A Case of Membranous Glomerulonephritis with Superimposed Anti-Neutrophil Cytoplasmic Antibody-Associated Rapidly Progressive Crescentic Glomerulonephritis / 전남의대학술지

Idiopathic membranous glomerulonephritis (IMGN) is commonly diagnosed in adults with proteinuria. Rapid deterioration of renal function is a rare complication of IMGN, except when accompanied by renal vein thrombosis, malignant hypertension, or other underlying disease, including lupus nephritis. Here, we present a case of rapid deterioration of renal function in a patient with MGN superimposed with anti-neutrophil cytoplasmic antibody (ANCA)-associated rapidly progressive crescentic glomerulonephritis (RPGN). Overall, about 20 cases of MGN with ANCA-associated RPGN have been reported. This case of biopsy-proven MGN with ANCA-associated RPGN is the first to be reported in Korea.

A Case of Membranous Glomerulonephritis with Superimposed Anti-Neutrophil Cytoplasmic Antibody-Associated Rapidly Progressive Crescentic Glomerulonephritis / 전남의대학술지

Idiopathic membranous glomerulonephritis (IMGN) is commonly diagnosed in adults with proteinuria. Rapid deterioration of renal function is a rare complication of IMGN, except when accompanied by renal vein thrombosis, malignant hypertension, or other underlying disease, including lupus nephritis. Here, we present a case of rapid deterioration of renal function in a patient with MGN superimposed with anti-neutrophil cytoplasmic antibody (ANCA)-associated rapidly progressive crescentic glomerulonephritis (RPGN). Overall, about 20 cases of MGN with ANCA-associated RPGN have been reported. This case of biopsy-proven MGN with ANCA-associated RPGN is the first to be reported in Korea.

Long-Term Survival after T-cell Lymphoblastic Lymphoma Treated with One Cycle of Hyper-CVAD Regimen / Journal of the Korean Cancer Association, 대한암학회지

T-lymphoblastic lymphoma (T-LBL) is a rare form of aggressive non-Hodgkin's lymphoma. The standard approach for management of T-LBL involves intensive multiagent chemotherapy regimens for induction and consolidation phases with central nervous system prophylaxis and a maintenance phase lasting 12-18 months. We report on a case of long-term survival after one cycle of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) and high-dose methotrexate. A 30-year-old woman diagnosed with T-LBL with a large mediastinal mass underwent one cycle of hyper-CVAD. Four days after the start of treatment, the mediastinal mass was markedly reduced. Treatment continued with one cycle of consolidation chemotherapy, comprising high-dose methotrexate and high-dose cytarabine. The patient then refused all further chemotherapeutic treatment. Seven years have passed without relapse.

Acute myocardial infarction caused by a floating thrombus in the proximal ascending aorta

No abstract available.

Percutaneous Closure of an Iatrogenic Ventricular Septal Defect Following Concomitant Septal Myectomy at the Time of Aortic Valve Replacement

A 77-year-old female patient underwent aortic valve replacement (AVR) with concomitant septal myectomy and tricuspid annuloplasty. Her symptoms did not improve after a successful operation. Echocardiogram demonstrated the presence of an iatrogenic ventricular septal defect (VSD). It was muscular in location and not the usual AVR with membraneous type of VSD, suggesting a complication from the myectomy. Percutaneous closure of the VSD remained the only feasible option due to her poor overall medical status. A 14-mm Amplazter VSD occluder was deployed successfully, by means of the trans-septal technique. She has improved very well postoperatively.

A Case on Streptococcal Pneumonia Associated with Leptomeningitis, Osteomyelitis and Epidural Abscess in a Patient with AIDS / 결핵및호흡기질환

Patients with acquired immunodeficiency syndrome (AIDS) are at higher risks of bacterial pneumonia than the general population, and the pathogen is the most commonly involved Streptococcus pneumoniae. We hereby report a case of pneumococcal pneumonia associated with leptomeningitis, osteomyelitis and epidural abscess in a patient with AIDS. He is being successfully treated with ampicillin/sulbactam and clindamycin. And because the pneumococcal infection is usually associated with morbidity and mortality rates in the setting of AIDS, we should consider for pneumococcal vaccinations among the AIDS populations.

