Synchronous Primary Low-grade Mucosa-associated Lymphoid Tissue Lymphoma of Colon and Stomach

Gastrointestinal tracts are the most frequently involved sites of mucosa-associated lymphoid tissue (MALT) lymphoma. Stomach is the most common site of involvement among the gastrointestinal tract. Simultaneous occurrence of primary gastric and colonic MALT lymphoma is rarely reported. We report a case of synchronous double primary MALT lymphoma of the colon and stomach in a healthy subject. A 62-year-old male underwent an esophagogastroduodenoscopy and colonoscopy for medical checkup. An endoscopic examination of the stomach showed an erythematous mucosa in the great curvature of the lower body. The endoscopic finding of the colon was a flat elevated lesion in the sigmoid colon. Microscopic examinations revealed MALT lymphoma and gastric Helicobacter pylori infection. We performed imaging studies to evaluate distant metastasis and confirmed that there is no other metastasis. The patient was treated with H. pylori eradication therapy and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy. He had not experienced any recurrence since the treatments, and reached a complete remission state after six months.

Hepatocolic Fistula after Radiofrequency Ablation for Hepatocellular Carcinoma / 대한내과학회지

Radiofrequency ablation (RFA) is a relatively safe therapy for patients with hepatocellular carcinoma (HCC); however, complications are not unknown. A hepatocolic fistula is a rare complication after RFA. We report a case of a hepatocolic fistula following a liver abscess after RFA for HCC in a 58-year-old male. The patient was diagnosed with HCC and liver cirrhosis from hepatitis B infection 3 years prior to admission. The HCC was in segment 6 of the liver and was treated with transarterial chemoembolization and RFA. One month after the second RFA, he was diagnosed with a liver abscess, for which he was treated with antibiotics for 2 months, but continued to have intermittent fever and chills. We made a diagnosis of hepatocolic fistula using colonoscopy, fluoroscopy, and liver dynamic computed tomography. The patient underwent a surgical procedure after antibiotic therapy. Although a hepatocolic fistula is a rare complication following RFA, clinicians should be aware of its existence.

A Case of Bilateral Acute Renal Cortical Necrosis Complicated by Tranexamic Acid Administration / 대한내과학회지

Acute renal cortical necrosis is an anuric form of acute renal failure. We experienced a case of renal cortical necrosis complicated by tranexamic acid administration. To our knowledge, only three cases of renal cortical necrosis have been reported worldwide. A 49-year-old man was referred with hemothorax and multiple bone fractures following a traffic accident. Tranexamic acid, and hemocoagulase were injected three times a day. After the 4th dose of hemostatics, anuria developed abruptly, the platelet count decreased to 84,000 /microL, and the serum creatinine was increased to 2.56 from 1.06 mg/dL. On the 4th Intensive Care Unit (ICU) day, computed tomography (CT) showed bilateral renal cortical necrosis with normal renal arteries and aorta. The oliguria persisted for 14 days and temporary hemodialysis was performed. The serum creatinine had decreased to 2.12 mg/dL 8 months after discharge.

Clinical Aspects of Intraabdominal Cystic Lymphangioma in Korea / 대한소화기학회지

BACKGROUND/AIMS: Cystic lymphangioma is an uncommon disease, and rarely develops in the intraabdomen. The aim of this article was to discuss about clinical characteristics of intraabdominal cystic lymphangioma developed in Korea. METHODS: Age, sex, symptoms, locations and size of the lesions, diagnostic methods, treatments, complications and recurrence were analyzed in 13 pathologically confirmed cases of intraabdominal cystic lymphangioma and 18 cases of literature consideration reported in Korea. RESULTS: Intraabdominal cystic lymphangioma commonly developed in adults compared to the other lymphangioma, and frequently located in the mesentery. Abdominal pain was the most common symptom, but it was a non-specific finding. Tenderness and abdominal mass were not significantly associated. The size of mass was diverse. Abdominal ultrasonography and abdominal CT were diagnostic tools most commonly used, but preoperative diagnosis was possible only in 22.6%. All patients were discharged without any complications, and no recurrence was reported. CONCLUSIONS: Preoperative diagnosis of intraabdominal cystic lymphangioma is difficult and symptoms and signs are not specific. Intra-abdominal cystic lymphangioma should be suspected in patients with non specific abdominal pain and intraabdominal mass and active diagnostic evaluation is mandatory.

One Case of Chronic Renal Failure and Another Case of Membraneous Glomerulonephritis Complicated by Acute A Viral Hepatitis / 대한신장학회지

Acute A viral hepatitis is a mild, self-limiting disease of liver and acute renal failure (ARF) is a rare complication. We report two cases of chronic renal failure (CRF) in nonfulminant acute A viral hepatitis and ARF. A 40-year-old man was admitted with ARF and acute A viral hepatitis, and underwent temporary hemodialysis therapy. The renal biopsy showed acute tubular necrosis with tubulointerstitial nephritis. At 13 months after discharge serum creatinine was 1.33 mg/dL and protein-creatinine ratio of spot urine was 0.47 (mg/mg Cr). The second case was a 28-year-old man and was managed conservatively. At discharge the serum creatinine was 3.14 mg/dL and the urinalysis showed hematuria, and protein-creatinine ratio 0.56 (mg/mg Cr). Thirty-nine months after discharge, the creatinine was 1.23 mg/dL, the urinalysis showed persistent nephritis findings and the protein-creatinine ratio 1.28. Kidney biopsy revealed the membranous glomerulopathy with mild tubulointerstitial nephritis, and all of findings suggested the systemic disease-associated secondary glomerulopathy. To our knowledge our case is the first one of chronic glomerulapathy that is confirmed by kidney biopsy.

Comparison of spirometry with cardiopulmonary exercise test of chronic obstructive pulmonary disease / 대한내과학회지

BACKGROUND/AIMS: Chronic obstructive pulmonary disease (COPD) is characterized by an incompletely reversible airflow limitation. Pulmonary function test (PFT) has been considered the gold standard test for diagnosis and severity evaluation in COPD. However, PFT by spirometry does not provide information about exercise performance in COPD patients. Therefore, the present study was performed to compare pulmonary function determined by spirometry with exercise function determined by cardiopulmonary exercise test (CPET) for grading of COPD. METHODS: A total of 105 patients with airway obstruction were examined. The patients' mean age was 65 years, and the mean smoking history was 27 pack-years. The patients underwent spirometry and CPET. The results were analyzed by categorical statistical comparison, based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and American Thoracic Society guidelines. RESULTS: The two methods agreed on the classification of only 44 patients (42%). Of the remaining patients, 21 (20%) were found to be less severe according to CPET than according to PFT, whereas 40 (38%) were more severe. Those who were more severe according to CPET had significantly low maximal minute ventilation, low anaerobic threshold, low oxygen pulse, and high breathing reserve. CONCLUSIONS: The present study revealed the large disagreement between the results of resting and exercise pulmonary function tests, and therefore suggests the need for a novel approach or guideline. Additional cardiological evaluation may be needed in patients classified as more severe according to CPET, who are assumed to have a greater degree of impairment of cardiovascular function.