A case of pimary malignant melanoma originated from esophageal melanosis / 대한내과학회지

Primary malignant melanoma of the esophagus(PMME) is an extremely rare but aggressive disease that composes less than 0.1% of all primary malignant neoplasm of the esophagus. PMME was first reported in 1906 and nearly 180 cases of primary esophageal malignant melanoma have been published in the medical literature. Symptoms of the primary malignant melanoma of the esophagus mimic that of any malignant obstructing lesion of the esophagus and the metastatic spread by lymphatics and vascular routes are common. Resection of the tumor with an anastomotic procedure seems to be the treatment of choice, however prognosis is poor. At present, chemotherapy and immunotherapy have no major role in treatment. We report a case of 67-year-old man with primary malignant melanoma of the esophagus originated from esophageal melanosis with a review of the literature.

Endoscopic Treatment of Bleeding Angioectasia of the Upper Gastrointestinal Tract / 대한소화기내시경학회지

BACKGROUND/AIMS: Angioectasia of the gastrointestinal tract have been recognized with increasing frequency as an important cause of acute and chronic gastrointestinal bleeding. The purpose of this study is to define the response of endoscopic treatment for bleeding angioectasia of upper gastrointestinal tract and to evaluate long term efficacy of endoscopic treatment. METHODS: A clinical study was done on 18 patients (20 cases) of angioectasia bleeding of upper gastrointestinal tract who admitted to Yeungnam University hospital from January 1989 to October 1998. Endoscopic therapy was done by electrocauterizaton, laser therapy, O-band ligation. In cases of failure to achieve hemostasis after endoscopic retreatment, we have done operation or used antifibrinolytic agent. RESULTS: The mean age was 60.6+/-11.2 years (range 31-77 years). Bleeding control was succeeded in 19 cases and one case was failed by endoscopic therapy. This patient was operated. Recurred bleeding was observed in 4 patients during long term follow-up period. Bleeding was controlled after endoscopic re-treatment in two of four patients. The other patients (Osler-Weber-Lendu syndrome 2 patients) were periodically required of transfusion after endoscopic therapy. Tranexamic acid was given to these patients. CONCLUSIONS: Endoscopic therapy for bleeding angioectasia could reduce bleeding or make it stop, but repeated treatment was often necessary for multiple angioectasia. Tranexamic acid may be a useful treatment for refractory bleeding due to multiple angioectasia, such as Osler-Weber-Lendu syndrome.

The effect of Transarterial Chemoembolization(TAE) on Lung metastasis of Hepatocellular Carcinoma / 영남의대학술지

BACKGROUND: During follow up period after transarterial embolization(TAE), cases of pulmonary metastasis were more prevalent in TAE-treated patients than in TAE-untreated patients. Therefore, a study was conducted to evaluate whether TAE increases the incidence of pulmonary metastasis of hepatocellular carcinoma and to clarify the risk factors for pulmonary metastasis. METHODS: From march 1991 to march 1995, 156 patients who had been diagnosed with hepatocellular carcinoma by serology, and radiographic and histologic method at Yeungnam university hospital were involved in this study. We excluded 12 patients with lung metastasis on initial diagnosis and the others. The remaining 144 patients had been followed up for at least 5 months, and divided into four groups according to lung metastasis and trans-arterial embolization treatment, and evaluated the age, sex, child-pugh score, liver cirrhosis, and the level of AFP. RESULTS: Pulmonary metastasis was found in 18.0% (26/144), of witch 92.3%(24/26) and 7.7%(2/26) of the patients with and without transarterial chemoembolization, respectively. Of thepatients, 23.5% (24/102) with TAE had lung metastais during follow-up periods and 4.7% (2/42) without TAE had lung metastasis. there was more likelihood for lung metastasis after TAE, but there was no difference between two groups in age, sex, child-pugh class, the presence of liver cirrhosis, and AFP. CONCLUSIONS: The incidence of pulmonary metastasis of hepatocellular carcinoma after TAE was higher. child-pugh class was the only related clinical precipitating factors for pulmonary metastasis in TAE in our study. Our results suggest that regular chest X-ray check-up may be more frequently needed by patients who had TAE treatment for hepatocellular carcinoma.

