A Case of Acute Respiratory Distress Syndrome with Pulmonary Embolism induced by Injection of Silicone at Vaginal Wall / 결핵

Silicone fluid(polydimethylsiloxane) is widely used in breast augmentation and other cosmetic procedures because of little incidence of complications and low mortality rate. However, local reaction following silicone injections can be occurred sometimes leading to serious complications. Especially, illicit silicone injections have resulted in severe reactions within the pulmonary area, and some have resulted in acute respiratory distress syndrome subsequently. We experienced a case of acute respiratory distress syndrome induced by subcutaneous injections of silicone at vaginal wall. The patients was 39-year-old, previously healthy woman who had complained of dyspnea related to silicone injection at vaginal wall. Chest X-ray and chest CT scan show diffuse air consolidation with ground glass opacities and perfusion lung scan revealed likelihood of pulmonary embolism as showing multiple perfusion defects. We report a case of acute respiratory distress syndrome after silicone injection with review of literature.

Successful Hemodialysis in Acute Phenobarbital Intoxication / 대한신장학회잡지

Phenobarbital is one of long-acting barbiturate with low lipid solubility and used frequently as an anticonvulsant. However, in severe intoxication, hypotension and respiratory arrest are the major causes of prehospital mortality. Mortality is 3M for blood levels over HO pg/mL and estimated lethal adult dose is 6-10g. No effective antidotes are available. We report a case of phenobarbital intoxication in a 29-year-old female, treated successfully with hemodialysis. She was found corhatose on the day of admission and was alleged to have taken 30g of phenobarbital. On physical examination, the blood pressure was 80/60mmHg, and pulse, 97/min. There was no respiration. Pupil was dilated fully. Corneal and deep tendon reflexes were absent. There was no response to painful stimuli. She was treated conservatively with mechanical ventilation, gut decontamination and forced diuresis. Hemodialysis was tried to remove excess phenobarbital for 13 hours. The blood phenobarbital level at admission was 162.2 pg/ mL, which was decreased to 114.4pg/mL after first session of hemodialysis. On the fifth hospital day, blood level decreased to 41.8 pg/mL and she regained her consciousness. She was discharged on the 10th hospital day without major sequelae.

A Case of Antinuclear Antibody(ANA) Negative Lupus Nephritis / 대한신장학회잡지

Systemic lupus erythematosus is a multisystemic autoimmune disease in which the kidneys are frequently involved. Clinical diagnosis of SLE is based on the criteria of American Rheumatism Association (ARA). A few cases who were classified as SLE by the ARA criteria but were antinuclear antibody (ANA)-negative have been reported. It was reported that critical factor in ANA positivity is the choice of substrate. It is generally accepted that the cultured cell of human origin, especially HEP-2 cell, is better than tissue section or animal cells. Thus, the ANA test is negative only in approximately 2M of SLE patients when human tissue culture cells are used as substrate. We report a 25-year-old man admitted to our hospital because of generalized edema. He was found to have active lupus nephritis(WHO class IV), photosensitivity and pancytopenia. The result of FANA test which used HEP-2 cell as substrate was repeatedly negative, but anti-ds DNA and anti-Ro antibody were positive.

Complete Remission in a Patient with Multiple Myeloma after High Dose Melphalan and CD34+ Selected Autologous Transplantation / 대한혈액학회지

Multiple myeloma is characterized by long clinical course and drug resistance. Conventional chemotherapy results in modest survival benefit. High dose therapy with autologous stem cell transplantation results in markedly increased response rate and survival, confirmed by a randomized study. But there are any evidences yet this approach confers cure. To decrease relapse rate, several approaches are ongoing. Among them, purified CD34+ selected transplantation is an attractive approach because of reduced contamination of myeloma cells. Recently we have experienced CD34+ selected autologous transplantation in a multiple myeloma patient. After VAD induction chemotherapy, high dose melphalan (200mg/m2) with CD34+ selected autotransplantation was followed. Immunoadsorption using CeprateSC resulted in 81% purity and 42% yield. Infused CD34+ cell number was 3.1x106/kg. Absolute granulocytopenic and thrombocytopenic period was less than a week. Grade lll or more extramedullary toxicities were not observed. After high dose therapy, complete remission by immunofixation was achieved. We have experienced a case of CD34+ selected transplantation in multiple myeloma and found that it was safe in terms of short term engraftment.