A case of primary bilateral adrenal non-Hodgkin's lymphoma / 대한내과학회지

Primary adrenal lymphoma is extremely uncommon. The tumor is accidentally discovered by abdominal ultrasonography(USG), computed tomography(CT) or magnetic resonance imaging (MRI) in patients with nonspecific symptoms and diagnosed at operation or autopsy. In this case, a 60-year-old man was admitted for the evaluation of mild left frank discomfort for two months before admission. The abdominal USG was performed and showed the dense masses in both adrenal glands. The laboratory tests including blood count, chemistry and hormonal tests showed the normal levels except for the basal ACTH level of 108 pg/ml(normal range: 9~52 pg/ml). The 123I MIBG scan was normal. The bilateral adrenalectomy was done. The tumor was diagnosed as diffuse large B-cell non-Hodgkin's lymphoma(NHL) according to the Revised European-American lymphoma(REAL) classification. He was treated with the adjuvant combination chemotherapy of CHOP(cyclophosphamide, adriamycin, vincristine and prednisolone) but expired due to sepsis after the second chemotherapy. We describe the first case of primary bilateral adrenal NHL in Korea. Primary adrenal lymphoma should be included in the differential diagnosis of suprarenal mass.

A Case of a Choledochal Cyst Combined with a Hepatocellular Carcinoma / 대한소화기내시경학회지

A choledochal cyst is relatively rare lesion in the biliary system, and a carcinoma arising from such a cyst is rarely reported. Until now, a case of a hepatocellular carcinoma combined with a choledochal cyst had not been reported. A 45-year-old woman was recently admitted due to abdominal pain. An abdominal computed tomography revealed a 5 cm-sized low attenuative mass involving the right anterior and left medial segment of the liver and gallbladder fossa. An endoscopic retrograde cholangiopancreatogram showed fusiform dilatation of the common bile duct, but anomalous union of pancreaticobiliary duct was not observed. Fine-needle aspiration of the liver was conducted and yielded a hepatocellular carcinoma. On celiac arteriography, a hypervascular hepatic mass was also found. Transarterial chemoembolization was performed. It is believed this may be the first case of a choledochal cyst combined with a hepatocellular carcinoma in the literature. Hence, this case is herein reported with a review of related literatures.

A Case of Mucinous Ductal Ectasia of the Pancreas Associated with Malignant Ascites and Liver Metastasis / 대한소화기내시경학회지

A 71-year-old man was admitted due to abdominal distension and periumbilical pain. He was diagnosed as having mucinous ductal ectasia (MDE) of the pancreas three months prior, but refused an operation. Three months later, an abdominal computed tomography revealed more dilated pancreatic duct, newly developed liver metastasis and ascites in comparison with previous findings. Fine-needle aspiration cytology of the cystic lesion in the pancreatic head was conducted and yielded adenocarcinoma. Also, an ascitic fluid cytology determined adenocarcinoma. This patient was diagnosed to be inoperable and received palliative chemotherapy and pain control. The patient expired 5 months after the initial diagnosis.

A Case of Angiosarcoma of the Maxillary Sinus / 대한암학회지

Angiosarcomas are extremely rare in the nasal cavity and para-nasal sinus. Upto the present only nineteen cases have been reported in the literature. A 31-year-old male presented with right facial swelling and large oral cavity mass. He was treated with wide excision of the tumor by radical maxillectomy. The tumor was diagnosed as angiosarcoma by immunohistochemical staining with factor VIII-reactive antigen. No adjuvant radiotherapy after surgery was done. After 9 montbs from surgery, the tumor recurred in the primary sites of oral cavity and right maxillary sinus and metastasized to the both lungs. He was treated with palliative chemotherapy and showed a stable disease in follow-up magnetic resonance image of para-nasal sinus and simple chest X-ray after second cycle of chemotherapy. He is undergoing further chemotherapy without any problems. We report first in Korea a case of primary angiosarcoma of the right maxillary sinus in a 31-year-old male.

The Effect of Oxygen Therapy on VPB in Patients with Chronic Obstructive Pulmonary Disease / 결핵

BACKGROUND: In patients with chronic obstructive pulmonary disease(COPD), it is well known that hypoxemia increases the frequency of VPB, which is associated with the poor prognosis such as sudden death. The aim of this study is to evaluate the effect of short and long-term low flow oxygen therapy on the development of VPBs in patients with COPD by correcting the hypoxemia. METHOD: In 19 patients with COPD, oxygen saturation and VPB are monitored by pulse oxymeter and 24-hour Holter EKG, with room air and the 1st and the 8th day during oxygen therapy by nasal prong (2L/min). RESULTS: The arterial oxygen saturation was significantly higher on the 1st day of oxygen therapy compared with breathing room air, and also higher on the 8th day of oxygen therapy than on the 1st day. We found that there was significant correlation between the minimal value of the arterial oxygen saturation and the mean value of the arterial oxygen saturation. The number of VPBs per hour was significantly higher on the 1st day of oxygen therapy compared with breathing room air, and also higher on the 8th day of oxygen therapy than on the 1st day. There was no significant correlation between the decrease of the frequency of VPBs and the increase of the minimal arterial oxygen saturation. But, because of the low p value as 0.056, The correlation is highly suggested. CONCLUSION: With oxygen therapy, the arterial oxygen saturation was increased and the number of VPBs was decreased, and with long-term oxygen therapy more than 7days, the number of VPBs was more decreased in patients with COPD.

Diagnostic Ability of Arm Exercise Thallium-201 SPECT in Detecting Coronary Artery Disease

BACKGROUND: Exercise testing is a standard noninvasive method used in the evaluation and management of patients with suspected coronary artery disease. However, patients with lower limb impairment are unable to undergo a standard bicycle or treadmill test. Alternative methods of exercise testing are needed for patients with vascular, orthopedic or neurologic conditions who cannot perform leg exercise. This study was aimed to determine the diagnostic accuracy of arm exercise thallium-201 SPECT for evaluating chest pain in patients unable to perform leg exercise. METHOD: Twenty-five anginal patients performed arm ergometry testing in conjunction with thallium-201 SPECT. Thereafter all underwent coronary angiography. RESULT: Significant coronary artery disease (> or =50% stenosis) in at least one vessel was present in 22 (88%) of the 25 patients. The sensitivity of thallium-201 SPECT for detecting coronary artery disease was 91%, which was significantly higher than the 32% sensitivity found with the electrocardiographic response alone (p <0.001). Thallium-201 SPECT yielded a sensitivity of 88, 86 and 100% for one, two, and three vessel diseases, respectively, and an 84% sensitivity and 81% specificity for detecting individual vessel stenosis. CONCLUSION: Arm exercise thallium-201 SPECT is useful for detecting coronary artery disease in patients unable to perform leg exercise. In addition, it provides an information regarding exercise tolerance. Therefore, this test appears to be reliable and useful and should be considered in the detection of coronary artery disease in nonambulatory patients.