Perianal Tick-Bite Lesion Caused by a Fully Engorged Female Amblyomma testudinarium

A perianal tick and the surrounding skin were surgically excised from a 73-year-old man residing in a southwestern costal area of the Korean Peninsula. Microscopically a deep penetrating lesion was formed beneath the attachment site. Dense and mixed inflammatory cell infiltrations occurred in the dermis and subcutaneous tissues around the feeding lesion. Amorphous eosinophilic cement was abundant in the center of the lesion. The tick had Y-shaped anal groove, long mouthparts, ornate scutum, comma-shaped spiracular plate, distinct eyes, and fastoons. It was morphologically identified as a fully engorged female Amblyomma testudinarium. This is the third human case of Amblyomma tick infection in Korea.

A Case of Amblyomma testudinarium Tick Bite in a Korean Woman

A case of tick bite was found in the inguinal region of a 74-year-old Korean woman. She was attacked by the tick while working in her vegetable garden in the vicinity of mountain located in Suncheon City, the southern coastal area of the Korean Peninsula. On admission she complained of mild discomfort and itching around the bite area. The causative tick was 23 mm long and had slender pedipalps. The scutum was quite ornate and had eyes at the edge. The genital aperture was located anterior to the level of the coxa II. The spiracular plate was comma-shaped and the anus was surrounded posteriorly by the anal groove. The coxa I had subequal 2 spurs; the external one slightly larger. The spur of coxa IV was slightly longer than those of coxae II and III. The tarsus IV had 2 distinct subapical ventral spurs. It was identified as the fully engorged adult female of Amblyomma testudinarium. This is the first human case of Amblyomma bite in Korea.

A Human Case of Clinostomum complanatum Infection in Korea

A 33-year-old Korean man visited a medical clinic with complaints of throat discomfort and pain for one week. The symptoms occurred one day after eating raw brackish water fish, perch. Endoscopy revealed a fluke, about 5 mm in length, attaching to and peristaltically moving on the surface of the mucosa at the arytenoid region of the larynx. Microscopically, the testes were triangular, tandem, and separated by the uterus. The ovary and cirrus pouch were placed apart from median line between testes. Numerous blood cells were observed in the ceca. The worm was identified to be Clinostomum complanatum. This is the second human case of clinostomiasis in Korea.

A Case of Gastritis Associated with Gastric Capillariasis

This report is about the case of gastritis associated with capillariasis. The patient was a 52-yr-old Korean woman who occasionally ate raw fish and chicken. She complained of mild abdominal pain and nausea, but not diarrhea. An endoscopic examination revealed an exudative flat erosive change on the gastric mucosa of the antrum. She was microscopically diagnosed as chronic gastritis with numerous eosinophil infiltrations. The sectioned worms and eggs in mucosa were morphologically regarded as belonging to the genus Capillaria. This is the first case of gastric capillariasis reported in the Republic of Korea.

Distribution of Genomic Species and Antimicrobial Susceptibility in Acinetobacters Isolated from Gangjin Bay, Korea

A total of 90 Acinetobacter isolates from freshwater and seawater in Gangjin Bay of Korea was investigated for the distribution of genomic species, antimicrobial resistance patterns and clonal relatedness. By amplified ribosomal DNA restriction analysis, eighty-nine Acinetobacter isolates were classified into 11 Acinetobacter genomic species. A. johnsonii (n=23) was the most prevalent, followed by A. baumannii (n=13), A. calcoaceticus (n=13), Acinetobacter genomic species 11 (n=10), A. phenon 6/ct13TU (n=9), A. junii (n=5), A. venetianus (n=5), Acinetobacter genomic species 17 (n=4), 14BJ (n=3), A. phenon 10/1271 (n=2), Acinetobacter genomic species 3 (n=1), and ungrouped (n=1). The majority of Acinetobacter genomic species were isolated from the site A and B, and some known nosocomial pathogens in the clinical environment were observed among them. Of the 11 antimicrobial drugs tested, several A. johnsonii isolates exhibited high-frequency resistance to a wide variety of antimicrobial agents, including ampicillin-sulbactam, piperacillin, ceftazidime, cefotaxime, and sulfamethoxazole (p < 0.001). Some Acinetobacter genomic species were resistant to currently used antibiotics but all isolates were susceptible to imipenem, amikacin, and tetracycline. Based on the results of antimicrobial resistance pattern and phylogenetic analysis, 23 A. johnsonii isolates were classified into 19 pulsotypes. In conclusion, there was a significant difference in the distribution of Acinetobacter species between freshwater and seawater. Predominance of A. johnsonii strains was probably due to their ability to proliferate in the contaminated aquatic environment originated from local geographic features. Therefore, the waste effluent from animals and humans plays an important role in the distribution of Acinetobacter species in aquatic environment.

