Identification of pulmonary paragonimiasis using Ziehl-Neelsen stain

Pulmonary paragonimiasis and tuberculosis are endemic in Asia, South America, and Africa. However, differential diagnosis among the diseases is difficult because they present with similar clinical symptoms and diagnostic features. Here, we report a case of pulmonary paragonimiasis that was identified using Ziehl-Neelsen stain after initially being assessed for pulmonary tuberculosis. Following anti-Paragonimus chemotherapy, the patient's symptoms, laboratory test results, and lung lesions improved. Thus, the identification of Paragonimus westermani using Ziehl-Neelsen stain can be considered in the diagnosis.

Perception on the Importance of Items on Psychosocial Assessment among Hospice and Palliative Care Social Workers / 한국호스피스완화의료학회지

PURPOSE: This preliminary study is aimed at developing standardized tools for psycho-social assessment of patients in needs for hospice/palliative care. To accomplish the purpose, investigators examined effects of perceptions of social workers on the importance of psycho-social domains of assessment in hospice/palliative care settings. Moreover, investigators paid attention to variances of perceptions of social workers' along with types of institution and credentials of those family settings. METHODS: A form of questionnaire was first explored from an initial interview assessment of 10 government-certified hospice care providers and a literature review, second constructed with eight domains and 80 items, and sent by e-mail to 55 institutions and hospitals providing hospice/palliative cares in Korea. Lastly, a total of 31 agencies returned with a completed responses and consent form (56% response rate). SPSS program (version 18.0) was used for data analysis. RESULTS: Study found that social workers perceived patients' family background (m=4.53, 5-point scale) as the most important assessment domain, whereas economic conditions (4.06 point) the least important. Social workers' perception varied by credentials (i.e., license types, training, full-time position, types of care facility). CONCLUSION: Based upon study findings, investigators can conclude strong needs for developing a assessment tool that measures multiple domains (i.e., psychological, social and ecological aspects) of patients. A standardized assessment tool should be structured with 2 axis (center/core and expanded/peripheral) and tailored for institution type. Second, professional trainings must be provided by strengthening legal institutionalization and fostering qualified social workers with full responsibilities of hospice and palliative care patients.

Presacral Abscess with Bilateral Sciatica in a Patient with Crohn's Disease

Crohn's disease can cause intestinal strictures, perforations, fistulas, or abscesses. Although fistulas and abscesses are common complications of Crohn's disease, a presacral abscess with neuromuscular complications is very unusual. A delayed diagnosis and treatment may increase morbidity. The diagnosis is frequently delayed, because the clinical features of presacral abscess are variable and nonspecific. We experienced a case of a presacral abscess with bilateral sciatica in a 25-year-old male patient. He was diagnosed with Crohn's disease of the terminal ileum 2 months previously and has been managed with mesalazine. He visited our hospital due to pain in the buttocks and severe neuralgia in both thighs. We confirmed enteric fistulas, resulting in a presacral abscess, which extended symmetrically through both sciatic notches and the gluteus medius muscles. He was managed with antibiotics after a small bowel segmentectomy, right hemicolectomy, fistulectomy, and surgical drainage. The bilateral radicular pain resolved completely within 2 weeks of surgery. The patient has remained in remission and asymptomatic 1 year after surgery.

Performance and Cost of Disposable Biopsy Forceps in Upper Gastrointestinal Endoscopy: Comparison with Reusable Biopsy Forceps

BACKGROUND/AIMS: It is believed that disposable biopsy forceps are more costly than reusable biopsy forceps. In this study, we evaluated performance and cost of disposable forceps versus reusable forceps in esophagogastroduodenoscopic biopsy. METHODS: Between October 2009 and July 2010, we enrolled 200 patients undergoing esophagogastroduodenoscopic biopsy at Seoul St. Mary's Hospital. Biopsies were performed with 100 disposable or 5 reusable forceps by random assignment. Seventy-five additional patients were studied to estimate durability of reusable forceps. The assisting nurses estimated the performance of the forceps. The evaluation of costs included purchase prices and reprocessing costs. The adequacy of the sample was estimated according to the diameter of the obtained tissue. RESULTS: Performance of disposable forceps was estimated as excellent in 97.0%, good in 2.0% and adequate in 1.0%. Reusable forceps were estimated as excellent in 36.0%, good in 36.0%, adequate in 25.1% and inadequate in 2.9%. The performance of reusable forceps declined with the number of uses. The reprocessing cost of reusable forceps for one biopsy session was calculated as 8,021won. The adequacy of the sample was excellent for both forceps. CONCLUSIONS: Disposable forceps showed excellent performance. Considering the reprocessing costs of reusable forceps, usage of disposable forceps with a low price should be considered.

