Four Cases of Polyarteritis Nodosa Presenting Initially as Pain and Pitting Edema in Both Lower Extremities

Polyarteritis nodosa (PAN) has a broad spectrum of clinical presentation, since it affects small and medium-sized muscular arteries with microaneurysm formation, aneurysmal rupture with hemorrhage, thrombosis, and, consequently, organ ischemia or infarction. Although skeletal muscle involvement is well documented in patients with PAN, it can mimic more common diseases, and cause confusion and delays in diagnosis. PAN muscular involvement may have limited or early systemic forms with a benign course and excellent clinical response to corticosteroid therapy. Herein, we describe the clinical course and outcome of four unusual cases of PAN manifested by acute onset of pain and pitting edema in both lower extremities; in addition, we reviewed the relevant literature.

Development of atrial flutter after induction of general anesthesia and conversion to atrial fibrillation: A case report

The most frequent perioperative cardiovascular event is cardiac dysrhythmia, defined as an abnormality of cardiac rate, rhythm or conduction. Although the occurrence of arrhythmia during the perioperative period is not uncommon, a case of newly developed perioperative atrial flutter which spontaneously converts to atrial fibrillation is rare. We report a case of atrial flutter that developed immediately after induction of general anesthesia, in a 70-year-old male patient who previously had a normal sinus rhythm. Atrial flutter changed spontaneously to atrial fibrillation after discharge to the recovery room. Dysrhythmia was unresponsive to drug therapy, and the atrial fibrillation disappeared after electric cardioversion.

Spontaneous Thymic Cyst Hemorrhage Manifesting as a Mediastinal Mass / 대한내과학회지

Thymic cysts are uncommon benign lesions in the anterior mediastinum. We here describe a 55-year-old male with spontaneous thymic cyst hemorrhage manifesting as a rapidly enlarging mediastinal mass that was resected completely with video-assisted thoracoscopic surgery. To the best of our knowledge, this is the first report of a spontaneous thymic cyst hemorrhage in Korea. In cases of rapidly enlarging mediastinal masses, spontaneous thymic cyst hemorrhage should be considered as a differential diagnosis.

Lupus-like Glomerulonephritis Associated with Extranodal Marginal Zone B-cell Lymphoma of MALT / 대한내과학회지

Lupus-like glomerulonephritis is an immune complex disease with features of lupus nephritis in the absence of systemic lupus erythematosus (SLE). We report a 49-year-old man diagnosed with lupus-like glomerulonephritis associated with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). He was admitted to the hospital for edema. At admission, the serum creatinine was 2.2 mg/dL and the urine protein level was 3.9 mg/day. A renal biopsy showed features of lupus nephritis with no clinical or serological evidence of SLE. Extranodal marginal zone B-cell lymphoma of MALT was discovered concurrently. After successful chemotherapy, the lupus-like glomerulonephritis and lymphoma entered complete remission.

Percutaneous cervical nucleoplasty using the L'DISQ(R) in patients with posterolateral disc extrusion: Three cases report

Recently, various studies evaluating percutaneous cervical nucleoplasty have reported good results. Percutaneous cervical nucleoplasty has been commonly used for treating contained herniated disc or protrusion, but a posterolateral extruded disc has not been considered to be an indication. The tip of the L'DISQ(R) wand can be curved to the desired angles by the rotation of the control wheel. Therefore, L'DISQ(R) can directly access the extruded disc. We report the application of percutaneous cervical nucleoplasty by using the L'DISQ(R) in three patients with an extruded disc. Decompression was successfully performed, and the symptoms improved immediately. In one patient, a 6-month follow-up magnetic resonance imaging study showed disappearance of the extruded cervical disc. Percutaneous cervical nucleoplasty using the L'DISQ(R) can be an effective, low complication, minimally invasive procedure for treating cervical disc herniation.

Acute Motor Weakness of Opposite Lower Extremity after Percutaneous Epidural Neuroplasty

Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication.

Paroxysmal pain during spinal anesthesia / 대한마취과학회지

No abstract available.

Paroxysmal pain during spinal anesthesia / 대한마취과학회지

No abstract available.

Multiple Primary Colorectal Cancer

To assess the clinico-pathological characteristics of patients with multiple primary colorectal cancer, 458 patients who underwent curative surgery and being followed-up at our institution between Jan. 1987 and Dec. 1993 were evaluated in this study. The median follow-up period was 42 months. Synchronous cancer was defined as distinct lesions separated by a distance of greater than 4cm with the invasion of the tumor below the muscularis mucosa at the time of diagnosis or within 6 months after initial treatment, and metachronous cancer was defined as the development of colon cancers more than 6 months after the initial treatment without evidence of the recurrence or metastases from primary tumor. There were 29 cases of multiple primary colorectal cancer(6.3%). Eighteen cases(3.9%) of them were synchronous, 11 cases(2.4%) were metachronous cancers. Seven cases(1.5%) were related to 5 hereditary non-polyposis colorectal cancer(HNPCC) families. During the follow-up period, 11 patients(2.4%) developed cancers in other organs. Adenomatous polyps were identified 14 cases of 29 patients with multiple primary colorectal cancers(48.3%), compared to 43 cases(10%) in 429 patients with solitary colorectal cancer(p0.05). In aspect of family history, there was close-relationship with this regarding in the group of multiple primary colorectal cancers. However, authors were unable to make analysis this regarding in the group of solitary primaries because of lack of the information. Conclusively, authors guess the frequent association of the adenomatous polyps in multiple primary colorectal cancers as the evidence of the adenoma-carcinoma sequence. In addition, authors emphasized the importance of the total colonoscopic examinations in pre-and post-operation in order to make diagnosis of the multiple primary colorectal cancers and paying attention as to the family history of colorectal cancer patients because we have good therapeutic results after operation of early stage in synchronous cancers and co-existent adenomatous polyps.