Angiomyolipoma of the Liver without a Fat Component, Mimicking a Hepatocellular Carcinoma / 대한소화기학회지

Angiomyolipoma (AML) is a rare benign mesenchymal tumor in the liver, which is composed of blood vessels, smooth muscle, and adipose cells. The proportion of each component varies, making a diagnosis difficult. This paper reports a case of AML in the liver without adipose tissue, mimicking a hepatocellular carcinoma (HCC), which was diagnosed by a surgical tissue biopsy. A 65-year-old woman was admitted for an evaluation of a hepatic mass that had been detected by ultrasonography. The serologic markers of viral hepatitis B and C were negative. The liver function tests and alpha fetoprotein level were within the normal limits. Magnetic resonance imaging revealed a 1.9 cm sized mass in segment 6 of the liver with early arterial enhancement and washout on the delayed phase accompanied by a rim-like enhancement, which is similar to the imaging findings of HCC. A frozen section examination during surgery indicated a hepatocellular neoplasm and suggested the possibility of HCC. On the other hand, the final pathologic diagnosis was epithelioid myoid type of AML with no adipose tissue component. The tumor cells were positive for human melanocyte B-45 and negative for cytokeratin and hepatocyte paraffin 1. This paper reports a very rare case of AML without adipose tissue in the liver mimicking HCC that was diagnosed by a surgical tissue biopsy.

A Case of Azygos Vein Thombosis Associated with Transient Antiphospholipid Syndrome in Urinary Tract Infection with Escherichia coli

A 73-year-old female with diabetes admitted for treatment of an intertrochanter fracture of the femur and a urinary tract infection (UTI) with Escherichia coli developed thrombosis in her right azygos vein, which was thought to be associated with antiphospholipid and immunoglobulin M anticardiolipin antibodies. After antibiotic therapy, antiphospholipid antibody was undetectable, and a repeat chest computed tomography showed complete resolution of the azygos vein thrombosis. A wide variety of infections can be associated with thrombotic events in patients with transient antiphospholipid syndrome (APS), and this case serves as a reminder that the possibility of transient APS should be considered in patients with venous thrombosis in the setting of a UTI.

A Case of Pneumonia Caused by Raoultella planticola / 결핵및호흡기질환

Raoultella species are gram-negative, non-motile, aerobic bacilli that are primarily considered as environmental bacteria. Raoultella planticola is reportedly a rare cause of human infections. Also, the definite pathological mechanism of Raoultella planticola is currently unknown. We report a case of pneumonia caused by Raoultella planticola.

Spontaneous Pneumomediastinum Complicating with Asthma / 이화의대지

Spontaneous pneumomediastinum is an uncommon disease that is defined as the presence of free air in the mediastinum in the absence of any obvious precipitating cause. This condition occurs as a rare complication of acute exacerbation of asthma. Classic symptoms include retrosternal chest pain, dyspnea and cough, but are not specific. Spontaneous pneumomediastinum complicated by asthma is usually self-limiting and well controlled with conservative management, but this condition can be potentially life threatening. We report a case of 18-year-old woman with asthma who presented with spontaneous pneumomediastinum. The patient was treated conservatively with oxygen and steroid therapy, and her clinical conditions were improved. Spontaneous pneumomediastinum disappeared.

Two Cases of Wernicke's Encephalopathy That Developed during Total Parenteral Nutrition in Colon Cancer Patients Treated with 5-Fluorouracil-based Chemotherapy / 대한소화기학회지

Wernicke's encephalopathy (WE) caused by thiamine deficiency is an acute neurological disorder. Clinically, the classic triad of WE consists of ophthalmoplegia, ataxia, and mental status changes. Thiamine deficiency is known to occur commonly in chronic alcoholic patients. Sometimes, it can occur in patients after gastrointestinal surgery and in those with malabsorption. In addition, patients undergoing renal dialysis, suffering from hyperemesis gravidarum, receiving total parenteral nutrition (TPN), and being treated with chemotherapeutic agents are also prone to develop thiamine deficiency. Herein, we report two cases of WE that developed following simultaneous 5-fluorouracil (5-FU) chemotherapy and TPN in colon cancer patients which was successfully treated with thiamine administration.

Portal and Splenic Vein Thrombosis Successfully Treated with Anticoagulants in Acute Pancreatitis / 이화의대지

Splanchnic vein thrombosis arising from complications of acute pancreatitis is very rare. It usually occurs as a form of portal, splenic and superior mesenteric vein thrombosis, either in combination or separately. It could develop portal hypertension, bowel ischemia and gastrointestinal variceal bleeding. Treatment of splanchnic vein thrombosis includes anticoagulants, thrombolysis, insertion of shunts, bypass surgery and liver transplantation. In some cases, anticoagulation therapy may be considered to prevent complications. However, the standard protocol for anticoagulation in splanchnic vein thrombosis has not been determined yet. We report a case of 43-year-old man who had portal and splenic vein thrombosis in acute pancreatitis. The patient was successfully treated with oral anticoagulants following low molecular weight heparin therapy.

Symmetrical Peripheral Gangrene Complicating Escherichia coli Sepsis Associated with Antiphospholipid Antibodies in Lupus Nephritis / 대한내과학회지

Antiphospholipid syndrome (APS) is an autoimmune disease that involves vascular thrombosis and pregnancy morbidity associated with elevated titers of antiphospholipid antibodies. APS can affect any organ and has a variety of clinical manifestations. Infections can be associated with thrombotic events in APS, including the potentially fatal subset catastrophic APS. We report a case of extensive symmetrical peripheral gangrene complicating Escherichia coli sepsis associated with antiphospholipid antibodies in a patient with lupus nephritis.

Differences in Bacterial Species and Their Resistance Rates based on Sputum Cultures between Tertiary Hospitals and Smaller Medical Institutions / 이화의대지

OBJECTIVES: Since the 1990s, drug-resistant bacteria have become common pathogens of hospital-acquired infections. In recent years, healthcare-associated infections have come to the fore, and it is reported that distribution rates of these bacteria are comparable to those of hospital-acquired infections. However, there have been few studies on differences in resistant bacteria depending on the size of hospitals. Thus, the authors studied differences in drug-resistant bacteria between a tertiary hospital and smaller medical institutions. METHODS: We retrospectively analyzed the clinical findings and sputum culture results of patients transferred from tertiary hospitals (group A, n=74) and those transferred from smaller medical institutions (group B, n=65). RESULTS: The number of patients with malignancy was higher in group A than in group B. The length of intensive care unit stay was longer in group A than in group B. Antibiotic therapy and mechanical ventilation were more frequently used in group A than in group B. There were no significant differences between the 2 groups in bacterial species (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa) and their resistance rates to carbapenem, while there were significant differences between the 2 groups in the bacterial species (Acinetobacter baumannii) and its resistance rate to carbapenem. CONCLUSION: In this study, there were significant differences between the 2 groups in the bacterial species and resistance rates to carbapenem for A. baumannii infection unlike other bacterial infections. Further studies on risk factors and patient classification are needed to confirm our results.