ABSTRACT
Many studies have recently reported reactivation in hepatitis B surface antigen (HBsAg)-negative subjects with the use of biologic agents such as rituximab. However, occult hepatitis B virus infection itself has little clinical impact. We experienced a case of acute exacerbation caused by occult hepatitis B infection without HBsAg seroconversion. No mutation was found on the major hydrophilic loop of the S protein. The patient recovered from acute exacerbation after antiviral therapy. In conclusion, acute exacerbation can be induced by occult hepatitis B virus infection itself without reactivation. In such a case, antiviral therapy should be considered.
Subject(s)
Humans , Antibodies, Monoclonal, Murine-Derived , Hepatitis , Hepatitis B , Hepatitis B Surface Antigens , Hepatitis B virus , RituximabABSTRACT
An intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is an uncommon tumor characterized by the secretion of large amounts of mucin and intraductal growth. The characteristic clinical symptoms and radiologic findings are due to bile-duct obstruction caused by mucin. A parapapillary choledochoduodenal fistula is a rare disorder. This fistula has no clinical symptoms and is diagnosed by chance. We report a case of parapapillary choledochoduodenal fistula associated with IPMN-B. A 63-year-old woman was admitted to Hanyang University Hospital because of jaundice. Computed tomography (CT) showed diffuse intra- and extrahepatic bile duct dilatation. The ducts were filled with heterogenous material. Duodenoscopy revealed a large choledochoduodenal fistula. Endoscopic retrograde cholangiography through the fistula showed a papillary mass in the common hepatic duct. IPMN-B with choledochoduodenal fistula was diagnosed. The patient underwent a left hepatectomy. Her postoperative course was uneventful, and she was observed regularly in the outpatient department.
Subject(s)
Female , Humans , Middle Aged , Bile , Bile Ducts , Bile Ducts, Extrahepatic , Biliary Fistula , Cholangiography , Dilatation , Duodenoscopy , Fistula , Hepatectomy , Hepatic Duct, Common , Jaundice , Mucins , OutpatientsABSTRACT
An intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is an uncommon tumor characterized by the secretion of large amounts of mucin and intraductal growth. The characteristic clinical symptoms and radiologic findings are due to bile-duct obstruction caused by mucin. A parapapillary choledochoduodenal fistula is a rare disorder. This fistula has no clinical symptoms and is diagnosed by chance. We report a case of parapapillary choledochoduodenal fistula associated with IPMN-B. A 63-year-old woman was admitted to Hanyang University Hospital because of jaundice. Computed tomography (CT) showed diffuse intra- and extrahepatic bile duct dilatation. The ducts were filled with heterogenous material. Duodenoscopy revealed a large choledochoduodenal fistula. Endoscopic retrograde cholangiography through the fistula showed a papillary mass in the common hepatic duct. IPMN-B with choledochoduodenal fistula was diagnosed. The patient underwent a left hepatectomy. Her postoperative course was uneventful, and she was observed regularly in the outpatient department.
Subject(s)
Female , Humans , Middle Aged , Bile , Bile Ducts , Bile Ducts, Extrahepatic , Biliary Fistula , Cholangiography , Dilatation , Duodenoscopy , Fistula , Hepatectomy , Hepatic Duct, Common , Jaundice , Mucins , OutpatientsABSTRACT
Systemic lupus erythematosus (SLE) is an autoimmune disorder with a potential for multisystem organ dysfunction. Systemic lupus erythematosus patients have more frequent and earlier manifested atherosclerosis including coronary artery disease than the general population. We report three patients having SLE that have experienced acute coronary syndrome with onset at a relatively young age. The patients have premature atherosclerosis in a coronary artery as determined by coronary angiography and intravascular ultrasonography (IVUS). We suggest that systemic lupus erythematosus is a significant risk factor for coronary atherosclerosis.
Subject(s)
Humans , Acute Coronary Syndrome , Atherosclerosis , Coronary Angiography , Coronary Artery Disease , Coronary Vessels , Lupus Erythematosus, Systemic , Risk Factors , Ultrasonography, InterventionalABSTRACT
BACKGROUND/AIMS: Ascites is a fairly common condition, but the clinical features of pseudomembranous colitis with ascites are not well-known. The aim of this study was to determine how the existence of ascites is related to the clinical factors. METHODS: Between March 2002 and June 2006, 67 pseudomembranous colits patients were diagnosed by performing lower endoscopy and biopsy. The patients' ascites was identified by abdominal plain radiography, ultrasonography or computerized tomography. The extension of colitis was evaluated by ultrasonography or computerized tomography. RESULTS: 16 patients (23.9%) had ascites. The serum WBC (p=0.01), hypoalbuminemia (p<0.01), CRP (p<0.01), recurrence (p<0.01), and extension of colitis (p<0.01) were associated with the existence of ascites. The four patients who had undergone paracentesis had a low SAAG level and PMN dominant ascites. CONCLUSIONS: There were correlations of ascities with leukocytosis, hypoalbuminemia, CRP, extension of colitis and recurrence of PMC.
