Gastric Inflammatory Fibroid Polyp Resected by Endoscopic Submucosal Dissection / 대한소화기내시경학회지

Inflammatory fibroid polyp (IFP) is a rare benign fibroproliferative disease that arises from the submucosal layer of the gastrointestinal tract. Surgical resection has been performed in most cases and the application of endoscopic resection is rare. Endoscopic submucosal dissection (ESD), which was recently introduced, enables en-bloc resection of a tumor regardless of the tumor size and location. Since IFP is benign, ESD can be very useful for both the diagnosis and treatment of a large-sized IFP. A 45-year-old woman was referred for the management of a gastric mass. Esophagogastroduodenoscopy showed a round submucosal mass with a central bulging at the gastric body. Endoscopic ultrasonography showed a 3.5x3.0 cm-sized hypoechoic mass in the third layer of the stomach. The tumor was removed by ESD with using a hook knife for complete en-bloc resection. The pathologic finding was compatible with the diagnosis of IFP. We report here on a case of IFP that presented as a gastric submucosal tumor and it was treated by the ESD method.

A case of colonic and omental lipomatosis and omental torsion presenting with abdominal pain / 대한내과학회지

A lipoma, one of the most commonly encountered submucosal tumors in the gastrointestinal tract, usually presents as one or a few lesions. Lipomatous polyposis, which is defined as the presence of multiple lipomas in the intestinal wall, is rare. Here, we report a case of colonic lipomatous polyposis that involved not only the colon, but also the omentum and skeletal muscle. The patient presented with right lower quadrant abdominal pain and was diagnosed using colonoscopy and computed tomography (CT). The abdominal pain caused by omental torsion due to an omental lipoma resolved after conservative treatment without surgical intervention.

Change in the serologic markers of hepatitis B after allogenic hematopoietic stem-cell transplantation / 대한간학회지

BACKGROUND/AIMS: This study examined the effects of hepatitis B virus (HBV) infection state and immunologic capability in both the recipients and donors of allogenic hematopoietic stem-cell transplantation (allo-HSCT) on changes in HBV serologic markers in recipients. METHODS: A total of 537 patients underwent allo-HSCT for the treatment of leukemia, malignant lymphoma, and solid tumor. HBV serologic markers were examined in both recipients and donors prior to and following the transplantation. The mean follow-up period was 36.6 months (range 3-80 months). RESULTS: Of the 537 patients who underwent allo-HSCT, 45 recipients were positive for HBsAg prior to transplantation. Of these 45 patients, 21 were transplanted from anti-HBs-positive donors and the remaining 24 were transplanted from anti-HBs-negative donors. In the former cases, seroconversion was noted in 4 of the 21 patients (19%). In the latter cases, however, no seroconversion was noted following the transplantation. Thirty patients who were negative for both HBsAg and anti-HBs were transplanted from anti-HBs-positive donors, and 15 out of 30 patients (50%) acquired anti-HBs. Four hundred and seven patients who were positive for anti-HBs were transplanted from anti-HBs-positive or HbsAg-negative donors; 8 of these proved HBsAg-positive following the transplantation. There were no changes in HBV serological markers following transplantation in 41 patients who were transplanted from HbsAg-positive donors. CONCLUSIONS: Due to the adoptive immunity that was transferred from anti-HBs-positive donors, a seroconversion of HBsAg could occur in some HBsAg-positive recipients. HBsAg-positive donors had a lesser effect on the HBV serologic markers of recipients. However, a reactivation of HBV can occur following hematopoietic stem-cell transplantation in the cases of recipients or donors with a history of HBV, infection by an accompanying immune suppression. Therefore, prevention should be instigated.

Utility of CT colonography in detecting colon polyps as a colon cancer screen / 대한내과학회지

BACKGROUND/AIMS: CT colonography is a rapid and safe imaging method for detecting polyps in the colon and rectum. We assessed the efficacy of CT colonography in colorectal polyp detection. METHODS: We prospectively studied 84 subjects (mean age 55.7+/-11.1 years; 52 men, 32 women) undergoing CT colonography followed by colonoscopy. Based on the results of CT colonography, all polyps were classified by size (any size, and those larger than 5, 7, and 10 mm) and were checked for location, morphology, and histological characteristics. We determined the sensitivity and specificity of CT colonography using colonoscopy as a reference standard with a segmental unblinding method. RESULTS: A total of 56 lesions were identified in 26 of 79 subjects undergoing both CT colonography and conventional colonoscopy. The sensitivities of CT colonography for polyps of any size, and larger than 5, 7, and 10 mm were 60.7%, 70.5%, 75.9%, and 81.8%, respectively. The per-subject sensitivities of CT colonography for the polyps of any size, and larger than 5, 7, and 10 mm, were 80.7%, 95.0%, 93.3%, and 90.9%, respectively. The per-subject specificities of CT colonography for polyps were 86.8%, 89.8%, 95.3%, and 100.0%, respectively. The sensitivities of CT colonography for flat, sessile, and pedunculated polyps were 30.8%, 85.0%, and 90.0%, respectively. CONCLUSIONS: CT colonography is a useful diagnostic method for screening colorectal neoplasias larger than 7 mm diameter, showing 75.9% sensitivity and 71.0% positive predictive value.

