Recurrent Acute Pancreatitis in a Patient with Type IIb hyperlipoproteinemia: A Case Report and Review of the Literature in Korea

Hyperlipidemia is a rare cause of pancreatitis. It has been believed that free fatty acids released from hydrolyzed serum chylomicrons or triglycerides and chylomicrons induce hyperlipidemic pancreatitis by damaging acinar cells and capillaries. Type I, IV or V hyperlipidemic (Fredrickson's classification) pancreatitides have distinctive features of increased and heightened serum chylomicron and triglyceride levels. In contrast, type IIb hyperlipidemia usually doesn't have increased chylomicrons. It is a dominant inherited genetic disorder and doesn't manifest the subjective symptom before combining vascular complications such as coronary artery disease. Only a few cases of type IIb hyperlipidemic pancreatitis have been reported. We experienced a male patient with recurrent hyperlipidemic pancreatitis combined with type IIb hyperlipidemia. We present the case report and a review of the literature of hyperlipidemic pancreatitis, especially cases in Korea.

The Agreements between FEV1 and PEFR in the Patients of Mild Bronchial Asthma / 결핵및호흡기질환

BACKGROUND: Several studies have shown considerable disagreement when using the FEV1 and PEFR to assess the severity of an airflow obstruction. A differential classification of the severity of asthma would lead to serious differences in the evaluation and management of asthma. The aim of this study was to examine the relationship between the FEV1 and PEFR in asthma patients with mild symptoms. METHODS: In this study, the PEFR and FEV1 were obtained from 92 adult asthma patients with mild symptoms attending an outpatient pulmonary clinic. The mean differences and the limits of agreement in the paired measurements of the FEV1 and PEFR were calculated. RESULTS: There was a considerable correlation between the FEV1 and PEFR measurements when expressed as a % of the predicted values (r=0.686, p<0.01). The 95% limit of agreement (mean difference +/-1.96SD) between the FEV1 % and PEFR % were acceptable(-27.4%~33.8%). In addition, the weighted k(kappa) coefficient for the agreement between the FEV1 % and PEFR % was 0.74 (95% CI, 0.63-0.81), indicating excellent agreement between the two measurements. CONCLUSION: The spirometer (FEV1) and the Mini-Wright peak flow meter (PEFR) can be used interchangeably in adult asthma patients with mild symptom.

A case of pseudo-Cushing's syndrome with unilateral nonfunctioning adrenal adenoma / 대한내과학회지

A pseudo-Cushing's state can be defined as some or all of the clinical features of Cushing's syndrome together with some evidence for hypercortisolism. It may be related to depression, alcohol abuse and obesity. Its manifestation may be transient and resolved with abstinence from causing factors. We report a case of a 70-year-old woman with unilateral nonfunctioning adrenal adenoma and geriatric depressive disorder, which diagnosed by Geriatric Depression Scale (GDS). She showed clinical and/or biochemical features of Cushing's syndrome. Low dose and high dose dexamethasone suppression tests were not identical to those in ACTH independent Cushing's syndrome. Few cases of pseudo-Cushing's syndrome were reported previously in Korea but there was no report about pseudo-Cushing's syndrome combined with nonfunctional adrenal adenoma.

Two Cases of Apathetic Hyperthyroidism associated with Peripheral Eosinophilia / 대한내분비학회지

Peripheral eosinophilia is perpetually associated with many disease conditions like asthma, parasitic disease, IL-2 therapy, hypereosinophilic syndrome and eosinophilia/myalgia syndrome. Furthermore, peripheral eosinophilia may also be linked with Graves' disease, which is induced by thyroid-stimulating anti-TSH receptor antibodies and is related to type 2 helper T cell(Th2) predominant condition that is dependent on humoral immunity. In some of the cases of Graves' disease, thyrotoxicosis may induce peripheral eosinophilia associated with relative cortisol deficiency. In our present study, we present a case of two patients who were suffering from Graves' disease without any thyrotoxic symptoms and exhibited increased levels of peripheral eosinophil count. But, the count was observed to decreas in euthyroid state.

Agranulocytosis Induced by Vancomycin in an ESRD Patient on CAPD

Agranulocytosis is a rare adverse effect associated with prolonged vancomycin therapy, and is potentially serious, especially in end stage renal disease (ESRD) patients. We describe a continuous ambulatory peritoneal dialysis (CAPD) patient that developed vancomycin-induced agranulocytosis during treatment for methicillin-resistant Staphylococcus aureus (MRSA) -associated external cuff infection and pneumonia. The agranulocytosis was rapidly resolved by granulocyte colony-stimulating factor (G-CSF) therapy and by the discontinuation of vancomycin.