A Case of Chemical Colitis Caused by Hydrogen Peroxide Enema / 대한소화기학회지

Hydrogen peroxide is commonly used as a disinfectant that has been reported to cause chemical colitis. We report a case of 49 year-old man who presented with chemical colitis caused by self-inflicted hydrogen peroxide enema. In the sigmoidoscopic examination, diffuse erythematous and edematous mucosal change with multiple ulcerations and easy touch bleeding was noted from the rectum to the proximal sigmoid colon. Abdominal computed tomography showed diffuse wall thickening of the rectum and the sigmoid colon with inflammatory and reactive change at surrounding. The patient was treated with NPO, intravenous fluid, and antibiotic therapy. On 5th hospital day, abdominal pain and bloody stool disappeared, and the patient started oral feeding. He discharged on 6th hospital day with fully recovered state.

Clinical Features of Abdominal Actinomycosis: A 15-year Experience of A Single Institute

This study was designed to evaluate the clinical features of abdominal actinomycosis and to assess its therapeutic outcome. We reviewed patients with abdominal actinomycosis in Seoul St. Mary hospital, between January 1994 and January 2010. Twenty-three patients (5 male and 18 female, mean age, 47.8 yr; range, 6-75 yr), with abdominal actinomycosis were included. Emergency surgery was performed in 50% due to symptoms of peritonitis. The common presentation on preoperative computerized tomography was a mass with abscess, mimicking malignancy. The mean tumor size was 7.0 cm (range, 2.5-10.5). In all patients, actinomycotic masses were surgically removed. Mean duration of hospital stay was 17.8 days (range, 5-49). Long term oral antibiotic treatment (mean 4.2 months; range, 0.5-7.0 months) were administered to all patients. All patients were free of recurrence after a median follow up of 30.0 months (mean 35.5 +/- 14.8 months, range, 10.0-70.0 months); recurrence was not seen in any patient. In conclusion, abdominal actinomycosis should be included as a differential diagnosis when an unusual abdominal mass or abscess presents on abdominal CT. Assertive removal of necrotic tissue with surgical drainage and long term antibiotic treatment provide a good prognosis in patients with actinomycosis.

Clinical courses and risk factors for renal graft survival in renal retransplantation patients / 대한내과학회지

BACKGROUND: It has been reported that the results of second renal transplantation are inferior to that of first transplantation and affected by several factors. The purpose of this study is to suggest guidelines for successful retransplantion by evaluating the factors which might affect the clinical courses and graft survival rates in the second renal transplantation. METHODS: Between March 1969 and February 2005, 1476 kidneys were transplanted in Kangnam St Mary's hospital. Among these, 77 cases were retransplantation (72 cases were second transplantation, 5 cases were third transplantation). Especially for the second transplantation, we retrospectively analysed the clinical courses of grafted kidneys and sought the factors which might be related to the long term graft survival. RESULTS: Among second transplant patients, male were 52 cases, female were 20 cases. The mean age at retransplantation was 38.4+/-11 years. Living donor were 62 cases and cadaver donor were 10 cases. The mean duration between primary graft failure and second transplantation was 20.1+/-36 months. The 1 yr, 3 yr, 5 yr survival rates of the second grafts were 86.4%, 78%, 71% respectively, and it is not significantly inferior to that of total primary transplantation at our center. Multivariate analysis showed that the duration of the first graft survival and the postoperative recovery pattern significantly predicted graft survival in the second renal transplantation. CONCLUSIONS: This study suggests retransplantation can be considered for patients who lost primary graft function. And the longer the duration of the first graft survival and the earlier the postoperative graft function recovery, the prognosis of retransplanted graft would be better.

A Case of Patent Ductus Arteriosus Associated with Pulmonary Valve Endocarditis

Isolated infective endocarditis in the native pulmonary valve is unusual in non-intravenous drug user. Intravenous drug abuse, alcoholism, sepsis, catheter related infections and congenital heart diseases account for the majority of predisposing factors. We report a case of patent ductus arteriosus complicating infective endocarditis involving pulmonary valve. A 24-year-old female was admitted with fever of unknown origin Physical examination revealed continuous murmur at left 2nd intercostals space. Transthoracic and transesophageal echocardiography was performed and patent ductus arteriosus and vegetation at the pulmonary valve were noted. Chest CT scan revealed multiple patch infiltrate suggestive of septic emboli. After 4 weeks of antibiotic treatment, she had no clinical signs of fever, and blood culture be negative. Percutaneous trans-catheter closure of patent ductus arteriosus was done after 2 months.

