aneurysm Presenting with Recurrent Embolism

Isolated left ventricular noncompaction (LVNC) is a rare disorder caused by embryonic arrest of compaction. LVNC is sometimes associated with other congenital cardiac disorders; however, there have been few reports of its coexistence with a left ventricular aneurysm. A 40-year-old woman was admitted to our hospital for renal infarction. She had a history of embolic cerebral infarction 10 years ago. Transthoracic echocardiography showed prominent trabeculae and deep intertrabecular recesses which are filled with blood from the left ventricular (LV) cavity. A thrombus in the akinetic apical wall was confirmed by contrast echocardiography. Using cardiac computed tomography and magnetic resonance imaging, we rejected a possible diagnosis of suspicion of coronary artery disease. She was diagnosed LVNC with a thrombus in apical aneurysm. Here, we report the first patient in Korea known to have LVNC accompanying LV congenital aneurysm presenting with recurrent embolism.

Efficacy and Tolerability of Mirtazapine and Sertraline in Treatment of Patients with Posttraumatic Stress Disorder with Depression: A Randomized Open Label Trial / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the potential use of mirtazapine in Korean veterans diagnosed with PTSD, by comparing it with sertraline, a drug approved for use in PTSD in the USA. METHODS: Efficacy was eveluated by Clinician Adninistered PTSD Scale (CAPS-2), the Hamilton Rating Scale for Depressin (HAMD-17) and the Clinical Global lmpresaion Scale (CGI), at baseline and week 1, 2, 6. Response was defined as a > or =30% decrease in CAPS-2 total score, a > or =50% decrease in total HAMD-17 score, and s CGI-I score<3. RESULTS: 51 patients on mirtazapine (measn age/duration of illness:59.1/33.5 yrs) and 49 on sertratine (mean age/duration of illness:60.6/35.6 years) completed the study. Mean daily dosage was 34.1 mg for mirtazapine and 101.5 mg for sertraline. On CAPS-2 total score more patients responded in the mirtazapine group at weak 1 (13 vs. 2%) and week 2 (51vs. 31%). At week 6 this difference was statistically significant (88 vs. 69%, p=0.039), CAPS-2 total score. HAMD-17 total score and CGI-I score decreased significantly in both groups, with no significant differences between groups on all time points. Main side effects for the rnirtazapine group:dry mouth (19.8%) and constipation (19.6%), somnolence (15.7%), weight gain (1.96%). For the sertraline group:indigestion (14.3%), palpitation (6.1%) agitation (2.0%), epigastric soreness (2.0%), insomnia (2.0%), sexual dysfunction (2.0%). CONCLUSION: Mirtazapine appeared to be an effective and well-tolerated treatment for PTSD in Korean veterans.

The Effects of Immobilization Stress on the Ultrastructure of Rat Atrial Myocytes / 체질인류학회지

This study was performed to investigate the subcellular changes of rat atrial muscle cells by immobilization stress. Sprague -Dawley rats weighting 200 gm were immobilized in small round plastic tube for 2, 6, 12, and 24 hours respectively. The atrial tissue obtained from each animals were observed by transmission electron microscopes. In the heart of rat subjected 2 hours immobilization stress no significant morphological changes were found in electron microscopy, similarly as in control animal. After 6 and 12 hours immobilization stress, the following electron -microscopic changes of atrial myocytes were observed at the swelling of mitochondrial matrix with disturbance in cristea, focal loss of cytoplasmic matrix, vacuoles with myeline -like structure, apoptotic changes of myocytes, focal widening of intercalated disc interspace and lysis of myofibrils. After 24 hours immobilization stress, very small sized mitochondria, similarly as small sized secretory granules and various sized granules are observed in the perinuclear region of atrial myocytes. Atrial specific granules are moved centripetally toward the central region of the atrial myocytes after immobilization stress. Above results will be aid in understanding the structures of atrium with dual function of blood circulation and endocrine, and in research of modulation of secretory granules in atrial muscle cells.

Diagnostic Value of Fine Needle Aspiration Cytology of the Breast Mass

BACKGROUND: Palpable breast tumors have traditionally been diagnosed with open biopsy. We propose fine needle aspiration (FNA) cytology as a reliable, safe initial procedure in these patients. METHODS: We performed 248 fine needle aspiration cytologies of breast tumors during the period of from Jan. 1994 to Dec. 1997 at the Department of Surgery, Chonbuk National University Hospital, among which 106 cases were histologically examined. RESULTS: The main clinical symptom was a palpable mass on the breast at the time of the visit to our hospital. Clinical diagnosis based on symptoms and physical examination had a sensitivity of 96.9% and a specificity of 57.5%. Based on definite histologic diagnosis, the sensitivity of FNA cytology was 96.9%, the specificity 91.7%, and the diagnostic accuracy 93.5%. Of the cytologic malignancies, 86.1% were proven malignant histologically, and 100% of the cytologically benign cases turned out histologically benign. CONCLUSION: Fine needle aspiration cytology of solid, palpable breast lesions should be the diagnostic procedure of choice for those patients classified clinically as probably benign or clinically as malignant.