A Case of Autoimmune Pancreatitis Manifested by a Pseudocyst and IgG4-Associated Cholangitis

Autoimmune pancreatitis (AIP) is a benign disorder and a unique form of chronic pancreatitis with several characteristic features. A cystic formation that mimics a pseudocyst is a rare finding. There have been a few reports of AIP complicated by pancreatic cysts. We present a case of AIP with multiple pseudocysts and obstructive jaundice caused by IgG4-associated cholangitis. We initially missed the diagnosis due to the pseudocyst. Based on the computed tomography images, laboratory findings and the therapeutic response to steroids, the case was diagnosed as AIP with pseudocysts and associated cholangiopathy.

A Case of Bleeding Gastric Villous Adenoma Treated with Endoscopic Mucosal Resection / 대한내과학회지

Villous adenomas of the stomach are rare, although they more frequently occur in the colon and rectum. Clinical symptoms are similar to gastric polyps, but acute or chronic bleeding with anemia occurs frequently. The size of tumors varies between 4 and 6 cm, and the malignant potential is greater when the tumor is larger. Complete resection with surgery or endoscopic resection is the treatment of choice. Endoscopic findings revealed a dome-like or pedunculated appearance. Microscopically, the tumor was composed of long fronds and papillations covered by columnar epithelia with a reduced number of goblet cells. We report a case of polyps with chronic intermittent and acute bleeding for 6 months, which was alleviated by endoscopic mucosal resection and was confirmed as a villous adenoma.

A case of propofol-induced anaphylaxis / 대한내과학회지

Propofol is widely used for sedation during endoscopy. Hemodynamic compromise and respiratory depression might occur under propofol sedation, whereas anaphylaxis is rare. We recently experienced this rare side effect. A 71-year-old woman suffering from substernal chest discomfort underwent endoscopic examination under propofol sedation. She denied any history of allergic reaction to drugs or foods such as beans and eggs. After completion of the endoscopic examination, she developed a whole-body rash with pruritus and edema of her face, including the eyelids and lips. Hypotension was seen on physical examination, and her oxygen saturation was decreased on pulse oximetry. She recovered completely after treatment with epinephrine, an antihistamine, and steroids, with supportive care. Anaphylaxis to propofol is a rare side effect, and prompt treatment is mandatory when it develops.

The Usefulness of Oral Rifampin as Switch Therapy for the Soft Tissue and Bone Infections Caused by Methicillin-Resistant Staphylococcus aureus / 감염과화학요법

BACKGROUND: Rifampin is sometimes used in combination with other anti-staphylococcal agents to treat methicillin-resistant Staphylococcus aureus (MRSA) infections but few reports are available about the usefulness of rifampin against MRSA infections, especially in soft tissue and bone infections. Thus, we evaluated the efficacy of rifampin as switch therapy for soft tissue and bone infections caused by MRSA and assessed the risk factors for treatment failure. MATERIALS AND METHODS: We retrospectively studied 44 patients who had soft tissue and bone infections caused by MRSA and were treated with rifampin in combination or as monotherapy as switch therapy from January 2001 to September 2004. RESULTS: The mean age of the subjects was 50.2 years and the number of male and female were 34 and 10, respectively. Median duration of rifampin use was 32 days and 25% of the patients had artificial prostheses. Thirty one patients (79.5%, 31/39) were cured with parenteral glycopeptide followed by rifampin in combination or as monotherapy. Eight patients (8/39) recurred after the completion of treatment. The presence of hip prosthesis was the only significant risk factor (P= 0.027) in multivariate logistic regression test. Rifampin was tolerable in all cases. CONCLUSION: Rifampin as switch therapy for soft tissue and bone infection caused by MRSA was effective in 79.5% (31/39) of sujects. The treatment failure seems to be associated with unremovable infected prosthesis.

