Endovascular Treatment in Ruptured Middle Cerebral Artery Dissection Preservation of Arterial Continuity

Rupture of spontaneous dissecting aneurysms of the middle cerebral artery (MCA) is rare and its etiology remains obscure, although the risk of rebleeding is greater than with saccular aneurysms. Most reports concerning the treatment of a ruptured dissecting aneurysm of the anterior circulation involve surgical trapping or wrapping. Here, we report on a case of an MCA dissecting rupture treated with endovascular procedures. A 22-year-old female presented with sudden stuporous mental change following severe headache and left side hemiparesis. A computed tomography scan showed a diffuse subarachnoid hemorrhage and diffusion MR showed diffusion restriction at the right putamen and internal capsule. A 3-hour follow-up digital subtraction angiography (DSA) showed a dissecting aneurysm, which was not seen on an initial DSA. A stent assisted coil embolization was performed and double stents were applied to achieve flow diversion effects. A small remnant area of the dissecting aneurysm had disappeared at 60-day and was not observed on 12-month follow-up DSA.

High Grade Myxofibrosarcoma in the Paravertebral Muscle: A Case Report

Many different abnormalities, such as, neoplasm, infection, traumatic hematoma, or congenital or immune myopathy, may be found in the paravertebral muscles. However, neoplasms of paravertebral muscle are an uncommon cause of back pain. Such neoplasms may arise from local lesions or due to metastatic spread from a distant malignancy. The differential diagnoses of a primary soft tissue malignancy and metastatic spread from a skeletal muscle tumor are important. In cases of soft tissue sarcoma, histopathological findings and surgical margins are both related to local recurrence and metastasis, therefore, percutaneous needle biopsy may be helpful before surgical excision. A degree of surgical excision is decided based on considerations of muscular function and histopathological findings.

A Case of Hepatocellular Carcinoma Within Hepatocellular Adenoma in a Non-Cirrhotic Male

Hepatocellular adenoma (HA) is a benign hepatic lesion that predominantly occurs in young women. Most hepatocellular carcinomas (HCC) arise in a cirrhotic liver during the fifth or sixth decades. There have been several reported cases of HCC developing from HA in female patients. However, there are rare cases about HCC arising in HA in a non-cirrhotic male patient. We have recently encountered a 53-year-old man who had a liver mass in a non-cirrhotic liver, and the liver mass was compatible with HA on the pre-operative computed tomography. The mass was completely resected and the histopathology revealed a focus of HCC arising in HA. We report here on this case along with a brief review of the relevant literature

Two Cases of Pulmonary Infection due to A. xylosoxidans Infection in an Immunocompentent Patient / 결핵및호흡기질환

lcaligenes xylosoxidans is a catalase and oxidase positive, motile, nonfermentative and gram-negative rod bacterium. A. xylosoxidans infection is a rare cause of pulmonary infection and little information concerning treatment is available. The majority of patients that develop A. xylosoxidans infection belong to a high-risk group due to an immunocompromised condition or due to pulmonary cystic fibrosis. We report two rare cases of immunocompentent patients that developed a pulmonary infection due to A. xylosoxidans. A 77-year-old man was admitted with a lung abscess. The patient denied having any prior medical illness. A culture of bronchial washing fluid showed the presence of A. xylosoxidans. Despite appropriate antibiotic treatment, the patient died from acute respiratory distress syndrome (ARDS). Another patient, a 61-year-old man without an underlying disease, was admitted with empyema. Under the condition of a closed thoracostomy, a high fever persisted and the empyema was also aggravated. A. xylosoxidans was detected from a culture of pleural fluid. Susceptible antibiotic treatment was provided and surgical intervention was performed. We report these cases with a review of the literature.

A Case of Multiple Micronodular Pneumocyte Hyperplasia of the Lung in a Man with Tuberous Sclerosis / 결핵및호흡기질환

Tuberous sclerosis (TS) is an autosomal dominant disorder that is characterized by cutaneous lesions, seizures, mental retardation and hamartomas in various organs including the skin, kidney and brain. Pulmonary involvement is extremely rare, and occurs in approximately 0.1 to 1% of TS cases. Recent reports have indicated multiple micronodular pneumocyte hyperplasia (MMPH) as another rare form of pulmonary involvement of tuberous sclerosis. We report a case of a 35 year-old-male patient who had no pulmonary symptoms but showed multinodular pulmonary shadows on his chest CT scan. The patient was finally diagnosed with TS with MMPH of the lung. MMPH does not appear to have any malignant potential but the clinical significance of MMPH in TS patients is unknown.(Tuberc Respir Dis 2008;64:369-373)

A Case of Polyarteritis Nodosa Mimicking Systemic Lupus Erythematosus / 대한류마티스학회지

Polyarteritis nodosa (PAN) is a rare systemic necrotizing vasculitis involving multiple organ system. Systemic lupus erythematousus (SLE) also presented as a vasculitic symptoms. So, systemic vasculitis and SLE share some clinical features. We report a case of polyarteritis nodosa mimicking SLE. A 45-year-old woman was admitted due to oliguria. She diagnosed SLE because of pericardial effusion, hemolytic anemia, proteinuria, hematuria, and positivity of anti-dsDNA antibody. But she re-diagnosed as PAN through renal angiography and renal biopsy afterwards. She was treated with high dose steroid, cyclophosphamide, and anti-TNF-alpha antibody, but didn't respond those therapies.

A Case of Extensive Involvement of Lupus Enteritis, from Small Bowel to Rectum / 대한류마티스학회지

Systemic lupus erythematosus (SLE) is a multisystem ic inflammatory disorder mediated by autoantibodies and immune complexes that manifests with a variety of symptoms. Lupus enteritis is a serious complication of SLE and carries a high mortality rate, however the diagnosis is not easy for there are no specific clinical manifestations and laboratory findings. Lupus enteritis usually involves the mesenteric arteries causing ischemic changes of the small and large bowels, and yet rarely involves the rectum. Here, we report a case of a 26-year-old female lupus enteritis patient who presented with atypical abdominal pain. Early diagnosis was made by abdominal pelvic computed tomography (CT) scan, which showed extensive involvement of lupus enteritis from proximal small bowel to rectum. She recovered after being treated with high dose steroid therapy.