An Acute Pulmonary Embolism Accompanying Greater Saphenous Vein Thrombosis / 대한내과학회지

Pulmonary embolism is most commonly related to deep vein thrombosis of the lower extremities. However, recent studies show that the thrombosis of superficial veins can also progress to deep vein thrombosis and pulmonary embolism. To our knowledge, there is no Korean report of pulmonary embolism associated with superficial vein thrombosis. We experienced an 82-year-old woman complaining of dyspnea and chest pain. On chest dynamic computed tomography (CT), pulmonary embolism was diagnosed. To evaluate the origin of the pulmonary embolism, abdominal CT, Doppler ultrasonography, and ascending venography of both lower extremities were done. We found no deep vein thrombosis, while thrombus of the proximal left greater saphenous vein was seen. We report a case of pulmonary embolism accompanying greater saphenous vein thrombosis without deep vein thrombosis.

The Effect of Indigocarmine on Improvement of the Polyp Detection Rate during Colonoscopic Examination with Hood Cap

BACKGROUND/AIMS: Hood cap-assisted chromocolonoscopy using indigocarmine is expected to improve the detection rate of colorectal polyps, especially adenomatous polyps. Therefore, aim of the present study was to evaluate the usefulness of hood cap-assisted chromocolonoscopy in routine colonoscopic examinations. METHODS: From January, 2013 through March, 2013, a total of 86 patients were enrolled (M:F=33:53, mean age=60 years). For each patient, hood cap-assisted colonoscopic examination was performed, followed by hood cap-assisted chromocolonoscopy using 0.2% indigocarmine from the cecum to the hepatic flexure. Total numbers and characteristics of polyps were compared before and after indigo carmine dye spraying. RESULTS: Prior to dye spraying, 48 polyps were found in 37 patients, and after dye spraying, 53 additional polyps were found in 34 patients. Of these undetected polyps, 45 (85%) were small sized polyps (< or =0.5 cm). Histologically, 19 (36%) were adenomatous polyps, and of these, 15 (28%) were tubular adenomas and 4 (8%) were serrated adenomas. As for the polyp detection rate, there was no difference between the expert and the non-expert groups. CONCLUSION: Hood cap-assisted chromocolonoscopic examination using indigocarmine was helpful in detecting cecum and ascending colon polyps, especially small sized polyps (<0.5 cm) and neoplastic polyps.

Two Cases of Spinal Epidural Abscess in Hemodialysis Patients / 영남의대학술지

While epidural abscesses are rare in hemodialysis patients, they can cause severe neurological complications that can be fatal because only nonspecific symptoms appear in the early stages of the infection. Their incidence increased recently due to intravenous drug abuse, invasive spinal surgery, percutaneous vertebral procedures, and the development of diagnostic modalities. The increased number of cases is related to the use of dialysis catheters in hemodialysis patients. If a patient has fever and back pain, doctors should eliminate the possibility of other common diseases and consider spinal epidural infection. Early diagnosis and proper treatment are important to prevent neurological complications. In this paper, the symptoms, blood work, magnetic resonanceimaging (MRI) findings, and clinical course of two hemodialysis patients who developed spinal epidural abscesses are described.

A Case of Successful Treatment of Refractory Synovitis Acne Pustulosis Hyperostosis Osteitis (SAPHO) Syndrome with Adalimumab / 영남의대학술지

Synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome is a rare disease that involves the skin, bones and joints. It is thought to be caused by infection with low-toxicity bacteria and to be the result of reactive infectious osteitis. However, this hypothesis has not yet been clearly established. New SAPHO syndrome treatment methods are needed because the disease does not respond to treatment in many cases. In this paper, a case is reported of SAPHO syndrome with pain in the acromioclavicular joint and with squamous and pustular macules on the palms and soles. First, the patient was treated with aceclofenac, prednisolon and sulfasalazine for two weeks. However, the symptoms were not relieved, so methotrexate and pamidronate were added to the treatment. Since no improvement was seen after four weeks of treatment, adalimumab was prescribed. The skin lesions were relieved two weeks later, and the bone pain and arthralgia, four weeks later. No recurrence or adverse effects were observed at the 22-week follow-up.

A Case of Oral Myiasis Caused by Lucilia sericata (Diptera: Calliphoridae) in Korea

We report here a case of oral myiasis in the Republic of Korea. The patient was a 37-year-old man with a 30-year history of Becker's muscular dystrophy. He was intubated due to dyspnea 8 days prior to admission to an intensive care unit (ICU). A few hours after the ICU admission, 43 fly larvae were found during suction of the oral cavity. All maggots were identified as the third instars of Lucilia sericata (Diptera: Calliphoridae) by morphology. We discussed on the characteristics of myiasis acquired in Korea, including the infection risk and predisposing factors.