Maxillary complete denture fabrication cases with posterior palatal seal considering palatal form and tissue displacement / 대한치과보철학회지

The role of the posterior palatal seal is important in retention of the maxillary complete denture. After taking the final impression, additional retention can be given to the maxillary denture through a mechanical method of forming a groove on master cast, but this is often overlooked in the clinical process. As a result, the posterior palatal seal is formed in a uniform way by the technician without considering the individual characteristics of the patient. Until now, various types of posterior palatal seal have been introduced by many people. This case report describes the process of manufacturing the maxillary complete denture by determining the position and form of an appropriate posterior palatal seal after considering the patient’s anatomical palatal form and tissue displacement during function.

Liver Metastasis of Synchronous Small Rectal Neuroendocrine Tumors in the Absence of Risk Factors / 대한내과학회지

The incidence of rectal neuroendocrine tumors (NETs) has increased worldwide, including in Korea. Rectal NETs are usually single lesions, but synchronous multiple lesions are reported in 2–4.5% of patients. Small rectal NETs (≤ 10 mm) are usually confined to the submucosal layer and rarely give rise to lymph node or distant metastases. Here we describe the case of a 54-year-old woman referred to National Cancer Center for the management of two rectal subepithelial tumors. Because computed tomography revealed a small hepatic nodule suggesting atypical hemangioma rather than metastasis, endoscopic submucosal dissection was performed. However, the size of the nodules increased during follow-up. The pathologic results of a liver biopsy confirmed metastatic NET. This case was unusual in that synchronous small rectal NETs and distant liver metastasis occurred in the absence of any risk factors for metastasis. Thus, patients with rectal NETs should be carefully evaluated, especially for the possibility of metastasis.

Liver Metastasis of Synchronous Small Rectal Neuroendocrine Tumors in the Absence of Risk Factors / 대한내과학회지

The incidence of rectal neuroendocrine tumors (NETs) has increased worldwide, including in Korea. Rectal NETs are usually single lesions, but synchronous multiple lesions are reported in 2–4.5% of patients. Small rectal NETs (≤ 10 mm) are usually confined to the submucosal layer and rarely give rise to lymph node or distant metastases. Here we describe the case of a 54-year-old woman referred to National Cancer Center for the management of two rectal subepithelial tumors. Because computed tomography revealed a small hepatic nodule suggesting atypical hemangioma rather than metastasis, endoscopic submucosal dissection was performed. However, the size of the nodules increased during follow-up. The pathologic results of a liver biopsy confirmed metastatic NET. This case was unusual in that synchronous small rectal NETs and distant liver metastasis occurred in the absence of any risk factors for metastasis. Thus, patients with rectal NETs should be carefully evaluated, especially for the possibility of metastasis.

Community-onset Necrotizing Fasciitis Caused by Extended-spectrum Beta-lactamase-producing Eshcerichia coli / 대한내과학회지

Necrotizing fasciitis (NF) is an uncommon but fatal infectious disorder that rapidly destroys connective tissue, causing extensive necrosis, severe sepsis, multiple organ failure, and death. NF is more common in patients with comorbid medical conditions. Most NF is caused by bacteria extending from localized skin infections, or remote bacteremia. Escherichia coli (E. coli) has been isolated from polymicrobial NF, but is rarely causative of monomicrobial NF. In addition, NF attributable to community-onset, extended- spectrum beta-lactamase (ESBL)-producing E. coli has not been described previously. As ESBL-producing E. coli are becoming significant pathogens of community-acquired infections worldwide, we report an exceptional case of community-onset NF attributable to monomicrobial ESBL-producing E. coli in a patient with liver cirrhosis.