A Case of Vancomycin-Induced Agranulocytosis in a Hemodialysis Patient: Successful Treatment with G-CSF / 대한신장학회잡지

Vancomycin induced agranulocytosis is a rare but life-threatening complication. We here report a case of vancomycin induced agranulocytosis in a patient with chronic renal failure. A 36-year-old woman receiving hemodialysis via jugular cannulation developed staphylococcus sepsis. The catheter was removed and she was started on vancomycin therapy (1.0 g/week). New catheter was inserted for next hemodialysis. Second sepsis of same organism developed 12 days after initial sepsis inspite of vancomycin therapy. We removed this catheter and continued vancomycin therapy. After 19 days of vancomycin treatment, the patient developed a severe agranulocytosis with white blood cell count of 1, 600/ mm3 and the complete absence of neutrophil. Vancomycin was discontinued and teicoplanin was substituted for vancomycin therapy and G-CSF (granulocyte colony stimulating factor) therapy was begun. White blood cell count including neutropil was completely recovered after 13 days of discontinuation of vancomycin.

A case of spongy myocardium initially manifested by ventricular tachycardia in adult / 대한내과학회지

Isolated noncompaction of ventricular myocardium, sometimes referred to as spongy myocardium, is a rare congenital cardiomyopathy. Spongy myocardium results from an arrest in normal endomyocardial embryogenesis. The clinical symptoms and electrocardiographic findings of this disorder can be showed variously. The diagnosis is usually made by echocardiography. We report a case of isolated noncompaction of the ventricular myocardium in a 20-year-old male patient initially presented with syncope caused by ventricular tachycardia, who was diagnosed with echocardiography, cardiac MRI and endomyocardial biopsy.

A case of spongy myocardium initially manifested by ventricular tachycardia in adult / 대한내과학회지

Isolated noncompaction of ventricular myocardium, sometimes referred to as spongy myocardium, is a rare congenital cardiomyopathy. Spongy myocardium results from an arrest in normal endomyocardial embryogenesis. The clinical symptoms and electrocardiographic findings of this disorder can be showed variously. The diagnosis is usually made by echocardiography. We report a case of isolated noncompaction of the ventricular myocardium in a 20-year-old male patient initially presented with syncope caused by ventricular tachycardia, who was diagnosed with echocardiography, cardiac MRI and endomyocardial biopsy.

A case of mixed prolactin and growth hormone-secreting pituitary microadenoma presenting galactorrhea / 대한내과학회지

We report a case of galactorrhea with acromegaly from the mixed prolactin and GH secreting pituitary microadenoma managed with a successful surgical complete removal. A 31-year-old woman visited our hospital complaining galactorrhea for more than 6 months after delivery. The physical findings of the patient were a prominent galactorrhea and mild acromegalic features of face and extremities. The laboratory findings of hematology and blood chemistry were normal. In addition, the basal levels of prolactin and GH were slightly elevated. The thyroid is in euthyroid state. The results of the combined anterior pituitary hormone-stimulation tests were that the prolactin and GH responses were stimulated exaggeratedly and the other hormonal ones were normal responses. The oral glucose loading test for acromegaly revealed non-responder results. The sellar MRI showed the 6 X 5 mm-sized pituitary microadenoma. She was operated for surgical removal of the lesions of which the immunohistochemistry findings were consistent with the positive findings for both prolactin and GH. She discharged without post-operative complication and has done well with normalized hormonal levels at outpatient department.

Superior Vena Cava Thrombosis Treated Successfully by Percutaneous Insertion of Metallic Stent in a Patient with Behcet's Disease / 대한류마티스학회지

The venous thrombosis is the most common vascular event in Behcet's disease. Among the thrombotic complications of Behcet's disease, thrombosis in superior vena cava is rare, but once it happens, it may be life-threatening. In this report, we describe a case of 45-year-old female with Behcet's disease complicated by the superior vena cava thrombosis, which was treated successfully with the operation and then endovascular stenting. This case shows that endovascular stent may be one of good strategies for the management of vascular complication in Behcet's disease.

Two Cases of Severe Plasmodium falciparum Malaria Complicated with Acute Respiratory Distress Syndrome / 감염

Malaria remains one of the most important infectious diseases in the world. For those not immuned to malaria, delayed diagnosis and treatment have been associated with an increase in morbidity and mortality, and development of severe complications. Pulmonary edema is one of the serious complications in falciparum malaria. It usually occurs in association with cerebral malaria, acute renal failure, high parasitemia, and delayed antimalarial treatment, as well as treatment-related side effects. We report two cases of severe falciparum malaria with rapidly developed pulmonary edema, which was not combined with cardiac decompensation or fluid overload. Both patients had a history of traveling to foreign countries, Thailand and Ghana, which chloroquine-resistant malaria is distributed. The first patient who developed hyperbilirubinemia, hypoglycemia, thrombocytopenia, decreased mentality, multi-organ failure, and pulmonary edema with acute respitatory distress syndrome, was treated with quinine, doxycycline, hemodialysis, and mechanical ventilation. The patient was recovered with a sequela of restrictive lung change. The second patient also developed anemia, thrombocytopenia, mental confusion, and pulmonary edema with aucte lung injury. Through the treatment of quinine, diuretics, and high concentration of oxygen via facial mask, the patient was successfully recovered without any sequela.