Long-term Results of Endoscopic Histoacryl(R) (N-butyl-2-cyanoacrylate) Injection for Treatment of Gastric Varices : A 10-year Experience / 대한소화기학회지

BACKGROUND/AIMS: Gastric variceal bleeding is an infrequent but serious complication of portal hypertension. Endoscopic injection of Histoacryl(R) (N-butyl-2-cyanoacrylate) has been approved as an effective treatment for gastric variceal bleeding. The aim of this study was to evaluate the long-term efficacy and safety of the endoscopic injection of Histoacryl(R) for the treatment of gastric varices. METHODS: Between January 1994 and January 2005, eighty-five patients with gastric varices received endoscopic injections of Histoacryl(R) . Among these 85 patients, 65 received the procedure within 1 week after gastric variceal bleeding, and 13 received as a prophylactic procedure. According to the Sarin classification, 32 patients were GOV1 and 53 were GOV2. Most of the varices were large (F2 or F3, 75 patients). The average volume of Histoacryl(R) per each session was 1.43 ml. Among 85 patients, 72 patients were followed-up and the median duration was 24.5 months. RESULTS: The rate of initial hemostasis was 98.6% and recurrent bleeding occurred in 29.2% (21 of 72). When rebleeding occurred, 76.2% was within 1 year after the initial injection. Treatment failure-related mortality rate was 1.4% (1 of 85). Twenty-seven patients died, mostly due to hepatocelluar carcinoma or liver failure. Two patients experienced pulmonary embolism and one experienced splenic infarction. They recovered without specific treatment. Rebleeding rate had a tendency to increase in patients with hepatocelluar carcinoma (p=0.051) and GOV2 (p=0.061). CONCLUSIONS: Histoacryl(R) injection therapy is a effective treatment method for gastric varices with high initial hemostasis rate and low major complications.

The Clinical Significance of the Absolute and Relative Classification of the Depth of Invasion for Submucosal Invasive Carcinomas of the Colon / 대한소화기내시경학회지

BACKGROUND/AIMS: We investigated the clinical significance of the criteria of the absolute and relative depth of invasion for submucosal invasive colorectal carcinomas. METHODS: We analyzed retrospectively the clinicopathological features of 29 submucosal invasive colorectal cancers. The relative depth of submucosal invasion was evaluated by a relative (sm1, 2, 3) classification and the absolute depth of submucosal invasion was measured in micrometers from the lower border of the muscularis mucosa to the deepest cancer gland. RESULTS: All sm1 cancers showed a submucosal layer invasion of less than 1,000micronm; invasion was seen between 500micronm and 1,000micronm. The rate of lymphovascular invasion was higher for sm1c, sm2 and sm3 than for sm1a and sm1b, and the rate of invasion was higher for a level of 500micronm or more than for a level of 500micronm or less for the depth of submucosal invasion. One of sixteen patients that underwent surgery showed lymph node involvement. For this patient, the relative depth of invasion was sm1c and the absolute depth was 900micronm. CONCLUSIONS: Endoscopically treated submucosal colorectal cancer needs to be evaluated by the absolute depth in addition to the relative depth. It seems that a submucosal invasive cancer less than 500micronm in submucosal depth probably can be treated by endoscopic resection.

The Clinical Significance of the Absolute and Relative Classification of the Depth of Invasion for Submucosal Invasive Carcinomas of the Colon / 대한소화기내시경학회지

BACKGROUND/AIMS: We investigated the clinical significance of the criteria of the absolute and relative depth of invasion for submucosal invasive colorectal carcinomas. METHODS: We analyzed retrospectively the clinicopathological features of 29 submucosal invasive colorectal cancers. The relative depth of submucosal invasion was evaluated by a relative (sm1, 2, 3) classification and the absolute depth of submucosal invasion was measured in micrometers from the lower border of the muscularis mucosa to the deepest cancer gland. RESULTS: All sm1 cancers showed a submucosal layer invasion of less than 1,000micronm; invasion was seen between 500micronm and 1,000micronm. The rate of lymphovascular invasion was higher for sm1c, sm2 and sm3 than for sm1a and sm1b, and the rate of invasion was higher for a level of 500micronm or more than for a level of 500micronm or less for the depth of submucosal invasion. One of sixteen patients that underwent surgery showed lymph node involvement. For this patient, the relative depth of invasion was sm1c and the absolute depth was 900micronm. CONCLUSIONS: Endoscopically treated submucosal colorectal cancer needs to be evaluated by the absolute depth in addition to the relative depth. It seems that a submucosal invasive cancer less than 500micronm in submucosal depth probably can be treated by endoscopic resection.