Ampulla of Vater Adenomyoma with Dilatations of Biliary and Pancreatic Duct / 대한췌담도학회지

Adenomyoma is a non-neoplastic lesion that frequently occurs in the gallbladder, but it's rarely found at the ampulla of Vater. When it develops at the ampulla of Vater, it may be mistaken for a periampullary malignancy. A 64-year-old asymptomatic male patient visited to our hospital with abnormal sonogram findings. Abdominal computed tomography and magnetic resonance cholangiopancreatography showed dilatations of common bile duct and main pancreatic duct. However, there was no definite ampullary mass. We performed endoscopic biopsies and endoscopic ultrasonography-guided fine needle aspiration. But the results were negative for malignant cells. Because we could not completely rule out malignancy, pylorus preserving pancreato-duodenectomy was performed. Histologically, hyperplastic components are intermixed with smooth muscle fibers in the subepithelial portion of ampulla of Vater. Awareness of adenomyoma of the ampulla of Vater is very important because of their clinical and endoscopic similarities to ampullary tumors.

A Case of Curative Resection of Advanced Combined Hepatocellular-cholangiocarcinoma after Neoadjuvant Chemotherapy / 대한췌담도학회지

Combined hepatocellular-cholangiocarcinoma (HCC-CC) is a primary liver cancer with histopathologic features of both hepatocelluar carcinoma and cholangiocarcinoma. As combined HCC-CC has been associated with poor outcomes, accurate diagnosis and proper treatment planning for patients are considered to be important for improving survival. Currently, surgery is known as the only treatment modality offering potential cure for localized disease. However, there are little published treatment options for advanced or recurrent disease. Furthermore, no published reports exist in respect to the applying successful curative resection after neoadjuvant therapy for advanced combined HCC-CC. Here, we report a case of combined HCC-CC subtype with stem cell feature, intermediate type who underwent curative surgical resection after neoadjuvant chemotherapy consisting of cisplatin and gemcitabine. Pathologic report revealed negative resection margin and follow-up imaging study shows no evidence of tumor recurrence.

Coexistence of AA and AL Cardiac Amyloidosis in a Patient with Ankylosing Spondylitis Accompanying Monoclonal Gammopathy of Undetermined Significance

Amyloidosis is a clinical disorder caused by extracellular deposition of proteinaceous insoluble fibrils in various tissues, resulting in organ compromise. Amyloid L (AL) amyloidosis is the most common type of systemic amyloidosis, which occurs in association with multiple myeloma or monoclonal gammopathy of undetermined significance (MGUS). Secondary amyloid A (AA) amyloidosis is a complication of chronic inflammatory conditions, such as rheumatoid arthritis or ankylosing spondylitis. We report a case of a 49-year-old manwith a 11-year history of ankylosing spondylitis, who was recently diagnosed with MGUS presented with cardiac amyloidosis of both the AA and AL types. We report this case along with a review of relevant literature.

A Case of Asymptomatic Severe Pulmonary Valve Stenosis with Patent Foramen Ovale and Patent Ductus Arteriosus in an Adult / 대한내과학회지

Pulmonary valve stenosis (PS) is the 3rd most common form of adult congenital heart disease. The patient was a 56-year-old woman, with known congenital heart disease but who was not receiving any treatment as she was not functionally limited. A two-dimensional echocardiogram showed severe right ventricular hypertrophy, pulmonary valve thickening and systolic doming. A color Doppler revealed a retrograde flow from the aorta to the left pulmonary artery. She had severe heart failure on the right hand side from a PS but did not display any symptoms. We hypothesized that she had a retrograde flow to the pulmonary circulation through a patent ductus arteriosus (PDA), through which oxygenated blood could be supplied to the systemic circulation and, hence, no hypoxia. We attempted a balloon valvuloplasty for the PS followed by a device closure for the PDA. Here we report on this adult female with severe PS but lacking any symptoms, due to the presence of a PDA.

A Case of Asymptomatic Severe Pulmonary Valve Stenosis with Patent Foramen Ovale and Patent Ductus Arteriosus in an Adult / 대한내과학회지

Pulmonary valve stenosis (PS) is the 3rd most common form of adult congenital heart disease. The patient was a 56-year-old woman, with known congenital heart disease but who was not receiving any treatment as she was not functionally limited. A two-dimensional echocardiogram showed severe right ventricular hypertrophy, pulmonary valve thickening and systolic doming. A color Doppler revealed a retrograde flow from the aorta to the left pulmonary artery. She had severe heart failure on the right hand side from a PS but did not display any symptoms. We hypothesized that she had a retrograde flow to the pulmonary circulation through a patent ductus arteriosus (PDA), through which oxygenated blood could be supplied to the systemic circulation and, hence, no hypoxia. We attempted a balloon valvuloplasty for the PS followed by a device closure for the PDA. Here we report on this adult female with severe PS but lacking any symptoms, due to the presence of a PDA.

