A Case of Weil's Disease associated with Acute Pancreatitis

Leptospirosis is a zoonotic disease of worldwide distribution that is caused by spirochetes known as Leptospira; more than 20 serogroups and more than 200 serovars are known. The disease has seasonal incidence occurring in the late summer or early fall. The typical severe case of leptospirosis is known as Weil's disease; it is characterized by hepatic and renal involvement and is common in Korea. Elevated amylase can be seen when ARF is associated but true acute pancreatitis is an uncomon complication of leptospirosis and only seven cases of well documented pancreatitis have been described abroad, with there was no case report in Korea yet. We experienced a 55-year old male patient who had Weil's disease associated with acute pancreatitis which was confirmed by elevated amylase and lipase with pancreatic swelling and peripancreatic fat infiltration on abdomen CT.

A Case of Weil's Disease associated with Acute Pancreatitis

Leptospirosis is a zoonotic disease of worldwide distribution that is caused by spirochetes known as Leptospira; more than 20 serogroups and more than 200 serovars are known. The disease has seasonal incidence occurring in the late summer or early fall. The typical severe case of leptospirosis is known as Weil's disease; it is characterized by hepatic and renal involvement and is common in Korea. Elevated amylase can be seen when ARF is associated but true acute pancreatitis is an uncomon complication of leptospirosis and only seven cases of well documented pancreatitis have been described abroad, with there was no case report in Korea yet. We experienced a 55-year old male patient who had Weil's disease associated with acute pancreatitis which was confirmed by elevated amylase and lipase with pancreatic swelling and peripancreatic fat infiltration on abdomen CT.

Use of RNA/RNA Duplex, Base Pair-mismatch Assay and 3-(4,5-dimethylthiazol- 2-yl)-2,5-diphenyl Tetrazolium Bromide (MTT) Assay for Rapid Detection of Rifampin-resistant Mycobacterium tuberculosis

BACKGROUND: Multidrug-resistant tuberculosis is an increasing concern for public health in many parts of the world. We have evaluated the specificity and sensitivity of the mismatch assay and 3- (4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay in detecting rifampin- resistant Mycobacterium tuberculosis. METHODS: Eleven rifampin-susceptible and 15 rifampin-resistant M. tuberculosis strains were isolated from clinical specimens obtained from patients in Yonsei University College of Medicine, Severance Hospital. RNA/RNA duplex, base pair-mismatch assay (Mismatch Detect II kit, Ambion) and MTT assay were performed. RESULTS: The specificity and sensitivity of detection of rifampin resistance were 91% and 87% in mismatch assay and 73% and 67% in MTT assay, respectively. CONCLUSION: These results suggest the usefulness of mismatch assay in detecting rifampin-resistant Mycobacterium tuberculosis.

Clinical Features and Prognostic Factors of Brain Abscess

BACKGROUND: Brain abscess is a important infectious disease of the central nervous system, although the mortality has been reduced due to new antibiotics therapy and improved imaging techniques. MATERIALS amp; METHODS: Over a period of 17 years, from March 1986 to Feburary 2003, 110 patients were identified as having brain abscess at the Severance Hospital. Based on medical records, we reviewed these cases and investigated retrospectively the epidemiology, clinical findings, therapeutic modalities and prognostic factors of brain abscess. RESULTS: There were 78 males and 32 females, and the mean age was 34.4 years. The most common location of brain abscess was the parietal lobe (24.5%), followed by temporal (20.9%) and frontal lobes (20.0%). Gram positive cocci were most frequently isolated as the causative microorganism. Tuberculous brain abscess were diagnosed in 6 (8.8%) cases. The common predisposing conditions were neurosurgery (21.8%), otitis media (10%) and congenital heart disease (8.2%). Headache (63.6%), fever (55.5%) and focal neurologic deficits (51.8%) were the common symptoms. Aspiration or open drainage was performed in 77 cases (70.0%), and excision was performed in 17 cases(15.5%). Thirty five (31.9%) patients had neurologic sequelae after treatment, and the mortality rate was 11.8%. Factors influencing mortality of brain abscess were mental status and multiple abscesses. CONCLUSION: Brain abscess is still a critical infectious disease of the central nervous system with high mortality and morbidity in Korea. Active surgical procedures including aspiration, open drainage or excision, as well as antibiotic therapy, are needed for the proper management.

