Erythropoietin Antibody-Positive Pure Red Cell Aplasia Diagnosed after Surgical Intervention for Malignant Gastric Ulcer Bleeding / 대한내과학회지

Rarely, patients on erythropoietin stimulating agent (ESA) therapy develop antibodies that neutralize both ESA and endogenous erythropoietin, resulting in antibody-mediated pure red cell aplasia (PRCA). The sudden development of severe transfusion-dependent anemia requires rapid recognition, the evaluation of PRCA, and prompt intervention after differentiating other causes of anemia, such as iron deficiency, occult bleeding, and infection. Here, we report the case of a 67-year-old male undergoing hemodialysis who presented with the anemia of chronic blood loss from a malignant gastric ulcer. Even after surgical intervention for stomach cancer and increasing the erythropoietin dosage, the anemia was not correctable and required monthly packed red blood cell transfusions. Further evaluation revealed positive erythropoietin antibody, and a bone marrow biopsy showed no red blood cell precursors, supporting the diagnosis of PRCA.

Spontaneous Renal Artery Dissection in a Patient with Protein C and S Deficiency / 대한내과학회지

Spontaneous renal artery dissection without aortic dissection in normotensive patients is rarely reported. Spontaneous renal artery dissection is also an uncommon cause of renal infarction that occurs, though rarely, in patients with hypercoagulable states such as protein C and S deficiency. We report here a case of spontaneous renal artery dissection and renal infarction associated with protein C and S deficiency.

A Case of Hemicranial Pneumocephalus Secondary to Removal of a Central Venous Catheter / 대한내과학회지

The presence of pneumocephalus associated with insertion, maintenance, and removal of intravenous catheters is a rare radiographic finding, but may be clinically relevant. Various pathways have been proposed to explain the development of pneumocephalus, but none are well understood. We present a patient with hemicranial pneumocephalus secondary to removal of a central venous catheter as determined by computed tomography, and we propose a possible mechanism of the pneumocephalus.

Aeromonas hydrophila Myonecrosis in an Immunocompetent Patient / 감염과화학요법

Aeromonas hydrophila is a facultative anaerobic Gram negative bacillus. It usually thrives in fresh and brackish water and primarily causes gastroenteritis in humans. Rarely aeromonads have been associated with extra-intestinal infections, such as skin and soft infection, meningitis, epidural abscess, endocarditis and pneumonia in immunocompromised hosts. Here we report Aeromonas hydrophila soft tissue infection occurring in a 53-year-old Korean woman without underlying disease who was successfully treated with proper antibiotics.

A Case of Successful Hemoperfusion in the Treatment of Acute Severe Clozapine Intoxication / 대한신장학회지

Clozapine, a psychotropic drug commonly used in the treatment of schizophrenia or schizophrenic affective disorders may show side effects such as agranulocytosis, cardiomyositis, cognitive and motor depression in therapeutic doses and central nervous system depression, respiratory depression, arrhythmia, seizures, and even death in case of severe intoxication, warranting an aggressive treatment. We hereby report a case of clozapine overdose patient who ingested a potentially fatal dose of 3 grams and showed stuporous mental state, who was treated successfully by hemoperfusion without any sequelae.

Clinical Utility of Access Blood Flow Measurement by Ultrasound Dilution in Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Prophylactic stenosis correction is important in the durability of the vascular access, and routine surveillance for the detection of stenosis has been widely recommended to allow preemptive intervention before thrombotic occlusion. The ultrasound dilution technique has been considering not only a popular and validated in vascular access surveillance, but also useful in the measurement of access recirculation and cardiac output. METHODS: Access flow, recirculation, and cardiac output of seventy-six hemodialysis patients with arteriovenous fistulae were measured by ultrasound dilution technique, followed by access flow measurement by color doppler ultrasound in sixty-four patients. Access stenosis was defined as 50% and more reduction in the diameter of vessels by color doppler ultrasound. Cardiac output of thirty-seven patients by echocardiography within a year was also analyzed. RESULTS: Access stenosis was diagnosed in six of sixty-four patients by color doppler ultrasound (9.4%). Access flow in the group with stenosis (621+/-322 mL/min) was lower than the group without stenosis (1, 005+/-633 mL/min), but no statistical significance was found. The access flow measured by ultrasound dilution technique was significantly correlated with color doppler ultrasound (r=0.436, p= 0.01). The cardiac output measured by ultrasound dilution technique was also significantly correlated with echocardiography (r=0.660, p=0.01). CONCLUSION: The data did not provide statistical significances for the detection of stenosis by ultrasound dilution technique. But this study suggests that ultrasound dilution technique is a useful method in the measurement of access flow, cardiac output and recirculation. We hope further prospective studies based on our data will be performed.

