A Case of Adrenalectomy after Preterm Delivery in Cushing's Syndrome of Third Trimester Pregnant Woman / 대한내분비학회지

A renin- or angiotensin-II responsive aldosterone producing tumor is a rare cause of primary hyperaldosteronism. This tumor can be identified by tests that show that the aldosterone producing adrenal tumor is not fully autonomous. In other words partially it is responsible for the stimulation of aldosterone secretion that results aldosterone levels in an increase in serum in response to the upright posture and spironolactone treatment. Furthermore, the urinary 18-hydroxycortisol level is within the normal range. Because of different responses to surgical removal, the differential diagnosis of the causes of primary aldosteronism can't be overemphasized even for rare causes of primary aldosteronism such as unilateral nodular hyperplasia or a renin-responsible aldosterone producing tumor. We should consider renin or angiotensin-II responsive adrenal adenoma in the differential diagnosis of primary aldosteronism when biochemical data shows atypical results. Here we present the first case in Korea of a renin-responsive aldosterone producing adrenal adenoma which was fully accessible and was successfully treated by surgical removal. Also, sampling for aldosterone secretion just above the insertion site in the left renal vein before surgery showed a suspiciously abberant left adrenal vein drainage into the IVC, This was very helpful information during adrenal vein ligation in laparoscopic adrenalectomy.

An Unusual Case of Guide Wire Fracture during Coronary Artery Stenting for Bifurcation Lesion

The complications associated with the use of a guide wire, used during angioplasy, are rare and often go unrecognized. However, occasionally the guide wire itself may cause serious complications such as perforation or dissection of the distal coronary artery. A guide wire fracture during angioplasty is a rare complication, however entrapment and uncoiling of the guide wire can cause fracture. We report a case of guide wire fracture that developed by entrapment of the distal bending portion during stenting for bifurcation lesion. The broken free end of the guide wire remained within the stent strut, and urgent surgical intervention was necessary for its retrieval. We experienced a case of entrapment and fracture of the guide wire during stenting that was successfully surgically removed.

Prospective Study of the Immunologic Factors Affecting the Prognosis of Severe Community-Acquired Pneumonia / 결핵

BACKGROUND: In the severe community-acquired pneumonia, it has been known that the immune status is occasionally suppressed. This study was performed to identify the immunologic markers related with the prognostic factors in severe community-acquired pneumonia. METHODS: 23 patients with severe community-acquired pneumonia were involved in this study, and divided into survivor (16) and nonsurvivor (7) groups. In this study, the medical history, laboratory tests(complete blood counts, routine chemistry profile, immunoglobulins, complements, lymphocyte subsets, cytokines, sputum and blood culture, urine analysis), and chest radiographs were scrutinized. RESULTS: 1) Both groups had lymphopenia(total lymphocyte count 995.6±505.7/mm2 in the survivor and 624.0±287.6/mm2 in the nonsurvivor group). 2) The T-lymphocyte count of the nonsurvivor group(295.9±203.0/mm2) was lower than the survivor group(723.6±406.5/mm2) (p<0.05). 3) The total serum protein(albumin) was 6.0±1.0(2.7±0.7) g/dl in the survivor and 5.2±1.5(2.3±0.8)g/dl in the nonsurvivor group. The BUN of the noncurvivor group(41.7±30.0mg/dl) was higher than that of the survivor group(18.9±9.8mg/dl)(p<0.05). The creatinine concentration was higher in the nonsurvivor group(1.8±1.0mg/dl) than that in the survivor group(1.0±0.3mg/dl)(p<0.05). 4) The immunoglobulin G level was higher in the survivor group (1433.0±729.5mg/dl) than in the nonsurvivor group(849.1±373.1mg/dl)(p<0.05). 5) The complement C3 level was 108.0±37.9mg/dl in the survivor group and 88.0±32.1mg/dl in the nonsurvivor group. 6) A cytokine study showed an insignificant differenne in both groups. 7) Chronic liver disease, DM, and COPD were major underlying diseases in both groups. CONCLUSION: These results suggest that decreased a T-lymphocyte count and immunoglobulin G level, and an increased BUN and creatinine level may be associated with the poor prognosis of severe community-acquired pneumonia.

A Case of Waldenstrom's Macroglobulinemia Presented as a Compression Fracture of Spine / 대한혈액학회지

Waldenstrom's macroglobulinemia is a rare disease of plasmacytoid lymphocyte proliferation usually presented without bone lesion which is the common presenting symptom in multiple myeloma. We report a 50-year-old female with Waldenstrom's macroglobulinemia presented as a bony lesion without many other features common in this diesease. She was admitted with the chief complaint of low back pain and low extremity paresthesia for two months. Bone marrow biopsy and aspiration, protein and immune electrophoresis showed findings consistent with Waldenstr m's macroglobulinemia. Magnetic resonance imaging of thoracic spine showed pathologic compression fracture in T6 and T7 with posterior epidural mass at T6 to T7 level. We report this unusual case of Waldenstrom's macroglobulinemia presented as compression fracture of thoracic spine with a review of literatures.