A Case of Primary Malignant Melanoma of the Esophagus / 대한소화기내시경학회지

Primary malignant melanoma of the esophagus is a rare, but aggressive tumor with a fatal prognosis. Hematogenous and lymphatic metastasis are common. The tumor has multiple black and pigmented lesions. Resection of the tumor with an anastomotic procedure is the treatment of choice. Despite this operation, the prognosis is quite poor with the mean life expectancy being less than 1 year. We describe here a case of a 54-year-old man with esophageal malignant melanoma, and we also include a review of the relevant literature.

A case of metronidazole induced encephalopathy in a cirrhotic patient / 대한내과학회지

Metronidazole induced encephalopathy is a rare disease caused by the antibiotic drug, metronidazole. Metronidazole is a nitroimidazole antibiotic used for anaerobic infections, Helicobacter pylori infection and spontaneous bacterial peritonitis. Metronidazole has good cellular penetration and is believed to penetrate the CSF and central nervous system. The incidence of metronidazole induced encephalopathy is unknown, though several previous studies have addressed brain changes caused by metronidazole neurotoxicity. Neurologic side effects include peripheral neuropathy, seizures, encephalopathy, dysarthria, and ataxia. We experienced a case of metronidazole induced encephalopathy, diagnosed by brain MRI in a patient with spontaneous bacterial peritonitis and performed follow-up imaging after discontinuation of metronidazole.

A case of gastric small cell carcinoma mimicking gastric lymphoma / 대한내과학회지

Primary gastric small cell carcinoma (SmCC) is rarely encountered and has a poor prognosis, even when discovered at an early stage. A 69-year-old man presented with upper abdominal pain and melena. Endoscopic examination revealed an 8-cm-diameter submucosal tumor with ulceration high on the body of the greater curvature suggesting malignant lymphoma. Histological examination revealed a solid proliferation of small cells with hyperchromatic round nuclei and scant cytoplasm. On immunohistochemical staining, the neoplastic cells were positive for synaptophysin, EMA, and CD56. Abdominal computed tomography (CT) revealed multiple variable-sized low-attenuated masses with peripheral rim enhancement in both hepatic lobes. He was diagnosed with a pure type gastric SmCC with multiple hepatic metastasis. After systemic chemotherapy, the tumor regressed substantially on CT and endoscopy. We report a case of hepatic metastasis of gastric SmCC mimicking gastric lymphoma.

A Case of Hypercapnic Respiratory Failurein a Patient with Eosinophilic Polymyositis / 대한류마티스학회지

Eosinophilic infiltration into skeletal muscles has been rarely reported in a variety of conditions such as parasite infection, sarcoidosis, rheumatoid arthritis, eosinophilia-myalgia syndrome, and idiopathic hypereosinophilic syndrome. Eosinophilic myositis (EM) is one of idiopathic inflammatory muscle diseases associated with muscle and/or blood eosiophilia. The case of EM complicated with hypercapnic respiratory failure has been extremely rarely reported. A 61-year-old woman was admitted with sudden-onset pain in both calves. She had elevated serum muscle enzymes and peripheral eosinophil count. Findings of electromyography were consistent with inflammatory myopathy. MRI showed diffuse hyperintensity of calf muscles on T2-weighted and enhanced T1 images. Muscle biopsy showed eosinophils' infiltration in the endomysium and perivascular area. During the diagnostic work-up, she presented with hypercapnic respiratory failure. She was successfully treated with mechanical ventilation and high doses of prednisolone. This case suggests EM can cause respiratory failure secondary to respiratory muscle involvement.

Hypersensitivity Reactions to Oxaliplatin / Journal of the Korean Cancer Association, 대한암학회지

Oxaliplatin is a third-generation platinum compound that is used as a single agent and in combination with fluorouracil (5-FU) to treat colorectal and gastric carcinoma. The patients treated with oxaliplatin may develop hypersensitivity and idiosyncratic reactions, although these complications are known to be rare. We report here on two patients who suffered with metastatic colorectal cancer and who underwent palliative combination chemotherapy with oxaliplatin; they then developed hypersensitivity reactions to oxaliplatin. The first case had an anaphylatic reaction immediately after the beginning of the 7(th) to 8(th) cycle infusion of oxaliplatin. The second case developed repeated febrile episodes from the 4th to 8th cycles of oxaliplatin infusion. With the increasing use of oxaliplatin in clinical practice, we are now encountering an increasing incidence of suspected hypersensitivity reactions. Physicians should keep their eyes wide open and carefully observe for the clinical manifestations of these hypersensitivity reactions.