A Case of Patent Ductus Arteriosus Associated with Pulmonary Valve Endocarditis

Isolated infective endocarditis in the native pulmonary valve is unusual in non-intravenous drug user. Intravenous drug abuse, alcoholism, sepsis, catheter related infections and congenital heart diseases account for the majority of predisposing factors. We report a case of patent ductus arteriosus complicating infective endocarditis involving pulmonary valve. A 24-year-old female was admitted with fever of unknown origin Physical examination revealed continuous murmur at left 2nd intercostals space. Transthoracic and transesophageal echocardiography was performed and patent ductus arteriosus and vegetation at the pulmonary valve were noted. Chest CT scan revealed multiple patch infiltrate suggestive of septic emboli. After 4 weeks of antibiotic treatment, she had no clinical signs of fever, and blood culture be negative. Percutaneous trans-catheter closure of patent ductus arteriosus was done after 2 months.

Reversal of Marrow Fibrosis Following Imatinib Mesylate Therapy in a Patient with Chronic Myelogenous Leukemia Who Was Refractory to Interferon-alpha

No abstract available.

A Case of Fatal Multiple Cerebral Aspergillosis in a Patient with Acute Promyelocytic Leukemia during Complete Remission

Cerebral aspergillosis accounts for about 10% of all the cases of invasive aspergillosis. The brain is the only infected site in less than 10% of cases. The patients at high risk for of aspergillosis are immunocompromised patients such as those in a neutropenic state after chemotherapy, AIDS and etc. We experienced a case of cerebral aspergillosis in a patient with acute leukemia that was in complete remission. The patient visited our hospital's ER due to nasal bleeding, and then he was quickly diagnosed as having acute promyelocytic leukemia. After the first induction chemotherapy, he achieved a complete remission. Loss of consciousness developed on day 31 after chemotherapy. High signal intensity in the right temporooccipital lobe and multiple nodular lesions in both cerebral hemispheres were observed on the brain MRI. Stereotaxic biopsy showed septate aspergillus hyphae in the brain specimen. Despite of the use of amphotericin B deoxycholate, the patient died of recurrent grand mal seizure and multiple organ failure.

The Trend of Antibiotic Production in Korea during 1981~2003 / 감염과화학요법

BACKGROUND: It is difficult to know the actual situation of antibiotic usage in Korea. We investigated the trend of antibiotic production every five years from 1981 to 2003 by using two parameters:the cost and the amount of antibiotics produced in Korea. MATERIALS AND METHODS: We analysed the data from "Annual Products of Medicine" published by Korea Pharmaceutical Manufactures Association. All antibiotics were classified into generic names, and the cost and the amount of antibiotic produced were compared with the results from previous years. RESULTS: The total production cost and the amount of antibiotics increased since 1980 and by 2003, it was 1,306 billion won and 965 tons respectively. However, the increasing rate of production cost has slowed down since 2000. Among all antibiotics produced in Korea, cephalosporins recorded the highest production cost, reaching 595 billion won (45.6%) in 2003. Cephalosporins made the largest portion of the total amount:252 tons (26.2%). Both 3rd and 4th generation cephlosporins have increased gradually. The second most frequently produced antibiotics in terms of amount were penicillins, although it decreased by 25% since 1998. Aminoglycosides showed similar production cost, but the production amount decreased compared to that of 1998. The production amount of quinolones had skyrocketed to 641% from 1998. Tetracyclines, lincosamides, and chloramphenicols insignificantly decreased in both production cost and amount. CONCLUSION: There seems to be an increase of antibiotics in production cost and amount in Korea, but the overall increasing rate of the cost has slowed down since 2000. The newer and more expensive antibiotics have grown in production.

The Trend of Antibiotic Production in Korea during 1981~2003 / 감염과화학요법

BACKGROUND: It is difficult to know the actual situation of antibiotic usage in Korea. We investigated the trend of antibiotic production every five years from 1981 to 2003 by using two parameters:the cost and the amount of antibiotics produced in Korea. MATERIALS AND METHODS: We analysed the data from "Annual Products of Medicine" published by Korea Pharmaceutical Manufactures Association. All antibiotics were classified into generic names, and the cost and the amount of antibiotic produced were compared with the results from previous years. RESULTS: The total production cost and the amount of antibiotics increased since 1980 and by 2003, it was 1,306 billion won and 965 tons respectively. However, the increasing rate of production cost has slowed down since 2000. Among all antibiotics produced in Korea, cephalosporins recorded the highest production cost, reaching 595 billion won (45.6%) in 2003. Cephalosporins made the largest portion of the total amount:252 tons (26.2%). Both 3rd and 4th generation cephlosporins have increased gradually. The second most frequently produced antibiotics in terms of amount were penicillins, although it decreased by 25% since 1998. Aminoglycosides showed similar production cost, but the production amount decreased compared to that of 1998. The production amount of quinolones had skyrocketed to 641% from 1998. Tetracyclines, lincosamides, and chloramphenicols insignificantly decreased in both production cost and amount. CONCLUSION: There seems to be an increase of antibiotics in production cost and amount in Korea, but the overall increasing rate of the cost has slowed down since 2000. The newer and more expensive antibiotics have grown in production.