Pathological differences between forceps biopsy specimens and endoscopic resection specimens in early gastric cancer patients / 고신대학교의과대학학술지

OBJECTIVE: Endoscopic resection(ER) is effective therapy on EGC and which is treated according to the histological diagnosis of forcep biopsy. But sometimes the histological diagnosis of forcep biopsy and post-ER does not match with each other and it might lead to wrong treatment. The aim of this study is to find the frequency of histologic differences between forcep biopsy and post-ER, and to confirm the characteristics of lesions which make errors. METHODS: We selected the confirmed cancer cases of 141 patients of 1359 gastric tumor lesions which were treated under the ER in Eulji university hospital from May 2005 to March 2013. They were sorted by the age and sex of patient, location of lesion, present of ulcer and depression to identify the discordance between forcep biopsy and ER. The discordant group was compared with non-cancer-diagnosed controlled group, retrospectively. RESULTS: 70 cases(5.5%) of 1283 cases of "cancer negative" in forceps biopsy were found to be diagnosed cancer on final diagnosis of cancer by post-ER result. In this discordant group showed characteristics of bigger size that are with more frequently in tumor size >==15mm(17.9% vs. 31.4%, p=0.03), have depressed lesion(14.3% vs. 41.4%, p==15mm, presented with depressed lesion and ulceration, we should consider combined cancer, even the result of forcep biopsy was negative. Therefore, more careful and accurate resection should be taken with characters listed above.

A Case of Different Organ Responses to Immunosuppressive Therapy In a Microscopic Polyangiitis Patient with Interstitial Lung Disease / 대한내과학회지

Microscopic polyangiitis (MPA) is an idiopathic autoimmune disease characterized by systemic vasculitis associated with antineutrophil cytoplasmic autoantibodies. Interstitial lung disease is a less recognized manifestation of MPA and has a poor prognosis. A 61-year-old man presented with persistent cough, sputum and dyspnea. Laboratory examination revealed microscopic hematuria and renal insufficiency. Perinuclear anti-neutrophil cytoplasmic autoantibodies were positive according to serological testing. Computed tomography scans showed bibasilar reticulation and honeycombing in a peripheral distribution. Therefore, renal biopsy was performed, and MPA was diagnosed. After treating with corticosteroids and immunosuppressive agents, the patient had a complete renal response but progressive interstitial lung disease. We report a case of MPA presenting with interstitial lung disease in which the patient experienced different responses in each organ.

Mycotic Abdominal Aortic Aneurysm Caused by Bacteroides Thetaiotaomicron and Acinetobacter Lwoffii: The First Case in Korea / 감염과화학요법

Mycotic aneurysms are uncommon, but are fatal without appropriate management. Previous reports have shown that anaerobes and gram-negative organisms are less common but more dangerous than other causative agents of mycotic aneurysm. We report the case of a 60-year-old man with poorly controlled diabetes mellitus and atherosclerosis in the aorta, and a 10-day of history of lower abdominal pain and fever. This man was diagnosed with an uncommon abdominal aorta mycotic aneurysm caused by Bacteroides thetaiotaomicron and Acinetobacter lwoffii. The aneurysm was successfully treated with antibiotics therapy and aorto-bi-external iliac artery bypass with debridement of the infected aortic wall. We present this case together with a review of the relevant literature.

Primary Synovial Sarcoma of the Lung With Rapid Progression in an Old Age Female

Synovial sarcoma comprises approximately 10% of soft tissue sarcomas. Primary pulmonary synovial sarcoma is a rare tumor. It makes up only 0.5% of all primary lung malignancies. It typically presents in adolescents and young adults. The usual progress of the tumor is unknown. We report the rapid progress of a primary pulmonary sarcoma that developed in a 67-year-old woman. In this case, metastatic sarcoma was excluded by positron emission tomography-computed tomography. Synovial sarcoma was histologically confirmed by a biopsy from the lung tissue. The patient had two masses located at the upper lobe of the lung. The patient refused all medical treatment and left our hospital. Two months later, she was readmitted and diagnosed with multiple metastases in the other lung and pancreas. She expired due to syndrome of inappropriate antidiuretic hormone secretion and superior vena cava syndrome four days after admission.

Desmoid Tumor of the Facet Joint: A Case Report

Desmoid tumors represent a particular type of fibromatosis. The common sites for extra-abdominal desmoid tumors, known as aggressive fibromatosis, are the shoulder, chest wall, and thigh. Desmiod tumors are rare at facet joints of the spine. We describe a patient with a desmoid tumor of a lumbar facet joint.

