Clostridium difficile Colitis after Topical Ophthalmic Use of Levofloxacin / 이화의대지

Clostridium difficile colitis (CDC) has been associated with virtually all available antibiotics. It is well known that administration of drugs by the ocular route can result in systemic absorption with the possibility of systemic effect. We report a case of a 74-year-old woman who was treated with 0.5% levofloxacin eyedrops for ten weeks running for the post operative management of two separate bilateral cataract surgeries. Toxin assay for C. difficile was positive and the endoscopic findings were compatible with CDC. The plasma concentrations reached after intraocular administration of levofloxacin seem so trivial, but the administration of topical agents could make accumulated effect and be a potential cause of systemic toxicity.

Clostridium difficile Colitis after Topical Ophthalmic Use of Levofloxacin / 이화의대지

Clostridium difficile colitis (CDC) has been associated with virtually all available antibiotics. It is well known that administration of drugs by the ocular route can result in systemic absorption with the possibility of systemic effect. We report a case of a 74-year-old woman who was treated with 0.5% levofloxacin eyedrops for ten weeks running for the post operative management of two separate bilateral cataract surgeries. Toxin assay for C. difficile was positive and the endoscopic findings were compatible with CDC. The plasma concentrations reached after intraocular administration of levofloxacin seem so trivial, but the administration of topical agents could make accumulated effect and be a potential cause of systemic toxicity.

Huge Gastric Schwannoma Characterized by a Gastric Ulcer During Endoscopy / 대한소화기내시경학회지

Gastric schwannomas are very rare mesenchymal tumors that can occur throughout the gastrointestinal tract, but are most commonly found in the stomach. The majority of patients have no symptoms, while others may complain of epigastric pain or upper gastrointestinal ulcer bleeding. Endoscopic examination of a gastric schwannoma commonly reveals a protrusive mass, but, as in this case, many types of ulceration can be observed with central necrosis. We report on a 62-year-old woman with endoscopic findings of 1 cm sized necrotizing ulceration and an 11 cm sized submucosal mass on radiological examinations. The patient underwent a wedge-shaped resection of the stomach and segmental resection of the transverse colon. Both histological and immunohistochemical staining revealed a gastric schwannoma.

Mallory-Weiss Syndrome Occurring in a Hanging Patient: Case Report

Reflex gasping when hanging leads to passive and vigorous vomiting, the mechanical force of which causes gastric mucosa laceration. Mallory-Weiss syndrome is a tear in the gastro-esophageal junction or its adjacent mucosa, and this can occur due to nausea or vomiting that is caused by various etiologic factors. Gastric fundus is the most common site of gastric mucosa lacerations. We report a case of a 41-year-old man, who tried to hang himself and, as a result, caused multiple gastric mucosa lacerations that were treated by an endoscopic hemostatic procedure in the emergency room.

Change in the serologic markers of hepatitis B after allogenic hematopoietic stem-cell transplantation / 대한간학회지

BACKGROUND/AIMS: This study examined the effects of hepatitis B virus (HBV) infection state and immunologic capability in both the recipients and donors of allogenic hematopoietic stem-cell transplantation (allo-HSCT) on changes in HBV serologic markers in recipients. METHODS: A total of 537 patients underwent allo-HSCT for the treatment of leukemia, malignant lymphoma, and solid tumor. HBV serologic markers were examined in both recipients and donors prior to and following the transplantation. The mean follow-up period was 36.6 months (range 3-80 months). RESULTS: Of the 537 patients who underwent allo-HSCT, 45 recipients were positive for HBsAg prior to transplantation. Of these 45 patients, 21 were transplanted from anti-HBs-positive donors and the remaining 24 were transplanted from anti-HBs-negative donors. In the former cases, seroconversion was noted in 4 of the 21 patients (19%). In the latter cases, however, no seroconversion was noted following the transplantation. Thirty patients who were negative for both HBsAg and anti-HBs were transplanted from anti-HBs-positive donors, and 15 out of 30 patients (50%) acquired anti-HBs. Four hundred and seven patients who were positive for anti-HBs were transplanted from anti-HBs-positive or HbsAg-negative donors; 8 of these proved HBsAg-positive following the transplantation. There were no changes in HBV serological markers following transplantation in 41 patients who were transplanted from HbsAg-positive donors. CONCLUSIONS: Due to the adoptive immunity that was transferred from anti-HBs-positive donors, a seroconversion of HBsAg could occur in some HBsAg-positive recipients. HBsAg-positive donors had a lesser effect on the HBV serologic markers of recipients. However, a reactivation of HBV can occur following hematopoietic stem-cell transplantation in the cases of recipients or donors with a history of HBV, infection by an accompanying immune suppression. Therefore, prevention should be instigated.

