Ventricular Fibrillation Soon after Endobronchial Epinephrine Application in a Young Man: A Case Report / 대한구급학회지

Ventricular fibrillation and cardiac arrest rarely occur after local application of epinephrine. Local and superficial application of epinephrine is a common hemostatic method during bronchoscopy, especially after biopsies. Although high plasma levels following endobronchial application of epinephrine have been observed in previous animal studies, there is no report of ventricular fibrillation after a usual dose of endobronchial application of epinephrine during bronchoscopy. We present a case of endobronchial epinephrine-induced ventricular fibrillation and cardiac arrest in a 31-year-old man with no previous history of cardiac disease.

A Case of Death Due to Hemophagocytic Lymphohistiocytosis Accompanied by Scrub Typhus / 감염과화학요법

Hemophagocytic lymphohistiocytosis (HLH) is a rare disease with a high mortality rate. It is associated with a variety of bacterial, viral, fungal, and parasitic infections. In the literature, there are several cases of HLH associated with scrub typhus in adults, all of which were successfully treated with antibiotic therapy for scrub typhus. This report describes a case of HLH accompanied by scrub typhus in an 81-year-old woman, in whom the disease progressed despite doxycyclin therapy. The patient refused to receive immunosuppressive chemotherapy for HLH and died 5 weeks after admission due to multi-organ failure. To our knowledge, this is the first case of death due to scrub typhus-associated HLH in an adult.

Follicular Dendritic Cell Sarcoma: A Case Report and Review of the Literature / Journal of the Korean Cancer Association, 대한암학회지

Follicular dendritic cells (FDC) are non-lymphoid, non-phagocytic accessory cells of the immune system and these cells are essential for antigen presentation and regulation of the reactions in germinal centers. Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm that shows a low-to-intermediate malignant potential. The most commonly involved sites are the lymph nodes, but FDCS may also occur at a variety of extranodal sites, including the oral cavity, tonsils, gastrointestinal tract and liver. We describe here a 79-year-old woman who had FDCS with extensive lymph node involvement, dry cough, and an itching sensation. The patient improved after systemic chemotherapy.

A Case of Systemic Lupus Erythromatosus Presenting with Periorbital Edema / 대한류마티스학회지

Periorbital edema is a rare manifestation of systemic lupus erythematosus (SLE). We describe here a patient with bilateral periorbital edema as a presenting symptom of SLE. A 23-year-old woman was admitted for a sudden onset of severe periorbital edema that developed 7 days previously. On the basis of the malar rash, arthritis of the right hand and left wrist, leukopenia, proteinuria and the positive anti-nuclear and anti-dsDNA antibodies, she was diagnosed with SLE. Kidney biopsy revealed lupus nephritis (WHO class IV). After treatment with high dose of steroids, intravenous cyclophosphamide and daily hydroxychloroquine, her symptoms resolved, including the periorbital edema. She was discharged with prescriptions for prednisolone and hydroxychloroquine and she remains well.

Congenital Middle Ear Cholesteatoma in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Congenital middle ear cholesteatoma (CMEC) is a rare entity that may go undiagnosed for years. Aims of this study were to assess the characteristic features and recurrence of CMEC in pediatric patients of different stages and to determine the value of preoperative CT scan in CMEC. SUBJECTS AND METHOD: Thirty cases of CMEC under 15 years old that had been treated at the hospitals of the Catholic University from 1995 through 2005 were reviewed retrospectively. The age range was from 2 to 13 with the mean age of 6.2. The main outcome measures were CT findings, surgical findings, recurrence rate and hearing assessment. RESULTS: Preoperative CT scan accurately predicted the extent of the cholesteatoma seen during surgery in 25/30 (83.3%). The recurrence rate of CMEC was 6.7% (2/30) and all of recurrent cases were belonged to stage IV. In the recurrent cases, cholesteatomas were extended to sinus tympani and facial recess at revisional operation as well as at the initial operation. CONCLUSION: Preoperative CT scan is essential in defining the extent of existing pathology. The intra-operative CMEC extension and location influence the outcome of surgery. In the higher stages, careful eradication of disease, particularly in the region of sinus tympani and facial recess, are recommended.

