A Case of Heyde's Syndrome with Abnormal von Willebrand Factor / 대한소화기학회지

A 68-year-old woman with known severe aortic stenosis was admitted to the hospital because of hematochezia and dizziness. She had received several blood transfusions over the preceding 3 years and undergone right hemicolectomy 2 years ago for severe lower gastrointestinal bleeding. Postoperative histology revealed angiodysplasia involving the ascending colon. After the hemicolectomy, she continued to have hematochezia and anemia and required additional blood transfusions for anemia. During this admission, platelet count, activated partial-thromboplastin time, von Willebrand factor antigen, and von Willebrand factor ristocetin cofactor were normal. She had a severe deficiency of high-molecular-weight multimers of von Willebrand factor. Colonoscopy showed angiodysplasia in the transverse colon at this time. Successful coagulation of the bleeding angiodysplasia was achieved by argon plasma coagulator. No additional bleeding was observed thereafter. We report a case of Heyde's syndrome with abnormal von Willebrand factor in a patient who presented with intestinal angiodysplasia and aortic stenosis.

Two Cases of Small Intestinal Nodular Lymphoid Hyperplasia / 대한소화기내시경학회지

Pseudolymphoma or lymphoid hyperplasia is a rare clinicopathologic disease which occurs in a variety of sites including the skin, orbit, salivary glands, gastrointestinal tract, lung, and other organs. Lymphoid hyperplasia of the gastrointestinal tract can be categorized into four clinicopathologic groups: focal lymphoid hyperplasia of the stomach, focal lymphoid hyperplasia of the small intestine, focal lymphoid hyperplasia of the rectum, and nodular lymphoid hyperplasia of the gastrointestinal tract. We experienced two cases of nodular lymphoid hyperplasia of the small intestine with hypogammaglobulinemia (IgA deficiency) and without hypogammaglobulinemia presented with epigastric discomfort. Esophagogastroduodenoscopy and small bowel series showed 0.2~.5 cm sized small, numerous Yamada-I or Yamada-II polypoid lesions from the duodenal bulb to the terminal ileum in two cases. Histologic finding of the duodenal bulb showed small round mature lymphocyte infiltration and reactive follicle with germinal center in two cases. We report two cases with a brief reviews of literature.

A case of polymyositis associated with scrub typhus / 대한내과학회지

We report the case of a 32-year-old female who developed polymyositis associated with scrub typhus. She exhibited the eschar with high titer of anti-Rickettsia(R)-tsutsugamushi antibody, severe muscle weakness, markedly elevated serum levels of muscle enzymes, EMG changes, and infiltration of macrophages in a muscle biopsy specimen. Initiation of appropriate antibiotic therapy resulted in complete healing of scrub typhus and disappearance of symptoms and signs of polymyositis within 1 month after high dose steroid therapy. We suggest that scrub typhus also be included within the causes of idiopathic inflammatory polymyositis.

A Case of Intrapericardial Cystic Teratoma

Teratoma of the heart is very rare and occurs mainly in children. A 44-year-old male patient was admitted due to foreign body sensation on throat and chest discomfort for a month. Chest CT, MRI and trans- thoracic and transesophageal echocardiographies showed 12x10 cm sized cystic mass with septataion and solid nodules, combined with pericardial and pleural effusion. Excision of the tumor was done and the pathologic diagnosis was mature cystic teratoma arising from pericardium.

The Clinical Characteristics of Hepatitis-B Virus Associated Membranous Nephropathy and Membranoproliferative Glomerulonephritis / 대한신장학회잡지

Chronic hepatitis B viral infection causes membranous nephropathy and membranoproliferative glomerulonephritis. Patients with positive serum HBsAg with membranous nephropathy or membranoproliferative are considered as hepatitis B virus associated glomerulonephritis(HBV-GN) in epidemic areas of hepatitis B viral infection. To elucidate the clinical difference between hepatitis B virus-associated membranous nephropathy and membranoproliferative glomerulonephritis, and idiopathic membranous nephropathy and membranoproliferative glomerulonephritis, the authors conducted a clinical study including 71 cases of patients with renal biopsy proven diagnoses. Among the patients with hepatitis B virus antigenemia, the pathologic diagnoses were 7 membranous nephropathy(HBV-MN), 13 membranoproliferative glomerulonephritis(HBV-MPGN) but patients with mixed pattern of both membranous nephropathy and membranoproliferative glomerulonephritis were excluded. For the patients with idiopathic glomerulonephritis, 35 of membranous nephropahty(MN) and 16 cases of membranoproliferative glomerulonephritis (MPGN) were enrolled in this study. The patients of HBV-GN groups had more than 80% of HBe antigenemia. The nephrotic range proteinuria presented more frequently in HBV-MN(86%) than in MN group(54%). The cases of HBV-MPGN group(4 cases, 31%) showed nephrotic range proteinuria less frequently than those with MPGN(69%, p< 0.05) and significant discrepancy existed in HBV- MN vs HBV-MPGN and HBV-MPGN vs MPGN. The cases with decreased serum C3 level below normal were over 50% of HBV-GN and MPGN group except MN group. Serum levels of SGOT and SGPT were significantly elevated in HBV-MN and HBV- MPGN groups than those of MN and MPGN groups, respectively(p<0.05). The number of cases with increased SGOT, SGPT and gamma-GTP were 4(57%), 2 (29%) and 1(16%) in HBV-MN and 15(83%), 12(67%) and 9(75%) cases in HBV-MPGN group, in respectively. The cases developed progressive renal functional impairment during follow-up period of at least one year were 3 of 5(60%) in HBV-MN, 2 of 8 (25%) in MPGN and 3 of 9(33%) in HBV-MPGN groups which were significantly more than 2 of 22 cases(9%) in MN group(respectively p<0.05, not in HBV-MPGN vs MN). The renal functional impairment rate defined by the ratio of patients with their serum creatinine elevated above 2mg/dL over 3 months in each group was more rapidly increased in HBV-MPGN and HBV-MN than the idiopathic groups by Kaplan-Meier statistic analysis. We suggest that the patients with HBV-associated glomerulonephropathy seem to have worse prognosis in terms of renal functional impairment than those with idiopathic types of glomerulonephropathy with same pathology.