Hepatic Actinomycosis with Abdominal Wall and Paracolic Gutter Involvement / 이화의대지

A 53-year-old female with intrauterine contraceptive device insertion was admitted for painful abdominal mass on the left upper quadrant abdomen. Abdominal computed tomography scan showed multiple enhancing masses on the right lobe of liver, left abdominal wall and right paracolic gutter. We performed incisional biopsy on the left abdominal wall lesion. Although microorganisms were not identified, the histopathologic result was consistent with actinomycosis which contained sulfur granules within the chronic granulomatous inflammation. She was treated with penicillin agents for 6 months. We report a case of hepatic actinomycosis with abdominal wall and paracolic gutter involvement.

Glycemic Effects of Rebaudioside A and Erythritol in People with Glucose Intolerance

BACKGROUND: Rebaudioside A and erythritol are nonnutritive sweeteners. There have been several studies of their glycemic effects, but the outcomes remain controversial. The purpose of this study was to evaluate the glycemic effects of rebaudioside A and erythritol as a sweetener in people with glucose intolerance. METHODS: This trial evaluated the glycemic effect after 2 weeks of consumption of rebaudioside A and erythritol as sweeteners in a pre-diabetic population. The patients were evaluated for fructosamine, fasting plasma glucose, C-peptide, insulin, and 2-hour plasma glucose before and after consumption of sweetener. The primary outcome was a change in fructosamine levels from the baseline to the end of treatment. Secondary outcomes were the changes in levels of fasting plasma glucose and 2-hour plasma glucose. RESULTS: From the baseline to the end of experiment, the changes in fructosamine levels after consumption of rebaudioside A and erythritol, did not differ significantly (244.00±19.57 vs. 241.68±23.39 µmol/L, P=0.366). The change in levels from the baseline to end of the study for rebaudioside A and erythritol were fasting plasma glucose (102.56±10.72 vs. 101.32±9.20 mg/dL), 2-hour plasma glucose (154.92±54.53 vs. 141.92±42.22 mg/dL), insulin (7.56±4.29 vs. 7.20±5.12 IU/mL), and C-peptide (2.92±1.61 vs. 2.73±1.31 ng/mL), respectively, and also did not differ significantly (P>0.05 for all). CONCLUSION: Our study suggests that consumption of rebaudioside A and erythritol does not alter the glucose homeostasis in people with glucose intolerance.

A Case of Acute Hepatitis Associated with Intravenous Infusion Amiodarone in Patient with Atrial Fibrillation

We report a case of intravenous infusion amiodarone induced acute hepatitis, occurs within 1 day after initiation of drug in a 72-year-old woman with paroxysmal atrial fibrillation. Liver function test before intravenous infusion amiodarone treatment was normal. She was treated with intravenous infusion amiodarone, and then developed acute hepatitis next day. We suspected drug induced hepatitis due to intravenous infusion amiodarone. The liver function test returned to normal after the amiodarone was stopped. We described an unusual case which intravenous infusion amiodarone induced acute hepatitis within.

A Case of Pheochromocytoma Presenting as Stress-Induced Cardiomyopathy with Large Left Ventricular Thrombus / 대한내과학회지

The clinical presentation of pheochromocytoma is variable. The classic symptoms are headache, diaphoresis, and tachycardia, with paroxysmal hypertension. Other less common cardiovascular manifestations, such as arrhythmias, angina pectoris, acute myocardial infarction, dilated cardiomyopathy, and acute heart failure, have been reported occasionally. We present the case of a middle-aged woman who had stress-induced cardiomyopathy with a left ventricular thrombus, due to the pheochromocytoma. The thrombus was embolized to the aorto-iliac bifurcation during hospitalization. We removed the thrombus by a catheter thromboembolectomy and performed a surgical left adrenalectomy. After the operation, all of her symptoms and the underlying diseases (hypertension, hyperglycemia, heart failure, dyslipidemia) resolved.

Device Closure of a Large Atrial Septal Defect in a Patient with Severe Pulmonary Arterial Hypertension after 1 Year Use of an Oral Endothelin Receptor Antagonist

The presence of severe pulmonary arterial hypertension (PAH) in patients with atrial septal defect (ASD) is still thought to preclude shunt closure, although there are several reports of good clinical outcomes after vasodilator therapy. We report the case of a young woman with ASD and severe PAH who was able to successfully undergo percutaneous shunt closure following 1 year use of the oral endothelin receptor antagonist, bosentan.

Left Ventricular Mass Estimated by Three Methods of Echocardiography in Normal Children

PURPOSE: Left ventricular hypertrophy is an important diagnostic and prognostic finding in children with various cardiovascular diseases. Echocardiographic determination of the left ventricular mass is the most accurate method for assessing left ventricular hypertrophy non-invasively. The purposes of this study are 1) to establish a reproducible, validated method for determining left ventricular mass in children by echocardiography, 2) to investigate correlation between LV mass and several factors (body surface area, weight, age, height), and 3) to define reference standards for the left ventricular mass. METHODS: Left ventricular mass was estimated in 63 normal children by three different methods of echocardiography (M mode, modified Simpson's method, Are-length method). RESULTS: The mean LV mass per body surface area were 49.7 +/- 19.4gm/m2, 40.1 +/- 11.2gm/m2, 39.9 +/- 9.6gm/m2 by M mode, Simpson and Area-Length method respectively and was highest by the M mode method. The mean LV mass per body weight were 2.6 +/- 0.9gm/kg, 2.3 +/- 0.6gm/kg, 2.1 +/- 0.5gm/kg by M mode, Simpson and Area-Length method respectively and was highest by the M mode method. Lineal regression analysis between LV mass and body surface area revealed the highest correlation. The values of LV mass by all three method were well correlated. Correlation between Area-Length method and Simpson method was higher than that between Area-Length and M mode method. CONCLUSION: Echocardiography is a very useful method to measure the left ventricular ass. Body surface area is highly correlated with LV mass in all three methods. Area-Length method and Simpson method are superior to the M mode method.

Study of Epstein Barr Virus Antibodies in Patients with Kawasaki Disease

PURPOSE: The etiology of the Kawasaki disease remains unclear, many strong clinical and epidemiologic characteristics suggest an infectious etiology. However, conventional bacterial and viral cultures and extensive serologic studies have not revealed a consistent causative agent. Thus we studied the Epstein Barr virus(EBV), one of the most important pathogens, to access the association between the EBV and Kawasaki disease. METHODS: Seventy-two patients with Kawasaki disease were studied between June 1993 and July 1994 at Ewha Womans University Hospital. The control children were composed of 145 patients who have no evidence of Kawasaki disease or EBV infection. The VCA -IgM and IgG titer were measured in both groups by Enzyme Linked Immunosorbent Assay. RESULTS: 1) The positive rate of VCA-IgG was significantly higher in Kawasaki disease group (75.0%) compared with the control group(59.4%). 2) The positive rate of VCA-IgM, the indicator of acute EBV infection, was significantly higher in Kawasaki disease(13.9%) compared with the control group(2.1%). CONCLUSIONS: The high positive rate of EBV antibody measured in Kawasaki disease patients suggested that EBV might be etiologic pathogen of Kawasaki disease. While the stereotyped nature of Kawasaki disease makes the multiple pathogenesis, more extensive research for identifying the cause of Kawasaki disease will be necessary.