A case of fatal hyperinfective strongyloidiasis with discovery of autoinfective filariform larvae in sputum

The autoinfective filariform larva of Strongyloides stercoralis causes hyperinfection in immunosuppressed hosts. Here we report on the case of a male patient who was admitted to the emergency room at Gwangju Veterans Hospital with a complaint of dyspnea, and who was receiving corticosteroid therapy for asthma. Many slender larvae of S. stercoralis with a notched tail were detected in Papanicolaou stained sputum. They measured 269 +/- 21.2 micrometer in length and 11 +/- 0.6 micrometer in width. The esophagus extended nearly half of the body length. The larvae were identified putatively as autoinfective third-stage filariform larvae, and their presence was fatal. The autoinfective filariform larva of S. stercoralis has not been previously reported in Korea.

Long-term Chelation Therapy in Patients with Chronic Lead Nephropathy by Excessive Body Lead Burden / 대한신장학회잡지

BACKGROUND: Although chelation therapy with calcium disodium ethylenediamine tetraacetic acid (CaNa2EDTA) reduces body burden of lead and improves clinical side effects from lead, it is unclear whether long-term repeated chelation is safe for chronic lead poisoning with nephropathy. We described the consequential changes of renal function and clinicopathological findings during one to two years of monthly administration of CaNa2EDTA in patients with chronic lead nephropathy and excessive body lead burden. METHODS: Three patients diagnosed as chronic lead nephropathy received 1 g/day of intravenous CaNa2EDTA for a 3-5 day/cycle. A total of 48-86 g CaNa2EDTA was administered. Midtibial bone lead, chelatable lead, and blood lead levels were assessed. Renal function was determined in each chelation, and renal biopsies before and after chelation were conducted and compared for microscopic and immunofluorescence changes. RESULTS: Cortical bone lead levels showed a high burden of lead (>200 microgram Pb/g bone mineral). During CaNa2EDTA treatment, blood lead level and renal function were in steady state. No evidence of progression of renal pathology was observed in both renal biopsies, showing similar interstitial fibrosis and glomerular sclerosis. CONCLUSION: Our results suggest that long-term repeated chelation therapy with CaNa2EDTA is safe and effective for patients who have suffered from severe chronic lead poisoning, even though renal pathologic change has started.

A life-threatening case of acute valproic acid overdose treated successfully with serial hemoperfusion and hemodialysis / 대한내과학회지

Valproic acid is available as an antiepileptic therapy and has been used treat bipolar disorder and migraine headaches. In the setting of accidental or intentional ingestion of valproic acid overdose, serious toxicitis have been reported including leukopenia, thrombocytopenia, hemodynamic compromise, respiratory failure, cerebral edema, renal failure, hepatotoxicitiy, and coma. The optimal therapy for life-threatening case of acute valproic acid overdose has not been clearly established. A 34-year-old man developed coma and shock after suicidally ingesting large amount of valproic acid (45,000 mg). The peak serum valproic acid concentration on admission was 1400 micro gram/mL (therapeutic range 50~100 micro gram/mL). His hypotension was refractory to crystalloid and pressor infusions, but resolved during concurrent hemoperfusion and hemodialysis to enhance elimination of valproic acid. After serial hemoperfusion and hemodialysis, serum valproic acid level decreased to 680 micro gram/mL, coincident with improvement in clinical status. Concurrent hemoperfusion and hemodialysis, in series, should be considered in hemodynamically unstable patients with valproic acid poisoning whose clinical condition is worsening in spite of aggressive supportive care.

A Case of Gastric MALT Lymphoma Presenting as a Submucosal Tumor (SMT)-like Lesion, Diagnosed by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Gastric MALT lymphoma usually presents with various endoscopic morphologic characteristics. The majority of gross findings reveal multiple and superficial erosions or ulcerations. However gastric MALT lymphoma, presenting as a submucosal tumor, is very rare. We recently experienced a case of low-grade gastric MALT lymphoma, presenting as a submucosal tumor-like lesion without definite mucosal lesion, confirmed by endoscopic mucosal resection. So we report this case with a review of the related literatures.

A Case of the Ruptured Splenic Artery Aneurysm Treated with Transcatheter Embolization / 대한소화기학회지

Splenic artery aneurysms are the most common visceral artery aneurysms, which are usually found incidentally. The most common complication of splenic artery aneurysms is spontaneous rupture into the peritoneal cavity, which leads to acute peritonitis and shock. Less commonly, it may rupture directly into the stomach, small bowel or pancreatic duct and may present with acute gastrointestinal hemorrhage. We report a rare case of the ruptured splenic artery aneurysm, presenting as acute massive hematochezia which was treated with transcatheter embolization.

A case of gastric strongyloidiasis in a Korean patient

A 69-year-old Korean man was admitted to emergency room with complaints of abdominal pain, vomiting, and diarrhea. Laboratory tests revealed eosinophilia, anemia, hypoproteinemia, and hyponatremia. The gastric mucosa showed whitish mottled and slightly elevated lesions on the body angle of antrum. Microscopically, chronic gastritis with incomplete intestinal metaplasia was observed. Many adult worms, larvae, and eggs in cross sections were located in the crypts. Furthermore, the filariform larvae of Strongyloides stercoralis with a notched tail were detected through the culture.