A case of successfully treated scrub typhus with azithromycin in pregnant woman / 대한내과학회지

Scrub typhus is a acute febrile illness by Orientia tsutsugamushi that is endemic in Asian-Pacific areas. But it is difficult to found this disease in pregnant woman. As yet, many clinicians have difficulty in making choice of appropriate and safe drugs to pregnant women with scrub typhus, because the drugs such as tetracycline (doxycycline) and chloramphenicol which have been used are proven harmful to fetus and neonates. We experienced a case of successfully treated scrub typhus with azithromycin in pregnant woman, and report it with references.

A Case of Abdominal Actinomycosis Complicated by Hydronephrosis / 감염과화학요법

Actinomycosis is a chronic suppurative and granulomatous disease caused by Actinomyces species, which normally colonize the mouth, colon, and vagina. Actinomycosis affects any organ and it is histologically characterized by sulfur granule. Most of abdominal actinomycosis develop following appendicitis, diverticulitis or perforated viscus. Abdominal actinomycosis is commonly misdiagnosed as other diseases of intestine because the clinical presentation is non-specific and the radiologic findings mimic tumor. We report a case of abdominal actinomycosis, which initially presented as hydronephrosis and finally diagnosed after laparotomy. Histological findings showed sulfur granules, chronic granulomatous inflammation, and acute inflammatory cells. In our knowledge, this is the first report in Korea of the abdominal actinomycosis associated with appendicitis and complicated with hydronephrosis.

A Case of Abdominal Actinomycosis Complicated by Hydronephrosis / 감염과화학요법

Actinomycosis is a chronic suppurative and granulomatous disease caused by Actinomyces species, which normally colonize the mouth, colon, and vagina. Actinomycosis affects any organ and it is histologically characterized by sulfur granule. Most of abdominal actinomycosis develop following appendicitis, diverticulitis or perforated viscus. Abdominal actinomycosis is commonly misdiagnosed as other diseases of intestine because the clinical presentation is non-specific and the radiologic findings mimic tumor. We report a case of abdominal actinomycosis, which initially presented as hydronephrosis and finally diagnosed after laparotomy. Histological findings showed sulfur granules, chronic granulomatous inflammation, and acute inflammatory cells. In our knowledge, this is the first report in Korea of the abdominal actinomycosis associated with appendicitis and complicated with hydronephrosis.

A case of upper gastrointestinal hemorrhage by recurred hepatocellular carcinoma with gastric invasion / 대한내과학회지

Hepatocellular carcinoma is an one of the most common malignancies worldwidely. Recent advances in both the diagnosis and treatment of hepatocellular carcinoma have improved the prognosis, but it has been known difficult in early diagnosis and treatment of extrahepatic metastasis because of low diagnosis rate. We have experienced one rare case of recurred hepatocellular carcinoma with gastric invasion in the postoperative tissue which was confirmed by endoscopy and operation in a gastrointestinal hemorrhage pateint.

A Case of Acute Ethanol Intoxication Complicated with Sciatic Neuropathy Treated with Hemodialysis / 대한신장학회잡지

A 20-year-old man presented with semicoma due to severe ethanol intoxication. Initially, his blood ethanol level was markedly elevated to 73 mmol/L. The patient's level of consciousness did not change for 6 hours with conservative treatment. In an attempt to expedite his recovery, hemodialysis was started using a femoral vein catheter. After an initial session of hemodialysis, his blood ethanol level was decreased to 19 mmol/L, and his mental status showed improvement. Subsequent hemodialysis further reduced his blood ethanol concentration to 3 mmol/L and improved his consciousness level. The patient was treated conservatively for additional complications caused by ethanol toxicity including liver failure, rhabdomyolysis and peripheral polyneuropathy. Most commonly, peripheral polyneuropathy is related with chronic ethanol intoxication and it is extremely rare in acute ethanol intoxication. We report a case of peripheral polyneuropathy related with acute ethanol intoxication and suggest that hemodialysis should be considered in patients with severe ethanol intoxication for life preservation and prevention of complications.

A case of postpregnancy spinal osteoporosis / 대한내과학회지

Osteoporosis associated with pregnancy is rare, but it is accompanied by a substantial bone loss, resulting in fracture by minimal trauma. Nevertheless, this clinical significance is often ignored because the pain in various parts of the body is taken as an integral part of the pregnancy and it is possible that milder forms of this condition go unnoticed. Also, this disease is often confused with a variety of other condition associated with pregnancy and misdiagnosed. Although its etiology is still unknown, but variant theory is speculated. Pregnancy and lactation increase the demand on the maternal skeletal calcium restores and underlying genetic susceptibility may cause it. Recently it has been proposed that PTH-related protein may be an important causative factor. There are three types of the pregnancy associated osteoporosis, a transient osteoporosis of the hip in pregnancy, a postpregnancy spinal osteoporosis and a lactation-associated osteoporosis. We present a case of 24-years old women with postpregnancy spinal osteoporosis that showed multiple lumbar compression fracture and biochemical evidence of increased bone resorption.