Jejunal Migration of the Stent-Graft Used for Common Hepatic Artery Pseudoaneurysm

Hemorrhage after pancreaticobiliary surgery is an infrequent but fatal complication. It is primarily caused by rupture of the pseudoaneurysm, and treatment options include endovascular coil embolization or endovascular stent-graft placement. Herein, we report a case of migration of an arterial stent-graft that was placed in the common hepatic artery to treat pseudoaneurysm after pylorus-preserving pancreaticoduodenectomy. The stent-graft migrated to the jejunum and was eventually excreted from the body.

Superior Mesenteric Venous Thrombophlebitis with Terminal Ileal Diverticulitis: A Case Report

Mesenteric venous thrombophlebitis secondary to inflammatory processes such as diverticulitis and appendicitis is a rare disease; however, it can nonetheless cause bowel ischemia and infarctions. Radiologic diagnosis is vital for mesenteric venous thrombophlebitis complicated with diverticulitis due to its non-specific clinical presentation and very low incidence. We report a case of a 61-year-old woman with superior mesenteric vein thrombosis and ileocecal diverticulitis on CT, which was resolved after treatment with a combination of antibiotic therapy and right hemicolectomy.

Imaging Findings of Scrotal Liposarcoma: A Case Report

Liposarcoma located in the scrotum is a very rare, and to our knowledge, only a few cases have been described in the radiologic literature. Clinically, scrotal liposarcoma manifests as a painless, slow-growing mass, which can be misdiagnosed as inguinal hernia, scrotal hydrocele or lipoma. Here, we present a case of scrotal liposarcoma. On CT and MRI, it manifested as a predominant fat-containing mass with heterogeneously enhancing soft tissue.

Potential Role of Immunodiagnosis for Pulmonary Tuberculosis Using Induced Sputum Cells

PURPOSE: To evaluate the diagnostic utility and predictors for determinate results of an enzyme-linked immunospot assay using induced sputum cells (IS ELISPOT) for a rapid diagnosis of pulmonary tuberculosis (TB). MATERIALS AND METHODS: Subjects suspected of pulmonary TB who had either sputum acid fast bacilli smear-negative or not producing sputum spontaneously were prospectively enrolled. ELISPOT assay was performed using cells from induced sputum. RESULTS: A total of 43 subjects, including 25 with TB (TB group) and 18 with non-TB disease (non-TB group) were enrolled. Results of IS ELISPOT were determinate in only 17/43 (39%) subjects, but all of determinate results were consistent with the final diagnosis. Of the 43 sputum samples, 11 (26%) were inadequate to perform IS ELISPOT. Of 32 adequate sputum samples, the proportion of determinate results was significantly higher in the TB group (75%, 15/20) than in the non-TB group (17%, 2/12) (p=0.002). The status of active TB was a unique predictor but smear positivity was not a significant predictor for determinate results. In addition, sensitivity of IS ELISPOT (75%, 9/12) in smear negative TB was higher than that of TB-polymerase chain reaction (25%, 3/12). CONCLUSION: IS ELISPOT showed relatively high diagnostic value and accuracy in the TB group, independent of smear positivity. IS ELISPOT may provide additional diagnostic yield for microbiological tools in the rapid diagnosis of smear-negative TB.

Impact of Implementation of an Automated Liquid Culture System on Diagnosis of Tuberculous Pleurisy

This study was conducted to evaluate the impact of implementation of an automated liquid culture system on the diagnosis of tuberculous pleurisy in an HIV-uninfected patient population. We retrospectively compared the culture yield, time to positivity, and contamination rate of pleural effusion samples in the BACTEC Mycobacteria Growth Indicator Tube 960 (MGIT) and Ogawa media among patients with tuberculous pleurisy. Out of 104 effusion samples, 43 (41.3%) were culture positive on either the MGIT or the Ogawa media. The culture yield of MGIT was higher (40.4%, 42/104) than that of Ogawa media (18.3%, 19/104) (P<0.001). One of the samples was positive only on the Ogawa medium. The median time to positivity was faster in the MGIT (18 days, range 8-32 days) than in the Ogawa media (37 days, range 20-59 days) (P<0.001). No contamination or growth of nontuberculous mycobacterium was observed on either of the culture media. In conclusion, the automated liquid culture system could provide approximately twice as high yields and fast results in effusion culture, compared to solid media. Supplemental solid media may have a limited impact on maximizing sensitivity in effusion culture; however, further studies are required.

