A case of spontaneous pneumomediastinum caused by endobronchial tuberculosis / 대한내과학회지

Spontaneous pneumomediastinum is a benign condition, caused by alveolar rupture and associated with many clinical conditions. There are numerous reports of spontaneous pneumomediastinum associated with various origins such as bronchial asthma, labor and a mechanically obstructed airway. A 20-year old woman visited our outpatient clinic because of a productive cough and dyspnea. A pneumomediastinum was seen on the chest radiograph and acid fast bacilli were observed on the sputum study. Endobronchial tuberculosis was diagnosed by bronchoscopy and improved with antituberculous treatment. Here, we report a case of spontaneous pneumomediastinum as a complication of endobronchial tuberculosis and review the medical literature.

Acute renal infarction : Clinical features in 23 cases / 대한내과학회지

BACKGROUND: Acute renal infarction is an uncommon disease which is often delyed or missed due to its rarity and unspecific clinical presentation. METHODS: In order to evaluate the clinical features and to elucidate diagnostic or therapeutic options, we analyzed the medical records of 23 patients who were admitted to Pusan National University Hospital from January, 1995 to July, 2004 and diagnosed as renal infarction. RESULTS: The mean age of the patients was 57.3 18.4 years and male to female ratio was 0.91:1. Underlying diseases were cardiovascular disease (n=18), tumor embolism (n=1), vasculitis (n=1), post kidney transplantation thrombosis (n=1), and trauma(n=1). One patient did not have any underlying disease. Initial symptoms were abdominal or flank pain (61%), fever (35%), anorexia (35%), nausea (26%), vomiting (17%), gross hematuria (9%), and oliguria (4%). On physical examination, costovertebral angle tenderness (43%), abdominal tenderness (9%), and hypertension (35%) were noted. Initial abnormal laboratory findings were elevated serum level of LDH (100%), AST (87%), ALT (83%), CK (22%), and creatinine (>1.4 mg/dL, 17%). Imaging diagnosis of renal infarction included renal angiography, isotope renal scan, computed tomography or ultrasonography. CT was done in 17/23 cases and useful in diagnosis of renal infarction. Nine patients were treated with heparin or warfarin. Thrombolysis was done in 3 patients. Others were treated conservatively. CONCLUSIONS: In a patients with an increased risk of thromboembolism, flank or abdominal pain, microscopic hematuria, and an elevated serum LDH are strongly supportive of diagnosis of renal infarction. Under such circumstances, enhanced CT is essential for the early diagnosis of renal infarction.

A Case of Respiratory Failure Caused by Gastropleural Fistula: A Case Report / 대한구급학회지

Gastropleural fistula is a very rare disorder, caused by various conditions, such as trauma and postoperative complication, subphrenic abscess, malignancy, hiatal hernia. The major causes of the gastropleural fistula have changed from trauma and subphrenic abscess to postoperative complication of malignant disorders. We report a case of empyema that developed respiratory failure caused by gastropleural fistula in a middle age woman with review of related articles.

Synchronous Double Primary Cancer: Gastric Hepatoid Adenocarcinoma and Rectal Adenocarcinoma / 대한소화기내시경학회지

Hepatoid adenocarcinoma (HAC) of the stomach is a rare neoplasm consisting of both adenocarcinomatous and hepatocellular carcinoma (HCC)-like foci; the latter of which showed the full spectrum of morphological and functional features of HCC. Numerous cases of HAC have been reported in a variety of primary organs, the stomach is one of the most common sites. HAC is associated with an increased serum alpha-fetoprotein (AFP) level and a strong tendency for lymphatic and venous invasion. Because of early hepatic metastasis, prognosis seems less favorable than more common types of adenocarcinoma. Here, we report a case of synchronous double primary cancer, consisting of hepatoid adenocarcinoma of the stomach and adenocarcinoma of the rectum.

A Case of Multiple Intrahepatic Duct Stones associated with Portal Biliopathy / 대한소화기내시경학회지

"Portal biliopathy" is a terminology used to describe the biliary, ductal and gallbladder wall abnormalities seen in patients with portal hypertension. These changes are predominantly seen in patients with extrahepatic portal vein obstruction (EHPVO), and they include abnormalities (stricture and dilatation) of both the extra and intrahepatic bile ducts, and varices of the gallbladder. The majority of the patients are asymptomatic, but these changes occasionally become significant and give rise to overt obstructive jaundice and they possibly contribute to the development of choledocholithiasis and cholangitis. Asymptomatic patients do not need any treatment. If there is persistent elevation of alkaline phosphatase or ductal dilatation on ultrasonography, ERCP or MRCP can be performed to detect choledocholithiasis or biliary stricture. We present here a 43-year-old male patient for whom portal biliopathy with accompanying multiple intrahepatic duct stones was diagnosed by MRCP and choledocoscopy.

A Case of Dermatomyositis Associated with Psoriasis / 대한류마티스학회지

Dermatomyositis is an autoimmune disorder characterized by symmetrical proximal muscle weakness and muscle atrophy due to chronic inflammation and degeneration of skeletal muscle. Psoriasis is a chronic, systemic disease with cutaneous manifestation characterized by infiltration of inflammatory cells in both the dermal and epidermal compartments of the skin. Dermatomyositis and psoriasis are autoimmune-mediated disorders. But, dermatomyositis associated with psoriasis has not been reported in Korea. We experienced a case of dermatomyositis associated with the psoriasis and as such we are reporting the case with literature reviews.