A Case of Avascular Necrosis of Mandible Associated with the Use of Bisphosphonate in a Patient with Rheumatoid Arthritis and Osteoporosis / 대한류마티스학회지

Bisphosphonates decrease osteoclastic activity and reduce bone resorption, therefore they are used in the treatment of patients with hypercalcemia secondary to malignancy or metastatic bone cancer, Paget's disease and osteoporosis. Recently, cases of jaw bone necrosis have been reported to be associated with the use of bisphosphonates. In patients with rheumatoid arthritis, osteoporosis is frequently developed because of osteoclast activation and steroids which are used for treatment and bisphosphonates are frequently prescribed. A 76-year-old female patient with rheumatoid arthritis was treated with alendronate for the management of osteoporosis for 36 months, and she was presented with pain and swelling on left mandibular area and gingival pus discharge. The patient was treated with curettage of necrotic bone, and biopsy showed avascular necrosis of mandible.

Infective endocarditis in hemodialized patient with end-stage renal disease / 대한내과학회지

No abstract available.

Clinical Significance of C4d-Positivity in Renal Transplant Recipients with Acute Rejection / 대한이식학회지

PURPOSE: C4d detection in peritubular capillaries in acute allograft rejection has been regarded as a poor prognostic factor for graft kidney survival. We investigated the clinical importance of C4d positivity in renal transplant recipients with acute rejection. METHODS: Forty eight renal allograft biopsies were selected, which were available for immunofluorescence study. The samples were divided into two groups, one which was diagnosed as acute rejection clinically (n=30), the other which underwent protocol biopsy 2 weeks after transplantation (n=18). Among the acute rejection group, C4d staining was positive in 50% of acute rejection cases (C4d (+), n=15) and negative in the others. (C4d (-), n=15). We compared the C4d (+) group and the C4d (-) group in terms of clinical parameters and graft survival duration. RESULTS: Renal function was reduced in the C4d (+) group compared to the C4d (-) group. In the C4d (+) group, 8 of 15 cases resulted in graft loss, but only one graft loss developed in the C4d (-) group. Graft survival duration after kidney biopsy was reduced in the C4d (+) group compared to the C4d (-) group. CONCLUSION: Renal transplant recipient with C4d-positive acute rejection shows inferior graft survival duration. So tight management in addition to steroid pulse therapy should be considered for these patients.

Heart Diseases in Korea

Statistical observation was made on 2,639 cases with heart disease which has been seen in the Deparment of Internal Medicine, National Medical Center, in Korea, during the past 15 years ranging from January 1959 to December 1973. The results were as follows; 1. During the last 15 years, 2,639 cases with heart disease were observed, which represents about 12.9% of total 20,434 medical In-patients, and variable incidence for the consecutive years was noted. 2. The disease occurred most frequently in group aged under thirty and its incidence decreased in the fifth and sixth decades. 3. The incidence in male was 49.8% and in female 50.2%, the ratio of which was almost same. 4. The most common etiologic form of heart disease was hypertensive heart disease which occurred in 43.2% of all cardiac patients, corresponding to 5.57% of all In-patients. The incidence was most frequent in the sixth decade and decreased in the fifth and fourth decades with the male preponderance. 5. The second common heart disease was rheumatic heart disease, 31.6% of all cardiac patients, corresponding to 4.08% of all In-patients. It affected the mitral valve in most of the cases, whereas involvement of the aortic valve was rare. 6. Coronary heart disease, the third common heart disease, occurred in 5.1% of all cardiac patients, and most frequently in sixth and seventh decades. it affected male 2.5 times more frequently than female. 7. Postpartum heart failure and beriberi heart disease showed 3.8% and 3.1% respectively. They occurred more frequently in younger female, but the frequency was much decreased recently. 8. Pericarditis occured in 2.6% of all cardiac patients and tuberculosis was still a common cause of pericarditis. 9. Congenital heart disease was seen in 1.7% of the cases and patent ductus arteriosus, tetralogy of Fallot, atrial septal defect and ventricular septal defect occupied 76% of all congenital heart disease. 10. Cor pulmonale was present in 1.6%, arrhythmia 1.3%, cardiomyopathy 1.3%, thyroid heart disease 0.8%, endocarditis 0.7% and syphilitic heart disease 0.2%.