The Efficacy of MIBG Scan as a Diagnostic and Docalization Test for Pheochromocytoma / 대한내분비학회지

BACKGROUND: Computed tomography(CT) is currently considered as the initial imaging procedure of choice for the localization of pheochromocytomas in most of the cases. 131I-or 123I-Metaiodobenzylguanidine scintigraphy(MIBG scan) was proven to be a highly specific tool for the detection of adrenal and extra-adrenal pheochromocytomas, but was less sensitive than CT. The present study is aimed to evaluate the usefulness of a MIBG scan in diagnosis and localization of pheochromocytoma when compared to CT. METHODS: We retrospectively evaluated 27 patients who underwent a MIBG scan for a pheochromocytoma at the Seoul National University Hospital from the year 2000 and 2002. According to the pathological and clinical findings, in 16 the patients pheochromocytoma was confirmed to be positive and the rest 11 of the patients were excluded from the study. RESULTS: Pheochromocytomas was identified in 16 patients. Eleven of them were localized in adrenal gland and 5 were extra-adrenal lesions. The sensitivity to MIBG scan in adrenal lesions and extra-adrenal lesions, was 72%(8/11) and 40%(2/5) respectively. In our study, the overall sensitivity to MIBG scan was 62%(10/16), and overall specificity was 90.9%(10/11). By CT four were identified to have equivocal biochemical abnormalities, but were definite and extraadrenal tumors by MIBG scan showed abnormal uptakes in two of them. CONCLUSION: The MIBG scan was especially useful in 2 of the 27 patients but we had no experienced about the additional benefits of a MIBG scan in the other 25 cases. Our results reveal that a MIBG scan should be performed carefully for the diagnosis and localization of a pheochromocytoma, while considering cost and time of operation.

A case of nephrotic syndrome in a patient with scleroderma / 대한내과학회지

Scleroderma is a connective tissue disorder characterized by fibrosis of the skin, vessels and internal organs (gastrointestinal tract, lung, heart, and kidney etc.). Renal involvement in scleroderma has a clinical manifestation from subnephrotic proteinuria to renal crisis accompanied by hypertension, and shows a typical histology of intimal proliferation and fibrinoid necrosis of blood vessel without primary glomerular pathology. We experienced a case of nephrotic syndrome in a 31-old-female patient with sclerodema. But the patient has not showed a clinical feuture of hypertension or renal crisis, moreover, renal biopsy of the patient showed global sclerosis and crescent formation in the glomeruli without vessel involvement. We report this case with a brief review of literature.

Comamonas Acidovorans Peritonitis in a CAPD Patient Managed with Preservation of the Catheter / 대한신장학회잡지

To date, only one case of peritonitis with exit site infection in peritoneal dialysis caused by this micro- organism has been reported. In spite of its apparently benign clinical course, which distinguished it from peritonitis caused by Pseudomonas, this peritonitis relapsed and Comamonas could not be eliminated from the peritoneal liquid, probably due to the persistence of the micro-organism in the exit site. Consequently, peritoneal catheter was removed. In this case, a 68-year-old man was admitted with fever, abdominal tenderness and cloudy peritoneal effluent and empirically treated with antibiotics(cefazolin, tobramycin), intraperitoneally(IP) for 7 days. The first culture was positive for Comamonas acidovorans, sensitive to ceftazidime, cefotetan, ceftriaxone, ciprofloxaxin and imipenem and the perotoneal effluent remained cloudy after 7 days. He was treated with ceftazidime IP, oral ciprofloxacin and nystatin for 26 days. 4 days after the antibiotics treatment, the patient was asymptomatic and the cell count of peritoneal effluent was 50 WBC/mm3 with negative culture. 25 days after the treatment, the patient remained asymptomatic and with 5 WBC/mm3 in peritoneal effluent. Consequently, We experienced a case of peritonitis due to Comamonas acidovorans in a patient on CAPD without exit site infection and managed with preservation of the catheter.