A Case of Pleural Effusion after Malposition of Central Venous Catheter / 결핵및호흡기질환

Central venous catheterization is used to provide a large amount of fluid, total parenteral nutrition and to administer antitumor agents with few complications reported. We report an uncommon case of pleural effusion that occurred after central venous catheterization. In many cases, the mechanism for the pleural effusion after central venous catheterization occurs through an injury to the superior vena cava by the continuous mechanical force of the catheter tip, the flow of large amount of fluid and an osmotic injury to the wall of the vein. This case is somewhat different in that the central catheter was placed in an aberrant vessel resulting in the pleural effusion. A post-placement chest roentgenogram and the correct approach of catheterization are important for preventing this complication.

A Case of Accelerated Silicosis Mimicking Miliary Pulmonary Tuberculosis / 결핵및호흡기질환

Silicosis is a chronic fibrosing lung disease that is initiated by prolonged and extensive exposure to respirable free crystalline silica. Accelerated silicosis is rare and is clinically identical to the classic form of silicosis with the exception that the time from initial exposure to the onset of the disease is shorter and the rate of disease progression is dramatically faster. We describe a case of accelerated silicosis, which mimicked miliary pulmonary tuberculosis. The patient had worked in a mine coal for a period of 9 years. Subsequently, he worked in construction dealing with cement and sand for 14 years until he visited this clinic. The clinical course was notable for the rapid progression of the radiological features of silicosis over a period of 2 months. Polarizing light microscopic studies of the biopsied specimens by a transbronchial lung biopsy showed polarizing particles, which were typical of silica. To the best of our knowledge, this is the first case report of accelerated silicosis in Korea.

A Case of Bacillus licheniformis Bacteremia Associated with Bronchoscopy / 결핵및호흡기질환

Bacillus species are aerobic, gram-positive, spore forming rods, and they are usually found in the surrounding environment. If they are isolated in the clinical specimen, they are generally considered as contaminants rather than a true pathogen. Infection with Bacillus licheniformis is usually associated with the immunocompromised state, trauma, an indwelling intravenous catheter or an intravenous drug abuser. This infection is easily controlled by removal of the catheter and surgical debridement of the local infected tissue as well as an appropriate antimicrobial therapy. We reported here on a case of Bacillus licheniformis bacteremia associated with a bronchoscopic procedure in an immune competent patient.

A Case of Pseudopseudohypoparathyroidism with Partial Empty Sella / 대한내분비학회지

Pseudohypoparathyroidism (PHP) is a rare endocrine syndrome, which is characterized by Albright's hereditary osteodystrophy (AHO). Pseudopseudohypoparathyroidism (PPHP) presents with AHO features, but does not show clinical symptoms or the same laboratory finding as hypoparathyroidism. A 54 aged woman visited our department with lower abdominal pain. She had a history of a total hysterectomy due to persistent uterine bleeding 30 years previously. She showed abnormal physical findings, including a round face, short stature and brachydactyly. Her hormonal data were within normal limits, as follows: PTH 40.72 pg/mL, calcium 8.6 mg/dL, phosphorus 4.0 mg/dL and 24 hour urine cAMP 3.2 nmol/mg. On a pituitary challenge test, the basal levels and response rates of FSH and LH were low, and a sella CT scan showed partially empty sella. Herein is reported a case of PPHP, with partial empty sella, with a review of the literature

A Case of Pseudopseudohypoparathyroidism with Partial Empty Sella / 대한내분비학회지

Pseudohypoparathyroidism (PHP) is a rare endocrine syndrome, which is characterized by Albright's hereditary osteodystrophy (AHO). Pseudopseudohypoparathyroidism (PPHP) presents with AHO features, but does not show clinical symptoms or the same laboratory finding as hypoparathyroidism. A 54 aged woman visited our department with lower abdominal pain. She had a history of a total hysterectomy due to persistent uterine bleeding 30 years previously. She showed abnormal physical findings, including a round face, short stature and brachydactyly. Her hormonal data were within normal limits, as follows: PTH 40.72 pg/mL, calcium 8.6 mg/dL, phosphorus 4.0 mg/dL and 24 hour urine cAMP 3.2 nmol/mg. On a pituitary challenge test, the basal levels and response rates of FSH and LH were low, and a sella CT scan showed partially empty sella. Herein is reported a case of PPHP, with partial empty sella, with a review of the literature

A Case of Thymolipoma Simulating Cardiomegaly / 결핵

Thymolipoma is rare benign tumor of the thymic gland and mostly occurs at anterior mediastinum. Thymolipoma comprises 2~9% of thymic tumor and less than 1% of mediastinal mass. Therefore, thymolipoma should be differentiated from anterior mediastinal tumor such as thymoma, germ cell tumor and lymphoma. These tumors resemble cardiomegaly, pleural effusion, basal atelectasis, pericardial tumor and cyst, pleural tumor, lung cancer and pulmonary sequestration, and differentiated from above mentioned diseases. Though most cases are asymptomatic, there can be dyspnea with compression of adjacent organ by mass effect, and myasthenia gravis. We experienced a thymolipoma simulating cardiomegaly and report the case with the review of literatures.

