Total Plasma Exchange in a Patient with HD-MTX-induced Acute Renal Failure: A Case Report / 대한혈액학회지

A 16-year-old male patient was diagnosed as chondroid osteosarcoma of the left humeral shaft. He showed normal serum creatinine level and no complications following the first course of high-dose methotrexate (HD-MTX) chemotherapy with a total dose of 12g/m2. After the 2nd HD-MTX chemotherapy with the same dosage as in the 1st course, plasma MTX levels soared up to 72micromol/L and serum creatinine level increased to 1.39mg/dL. We failed to lower the plasma MTX levels and to recover the renal function by high-dose leucovorin rescue and plasmapheresis. Plasma MTX level was successfully lowered after three consecutive total plasma exchanges and the withdrawal of aceclofenac which was suspected as an aggravating agent. No rebound in plasma MTX level was observed. We report that total plasma exchanges were effective in a patient with renal failure and delayed MTX excretion which occurred after HD-MTX chemotherapy.

A Case of Idiopathic Colorectal Varices: Case report / 대한소화기내시경학회지

Colorectal varix (CRV) is a rare cause of lower gastrointestinal bleeding and usually associated with portal hypertension from liver cirrhosis or portal venous obstruction. Idiopathic CRV have no identifiable underlying cause and can only be diagnosed after the cause of portal or mesenteric vein circulation have been excluded. We report a case of idioipathic CRV presented with rectal bleeding for a week. Colonoscopy revealed markedly dilatated tortuous, and bluish veins in the rectum as well as coexistent adenomatous polyp and internal hemorrhoid. Despite extensive investigation, there was no evidence of portal hypertension or any other cause. Family history was also negative. Although blood transfusions were required, the patient remained asymptomatic without further rectal bleeding.

Proton Magnetic Resonance Spectroscopy in Patients with Neuro-Behcet's Disease / 대한류마티스학회지

Magnetic resonance imaging (MRI)and computed tomography had been used to detect the neurologic lesions of the Behcet's disease.However,there are a number of cases which can not be detected by conventional imaging studies in neuro-Behcet's disease.To overcome this problem,magnetic resonance spectroscopy (MRS)has been introduced in several autoimmune diseases involving central nervous system such as neuropsychiatric lupus,but which was rarely performed in Behcet's disease.In the present study,we report two cases of neuro-Behcet's disease that showed normal MRI but abnormal proton MRS (1HMRS)findings.MRS in two cases revealed a reduction of the N-acetyl aspartate (NAA)/creatine (Cr)ratio in the substantia nigra and thalamus,respectively, which were the areas without abnormality on MRI,suggesting a functional defect of neurons in these areas.In a case with thalamic dysfunction,abnormal NAA/Cr ratio was normalized in parallel with clinical improvement after treatment with high-dose steroids and immuno-suppressive agents.These observa-tions suggest that MRS may be useful to early detect the functional abnormality in neuro-Behcet's disease and to monitor neurologic status after treatment with immuno-suppressive agents.

A Case of Relapsing Polychondritis Associated with Sjogren's Syndrome / 대한류마티스학회지

Relapsing polychondritis is a rare multisystem rheumatic disease,characterized by recurrent and potentially destructive inflammatory lesions of cartilaginous structures.All types of cartilage & other proteoglycan-rich structures may be involved,resulting in auricular chondritis,laryngotracheal chondritis,ocular symptoms,vasculitis,cardiac abnormalities,skin lesions and glomerulonephritis. The disease may be associated with another connective tissue and autoimmune diseases such as rheumatoid arthritis,systemic lupus erythematosus,Sjogren's syndrome and systemic vasculitis. We experienced a 69-year-old female patient who had been previously diagnosed as Sjogren's syndrome,presenting respiratory tract involvement,episcleritis,auricular chondritis and vestibular dysfunction.

Endoscopic Removal of a Metal Thread in the Duodenal Wall after Eating Raw Fish: A case report / 대한소화기내시경학회지

Foreign bodies in the stomach and duodenum are usually accidentally swallowed by children, mentally ill patients, alcoholics, or persons with dentures. Swallowed foreign bodies are usually asymptomatic, and moved down the alimentary tract to be passed spontaneously without discomfort. There had been reported many kinds of foreign bodies, for example, metal fragments, fish bones and so on. A metal thread, which looks like a fishing hook in gastrointestinal tract as a foreign body, has never been reported in humans. A 62-year-old male patient was admitted due to abdominal discomfort for five days after eating raw fish. We performed gastroduodenoscopy and could find a thread penetrating to the anterior wall of duodenal bulb. It was removed by biopsy forcep. Herein, we report a case of a metal thread in duodenal bulb, which looked like a fishing hook.

Small Intestinal Obstruction due to Phytobezoars: Case reports / 대한소화기내시경학회지

Phytobezoars are the most common type of bezoars composed of nondigestible food material. They are usually formed in stomach and do not migrate to the other intestinal tract. Recently, we experienced two cases of small bowel phytobezoars resulting in obstruction. The first case is a 72-year-old male patient who had no previous history of surgery. He had poor dentition, and the history of eating dry persimmons 20 days before the onset of symptoms. The phytobezoar (4 X 3 cm) obstructed the terminal ileum. Colonoscopic removal was performed successfully. The second case is a 45-year-old male patient undergone previous vagotomy and pyloroplasty for duodenal ulcer perforation. He had a huge phytobezoar (10 X 6 cm) in stomach, which was treated by endoscopic removal. After incomplete endoscopic treatment, it moved into the proximal jejunum and obstructed the lumen. It was removed by operation.