Subject(s)
Humans , Ascites , Biopsy , Colitis , Endoscopy , Enterocolitis, Pseudomembranous , Hypoalbuminemia , Leukocytosis , Paracentesis , Radiography , Recurrence , UltrasonographyABSTRACT
PURPOSE: Arterial stiffness is a major independent risk factor for cardiovascular morbidity and mortality in hemodialysis patients. It is hypothesized that arterial stiffness factor is attributable to the structural and functional changes of left ventricle (LV) caused by increased cardiac workload. So we investigated the relationship between brachial-ankle pulse wave velocity (baPWV) and diastolic dysfunction of left ventricle using echoardiographic transmitral blood flow pattern. METHODS: For 96 subjects (48 control patients, 48 hemodialysis patients), baPWV and echocardiographic indices for diastolic function, i.e. transmitral E, A, E/A, DT, IVRT were measured just before hemodialysis session. Role of baPWV was tested in a multiple regression model including age, gender, body mass index, predialysis blood pressure, heart rate, LV mass index and interdialysis weight gain. RESULTS: In the control group, LV mass index (beta=-0.350) and rbaPWV (beta=-0.403) had an independently correlation with E/A ratio. Rt-baPWV was independently correlated with DT (beta=-0.410) and IVRT (beta=0.500). In the hemodialysis group, systolic blood pressure (beta=-0.389) and heart rate (beta=-0.403) were the factors of E/A ratio. Rt-baPWV (beta=-0.557) was the factor determining E/A ratio only in female hemodialysis patients. CONCLUSION: PWV is independently correlated with E/A ratio only in female hemodialysis patients. Their relationship is limited or weak compared to normal control group.
Subject(s)
Female , Humans , Blood Pressure , Body Mass Index , Compliance , Echocardiography , Fibrinogen , Heart Rate , Heart Ventricles , Mortality , Pulse Wave Analysis , Renal Dialysis , Risk Factors , Vascular Stiffness , Ventricular Function, Left , Weight GainABSTRACT
Although acute humoral rejection is a major cause of renal allograft loss, the diagnosis and treatment of acute humoral rejection have been very difficult because of lack of proper diagnostic tools and effective therapeutic modalities. Recently C4d deposition in peritubular capillaries of renal allografts has been demonstrated to be a sensitive and diagnostic in-situ marker of humoral rejection that correlates strongly with the presence of circulating donor-specific antibodies. Whereas conventional immunosuppressive agents are effective for the treatment of cellular rejection, specific therapeutic strategies targeting the humoral limb of immunosuppression should be necessary for the treatment of humoral rejection. Here we report a case of acute humoral rejection diagnosed with C4d immunostaining from transplant kidney biopsy and treated successfully with combination of plasma exchange, polyclonal rabbit anti-thymocyte globulin, and rituximab.
Subject(s)
Allografts , Antibodies , Antilymphocyte Serum , Biopsy , Capillaries , Diagnosis , Extremities , Immunosuppression Therapy , Immunosuppressive Agents , Kidney , Plasma Exchange , Plasma , RituximabABSTRACT
An acinar cell carcinoma of the exocrine pancreas is a rare tumor with reported a incidence of 1% to 2% of pancreatic carcinomas. Cases of acinar cell carcinomas with amphicrine features have been reported in recent decades. However, there are no reports of two simultaneous pancreatic masses: an endocrine tumor and, an exocrine tumor. We encountered a 59-year-old female patient presenting with abdominal pain and melena. The acinar cell carcinoma was a 1x1 cm-sized round solid mass in the head of the pancreas. The islet tumor was a 2.5x1.5 cm-sized round mass in the body of the pancreas. The endocrine tumor was nonfunctioning. Melena resulted from the hemosuccus pancreaticus due to a ductal invasion of the acinar cell carcinoma. The patient had a parathyroid adenoma with hyperparathyroidism. Therefore, both the islet tumor and parathyroid adenoma with hyperparathyroidism were strongly suggestive of a MEN I.
Subject(s)
Female , Humans , Male , Middle Aged , Abdominal Pain , Acinar Cells , Carcinoma, Acinar Cell , Head , Hyperparathyroidism , Incidence , Melena , Multiple Endocrine Neoplasia Type 1 , Pancreas , Pancreas, Exocrine , Parathyroid NeoplasmsABSTRACT
Nocardiosis is usually a subacute infection, which can occur as an opportunistic infections in patients with systemic lupus erythematosus. There are rare cases of nocardiosis concurrent with Mycobacterium tuberculosis. We report a case of intramuscular nocardial abscess concurrent with pulmonary tuberculosis in a patient with lupus nephritis. She has received cyclophosphamide pulse therapies and is receiving oral steroid therapy 3 months ago. After Nocardia farcinica and Mycobacterium tuberculosis were confirmed by PCR and PCR-RFLP, we initiated trimethoprim/ sulfamethoxazole and antituberculous agents. After then, patient was improved and discharged, maintaining the medications.