A Case of Colonic Injury after Colonic Irrigation / 대한소화기내시경학회지

Colonic irrigation is a procedure in which large quantities of liquids are infused into the colon via the rectum through a tube, in an effort to wash away and remove fecal materials. Liquids mostly used in colonics include water and coffee. This procedure has been performed generally in the alternative medicine community and becomes more popular in recent years. However, physicians criticize its potential hazards by insisting that there are not of any scientifically proven health benefit of this procedure. With the current popularity of colonic irrigation, it is important to investigate the adverse effect of colonic irrigation which has not been known or published yet. We report a case of 56 years old female with colonic injury after colonic irrigation.

A Case of Adult-onset Still's Disease associated with Congestive Heart Failure / 대한류마티스학회지

Adult onset Still's disease (AOSD) is a multi-systemic inflammatory disorder characterized by several distinguished manifestations including high spiking fever, evanescent salmon-colored skin rash, arthralgia/arthritis, hepato-splenomegaly, lymphadenopathy, sore throat, serositis, and leukocytosis. The frequently noticed cardiopulmonary manifestation is pleuritis, pneumonitis, and pericarditis. Diffuse myocardial dysfunction is uncommon in AOSD, but it may be the cause of life-threatening heart failure. We have experienced a case of AOSD with acute heart failure in 20-year-old female complained of high fever and skin rash. On echocardiogram, the wall motion of left ventricle was globally decreased with a marked diminished ejection fraction (<25%). Two weeks after treatment with high dose steroid and intravenous immunoglobulin, her symptoms and cardiac function on echocardiogram was completely resolved. To our knowledge, this is the first case of AOSD with acute heart failure reported in Korea.

Effects of Sertraline on Memory Function of Patients with Posttraumatic Stress Disorder / 대한정신약물학회지

OBJECTIVE: This study was conducted to evaluate effects of sertraline treatment on symptoms and memory function of posttraumatic stress disorder (PTSD). METHODS: Thirty Vietnam veterans were collected for this study, among whom fifteen were PTSD patients and fifteen were combat control subjects. We used Mississippi Scale for Combat-Related PTSD, Combat Exposure Scale (CES), Hamilton Depression Rating Scale (HDRS) and Clinician Administered PTSD Scale (CAPS). Digit Span, Paired Association Learning Test (PALT) and Rey- Osterreith Complex Figure Test (CFT) were assessed for memory function. We evaluated HDRS, CAPS and memory function tests at baseline, 2-week and 6-week intervals with each subjects. RESULTS: There were significant differences between PTSD and Non-PTSD veterans in Mississippi Scale for Combat-Related PTSD, CES, HDRS and CAPS. Significant difference was found in memory function tests between PTSD and Non-PTSD veterans. PTSD veterans showed significant improvement in HDRS and CAPS at 2-week and 6-week and in memory function tests at 6-week of sertraline treatment. There was no significant correlation between symptoms and memory function. CONCLUSION: These results suggest that sertraline improve symptoms and memory function of PTSD. There was no significant correlation between PTSD sysmtoms and memory function.

Severe Acute Renal Failure Requiring Hemodialysis Treatment due to Malignant Hyperthermia / 대한신장학회잡지

Malignant hyperthermia is an inherited hypermetabolic syndrome, characterized by temperature elevation, muscle destruction, muscle rigidity, high oxygen consumption, and metabolic acidosis. It is usually triggered by anesthetic agents and neuromuscular relaxants. We present a case of malignant hyperthermia who developed rhabdomyolysis, acute renal failure, disseminated intravascular coagulopathy following an apparently uneventful general anesthesia. Anesthesia was induced with thiopental sodium and succinylcholine. He was successfully treated with dantrolene along with cardiopulmonary resuscitation and hemodialysis.

A case of Krukenberg tumor / 대한구급학회지

No abstract available.

A case of the neonatal necrotizing enterocolitis / 대한주산의학회잡지

No abstract available.