Primary hepatic tuberculoma misconceived as a cholangiocarcinoma / 대한내과학회지

Primary hepatic tuberculoma is a rare malady that is not accompanied by local symptoms, so the diagnosis can frequently be delayed or misconceived as other disease. We report here on an unusual case of primary hepatic tuberculoma that was misconceived as a cholangiocarcinoma on the imaging study. A 54-year-old man presented with dyspepsia and weight loss for 1 month. Abdominal computerized tomography demonstrated a solitary space-occupying lesion on the left lobe of the liver that suggested there was a cholangiocarcinoma accompanied with gastric outlet obstruction. The lesion was diagnosed by the ultrasonographic guided liver biopsy as a chronic granulomatous inflammation with necrosis, and the patient was treated via surgical resection with gastro-jejunostomy followed by antituberculosis chemotherapy. Twelve months later, no evidence of recurrence was noted when examining the patient's symptoms and the imaging studies.

Colonic Transit Time in Maintenance Hemodialysis Patients with Constipation / 대한신장학회잡지

Many hemodialysis patients suffer from constipation. The increased incidence of constipation in long-term dialysis patients is based mainly on self-reported data. So, we conducted a survey on 10 hemodialysis patents with constipation by using total and segmental colonic transit time of radio-opaque markers. Segmental colonic transit times were calculated separately for 3 segments of the colon (right, left, and rectosigmoid) and total transit time, which was the sum of all 3 segment times. On results, colonic transit time was significantly prolonged in hemodialysis patient than in healthy control (42.2+/-20.11 versus 10.57+/-12.8 hour; p<0.0001). Increased colonic transit times in the right and especially rectosigmoid segments, but not the left segment, contributed to the prolongation in total colonic transit time. In conclusion, we suggest that colonic transit time measurement is helpful to tailor therapy because it helps us determine the prolonged segment of the colon in hemodialysis patients with constipation.

A Case of Acute Renal Failure Caused by Ingestion of Glacial Acetic Acid / 대한신장학회잡지

Acetic acid is a colorless liquid with a pungent vinegar-like order. Glacial acetic acid is 99% acetic acid. Acetic acid may lead to different effect on the damaged organ. Acetic acid ingestion is most common and results in pharyngeal, esophageal and GI burns, bleeding and volume depletion. Systemic effect include hemolysis, hepatic dysfunction, hypotension, renal failure and disseminated intravascular coagulation after ingestion of 90-100% acetic acid. Acute renal failure in acetic acid poisoning is rare and the mechanism of acute renal failure remains unclear. But tubular toxic effect of myoglobin or hemoglobin and direct action of acetic acid are suggested as the mechanism. Because of the acute renal failure may be fatal, the immediate treatment of hemolysis, substitution of blood and clotting factor and hemodialysis lead to improvement in general condition and renal function.