A Case of Biliary Papillomatosis which Underwent Curative Resection / 대한소화기내시경학회지

Biliary Papillomatosis is an extremely rare pathologic entity. Only about 40 cases of intrahepatic or diffuse intra- and extrahepatic papillomatosis have been described since the first report in 1959 by Caroli. Although this is a histologically benign lesion, its course is unfavaurable because of its tendency to extend to the entire biliary tract, high recurrence rate following local excision and the probability of progression to malignancy. We described herein a case of biliary papillomatosis associated with diffuse bile duct dilatation. The patient, a 59-year-old male, was admitted to our hospital because of right upper abdominal pain and weight loss. Cholangiogram revealed multiple round filling defects in common hepatic duct with intrahepatic bile duct dilatation. The patient underwent Whipple's operation with right lobectomy. Grossly, multiple small pin-head sized polypoid masses were seen in common bile duct, common hepatic duct and right intrahepatic duct. Microscapically, papillary epithelial hyperplasia with moderate cellular atypia was seen and there was no evidence of stromal invasion. He is healthy with a follow-up for 7 months.

A Case of Becker Muscular Dystrophy Associated With Dilated Cardiomyopathy / 대한내과학회지

Dilated cardiomyopaty is a rare occurrence in Hecker muscular dystropy. We report a case of Becken muscular dystrophy in 28 old man who presented with dyspnea, progressive muscle weakness, and dilated cardiomyopathy with severe left ventricular dysfunction which was detected by echocardiograpy. Muscle biopsy demonstrated diffuse degenerated changes consistent with progressive muscular dystropy, His brother has also Becker muscular dystrophy and dilated cardiomyopathy, The patient is on NYHA Class II~III with medical therapy.

A case of idiopathic anaphylaxis / 알레르기

Idiopathic anaphylaxis is a life-threatening systemic reaction of unknown cause. The pathophysiology has not been established, although it has been postulated that the clinical manifestations of idiopathic anaphylaxis may result from the chemical mediators released by mast cells or basophils. The diagnosis of idiopathic anaphylaxis is made after an appropriate allergic evaluation and exclusion of provocative triggers. We report an unusual case of idiopathic anaphylaxis manifesting with periodically repeated urticaria, angioedema, dyspnea, and hypotension. His symptoms were not related to known causes of anaphylaxis such as foods, drugs, insect stings, or exercise. Other diseases simulating anaphylaxis were excluded by careful history, physical examination, and relevant diagnostic tests. High dose prednisolone, hydroxyzine, salbutamol, ketotifen, and methotrexate were prescribed to prevent recurrent episodes, but the symptoms relapsed 5 months after cessation of the treatment.

A Case of Crohn's Disease Associated with Takayasu's Arteritis / 대한소화기내시경학회지

Vascular manifestations as extraintestinal symptoms of inflammatory bowel diseases have rarely been reported, More than 10 case reports in the worldwide literature have suggested that Takayasu's arteritis be one of the rare vascular complications in inflammatory bowel diseases. We describe herein a 33-year-old woman with Takayasu's arteritis who was subsequently found to have Crohn's disease. Aortic arch angiogram showed typical findings of Takayasu's arteritis, and the diagnosis of Crohn's disease was made by colonoscopic and radiologic findings, clinical course, and the response to medical therapy. To our knowledge, this is the first case report in Korea.

Clinical Aspects of Bacteremia in Medical and Surgical Intensive Care Units / 결핵

BACKGROUND: Intensive care units(ICUs) probably represent the single largest identifiable source of infection within the hospital. Although there are several studies on ICU infections in respect to their bacteriology or mortality rate for individual types of ICU, few studies have compared ICU infections between different types of ICU. The aim of this study was to identify clinical differences in bacteremia between medical ICU(MICU) and surgical ICU(SICU) patients. METHODS: 256 patients with bacteremia were retrospectively evaluated. Medical records were reviewed to obtain the clinical and bacteriologic informations. RESULTS: 1) The mean age of the patients with bacteremia of MICU(58.6+/-17.2 yr) was greater than that of all MICU patients(54.3+/-17.1 yr)(p0.05). ICU stay was longer(MICU patients: 23.4 +/-40.8 day, SICU patients: 30.3 +/-26.8 day) than the mean stay of all patients(6.8+/-15.5 day)(p<0.05, respectively). Bacteremia of both ICU patients developed past the average day of ICU stay(all MICU patients: 7.9 day, all SICU patients: 6.0 day, MICU bacteremia: 19th day, SICU bacteremia: 17th day of ICU stay)(p<0.05, respectively). 2) There were no significant differences in mean age, sex, and length of stay of both ICU patients with bacteremia. 3) Use of antibiotics or steroid, use of percutaneous devices and invasive procedures before development of bacteremia were more frequent in SICU patients than in MICU patients(prior antibiotics use: MICU 45%, SICU 63%, p<0.05; steroid use: MICU 14%, SICU 36%, p<0.01; use of percutaneous devices: MICU 19%, SICU 39%, p<0.01; invasive procedures: MICU 19%, SICU 61%, p<0.01). 4) The prevalence of community acquired infections was significantly higher in MICU patients than in SICU patients(MICU 42%, SICU 9%)(p<0.01), whereas SICU patients showed higher prevalence of ICU-acquired infection than MICU patients(MICU 48%, SICU 78%)(p<0.01). 5) There were no differences in causative organisms, primary sites of infection and time interval to bacteremia between both ICUs. 6) There were no significant differences in outcome according to pathogenic organisms or primary sites of infection. 7) The mortality rate was higher in patients with bacteremia than without bacteremia(MICU mortality rate: patients with bacteremia 72.5%, patients without bacteremia 36.0%, p<0.01; SICU mortality rate: patients with bacteremia 40.3%, patients without bacteremia 8.5%, p<0.05), and the mortality rate of MICU bacteremia was significantly higher compared with that of SICU bacteremia(MICU 72.5%, SICU 40.3%)(p<0.01). CONCLUSION: ICU patients with bacteremia stayed longer before the development of bacteremia, and showed higher mortality than the overall ICU population. The incidence of bacteremia was higher in MICU patients than SICU patients. MICU patients with bacteremia showed higher prevalence of liver diseases and acute respiratory failure, community-acquired bacteremia and greater mortality rate than SICU patients with bacteremia. SICU patients with bacteremia, on the other hand, showed higher prevalence of trauma, prior use of immunosuppressive agents, invasive procedures, and ICU-acquired bacteremia, and lower mortality rate than MICU patients with bacteremia.