A Case of Hemolytic Uremic Syndrome Caused by Escherichia coli O8: Case Report / 대한소화기내시경학회지

Since 1982, many countries have reported outbreaks or sporadic cases by enterohemorrhagic Escherichia coli (E. coli) serogroup strains, mainly E. coli O157 : H7. Hemorrhagic E. coli induces hemolytic uremic syndrome (HUS) in 10 to 15% of cases in infants and young chilidren. HUS is a clinical syndrome of hemolytic anemia, acute renal failure, and thrombocytopenia. We experienced a case of E. coli O8 as the causative organism of hemorrhagic colitis and hemolytic uremic syndrome in 16 year-old man. Hemorrhagic colitis was diagnosed by the sigmoidoscopy and E. coli O8 was identified in the stool culture. Hemolytic uremic syndrome was clinically diagnosed. A conservative management including total parenteral nutrition, plasma exchange transfusion, hemodialysis and continuous arteriovenous hemofiltration with dialysis resulted in a complete recovery of the patient. We herein report this manifestations of E. coli O8 and discuss the therapeutic issues related to hemorrhagic colitis and hemolytic uremic syndrome.

Comparison of Epidemiological and Clinical Characteristics of Native Valve Endocarditis between 1979~1984 and 1991~1996 / 감염

BACKGROUND: The changes in the epidemiology of native valve endocarditis have been known in western countries recent years due to the decrease in the inci-dence of rheumatic heart disease, increased longevity of patients with valvular or congenital heart diseases, and the increase in degenerative heart disease due to the in-crease in the average life span of the general popula-tion. In this study, we analyzed and compared the epide-miological and clinical characteristics of patients with na-tive valvular endocarditis fro two different time periods. METHODS: We compared native valve endocarditis patients diagnosed from 1979 - 1984(group I) with those diagnosed from 1991 - 1996(group II). We used modified Duke' s criteria for the diagnosis and statistical analysis was done using SPSS window program. RESULTS: In our study, mean age of the population was higher in group II and significantly larger number of patients were over the age of 50 in group II. Involve-ment of multiple valves with vegetations and peri-valvular abscess were found more frequently in group II. Also, significantly higher percentage of patients from group II underwent surgical treatment. CONCLUSION: The results of this study suggest that the epidemiolocaland clinical characteristics of infective endocarsitis in Korea may change to resemble those in western countries. Further studies regarding this subject are needed.

Sensitivity and Specificity of Vi-Indirect Fluore scent Antibody Test in Diagnosis of Typhoid Fever / 감염

BACKGROUND: Typhoid fever is diagnosed by culture or serological study. The confirmative diagnosis of typhoid fever is made by culture of the causative orga-nism usually from body fluids. Serological test is a supportive diagnostic tool, which is useful for early dia-gnosis. In Severance Hospital, Vi-indirect fluorescent antibody test(Vi-IFAT) using the Vi-antigen of Salmo-nella typhi has been used in the diagnosis of typhoid fever since 1989. We investigated the test results from the past 7 years, in order to clarify the sensitivity and specificity of Vi-IFAT. METHODS: A retrospective study was done on pa-tients whose chief complaint was fever and who were tested using Vi-IFAT in the Severance Hospital from 1989 to 1996. The positive value for Vi-IFAT was de- fined as 1:64 or higher. RESULTS: The sensitivity and specificity of Vi-IFAT for typhoid fever was 94.4% and 95.1%, respectively. The positive and negative predictive values were 85.7% and 98.2% respectively. Positive rates of Vi-IFAT after fever onset increased with time and 68% were positive before the first week. From the first to the second week, 89.5% were positive and after the second week, 100% were positive. CONCLUSION: Vi-IFAT is not only a valuable sero-logic test for the diagnosis of typhoid fever, but also useful in the early diagnosis of the disease.

Four Cases of Mold-Form Fungemia Related to Implantable Subcutaneous Central Venous Catheter / 감염

Mold form fungi such as Fusarium, Acremonium, and Sporothrix species are thought to represent contamination or harmless colonization when isolated from immunocompromised patients. More recently, the pathogenic role of these fungi has been clearly established. The role of implantable subcutaneous central catheters as potential portals of entry for mold form fungus has been underestimated. We describe four cases of implantable subcutaneous central catheter- related mold form fungemia in patients with cancer. One patient responded well only after removal of the implantable subcutaneous central catheter, two patients responded after catheter-removal and IV fluconazole but one patient did not in spite of catheter-removal and amphotericin B.

A Case of Amylase Producing Small Cell Lung Cancer / 결핵

The majority of lung cancers associated with hyperamylasemia are adenocarcinomas. Here we report an unusual case of a 54-year-old male patient who complained of dyspnea, anterior chest wall discomfort and facial edema for one month, presenting with a huge mediastinal mass and hyperamylasemia complicated by pericardial effusion Histological evaluation of mediastinal mass revealed small cell carcinoma and pericardium showed nonspecific inflammation with fibrosis. The serum amylase had an electrophoretic mobility similar to that of salivary gland enzyme. There were no evidence of a salivary or pancreatic causes of hyperamylasemia. After chemotherapy, parenchymal lung lesions improved and hyperamylasemia disappeared. For the mannagement of peracardial effusion a pericardial window was forms(i. We concluded that the striking increase in serum amylase was due to the ectopic production of this enzyme by the tumor.