A Study on the Usefulness of ERCP in Patients with Pyogenic Liver Abscess / 대한소화기내시경학회지

BACKGROUND/AIMS: This study was undertaken to evaluate the usefulness of ERCP in patients with pyogenic liver abscess. METHODS: An endoscopic retrograde cholangiographic study of 70 consecutive cases of pyogenic liver abscess was conducted during the period from January, 1993 to December, 1997. Among 70 cases of pyogenic liver abscess, the male to female ratio was 1.69 :1, and the peak incidence was in the sixth decade. RESULTS: The common associated diseases were liver cirrhosis (11.4%), diabetes mellitus (8.5%), and malignancy (5.7%). The most common origins of the abscess in decreasing order of frequency were, transbiliary infection (51%), hematogenous spread, and trauma-associated causes. The ascending infection through the biliary tract as the etiology of liver abscess, has been common since the 1970's. The positive rate of abdominal US, CT, and ERCP in the diagnosis of the etiology of the liver abscess was 68, 82, 84% respectively. The treatments of the pyogenic liver abscess were, surgical drainage in 15 cases (21%) and percutaneous drainage in 51 cases (73%). Among 70 patients treated for pyogenic liver abscess, 12 patients had CBD stones and 11 patients were cured by EST. CONCLUSIONS: The most common origin of liver abscess is ascending infection through the biliary tract and ERCP may be a effective tool in the assessment and management of the etiology of pyogenic liver abscess.

A Case of Antiphospholipid Antibody Syndrome with AhA Nephropathy / 대한신장학회잡지

The antiphospholipid antibody syndrome is cha- racterized by antibodies directed against either phos-pholipids or plasma proteins bound to anionic phos- pholipids. These antibodies have been characterized by lupus anticoagulants and anticardiolipin antibodies. Patients with the antiphospholipid antibody syndrome may display a constellation of clinical features including venous and arterial thrombosis, recurrent fetal losses, and thrombocytopenia. Although the majority of patients reported have a thrombotic microangiopathy, some have also seen membranous nephopathy as well as IgA nephropathy in a patient with anti-phospholipid antibody syndrome accompanying glo-merulonephritis. Authors experienced a 37-year-old male patient who presented with generalized edema at the moment of follow-up for primary antiphos-pholipid syndrome accampanying systemic thrombotic events. Anticardiolipin antibody-IgM positivity was detected by seroligic test but no evidence for systemic lupus erythematosus was found. Kidney biopsy showed mesangial IgA deposition without th throm-botic microangiopathy of gomerular capillaries and was diagnosed finally as primary antiphospholipid syndrome with IgA nephropathy. Patient's symptom was relieved with steroids and anti platelete agents and now he is being follow-up to out patient department. This case suggests some possibility that anticardiolipin antibody may induce the IgA nephropathy. Therefore clinician should have concern about the relationship between antiphospholipid antibody and immune mediate glomerulonephritis.

A Case of Squamous Cell Carcinoma of the Common Bile Duct / 대한소화기내시경학회지

A 57-year-old female with jaundice and right upper quadrant abdominal pain, was found on exploration to have squamous cell carcinoma of the common bile duct. Squamous cell carcinoma of the common bile duct is a very rare tumor, simulating adenocarcinoma in its clinical presentation and aggressiveness. Although no consistent causative factors for this tumor has been demonstrated, it has been theorized that the normal columnar epithelium of the bile duct under the influence of an inflammatory stimulus, can develop into squamous epithelium with the ongoing process leading to squamous metaplasia, and eventually carcinoma. Cholelithiasis has been implicated as a cause for bile duct cancer, which was manifested in this patient. The prognosis of this carcinoma was grave, despite all forms of surgical and medical management. A case of squamous cell carcinoma of the common bile duct is reported with a review of relevant literature.

A Case of Spontaneous Regression of Small Cell Lung Cancer / 대한암학회지

Small cell lung cancer is the most aggressive tumor among lung cancers and has a greater tendency to be widely disseminated by the time of diagnosis. Without treatment, the median survial time of small cell lung cancer patients is only 2~4 months. However, though spontaneous regression of the malignant tumor has been frequently reported, spontaneous regression of the small cell lung cancer is rare. In this study a spontaneous regression of the small cell lung cancer is reported, along with a brief review of the literature. A 69 year-old woman was admitted for an evaluation for dyspnea. A chest roentgenogram obtained on admission revealed an abnormal mass shadow at the right hilus. She was diagnosed as having small cell lung cancer through a bronchoscopic biopsy. However this tumor regressed spontaneously without specific treatment after 12 months.

Ensulin Autoimmune Syndrome in a Patient with Methimazole-Treated Graves' Disease: A Case report / 대한내분비학회지

Insulin autoimmune syndrome (IAS) includes fasting or reactive hypoglycemia, hyperinsulinemia and the presence of insulin-binding antibodies in patients who have never been exposed to exogenous insulin. This report concems a 29-year-old male patient with Graves disease who had history of having taken methimazole for two months, without any consequence, 6 months previously. However, when methimazole was administered again for three weeks, the patient suffered hypoglycemia during the next fourth week. He denied history of diabetes mellitus (DM), of taking any oral hypoglycemic agent or of having received insulin injection. Laboratory data showed total serum insulin level > 300 pu/mL, C-peptide reactivity (CPR) 8.0ng/mL and insulin antibody 89%. After stopping methimazole, he was treated with radioiodine (131I). There was no episode of hypoglycemic attack during 8 months of follow-up.