Clinical implications in laboratory parameter values in acute Kawasaki disease for early diagnosis and proper treatment / 소아과

PURPOSE: This study aimed to analyse laboratory values according to fever duration, and evaluate the relationship across these values during the acute phase of Kawasaki disease (KD) to aid in the early diagnosis for early-presenting KD and incomplete KD patients. METHODS: Clinical and laboratory data of patients with KD (n=615) were evaluated according to duration of fever at presentation, and were compared between patients with and without coronary artery lesions (CALs). For evaluation of the relationships across laboratory indices, patients with a fever duration of 5 days or 6 days were used (n=204). RESULTS: The mean fever duration was 6.6±2.3 days, and the proportions of patients with CALs was 19.3% (n=114). C-reactive proteins (CRPs) and neutrophil differential values were highest and hemoglobin, albumin, and lymphocyte differential values were lowest in the 6-day group. Patients with CALs had longer total fever duration, higher CRP and neutrophil differential values and lower hemoglobin and albumin values compared to patients without CALs. CRP, albumin, neutrophil differential, and hemoglobin values at the peak inflammation stage of KD showed positive or negative correlations each other. CONCLUSION: The severity of systemic inflammation in KD was reflected in the laboratory values including CRP, neutrophil differential, albumin, and hemoglobin. Observing changes in these laboratory parameters by repeated examinations prior to the peak of inflammation in acute KD may aid in diagnosis of early-presenting KD patients.

Recurrent macrophage activation syndrome since toddler age in an adolescent boy with HLA B27 positive juvenile ankylosing spondylitis / 소아과

Recurrent macrophage activation syndrome (MAS) is very rare. We present the case of an adolescent boy with human leukocyte antigen (HLA) B27-positive ankylosing spondylitis (AS), who experienced episodes of recurrent MAS since he was a toddler. A 16-year-old boy was admitted because of remittent fever with pancytopenia and splenomegaly after surgical intervention for an intractable perianal abscess. He had been diagnosed with hemophagocytic lymphohistiocytosis (HLH) 4 different times, which was well controlled with intravenous immunoglobulin and steroids since the age of 3. We were unable to identify the cause for the HLH. He remained symptom-free until the development of back pain and right ankle joint pain with swelling at 15 years of age. He was diagnosed with HLA B27-positive AS with bilateral active sacroiliitis. He showed symptom aggravation despite taking naproxen and methotrexate, and the symptoms improved with etanercept. On admission, his laboratory data showed leukopenia with high ferritin and triglyceride levels. Bone marrow biopsy examination showed histiocytic hyperplasia with hemophagocytosis. There was no evidence of infection. He received naproxen alone, and his symptoms and laboratory data improved without any other immunomodulatory medications. Genetic study revealed no primary HLH or inflammasome abnormalities. In this case, underlying autoimmune disease should have been considered as the cause of recurrent MAS in the young patient once primary HLH was excluded.

Clinical Application of the Threshold Equalizing Noise Test in Patients with Hearing Loss of Various Etiologies: A Preliminary Study

BACKGROUND AND OBJECTIVES: We aimed to make a preliminary assessment of the prevalence of cochlear dead regions (DRs) and the factors affecting the results of the threshold-equalizing noise (TEN) test in patients with hearing loss of various etiologies. SUBJECTS AND METHODS: Between May and July 2014, 109 patients (191 ears) with hearing loss who visited our outpatient clinic were prospectively enrolled. Pure tone audiometry and TEN (HL) test were performed for all the patients. DR at each frequency was indicated by masked thresholds of > or =10 dB above the TEN level and > or =10 dB above the absolute threshold. RESULTS: DR was present in 15.7% (n=30) of the 191 ears. According to disease entity, 16.6% of patients with sensorineural hearing loss had a DR. However, DR was absent in patients with chronic otitis media. According to audiometric configurations, DR was most common in moderately severe, flat hearing loss. Significantly worse hearing thresholds for both mean hearing level and hearing threshold at each frequency were found in the presence of DR (p<0.001). Logistic regression analysis showed that only the mean hearing level (odds ratio: 1.053, 95% confidence interval: 1.021-1.085) affected the presence of DR. CONCLUSIONS: Although performance of the TEN test is limited by frequencies and hearing levels, it provides additional information regarding DRs and may therefore have the potential to be used as a prognostic tool for diverse diseases causing hearing loss.