Risk Factors Associated with Subdural Hygroma after Decompressive Craniectomy in Patients with Traumatic Brain Injury : A Comparative Study

OBJECTIVE: Subdural hygroma (SDG) is a complication occurring after head trauma that may occur secondary to decompressive craniectomy (DC). However, the mechanism underlying SDG formation is not fully understood. Also, the relationship between the operative technique of DC or the decompressive effect and the occurrence and pathophysiology of SDG has not been clarified. Purpose of this study was to investigate the risk factors of SDG after DC in our series. METHODS: From January 2004 to December 2008, DC was performed in 85 patients who suffered from traumatic brain injury. We retrospectively reviewed the clinical and radiological features. For comparative analysis, we divided the patients into 2 groups : one group with SDG after craniectomy (19 patients; 28.4% of the total sample), the other group without SDG (48 patients; 71.6%). The risk factors for developing SDG were then analyzed. RESULTS: The mean Glasgow Outcome Scale (GOS) scores at discharge of the groups with and without SDG were 2.8 and 3.1, respectively (p<0.0001). Analysis of radiological factors showed that a midline shift in excess of 5 mm on CT scans was present in 19 patients (100%) in the group with SDG and in 32 patients (66.7%) in the group without SDG (p<0.05). An accompanying subarachnoid hemorrhage (SAH) was seen in 17 patients (89.5%) in the group with SDG and in 29 patients (60.4%) in the group without SDG (p<0.05). Delayed hydrocephalus accompanied these findings in 10 patients (52.6%) in the group with SDG, versus 5 patients (10.4%) in the group without SDG (p<0.05). On CT, compression of basal cisterns was observed in 14 members (73.7%) in the group with SDG and in 18 members of the group without SDG (37.5%) (p<0.007). Furthermore, tearing of the arachnoid membrane, as observed on CT, was more common in all patients in the group with SDG (100%) than in the group without SDG (31 patients; 64.6%) (p<0.05). CONCLUSION: GOS showed statistically significant difference in the clinical risk factors for SDG between the group with SDG and the group without SDG. Analysis of radiological factors indicated that a midline shifting exceeding 5 mm, SAH, delayed hydrocephalus, compression of basal cisterns, and tearing of the arachnoid membrane were significantly more common in patients with SDG.

Atlantoaxial Rotatory Fixation in Adults Patient

Atlantoaxial rotatory fixation (AARF) in adult is a rare disorder that occurs followed by a trauma. The patients were presented with painful torticollis and a typical 'cock robin' position of the head. The clinical diagnosis is generally difficult and often made in the late stage. In some cases, an irreducible or chronic fixation develops. We reported a case of AARF in adult patient which was treated by immobilization with conservative treatment. A 25-year-old female was presented with a posterior neck pain and limitation of motion of cervical spine after a traffic accident. She had no neurological deficit but suffered from severe defect on the scalp and multiple thoracic compression fractures. Plain radiographs demonstrated torticollis, lateral shift of odontoid process to one side and widening of one side of C1-C2 joint space. Immobilization with a Holter traction were performed and analgesics and muscle relaxants were given. Posterior neck pain and limitation of the cervical spine's motion were resolved. Plain cervical radiographs taken at one month after the injury showed that torticollis disappeared and the dens were in the midline position. The authors reported a case of type I post-traumatic AARF that was successfully treated by immobilization alone.

Characteristics of Infective Endocarditis in 4 University Hospitals where Staphylococcus aureus is the Most Common Causative Organism / 감염과화학요법

BACKGROUND: To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. MATERIALS AND METHODS: Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University Hospitals (located in Seoul, Bucheon, Cheonan, and Gumi) from January of 2000 to June of 2007 were enrolled. Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. RESULTS: The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients, making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. CONCLUSION: In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology.

Characteristics of Infective Endocarditis in 4 University Hospitals where Staphylococcus aureus is the Most Common Causative Organism / 감염과화학요법

BACKGROUND: To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. MATERIALS AND METHODS: Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University Hospitals (located in Seoul, Bucheon, Cheonan, and Gumi) from January of 2000 to June of 2007 were enrolled. Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. RESULTS: The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients, making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. CONCLUSION: In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology.