Predictive Factors for Seizure Attack in Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: This study was designed to identify the risk factors associated with seizure attack in patients with systemic lupus erythematosus (SLE) and to propose the usefulness of them as predictive factors for seizure attack. METHODS: One hundred patients with SLE were included in this study. Twenty-five of these patients had seizure attacks during the course of their disease and age-, sex-matched 75 patients who did not have seizure were control group. We compared clinical manifestations and laboratory findings between the two groups. Seizures not related to SLE were excluded. RESULTS: Risk factors associated with seizure attack in SLE were high damage index at initial presentation and the presence of anticardiolipin antibody IgG regardless of its titer. Underlying illness other than SLE, duration of SLE, presence of previous organic brain abnormality, SLEDAI at initial presentation, clinical manifestations of SLE, laboratory findings (including hematologic, immunologic parameters and known laboratory activity indices) and medications before seizure attack were not significantly associated with seizure attack. Recurred seizure was not associated with any of these factors. CONCLUSION: High damage index at initial presentation and the presence of anticardiolipin antibody IgG were associated with seizure attacks in patients with SLE. These factors may be used as predictive factor for seizure attack in SLE.

Diagnostic Value of C-Veactive Protein and Vascular Endothelial Growth Factor in Differentiation of Pleural Effusions / 결핵

BACKGROUND: Pleural effusions are generally divided into transudates and exudates. If it is exudative, more diagnostic tests are required in order to determine the cause of the local disease. A malignancy is a common and important cause of exudative pleural effusions. Because the pleural fluid cytology and pleural biopsy specimens do not provide a diagnosis in a high percentage of malignant effusions, several tumor markers have been examined. In order to overcome this limitation, this study hypothesized that C-reactive protein(CRP) and vascular endothelial growth factor(VEGF) measurements would be useful for differentiating trasudates from exudates and determining the differences between a benign and malignant effusion. METHODS: Eighty consecutive patients with a pleural effusion (tuberculous 20, parapneumonic 20, malignant 20, transudative 20) were examined prospectively: 60 of them were classified according to Light's criteria as having an exudative fluid and 20 had a transudative fluid. The standard parameters of a pleural effusion were examined and the serum and pleural effusion VEGF levels were measured using enzyme linked immunosorbent assay(ELISA). CRP in the serum and pleural fluid was determined by a turbidimetric immunoassay. RESULTS: The pleural CRP levels in the exudates were significantly higher than those in the transudates, 4.19+/-4.22 mg/dl and 1.29+/-1.45 mg/dl, respectively. The VEGF levels in the pleural effusions were significantly elevated in the exudates compared to the transudate, 1,011+/-1,055 pg/ml and 389+/-325 pg/ml, respectively. The VEGF ratio in the exudative effusion is significantly higher than a transudative effusions, 3.9+/-4.7 and 1.6+/-0.9, respectively. The pleural CRP levels in the patients with a benign effusion(4.15+/-4.20 mg/dl) were significantly higher than those in the malignant effusion(1.43+/-1.91 mg/dl). The VEGF ratio is significantly higher in malignant effusions(4.9+/-5.5) than in benign effusions(2.8+/-3.6). CONCLUSION: In conclusion, the CRP and VEGF levels in the serum and pleural effusion can distinguish between transudates and exudates. Moreover it can differentiate between benign and malignant pleural effusions.

A case of parathyroid carcinoma with meningioma / 대한내과학회지

Parathyroid carcinoma is a very rare disease which comprising 0.1~5% of hyperparathyroidism, and it usually presents with marked hypercalcemia. Clinically, it shows hypercalcemia due to the effect of excessive secretion of parathyroid hormone, bone disease, renal involvement and palpable neck mass. It is known that hyperparathyroidism is induced mostly by parathyroid adenoma but it can be seen in parathyroid hyperplasia, hyperparathyroid carcinoma, rarely associated with familial or multiple endocrine neoplasia. Parathyroid carcinoma can be diagnosed with distant metastasis or local invasion. Treatment is complete resection of primary cancerous lesion and local tissue. Since recurrence or distant metastases are frequent, radiological studies should be done when hypercalcemia is recurred. Sometimes, other tumors can causes hypercalcemia. There are several reports of parathyroid cancer associated with multiple endocrine neoplasia, but has never been reported of parathyroid carcinoma associated with meningioma. We experienced a parathyroid carcinoma with meningioma in 68 year old woman and report the case with the review of literatures.

A case of parathyroid carcinoma with meningioma / 대한내과학회지

Parathyroid carcinoma is a very rare disease which comprising 0.1~5% of hyperparathyroidism, and it usually presents with marked hypercalcemia. Clinically, it shows hypercalcemia due to the effect of excessive secretion of parathyroid hormone, bone disease, renal involvement and palpable neck mass. It is known that hyperparathyroidism is induced mostly by parathyroid adenoma but it can be seen in parathyroid hyperplasia, hyperparathyroid carcinoma, rarely associated with familial or multiple endocrine neoplasia. Parathyroid carcinoma can be diagnosed with distant metastasis or local invasion. Treatment is complete resection of primary cancerous lesion and local tissue. Since recurrence or distant metastases are frequent, radiological studies should be done when hypercalcemia is recurred. Sometimes, other tumors can causes hypercalcemia. There are several reports of parathyroid cancer associated with multiple endocrine neoplasia, but has never been reported of parathyroid carcinoma associated with meningioma. We experienced a parathyroid carcinoma with meningioma in 68 year old woman and report the case with the review of literatures.