Missed Spermatic Cord Torsion in an Old Man

The fate of testicular salvage in spermatic cord torsion depends on the duration of ischemia and the degree of torsion. Even though spermatic cord torsion (SCT) can occur at any age, it is rarely reported in older patients. If the physician does not pay close attention to this unusual situation, the lack of suspicion for SCT may result in a missed or delayed diagnosis. We report a very uncommon case of missed SCT occurring in a 63-year-old man.

Impact of Intravesical Protrusion of the Prostate in the Treatment of Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia of Moderate Size by Alpha Receptor Antagonist / 대한배뇨장애요실금학회지

PURPOSE: To evaluate whether intravesical protrusion of the prostate (IPP) is related to the treatment effect of alpha-1 receptor antagonist in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) with a prostate size of less than 40 g. METHODS: A total of 77 BPH patients over 50 years of age treated with alfuzosin (alpha blocker) were enrolled prospectively. The study included only patients with BPH of 40 g or less. The patients were classified into two groups depending on the presence of IPP at baseline: the IPP group (41 patients) and the non-IPP group (36 patients). Prostate volume, prostate-specific antigen (PSA), International Prostate Symptom Score and quality of life (IPSS/QoL), maximum flow rate (Qmax), and postvoid residual (PVR) volume were compared between the groups. The clinical significance of IPP was evaluated after the patients had been taking alfuzosin for 8 weeks. RESULTS: PSA and IPSS (total and voiding subscore) showed significant correlations with IPP (P<0.05). Comparison of parameters before and after 8 weeks showed that alfuzosin improved the total IPSS and all subscores (P<0.001), QoL (P<0.001), Qmax (P<0.001), and PVR (P=0.030) in the non-IPP group. CONCLUSIONS: Alfuzosin may be less effective in improving symptom scores, PVR, and Qmax in the treatment of LUTS/BPH in the presence of IPP.

Experience of Combination Therapy with Alpha Adrenergic Receptor Antagonist and Anticholinergic Agent in Patients with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: 12 Month Follow-up / 대한남성과학회지

PURPOSE: Through more than 12 months of follow-up, the efficacy and safety of combination therapy with alpha adrenergic receptor antagonist and anticholinergic agent was investigated retrospectively. MATERIALS AND METHODS: This study retrospectively analyzed the data of 84 patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) who were managed with an alpha adrenergic receptor antagonist and anticholinergic agent for at least 12 months between Jan 2007 and Dec 2010. On patients' first visit to our department, we obtained the patients' demographic data and information about the prostate total volume, serum prostate specific antigen (sPSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR) of each patient. After 12 months, changes in the above factors and the side-effects of anticholinergic agents were investigated. RESULTS: The mean age of the patients was 66.1 years and the total observation period after drug administration was an average 20 months; the total sPSA and prostatic volume of patients was 1.8+/-0.8 ng/dl and 37.3+/-9.5 g, respectively. Qmax in uroflowmetry was improved after 12 months of medication (changed from 9.0+/-3.4 to 13.8+/-4.5 ml/sec; p<0.001). PVR was increased from 35+/-22.2 ml to 49.3+/-37 ml (p<0.001), but the change was not clinically significant, and no acute urinary retention occurred. The total IPSS score decreased from 21.4+/-5.1 to 13.3+/-4.6 (p<0.001), the storage score of IPSS decreased from 9.8+/-2.4 to 5.6+/-2 (p<0.001), and the voiding score was decreased from 11.6+/-3.7 to 7.7+/-3.2 (p<0.001). The QoL with IPSS was improved from 4.2+/-0.8 to 2.8+/-0.7 (p<0.001). During the 12 months there were 34 patients (56 cases) of adverse events. However, no serious adverse events were reported. CONCLUSIONS: Combination therapy with alpha adrenergic receptor antagonist and anticholinergic agent was safe and made an improvement in LUTS in patients with BPH and storage symptoms.