Clinicopathologic Analysis of Gastric Carcinoma Patients with Outlet Obstruction

PURPOSE: This study was conducted to analyze the clinical course of patients of gastric cancer with outlet obstruction by comparing them with the gastric cancer patients without outlet obstruction. METHODS: The records of gastric cancer patients with outlet obstruction and who underwent radical gastrectomy from January 1996 to December 2005 were retrospectively reviewed and compared with those patients with gastric cancer and who were without outlet obstruction. RESULTS: The number of the patients who underwent radical gastrectomy was 461. Out of 461 patients, the number of gastric cancer patients with outlet obstruction was 42 (9.1%), and they had nasogastric tube insertion for an average of 4.4 days before operation. These patients showed several significant features such as large tumor size, advanced stage, an increased the number of involved LNs, a low serum albumin level, a frequent antral tumor location and duodenal invasion. There was no difference in complication rates between the two groups, but a higher mortality rate was noted in the gastric cancer patients with outlet obstruction than that in the other patients (P=0.038). The survival rate after the operation was significantly lower among the gastric cancer patients with outlet obstruction (P=0.0008), whereas no difference was found in the survival rate between the above two groups at the same stage (P=0.1951). CONCLUSION: The gastric cancer patients with outlet obstruction showed a comparatively poorer prognosis than those gastric cancer patients without outlet obstruction. However, there was no significant difference in the complication rate and the survival rate for both types of patients who were at the same stage. These results suggest that the patients with outlet obstruction can show the same result as the patients without outlet obstruction by undergoing radical gastrectomy.

Surgical Treatment for Chronic Peptic Ulcer with Gastric Outlet Obstruction

PURPOSE: With the introduction of H. pylori eradication and proton pump inhibitor, the operative treatments for the acute or chronic complications of peptic ulcer, such as perforation, bleeding and stricture, have decreased. Also owing to the development of non-operative treatment such as interventional endoscopic treatment, the surgical approach to the acute complications, like perforation and bleeding, has diminished. The non-operative treatments for the stricture and obstruction of chronic peptic ulcer in part related to discontinuation of medication have not been satisfactory. We analyzed the clinical outcomes of the patients who underwent operative treatment for outlet obstruction with peptic ulcer. Materials of Methods: From January 1994 to December 2007, we reviewed 31 patients who had been operated on at the National Medical Center for peptic ulcer obstruction. We excluded the cases of adhesive obstructions that were caused by a former ulcer operation and also the cases of obstructions found during emergency operations for treating perforation and bleeding. We classified the surgical treatment group into the bypass operation group and the surgical resection group. We evaluated the effects of the operations by the Visick score. The recurrences were confirmed only by the endoscopic observation of peptic ulcer. RESULTS: The number of patients in the bypass operation group was 6 (19.4%) and that of resection group was 25 (80.6%). The mean age was 57.5 (25~81) years. The number of male patients was 29 (93.5%) and the number of females was 2 (6.5%). The mean symptom duration was 29.6 months. There were 19 smokers (61.3%), 6 NSAID users (19.4%) and 7 H. pylori positive patients (22.6%). Two patients underwent endoscopic balloon dilatation with no success. The locations of lesion were the stomach, the duodenum and both in 9, 20 and 2 cases, respectively. There were operative complications in 13 cases (41.9%), recurrent ulcers in 2 cases (6.5%), and reoperations in 4 cases. The mean Visick score was 1.8 (1~4). There were no statistically significant clinicopathologic differences between the bypass operation group and the resection group. The two groups had 1 case each of recurrence. Although the bypass group had a greater complication rate (83.3%) than the resection group (32%), this was not statistically meaningful (P=0.175). The mean Visick score was 3.0 in the bypass group and 1.6 in the resection group, so the resection group was better (P=0.001). CONCLUSION: For a case of chronic peptic ulcer with outlet obstruction, even though it has been reported that endoscopic balloon dilatation worked well, surgery is still regarded as an important treatment. If you consider the patients' satisfaction and the difficulty of diagnosing malignant ulcers, surgical resection should be recommended more often than a bypass operation.

A Case of Pancreaticobiliary Duct Obstruction due to Pancreatic Tuberculosis Combined with a Colon Adenocarcinoma and Tuberculous Colitis / 대한소화기내시경학회지

Systemic manifestation of tuberculosis is common, but tuberculous biliary obstruction of the pancreas and a colon adenocarcinoma with combined colonic tuberculosis is an uncommon disorder. We encountered a case of the above condition in 63-year-old male that was admitted to our hospital because of fever, diffuse abdominal pain and rigidity. Abdominal computed tomography showed biliary and pancreatic duct dilatation with left colonic wall thickening and surrounding peritoneal infiltration. Emergency segmental resection of the descending colon with intraoperative T-tube choledochostomy was performed due to the colon mass and biliary obstruction. A colonofiberoscopy was performed for low abdominal pain and hematochezia at 12 days after surgery. It showed multiple colonic ulcerations with a partial stricture. A colonic biopsy showed granulomatous inflammation with acid-fast bacilli. The cause of the biliary obstruction was also revealed as pancreatic tuberculosis by an intraoperative pancreatic and mesenteric biopsy. The patient improved after antituberculous treatment and the patient has been in good health until the last outpatient follow-up visit.

The maximal surgical blood order schedule and surgical blood use in Severance Hospital / 대한수혈학회지

No abstract available.