Therapeutic Response of Different Treatment Modalities in the Adult Idiopathic Thrombocytopenic Purpura / 대한혈액학회지

BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a severe reduction in the number of circulating platelets. Corticosteroid therapy, which has been used in ITP for many years, has produced a complete or partial response rate of 65% to 75%, although sustained remissions have been reported in only 18% to 32% of the patients. The purpose of the present study is to define response to each treatment and ultimate outcome of adults with ITP. METHOD: A clinical study was done on 35 cases of ITP who had admitted to the department of Internal Medicine, Yeungnam University Hospital from June 1983 to July 1996. The response of each treatment modalities was based on criteria of Defino and Cooperative Latin American Group on Hemostasis and Thrombosis. RESULTS: The mean age of patients was 41.9 years old and female to male ratio was 1:0.6 (female:22 cases, male:13 cases). The complete response rate to intravenous gamma-globulin as early therapy was obtained in 72% of the patients and the duration to platelet count above 50,000/ microliter was 3 days after intravenous gamma-globulin therapy. Duration of response was 15 days. The CCR (continuing complete response) to corticosteroid was obtained in 16% of the patients, and no CCR to reinduction with corticosteroid was observed. The CR to splenectomy was obtained in 85% of the patients. The overall results of all therapeutic modalities were CCR 43%, TCR (temporary complete response) 20%, PR (partial response) 31%, and NR (no response) 6%. CONCLUSION: This analysis of ITP in adults suggests that splenectomy remains as the most effective treatment and intravenous gamma-globulin is effective for rapid elevation of platelet count.

A Case of Right Atrial Mass Associated With Hepatocellular Carcinoma / 영남의대학술지

Right atrial metastasis occurs in 1 to 4% of patients with hepatoma. and the extention to intracavitary or metastasis of tumor as a large mass rare. However, the high risk of progressive heart failure and sudden death from the tricuspid valve obstruction necessitates prompt diagnosis of intracavitary extension, and adequate intervention is needed to prolong a patient's life. A 49 year-old female was referred to our hospital for further evaluation of a liver mass, which was identified at a local clinic. The liver mass was confirmed as hepatocellular carcinoma with CT and celiac angiographic finding. She was treated with transarterial chemoembolization. Thirty-four months after discharge, a low density right atrial mass was noted incidentally with chest computed tomography while investigating massive right pleural effusion for possible pulmonary metastasis. Echocardiography showed a huge inhomogenous echogenic mass at the right atrium. The present report describes a case of primary hepatocellular carcinoma with a intracavitary cardiac mass detected with two dimensional echocardiography.

Effect of alpha-Interferon 2b on Chronic Hepatitis B Patients with High Serum ALT / 영남의대학술지

No abstract available.

Two Cases of Systemic Lupus Erythematosus with Cerebrovascular Involvement / 영남의대학술지

Systemic lupus erythematosus(SLE) is an autoimmune disease which may affect many different organs and disclose various clinical manifestations. Recently central nervous system(CNS) involvement has been recognized as an increasingly significant contributor to morbidity and mortality of SLE. The clinical manifestations of CNS-lupus are highly variable and range from mild cognitive dysfunction, movement disorder, headache, psychosis to life-threatening stroke and coma. Among the neuropsychiatric disorders encountered in patients with SLE, cerebrovascular disease has been a relatively rare complication. The diagnosis and management of CNS-lupus is difficult because of the lack of useful diagnostic methods. If, cerebrovascular involvement is suspected, then aggressive treatment such as high dose steroid, immunosuppressive therapy, plasma exchange, may be required to reduce high mortality rate. We experienced 2 cases cerebrovascular disease occurring in SLE patients which presented with various neuropsychiatric manifestations. They were diagnosed as CNS-lupus by neuropsychiatric symptoms, brain MRI, and EEG, and showed good response to high dose steroid pulse therapy.