A Case of Fungal Ball of Aspergillus in Chronic Otitis Media / 대한이비인후과학회지

Fungal infections in the ear of immunocompetent patients are mainly observed as otomycosis within the external auditory canal. Benign fungal colonization (fungal ball), though they are common in the paranasal sinuses, has never been reported in the middle ear cavity of a healthy population. We present a case of fungal ball in the middle ear of a 30-year-old, immunocompetent male. He did not have any illness except chronic suppurative otitis media in the right ear. On physical examination, only small central perforation was seen in the right tympanic membrane. Temporal bone computed tomography did not reveal any abnormal finding except thickened tympanic membrane. Intraoperative examination demonstrated a dark gray, cheese-like material in the mesotympanum. After tympanoplasty, mycological staining and histopathologic examination identified the surgical sample to be Aspergillus. So we reported, with a review of literature, the first case of Aspergilloma occurring in the middle ear of a healthy patient.

Bilateral Second Branchial Cleft Fistulas: A Case Report / 대한이비인후과학회지

The branchiogenic anomalies are common congenital cervical anomalies. They usually arise from an incomplete obliteration of the branchial apparatus during fetal development. These anomalies may be confused with and mistaken for other potentially more serious lesions, such as cystic hygromas, teratomas, and lymphomas. The anomalies are typically discovered in the pediatric and adolescent population and develop unilaterally. Bilateral manifestations are very rare and have a familial tendency. In addition, anomalies such as intrauterine and postnasal growth retardation, premature aging and unusual faces may be related with bilateral occurrence. This is the first report in the Korean language literature of bilateral branchial fistulas.

Rate and Predictive Factors of Rebleeding with Obscure-Overt Gastrointestinal Bleeding / 대한소화기학회지

BACKGROUND/AIMS: Little information is available on the rate and predictive factors of rebleeding of unknown cause, which is very important in deciding further investigations on obscure-overt gastrointestinal bleeding. The aim of this study was to evaluate the rebleeding rate and related factors in obscure-overt gastrointestinal bleeding patients who revealed normal gastroscopic and colonoscopic findings. METHODS: A total of 69 patients with negative first-line gastroscopy and colonoscopy were enrolled in this study as obscure-overt gastrointestinal bleeding cases. The relationships between rebleeding and clinical characteristics were analyzed retrospectively. RESULTS: The causes of obscure-overt gastrointestinal bleeding were confirmed in 30 cases among the 69 cases. Small bowel tumors (14 cases) were the most common cause, followed by vascular lesions (6 cases). The mean follow-up period was 28 months and rebleeding was noticed in 19 patients (27.5%). Among these rebleeding patients, 14 cases (73.7%) occurred within 6 months. The past experience of previous bleeding was significantly related with rebleeding (p=0.0009). CONCLUSIONS: Close observation and detailed investigations are needed for obscure-overt gastrointestinal bleeding patients with bleeding history, especially during 6 months follow-up.

Characteristics of Early Colon Cancer in Korea / 대한소화기내시경학회지

BACKGROUND/AIMS: Recently, early detection and treatment of early colon cancer (ECC) has increased, and the concept of de novo carcinogenesis of colon cancer was introduced. However there were few studies in Korea. So we tried to find the incidence of ECC and the possibility of de novo colon cancer (DCC) in Korea. METHODS: From Jun 1995 to Jun 2003, 3072 patients who first treated as colon cancer at Samsung Medical Center were enrolled. We selected ECC by medical record review, and pathologic slides and endoscopic photos were reviewed to evaluate the underlying tissue of cancer focus and morphologic characteristics of ECCs. ECC was defined as the cancer confined to mucosa or submucosa, and DCC was defined as the cancer lesser than 1 cm but had no adenoma component. RESULTS: The 192 patients (6.3%) had 196 cases of ECC. The ratio of mucosal and submucosal (SM) cancers was 36.7%:63.3%. The protruded type was the most frequent type (82.1%). The depressed type was the smallest (12.9+/-6.3 mm), in size and 100% showed and SM involvement. It has significantly higher rate of the cancer without underlying adenoma component (57.1%, p<0.001). The DCC were 6 cases and all were SM cancer and had 3 cases of protruded and depressed type each other. CONCLUSIONS: The most common shape of ECC was protruded type. However, depressed type was smaller and had higher rate of SM involvment and no adenoma component around the cancers. And we found some of DCC although the frequency was very low.