A Case of ReVersible Posterior Leukoencephalopathy Syndrome (RPLS) in a Patients with Chronic Renal Failure / 대한신장학회잡지

The reVersible posterior leukoencephalopathy syndrome (RPLS) describes a syndrome of headaches, confusion, seizures, and visual disturbances associated with transient, predominantly posterior cerebral lesions revealed by neuroimaging. RPLS has been associated clinically with hypertension, immunosuppression, and known triggers include acute renal failure, eclampsia, cyclosporine, and lupus. We report a 45-year-old male with chronic renal failure showed RPLS following hemodialysis and review literatures.

A Case of Hyperammonemic Encephalopathy with Serum Amino Acid Alteration in Multiple Myeloma / 대한혈액학회지

Disturbance of consciousness in patients with multiple myeloma is usually related with uremia, hypercalcemia or hyperviscosity syndrome. Currently, hyperammonemic encephalopathy which accompanies characteristic change of amino acid levels in pheripheral blood has been reported as a rare cause of mental change in multiple myeloma. We experienced a case of hyperammonemic encephalopathy in a 60-year-old man with multiple myeloma who had shown transient response to the combination chemotherapy with melphalan and prednisolone. Measurement of amino acid concentrations in peripheral blood revealed high glycine/tyrosine ratio and low Fisher ratio. In spite of conventional treatment on hyperammonemic encephalopathy, he died of disease progression without improvement of consciousness level.

A Case of Giant T wave and QT Prolongation Associated with Acute Pulmonary Edema

A variety of clinical conditions are known to result in a giant T wave and a marked QT prolongation. We report a case of a giant T wave and a QT prolongation after the resolution of an acute cardiogenic but nonischemic pulmonary edema.

Acute Myocardial Infarction in Young Man with Nephrotic Syndrome

The association between nephrotic syndrome and intravascular coagulation has been known for more than a century, but it was not until 1948 that a thrombotic diathesis in nephrotic patients was proposed. The prevalence of thrmbo-embolic complications is much higher in adult patients. Deep vein thrombosis of the leg is the most common complications in nephrotic adult and was responsible for one-third of the thrombo-embolic complications of nephrotic children. Arterial thrombosis occurs less frequently and is seen primarily in childern. We present a case of acute anterior myocardial infarction in a young man with nephrotic syndrome, secondary to minimal change glomerulonephritis, in which thrombosis of the proximal left anterior descanding artery was the actual cause of acute myocardial infarction.

A Case of Clostridium Perfringens Endocarditis

Endocarditis due to anaerobes is not a rare ocurrence. However, Clostridial endocarditis, most cases are caused by Clostridium perfringens, is an uncommon disease. Clostridium are gram positive spore forming obligate anaerobes that are found widely in soil, water, and foods. They naturally inhabit the respiratory, gastrointestinal, and female genital tract. We observed a case of Clostridium perfringens endocarditis in a 67 years old woman. Who experienced fever, chronic diarrhea and vegetation in the aortic valve.

A Case of ST-Segment Elevation in a Patient with Subarachnoid Hemorrhage

There are several EKG changes in cerebrovascular disease(CVD). The wide prominent of inverted T wave is frequently developed in patients with CVD. There were case reports for CVD in patient with ST-segment elevation without myocardial infarction, but the exact mechanism is unknown. EKG abnormalities associated with subarachnoid hemorrhage were first described by Byer et al, in 1947.1 We report the case of 72 years old female patient who developed subarachnoid hemorrhage and intraventricular hemorrhage with ST-segment elevation.