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 colonic and omental lipomatosis and omental torsion presenting with abdominal pain / 대한내과학회지

A lipoma, one of the most commonly encountered submucosal tumors in the gastrointestinal tract, usually presents as one or a few lesions. Lipomatous polyposis, which is defined as the presence of multiple lipomas in the intestinal wall, is rare. Here, we report a case of colonic lipomatous polyposis that involved not only the colon, but also the omentum and skeletal muscle. The patient presented with right lower quadrant abdominal pain and was diagnosed using colonoscopy and computed tomography (CT). The abdominal pain caused by omental torsion due to an omental lipoma resolved after conservative treatment without surgical intervention.

A Case of Acute Pancreatitis Associated with Fasciola Hepatica / 대한소화기내시경학회지

Fascioliasis is a zoonotic helminthiasis caused by the trematode Fasciola hepatica, which is a parasite that infects the hepatobiliary system of herbivorous animals such as cattle and sheep. Humans are accidentally infected after ingestion of the water, raw aquatic plants and raw liver of herbivorous animals that are all contaminated by metacercaria. Fascioliasis produces no symptoms in most patients, but adult Fasciola hepatica occasionally gives rise to intestinal obstruction or pancreatobiliary disease. The metacercaria can migrate along the vessels or lymphatic ducts, and they can induce disease of the liver, lung and heart. We report here on a rare case of a 68-year-old male who presented with acute abdominal pain. He was diagnosed as acute pancreatitis associated with Fasciola hepatica.

The Therapeutic Effect of Menatetrenone (Vitamin K2) on Posttransplant Osteoporosis in Renal Transplant Recipient / 대한신장학회잡지

BACKGROUND: Posttransplant osteoporosis in renal transplant recipient is frequently observed complications, but therapeutic modalities are not clearly elucidated. Recent studies indicate that vitamin K2 also play a role in bone metabolism. Therefore, we performed prospective study to evaluate the effect of vitamin K2 (Menatetrenone(R)) on posttransplant osteroporosis. METHODS: Our study included total 83 patients (40 male, 43 female; age 36.9+/-5.5 years) who received a renal transplant more than 6 months ago. They underwent dual-energy X-ray absorptiometry (DEXA) at lumbar spine and femoral neck. The patients with osteoporosis were treated with vitamin K2 (glakay 15 mg) (group 1) or vitamin D3 with calcium carbonate (group 2). The patients without osteoporosis was observed without any treatment (group 3). After one year, follow-up BMD was performed in all patients. RESULTS: Of 83 patients, 44 patients (53.0%) had osteoporosis and 39 patients (47.0%) had not. In group 1 (N=28), vitamin K2 treatment significantly increased BMD at femoral neck (-3.2+/-0.4 vs 2.6+/-0.6, p0.05). In group 2 (N=16), there was significant increase in BMD at femoral neck (-3.0+/-0.6 vs -2.5+/-0.8, p0.05). Between group 1 and 2, there was no significant difference in BMD change. In group 3, BMD decreased at femoral neck (-1.3+/-0.2 vs -1.5+/-0.2) and lumbar spine (-0.8+/-0.2 vs -1.0+/-0.2) during follow-up period. CONCLUSION: Vitamin K2 (Menatetrenone(R)) is effective in treating osteoporosis at femoral neck and its effectiveness is s imilar with that of using vitamin D3 with calcium carbonate.

