A synchronous hepatocellular carcinoma and renal cell carcinoma treated with radio-frequency ablation

Radio-frequency ablation (RFA) is a curative treatment for hepatocellular carcinoma (HCC). Percutaneous RFA has been shown to be beneficial for patients with small renal cell carcinoma (RCC) lacking indications for resection. We experienced the case of a 53-year-old male who had conditions that suggested HCC, RCC, and alcoholic liver cirrhosis. Abdominal contrast-enhanced computed tomography (CT) and magnetic resonance image showed liver cirrhosis with 2.8 cm ill-defined mass in segment 2 of the liver and 1.9 cm hypervascular mass in the left kidney. These findings were compatible with the double primary cancers of HCC and RCC. Transarterial chemoembolization (TACE) was performed to treat the HCC. After the TACE, a focal lipiodol uptake defect was noticed on a follow up CT images and loco-regional treatment was recommended. Therefore, we performed RFAs to treat HCC and RCC. There was no evidence of recurrence in the follow up image after 1 month.

Role of Photodynamic Therapy in the Palliation of Obstructing Esophageal Cancer

BACKGROUND/AIMS: The aim of this non-randomized study was to determine the role of photodynamic therapy (PDT) in a multimodal approach for the palliation of advanced esophageal carcinoma. METHODS: Twenty consecutive patients with obstructing esophageal cancer were enrolled in this study. Each subject had dysphagia, and nine could not swallow fluid. External beam radiotherapy or a self-expandable metal stent was used following PDT for dysphagia due to recurrence of the malignancy. RESULTS: At 4 weeks post-PDT, a significant improvement in the dysphagia score was observed in 90% of patients, from 2.75 +/- 0.91 to 1.05 +/- 0.83 (p < 0.05). Patients with recurrent dysphagia underwent stent insertion at an average of 63 days (range, 37 to 90). The rate of major complications was 10%. Two esophageal strictures occurred, which were treated by placement of a modified expandable stent across the stricture. The median survival in these cases was 7.0 +/- 0.6 months. One patient that was treated with PDT and radiotherapy is alive and showed a complete tumor response. CONCLUSIONS: PDT as a multimodality treatment is safe and effective for relieving malignant esophageal obstruction with minimal complications.

A Case of Pulmonary Thromboembolism in a Patient with Hyperhomocysteinemia / 결핵및호흡기질환

Hyperhomocysteinemia is an independent risk factor for cardiovascular, cerebrovascular and peripheral vascular diseases that are complicated by atherosclerosis and a thromboembolism. An increased level of plasma homocysteine develops from a genetic defect in the of enzyme for the homocysteine metabolism or a vitamin deficiency. Hyperhomocysteinemia has direct toxic effect on the vascular endothelium and causes damages to the antithrombotic action of vascular endothelial cells. Most cases of hyperhomocysteinemia are asymptomatic, but cardiopulmonary or cerebrovascular incidents developin rare cases. In the case of a thromboembolism with an unknown cause, hyperhomocysteinemia should be considered in a differential diagnosis. The authors report a case of pulmonary thromboembolism in a patient with hyperhomocysteinemia with a review of the relevant literature.

A Case of Tracheostomy Induced Bilateral Tension Pneumothorax / 결핵및호흡기질환

Tracheostomy is one of the oldest surgical procedures in medical history. The indications for a tracheostomy include the relief of an upper airway obstruction, long-term mechanical ventilation, and decreased airway resistance to help wean the patient from mechanical ventilator support. Unfortunately, tracheostomy is also associated with a number of problems including, bleeding, infection, pneumothorax, and tracheal stenosis. A pneumothorax is an uncommon complication of a tracheostomy, and can result from direct injury to the pleura or positive pressure ventilation through a dislocation of the tracheostomy tube. We report an uncommon case of a tracheostomy-induced bilateral tension pneumothorax with a review of the literature.

A Case of Secondary Organizing Pneumonia Occurring in Therapy for Lung Abscess / 결핵및호흡기질환

The patient is a 62-year-old man with known diabetes mellitus who presented with a two-weeks-history of dyspnea, cough, and fever. He was diagnosed with a lung abscess in the right upper lobe and was treated with intravenous antibiotics. The patient's clinical and radiological findings improved within seven days after medical treatment. However, newly developed ground-glass opacity and infiltrations were observed in the right lower lung. Fourteen days after admission, the patient's symptoms and imaging finding became aggravated despite trestment with susceptible antibiotics for lung abscess. Trans-bronchial lung biopsy (TBLB) was performed in the lateral basal segment of the right lower lobe of the lung. A histologic photomicrograph showed organizing pneumonia, also called bronchiolitis obliterans with organizing pneumonia(BOOP), that became more definite as the terminal bronchioles and alveoli became occluded with masses of inflammatory cells and fibrotic tissue. The clinical symptoms and radiograph findings resolved quickly with prednisone treatment. We report a case of secondary organizing pneumonia diagnosed after TBLB following lung abscess treatment and provide a review of the literature.

A case of lymphoplasmacytic sclerosing pancreatitis presenting as an obstructive jaundice / 대한내과학회지

Lymphoplasmacytic sclerosing pancreatitis, also referred to as autoimmune pancreatitis, is a benign disease characterized by irregular narrowing of the pancreatic duct, swelling of the pancreatic parenchyma, lymphoplasmacytic infiltration and fibrosis. A few cases with locally affected lesions show features similar to cancer. Lymphoplasmacytic sclerosing pancreatitis is the most common benign disease in patients undergoing Whipple resection for a presumed pancreatic malignancy. We report a case of lymphoplasmacytic sclerosing pancreatitis diagnosed after surgery in a patient presenting with obstructive jaundice, with a review of the literature.

Clinical Features of Hospitalized Adults with Infectious Mononucleosis

BACKGROUND: Infectious mononucleosis (IM) is typically caused by Epstein-Barr virus (EBV), but can also be caused by drugs and other pathogens, such as cytomegalovirus (CMV) and hepatitis B virus. It shows a wide range of clinical and laboratory characteristics, which are presumed to be dependent on the patient age during the primary infection. This report describes the clinical features of hospitalized adults who developed EBV- or CMV-induced IM. METHODS: The medical records of adult patients, diagnosed as EBV- or CMV-induced IM at the Hallym Medical Center and Dankook University Hospital, between January 1999 and July 2004, were retrospectively reviewed. RESULTS: The analysis included 23 patients, consisting of 16 with EBV-induced IM and 7 with CMV- induced IM. Many of these patients were hospitalized under the impressions of either acute pharyngitis, acute hepatitis, fever of unknown origin or a malignant lymphoma. The vast majority of patients initially demonstrated lymphocytosis, with atypical lymphocytes. While patients younger than 20 years of age, usually presented with the classic triad of symptoms; IM-fever, pharyngitis and lymphadenopathy; those over the age of 20 often presented without pharyngitis or lymphadenopathy. There were no significant differences in the laboratory findings between EBV- and CMI-induced IM. Compared with patients with EBV-induced IM, however, those with CMV-induced IM were more likely to have abdominal pain (12.5% vs. 57%, P=0.04) and nausea or vomiting (25% vs. 75%, P=0.07), but less likely to have pharyngitis (69% vs. 14%, P=0.03) and cervical lymphadenopathy (75% vs. 14%, P=0.01). CONCLUSION: IM in adults, especially in those above 20 years of age or if induced by CMV, are characterized by the atypical clinical manifestations. A higher index of suspicion and more attention must be paid to reduce unnecessary diagnostic work-ups and management.