Use of RNA/RNA Duplex, Base Pair-mismatch Assay and 3-(4,5-dimethylthiazol- 2-yl)-2,5-diphenyl Tetrazolium Bromide (MTT) Assay for Rapid Detection of Rifampin-resistant Mycobacterium tuberculosis

BACKGROUND: Multidrug-resistant tuberculosis is an increasing concern for public health in many parts of the world. We have evaluated the specificity and sensitivity of the mismatch assay and 3- (4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay in detecting rifampin- resistant Mycobacterium tuberculosis. METHODS: Eleven rifampin-susceptible and 15 rifampin-resistant M. tuberculosis strains were isolated from clinical specimens obtained from patients in Yonsei University College of Medicine, Severance Hospital. RNA/RNA duplex, base pair-mismatch assay (Mismatch Detect II kit, Ambion) and MTT assay were performed. RESULTS: The specificity and sensitivity of detection of rifampin resistance were 91% and 87% in mismatch assay and 73% and 67% in MTT assay, respectively. CONCLUSION: These results suggest the usefulness of mismatch assay in detecting rifampin-resistant Mycobacterium tuberculosis.

Clinical Features and Prognostic Factors of Brain Abscess

BACKGROUND: Brain abscess is a important infectious disease of the central nervous system, although the mortality has been reduced due to new antibiotics therapy and improved imaging techniques. MATERIALS amp; METHODS: Over a period of 17 years, from March 1986 to Feburary 2003, 110 patients were identified as having brain abscess at the Severance Hospital. Based on medical records, we reviewed these cases and investigated retrospectively the epidemiology, clinical findings, therapeutic modalities and prognostic factors of brain abscess. RESULTS: There were 78 males and 32 females, and the mean age was 34.4 years. The most common location of brain abscess was the parietal lobe (24.5%), followed by temporal (20.9%) and frontal lobes (20.0%). Gram positive cocci were most frequently isolated as the causative microorganism. Tuberculous brain abscess were diagnosed in 6 (8.8%) cases. The common predisposing conditions were neurosurgery (21.8%), otitis media (10%) and congenital heart disease (8.2%). Headache (63.6%), fever (55.5%) and focal neurologic deficits (51.8%) were the common symptoms. Aspiration or open drainage was performed in 77 cases (70.0%), and excision was performed in 17 cases(15.5%). Thirty five (31.9%) patients had neurologic sequelae after treatment, and the mortality rate was 11.8%. Factors influencing mortality of brain abscess were mental status and multiple abscesses. CONCLUSION: Brain abscess is still a critical infectious disease of the central nervous system with high mortality and morbidity in Korea. Active surgical procedures including aspiration, open drainage or excision, as well as antibiotic therapy, are needed for the proper management.

Enhancement of Human Monocyte Activities against Aspergillus fumigatus by Interleukin-15 / 대한의진균학회지

BACKGROUND: Despite recent advances in antifungal chemotherapy, invasive aspergillosis remains an important cause of morbidity and mortality in immunocompromised patients. Interleukin-15 (IL-15) is a cytokine that is known to enhance antifungal activities of monocytes against Candida albicans. OBJECTIVE: The purpose of this study is to investigate the potentials of IL-15 to enhance antifungal activities of monocytes against Aspergillus fumigatus. METHODS: Peripheral blood monocytes from healthy adults were incubated with 0, 1, 10, 100 ng/ml of IL-15 for 1, 2, and 4 days. Then, the ability of IL-15 to elicit the production of superoxide anion, the damage of hyphae by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, and the killing ability of Aspergillus fumigatus conidia was investigated. RESULTS: Incubation of peripheral blood monocytes with 100 ng/ml of IL-15 enhanced hyphal damage after 2 days (p<0.05), conidicidal activity from the first day (p<0.05), and increased the production of superoxide anion (O2- ) in response to phorbol myristate acetate. CONCLUSION: Our results indicate that IL-15 augments the microbicidal activity of human monocytes against Aspergillus fumigatus.

A Case of Hypertrophic Gastropathy and Early Gastric Cancer Associated with Pachydermoperiostosis / 대한소화기내시경학회지

Pachydermoperiostosis is a rare hereditary syndrome characterized by finger clubbing, periosteal new bone formation of tubular bones, and hypertrophic skin changes (pachydermia). This syndrome is known to be associated with a variety of diseases such as cranial suture defect, female escuchen, bone marrow failure and autonomic nervous system symptoms such as facial flushing and hyperhidrosis. There are just a few reports documenting gastric ulcer, hypertrophic gastropathy and Crohn's disease as associated diseases. A case is herein reported of pachydermoperiostosis accompanied by hypertrophic gastropathy and early gastric cancer.

