A Case of a Pancreaticobiliary Fistula Accompanied by Pancreatic Duct Stones / 대한소화기내시경학회지

A Pancreaticobiliary fistula is a rare complication of acute necrotizing pancreatitis or pancreatic abscess. One case is herein reported of pancreaticobiliary fistula that was found following removal of pancreatic duct stones by extracorporeal shock-wave lithotripsy and endoscopic sphincterotomy. The patient was a 53-year old woman who was admitted with epigastric pain and fever. Endoscopic retrograde pancreatography revealed multiple stones in the main pancreatic duct. Pus from the pancreatic duct was drained through the major papilla during cannulation. On balloon cholangiogram obtained after removal of the stones, a direct fistulous connection between the main pancreatic duct and distal common bile duct was noted. It is speculated that pancreatic abscess or mechanical compression of pancreatic duct stones may contribute to the destruction of the intrapancreatic bile duct, which leads to the formation of a pancreaticobiliary fistula.

Three Cases of Dysphagia Due to Vascular Ring in Adults / 대한소화기내시경학회지

Vascular rings resulting from abnormalities of the aortic arch can cause symptoms of esophageal or tracheal compression early in life. Right aortic arch with aberrant left subclavian artery is the most common type of aortic arch abnormalities, followed by double aortic arch, and then left arch with aberrant right subclavian artery. These anomalous vessels usually do not produce symptoms, but occasionally symptomatic patients require surgical intervention. Development of symptoms later in life is due to atherosclerotic enlargement of the arch (Kommerell's diverticulum). We experienced three adults who had anomalous vessels with dysphagia. Diagnosis was made by esophagography and chest CT. Of these three patients, one patient had Kommerell's diverticulum and underwent surgical repair to prevent rupture of an enlarged diverticulum as well as to relieve dysphagia. We consider that diagnosis of dysphagia caused by anomalous vessel is made by noninvasive chest CT and that the patients who have enlarged diverticulum should undergo surgical repair even with mild symptoms to prevent vascular rupture.

Nuclear Hyperploidy of Megakaryocytes and Platelet Aggregation Test in Essential Thrombocythemia / 대한혈액학회지

BACKGROUND: Essential thrombocythemia (ET) is a rare chronic myeloproliferative disorder characterized by an extremely high platelet count in the circulating blood and abnormal proliferation of the megakaryocytes in bone marrow, resulting in splenomegaly, thromboembolic or hemorrhagic complications. We studied the presence of nuclear hyperploidy of the megakaryocytes in bone marrow, the presence of abnormal response to the individual reagent on platelet aggregation test, and its clinical implication. METHODS: We analyzed the 43 cases of ET at the Asan Medical Center between January, 1989 and March, 1999. The Polycythemia Vera Study Group criteria were used to diagnose ET. RESULTS: Nuclear hyperploidy was observed at 43 cases (100%). Platelet aggregation test was done at 32 (74.4%) cases, of which 27 (84.4%) cases showed abnormal response to more than one reagent, 16 (50%) cases to more than two reagents. Abnormal response to epinephrine and collagen was most common, but 5 cases showed normal response. By individual reagent, 1 (3%) cases to adenosine diphosphate, 1 (3%) case to ristocetin, 22 (69%) cases to epinephrine, 19 (59%) cases to collagen showed abnormal response. CONCLUSION: We observe that nuclear hyperploidy of the megakaryocyts and abnormal response on platelet aggregation test are frequent in ET in this study.

A Case with Mixed Infection of Actinomyces and Aspergillus in the Lung / 결핵

Actinomycosis is a bacterial infection that can affect virtually any site in the body. There are three major forms of actinomycosis: cervicofacial, abdominal and thoracic. Aspergillus spp. are ubiquitous in the environment in most countries of the world. Pulmonary aspergillosis is clinically classified by aspergilloma, allergic bronchopulmonary aspergillosis and invasive aspergillosis. Actinomyces and Aspergillus, each of them was often reported in case, but mixed infection of both organisms have not kern reported. We experienced a case of mixed infection of Actinomyces and Aspergillus involving the same area of the lung in a 62 year-old housewife presented with hemoptysis and solitary pulmonary nodule. Percutaneous needle aspiration and later surgical resection revealed sulfur granule mixed with Aspergillus hyphae in the same lesion. We report this case with a review of the literature.