The Usefulness of Oral Rifampin as Switch Therapy for the Soft Tissue and Bone Infections Caused by Methicillin-Resistant Staphylococcus aureus / 감염과화학요법

BACKGROUND: Rifampin is sometimes used in combination with other anti-staphylococcal agents to treat methicillin-resistant Staphylococcus aureus (MRSA) infections but few reports are available about the usefulness of rifampin against MRSA infections, especially in soft tissue and bone infections. Thus, we evaluated the efficacy of rifampin as switch therapy for soft tissue and bone infections caused by MRSA and assessed the risk factors for treatment failure. MATERIALS AND METHODS: We retrospectively studied 44 patients who had soft tissue and bone infections caused by MRSA and were treated with rifampin in combination or as monotherapy as switch therapy from January 2001 to September 2004. RESULTS: The mean age of the subjects was 50.2 years and the number of male and female were 34 and 10, respectively. Median duration of rifampin use was 32 days and 25% of the patients had artificial prostheses. Thirty one patients (79.5%, 31/39) were cured with parenteral glycopeptide followed by rifampin in combination or as monotherapy. Eight patients (8/39) recurred after the completion of treatment. The presence of hip prosthesis was the only significant risk factor (P= 0.027) in multivariate logistic regression test. Rifampin was tolerable in all cases. CONCLUSION: Rifampin as switch therapy for soft tissue and bone infection caused by MRSA was effective in 79.5% (31/39) of sujects. The treatment failure seems to be associated with unremovable infected prosthesis.

Hemophagocytic Syndrome Associated with Bilateral Adrenal Gland Tuberculosis

We report a case of a patient who presented with hemophagocytic syndrome (HPS) and adrenal crisis associated with bilateral adrenal gland tuberculosis, and resulted in a poor outcome. A 50-year-old man was transferred to our hospital from a local clinic due to fever, weight loss, and bilateral adrenal masses. Laboratory findings showed leukopenia, mild anemia, and elevated lactate dehydrogenase. Computed tomography (CT) of the abdomen revealed bilateral adrenal masses and hepatosplenomegaly. CT-guided adrenal gland biopsy showed numerous epithelioid cells and infiltration with caseous necrosis consistent with tuberculosis. Bone marrow aspiration and biopsy showed significant hemophagocytosis without evidence of malignancy, hence HPS associated with bilateral adrenal tuberculosis was diagnosed. During anti-tuberculosis treatment the patient showed recurrent hypoglycemia and hypotension. Rapid ACTH stimulation test revealed adrenal insufficiency, and we added corticosteroid treatment. But pancytopenia, especially thrombocytopenia, persisted and repeated bone marrow aspiration showed continued hemophagocytosis. On treatment day 41 multiple organ failure occurred in the patient during anti-tuberculous treatment and steroid replacement.

Prognostic Factors in Patients with Paraquat Poisoning and Effect of Hemoperfusion

PURPOSE: Paraquat is a nonselective contact herbicide that may induce damage to many organs poisoned with it. Due to the high mortality associated with paraquat poisoning, a prediction of the outcome is a prerequisite for determining the therapeutic modality. METHODS: To identify prognostic factors for paraquat poisoning, the authors analyzed retrospectively the clinical features and outcomes of 45 patients (mean age: 45.9 years; male-to-female ratio: 1.1 : 1) poisoned with paraquat herbicides; they had been admitted to the emergency room of Kyungpook National University Hospital between June 1992 and June 2001. RESULTS: Most patients (91.1%) ingested liquid paraquat concentrate; twenty-six (62%) patients had intended to commit suicide. The overall mortality rate was 64.4% (29 patients); the mortality rate with ingestion of more than two mouthfuls was 93.3%. Seventy-six percent of the fatal cases expired within 2 days after intoxication. Azotemia, hypokalemia, hypoalbuminemia, leukocytosis, and decreased level of arterial PaCO2 and bicarbonate on the first hospital day were significantly related with mortality. Increased level of serum AST on the 4th hospital day was an additional marker of mortality. The survival rates according to the Yamaguchi index were significantly different (A: 60%, B: 12.5%, C: 17%). There was no significant difference in the mortality rate between patients treated with and without hemoperfusion. CONCLUSION: Acid-base and electrolyte imbalances, an abnormal renal function, a low Yamaguchi index, and a positive urine paraquat test might be useful as early markers of poor prognosis. The effect of hemoperfusion remains to be determined by a further larger prospective study.