A Case of Myocardial Ischemia and Myocardial Injury Caused by Coronary Vasospasm Associated with Hyperthyroidism

There are many kinds of cardiac complications of hyperthyroidism such as angina pectoris, myocardial infarction, atrial fibrillation, congestive heart failure, heart block and sudden death. While angina is not uncommonly seen in association with hyperthyroidsm, it is rare that myocardial ischemia or infarction may be caused by coronary vasospasm. A 46 year-old man, who had been diagnosed with hyperthyroidism at the first admission, presented with chest pain. The serum thyroid hormone was still elevated. Serial ECGs showed significant ST elevation suggesting transmural ischemia, but coronary angiogram did not reveal any significant lesion. ECG at discharge was normalized without evidence of myocardial infartion. We report this case as an example of severe transmural ischemia with myocardial injury caused by coronary spasm associated with hyperthyroidism.

A Case of Hypereosinophilic Syndrome with Hepatic and Gastrointestinal Involvement / 대한간학회지

Hypereosinophilic syndrome is characterized by prolonged eosinophilia of blood and tissue without an identifiable underlying cause and multiorgan system dysfunction by eosinophil-related tissue damage to variable organs: liver, heart, lung, kidney, gastrointestinal tract, skin, nerve. Some case of hypereosinophilic syndrome with hepatic and gastrointestinal involvement have been reported, but not much. We are reporting a case of hypereosinophilic syndrome with hepatic and gastrointestinal involvement in 56-year-old man who presented general weakness and epigastric discomfort. In abdominal US, CT and MRI, intrahepatic multifocal ill-defined lesions were detected. The patient was treated with prednisolone for 16 weeks and recovered from eosinophilia and gastric involvement. A gastric biopsy was taken to confirm recovery. Also, the ill-defined lesions in US and CT disappeared after treatment.

A Case of Glomus Tumor of the Stomach: Role of Endoscopic Ultrasonography / 대한소화기내시경학회지

A glomus tumor of the stomach is a rare submucosal lesion that was first described by De Busscher in 1948. Submucosal tumors of the stomach are mostly leiomyoma, leiomyosarcoma, and malignant lymphoma. It is difficult to diagnose this kind of tumor preoperatively. We present a patient with a gastric glomus tumor which showed the characteristic endoscopic ultrasonographic (EUS) finding. Our case was also diagnosed by pathology after surgery. The major EUS findings in the present case are circumscribed low echoic mass in the forth submucosal layer and an internal heterogenous echo mixed with high echoic spots. The EUS seems to be useful in distinguishing between glomus tumor and other submucosal tumors.

A Case of Massive Hematochezia from a Meckel's Diverticulum without Ectopic Mucosa / 대한소화기내시경학회지

Meckel's diverticulum, which is a persistence of a remnant of the omphalomesenteric duct, is the most common developmental anomaly of the gastrointestinal tract, with an incidence of about 2% in the general population. Typically, Meckel's diverticulum is a true diverticulum because it arises from the antimesenteric border of the small bowel and all layers of the intestinal wall are present. Complications of Meckel's diverticulum include bleeding, perforation, diverticulitis, intestinal obstruction, stones, intussusception, hernia, and neoplasm. Bleeding in particular is a common complication and has always been caused by an ulceration of the ileal mucosa adjacent to the acid-producing ectopic gastric mucosa in a Meckel's diverticulum. A case was recently experienced involving massive hematochezia from Meckel's diverticulum without ectopic gastric mucosa in a 27 year-old woman, and in herein reported.