A Case of Coccidioidal Meningitis / 감염과화학요법

A 35-year-old man with known coccidioidal meningitis developed a severe headache and vomiting during routine treatment. Hydrocephalus was visible on brain imaging, and CSF study revealed pleocytosis, lowering of glucose, and increased intracranial pressure. Dexamethasone and mannitol was used for intracranial pressure control. Intrathecal amphotericin B administration and switching to itraconazole resulted in gradual improvement of symptoms. After 4 months of discontinuing amphotericin B intrathecal administration, the patient developed severe headaches with vomiting, diplopia and tandem gait. Coccidioidal meningitis aggravation was suspected based on brain MRI and CSF studies. Ventriculo-peritoneal shunt insertion was performed for intracranial pressure control and the combined therapy of intrathecal amphotericin B administration and fluconazole was maintained. This combined regimen kept the meningitis stable for 1 month.

A Case of Patent Ductus Arteriosus with Congestive Heart Failure in a 80-Year-Old Man

Patent ductus arteriosus (PDA) is a rare clinical finding in adult patients. Considering the increase in cases of PDA discovered incidentally on echocardiograms at young ages, and the life-shortening effect of PDA, it is rare to diagnose PDA in old patients. We report a case of an 80-year-old patient who experienced symptoms of congestive heart failure showed findings suggestive of PDA in echocardiogram and confirmed the diagnosis through a cardiac catheterization and a coronary angiography. After percutaneous occlusion of PDA with an Amplatzer duct occlusion device, symptoms related to congestive heart failure improved.

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.

Influence of vascular endothelial growth factor (VEGF) and endostatin on coronary artery lesions in Kawasaki disease / 소아과

PURPOSE: Recently, there has been several studies to clarify the pathogenesis of Kawasaki disease (KD) and the relations of VEGF and endostatin that act on vascular endothelial cells to the coronary artery complications. In this report, we measured serum levels of VEGF and endostatin in acute and subacute phases of KD to assess the change of these levels and the relations to the development of coronary artery lesions (CAL). METHODS: Twenty six patients were diagnosed and treated for KD between January, 2001 and July, 2005 at Kangnam St. Mary's Hospital, the Catholic University of Korea. They were divided into those with and without CAL. Serum levels of VEGF and endostatin were measured during acute and subacute phases and compared to those measured in healthy and disease control groups. RESULTS: Serum levels of VEGF were increased in KD but no differences were noted in KD with and without CAL. Serum levels of endostatin were decreased in the acute phase of KD, however they were recovered in the subacute phase of KD, regardless of CAL. The VEGF/endostatin ratio was increased in KD. KD without CAL showed a relative decrease in this ratio during the subacute phase. Significant positive correlations were found between serum VEGF and WBC count, VEGF and ESR, VEGF/endostatin ratio and ESR in the acute phase of KD. CONCLUSION: Analysis of factors influencing the vascular endothelium such as VEGF and endostatin will help to clarify the etiology of KD and the pathogenesis of CAL.

A Case of Pulmonary Sarcoidosis in a 6-year-old Girl / 소아알레르기및호흡기학회지

Sarcoidosis is a rare multisystemic granulomatous disease. The lungs, lymph nodes, eyes, skin and liver are the most commonly involved. There are two distinct forms of sarcoidosis in children. One is early-onset(younger) childhood sarcoidosis characterized by skin rash, uveitis, and arthritis occurring before age 4 years. The other is late-onset(older) childhood sarcoidosis characterized by involvement of the lungs, the common radiographic finding is bilateral hilar lymph node enlargements, similar to the adult manifestation. We report a case of late-onset childhood sarcoidosis in a 6-year-old girl which is the first pediatric pulmonary sarcoidosis reported in Korea.