High-Resolution CT Findings of Active Pulmonary Tuberculosis: Different Features between AFB Stain Positive and Negative Group / 결핵

BACKGROUND: We studied about the The different features of high-resolution CT (HRCT) findings of active pulmonary tuberculosis(TB) were studied between acid fast bacilli(AFB) smear or culture positive and negative group. METHODS: We prospectively evaluated 36 patients who had been confirmed for active pulmonary tuberculosis by the smear or culture of AFB in sputum(n=25), and changes on serial chest radiographs(n=11). The patient were divided into 3 groups by the results on sputum AFB stain and culture. Group 1(n=11) is negative in both AFB stain and culture ; group 2(n=13) is negative in AFB stain but positive in culture ; and group 3(n=12)is positive in both AFB stain and culture. We evaluated the findings of HRCT in each group randomly. RESULT: On the HRCT scans, acinar nodule(100%), macronodule(75%), and cavity(75%) in group 3 were more frequently found than group 1(63%, 18%, 9%) and group 2(46%, 15%, 23%)(p0.05). AFB positive group was statistically different than the negative group in the HRCT findings such as with respect to acinar nodule(100% vs 54%), macronodule(75% vs 17%), and cavity(75% vs 17%)(p<0.05). TB culture positive group was statistically different than the negative group in the HRCT findings such as with respect to acinar nodule(72% vs 45%) and cavity(48% vs 9%)(p<0.05). CONCLUSIONS: HRCT scans are helpful in determining disease acitivity in sputum AFB stain- negative pulmonary tuberculosis. When HRCT shows centrilobular nodule and branching structure, acinar nodule, macronodule, cavity, we are able to decide more study such further studies as sputum induction and bronchoscopy for determination of can be performed to determine the presence of bacilli in patients of AFB stain-negative tuberculosis.

Kaposiform Hemangioendothelioma Complicated by Kasabach - Merritt Phenomenon with Bone Involvement in an Adult / 대한암학회지

Kasabach-Merritt phenomenon does not occur with common hemangioma, rather it is associated with the more aggressive Kaposiform hemangioendothelioma and rarely with other vascular neoplasm. We report the case of an adult who was diagnosed as Kaposiform hemangioendothelioma complicated by Kasabach-Memtt phenomenon. This is the first report in Korea of an adult with Kasabach-Merritt phenomenon who has osteolytic changes of femur, pelvic bone, and lumbar spine.

Persistent Truncus Arteriosus with Survival to the Age of 29 Years

The Truncus arteriosus is a congenital malformation in which only one great artery arises from the base of the heart and gives origin to the systemic, pulmonary and coronary arteries proximal to the aortic arch. Pulmonary blood flow is governed by the size of the pulmonary arteries and the pulmonary vascular resistance. In infancy, pulmonary blood flow is usually excessive because pulmonary vascular resistance is not greatly increased. Thus, despite an obligatory admixture of systemic and pulmonary venous blood in the common trunk, only minimal cyanosis is present. Rarely pulmonary blood blood flow is restricted by hypoplastic or stenotic pulmonary arteries arising from the truncus. The prognosis in persistent truncus arteriosus is very poor. the median age of survival of the 94 patients with the disease reported up to 1962 was only five weeks. The longest survival reported is the case of the man described by Carr et al who lived to the age of 36 years and 2 months. We report the case of a man with persistent truncus arteriosus who lives to the age of 29 years.

A Case of Isolated ACTH Deficiency Accompanied by hyperprolactinemia / 대한내분비학회지

Isolated ACTH deficiency is a uncommon disorder causing secondary adrenocortical insufficiency. Less than 200 cases have been reported in the world. The major clinical manifestations are hypoglycemia, weight loss, hypotension, anemia, weakness, nausea, inability to excrete water load, and hyponatremia. A 56-year-old male was admitted because of weakness, fatigue, nausea and vomiting. He was pallor and not associated with hyperpigmentation. The basal plasma ACTH and cortisol levels were 8.30 pg/ml and 0.6 ug/dl. The serum cortisol did not response to rapid ACTH stimulation test. On combined pituitary stimulation test, the cortisol did not response to insulin-induced hypoglycemia. Other anterior pituitary hormones showed normal responses except elevated prolactin level. Six months after glucocorticoid replacement therapy, the elevated basal prolactin level returned to normal. Brain MRI did not show any anatomic abnormalities of the sellar and suprasella area. We report a case of isolated ACTH deficiency accompanied by hyperprolactineia, which respond to glucocorticoid replacement therapy.