A Case of Pseudopolycytemia in Dilated Cardiomyopathy

We experience a case of pseudopolycytemia in dilated cardiomyopathy in a 62 years old man with chronic alcoholism. The patient was successfully managed by stress reduction, stopping of smoking, abstaining from alcohol drinking, use of digoxin, small dose lasix, and phlebotomy. To our knowledge, this is the first case of pseudopolycytemia in dilated cardiomyopathy in Korea. We reported this case with a review of literatures.

A Case of Tracheal Hemangioma Manifested Massive Hemoptysis / 결핵

Hemangioma is benign tumor that represent an fail in development of the vascular system, network or retiform stage. As with hemangioma elsewhere, spontaneous regression may occur. Histologically capillary hemangioma has a diagnostic lobular arrangement of capillaries and almost all of them are located in nasal or oral mucous membranes. But, as we know, there is no report of hemangioma located in the trachea in Korea, so we report a case of tracheal hemangioma which was manifested massive hemoptysis.

A Case of Complete Remission in Ruptured Hepatocellular Carcinoma after One -time Transcatheter Arterial Chemoembolization / 대한간학회지

There are many kinds of treatments for hepatocellular carcinoma (HCC) such as surgical resection, liver transplantation, chemotherapy, interventional therapy [TACE, ethanol embolization, Immuno -chemoembolization, I131 -lipiodol embolization], thermal therapy, cryotherapy, and radiation therapy. Generally spontaneous remission is not common in HCC, however underlying mechanism of spontaneous remission is uncertain. We report a case of complete remission after one time TACE in ruptured HCC with review of literature about the effect of TACE and spontaneous remission. We conclude that arterial embolization is an effective alternative to surgery for hepatic hemostasis in patients with spontaneous rupture of hepatocellular carcinoma.

A Case of Liddle's Syndrome Associated with Muscle Weakness / 대한신장학회잡지

Liddle's syndrome was described in 1963 by Liddle, et al., as the disease featuring a hypertension and hypokalemia but with negligible secretion of aldosterone. This syndrome, which morphologically belongs to an abnormal intrinsic tubular disorder with normal renal function, is characterized by hypokalemia, metabolic alkalosis, and hypertension due to the abnormal increase in excretion of potassium in distal tubules or collecting duct and the increase in reabsorption of sodium in distal tubules. This syndrome, which is rare disease, is observed with the low level of plasma and urinary aldosterone and suppressed plasma renin level and is known as dominant mode of inheritance with a family background. The authors paid attention to a 79-year-old man who showed a high blood pressure of 210/130mmHg as well as musle weakness, especially lower extremities due to metabolic alkalosis featuring a hypokalemia level of 2.0mEq/L when he was admitted to our hospital, Because his serum potassium were not improved with the medication of intravenous potassium supply, and his blood pressure continued to be high without the improvement of muscle weakness, we prescribed 300mg of spironolactone for two weeks. His symptom, however, was not cured. Then, instead of spironolactone, we prescribed 150mg of triamterene and a low salt diet which finally improved his symptoms. Because there has been no reported case in the Korean medical literature, we report a case of successfully treated Liddle's syndrome due to triamterene administration.

A Case of Frontoethmoidal Meningoencephalocele

Meningoencephalocele in the anterior part of the cranium is a rare congenital anomaly and has been sparsely reported in the neurologic literature. Recently we encountered a case of bilateral frontoethmoidal meningoencephalocele in a 3-year-old otherwise healthy boy. The cranial ends of the tumors were amputated by bifrontal craniotomy and dural defect was tightly repaired with Neodura. The external portions of the tumors were excised at the second stage and double-limbed YV shaped canthoplasty was performed. Postoperatively, the patient recovered uneventfully without any complication.