Adenosquamous Carcinoma in Distal Transverse Colon in a 72-Year-Old Female Patient

Adenocarcinoma accounts for most of the malignant tumors which originate from the colon, whereas the adenosquamous carcinoma is rather rare, totaling to about 0.06% of all colon cancers. Herein, we present a case of adenosquamous carcinoma of the transverse colon with hepatic metastasis. The patient is a 72-year-old woman who is presented with a chief of lower abdominal pains. Her colonoscopy has indicated an ulcerofungating mass about 4 cm x 3 cm in size in the distal transverse colon, and the biopsy confirmed her diagnosis of adenosquamous carcinoma. An abdominopelvic computed tomography shows an circumferential enhancing mass on her distal transverse colon with three hepatic metastatic nodules. Transverse colectomy and hepatectomy are later being performed.

Clinical and Histopathological Analysis of the Kidney Biopsies of 2,450 Patients seen over 30 Years at Chungnam National University Hospital / 대한내과학회지

BACKGROUND/AIMS: This study evaluated the clinical characteristics of patients who underwent kidney biopsies, and the relative changes in pathological diagnosis, according to time periods over the last 30 years (1981-2010). METHODS: This study included 3,051 patients who were older than 15 years and underwent kidney biopsies at Chungnam University Hospital between January 1981 and December 2010. For analysis, the patients were grouped into three time periods: I (1981-1990), II (1991-2000), and III (2001-2010). We reviewed the available medical records of 2,450 patients and analyzed the changes in their clinical characteristics over time. RESULTS: The mean patient age was 35.9 (range 15-91) years and the male-to-female ratio was 1.3:1. The most common indication for a kidney biopsy was an asymptomatic urinary abnormality (64.2%) and the proportion with this indication increased significantly over time (p < 0.001). Primary glomerular diseases comprised 65.4% of all pathological diagnoses, followed by secondary (13.6%) and hereditary (12.5%) glomerular diseases. The proportion of primary glomerular diseases decreased significantly with time (p < 0.001), while the proportions of secondary and hereditary glomerular diseases increased correspondingly (p < 0.001). IgA nephropathy was the most common pathological diagnosis (36.7%) overall. The proportion of IgA nephropathy increased significantly with time (p < 0.001), while minimal change disease and acute post-streptococcal glomerulonephritis decreased significantly (p < 0.001 and p = 0.013, respectively). CONCLUSIONS: The results demonstrated that the clinical indications and pathological diagnoses in patients who underwent kidney biopsies changed significantly over the last 30 years.

Successful Fecal Transplantation by Enema for Recurrent and Refractory Clostridium difficile Infection

Clostridium difficile infection (CDI) is a common cause of antibiotic-associated diarrhea with an increase in severity and frequency in the recent times. CDI can be refractory and relapses, especially in the elderly or patients with significant comorbidities. Conventional treatments with antibiotics often fail to cure the infection. Even when successfully treated, recurrent infection is common. Some studies have reported that fecal transplantation may be effective and safe for the treatment of recurrent and intractable CDI. We present two CDI cases (one recurrent and one refractory) which were treated successfully by fecal transplantation using enema.

Nondiabetic kidney diseases in type 2 diabetic patients

BACKGROUND: The aim of this study was to evaluate the clinical characteristics of nondiabetic nephropathy in type 2 diabetes mellitus patients and to find a clinical significance of renal biopsy and immunosuppressive treatment in such a patient. METHODS: Renal biopsy results, clinical parameters, and renal outcomes were analyzed in 75 diabetic patients who underwent kidney biopsy at Chungnam National University Hospital from January 1994 to December 2010. RESULTS: The three most common reasons for renal biopsy were nephrotic range proteinuria (44%), proteinuria without diabetic retinopathy (20%), and unexplained decline inrena lfunction (20.0%). Ten patients (13.3%) had only diabetic nephropathy (Group I); 11 patients (14.7%) had diabetic nephropathy with superimposed nondiabetic nephropathy (Group II); and 54 patients (72%) had only nondiabetic nephropathy (Group III). Membranous nephropathy (23.1%), IgA nephropathy (21.5%), and acute tubulointerstitial nephritis (15.4%) were the three most common nondiabetic nephropathies. Group III had shorter duration of diabetes and lesser diabetic retinopathy than Groups I and II (P = 0.008).Group II had the lowest baseline estimated glomerular filtration rate (P = 0.002), with the greatest proportion of renal deterioration during follow-up (median 38.0 months, P < 0.0001). The patients who were treated with intensive method showed better renal outcomes (odds ratio 4.931; P = 0.01). Absence of diabetic retinopathy was associated with favorable renal outcome in intensive treatment group (odds ratio 0.114; P = 0.032). CONCLUSION: Renal biopsy should be recommended for type 2 diabetic patients with a typical nephropathy because a considerable number of these patients may have nondiabetic nephropathies. And intensive treatment including corticosteroid or immunosuppressants could be recommended for type 2 diabetic patients with nondiabetic nephropathy, especially if the patients do not have diabetic retinopathy.

A Case of Urine Leakage: An Unusual Complication after Renal Biopsy / 전남의대학술지

Renal biopsy is a crucial method in the diagnosis and treatment of acute renal failure of unknown origin, nephrotic syndrome, suspicious interstitial nephritis, and glomerulonephritis as a possible cause of hematuria or proteinuria. Complications occur in 2% to 8% of patients after percutaneous renal biopsy. Complications include gross hematuria, perirenal hematoma, arteriovenous fistula, aneurysm, injury of other organs, and urine leakage. Urine leakage as a complication after kidney biopsy is rare. We experienced a case of urine leakage into the intra-abdominal cavity after renal biopsy.

A Case of Urine Leakage: An Unusual Complication after Renal Biopsy / 전남의대학술지

Renal biopsy is a crucial method in the diagnosis and treatment of acute renal failure of unknown origin, nephrotic syndrome, suspicious interstitial nephritis, and glomerulonephritis as a possible cause of hematuria or proteinuria. Complications occur in 2% to 8% of patients after percutaneous renal biopsy. Complications include gross hematuria, perirenal hematoma, arteriovenous fistula, aneurysm, injury of other organs, and urine leakage. Urine leakage as a complication after kidney biopsy is rare. We experienced a case of urine leakage into the intra-abdominal cavity after renal biopsy.