The First Case of Capillaria hepatica Infection in a Nutria (Myocastor coypus) in Korea

This study reports the first case of Capillaria hepatica infection in a nutria in Korea. Ten nutrias, captured near the Nakdong River, were submitted to our laboratory for necropsy. White-yellowish nodules were found in the liver of 1 of the nutrias at necropsy. Histologically, the lesions were granulomatous, and infiltrations of lipid-laden macrophages, eosinophils, and several multinucleated giant cells were observed. The lesions consisted of numerous eggs and necrotic hepatocytes. The eggs were lemon-shaped and had polar plugs at the ends of both long sides. The eggs were morphologically identified as those of C. hepatica. Worldwide, C. hepatica infection in nutrias is very rare. Nutrias are a kind of livestock, as well as wildlife; therefore, an epidemiological study for parasitic infections needs to be conducted.

Endovascular Embolization of Intracranial Aneurysms Using Bare Platinum Axium(TM) Detachable Coils: Immediate and Short-Term Follow-up Results from a Multicenter Registry / 신경중재치료의학

PURPOSE: Axium(TM) coils were developed to improve the durability of coil-embolized cerebral aneurysms by increasing packing density. The purpose of this prospective multicenter registry was to evaluate the safety and durability of Axium(TM) coils. MATERIALS AND METHODS: One hundred twenty-six patients with 135 aneurysms of < or = 15 mm in size underwent coil embolization using bare platinum coils, with Axium(TM) coils constituting over 50% of the total coil length. Immediate and short-term follow-up results were prospectively registered and retrospectively evaluated. RESULTS: Of the 135 aneurysms (83 unruptured and 52 ruptured), immediate post-embolization angiography revealed complete occlusion in 80 aneurysms (59.3%), neck remnants in 47 (34.8%), and incomplete occlusion in 8 (5.9%). The mean packing density was 42.8% (range, 9.5 - 90%) with Axium(TM) coil length constituting a mean of 87.9% of total coil length. The rate of procedure-related complications was 16.3%. Procedure-related permanent morbidity and mortality rates were 3.2% and 0.8%, respectively. Follow-up catheter or MR angiography, which was available in 101 aneurysms at 6 - 15 months (mean, 7.7 months), revealed stable or improved occlusion in 95 aneurysms and worsening in 6 aneurysms (5.9%). Lower packing density (< 30%) remained the only predictor for anatomical worsening on multivariable logistic regression analysis (P < 0.05). CONCLUSION: In this registry, Axium(TM) coils showed a relatively low rate of anatomical worsening on short-term follow-up imaging with an acceptable periprocedural safety profile compared to reports of other platinum coils. These results may warrant further study of long-term durability with Axium(TM) coils in larger populations.

Acute Severe Hyponatremia with Seizure Following Polyethylene Glycol-Based Bowel Preparation for Colonoscopy / 고신대학교의과대학학술지

4 liters of polyethylene glycol (PEG) solution is commonly used to evacuate the colon before colonoscopy. This substance, however, is known to cause electrolyte abnormalities such as hyponatremia. Seizures caused by hyponatremia associated with bowel preparation have only rarely been reported. We report the case that a 75-year-old woman with no prior history of seizures was developed severe hyponatremia (112 mEq/L) with generalized tonic-clonic seizure and mental change after ingestion of 4L of PEG solution. Past medical history was notable for thiazide diuretics. Her symptoms are improved during intravenous administration of hypertonic saline for the correction of hyponatremia. Patients with impaired ability to excrete free water those with renal insufficiency, hypothyroidism, mineralocorticoid deficiency, liver cirrhosis, or heart failure as well as those taking drugs which including thiazide diuretics, NASIDs, and ACE inhibitors have risk of hyponatremia following bowel preparation for colonoscopy. We conclude that physicians should check patient's condition and electrolyte abnormalities before colonoscopy procedures.

