A Case of Needle Tract Seeding of Hepatocellular Carcinoma after Percutaneous Ethanol Injection Therapy; Needle Tract Seeding after Percutaneous Ethanol Injection Therapy / 대한간학회지

The tumor seeding after percutaneous ethanol injection (PEI) therapy has been considered to be a rare complication in hepatocellular carcinoma. We report a case of needle tract implantation of hepatocellular carcinoma following PEI manifested as subcutaneous nodule. A 57-years old male patient had been treated with PEI for hepatocellular carcinoma. Thirteen months after completion of the PEI session, a subcutaneous nodule was palpated at the site of the needle puncture. A CT scan showed that the subcutaneous nodule was 1.7 cm in size and enhanced in the early phase. The nodule was surgically removed. Microscopic examination showed hepatocellular carcinoma.

Analysis of Elderly Patients who visited Emergency Room

BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. To solve the problem of emergency medical service in elderly patients, it is very important to analyze the emergency patients who visit medical service and to accumulate date bases of various hospitals. So the purpose of this study is to evaluate the use of emergency services by the elderly to provide better understanding of the emergency care needs of this specialized populations and provide a basis planning to meet the needs of the expanding geriatric population. METHODS: We performed a retrospective study of 2380 elderly patients who visited Emergency room of national medical center, from August 1, 1999 to July 31, 2000. We analyzed the patients gender, age, arrival time, final diagnosis, admission rate, mortality, ects. RESULT: Male to female ratio is 1:1.29, and most common age group was between 65 and 69 years old. The peak time of patients entrance was between 10 AM and 11AM, in a week monday was most crowding day. The most predomint monthly distribution of visit was January. The respiratory disease are most common problem (14.7%), and cardivascular disease (12.01%) are next, and cerebrovascular disease (11.17%) are following. Diabetic complication (7.53%) are common problems and hypoglycemia and diabetic foot infection are frequent. Admission rates was 32.53%. ICU admission rate is 2.77%. Emergency operation rate is 5.91%. During admission, mortality case was 127 patients. The cause of death were cerebrovascular disease (16.94%) and advanced respiratory disease (15.43%). CONCLUSION: The results show that cerebrovascular disease and respiratory disease and cardiovascular disease that needed prompt medical service are major problem who visit emergency room. And diabetic complications that are prevented by proper educations are common. So more concentrated medical service and preventive effort focused on these disease.

A case of microscopic polyangiitis combined with pulmonary silicosis / 대한내과학회지

Microscopic polyangiitis (MPA) is a distinct type of systemic small vessel vasculitis affecting small sized vessels with few or no immune deposit and no granulomatous inflammation. Cause or pathogenetic mechanism of MPA has been unknown but association with silicon or silica exposure or pulmonary silicosis has been reported rarely and supports hypothesis that environmental factors are important modulating or triggering factors of the vasculitis in the indivisual who may be genetically predisposed. We report a case of microscopic polyangiitis with underlying pulmonary silicosis in 43 year-old male. He was admitted due to hemoptysis, dyspnea, fever and bilateral pulmonary infiltration with underlying small nodular densities in whole lung field and egg-shell calcification of both hilar areas. Laboratory findings showed hematuria, proteinuria and rapid deterioration of renal function. Renal biopsy revealed focal segmental necrotizing glomerulonephritis with early cellular crescents accompanied with membranous glomerulonephropathy and perinuclear-antineutrophil cytoplasmic antibody was positive. Under the diagnosis of MPA, he has been managed with high dose steroid, cyclophosphamide and hemodialysis. Chest infiltration decreased and hemoptysis and hypoxia was improved but renal function was not recoverd and he needed regular hemodialysis continuously.

A Case of Empyema and Retropharyngeal Abscess Complicated by Acute Epiglottitis / 감염

After the introduction of antibiotics, empyema is a rare complication of retropharyngeal abscess caused by acute epiglottitis. But once it occurs, it may be a fatal outcome. Retropharyngeal abscess may spread to mediastinum and pleural cavity along the deep cervical fascia, then it can induce pneumonia, mediastinitis, empyema, and sepsis. Because of its fatal complication, early diagnosis and intensive surgical treatment, such as incision and drainage, is necessary. Now we have a experience of empyema caused by retropharyngeal abscess in a 56-year old diabetic patient with nephropathy. He was admitted to our hospital because of hoarseness and sore throat due to acute epiglottitis. Several days after his admission, he complained of swelling of neck, which was diagnosed as retropharyngeal abscess by the computerized tomography. Retropharyngeal abscess was managed with antibiotics, incision and drainage and culture revealed Peptostreptococcus prevotii. Subsequently empyema developed in his right chest, which was managed with closed thoracotomy, though, he expired due to progression of sepsis.