Relationship of body iron stores with the development of nonalcoholic fatty liver disease / 대한내과학회지

BACKGROUND: Although numerous reports have shown the influence of the iron overload state on the development of nonalcoholic fatty liver disease (NAFLD), there have been few reports on the prevalence of NAFLD according to the body iron stores. The aim of the present study was to determine the relationship of body iron stores with the development of NAFLD in apparently healthy women. METHODS: The present cross-sectional study was performed with data obtained from 5,249 women (mean age: 40.6+/-8.9 years), that received an annual health check-up. All components of metabolic syndrome criteria, anthropometric parameters, fasting insulin levels, level of C-reactive protein and serum iron tests were measured in each subject. RESULTS: The prevalence of NAFLD was significantly different according to body iron status (normal iron store/iron store depletion/iron deficient erythropoiesis/iron deficiency anemia: 10.6%/4.1%/6.5%/11.2%, p<0.001). Multivariate analysis revealed that age (odds ratio [OR]=1.284; 95% confidence interval [CI]: 1.1161.507) per 10 years), being overweight (OR=1.952; 95% CI: 1.3952.732), diabetes mellitus (OR=1.694; 95% CI: 1.198-2.397), hypertriglyceridemia (OR=2.434; 95% CI: 1.737-3.409), abdominal obesity (OR=3.559; 95% CI: 2.538-4.992), insulin resistance (OR=2.665; 95% CI: 1.979-3.587), anemia (OR=2.015; 95% CI: 1.150-3.532) and stored iron depletion (OR=0.580; 95% CI: 0.405-0.830) were profoundly associated with the development of NAFLD. CONCLUSION: The present study reveals a possible correlation between the development of NAFLD and body iron stores, and stored iron depletion and anemia seem to be key factors for this correlation.

A Case of a Solid and Papillary Epithelial Neoplasm of the Pancreas Associated with Malignant Change / 대한소화기내시경학회지

The solid and papillary epithelial neoplasm of the pancreas is a relatively uncommon disease. It accounts for approximately 1 to 2 percent of all exocrine pancreatic tumors. This benign or low grade malignant tumor is reported to occur predominantly in young women and rarely in men. Recurrence and development of metastasis after resection are found only in a small fraction of the general population. A case is herein reported involving a solid and papillary epithelial neoplasm of the pancreas which extensively spread to nearby organs, in a 34 year-old man. Chief complaints were black stool. Physical examination revealed tenderness on the left upper quadrant of the abdomen. Esophagogastroduodenoscopy revealed multiple cardiac variceal bleeding. Abdominal sonography and CAT scan findings showed a huge lobulated mass on the left upper quadrant area with an internal necrotic portion. Surgical findings showed determined a splenic vein tumor thromboembolus, portal vein involvement, distal stomach involvement, and multiple colonic invasion. Therefore, distal pancreatectomy, wedge resection of the stomach, splenetomy, segmental resection of the transverse colon, and excision of the mass were all performed. Pathologic examination revealed a solid and papillary epithelial neoplasm in the pancreatic tail with a marked dilated splenic vein filled with tumor thromboembolus. The patient has been under chemotherapy since then, and is being closely observed.

A Case of Interstitial Nephritis with Nephrotic Syndrome Induced by Piroxicam (Brexin) / 대한신장학회잡지

Abnormalities of body fluid and electrolyte balance, acute renal failure, nephrotic syndrome, interstitial nephritis and papillary necrosis are well known disease of wide spectrum of NSAID induced renal side effect. Many different mechanism such as inhibition of prostaglandin pathway, delayed hypersensitivity reaction and direct toxicity are reported to relate to development of disease. Recently, overuse of NSAID has steadily increased the cases of NSAID induced side effects and in some cases permanent damage to kidney has been reported. Authors experienced a 67-year-old male patient who presented with gross hematuria, edema and azotemia and diagnosed as interstitial nephritis accompanying nephrotic syndrome. Kidney biopsy shows the edema and the diffuse infiltration of lymphocytes in the interstitium. The glomerular changes suggest minimal change lesion or focal segmental glomerular sclerosis in early stage. The patient had continuously consumed piroxicam for 6 months and had improved after discontinuation of this drug as well as treatment with steroid but remained renal damage. This case suggest that piroxicam may be an agent that causes interstitial nephritis and nephrotic syndrome. Therefore clinician should use it with caution especially in patients with high risk factors.