A Case of Infective Endocarditis Occurred during Treatment for Infectious Spondylitis Accompanied by Peptostreptococcus Anaerobius Bacteremia / 고신대학교의과대학학술지

It is necessary to distinguish between pyogenic and tuberculous spondylitis of infectious spondylitis, if it is pyogenic spondylitis, antimicrobial therapy should be directed against an identified microorganism and clinical assessment should be done at 4 weeks. But if microorganism is a anaerobic bacteria, especially Peptostreptococcus anaerobius, combination antibiotic therapy should be considered bacause it may be a component of mixed infections as a passenger and have abilities to induce abscesses, other bacterial growth as a synergy effect. In addition, echocardiography may be necessary because pyogenic spondylitis is associated with infective endocarditis about 12%. We report a 64-year-old man who was treated for infectious spondylitis accompanied by Peptostreptococcus anaerobius bacteremia, but had to undergo heart surgery because an attack of infective endocarditis with systemic embolism during hospitalization.

Cerebral Venous Thrombosis Complicated by Intracranial Hypotension

Intracranial hypotension caused by cerebral venous thrombosis has rarely been reported. We report a patient with cerebral venous thrombosis with intracerebral hemorrhage complicated by intracranial hypotension. Initial manifestations were headache, drowsy mentality, generalized tonic-clonic seizure and left-sided weakness. The pattern of headache changed and typical orthostatic headache developed after anticoagulation following endovascular thrombolysis. If an orthostatic headache develops in patient with cerebral venous thrombosis, subsequent intracranial hypotension may be considered.

Case of Mycobacterium Massiliense Infection Presenting as Recurrent Pneumonia in Sjogren's Syndrome / 대한내과학회지

Mycobacterium massiliense is an emerging pathogen that is increasingly reported as a causative agent occurring during medical procedures, at surgical sites, and intramuscularly [1]. Although previously classified as part of M. abscessus, M. massiliense has recently been identified as a new species of rapidly growing nontuberculous mycobacteria [1,3] via a comparative sequence analysis of rpoB and hsp65 [3,5]. However, the clinical manifestations of M. massiliense have not been well characterized. We report here in a case of recurrent pneumonia for 3 years that improved with antibiotic treatment for M. massiliense in a 37-year-old woman with Sjogren's syndrome. The patient showed a substantial response to treatment with a combination of antimicrobial therapies comprising clarithromycin and amikacin without cefoxitin for 6 months. This is the first report of pulmonary infection of M. massiliense with Sjogren's syndrome in Korea.

Distal Renal Tubular Acidosis with Nephrocalcinosis in a Patient with Primary Sjogren's Syndrome

Renal involvement is not uncommon in primary Sjogren's syndrome; however, it is clinically insignificant in most cases. Distal renal tubular acidosis accounts particularly for the majority. While the underlying distal renal tubular acidosis is an important cause of nephrocalcinosis and urolithiasis, nephrocalcinosis is rarely a presenting feature of primary Sjogren's syndrome. We report a 65-year-old woman who was diagnosed with distal renal tubular acidosis accompanied by primary Sjogren's syndrome, according to nephrocalcinosis, which was incidentally identified by an abdominal ultrasonography during a medical examination.

Left Ventricular Myxoma Leading to Left Ventricular Outflow Tract Obstruction / 대한내과학회지

Cardiac myxoma is the most common primary cardiac tumor, but ventricular myxoma accounts for only 5% of the cases. We report a case of a 62-year-old woman with a left ventricular myxoma emerging from the ventricular side of the mitral valve that led to left ventricular outflow tract obstruction. The patient complained of chest discomfort and dyspnea. A mobile intracardiac mass was seen on echocardiography. The mass was excised and confirmed to be a myxoma by histopathological examination. She was discharged from the hospital without complications and remains asymptomatic.

A Case of Angiotensin Converting Enzyme Inhibitor-Induced Systemic Lupus Erythematosus

Drug-induced lupus erythematosus is defined as a lupus-like syndrome related to continuous drug exposure which resolves after discontinuation of the offending drug. Here we report a case of a 70-year-old man who developed drug-induced lupus erythematosus after receiving angiotensin converting enzyme inhibitor medication for unstable angina pectoris, for 5 years. He was hospitalized with arthralgia, edema, and newly developed pleural effusion. The serum analysis revealed an elevated level of antinuclear antibody and antihistone antibody. After discontinuation of angiotensin converting enzyme inhibitor and receiving a course of prednisolone treatment, his symptoms and pleural effusion improved. To the best of our knowledge, this is, the first case report of angiotensin converting enzyme inhibitor-induced systemic lupus erythematosus in Korea.

