A Case of Paroxysmal Atrial Fibrillation after Electric Injury / 대한내과학회지

Electrical injuries can cause cardiac abnormalities, ranging from dysrhythmias to myocardial infarction. Atrial fibrillation after electrical injury is extremely rare. The mechanisms underlying electrical current-induced arrhythmias are unclear. However, due to differences in electrical resistance, current travels preferentially along blood vessels and nerves, making the heart the most susceptible organ to electrical injury. Cardiac arrhythmias may occur at the time of electrical injury or later, but most occur within the first day of injury. Almost all patients described in previous reports with atrial fibrillation developed the condition after high voltage injuries (> 1,000 V). In our case, however, atrial fibrillation developed after a low voltage injury (220 V). Atrial fibrillation was detected and the rate was controlled with intravenous digoxin infusion. A normal sinus rhythm was restored 21 h after the electrical injury.

A Case of Idiopathic Retroperitoneal Fibrosis with Acute Renal Failure and a Pleural Effusion / 대한내과학회지

Idiopathic retroperitoneal fibrosis (IRF) is characterized by a fibrotic process and chronic inflammation of the retroperitoneal area and aorta. The development of retroperitoneal inflammation and fibrosis often results in periureteral encasement, ureteral obstruction, acute renal failure, and subsequent chronic renal failure and, rarely, mediastinal, pericardial, or pleural involvement. Our patient presented with left flank pain and abdominal computed tomography (CT) showed a retroperitoneal mass encompassing the aorta and both ureters. IRF was diagnosed after a biopsy of the retroperitoneal mass. A complicating left pleural effusion and acute renal failure developed and the patient underwent a percutaneous nephrostomy and was treated with prednisolone. After this, the patient's symptoms, renal failure, and pleural effusion improved and the retroperitoneal mass decreased in size. We report a case of IRF with a pleural effusion and acute renal failure that improved with steroid treatment, with a literature review.

A Rare Case of Fat-Forming Variant of Solitary Fibrous Tumor Presenting as a Pleural Mass / 결핵및호흡기질환

The fat-forming variant of solitary fibrous tumors (SFTs) is a rare soft tissue neoplasm that was previously referred to as a lipomatous hemangiopericytoma (L-HPC). The most common affected site is deep soft tissue. Here, we present the first case, worldwide, of a fat-forming variant of SFT of the pleura. A 74-year-old man presented with left lower chest pain. Chest radiographs showed a mass-like lesion at the left lower lung field and chest computed tomography revealed a 12 cm fat-containing enhancing mass that was well-separated, lobulated and inhomogeneous. Radiology findings suggested a liposarcoma. Percutaneous needle biopsy was performed and pathological diagnosis of the mass was a fat-forming variant of SFT. Surgical resection was carried out and there has been no recurrence to date. So, a benign fat-forming variant of SFT must be considered as one of the differential diagnoses of lipomatous tumors of the pleura.

A Case of Clopidogrel-induced Neutropenia in Chronic Renal Failure / 대한신장학회지

Clopidogrel, a thienopyridine derivative, is an anti-platelet agent that acts as an antagonist of the platelet adenosine diphosphate receptor and considered for essential prophylaxis for intracoronary stent thrombosis in the treatment of ischemic heart disease. Clopidogrel is considered as safe as aspirin but a few cases of severe hematologic adverse reactions associated with clopidogrel had been reported such as neutropenia, aplastic anemia, thrombocytopenic purpura, and thrombocytopenia. We report a rare case of neutropenia induced by clopidogrel in chronic renal failure in a patient who underwent percutaneous coronary intervention.

Renal cell carcinoma developed in a patient treated with huge simple renal cyst sclerotherapy / 대한내과학회지

Simple renal cysts are a common cystic disease of the kidneys, which is not symptomatic in most cases and is diagnosed by radiological examination. However, if the cyst is huge or symptomatic, it must be treated. Renal cyst aspiration and alcohol sclerotherapy is a safe and effective treatment for symptomatic simple renal cysts. Simple renal cysts have benign clinical features in the main and transformation of a simple renal cyst into renal cell carcinoma has rarely been reported. However, one case of renal cell carcinoma during renal cyst follow-up has been reported. We report a case of renal cell carcinoma that developed in a patient who was being treated with huge simple renal cyst sclerotherapy.

Partial Duodenal Obstruction Caused by an Impacted Gastritis Cystica Polyposa / 대한소화기내시경학회지

Gastritis cystica polyposa is an uncommon lesion that usually occurs at the gastroenterostomy site, but it may also develop in the non-operated stomach. This malady is characterized by polypoid mucosal changes with hyperplasia and cystic dilatation of glands that infiltrate into the submucosal layer. We report here on a case of gastritis cystica polyposa that presented as a mass impacted in the duodenum in a 63-year-old male, and this patient had been admitted for evaluation of progressive epigastric fullness and dyspepsia. Esophagogastroduodenoscopy revealed that the partial duodenal obstruction was caused by impaction of a huge polypoid mass with a stalk that originated from the lower body of the stomach. We fished out the impacted mass with a forceps catheter while holding the neck with a snare catheter. Thereafter, an endoloop was applied to the stalk of mass, and this was followed by polypectomy using a snare catheter.

Bacterial etiology in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease / 대한내과학회지

(AECOPD). While critically ill patients requiring admission need proper antibiotic treatment for the causative pathogen, little is known about the bacterial etiology of AECOPD in Korea. We therefore studied the bacterial etiology of hospitalized patients with COPD in our institution. METHODS: The study enrolled 149 patients who were admitted to the hospital in Sungnam with the diagnosis of AECOPD between July 1, 2004 and June 1, 2007. We retrospectively reviewed the clinical data and results of sputum cultures. RESULTS: Of the 149 subjects with sputum collected, 51% (76 cases) had positive bacterial cultures [age 70.7+/- 9.2 years (mean+/- SD); 116 males] of sputum. Pseudomonas aeruginosa (24 cases, 30.4%) was the organism cultured in sputum most commonly, followed by Streptococcus pneumonia (15 cases, 18.9%), Acinetobacter sp. (9 cases, 11.4%), and Klebsiella pneumonia (7 cases, 8.9%). Patients whose FEV1 was 50% (17/96 vs. 4/53, respectively, p=0.002). Patients taking systemic steroids also had a higher rate of sputum culture of P. aeruginosa (85.7%). CONCLUSIONS: P. aeruginosa was the pathogen most commonly isolated in hospitalized patients with COPD. This species should be considered when physicians select empirical antibiotics to treat patients with AECOPD.