A Case of Henoch-Schonlein Purpura Presenting with Cholestatic Hepatitis / 대한내과학회지

Hepatobiliary involvement is a rare manifestation of Henoch-Schonlein purpura (HSP). HSP cases related to hepatitis A, B or C virus have been reported but little is known about HSP cases complicated by cholestatic hepatitis without underlying hepatobiliary disease. Here, we report a case of Henoch-Schonlein purpura presenting with cholestatic hepatitis. The patient presented with upper abdominal pain and cholestasis that developed characteristic purpura. The patient was treated conservatively by therapeutic fasting and nutritional support, and liver function recovered 7 weeks after admission.

A Case of Bronchiectasis with Elevated Serum CA 125 Level / 결핵및호흡기질환

Serum CA 125 is the most useful marker for monitoring patients with epithelial ovarian cancer. However, it can be elevated above normal level in a variety of conditions other than ovarian cancer such as endometriosis, pelvic inflammation disease, and other malignant or nonmalignant disorders, including pulmonary diseases. Recently, we experienced a case of bronchiectasis in which the serum CA 125 level was elevated, changing with the patient's condition. There was no evidence of underlying malignant disease on positron emission tomography or on gynecologic examination, including transvaginal ultrasonography. During follow-up for 14 months, we could not find any clue of malignant disease that could have been the cause of the elevated levels of serum CA 125. Elevated serum CA 125 level should be interpreted carefully according to the patient's clinical condition. In addition, our case suggests that CA 125 may be used as a surrogate marker for acute inflammatory status for chronic pulmonary diseases.

Diagnosis of Malignant Pleural Effusion by using Aberrant Methylation of p16 and RARB2 / 결핵및호흡기질환

BACKGROUND: A diagnosis of malignant pleural effusion is clinically important, as the prognosis of lung cancer patients with malignant pleural effusion is poor. The diagnosis will be difficult if a cytological test is negative. This study was performed to investigate whether the detection of hypermethylation of the p16 (CDKN2A) and retinoic acid receptor b2 (RARB2) genes in pleural fluid is useful for a diagnosis of malignant pleural effusion. METHODS: Pleural effusion was collected from 43 patients and was investigated for the aberrant promoter methylation of the RARB2 and CDKN2A genes by use of methylation-specific PCR. Results were compared with findings from a pleural biopsy and from pleural fluid cytology. RESULTS: Of 43 cases, 17 cases of pleural effusion were due to benign diseases, and 26 cases were from lung cancer patients with malignant pleural effusion. Hypermethylation of the RARB2 and CDKN2A genes was not detected in the case of benign diseases, independent of whether or not the patients had ever smoked. In 26 cases of malignant pleural effusion, hypermethylation of RARB2, CDKN2A or either of these genes was detected in 14, 5 and 15 cases, respectively. The sensitivities of a pleural biopsy, pleural fluid cytology, hypermethylation of RARB2, hypermethylation of CDKN2A, or hypermethylation of either of the genes were 73.1%, 53.8%, 53.8%, 19.2%, and 57.7%, respectively; negative predictive values were 70.8%, 58.6%, 58.6%, 44.7%, and 60.7%, respectively. If both genes are considered together, the sensitivity and negative predictive value was lower than that for a pleural biopsy, but higher than that for pleural fluid cytology. The sensitivity of hypermethylation of the RARB2 gene for malignant pleural effusion was lower in small cell lung cancers than in non-small cell lung cancers. CONCLUSION: These results demonstrate that detection of hypermethylation of the RARB2 and CDKN2A genes showed a high specificity, and sensitivity was higher than for pleural fluid cytology. With a better understanding of the pathogenesis of lung cancer according to histological types at the molecular level, and if appropriate genes are selected for hypermethylation testing, more precise results may be obtained.

A Case of Bronchiectasis with High Serum CA19-9 / 결핵및호흡기질환

An elevated serum CA19-9 level is an indication of pancreatic and biliary tract cancer. However, it has recently become known that nonmalignant gastrointestinal diseases and a variety of nonmalignant respiratory diseases, such as idiopathic interstial pneumonia, collagen vascular disease associated lung diseases, diffuse panbronchiolitis and bronchiectasis, can also show an elevated serum CA19-9 level. We recently encountered a case of bronchiectasis with persistently elevated serum CA19-9, but without any evidence of malignant disease in endoscopic retrograde pancreatocholangiography, abdominal computed tomography, and positron emission tomography. After serial follow-up of 3 years and 10 months, there was still no evidence of cancer. It is believed that the elevated serum CA19-9 level was due to bronchiectasis. An elevated serum CA19-9 level should be interpreted carefully with the patients' clinical condition.

Effect of Liposome-Entrapped Superoxide Dismutase on Lipid Peroxidation in Experimental cerebral Infarction

To observe the role of lipid peroxidation and the effect of liosome-entrapped superoxide dismutase(SOD) on lipid peroxidation experimental cerebral infarct, an infarction model was created by transorbital occlusion of the middle cerebral artery. Malondialdehyde(MDA), which is the degradation product of polyunsatunsaturated fatty acids in the cell wall, were measured at both the cortical and basal ganglia area of cat brain before and after administration of liposome-en-trapped superdioxide dismutase. The results were as follows: 1) There was a more significant increase of MDA in the left cerebral cortex than in the right than in the right cortex after occlusion of the left middle cerebral artery, but there was no significant difference between the 2 sides of the basal ganglia. 2) In the left cerebral cortex of the 1 and 3 hours subgroups with in experimental group, which were treated with liposome-entrapped SOD, there was a more significant decrease of MDA than the left cortex of control group. But there was no significant difference of MDA in the cortex of 6 hours group and the basal ganglia. 3) There was a more significant increase of MDA in the left cortex of control group, which was not treated with liposome-entrapped SOD, than in the right cortex. But there was no significant difference of MDA between both sides of the experimental group. 4) In the basal ganglia, there was no significant difference of MDA between the 2 sides of the control and experimental group. It is suggested that brain damage following cerebral infarction can be prevented or attenuated by the treament of liposome-entrapped SOD.