Significance of Clopidogrel Resistance Related to the Stent-Assisted Angioplasty in Patients with Atherosclerotic Cerebrovascular Disease

OBJECTIVE: To evaluate the prevalence and risk factors of clopidogrel resistance, and association between thromboembolic complications and clopidogrel resistance in patient with stent-assisted angioplasty for atherosclerotic cerebrovascular disease. METHODS: Between September 2006 and June 2008, clopidogrel resistance test was performed on 41 patients who underwent stent-assisted angioplasty for atherosclerotic cerebrovascular disease. It was performed before drug administration and about 12 hours after drug administration (loading dose : 300 mg, maintain dose : 75 mg). Two patients were excluded, and 41 patients were included (mean : 67.59+/-7.10 years, age range : 41-79). Among 41 patients, 18 patients had intracranial lesions, and 23 had extracranial lesions. We evaluated the prevalence, risk factors and complications related to clopidogrel resistance. RESULTS: Twenty-one patients (51.2%) showed clopidogrel resistance [intracranial : 10 patients (55.6%), extracranial : 11 patients (47.8%)] and no clopidogrel resistance was seen in 20 patients. Hypercholesterolemia was an indepedent risk factor of clopidogrel resistance. Stent-assisted angioplasty was technically successful in all patients, but acute in-stent thrombosis occurred in 5 patients with intracranial lesions (4 patients with clopidogrel resistance and 1 without clopidogrel resistance). Acute thrombi were completely lysed after intra-arterial infusion of abciximab. CONCLUSION: There was relatively high prevalence of clopidogrel resistance in patients with atherosclerotic cerebrovascular disease. Hypercholesterolemia was an independent predictive factor of clopidogrel resistance. Acute in-stent thrombosis was more frequently seen in the clopidogrel resistant group. Therefore, clopidogrel resistance test should be performed to avoid thromboembolic complications related to stent-assisted angioplasty for atherosclerotic cerebrovascular disease, especially patients with hypercholeterolemia and intracranial lesion.

A Case of Prostatic Abscess due to Burkholderia pseudomallei / 대한내과학회지

Melioidosis is an infectious disease caused by the Gram-negative bacillus, Burkholderia pseudomallei. It is endemic in Southeast Asia and northern Australia, where B. pseudomallei is a soil saprophyte and invades the host through inoculation, inhalation or ingestion. It infects mostly adults with predisposing conditions, mainly diabetes mellitus. The lung is the most commonly affected organ, presenting with either cough or fever resulting from a primary spread. Also, seeding and abscess formation can arise in any organ. However, prostatic abscess due to melioidosis is uncommon. We report a case of pneumonia, and prostate and scrotal abscesses due to Burkholderia pseudomallei, in a 48-year-old man with diabetes mellitus who had a history of working in Malaysia. This is the first report of genitourinary infection of melioidosis in Korea.

Changes in Sexual Function after Mid-Urethral Tape Sling Operations for Stress Urinary Incontinence in Korean Women

PURPOSE: We assessed sexual function by using a questionnaire in women who were diagnosed with stress urinary incontinence and underwent mid-urethral tape sling surgery. MATERIALS AND METHODS: A retrospective survey was conducted of 151 women without evidence of detrusor overactivity or concomitant prolapse who underwent surgery (tension-free vaginal tape or tension-free vaginal tape-obturator) for stress urinary incontinence. The participants filled out a questionnaire regarding their preoperative and 6-month postoperative sexual function. Paired t-tests were used to compare changes over time. The generalized McNemar test was used to compare individual preoperative and postoperative findings. We considered a p-value less than 0.05 as significant. RESULTS: Of the 303 women who fulfilled the inclusion criteria, 204 (67.3%) returned the questionnaire. Of those 204 women, 151 were sexually active before and after surgery. No significant differences were observed after surgery in the frequency or appreciation of intercourse or the extent of sexuality. A significant reduction in leakage symptoms was observed after surgery (p<0.01). Of the 151 women, 29 (19.2%) reported an improvement in satisfaction with intercourse and 23 (15.2%) reported a deterioration after the anti-incontinence procedure. Partner discomfort remained unchanged. Of the 151 patients, 26 (17.2%) patients were unsatisfied with the surgical outcome because of persistence or recurrence of stress urinary incontinence and deterioration in satisfaction with intercourse after surgery. CONCLUSIONS: These results suggest that mid-urethral tape sling operations for stress urinary incontinence improved the continence rate, but had little effect on preexisting sexual disturbances. Additional and larger retrospective studies are warranted to support these preliminary findings.

