Mucinous Cystic Neoplasm of the Pancreas Presenting with Acute Pancreatitis, Initially Misdiagnosed as a Pseudocyst / 대한내과학회지

Pancreatic cystic lesions include retention cysts (congenital cysts), pseudocysts, and cystic neoplasms. Pancreatic cystic neoplasms have recently been diagnosed more commonly, possibly due to advances in imaging and widespread screening programs. Cystic neoplasms of the pancreas account for 10-20% of pancreatic tumors. Mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms are regarded as premalignant lesions, whereas serous cystadenoma is not. In the clinical setting of acute pancreatitis, pancreatic cystic lesions are usually diagnosed as pseudocysts. However, cystic neoplasms of the pancreas should be considered in the differential diagnosis of pancreatic cysts, even in patients with a history of pancreatitis. In the Korean literature, MCN combined with acute pancreatitis has rarely been reported. Here, we report a case of MCN presenting with acute pancreatitis in a 22-year-old female, which was initially misdiagnosed as pancreatic pseudocyst.

A Case of Perforated Gastrointestinal Stromal Tumor in the Jejunum as a Rare Cause of Acute Abdomen

Preoperative diagnosis of Gastrointestinal Stromal Tumors (GISTs) in the small intestine is often delayed until complications such as hemorrhage, bowel obstruction or perforation develop. Such GISTs are usually asymptomatic and tumor perforation is an uncommon clinical presentation. In this report, we review the diagnosis, pathology and treatment of a 32-year-old male with a perforated GIST in the jejunum who presented with symptoms of acute abdomen. Abdominal computed tomography (CT) showed a ruptured huge tumor with inhomogeneous density in the small intestine. The patient underwent a complete tumor excision and jejunal segmental resection. A histopathological examination of the tumor confirmed that it was a GIST. Postoperatively, the patient received medical treatment, using oral Imatinib 400 mg daily for 10 months without any signs of disease recurrence. Prognosis is worse in ruptured GISTs and in these cases, complete surgical resection of the tumor must be followed by adjuvant therapy with Imatinib.

A Case of Acute Colonic Diverticulitis as a Complication of Colonoscopy

Colonoscopy is a good diagnostic tool and facilitates treatment of various colonic diseases. Nevertheless, it can induce many serious complications such as perforation and hemorrhage. Diverticulitis has also been reported as a serious complication of colonoscopy, with an incidence ranging from 0.04% to 0.08%. A 44-year-old male with chronic hepatitis B was presented with general weakness, myalgia, and febrile sensation. After admission for evaluation, pneumonia detected in the left upper and lower lobe and treated. We performed colonoscopy for screening and found multiple colonic diverticula in the right side of the colon. After 48 hours, the patient complained of abdominal pain and febrile sensation. Physical examination revealed tenderness in the right side of the abdomen. Abdomen-pelvis computed tomography showed bowel wall thickening of the cecum and ascending colon and multiple inflamed diverticula at the cecum with pericolic fat infiltration and fluid collection. We diagnosed the patient with acute diverticulitis after colonoscopy. Thereafter, he was treated with bowel rest and broad-spectrum intravenous antibiotics, and recovered. With a review of the relevant literature, we report a case of acute colonic diverticulitis as a complication of colonoscopy.

A Case of Acute Aluminum Encephalopathy with Intraperitoneal Bladder Rupture Following Aluminum Bladder Irrigation in a Patient with Normal Renal Function / 대한내과학회지

Acute aluminum intoxication is uncommon in clinical practice but can be fatal. Most cases have been reported in patients with decreased renal function, especially dialysis patients. We describe a case of acute aluminum encephalopathy with intraperitoneal bladder rupture following aluminum bladder irrigation in a patient with normal renal function. A 51-year-old woman with a radical hysterectomy and external irradiation therapy for cervical cancer 15 years earlier was admitted due to gross hematuria. An aluminum intravesical irrigation was performed. After 1 day of intravesical irrigation, abdominal pain and fever developed. Abdominal CT images demonstrated bladder perforation and peritonitis. An emergency laparotomy was performed. Operative findings showed a perforated dome of the bladder with gray colored peritoneal fluids. Two days after the operation, she complained of numbness and pain in the left side of her face. Acute aluminum encephalopathy was diagnosed after excluding infectious, rheumatological, and other vascular causes. She was treated with combined intravenous deferoxamine and hemodialysis.

Incidence and Cinical Characteristics of Severe Community-Acquired Pneumococcal Pneumonia: Comparisons with Non-Pneumoccocal Pathogens / 대한내과학회지

BACKGROUND/AIMS: Only limited data are available on severe community-acquired pneumonia (severe CAP or SCAP) caused by Streptococcus pneumoniae in Korea. METHODS: All patients who were admitted to a tertiary hospital for CAP from January 2007 to December 2008 were reviewed retrospectively, and SCAP was defined by 2007 Infectious Disease Society of America/American Thoracic Society criteria. RESULTS: In total, 94 patients were diagnosed with SCAP (mean age, 73.5 +/- 14.3 years; male, 70). Among them, pneumococcal SCAP (P-SCAP) accounted for 24.5%, and non-P-SCAP accounted for 18.1% (four with Pseudomonas aeruginosa, [4.3%]; four with Staphylococcus aureus, [4.3%]), and no organisms were identified in 57.4% of the patients. A history of neoplasm was less frequent, and the incidence of shock and pneumonia severity index (PSI) scores were lower in patients with P-SCAP than in those with non-P-SCAP or with SCAP with no organism identified (p = 0.012, 0.023 and 0.007, respectively). Patients with P-SCAP had a lower rate of treatment failure (p = 0.048) and tended to have lower in-hospital and 30-day mortalities compared with those with non-P-SCAP. In a multivariate analysis, the history of neoplasm was the strongest independent factor for predicting 30-day mortality (odds ratio, 9.068; 95% confidence interval, 1.856-44.309). CONCLUSIONS: P-SCAP accounted for 24.5% of SCAP cases. P-SCAP was associated with lower disease severity and a tendency toward better hospital outcomes compared with non-P-SCAP.

The Clinical Outcomes of Photodynamic Therapy in Early Lung Cancer Patients / 결핵및호흡기질환

BACKGROUND: Photodynamic therapy (PDT) is effective in managing small superficial early lung cancer patients who were deemed nonsurgical candidates. However, we do not have any previous report on the usefulness of PDT in early lung cancer in South Korea. Thus we report here our experience of PDT in early lung cancer patients. METHODS: 10 patients who underwent PDT for managing early lung cancer between June 2006 and July 2010 were analyzed. PDT was carried out 48 hours after photosensitizer injection. Re-bronchoscopy was carried out 48 hours after PDT in order to remove a necrotic tissue from the PDT site. For evaluation of PDT response, bronchoscopy and chest computed tomography (CT) were performed after 3 months. RESULTS: The median age of patients was 69 (49~77) and all patients were male. The smoking history of patients was 48 (20~75) pack-year and the median follow up of patients was 25 (11~52) months. Complete remission was observed in 10 patients and the recurrence of lung cancer was observed in 3 patients. Out of 10 patients, 3 patients died (one case of lung cancer progression and two cases of pneumonia). CONCLUSION: The PDT is a safe and effective treatment in early lung cancer patients who are not suitable for surgical resection. The PDT in clinical practice is an attractive option in the treatment of early lung cancer.