Vascular Endothelial Growth Factor Stimulates Productions of Tumor Necrosis Factor-alpha and Interleukin-6 from Mononuclear Cells and Synoviocytes of Rheumatoid Arthritis Patients / 대한류마티스학회지

OBJECTIVE: Vascular endothelial growth factor (VEGF), an angiogenic factor, has been suggested to play a critical role in the pathogenesis of rheumatoid arthritis (RA). In this study, we investigated whether VEGF would directly regulate the activation of mononuclear cells of RA patients. MEHTODS: Mononuclear cells and/or synoviocytes of RA patients were cultured in the presence of VEGF, and the levels of TNF-alpha and IL-6 were determined in the culture supernatants by ELISA. The TNF-alpha-or IL-6-producing cells were also assessed by flow cytometry analysis. Blocking experiments were performed by adding anti-VEGF receptor (anti-Flt-1) mAb to the cells, stimulated with VEGF. RESULTS: VEGF directly increased the productions of TNF-alpha and IL-6 from peripheral blood mononuclear cells (PBMC) from healthy controls. Treatment of PBMC with anti-VEGF receptor (anti-Flt-1) mAb blocked the VEGF-induced productions of TNF-alpha and IL-6, suggesting that VEGF activates the PBMC via a receptor (Flt-1) coupling event. Synovial fluid mononuclear cells (SFMC) of RA patients showed a greater response to VEGF stimulation than the PBMC of healthy controls. The major cell types responding to VEGF were monocytes and synoviocytes. In addition, dexamethasone completely abrogated VEGF- stimulated productions of TNF-alpha and IL-6 from adherent cells, isolated from SFMC. CONCLUSION: Our data suggest that VEGF may directly activate RA monocytes and synoviocytes to produce TNF-alpha and IL-6.

The anti-inflammatory effects of angiotensin II blockade in animal model of cyclosporine-induced nephropathy / 대한내과학회지

BACKGROUND: Long-term treatment of immunosuppresant CsA causes interstitial inflammation and fibrosis in the kidney. Renin-angiotensin system (RAS) plays the most important role in the pathogenesis CsA-induced renal injury. Accordingly we evaluated the anti-inflammatory effect of angiotensin II blockades using losartan (LSRT) in a rat model of chronic CsA nephropathy. METHODS: Male Sprague-Dawley rats, initially weighing 225 to 250 g, were used. After 1 week of a low-salt diet (0.05% sodium), the rats were randomized into four groups and treated for 4 weeks. The Vehicle (VH) group was treated with olive oil. The VH+LSRT group was treated with olive oil and LSRT. The CsA group received CsA. The CsA+LSRT group was simultaneously treated with CsA and LSRT. The anti-inflammatory effect of LSRT was evaluated with C-reactive protein (CRP) expression, osteopontin (OPN) mRNA and protein expression, and ED-1 infiltration RESULTS: The CsA treatment caused an increase in serum creatinine and a decrease in creatinine clearance compared with that of the VH group. Intrarenal CRP positive cells were significantly decreased in the CsA+LSRT group compared with the CsA group (38.0 +/- 2.1 vs. 65.0 +/- 5.1, p<0.01). In the CsA group, the degree of OPN mRNA expression was increased compared with that of the VH group. But, OPN mRNA expression was decreased in the CsA+LSRT group (387.5 +/- 56.6% vs. 719.8 +/- 58.5%, p<0.05). In the degree of ED-1 infiltration, we had a similar results such as CRP and OPN mRNA expression (CsA group 30.5 +/- 8.0 vs. CsA+LSRT 86.0 +/- 11.0, p<0.01). CONCLUSION: We concluded that the anti-inflammatory effects of angiotensin II blockade has a potential protective effect against CsA-induced renal injury.

A Case of Recurrent Thrombus Associated with Left Atrial Calcification

Sporadic calcification of the left atrium is frequently observed in patients with long standing rheumatic valvular heart disease. However, massive calcification involving the entire left atrium, the so-called porcelain or coconut atrium, is extremely rare. A case of recurrent thrombosis in the left atrium was experienced due to massive calcification of the left atrial wall, despite the therapeutic anticoagulant level of the patient following a surgical thrombectomy.