Relations between Prostatic Calculi and Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia

PURPOSE: Recently as ultrasonography is increasingly used to evaluate lower urinary tract symptoms (LUTS) in the elderly patients, prostatic calculi are more often revealed; however, the mechanism of formation of prostatic calculi is not clearly known, and their impacts on LUTS are controversial. We investigated whether the type and location of prostatic calculi might influence LUTS in benign prostatic hyperplasia (BPH) patients. MATERIALS AND METHODS: From July 2003 to January 2008, 1,437 consecutive patients underwent transrectal ultrasonography. Of these patients 383 with clinical BPH were retrospectively studied. According to the type (type A: a discrete small reflection; type B: a large mass of multireflection; type M: mixed) and location (periurethral vs. non-periurethral) of prostatic calculi, the serum prostate-specific antigen (PSA) levels, volume of prostate, maximum urinary flow rate and residual urine volume, and International Prostate Symptom Score (IPSS) were compared. RESULTS: Prostatic calcification was found in 70% (268/383), and type A in 38%, type B in 46% and type M in 16%. There was no significant difference according to the presence or types of prostatic calcification, comparing serum PSA levels, volume of prostate, maximum urinary flow rate and residual urine volume. And there was no significant correlation between the types of prostatic calcificaton and each item of IPSS. Periurethral and non-periurethral prostatic calcification failed to show the significant difference in each items of IPSS. CONCLUSIONS: There is no significant difference in LUTS according to presence, types, or locations of prostatic calculi in clinical BPH patients.

Track Seeding in a Breast Cancer Patient after a 14-Gauge Core Needle Biopsy: A Case Report

US-guided large-gauge core needle biopsy has replaced fine-needle aspiration and excisional biopsy for sampling suspicious breast lesions. The core needle biopsy has many advantages: it is relatively simple, it can be done with local anesthesia, it enables accurate targeting under sonographic guidance and it leaves no scar. However, one rare disadvantage of this technique is the possible seeding of malignant cells along the needle track. We report here on a case of gross track seeding in a 76-year-old woman, and this was observed 70 days after performing a 14-gauge core needle biopsy.

The Differences of the Magnetic Resonance Spectroscopy Findings Between a Subacute Infarction and a Malignant Glioma with a Similar Mass-Like Enhancing Lesion

PURPOSE: We evaluated the usefulness of magnetic resonance spectroscopy (MRS) method to differentiate the mass-like enhancing subacute infarction from malignant gliomas. MATERIALS AND METHODS: Twenty patients (M:F =11:9, mean age: 56.1 yrs) with mass-like enhancing lesions (via an MRI) were studied. Ten of the twenty patients suffered a subacute infarction, whereas the other ten had malignant gliomas. The subacute infarctions were confirmed clinically by a follow-up MRI, while malignant gliomas were confirmed via surgical biopsies. We checked the metabolite peak intensity (Choline [Cho], Creatine [Cr], N-acetyl-aspartate [NAA]) and the metabolite ratios (Cho/Cr, NAA/Cr) of (1)H MRS data, obtained on mass-like enhancing lesion in subacute infarction and malignant glioma. RESULTS: Of the (1)H MRS confirmed, the subacute infarctions (10 cases), three metabolites were identified at peak intensity (NAA, Cho and Cr peak intensity), which decreased below the normal value, while eight of ten patients (80%) of the malignant gliomas, showed a noticeable increase in Cho peak intensity, with decreased NAA and Cr peak intensity. The Cho peak intensity was statistically different between the two groups (p < 0.05). The two groups revealed that all increased Cho/Cr ratio; however, the malignant glioma group showed an increase in Cho/Cr ratio over the subacute infarction group (p < 0.05). CONCLUSION: The MRS findings revealed that the decreased Cho level, as well as the slightly increased Cho/Cr ratio on the mass-like enhancing lesion, suggests a subacute infarction rather than a malignant glioma.