Acute Pancreatitis Complicating Spontaneous Acute Exacerbation of Chronic Hepatitis B Virus Infection: Case Report and Review of the Literature

Acute pancreatitis may complicate viral hepatitis B, as well as the other causes of viral hepatitis. There have been reports of acute pancreatitis complicating acute exacerbations of chronic hepatitis B virus infection, most of which were related to immunosuppressive treatment or organ transplantation. However, acute pancreatitis complicating spontaneous acute exacerbation of chronic hepatitis B virus infection is rare. We report a case of acute pancreatitis that developed while a spontaneous acute exacerbation of chronic hepatitis B virus infection was underway in a healthy carrier.

Diagnostic Performance of Routine Objective Tests and Cost-Effective Approach for Chronic Cough / 결핵및호흡기질환

BACKGROUND: Despite the clinical clues of bronchial asthma, some chronic coughers fail to be diagnosed due to negative test results. This study was aimed at evaluating the diagnostic performance of routine objective tests and identifying a cost-effective approach for asthmatics with a chronic cough. METHODS: Patients with a chronic cough of more than 3 weeks duration, and showing normal chest radiograph and spirometry were enrolled. On the first visit, objective tests, composed of serum total IgE, peripheral blood eosinophil count, spontaneous sputum eosinophil count, methacholine bronchial provocation test (MBPT) and paranasal sinus radiograph, were performed, with the simultaneous administration of oral prednisolone (0.5mg/kg) for one week. The final diagnoses were made on the basis of the test results, and the patients grouped according to their steroid responsiveness. The role of the etiologic diagnosis tests was evaluated, and the medical costs of the final management plan simulated with respect to three assumed models. RESULTS: Sixty chronic coughers were finally analyzed. The final diagnoses were as follows: bronchial asthma 21.7%, eosinophilic bronchitis 6.7%, paranasal sinusitis 18.3%, presumptive allergy 8.3% and non-diagnostic case 45.0%. Ninety percent were steroid responder. With the bronchial asthma cases, the positive rate of MBPT was 38.5%, with sputum eosinophil count in 84.6%, serum total IgE in 38.5%, and a peripheral blood eosinophil count rate of 30.8%. When the test results and steroid responsiveness data were applied to the 3 models, the chest radiograph, spirometry, sputum eosinophil count and paranasal sinus radiograph test results, and simultaneous short term steroid treatment seemed to have acceptable diagnostic performances, which could be used as a further guide to cost-effective planning. Conclusion:Objective tests, composed of chest radiograph, spirometry, paranasal sinus radiograph and sputum eosinophil count, with simultaneous short term steroid treatment, are suggested as cost-effective approaches for asthmatics with a chronic cough.

Clinical Investigation of Recurrent Pneumonia in Adults: Analysis of Patients From Hallym University Medical Center / 결핵및호흡기질환

BACKGROUND: Recurrent pneumonia in adults is not uncommon. However, there is no domestic data about recurrent pneumonia in adults. Therefore, we investigated the associated diseases and clinical findings of recurrent pneumonia in adults. METHODS: Among 5513 patients who were treated in five teaching hospitals of Hallym medical center?over a 5-year period, we retrospectively reviewed the medical records of the 58 who were compatible with diagnostic criteria of recurrent pneumonia. RESULTS: The number of patients with recurrent pneumonia was 58 (1.05%, 58/5513) during the 5 years. Thirty- seven patients were male and 21 were female. Mean age was 66.4 (+/-14.9) years. Median interval between each pneumonic episode was 18.5 months. Associated diseases were 25 cases of respiratory diseases, 13 of heart diseases, 13 of diabetes mellitus, 7 of lung malignancies, 11 of malignancies other than lung, 7 of neurologic disease, and 8 of miscellaneous diseases. Three cases had no underlying illness. Of the 8 cases with 2 or more times of recurrence, 4 were associated with respiratory diseases, 2 with aspiration pneumonia due to neurologic diseases, 1 with heart disease and 1 with no underlying illness. Recurrent pneumonic episodes affecting the same location were 30 of the total recurrent pneumonic episodes (30/67, 47.8%) and common associated diseases were respiratory diseases including lung malignancies. The etiology of recurrent pneumonia was Streptococcus pneumoniae, methicillin- resistant Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, atypical organisms, etc. CONCLUSION: Recurrent pneumonia in adults had a low incidence rate compared with children, but most cases had associated illness. Respiratory diseases including lung cancer were the most common associated illness of recurrent pneumonia.

A Case of Scleroderma Preceded by Esophageal Carcinoma / 대한류마티스학회지

Scleroderma is rare disease of unknown etiology characterized by fibrosis of skin and internal organs such as lung, gastrointestinal tract, kidney, heart and so on. The association between scleroderma and malignancy has been a controversy during recent years. We report a 77-year old female who had scleroderma and squamous cell carcinoma of esophagus. She was diagnosed as esophageal carcinoma and then sclerotic skin change developed in both hands and feet 3 months later. We present this case with a review of literatures.

Two cases of tsutsugamushi disease complicated with splenic infarction / 대한내과학회지

Tsutsugamushi disease is an acute febrile illness caused by infection with Orientia tsutsugamushi transmitted by the bite of larval trombiculid mites and characterized by fever, myalgia, lymphadenopathy, rash and eschar. O. tsutsugamushi has been known to cause diffuse vasculitis of small blood vessels. Disseminated intravascular coagulation associated with endothelial cellular injury by O. tsutsugamushi has been occasionally reported. However, in our knowledge, splenic infarction-associated scrub typhus has not been previously reported. We experienced two cases of tsutsugamushi disease with splenic infarction, which were improved after doxycycline treatment finished.