Six cases of fungal endocarditis / 대한내과학회지

Fungal endocarditis is rare but has been reported with increased frequency in the last few decades. Also fungal endocarditis has become an important infection in the aspect of medical progress and predisposing factors such as previous cardiac surgery, antibiotics use and hyperalimentation, immunosuppression, long-term intravenous catheterization, and drug use. We hereby describe six cases which occurred from January 1992 at Severance hospital, Yonsei University College of Medicine. In five cases infection was associated with previous cardiac surgery and in one case associated with subcutaneous central catheterization in a patient who underwent cancer chemotherapy. Only one patient survived after intensive treatment with fluconazole and surgical removal of vegetation. Others were discharged without improvement of disease or expired during therapy. Fungal endocarditis is still a serious disease with high mortality and whenever the diagnosis is suspected, transesophageal echocardiography should be performed with empirical antifungal therapy. Antifungal therapy and surgery would yield the best results. But overall survival in patient with fungal endocarditis is rather poor. Attentions and efforts for early diagnosis are needed in order to improve the prognosis of fungal endocarditis.

Antiviral effect and safety of triple combination therapy in human immunodeficiency virus (HIV)-infected persons / 대한내과학회지

BACKGROUND: Antiretroviral combination therapy with one protease inhibitor and two reverse transcriptase inhibitors is profoundly suppressive of HIV replication. To determine the efficacy and safety of the triple combination therapy in persons with HIV infection in Korea, we analyzed the response of therapy in terms of immunity and viral load. METHODS: Ten persons with HIV infection, who were treated with triple combination therapy at least 12 months at Yonsei University College of Medicine from 1997 to 1999 were studied. The triple combination therapy regimen consisted of two reverse transcriptase inhibitors (zidovudine or didanosine, lamivudine) and one protease inhibitor (indinavir). We analyzed the levels of HIV RNA, CD4+ cell counts, beta2MG, and p24Ag before and after treatment. Adverse drug reactions during therapy were described. RESULTS: The mean age of patients at treatment was 38.7 years. Nine patients were male, and 1 patient was female. Six patients received triple combination therapy as initial treatment, while 4 patients received it as re-treatment. The mean level of HIV RNA was 129,222 copies/mm3 before treatment. RNA level decreased to less than 500 copies/mm3 (non-detectable range) at 1 month in 7 of 10 patients, at 12 months in 9 of 10 patients. The mean CD4+ cell counts was 206/mm3 before treatment, and 376/mm3 after 12 months treatment. The beta2MG decreased to 2.7 mg/L from 2.8 mg/L after 12 months of treatment. The p24Ag was positive in 3 of 10 patients and negative in all of the patients at 3 months treatment. Mild hyperbilirubinemia (5 cases) was the most frequent adverse reaction followed by flank pain (3 cases), skin rash (2 cases), abdominal discomfort (2 cases), and mild elevation of AST/ALT (1 case). CONCLUSION: The triple combination therapy in HIV infection appeared to be generally well tolerated, and was able to profoundly sustain suppression of HIV replication.

Four cases of candida meningitis / 대한내과학회지

No abstract available.

A Case Report of Purple Toe Syndrome Associated with Acute Renal Failure during Warfarin Therapy / 대한내과학회지

"Purple toe" syndrome is an extremely rare complication of warfarin therapy. The occurrence of purple toe syndrome is characterized by a sudden appearance of purplish discoloration of toes and the sides of feet. The skin lesions usually develop 3-8 weeks after beginning anticoagulation. The pathogenesis was not clearly defined but the presence of atherosclerosis in most of patients led to suggest that the mechanism was related to cholesterol emboli from the atherosclerotic plaques and warfarin- induced bleeding into the plaques. These microemboli are commonly associated with irreversible organ dysfunction such as renal failure, distal gangrene, pancreatitis, and multifocal myocardial necrosis. Therefore purple toe syndrome may be considered as a sentinel of cholesterol crystal embolism. Once established, anticoagulation and thrombolysis are contraindicated. Necrosis and gangrenous changes may result in loss of limb and occasional mortality has been reported. We report a case of purple toe syndrome associated with acute renal failure after warfarin therapy with a review of literatures.