A case of sarcomatoid carcinoma in the gallbladder / 대한내과학회지

Sarcomatoid carcinomas are rare neoplasms that have been described using various terms, pseudosarcoma, carcinosarcoma or spindle cell carcinoma. Sarcomatoid carcinomas are epithelial tumors with sarcomatoid components and characterized by the presence of cytokeratin in pleomorphic spindle cells. These tumors of gallbladder rarely have been reported predominantly in older women with associated gallstones and their prognosis was very poor. However, the clinical and histological data are very limited. We report a case of sarcomatoid carcinoma in gallbladder confirmed by light microscopy and immunohistochemistry.

A Case of Splenic Abscess with Multiple Fistulas Caused by Klebsiella pneumoniae / 감염

Splenic abscess is an uncommon but frequently fatal condition. Signs and symptoms are variable and do not always include left upper quadrant pain or tenderness. Unexplained thrombocytosis in a septic patient with persistent left pleural effusion is suggestive of splenic abscess. We report a case of splenic abscess with complicated multiple fistulas by Klebsiella pneumoniae which was successfully managed by antibiotic therapy, and percutaneous catheter drainage.

A Case of Mixed Malarial Infection with Plasmodium falciparum and Plasmodium vivax / 감염

We experienced a case of mixed infection with Plasmodium falciparum and P. vivax in a 48-year old Korean man. He returned to Korea from Papua New Guinea, where he worked for 20 days. Approximately one month after return to Korea, he developed high fever and myalgia. Malaria was suspected and he was admitted to our hospital. The peripheral blood smear demonstrated ring forms of P. falciparum. He was treated with quinine and doxycycline successfully. However, fever and myalgia reappeared five months later. This time, the peripheral blood smear showed gametocytes of P. vivax, while indirect immunofluorescence antibody test revealed high titers to both P. vivax and P. falciparum. He was treated with chloroquine and primaquine. Three months later, vivax malaria recurred again; he was treated with chloroquine and higher dose of primaquine. The patient was well after 6 months of follow-up. We hereby report a case of mixed malarial infections with a review of literatures.

Effect of Erythropoietin on Dialyzer Reuse, Dialysis Efficacy and Other Clinical Parameters / 대한신장학회잡지

The use of erythropoietin for correction of anemia in maintenance hemodialysis patients affects dialyzer reuse, dialysis efficacy and other clinical parameters. This study showed the change of Kt/Vurea, nPCR, pre-dialysis BUN, body weight, ultrafiltration volume, pre-dialysis blood pressure, heparin dosage, the number of dialyzer reuse caused by the administration of erythropoietin in reuse(n=11) and first use(n=9) patients who were started erythropoietin since January, 1995. 1) In 20 all patients, hematocrit increased significantly after EPO treatment 20.7+/-0.8%, 27.8+/-0.7%, ultrafiltration volume increased from 2.0+/-0.3L to 2.5+/-0.2L(P1.0/kg/ day) and then pretreatment versus posttreatment nPCR, pre-dialysis BUN and ultrafiltration volume were compared. In low baseline protein intake group, significant increases of ultrafiltration volume, nPCR were observed. However, pre-dialysis BUN were not changed significantly. In high protein intake group, nPCR, pre-dialysis BUN, ultrafiltration volume were changed without significance. In conclusion, EPO treatment did not affect Kt/Vurea, dialyzer reuse, nPCR, predialysis blood pressure, heparin dosage. But ultrafiltration volume increased significantly after EPO treatment. Maybe increased appetite in low baseline protein intake group caused the increased posttreatment ultrafiltration volume.

24 hour circadian pattern of blood pressure and its related target organ damage in hypertensive subjects / 대한내과학회지

OBJECTIVE: Pattern with essential hypertension generally shows the same circadian pattern as the normothensive person with a night-time reduction or "DIP" in blood pressure in sleep. The definition of "Dipper" and "Non-dipper" are assigned according to arbitrary criteria e.g. a night time average blood pressure which is at least 10% less than the average daytime blood pressure. Prospective evidence that the absence of an overnight dip is a strong adverse prognostic indicator for target organ damage .Thus we investigate circardian rhythm of blood pressure, related target organ damage, its frequency & drug in hypertensive subjects. Method : 24hr ambulatory blood pressure monitoring, history taking, physical examination, fundoscopy, ECG, chest X ray, dipstick urinanlysis, serum creatinine level are performed in essential hypertensive subjects. Exclusion criteria are duration of hypertension over 5 years, DM, renovascular hypertension & heart failure. RESULTS: Total 42 patients performed study.17 subjects classify dipper group,25 subjects classify non-dipper group. Between dipper & non-dipper group shows no significantly difference at stroke history, C/T ratio over 0.5 in chest X-ray, left ventrcular hypertrophy in ECG,ST-T change in ECG, proteinuria & serum creatinine level. Non-dipper group shows significantly difference to dipper group in frequency of hypertensive retinopathy and number of combined drug used subjects. CONCLUSION: Number of hypertensive retinopathy is significantly frequency in non-dipper group. Hypertensive retinopathy is atherosclerotic complication, thus we predict other target organ damage, therefore non-dipper type circardian rhythm of blood pressure is adverse prognostic factor for target organ damage of hypertensive subjects.

Utility of Serum Fructosamine as a Measure of Glycemia in Elderly Diabetic Patients

BACKGROUND: Glycemic profile has traditionally been with the use of HbAlc over a 2 to 4 month period. Recently, serum fructosamine is highly sensitive to acute metabolic deterioration(period 2 to 3 weeks), and is suitable for automation, allowing multiple assays with minimal effort. In some report, despite evidence suggesting a reduction in serum albumin level with increasing age, serum fructosamine was strongly correlated with HbAlc in elderly diabetic patients. This study was conducted to define the correlation between fructosamine and other parameters in elderly diabetic patients. METHODS: The study group consisted of 56 elderly patients(age range : 66-85 years, group A) and 58 adult patients(age range: 18-64 years, group B), who were stable over recent 2 months in fasting glucose values and serum albumin levels. Fructosamine was measured in 114 diabetic patients. The measured levels were related to HbAlc and fructosamine/albumin index(FAI). RESULTS: 1) There was significant correlation between HbAlc and fructosamine in all diabetic patients(r=0.705, p=0.0001). The correlation between HbAlc and fructosamine was stronger in group A than in group B [group A: r=0.831, group B: r=0.367, p=0.0001](p<0.05). 2) The correlation between HbAlc and FAI was significantly stronger compared to that between HbAlc and fructosamine in elderly diabetic patients(p<0.05). 3) Glycation ratio provides a vector-like insight into the recent trend of glycemia, and Glycation ratio was stable in all diabetic patients. CONCLUSIONS: Our study suggests that correlation between HbAlc and fructosamine in elderly daibetic patients was significantly lower in adult diabetic patients. Further studies are needed to determine the ultimate values of this test in the clinical management of elderly patient with diabetes.